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Objective To estimate the levels of perceived stress and determine the professional quality of life domains namely, compassion satisfaction, burnout, and secondary trauma and their associated factors in neonatal intensive care unit (NICU) nurses. Methods A multicenter cross-sectional study was carried out across a number of NICUs in North India from May to June 2022. A total of 223 nurses included in the study were given a self-administered questionnaire consisting of their sociodemographic profile, work profile, PSS 14 scale, and ProQol 5 scale. Data was analyzed using descriptive statistics, correlation coefficient, and multiple regression. Results Based on PSS 14, 52(23.3%), 132(59.2%), and 39(17.5%) nurses experienced mild, moderate, and severe stress, respectively. Burnout and secondary trauma were found to be average in the majority of nurses (178[79.8%] and 175 [78.5%], respectively) in regard to professional quality of life domains. A sizable portion of the nurses was found to have average to high compassion satisfaction. Factors such as more number of night duties, alarms and lights in NICU, lesser professional experience, high workload, being unmarried, and having no children were found to be significant in association with perceived stress and professional quality of life. Conclusion According to this study, the majority of nurses who work in NICUs experience moderate levels of stress, which negatively impacts their professional quality of life. Therefore, it is important to consider various stress management programs based on the stressors.

Intra-arterial blood pressure (IABP) measurement, although considered the gold standard in critically ill children, is associated with certain risks and lacks widespread availability. This study was conducted to determine the differences and agreements between oscillometric non-invasive blood pressure (NIBP) and invasive IABP measurements in children. Inclusion criteria consisted of children (from 1 month to 18 years) admitted to the pediatric intensive care unit (PICU) of a teaching hospital who required arterial catheter insertion for blood pressure (BP) monitoring. The comparison between IABP and NIBP was studied using paired t-test, Bland–Altman analysis, and Pearson's correlation coefficient. In total, 4,447 pairs of simultaneously recorded hourly NIBP and IABP measurements were collected from 65 children. Mean differences between IABP and NIBP were −3.6 ± 12.85, −4.7 ± 9.3, and −3.12 ± 9.30 mm Hg for systolic, diastolic, and mean arterial BP, respectively (p

Background: Mechanical ventilation is lifesaving in children with respiratory failure. However, its unnecessary prolongation once a child is capable of sustaining spontaneous effective ventilation is associated with significant complications. Objective: To identify the factors that lead to higher chance of extubation failure in mechanically ventilated children. Materials and Methods: A prospective, observational study was conducted over a period of 1 year. Children admitted to pediatric intensive care unit of a tertiary care hospital of Northern India aged 1 month–17 years, needing mechanical ventilation were included in the study. Predefined criteria were used to decide the timing of extubation. Relevant details were recorded to study various patient-related parameters and their association with extubation outcome. Results: Mean age of the study group was 50 months with a male:female ratio of 3:1. Extubation failure rate was 14.5%. Extubation failure was significantly higher in patients ventilated for >7 days (p=0.01), those with the pediatric risk of mortality score >10 at admission (p=0.009), in addition to peak inspiratory pressure >16 cm H2O (p=0.009) and FiO2 ?0.35 (p=0.01) before extubation. Accidental extubation was also associated with higher extubation failure (p

The primary objective was to evaluate the postnatal maturation pattern on aEEG during first two weeks of life in clinically stable and neurologically normal preterm small for gestational age (PSGA) and gestation matched (1 week) preterm appropriate for gestational age (PAGA) neonates born between 300/7 and 346/7 weeks of gestation. Serial aEEG tracings were recorded on 3rd, 7th and 14th day of life. The primary outcome was total aEEG maturation score. Three blinded assessors assigned the scores. We analyzed a total of 117 aEEG recordings in 40 (19 PSGA and 21 PAGA) neonates. The baseline characteristics were comparable except for birthweight [1186 (263) vs 1666 (230) g]. There was no difference in the mean (SD) total scores on day 3 (9.0 (1.8) vs. 9.5 (1.1), P=0.32) and day 14 of life, but was lower in PSGA infants on day 7 (8.6 (2.4) vs. 10.1 (1.1), P=0.02). On multivariate analysis, maturation of PSGA neonates was found to be significantly delayed at any point of life from day 3 to day 14 (mean difference, -0.8, 95 % CI: -1.6 to -0.02, P=0.04). Lower aEEG maturation score on day 7 possibly indicates delayed maturation in PSGA neonates in the first week of life.

