Eligible Babies Research Articles

Cohort profile: Understanding Pregnancy Signals and Infant Development (UPSIDE): a pregnancy cohort study on prenatal exposure mechanisms for child health

PurposeExtensive research suggests that maternal prenatal distress is reliably related to perinatal and child health outcomes—which may persist into adulthood. However, basic questions remain regarding mechanisms involved. To better understand...

Stabilisation of the preterm infant in the delivery room using nasal high flow: A 5-year retrospective analysis.

This study reviews clinical outcomes after initiating a routine policy of preterm respiratory stabilisation using nasal high flow (HF) in the delivery room (DR). This was a retrospective observational cohort study in a single-centre neonatal intensive care unit and included all neonates born before 32weeks of gestation between 1 April 2015 and 31 March 2020. Stabilisation measures and outcomes were recorded including oxygen requirements, admission temperature, surfactant administration, invasive ventilation within 72h of birth, bronchopulmonary dysplasia (BPD) and death. There were 491 eligible babies during the 5-year epoch. 292 were stabilised using HF in the DR. The median admission temperature in babies transferred on HF was 36.8°C, and the median FiO2 at admission was 25%. 45% of these infants received surfactant. At 72 postnatal hours, 78% were either sustained on HF or were either self-ventilating in air (SVIA) or receiving low-flow nasal cannula (LFNC) respiratory support. 27% were intubated within 7days. At 36weeks postmenstrual age, 36% of survivors had BPD. We have demonstrated that preterm babies <32weeks can be effectively stabilised on HF in the DR.

Pain Relief in Late Preterm Neonates: A Comparative Study of Kangaroo Mother Care, Oral Dextrose 50%, and Supine Nesting Position.

Objective:The objectrve is to compare the analgesic effect of Kangaroo Mother Care (KMC), oral dextrose 50% (D50) and supine nesting position in late preterm neonates (34 week to <37 week Gestation Age) while doing heel prick for blood glucose monitoring. Materials and Methods:Babies were randomized into three groups; KMC, D50 and supine nesting. Premature infant pain profile (PIPP) score was used to measure pain severity following heel prick. Total crying time was also compared.Results:Data of 149 eligible babies were analyzed; significant difference was noted in total PIPP scores (mean; SD) across groups; KMC (8.42 [1.99]), D50 (8.76 [1.84]) and nesting (13.08 [1.70]) (P < 0.001). Post hoc analysis revealed comparable scores among KMC and D50 groups (P = 0.638), significantly less than nesting group (P < 0.001). Significant difference in crying time (median; interquartile range) was also noted amongst three groups (P < 0.001).Conclusion:The analgesic effect of KMC and oral D50 is comparable and found to be superior to supine nesting position in reducing pain of heel prick.

The BaSICS (Baby Skin Integrity Comparison Survey) study: A prospective experimental study using maternal observations to report the effect of baby wipes on the incidence of irritant diaper dermatitis in infants, from birth to eight weeks of age

Baby wipes have been shown to be safe and effective in maintaining skin integrity when compared to the use of water alone. However, no previous study has compared different formulations of wipe. The aim of the BaSICS study was to identify any differences in incidence of irritant diaper dermatitis (IDD) in infants assigned to three different brands of wipe, all marketed as suitable for neonates, but which contained varying numbers of ingredients. Women were recruited during the prenatal period. Participants were randomly assigned to receive one of three brands of wipe for use during the first eight weeks following childbirth. All participants received the same nappies. Participants reported their infant's skin integrity on a scale of 1-5 daily using a bespoke smartphone application. Analysis of effect of brand on clinically significant IDD (score 3 or more) incidence was conducted using a negative binomial generalised linear model, controlling for possible confounders at baseline. Analysts were blind to brand of wipe. Of 737 women enrolled, 15 were excluded (admitted to neonatal intensive care, premature or other infant health issues). Of the 722 eligible babies, 698 (97%) remained in the study for the full 8-week duration, 24.6% of whom had IDD at some point during the study. Mothers using the brand with the fewest ingredients reported fewer days of clinically significant nappy rash (score≥3) than participants using the two other brands (p=0.002 and p<0.001). Severe IDD (grades 4 and 5) was rare (2.4%). Rarity of severe IDD suggested that sensitive formula baby wipes are safe when used in cleansing babies from birth to eight weeks during nappy changes. The brand with fewest ingredients had significantly fewer days of clinically significant IDD. Daily observations recorded on a smartphone application proved to be a highly acceptable method of obtaining real-time data on IDD. This study was not designed or registered as a clinical trial as no intervention in normal patterns of infant care took place. Mothers who had already decided to use disposable nappies and a baby wipe product agreed to observe and report on their infants' skin condition; in return they received a 9-week supply of free nappies and wipes.

