Hospital NICU Research Articles

Breast Milk Feeding for Infants Who Required Major Surgery

ObjectiveTo identify barriers or facilitators that influenced mothers to provide mother’s own milk (MOM) for 6 months to their infants who were hospitalized in the NICU after major surgery. DesignDescriptive qualitative. SettingAn 80-bed, Level 4 NICU of a regional pediatric hospital in the western United States. ParticipantsFourteen mothers who provided MOM for their infants who required surgery within 1 week of age. MethodsWe conducted in-person interviews upon admission and discharge of the infant, phone interviews 1 and 2 weeks after discharge, and phone interviews monthly for 6 months or until discontinuance of the provision of MOM. We analyzed interviews using the Brooks thematic template analysis method. ResultsEleven infants received exclusive MOM at discharge, and nine infants remained on exclusive MOM at 6 months. We generated four principal themes from the participants’ comments: Value of Breast Milk, Challenges of Providing MOM, Emotional Fluctuation, and Coping With Reality of Circumstances. ConclusionInternalizing the value of MOM, family support, and coping with barriers were key factors that influenced participants to provide MOM for at least 4 months. Findings of this study suggest that prenatal education with anticipatory guidance and lactation support in the NICU can help mothers achieve the goal of extended provision of MOM to infants with serious conditions that require surgery. Education and support may be especially helpful for young, first-time mothers.

Perioperative Quality Improvement in Children's Hospitals Neonatal Consortium NICUs.

Infants admitted to NICUs in children's hospitals represent a different population than those in a traditional birth hospital. The patients in a children's hospital NICU often have the most complex neonatal diagnoses and are cared for by various subspecialists. The Children's Hospitals Neonatal Consortium is a collaborative of more than 40 NICUs that collect data and perform quality improvement (QI) work across the United States and Canada. The collaborative's database provides an opportunity to benchmark clinical outcomes for this specialized population and to support the QI efforts. In this review, we summarize the success of individual collaborative QI projects focused on improving the care of the neonate in the perioperative period related to clinical team handoffs, postoperative hypothermia prevention, and improvement of postoperative pain management. The collaborative's experience can serve as a model for other national collaboratives seeking to support QI efforts.

Gram-Negative Colonization and Bacterial Translocation Drive Neonatal Sepsis in the Indian Setting.

The gut microbiota, comprising billions of microorganisms, plays a pivotal role in health and disease. This study aims to investigate the effect of sepsis on gut microbiome of neonates admitted to the Neonatal Intensive Care Unit. A prospective cohort study was carried out in the NICU of tertiary care hospital in Karnataka, India, from January 2021 to September 2023. Preterm neonates with birth weight < 1500g and gestational age < 37 weeks were recruited, excluding those with congenital gastrointestinal anomalies, necrotizing enterocolitis, or blood culture-negative infections. The study population was divided into three groups: healthy neonates (Group A), neonates with drug-sensitive GNB sepsis (Group B), and neonates with pan drug-resistant GNB sepsis (Group C). Stool samples were collected aseptically, snapped in liquid nitrogen, and stored at -80⁰C for extraction of DNA and microbiome analysis. The gut microbiota of healthy neonates (Group A) was dominated by Proteobacteria (24.04%), Actinobacteria (27.13%), Firmicutes (12.74%), and Bacteroidetes (3%). Predominant genera included Bifidobacterium (55.17%), Enterobacter (12.55%), Enterococcus (50.69%), Streptococcus (7.92%), and Bacteroides (3.58%).Groups B and C, the microbiota exhibited higher Proteobacteria abundance (57.16% and 66.58%, respectively) and reduced diversity of beneficial bacteria. Notably, the presence of sepsis was associated with an increase in pathogenic bacteria and a decrease in beneficial commensal bacteria. Neonates with sepsis exhibited significant gut microbiome dysbiosis, characterized by increased Proteobacteria and reduced beneficial bacteria diversity. These findings highlight the potential of microbiome profiling as a diagnostic tool and underscore the importance of gut microbiota modulation in managing neonatal sepsis.