Background: Congenital malformations (CMF) are major causes of fetal demise which can be detected antenatally by Ultrasonography (USG). Methods: We studied 100 perinatal autopsies for CMF. Sensitivity of USG was determined and accuracy of USG with that of autopsy was compared. Results: At Autopsy 134 individual CMF were seen in 40 cases. The sensitivity of USG in detecting major CMF was 54.47%. A complete agreement between autopsy and USG findings was seen in 13/40 (32.5%) and partial agreement in 17/40 (42.5%) fetuses while autopsy completely changed antenatal diagnosis in 10/40 (25%) fetuses. Major findings were added in all 17 fetuses with partial agreement. In 2 cases, CMF suspected on USG were not detected on autopsy due to fetal maceration. Conclusion: Autopsy significantly adds to the prenatal USG diagnosis and may help in predicting the probability of recurrence, and thus counseling the affected couple to prevent any such future event.

A two-year old male child presented to the ophthalmology outpatient department (OPD) with parents complaining of child’s inability to make an eye contact. On examination, the patient had horizontal manifest nystagmus with no fixing and following. The pupillary reactions and the anterior segment examination were normal. Fundus examination in both eyes revealed small optic disc with 360 degree hyperpigmented ring in both the eyes (Figure 1 A and B). The macula was >2 disc diameter (DD) in distance from optic disc, suggestive of optic nerve hypoplasia. Magnetic resonance imaging (MRI) brain showed absent septum pellucidum (Figure 1 C and D). Serum growth hormone levels were significantly high. Based on the examination and investigations, diagnosis of de Morsier’s syndrome was made.

The primary objective was to evaluate the postnatal maturation pattern on aEEG during first two weeks of life in clinically stable and neurologically normal preterm small for gestational age (PSGA) and gestation matched (1 week) preterm appropriate for gestational age (PAGA) neonates born between 300/7 and 346/7 weeks of gestation.Serial aEEG tracings were recorded on 3rd, 7th and 14th day of life. The primary outcome was total aEEG maturation score. Three blinded assessors assigned the scores.We analyzed a total of 117 aEEG recordings in 40 (19 PSGA and 21 PAGA) neonates. The baseline characteristics were comparable except for birthweight [1186 (263) vs 1666(230) g]. There was no difference in the mean (SD) total scores on day 3 (9.0 (1.8) vs. 9.5 (1.1), P=0.32) and day 14 of life, but was lower in PSGA infants on day 7 (8.6 (2.4) vs. 10.1 (1.1), P=0.02). On multivariate analysis, maturation of PSGA neonates was found to be significantly delayed at any point of life from day 3 to day 14 (mean difference, -0.8, 95% CI: -1.6 to -0.02, P=0.04).Lower aEEG maturation score on day 7 possibly indicates delayed maturation in PSGA neonates in the first week of life.

The objective of this study was to evaluate and compare the efficacy of combined sucrose and non-nutritive sucking (NNS) for analgesia in newborn infants undergoing heel-stick procedures.This randomized control trial was conducted in the neonatal intensive care unit of a tertiary care hospital over a period of 1 year. One hundred and eighty full-term neonates with birth weight2200 g and age24 h were randomized to one of four interventions administered 2 min before the procedure: 2 ml of 30% sucrose (group I, n=45) or NNS (group II, n=45) or both (group III, n=45) or none (group IV, n=45). Primary outcome was composite score based on Premature Infant Pain Profile (PIPP) score.Baseline variables were comparable among the groups. Median (interquartile range) PIPP score was 3 (2 to 4) in group III as compared with 7 (6.5 to 8) in group I, 9 (7 to 11) in group II and 13 (10.5 to 15) in group IV. Group III had significant decrease in the median PIPP score compared with other groups (P=0.000). Median PIPP score also decreased significantly with any intervention as compared with no intervention (P=0.000).Sucrose and/or NNS are effective in providing analgesia in full-term neonates undergoing heel-stick procedures, with the combined intervention being more effective compared with any single intervention.

