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Aim: Kangaroo mother care (KMC) has immense short‐term benefits, but data on long‐term outcomes are scarce. Hence, this study aimed to compare the neurodevelopmental outcomes at 12 months of corrected age (CA) in infants <2000 g receiving early and prolonged KMC to a control group. Methods: This was a cohort study that was conducted from January 2017 to November 2018. All neonates<2000 g were eligible for the study. Neonates that received early initiation (<72 h of life) and prolonged KMC comprised the intervention group and were compared to neonates without the intervention. Bayley Scales of Infant and Toddler Development, Third edition (BSID‐III) was done at 12 months of CA, and this was analysed using t‐test and multi‐linear regression analysis. Results: There were 75 neonates in the intervention and 69 in the control group. Baseline characteristics were comparable. We found higher composite scores for cognition (110.38 ± 9.89 vs. 105.44 ± 8.77, p value = 0.023), language (107.51 ± 10.72 vs. 101.05 ± 12.06, p value = 0.014) and adaptive behaviour (87.97 ± 9.97 vs. 80 ± 9.1, p value<0.001) in the early and prolonged KMC group in comparison to the control group. Conclusion: Infants with early and prolonged KMC have better neurodevelopmental outcomes in terms of cognition, language and adaptive behaviour at 12 months of CA. [ABSTRACT FROM AUTHOR]

Exclusively breastfed healthy neonates can lose weight excessively due to poor milk production, inadequate enteral intake or due to poor milk transfer. The studies assessing risk factors for infants to lose weight excessively are diverse and results are highly varied. We aimed to determine the risk factors for weight loss of over 10% in term and late preterm newborns who were exclusively breastfed. This was a case-control study which was conducted in a tertiary care hospital. Exclusively breastfed neonates of ≥34 weeks having weight loss of >10% in the first 14 days of life comprised the study group with gestational age and weight-matched neonates without significant weight loss forming the control group. Demographic details, LATCH score, maternal EPDS (Edinburg postpartum depression score) and neonatal morbidities were assessed. Of the 53 mother-infant dyad in each group, baseline characteristics were similar. Gestational Diabetes Mellitus (GDM), Lower segment Caesarean section (LSCS) delivery, higher EPDS score, low LATCH score, absence of immediate skin to skin contact were associated with excessive weight loss and was found to be significant statistically. Babies in the study group had higher incidence of jaundice and hypernatremia and had longer duration of stay in hospital. Lack of early skin to skin contact, higher EPDS scores and lower LATCH scores are predisposing factors for exclusively breastfed infants to lose weight excessively. [ABSTRACT FROM AUTHOR]

Objective: To describe an innovative interactive e-learning method to disseminate knowledge to larger group of participants over a wide geographical area. Methods: The course material included standard training tool "Best Practices in Preterm Care," hosted on Telegram, a cloud-based instant messaging platform. The participants were enrolled in the group created on Telegram by the facilitators and included in-service nurses from India, Bhutan, Bangladesh, and UAE. They were mentored by 62 facilitators over 10 wk. Content of each module was loaded every week on two specific days. Mentors specified for that week facilitated learning through discussions. There was a live session every week to address any additional queries and to summarize the key messages of the week. Each week ended with weekly assessments through quiz. Results: In this course, 4623 nursing professionals from India and Southeast Asian Region involved in providing neonatal care, participated. There were 9939 posts with an average of 126 posts per day. Majority of the participants felt that the topics were relevant (~95%) and they were comfortable in asking questions and could clarify their doubts (~90%). Majority rated their overall experience as very good to excellent (~98%). Conclusions: Interactive e-learning using the current approach if channelized optimally seems to be acceptable and feasible method to reach wide geographical area. This, however, needs local champions ready to mentor their own health professionals with context-specific guidance. [ABSTRACT FROM AUTHOR]