Effect of a quality improvement package for intrapartum and immediate newborn care on fresh stillbirth and neonatal mortality among preterm and low-birthweight babies in Kenya and Uganda: a cluster-randomised facility-based trial

SummaryBackgroundAlthough gains in newborn survival have been achieved in many low-income and middle-income countries, reductions in stillbirth and neonatal mortality have been slow. Prematurity complications are a major driver of stillbirth and neonatal mortality. We aimed to assess the effect of a quality improvement package for intrapartum and immediate newborn care on stillbirth and preterm neonatal survival in Kenya and Uganda, where evidence-based practices are often underutilised.MethodsThis unblinded cluster-randomised controlled trial was done in western Kenya and eastern Uganda at facilities that provide 24-h maternity care with at least 200 births per year. The study assessed outcomes of low-birthweight and preterm babies. Eligible facilities were pair-matched and randomly assigned (1:1) into either the intervention group or the control group. All facilities received maternity register data strengthening and a modified WHO Safe Childbirth Checklist; facilities in the intervention group additionally received provider mentoring using PRONTO simulation and team training as well as quality improvement collaboratives. Liveborn or fresh stillborn babies who weighed between 1000 g and 2500 g, or less than 3000 g with a recorded gestational age of less than 37 weeks, were included in the analysis. We abstracted data from maternity registers for maternal and birth outcomes. Follow-up was done by phone or in person to identify the status of the infant at 28 days. The primary outcome was fresh stillbirth and 28-day neonatal mortality. This trial is registered with ClinicalTrials.gov, NCT03112018.FindingsBetween Oct 1, 2016, and April 30, 2019, 20 facilities were randomly assigned to either the intervention group (n=10) or the control group (n=10). Among 5343 eligible babies in these facilities, we assessed outcomes of 2938 newborn and fresh stillborn babies (1447 in the intervention and 1491 in the control group). 347 (23%) of 1491 infants in the control group were stillborn or died in the neonatal period compared with 221 (15%) of 1447 infants in the intervention group at 28 days (odds ratio 0·66, 95% CI 0·54–0·81). No harm or adverse effects were found.InterpretationFresh stillbirth and neonatal mortality among low-birthweight and preterm babies can be decreased using a package of interventions that reinforces evidence-based practices and invests in health system strengthening.FundingBill & Melinda Gates Foundation.

Determinants of maternal knowledge of neonatal danger signs among postnatal mothers visiting neonatal intensive care unit, north Central Ethiopia, 2019: a cross-sectional study