Background: Asthma is the most common chronic childhood disease being increasingly diagnosed in recent years. A review estimating the prevalence of bronchial asthma in the Indian children concluded the burden to be high than previously understood. There is paucity of data from Punjab, and no study from Ludhiana has estimated the true prevalence of asthma in urban area. Objective: To determine the prevalence and risk factors for childhood asthma using questionnaires and pulmonary function tests. Material and Methods: This was a questionnaire based cross-sectional study over a period of 1.5 year in the age group of 5-15 years studying in three schools of urban Ludhiana. The data were analyzed b STATA Software (version 16, college station Tx, USA). P < 0.05 was considered as significant. Results: The retrieval of questionnaire I was possible in 80% of the 2500 distributed. The prevalence of asthma was calculated as 7.5% (95% confidence interval, 5.2-10.5). The mean age of the children with asthma was 8.67 ΁ 2.62 years. The most common symptoms reported by the cases were wheezing and seasonal allergy. No predilection for sex, socioeconomic status, and pet at home was noted. The family history of asthma and allergy, family history of smoking were emerged as significant risk factors. Conclusions: The prevalence of asthma in the urban schools of Ludhiana was found to be 7.5% which was much higher than previously reported. Age groups 5-8 years were commonly affected. Family history of asthma or allergy, and smoking history were found to be significant risk factors for development of asthma.

Oligohydramnios is associated with increased maternal and foetal morbidities. However, some of the recent studies have shown no adverse effect of isolated oligohydramnios on perinatal outcome and recommends continuation of pregnancy. Pregnancies between 18-28 weeks with isolated Oligohydramnios were included. History and physical examination was recorded in a pre-designed proforma. All the cases received care as per the protocol. A total of seven patients were recruited of which one was a twin pregnancy with Oligohydramnios in both sacs. The mean age at presentation was 30 years. Three patients went into spontaneous explusion at an average gestational age of 22-24 weeks. One patient with twins delivered vaginally at 32 weeks. Rest were delivered by caesarean section between 34-35 weeks (indication in majority of the cases was foetal distress and cord compression). None of the babies suffered any complication and were discharged in good condition. Isolated oligohydramnios during second trimester does not increase adverse perinatal outcome significantly (but increases the caesarean section rate) and therefore, should not be an indication for termination of pregnancy.

Background: Labour analgesia has been recommended but sufficient data on use of labour epidural analgesia with ropivacaine and fentanyl combination during labour is not available.Methods: A comparative study was conducted on 40 high risk labouring partuirents, randomly allocated to group A (iv tramadol) and group B (epidural analgesia with ropivacaine plus fentanyl). Assessments were done for fetal heart rate abnormality, mode of delivery, duration of labour, and Apgar score. The VAS score, patient satisfaction score, and complications were recorded.Results: Group A had more number of instrumental deliveries compared to group B, the later had higher number of caesarean sections. No difference was observed in vaginal deliveries in both the groups. Pain relief was significant in patients of epidural group. The neonatal outcome was same in both the groups. Significant number of patients had a higher degree of satisfaction score in group B compared to group A.Conclusions: Tramadol and epidural analgesia in labour are safe and effective. Patient satisfaction is significantly higher in epidural group as compared to the tramadol group.