Adverse effects of human milk fortifier on preterm neonates in a neonatal intensive care unit of a tertiary care hospital, Karachi.

Objective: To determine adverse effects of Human Milk Fortifier on Preterm neonates in a Neonatal Intensive Care Unit. Study Design: Descriptive study. Setting: Indus Hospital NICU in Karachi. Period: Mar 2022 to September 2023. Methods: Aimed to investigate the adverse effects of HMF on 139 preterm neonates. The study excluded infants with congenital anomalies. Adverse effects, including Necrotizing Enterocolitis (NEC), metabolic acidosis, feeding intolerance, and other complications, were monitored. Results: The findings revealed that feeding intolerance was the most common adverse effect of HMF. Mild metabolic acidosis and NEC were also observed. These results are consistent with previous studies and may be attributed to the high osmolality of feeds following fortification with HMF. Despite the well-established role of HMF in promoting weight gain in preterm infants, the study underscores the importance of closely monitoring its use. Conclusion: Careful consideration of the potential risks and benefits of HMF is essential before prescribing it to preterm neonates. Future research with larger sample sizes and controlled designs is needed to validate these findings and explore strategies to mitigate the adverse effects of HMF in NICU settings.

Prevention of NICU Admission Hypothermia in Moderate- and Late-Preterm Infants.

Neonatal hypothermia is a common and preventable cause of neonatal morbidity and mortality. Although hypothermia prevention has been extensively studied in infants <32 weeks' gestation, the authors of few studies have targeted moderate- and late-preterm infants (MLPIs) in the delivery room. This quality improvement initiative was conducted from June 2019 to June 2023 at the Massachusetts General Hospital NICU and Labor and Delivery Unit. All inborn MLPIs 32 + 0/7 to 36 + 6/7 weeks' gestation admitted to the NICU were included. We expanded thermoregulatory measures typically used in protocols for infants <32 weeks' gestation, including increasing delivery room ambient temperature to 74°F and thermal mattress use. The primary outcome was hypothermia (<36.5°C) after NICU admission. The balancing measure was hyperthermia (≥38 °C). During the study period, there were 566 inborn MLPIs with a mean gestational age of 34 + 3/7 weeks and a mean birth weight of 2269 g. Special cause variation in neonatal hypothermia incidence was observed with a decrease from a mean baseline of 27% to 7.8% postintervention. Special cause variation was observed in hyperthermia incidence, with an increase from 1.4% to 6.2% postintervention largely initially associated with noncompliance with the protocol for thermal mattress removal. The expansion of several thermoregulation techniques commonly used in infants <32 weeks' gestation, particularly thermal mattress use, was associated with a decreased incidence of NICU admission hypothermia in MLPIs, with an increase in mild hyperthermia predominantly associated with concomitant polyethylene wrap use.

Implementation of Nasal CPAP Weaning Guidelines in Preterm Infants.

