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Background: Maternal skin contact has impact on physiological parameters in newborns, some studies showed positive effects but as we live in under developing country and the data on impact of kangaroo mother care (KMC) on physiological parameters is very limited. We hypothesized that KMC is effective in stabilizing the heart rate, respiratory rate and maintaining the oxygen saturation and body temperature of low birth weight (LBW) newborns. Objective: The aim of the study was to determine effects of 3 hours KMC on physiological parameters such as body temperature, heart rate, respiratory rate and oxygen saturation in LBW neonates. Study Design: Observational Quasi-experimental study Study Setting: This study was conducted in Department of Neonatology, Children Hospital, PIMS, Islamabad, Pakistan from 1st June 2022 to 1st December 2022. Methodology: The neonates were hemodynamically stable admitted in NICU and Nursery of Children Hospital, PIMS with LBW with the bodyweight

Background: The addition of medium chain triglycerides is preferable as they are more easily digested and quickly absorb in bloodstream than long chain fat and provide ready supply of energy by increasing fatty acid bioavailability. Modular products like micro lipids and medium-chain triglyceride (MCT) oils are now focused as a fat supplementation. The rate of weight gain with MCT is not well known, and there is very less research done in Pakistan. Objective: To determine the effect of MCT oil supplemented human milk compared with un supplemented human milk fed to preterm infants on promoting weight gain. Study Design: Randomized controlled trial Study Setting: This study was conducted in Department of Neonatology, Children Hospital, PIMS, Islamabad, Pakistan from 20th August 2022 to 20th February 2023. Methodology: The study conducted after approval from institutional ethical committee. A total of 160 preterm infants fulfilling the inclusion criteria and enrolled in the study after informed consent from parents. The patients were receiving enteral feeding of human milk within neonatology department of hospital was included and they were randomly assigned to Group NF (receiving 20 ml of human milk without MCT oil), Group F (receiving 20ml of human milk with 1 ml of MCT oil fat). Primary outcomes were including growth in term of weight gain at measured at 1st ,5th and 10th day of MCT oil intake after hospital admission. Secondary outcome included feeding intolerance, diarrhoea, sepsis and necrotising enterocolitis. All the data was collected in the form of a questionnaire. The statistical analysis was done by using SPSS version 20. Results: One sixty very low birth weight infants were analyzed in this study. All infants were randomly divided into two groups: F and NF, the demographic details. The weight of infants was measured on first day, fifth day and tenth day and noted that the frequency of infants improved the weight gain after taking human milk without fat supplementation or human milk with fat supplementation. We found the gradually infants more increasing their weights in Group F as compared to Group NF. On tenth day 75% infants reaches between1400-1490 gm weight (p

In a recent meta-analysis, based on 13 randomized control trials, the researchers concluded that the neonates care with KMC at least 6 hours per day got significant weight gain as compared to the Non-KMC group with a mean difference 8.99 gm per day. They also concluded that the infants received KMC for less or equal to 02 hours per day not showed a significant difference in weight gain as compared to controls.16

Background: Ventilator associated pneumonia (VAP) is a relatively common and sometimes deadly complication of mechanical ventilation seen in neonatal ICUs around the globe. Objective: The study aimed to analyze the effect of three different infant positions on the rate of ventilator associated pneumonia in newborns in NICU. And compare the bacterial growth on tracheal aspirates in all three groups. Study design: It was randomized controlled trial study conducted for the duration of six months from 1st January 2021 to 30th June 2021 at Neonatal ICU department of Children Hospital PIMS, Islamabad. Material and Methods: The sample size was calculated by WHO sample size calculator, with power of test 80% and level of confidence 05%. Population proportion for group 1 was 67% (rate of bacterial colonization in supine group). Population proportion for group 2 was 47% (rate of bacterial colonization in lateral group). Sample size was turned out to be 50 in each group and a total of 150 patients were included in the study. The patients were randomized to one of the three groups using lottery method. The ethical and review board committee of the hospital approved the study. Results: First group patients were in supine position after the procedure of endotracheal intubation on the ventilator. The second group was the one in which infants were put in prone position by following protocol. And the third group contained patients in lateral positions. The goal of the study was to study the effect of these three positions on the incidence of ventilator associated pneumonia in case of infants admitted in hospital. The other goal was to do a comparison on the bacterial growth produced on tracheal aspirates in case of all these groups. Infants were kept in these positions and there was no information collected for 10 minutes as there could be any potential instability in respiration. After the patients were stable data was collected. Conclusion: There was no difference found in the incidence of VAP in case of all three positions and the bacterial colonization was found to be increased in case of supine position as compared to other groups. Keywords: Ventilator associated pneumonia (VAP), Neonatal ICUs, Respiratory tract.