Aim Neonates frequently undergo minor painful procedures for which they are often not offered any analgesia. Sucrose and Non-nutritive sucking (NNS) can be effective non-pharmacological methods for pain relief in neonates. Aim of the study was to evaluate and compare the efficacy of combined sucrose and non-nutritive sucking for analgesia in newborn infants undergoing minor painful procedure. Methods This randomised control trial (RCT) was conducted in the neonatal intensive care unit of a tertiary care hospital over a period of one year. 180 full term neonates with birth-weight >2200 g and age >24 h were randomised to one of four interventions administered two min before the procedure: 2 ml of 30% sucrose (group I, n = 45) or non-nutritive sucking (NNS) (group II, n = 45) or both (group III, n = 45) or none (group IV, n = 45). Primary outcome was composite score based on Premature Infant Pain Profile (PIPP) score. Results Baseline variables were comparable among the groups. Mean (±SD) PIPP score was 3.42 ± 1.6 in group III, 7.47 ± 1.6 in group I, 8.42 ± 2.5 in group II, and 12.49 ± 2.9 in group IV. Group III had significant decrease in the mean PIPP score compared to other groups (p = 0.001). Mean PIPP score also decreased significantly with any intervention as compared to no intervention (p = 0.001). Conclusions Sucrose and NNS in combination are effective in providing analgesia in full term neonates undergoing minor painful procedure, with the combined intervention being more effective than single intervention.

A term male infant born by normal vaginal delivery was diagnosed to have holoprosencephaly on antenatal ultrasound, which was confirmed by postnatal MRI as alobar holoprosencephaly (figure). Clinical examination revealed no microcephaly or dysmorphism, except flat nasal bridge.

The authors report a preterm infant with Rh-isoimmunization, who had persistent hepato-splenomegaly with conjugated hyperbilirubinemia, transaminitis, and hyperammonemia. Ultrasound abdomen revealed an intrahepatic portosystemic venous shunt (PSVS). The child was managed conservatively. On follow up at 2.4 y of age, the child is having normal growth and development, but with persisting shunt. Severe Rh-isoimmunisation in a neonate can sometimes share some of the features of congenital PSVS and delay the diagnosis of the latter. The index case had shunt ratio >80 % during the neonatal period but did not require any intervention.

Fryns syndrome (FS) is a multiple congenital anomaly syndrome, inherited as an autosomal recessive defect with variable expression. The authors report a newborn with FS, whose mother had two previous affected pregnancies with the infants having variable phenotypic expression. FS is characterized by craniofacial dysmorphism, diaphragmatic hernia and distal limb hypoplasia. This is the first published report from India describing a case of FS with familial recurrence, which would serve further to illustrate the clinical variability of this disorder.

Objectives: The objective was to review the available evidence comparing oral paracetamol versus oral ibuprofen for the closure of patent ductus arteriosus (PDA) in preterm infants. Methods: We searched all the major databases (Medline via Ovid and PubMed) till April 2014. Randomized trials were included. Primary outcome measure was the primary closure rate of PDA after the first course of the drug. Review manager (version 5.2) was used for all the analyses. GRADE criteria were used to rate the quality of evidence. Results: Of 38 full-text articles assessed for eligibility, two trials (n = 240) were included in the final analysis. There was no significant difference between the two groups except for the following parameters, which favored the paracetamol group: Shorter mean days needed for PDA closure (mean difference, −0.49 [95% confidence interval [CI], −0.54 to − 0.44], P < 0.00001), a lower risk of gastro-intestinal bleeding (odds ratio [OR], 0.25 [95% CI, 0.06-1.02], P = 0.05) as well as hyperbilirubinemia (OR, 0.46 (95% CI, 0.23-0.95), P = 0.04). The GRADE evidence was found to be of low quality. Conclusions: There is not enough evidence to judge about the efficacy or safety of ibuprofen versus paracetamol for treating the PDA in preterm infants. Randomized trials with low risk of bias and adequate sample size including different subgroups of preterm infants are needed before any firm recommendation can be made.

A boy was born at 35 weeks’ gestation via caesarean section to a fourth gravida mother with a history of rhesus isoimmunisation. At …