Continuous positive airway pressure (CPAP) benefits preterm infants with respiratory distress, including reduced bronchopulmonary dysplasia (BPD) incidence, surfactant use, and extubation failure. Successful CPAP weaning also promotes oral feeding. However, there is no consensus on the optimal weaning of CPAP in neonates. This study aims to determine the effects of CPAP (CPAP) weaning guideline implementation on neonatal outcomes. CPAP gradual pressure weaning guidelines were implemented in the Penn State Children's Hospital NICU in 2020. We included baseline data from infants (Epoch1) before bubble CPAP implementation in 2018-19. We included infants (Epoch2) after implementing the guidelines during 2020-21. The inclusion criteria were infants <32 weeks gestation with CPAP support. Compliance with the CPAP weaning guidelines was the primary process measure. Primary outcome measures included successful CPAP wean on the first attempt. Balancing measures used were total days on respiratory support and length of hospital stay. 195 infants were included in this study, 95 infants in Epoch 1 before bubble CPAP implementation and 100 infants in Epoch 2 after implementing guidelines. Infants in the two Epochs were similar in median gestational age at 29 vs 30 weeks (p=0.47) and were similar in median birth weight at 1190 vs 1130 grams (p=0.73). After implementing weaning guidelines, the successful weaning off CPAP improved from 9.5% to 54% (p<0.001). The total days needed to achieve full oral feeds decreased by 7 days (29 vs 22 median days, p<0.001). The BPD incidence was not significantly different between the two Epochs at 17% vs 16%, p= 0.87. There was no difference in total days of respiratory support, total length of stay, the number of infants discharged on home nasogastric feeding, and demographic variables. The implementation of the bubble CPAP weaning guideline improves the successful weaning of CPAP and promotes oral feeding in preterm infants.

Maternal and neonatal outcomes associated with breech presentation in planned community (home and birth center) births in the United States: A prospective observational cohort study.

Investigate maternal and neonatal outcomes associated with breech presentation in planned community births in the United States, including outcomes associated with types of breech presentation (i.e., frank, complete, footling/kneeling). Secondary analysis of prospective cohort data from a national perinatal data registry (MANA Stats). Planned community birth (homes and birth centers), United States. Individuals with a term, singleton gestation (N = 71,943) planning community birth at labor onset. Descriptive statistics to calculate associations between types of breech presentation and maternal and neonatal outcomes. Maternal: intrapartum/postpartum transfer, hospitalization, cesarean, hemorrhage, severe perineal laceration, duration of labor stages and membrane rupture Neonatal: transfer, hospitalization, NICU admission, congenital anomalies, umbilical cord prolapse, birth injury, intrapartum/neonatal death. One percent (n = 695) of individuals experienced breech birth (n = 401, 57.6% vaginally). Most fetuses presented frank breech (57%), with 19% complete, 18% footling/kneeling, and 5% unknown type of breech presentation. Among all breech labors, there were high rates of intrapartum transfer and cesarean birth compared to cephalic presentation (OR 9.0, 95% CI 7.7-10.4 and OR 18.6, 95% CI 15.9-21.7, respectively), with no substantive difference based on parity, planned site of birth, or level of care integration into the health system. For all types of breech presentations, there was increased risk for nearly all assessed neonatal outcomes including hospital transfer, NICU admission, birth injury, and umbilical cord prolapse. Breech presentation was also associated with increased risk of intrapartum/neonatal death (OR 8.5, 95% CI 4.4-16.3), even after congenital anomalies were excluded. All types of breech presentations in community birth settings are associated with increased risk of adverse neonatal outcomes. These research findings contribute to informed decision-making and reinforce the need for breech training and research and an increase in accessible, high-quality care for planned vaginal breech birth in US hospitals.

Decreasing Blood Transfusions in Premature Infants Through Quality Improvement.

Packed red blood cell transfusions (pRBCT) in preterm infants have been associated with significant morbidity. Although infants <26 weeks' gestational age typically require several pRBCT, preterm infants born between 26 and 34 weeks' gestational age may also require pRBCT during their hospitalization that are potentially preventable. We aimed to reduce pRBCT in this population by 20%. This quality improvement project was conducted in the Duke University Hospital NICU between July 2018 and February 2023. Interventions included the implementation of evidence-based transfusion thresholds, supporting bone marrow erythropoiesis, and reducing laboratory specimen volumes by increasing capillary test panels. The rates per 1000 patient days for pRBCT (outcome measure), number of new patients initiated on erythropoietin (process measure), number of basic metabolic panels (process measure), and total capillary panels (process measure) were monitored during the project period. Statistical process control charts were used to observe trends over time. Among infants born between 26 0/7 and 34 6/7 weeks' gestational age, the rate of pRBCT decreased from an average of 23.8 to 12.7 transfusions per 1000 patient days, which is a 46.6% decrease. Increases in the use of erythropoietin and capillary panels were observed, along with a decrease in the use of basic metabolic panels. There was no change in mortality or the rate of necrotizing enterocolitis. Improvement was sustained for 24 months after implementation. pRBCT can be decreased in preterm infants born between 26 and 34 completed weeks' gestation through a combination of strategies utilizing quality improvement methodology.