Objectives  Nosocomial infections are a significant threat to the survival and neurodevelopment of neonates.The present study attempts to correlate enteral feeding practices as measured by nil per oral (NPO days) with bloodstream infection (BSI) rates and central line-associated bloodstream infection (CLABSI) over a period of 2 years and 3 months. Methods  This was a prospective observational study done in a tertiary level neonatal intensive care unit (NICU). Data were recorded on the presence of central lines or peripheral intravenous (IV) lines, receipt of intravenous fluids (IVF), total parenteral nutrition (TPN) or IV antibiotics, and mechanical ventilation status. BSI and CLABSI, regarded as sentinel events, were recorded and root cause analysis done. Results  A total of 3,448 infants constituting 17,846 patient days with mean gestational age and birth weight of 34.3 ± 3 weeks and 1,868 ± 434 g, respectively were studied. NPO per 1,000 days shows a significant positive correlation with BSI (ρ  = 0.513; p  = 0.004), CLABSI (ρ = 0.425; p  = 0.021), antibiotic days (ρ = 0.7; p  < 0.000), IV fluid days (ρ = 0.459; p  = 0.014), and central line days (ρ = 0.634; p  < 0.001). The IV fluid days showed correlation with BSI (ρ  = 0.4, p ≤ 0.03) and CLABSI (ρ  = 0.43, p  = 0.02). Conclusion  BSI in NICU correlates with higher NPO and IV fluid days. Strengthening of enteral feeding practices reduces health care-associated infections. [ABSTRACT FROM AUTHOR]

Newborns, especially preterms, have a higher risk of developing pneumothorax. We report a 33-week preemie who presented with recurrent, persistent right pneumothorax, which failed to resolve with standard treatment. The child underwent surgical removal of a suspect nonexpanding upper lobe of the right lung with clinical improvement. Histopathology was atypical but nearly consistent with congenital pulmonary airway malformation (CPAM). This report highlights the clinicopathological discordance noted and aims to draw an embryological explanation toward the atypical histomorphology of CPAM in preemies. [ABSTRACT FROM AUTHOR]

Background: Currently nonselective cyclooxygenase (COX) inhibitors, ibuprofen and indomethacin, are approved drugs for closure of patent ductus arteriosus but have potential toxicities. There are reports of the effectiveness of paracetamol in ductal closure. However, there is paucity of data comparing paracetamol to ibuprofen or indomethacin in relation to the efficacy and safety profile.Methods: This randomized clinical trial was done in our tertiary care neonatal unit from October 2014 to January 2016 after clearance from ethical committee. It was registered with clinical trial registry of India (CTRI/2016/09/007261) and drug controller general of India (CT/Drugs/56/2014). Preterm neonates with clinical suspicion of hemodynamically significant PDA after echo confirmation were included in the study. Randomization was done by stratified randomization through sealed opaque envelopes. A sample size of 150 was estimated with an expected difference in success of closure as 20% between the treatment groups at level of 5% significance and 80% power. The echocardiography was done 24 hours after completion of treatment by a cardiologist blinded to treatment.Results: The baseline parameters were comparable between two groups. One hundred and forty-six babies had hs-PDA, out of which 110 babies were randomized. No significant difference was found between the two groups with respect to PDA closure (RR 0.97, 95%CI 0.78-1.20, p = 1), mortality or cardio-respiratory morbidity. The babies who received ibuprofen had a higher occurrence of acute kidney injury (RR 0.33, 95%CI 0.13-0.85, p = 0.024).Conclusions: Paracetamol is as effective as ibuprofen for PDA closure in preterm neonates. Ibuprofen used for PDA closure in preterms poses an increased risk for acute kidney injury compared to paracetamol. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study is to assess the diagnostic accuracy of a novel hypothermia monitoring and alert bracelet device (BEMPU Bracelet) in low birth weight (LBW) neonates weighing less than 2000 g.Design: This was a controlled prospective study.Setting: This study was done in the step-down nursery of a tertiary level newborn unit of a major teaching hospital in India.Methods: Eligible cases fulfilling inclusion criteria were given BEMPU Bracelets for a period of 24 h. A comparison was made between skin temperatures taken at the axilla by a mercury thermometer and skin temperatures taken at the wrist by the BEMPU Bracelet. Temperatures were taken every 6 h and every time the BEMPU Bracelet alarmed. Trained nurses obtained temperature measurements on newborns during their 24-h stay in the hospital step-down nursery.Results: A total of 461 neonates were screened for hypothermia, giving 2428 temperature readings. Three hundred and eleven of 461 babies experienced hypothermia at some point. The 461 babies studied experienced 495 episodes of hypothermia in total. The sensitivity and the specificity of the bracelet in diagnosing hypothermia were 98.6% and 95% respectively. The positive and negative predictive values of the bracelet were 83.6% and 99.6%, respectively. The accuracy of the bracelet in diagnosing hypothermia was 95.8%.Conclusion: The BEMPU Bracelet is an accurate screening tool to detect and alert for neonatal hypothermia, thereby facilitating prompt management, which could prevent complications. [ABSTRACT FROM AUTHOR]