BackgroundSick neonates can be early readmitted if and only if their mothers have good knowledge of the key neonatal danger signs at first discharge. Thus, it was aimed to assess the level and determinants of maternal knowledge on these signs at first discharge from NICU.MethodsA hospital based cross sectional study design was employed at Debre Tabor General Hospital, South Gondar Zone. A sample of 363 participants was included to the study from September 2018 to February 2019 through systematic selection of every other eligible mother baby pair. Data were collected through face to face interview at time of discharge from NICU. Knowledge score of neonatal danger signs was computed by adding the total number of correct spontaneous responses to 9 key danger signs with a minimum score of 0 and maximum of 9 [0 when a mother named none of the key danger signs and 9 when the mother named all the signs]. Mothers who scored ≥3 points were considered to have good knowledge whereas those scoring less than 3 points had poor knowledge.Results224(61.70%) mothers had good knowledge of neonatal danger signs at discharge from NICU. Secondary and above level of education [AOR = 4.62], receiving danger sign information during stay at NICU [AOR = 3.64], four and above antenatal visits [AOR = 3.04], well preparedness of birth [AOR = 13.70], institutional delivery [AOR = 6.46] and good knowledge of essential newborn care [AOR = 4.41] were significant factors.ConclusionsAt discharge time, maternal knowledge of neonatal danger signs wasn’t comparable to their exposure of NICU environment. Therefore, danger sign education should be routinely given during maternal stay at NICU. Moreover, existing efforts should be enhanced to improve number of antenatal visits, institutional delivery rate and postnatal services along the continuum of maternal and child health care in South Gondar Zone.

Prevention of Pain During Screening for Retinopathy of Prematurity: A Randomized Control Trial Comparing Breast Milk, 10% Dextrose and Sterile Water.

ObjectivesTo compare the efficacy of orally administered 10% dextrose, breast milk and sterile water on pain prevention during screening examination for Retinopathy of prematurity (ROP) in preterm neonates as measured by Premature infant pain profile (PIPP).MethodsA three-limbed double-blinded randomized control trial was conducted in a Level 3 neonatal intensive care unit. Forty five preterm neonates undergoing ROP screening were included. Eligible babies were randomly assigned to one of the three groups that orally received either expressed breast milk (n = 14), 10% dextrose solution (n = 14) or sterile water (n = 17), one minute before eye examination. The outcome measure was PIPP score.ResultsAll 3 groups were similar in baseline characteristics. The mean PIPP scores were comparable (p = 0.18) in the three groups (11.8 ± 2.8 vs. 9.8 ± 3.3 vs. 10.2 ± 2.9). The behavioral and physiological variables were also similar across all three groups.ConclusionsExpressed breast milk, 10% dextrose or sterile water administered orally before ROP screening in preterm neonates have similar analgesic effects and do not significantly alleviate pain during the procedure.

Pattern of haemoglobin phenotypes in newborn infants at the national hospital abuja using high performance liquid chromatography

Haemoglobin (Hb) disorders are among the most common blood genetic disorders worldwide, and they constitute an important cause of morbidity and mortality, especially in Nigeria. Despite the clinical significance of early diagnosis, newborn screening for these conditions is not routinely done in Nigeria. This study was undertaken to document the pattern of Hb phenotypes of newborn babies at the National Hospital Abuja and highlight the relevance of neonatal screening for early diagnosis of abnormal Hb phenotypes in Nigeria. A prospective study of eligible newborn babies delivered in the hospital at the study site was undertaken following parental informed consent. Venous blood was collected from the babies into an ethylenediaminetetraacetic acid sample bottles. The samples were analysed using high-performance liquid chromatography (HPLC) techniques, and the Hb phenotypes obtained were documented. Data were analysed using the Statistical Package for Social Sciences (SPSS) version 20 (IBM-SPSS, Armonk, NY, USA). Three hundred and eleven newborns (male = 173, female = 138) aged 0-28 days were recruited. Two hundred and thirty-six (75.9%) babies had Hb AA (FA) phenotype, 63 (20.3%) Hb AS (FAS), 6 (1.9%) Hb SS (FS), 4 (1.3%) Hb AC (FAC) and 2 (0.6%) had abnormal HbA variants. The overall prevalence of abnormal Hb phenotype was 24.1%. The results showed a significant association of sex (P = 0.003) and ethnicity (P = 0.047) with Hb phenotype. There is a wide spectrum of abnormal Hb phenotypes in Nigeria, and these phenotypes can easily be detected at birth using HPLC. We, therefore, recommend routine neonatal screening for sickle cell disease by HPLC in Nigeria.