The Role of Serum Lactate Values as a Predictor of Morbidity in Preterm Infants

Abstract Background Early hemodynamic assessment of critically ill newborns requires mostly invasive measurements in neonatal intensive care unit. Base deficit and serum lactate concentrations may be important prognostic indicators in preterm infants. Aim and Objectives to investigate the relationship between serum lactate levels and adverse outcome in preterm infants who were admitted to NICU of Ain Shams University Hospital. Subjects and Methods This study is prospective cohort study, that included 90 preterm patients that were admitted to neonatal intensive care unit during a period of 6 months, all the neonates had the level of serum lactate been evaluated by ELISA (at 6, 12, 18 and 24 hours of birth) and correlated with the incidence of intracranial hemorrhage as diagnosed by cranial ultrasonography. Result: The initial serum lactate level was compared with the follow up readings at 12, 18 and 24 hours and showed statistically significant reduction of serum lactate in follow up recordings (p-value &amp;lt;0.05), Serum lactate was statistically significant predictors of death with increase serum lactate at 12hrs., at 18hrs. and at 24hrs, with p-value (p &amp;lt; 0.05). Serum lactate had no statistically significant association with intracranial hemorrhage as detected by transcranial ultrasonography. Conclusion Serial lactate measurements greater than 5.6 mmol/l predict adverse outcome and may aid the clinician in bedside decision making.

Early Prediction of Hemodynamically Significant Patent Ductus Arteriosus in Preterm Infants using Non-invasive Electrical Cardiometry

Abstract Background Prematurity is a term for the broad category of neonates born at less than 37 weeks' gestation following onset of the last menstrual period. Different degrees of prematurity are defined by gestational age (GA) or birth weight (BW). Prematurity is associated with approximately one- third of all infant deaths. Complications of prematurity are the underlying cause of the higher rate of infant mortality and morbidity in preterm infants compared to full term infants. Objective To identify hemodynamic changes during the first 48hrs in life using non-invasive cardiometry and how these changes can predict which infants would develop clinical and echocardiographic criteria for PDA treatment. Patients and Methods This Prospective cohort study was conducted at tertiary care hospital at the neonatal intensive care units of Ain Shams University, Children’s Hospital from October 2021 till April 2022 and performed on preterm neonates who are less than 35 weeks gestational age and admitted to the NICU of pediatric hospital. Results Hemodynamically-significant PDA group had significantly lower systolic, diastolic blood pressure and mean arterial blood pressure than hemodynamically not significant PDA group at each time of follow up and significantly higher heart rate at (12, 15, 18, 21, 24, 27, 30, 33, 36, 39, 45, 48) hours in patients with hemodynamically-significant PDA. There was statistically significant difference between the two studied groups as regards vital data of Oxygen saturation (SpO2) and UOP which were significantly lower in hemodynamically-significant PDA. Conclusion in our prospective cohort study increased heart rate, decreased mean arterial blood pressure predict a clinically significant PDA requiring treatment. Furthermore, vital data seem to be a good non invasive tools to monitor hemodynamic changes in preterms with hemodynamically significant PDA. However, further studies with a higher number of patients are necessary to ground the outcomes of these preliminary considerations.