Objective: To determine the efficacy of nasal continuous positive airway pressure (NCPAP) versus heated humidified high-flow nasal cannula (HHHFNC) as a primary mode of respiratory support in preterm infants with respiratory distress. Methodology: This randomized controlled trial study was conducted at in-patient department of neonatology (Nursery & NICU) of Pakistan Insitute of Medical Sciences (PIMS) from July 2020 to Dec 2020. A total of 280 neonates randomly divided (140 in each study group) of both genders, with gestational age between 28-34 weeks and having mild-to-moderate respiratory distress within 1st 6 hours of birth requiring non-invasive ventilation were enrolled. Neonates in NCPAP Group (n=140) were given NCPAP whereas neonates in HHHFNC Group (n=140) were given HHHFNC. The efficacy of both groups were compared on the basis of treatment failure within 1st 3 days, total duration (hours) of non-invasive ventilator (NIV) required and total duration (hours) of supplementary oxygen required. Results: Overall, mean gestational age was noted to be 30.0+6.4 weeks. There were 144 (51.4%) neonates with birth weight between 1 to 1.4 kg, 90 (32.1%) between 1.5 to 1.9 kg and 46 (16.4%0 between 2.0 to 2.4 kg. Treatment failure was noted in 67 (47.6%) neonates in NCAP group while HHHFNC group reported 73 (52.4%) neonates with treatment failure (p=0.4733). No significant difference was observed in mean total duration of NIV support required (p=0.2598) or mean total duration of supplementary oxygen (p=0.1946) in between study groups. Conclusion: HHHFNC had similar efficacy when compared to NCPAP among neonates with RDS. In comparison to NCPAP, HHHFNC could be a simple, well-tolerated and effective alternative in terms of respiratory support. No major difference in terms of complication was observed between both treatment approaches.

To compare the need of mechanical ventilation between LISA (less invasive surfactant administration) method and conventional INSURE method (INtubation SURfactant administration and Extubation) in spontaneously breathing preterm infants with respiratory distress syndrome (RDS).An experimental study.Department of Neonatology, PIMS, Islamabad, from April to December 2017.A total of 100 preterm infants34 weeks gestation, on nasal CPAP requiring fraction of inspire oxygen (FiO2)0.4, with respiratory distress syndrome (RDS) were included in the study and divided randomly into two groups, 50 each.There were 28 (56%) males in LISA and 31 (62%) in the INSURE group. Median birth weight was 1300 grams (IQR 600) in LISA, while 1400 grams (IQR 400) in INSURE infants. C-section rate was 52% (n=26) and 48% (n=24) in LISA and INSURE, respectively. Pre-natal steroids were given to 38 patients (76%) in LISA and 30 patients (60%) in INSURE group. LISA patients had significantly less need of mechanical ventilation with p-value0.05 {30% (n=15) vs. 60% (n=30)}. The median duration of mechanical ventilation was 40 hours (IQR 75) and 71 hours (IQR 62) in LISA and INSURE, respectively. Similarly, median FiO2 reduction was 30 (IQR 30) in LISA group and it was 25 (IQR 10) in INSURE group, with p-value0.05. There was no significant difference in mortality, hospital stay and complications.LISA technique was safe, non-invasive approach of surfactant administration, with reduced need of mechanical ventilation rate and duration.

To measure the frequency of ophthalmia neonatorum among all babies born in MCH Center, PIMS (Pakistan Institute of Medical Sciences), Islamabad, in one month's time and to determine their causative organisms.An observational study.The MCH Center, PIMS, during the month of November 2008.All babies born from 1st to 30th November, 2008 in the MCH Center, PIMS, Islamabad, Pakistan were included in the study. All babies were examined for signs of conjunctivitis on days 1, 3, 7, 14, 21 and 28 of life. Conjunctival swabs were taken for gram staining and culture from those with clinical diagnosis of conjunctivitis. Frequency of known maternal and neonatal risk factors for the disease were assessed. Proportions were compared using chi-square test with significance at p0.05.Seventeen percent of the 1010 babies developed conjunctivitis. Staphylococcus aureus (65% of all positive cultures) was the most common causative organism. No case of gonococcus was isolated. Meconium stain liquor (p=0.004) and caesarain section (p0.001) were found to be the most frequent associated conditions in conjunctivitis.There was a high frequency of neonatal conjunctivitis, with Staphylococcus aureus as the most common causative agent. Poor hygienic conditions and practices could be an important risk factor in Pakistan.

To describe the presentations, complications and to look at the subtypes of children with osteopetrosis.A case series.This study was conducted at the National Institute of Child Health (NICH) from July 2002 to December 2003.All children presenting as outpatients or inpatients with anemia, thrombocytopenia, and hepatosplenomegaly were evaluated. Those suspected of the disorder (n=126) were screened by X-rays of long bones.Eighteen children including 10 girls and 8 boys in 16 families were diagnosed as having osteopetrosis over a period of 18 months. Fifteen had isolated autosomal recessive osteopetrosis. The mean age at diagnosis was 33 months. Parental consanguinity was high (83.3%). Anemia, hepatosplenomegaly, failure to thrive, recurrent infections and neurological manifestations were common. A high mortality (33.3%) owing to infection was noted.Osteopetrosis should be considered in children presenting with unexplained anemia and hepatosplenomegaly. Once diagnosed, these children should then be monitored for the complications that occur with high frequency in the disorder. Early diagnosis and treatment of the disorder improves the outcome.