Assessing the risk of early unplanned rehospitalisation in preterm babies: EPIPAGE 2 study

BackgroundGaining a better understanding of the probability, timing and prediction of rehospitalisation amongst preterm babies could help improve outcomes. There is limited research addressing these topics amongst extremely and very preterm babies. In this context, unplanned rehospitalisations constitute an important, potentially modifiable adverse event. We aimed to establish the probability, time-distribution and predictability of unplanned rehospitalisation within 30 days of discharge in a population of French preterm babies.MethodsThis study used data from EPIPAGE 2, a population-based prospective study of French preterm babies. Only those babies discharged home alive and whose parents responded to the one-year survey were eligible for inclusion in our study. For Kaplan-Meier analysis, the outcome was unplanned rehospitalisation censored at 30 days. For predictive modelling, the outcome was binary, recording unplanned rehospitalisation within 30 days of discharge. Predictors included routine clinical variables selected based on expert opinion.ResultsOf 3841 eligible babies, 350 (9.1, 95% CI 8.2–10.1) experienced an unplanned rehospitalisation within 30 days. The probability of rehospitalisation progressed at a consistent rate over the 30 days. There were significant differences in rehospitalisation probability by gestational age. The cross-validated performance of a ten predictor model demonstrated low discrimination and calibration. The area under the receiver operating characteristic curve was 0.62 (95% CI 0.59–0.65).ConclusionsUnplanned rehospitalisation within 30 days of discharge was infrequent and the probability of rehospitalisation progressed at a consistent rate. Lower gestational age increased the probability of rehospitalisation. Predictive models comprised of clinically important variables had limited predictive ability.

Parents of babies who participated in an invasive clinical study report a positive experience: the Glucose in Well Babies (GLOW) study

ObjectiveThere is a paucity of data about normal blood metabolite concentrations in healthy babies, in part because of a reluctance to undertake non-therapeutic invasive testing in newborns. The Glucose in...

Risk Indicators for Hearing Impairment in Neonates

To identify relation between prevalence of hearing impairment and risk factors at the time of birth in high risk neonates. A year-long study is performed at HBT Medical College and Dr. R. N. Cooper Municipal General Hospital, Vile Parle (west), Mumbai. The Study comprised of 478 high risk babies born between March 2016 and February 2017 and admitted in NICU of the hospital. Out of these 68 babies were either transferred to higher centre or took discharge against medical advice. A total of 410 babies completed the study. Additional 21 eligible babies died in NICU during the study. A Prospective Observational Study is used to analyse the findings of the study. Skew analysis of spread of prevalence across risk factors is used to establish higher prevalence of hearing impairment in high risk neonates. Cramer's Moment Coefficient of Skewness and Corresponding Test Statistics are used for studying the skewness. Out of 410 babies screened during the study 5 babies were diagnosed with profound SNHL. The risk factors associated with babies is plotted against frequency of babies with Profound SNHL. The plot is found to be un-uniformly distributed and shows inclination towards higher prevalence with high risk babies. Sample skewness (G1) value - 0.81 indicates moderately negative skewed sample. This means the number of babies with profound SNHL found by 3 stage screening is moderately concentrated at high risk weightage.