Pregnancy-related complications in patients with endometriosis in different stages

BackgroundEndometriosis is one of the most common and costly diseases among women. This study was carried out to investigate pregnancy outcomes in women with endometriosis because of the high prevalence of endometriosis in reproductive ages and its effect on pregnancy-related complications outcomes.MethodsThis was a cross-sectional study performed on 379 pregnant women with endometriosis who were referred to the endometriosis clinic of the Avicenna Infertility Treatment Center from 2014 to 2020. Maternal and neonatal outcomes were assessed for the endometriosis group and healthy mothers. The group with endometriosis was further divided into two groups: those who underwent surgery and those who either received medication alone or were left untreated before becoming pregnant. The analysis of the data was done using SPSS 18.ResultsThe mean age of the patients was 33.65 ± 7.9 years. The frequency of endometriosis stage (P = 0.622) and surgery (P = 0.400) in different age groups were not statistically significant. The highest rates of RIF and infertility were in stages 3 (N = 46, 17.2%) (P = 0.067), and 4 (N = 129, 48.3%) (P = 0.073), respectively, but these differences were not statistically different, and the highest rate of pregnancy with ART/spontaneous pregnancy was observed in stage 4 without significant differences (P = 0.259). Besides, the frequency of clinical/ectopic pregnancy and cesarean section was not statistically different across stages (P > 0.05). There is no significant relationship between endometriosis surgery and infertility (P = 0.089) and RIF (P = 0.232). Most of the people who had endometriosis surgery with assisted reproductive methods got pregnant, and this relationship was statistically significant (P = 0.002) in which 77.1% (N = 138) of ART and 63% (N = 264) of spontaneous pregnancies were reported in patients with endometriosis surgery. The rate of live births (59.4%) was not statistically significant for different endometriosis stages (P = 0.638). There was no stillbirth or neonatal death in this study. All cases with preeclampsia (N = 5) were reported in stage 4. 66.7% (N = 8) of the preterm labor was in stage 4 and 33.3% (N = 4) was in stage 3 (P = 0.005). Antepartum bleeding, antepartum hospital admission, preterm labor, gestational diabetes, gestational hypertension, abortion, placental complications and NICU admission were higher in stage 4, but this difference had no statistical difference.ConclusionEndometriosis is significantly correlated with infertility. The highest rates of RIF and infertility are observed in stages 3 and 4 of endometriosis. The rate of pregnancy with ART/spontaneous pregnancy, preterm labor, preeclampsia and pregnancy-related complications is higher in stage 4. Most of the people who had endometriosis surgery with assisted reproductive methods got significantly pregnant. Clinical/ectopic pregnancy, cesarean sections, and live birth were not affected by the endometriosis stages.

Clinical Profile and Outcome of Neonates Admitted in Intensive Care Unit: A Cross Sectional Study in District Hospital

Neonatal period, which is the first 28 days of an infant’s life, is the most crucial and vulnerable period. A remarkable decline in mortality rates during neonatal period for the past two decades is due to the advances of obstetric practice in term of medical screening and surveillance and increased neonatal specialization. However, respiratory tract disorders, along with sepsis and other types of infection, are the major causes of neonatal morbidities and mortalities. Hence, this study is aimed to bridge these gaps and provide inputs to the program implementers to design necessary interventions that could contribute to the reduction of neonatal morbidity and mortality.Aims: To determine the clinical profile and neonatal outcome admitted to NICU in district hospitalObjectives: 1. To determine the socio demographic factors associated with neonatal outcome 2. To determine the obstetric profile associated with neonatal outcome.Methods: This hospital based retrospective study was conducted in the NICU of Tumakuru district hospital from Jan to March 2023. Records of all the admitted neonates were reviewed. The details were collected based on a structured questionnaire prepared in English. This contained information regarding obstetric and antenatal care (ANC), gestational age at birth, birth weight, sex, APGAR score, age at admission, admission diagnosis, neonatal outcomes and other related details. The data collected was entered in Microsoft excel (MS Excel) and quantitative variables was analysed by mean and qualitative variable by proportion by epi in go 3.4.3. Chi square was used to find out the association between the neonatal outcome and other variables. P value &lt;0.05 was considered significant.&#x0D; Results: A total of 120 neonates were admitted during the study period. 47 (39.1%) mothers of the neonates were aged 21-25years and followed by 34 (28.3%) mothers in the age of 26-30 years. Association between neonatal outcome and socio demographic components was not statistically significant but definitely outcome was better with the good socio demographic profile. Regarding ANC follow up, 119 (99.1%) mothers had attended at leastone prenatal visit and majority 100 (80%) were having ANC check-up at government hospital. The most commoncauses of neonatal mortality were respiratory distress syndrome 4(3.33%), followed by low birth weight 4(3.33%), and preterm 3(2.5%).Conclusion: Inspite of improved technology and facilities available still the neonatal outcome is worst. These all are preventable causes of neonatal mortality and morbidities which has to be taken care bygiving due importance to its predictors. Maternal and environmental factors has to be taken care and dealt.

Morbidity pattern based on clinico-biochemical profile of neonates admitted in NICU of a tertiary care hospital in the mid north bank region of Assam

The neonatal period carries the highest risk of death per day compared to any other period during childhood. Of all newborn deaths three fourths result from three preventable and treatable conditions– complications due to prematurity, intrapartum related deaths (including birth asphyxia) and neonatal infections. The study was to describe the morbidity pattern with outcome, based on clinical diagnosis and relevant biochemical parameters amongst neonates admitted in NICU in the tertiary care hospital. A retrospective case record analysis of all the NICU admissions between January 2021 to March 2021 was done based on both electronic and hard data. The neonates with complete records of clinical presentation, relevant biochemical investigations were included in the study. Out of 624 neonates admitted in NICU during the study period, 622 were included in the final analysis. The proportion of fullterm and preterm among inborns (77.6% &amp;18.8%) and outborns (76.2% &amp; 21.8%) were similar, but the proportion of low-birth-weight babies in outborns was higher than in the inborns. The overall discharge rate was 85.5%. It was higher for inborn neonates as compared to outborn neonates (88.7% vs 79%). The death rate was higher in outborns than in inborns. The highest no of NICU admission was due to asphyxia related conditions followed by neonatal jaundice in both genders and in all inborn and outborn neonates. Out of total admissions in NICU, 72(11.6%) was due to infections causing neonatal sepsis, meningitis and acquired pneumonia. While neonatal jaundice has a lower mortality rate, preventable conditions like birth asphyxia and infections remain major concerns for neonatal morbidity and mortality in this region. The study emphasizes the need for strengthened antenatal care, improved infection control, and increased access to trained neonatologists to ensure better outcomes for newborns.

Assessment of gentamicin dosing and monitoring in neonates: A single center experience.

Gentamicin is a commonly used medication in NICUs. It is known to have ototoxic & nephrotoxic side effects. To date there is no consensus about dosing regimen in different institutions. Our study aims to evaluate the Neofax® dosing regimen for gentamicin in neonatal early onset sepsis in relation to trough level before the second dose and its association with the incidence of gentamicin side effects, namely hearing impairment/loss and acute kidney injury. Retrospective chart review of newborns admitted to Tawam hospital NICU (June 2019-May 2020) who received gentamicin for early onset sepsis (≤72 hours old). Trough levels before the second dose at 24,36 and 48 hours were reviewed (≥1 mg/L is high). Excluded patients with renal risk factors. Side effects (hearing impairment, acute renal injury) were also assessed. Total of 265 infants were included, among whom 149 patients received gentamicin at 24 hours interval, 99 at 36 and 17 at 48 hours interval. Trough level was high in 76% (P = 0.022), 65% (P = 0.127), and 53% (P = 0.108) of patients who received gentamicin at 24, 36, and 48 hours, respectively. Hearing screening was normal in 99.2% of patients, while 2 patients failed the test (Both with normal trough levels). No patients in our study developed renal injury related to gentamicin use. Neofax® gentamicin dosing often results in high trough levels, especially in late preterm/term infants. This study found no correlation between high trough levels and hearing impairment upon discharge or acute kidney injury. Further studies with larger sample size are recommended.