RECRUITMENT OF BABIES IN VACCINE TRIAL: A CHALLENGE

Introduction: The enrollment of children into clinical trials is challenging. India is increasingly recognized as a site for clinical research due to its large population and growing research capabilities, though data regarding barriers for recruitment into pediatric vaccine clinical trials are scarce. Objective: The objective of this study was to assess the barriers in recruitment and to find out parental factors for non-participation of their babies in the vaccine clinical trial. Materials and Methods: This was a prospective cross-sectional non-interventional study which was carried out in the pediatric clinical research unit of a tertiary care multispecialty teaching hospital in Pune. The study social worker visited postnatal ward to prime mothers regarding the pneumococcal vaccine clinical trial. Parents of babies aged 6–8 weeks, who were eligible for participation in the ongoing pneumococcal vaccine trial were explained the informed consent form of this clinical trial and their willingness for participation was sought. The reason for refusal of the parents, who declined the study participation of their baby, was documented. Results: Even though eligible inborn baby pool was large (n=384), only 148 (38.54%) inborn babies were brought to our clinical research unit showing a major barrier in the recruitment. Of 204 babies who presented to clinical research unit, 94 babies (46.08%) were enrolled in the ongoing clinical trial and the majority of them were inborn (89.36%), whereas only 10 of 56 (17.86%) outborn babies were enrolled. There was no gender difference noted in enrolled versus non-enrolled babies. There was no significant association between baby’s gender and place of delivery. The major reasons for non-enrollment were “unwillingness” for participation in clinical trial (68.18%) followed by mothers going outstation, staying far away from our hospital, lack of time, and concerns due to research vaccine. Conclusion: Our study has shown that even though eligible inborn baby pool was large, only 38.54% of inborn babies were brought to our clinical research unit, thus a major barrier in recruitment. More effective counseling and recruitment strategies are needed to scale up the enrollment more so for the outborn babies.

Effectiveness of oral glucose as analgesic for neonates undergoing retinopathy of prematurity screening – A randomized pilot study for a parallel randomized control trial

Background: Eye examination is a painful procedure. Neonates exposed to painful stimuli have short- and long-term behavioral and sensory problems. To determine an analgesic for alleviating pain during this mandatory painful, medical procedure is of utmost importance, to have optimal outcomes in these vulnerable preterm babies. We analyzed the effectiveness of 25% dextrose solution as analgesic for retinopathy of prematurity (ROP) screening. Objective: The objective was to study the feasibility of conducting a Phase III randomized controlled trial, for oral analgesic during ROP screening in neonates and to utilize this pilot data for calculating sample size for Phase III trial. Place of the Study: The study was conducted in a tertiary care neonatal unit, Southern India. Type of Study: This was a randomized parallel group masked Phase I/2 external pilot study. Methods: Feasibility was defined a priori; the study population was inpatient babies undergoing ROP screening procedure for the first time as per unit protocol. All subsequent babies, after a written consent from parents/legal guardian, were randomized to oral glucose (25% dextrose solution) or placebo group (distilled water). Premature infant pain profile (PIPP) scores were assessed at basal and post procedure. Babies were observed for 24 h for predefined adverse events. Statistical analysis was done using Stata 11.2. Continuous data were expressed as median based on the skewness, and Mann–Whitney U-test was used for hypothesis testing. Results: Twenty-six inpatient neonates were randomized. The median pain scores (PIPP) at 1 min post procedure for the placebo group were 7 IQ (6, 8), and median pain scores of the oral glucose group were 4 IQ (3–5). Eighty-six percent of the eligible babies were randomized for the study. Eighty-five percent of the randomized babies where available for total observation period of 24 h. Inter-rater variability was assessed by interclass correlation (ICC) coefficient. No adverse events (predefined) were recorded in both groups. Conclusion: This randomized pilot trial is feasible to deliver. Oral glucose (25% dextrose) solution has a significant pain alleviation compared to placebo, in our pilot population. Pain scores assessed were validated by independent reviewer with high ICC of 0.89.

Establishing a composite neonatal adverse outcome indicator using English hospital administrative data

ObjectiveWe adapted a composite neonatal adverse outcome indicator (NAOI), originally derived in Australia, and assessed its feasibility and validity as an outcome indicator in English administrative hospital data.DesignWe used Hospital...

Improving First-hour Breastfeeding Initiation Rate After Cesarean Deliveries: A Quality Improvement Study

To improve the rates of first hour initiation of breastfeeding in neonates born through cesarean section from 0 to 80% over 3 months through a quality improvement (QI) process. Quality improvement study. Labor Room-Operation Theatre of a tertiary care hospital. Stable newborns ≥35 weeks of gestation born by cesarean section under spinal anesthesia. A team of nurses, pediatricians, obstetricians and anesthetists analyzed possible reasons for delayed initiation of breastfeeding by Process flow mapping and Fish bone analysis. Various change ideas were tested through sequential Plan-Do-Study-Act (PDSA) cycles. Proportion of eligible babies breast fed within 1 hour of delivery. The rate of first-hour initiation of breastfeeding increased from 0% to 93% over the study period. The result was sustained even after the last PDSA cycle, without any additional resources. A QI approach was able to accomplish sustained improvement in first-hour breastfeeding rates in cesarean deliveries.

Comparison of the Effectiveness of New Material Diapers versus Standard Diapers for the Prevention of Diaper Rash in Chinese Babies: A Double-Blinded, Randomized, Controlled, Cross-Over Study.

Background Diaper rash, also known as diaper dermatitis (DD), is a very common skin condition in infants, and use of disposable diapers with breathable materials is an effective approach for the management of diaper rash. In China, new material diapers and standard diapers are currently the two most commonly used disposable diapers. This study aimed to compare the effectiveness of new material diapers versus standard diaper for the prevention of diaper rash in Chinese babies. Methods A total of 80 eligible babies admitted to Shanghai Skin Diseases Hospital during the period from June through July, 2016, were enrolled and randomized into two groups. Babies in Group A (n = 41) used the new material diapers, and babies in Group B (n = 39) used standard diapers. Two weeks after the use of the diaper, the babies used the alternate product for the next 2 weeks. Skin conditions were assessed on the front and back waist, right and left buttock, pubic region, anal region, and right and left groin using a 6-point scoring system based on four parameters in 0, 2, and 4 weeks after use of the diapers. Results There were changes of the mean skin assessment score in each of the six regions after the use of the diapers. There were significant differences, in the mean skin assessment score of the front waist in Group A between weeks 2 and 4 (P = 0.006) and in Group B between weeks 0 and 2 (P = 0.004), and no significant differences were detected in the mean skin assessment score of the back waist and buttock in both Group A and Group B on weeks 0, 2, and 4. A higher mean skin assessment score of the pubic region was assessed in Group A on week 4 than on week 2 (P = 0.036), with a higher score seen on week 2 than on week 0 (P = 0.048), while no significant differences were found in Group B among weeks 0, 2, or 4. There was a higher mean score of the anal region assessed in Group A on week 2 than on week 0 (P = 0.01), while a higher mean score was found in Group B on week 2 than on weeks 0 (P = 0.036) and 4 (P = 0.01). In addition, a higher mean skin assessment score of the groin was detected on week 2 than on week 0 in both Group A (P = 0.00001) and Group B (P = 0.0001). Conclusion The new material diaper is superior to the standard diaper for the prevention of diaper rash in Chinese babies.

CHIPS-Child: Testing the developmental programming hypothesis in the offspring of the CHIPS trial.

As a follow-up to the CHIPS trial (Control of Hypertension In Pregnancy Study) of 'less tight' (versus 'tight') control of maternal blood pressure in pregnancy, CHIPS-Child investigated potential developmental programming of maternal blood pressure control in pregnancy, by examining measures of postnatal growth rate and hypothalamic-pituitary adrenal (HPA) axis activation. CHIPS follow-up was extended to 12 ± 2 months corrected post-gestational age for anthropometry (weight, length, head/waist circumference). For eligible children with consent for a study visit, we collected biological samples (hair/buccal samples) to evaluate HPA axis function (hair cortisol levels) and epigenetic change (DNA methylation analysis of buccal cells). The primary outcome was 'change in z-score for weight' between birth and 12 ± 2 mos. Secondary outcomes were hair cortisol and genome-wide DNA methylation status. Of 683 eligible babies, 183 (26.8%) were lost to follow-up, 83 (12.2%) declined, 3 (0.4%) agreed only to ongoing contact, and 414 (60.6%) consented. 372/414 (89.9%) had weight measured at 12mos. In 'less tight' (vs. 'tight') control, the primary outcome was similar [-0.26 (-0.53, +0.01); p = 0.14, padjusted = 0.06]; median (95% confidence interval) hair cortisol (N = 35 samples) was lower [-496 (-892, -100) ng/g; p = 0.02], and buccal swab DNA methylation (N = 16 samples) was similar. No differences in growth rate could be demonstrated up to 5 years. Results demonstrate no compelling evidence for developmental programming of growth or the HPA axis. Clinicians should look to the clinical findings of CHIPS to guide practice. Researchers should seek to replicate these findings and extend outcomes to paediatric blood pressure and neurodevelopment.