Unintended Events in Long-Distance Neonatal Interhospital Transport in Western Australia: A Comparison of Neonatal Specialist and Non-Neonatal Specialist Transport Teams

ObjectiveTo compare unintended events in transfers performed by neonatal specialist (NS) and non-neonatal specialist (NNS) teams in Western Australia (WA). Study designRetrospective comparison of neonatal transfers from the Kimberley and Pilbara regions (WA) to tertiary services, King Edward Memorial (perinatal) and Perth Children’s Hospital NICU, in Perth (state capital, distance up to 2200km) between January 2018 - June 2021. NS teams travelled from the tertiary to the referring center and back. NNS travelled from the referring to the tertiary center. Transport time, team composition, total unintended clinical and endotracheal tube (ETT) events were compared. Categorial data are expressed as numbers (%) and compared by chi-squared test; continuous data are expressed as median (interquartile range) and compared by Mann-Whitney U test. ResultsDuring the study period, 3,709 infants were transported in WA to tertiary services for escalation of care: 119/3709 (3.2%) from the Kimberley and Pilbara, 49 with NS and 70 with NNS teams. NNS had shorter transport times than NS teams (508(433 – 610) vs 675(610 – 735) min; p<0.0001). Neonatal nurses were on NS more than NNS teams (36/49(73.5%) vs 6/70(8.6%); RR 5.08 95% CI (3.13 to 8.56), p<0.001). Total unintended clinical and ETT events were less in NS vs. NSS teams (28/49(57%) vs. 54/70(77%); RR 0.66 95%CI (0.40 to 0.92), p=0.03) and (0/26(0%) vs. 7/23(30%); p=0.004). ConclusionAlthough NS teams had longer transport times there were fewer unintended clinical and ETT events. NS teams should be considered as the first choice to undertake neonatal transport.

Neonatal Dermatopathology: A 10-Year Institutional Review

Background/objective Neonatal skin conditions are typically diagnosed through noninvasive methods. Few studies describe the spectrum of biopsy- evaluated neonatal skin lesions. We present our institutional experience with the conditions leading to skin biopsies in neonates. The objective is to describe the conditions for which skin biopsies are performed in neonatal patients. Methods There were 20 neonatal skin biopsies over a 10-year period from the hospital’s delivery unit, NICU, and pediatric hospital. Biopsies were categorized as inflammatory (not caused by an infectious agent), congenital, neoplastic, infectious, and vascular conditions. Results The patients’ ages ranged from 1 day to 4 weeks, with a male predominance. There were 6 inflammatory, 7 congenital, 5 neoplastic, 1 infectious, and 1 vascular lesions. Conclusions The most frequent neonatal skin biopsy lesions were inflammatory or congenital lesions. This review described the types of neonatal dermatopathology specimens that we encountered in practice.

Clinico-Bacteriological Study of Sepsis in VLBW Neonates in Tertiary Care NICU in Central India: A Descriptive Observational Study