Nurse’s perspective on barriers in the implementation of kangaroo mother care in a tertiary care hospital from North India

Background: Despite the established benefits of kangaroo mother care (KMC), it is not being implemented in all eligible babies. There are several barriers in its implementation including those from the nurses, mothers, and institution. Objective: The objective of the study was to determine the nurse’s perspective on various barriers in the implementation of KMC. Materials and Methods: This was a cross-sectional descriptive study in which data were collected from all the nurses of the Department of Neonatology and Obstetrics in a tertiary care hospital, from North India, over 1 week using a structured pre-tested questionnaire covering barriers in three main domains - mothers (6), nursing staff (7), and institutional (5). Results: There were a total of 40 nurses, who responded to questionnaire; among them, 70% were from neonatology and 30% were from obstetrics. Mean barrier-free score (BFS) (%) was 48.93±14.77 with a range of 29.17–76.39, while median (interquartile range) was 47.22 (44.4–52.4). Mean BFS was found to be statistically significant when compared between maternal and nursing domains (54.5±11.1 vs. 43.3±11.9 vs. 49.0±18.4, p=0.003). Conclusion: The present study shows that the most important barriers in KMC implementation were lack of support to mother, duty schedule of staff, difficulty in convincing, and a private/separate environment for KMC. Therefore, actions need to be taken to overcome these barriers to use this simple intervention with enormous benefits.

Role of oral erythromycin for feed intolerance in neonates - A randomized controlled trial

Objective: The objective of this study was to compare the effect of high and low dose of erythromycin with placebo and to determine the efficacy and safety of oral erythromycin for feed intolerance in neonates admitted to the neonatal intensive care unit. Methodology: The study was a double-blind, randomized, and placebo-controlled trial. Term and preterm babies having feed intolerance were included in the study, and babies with congenital malformations, necrotizing enterocolitis, and sepsis were excluded from the study. After parental consent, the subjects were randomized into Groups 1, 2, or 3 to receive low-dose (3 mg/kg/dose) or high-dose (10 mg/kg/dose) oral erythromycin estolate or the placebo (equal volume of 5% dextrose). Feeding of all the study neonates was managed as per the unit protocol and babies were monitored for the complications. The primary outcome was the time to reach full feeds of 150 ml/kg/day, without significant gastric residuals. Results: Of 58 eligible babies, 84.5% were preterm babies. The median time for reaching full feeds with placebo was 6 days with interquartile range 3

Growth patterns of preterm infants: A prospective study in an indigenous African population

Background: Optimal growth of preterm infants reflects their overall health status; however, indigenous growth charts are rarely available to monitor them adequately in infancy. Objectives: The aim of this study was to describe growth patterns of preterm infants and to generate percentile charts as well as relevant predictive equations for expected weight-for-age in their various birth weight categories. Materials and Methods: This was a prospective, analytic study. Anthropometric measurements of eligible consecutive preterm babies were monitored biweekly/monthly in infancy. Temporal changes in body weights and occipitofrontal circumferences (OFCs) were presented graphically. The Pearson's correlation coefficient was done to derive predictive equations. LMS chartmaker light version 2.54 (Medical Research Council, UK) generated percentile charts. P