Introduction: Low birth weight (LBW) is one of the most serious challenges in maternal and child health in developing countries. Neonatal sepsis is responsible for about 30-50% of the total neonatal deaths in developing countries. Given the high prevalence of Very Low Birth Weight (VLBW) neonates and the increasing incidence of sepsis in this population, there is a need to study the clinical and bacteriological profile of sepsis. Aim: To study the clinico-bacteriological profile of neonatal sepsis in VLBW neonates (Birth weight &lt;1500 gm) in a tertiary care NICU in central India. Materials and Methods: The descriptive observational study was conducted among VLBW neonates with clinically suspected sepsis admitted to the NICU of Indira Gandhi Government Medical College and Mayo Hospital in Nagpur, Maharashtra, India, from November 2019 to October 2021. All 160 VLBW neonates with clinically suspected sepsis and positive sepsis screen consisting of four parameters {Absolute Neutrophil Count (ANC), Total Leucocyte Count (TLC), Immature/Total Neutrophil Ratio (I/T Ratio), C-Reactive Protein (CRP)+} and whose mothers provided informed consent were included in the study within 24 hours of admission. Details such as demographic data, maternal risk factors and type of delivery, clinical signs of sepsis presentation, any Central Nervous System (CNS) signs, day of onset of sepsis, sepsis screen parameters (CRP, TLC, ANC, I/T Ratio), blood culture, and Cerebro-spinal Fluid (CSF) examination findings were studied. Continuous variables were evaluated using the student t-test, and categorical variables were evaluated using the chi-square test. Results: There were 96 (60%) males and 64 (40%) females. In the sepsis screen parameters, the majority of the neonates were CRP positive 148 (92.3%) followed by TLC positive among 119 (74.38%) neonates. Lethargy was the most common clinical presentation among 147 (91.88%) neonates followed by difficulty in feeding among 121 (75.63%) neonates. Blood culture was positive among 61 (38.13%) neonates, and Escherichia coli was the most common organism isolated among 21 (34.43%) neonates. Conclusion: The most common clinical presentation of neonatal sepsis was lethargy followed by difficulty in feeding. In the present study, the most common organism isolated was E.coli.

Effectiveness of nesting practice on posture and movements among preterm babies in NICU of a tertiary care hospital at Bhubaneswar

Effectiveness of nesting practice on posture and movements among preterm babies in NICU of a tertiary care hospital at Bhubaneswar

Immediate Outcomes in Neonates Born to Diabetic Mothers

Background: Infants born to diabetic mothers are at a higher risk of developing complications like macrosomia, hypoglycemia, hypocalcemia, hypomagnesemia, polycythemia, hyperbilirubinemia, prematurity, transient tachypnea of newborn, respiratory distress syndrome, birth asphyxia, congenital heart diseases etc. The predominant causes of mortality are congenital anomaly, birth trauma, respiratory distress syndrome, prematurity and unexplained still birth. Hence this present study was conducted to study the incidence of complications among neonates of diabetic mothers.&#x0D; Materials and Methods: This was hospital-based observational study conducted in NICU and postnatal ward of a tertiary care hospital among 55 neonates. A detailed maternal history and complications during labor were recorded. Investigations like glucose estimation, PCV, serum calcium, serum bilirubin were done. The incidence of complications was assessed in terms of frequency and percentage.&#x0D; Results: Complications related to maternal diabetes were observed among 33 (18.15%) neonates. They were hypoglycemia, hypocalcemia, hyperbilirubinemia and polycythemia. Among them, hypoglycemia was the most common complication observed among 13(23.63%) neonates followed by hyperbilirubinemia among 10 (18.18%) neonates.&#x0D; Conclusion: Hypoglycemia was the most common complication followed by hyperbilirubinemia among infants born to diabetic mothers.

Improved outcomes after the introduction of donor breast milk

Premature infants are at considerable risk of increased morbidity and mortality. They have a higher risk of learning disabilities, cerebral palsy, sensory deficits, respiratory illnesses, and gastrointestinal illnesses.1,2 Providing mother's own milk to the preterm infant has nutritional, gastrointestinal, immunological, developmental, and psychological benefits. Breastfed preterm infants have a lower rate of ear infections, respiratory infections, or infection‐related events. They have lower rates of gastrointestinal infections, necrotizing enterocolitis, and mortality. When milk from the mother is not available, human donor milk is an important option, because it maintains many of its health benefits. This article shines light on the improved outcomes of premature infants after the introduction of donor breast milk and also discusses the multiple challenges faced by a level three NICU of a tertiary care hospital during the implementation of Donor Breast Milk program.