Stable Preterm Neonates Research Articles

Evaluating Pressure Variability and Influencing Factors during High-Flow Nasal Cannula Therapy in Premature Infants.

Heated humidified high-flow nasal cannulas (HHHFNCs) are increasingly used as an alternative strategy for weaning from nasal continuous positive airway pressure (NCPAP) in premature infants. However, the optimal pressure provided by HHHFNCs is unknown. This retrospective study investigated the pressure changes and associated factors during HHHFNC therapy in preterm infants. Clinically stable preterm neonates born with a birth weight of 2500 g or less and receiving HHHFNC therapy for weaning from NCPAP were enrolled. The flow of the HHHNFCs was adjusted to achieve an initial pressure equivalent to the positive expiratory pressure (PEEP) of NCPAP. Subsequent pressure changes in the HHHFNCs were measured by a GiO digital pressure gauge. Nine premature infants were enrolled. Their gestational age (mean ± SD) was 28.33 ± 2.61 weeks, and the birth weight was 1102.00 ± 327.53 g. Overall, 437 pressure measurements were conducted. The median pressure of the HHHFNCs was 5 cmH2O. The generated pressure had a significant association with the body weight, postmenstrual age (PMA) and flow rate. A multiple regression model revealed that the measured pressure (cmH2O) = -5.769 + 1.021 × flow rate (L/min) - 0.797 × body weight (kg) + 0.035 × PMA (days) (r2 = 0.37, p < 0.001). The pressure provided by HHHFNCs is influenced by body weight, PMA, and flow rate. It is feasible to set the delivered pressure of HHHFNCs to match the applied PEEP of NCPAP initially, facilitating the weaning of preterm infants from NCPAP to HHHFNCs.

Influence of Early Total Enteral Feeding in Preterm Infants with Respiratory Distress Syndrome

Plain Language SummaryThe objective of this secondary analysis of data from the randomized trial comparing less invasive surfactant therapy (LISA) with InSurE method of surfactant administration among preterm infants with respiratory distress syndrome (RDS) is to demonstrate the feasibility of ETEF in hemodynamically stable preterm neonates on respiratory support.In this randomized control trial comparing LISA versus InSurE among preterm infants with RDS between 26 and 34 weeks of gestation, 150 infants were enrolled with 117 being hemodynamically stable. In 33 patients, early total enteral feeding could not be started due to various reasons – 7 babies had absence/reversal of end-diastolic flow (A/REDF) on antenatal Doppler, 15 babies had shock and required inotropic support on day 1 of life, 8 babies had higher ventilatory settings at the time of admission, and in the 3 babies, the abdomen was not soft to start total enteral feeding. Full-volume enteral feeding without any parenteral supplementation was started on day 1 of life using the mother’s own milk (MoM) or donor human milk (≤32 weeks of GA) and MoM or preterm formula (33–34 weeks of GA). The data were analyzed to assess the proportion of babies developing feed intolerance and/or NEC and factors associated with failure of ETEF. Out of these 117 babies, 102 tolerated ETEF, and 15 had one or more episodes of FI requiring parenteral supplementation, but none developed NEC. There was a statistically significantly increased incidence of culture-positive sepsis as well as the requirement of antibiotic therapy for possible sepsis in babies with failure of ETEF. There was no difference in the morbidities noted such as intraventricular hemorrhage grade 2 or more, patent ductus arteriosus requiring medical or surgical management, retinopathy of prematurity requiring treatment, and NEC stage II or more. Our study suggests that hemodynamically stable preterm infants with RDS on respiratory support can be successfully fed with exclusive enteral feeds started immediately post-birth. ETEF results in early attainment of full feeding and reduces the incidence of sepsis and the duration of hospital stay without increasing the risk of NEC.

Clinical Outcomes of Slow versus Rapid Enteral Feeding Advancement in Very Low Birth Weight Neonates at a Tertiary Care Center

In India, every year around 3.5 million babies are born premature, accounting for almost 13% of total livebirths in the country as compared to 5% to 7% incidence in the West. Preterm is defined as babies born before 37 weeks ofpregnancy. The rapidity of feed volume increments involves controversies like faster weight gain, shorter hospital stays, therisk of necrotizing enterocolitis and vice versa. Methods: The present study was a randomized controlled trial conducted fromJune 1, 2018 to October 31, 2019. All infants in the study were randomized to slow and rapid feeding protocols by a stratifiedblock randomization sequence of 2, 4, 6 blocks. Group 1 or the slow advancement group included 64 newborns babies andGroup 2 or the rapid advancement group included 69 newborns babies. Results: The average weight gain in Group 1 was4.41 ± 0.9 g and in Group 2 it was 6.33 ± 1.3 g, the difference was statistically significant (p &lt; 0.02). Sixty out of 64 newbornsregained birth weight within 16.87 ± 0.9 days in Group 1, while 64 out of 69 newborns regained birth weight within 13.63 ±0.9 days in Group 2. The difference was statistically significant. Increment in the mean occipitofrontal circumference perweek was 0.29 ± 0.27 cm Group 1, while in Group 2 it was 0.42 ± 0.05 cm; the difference was statistically significant. Meanaverage length increment per week was found to be 0.55 ± 0.04 cm and 0.69 ± 0.05 cm in Group 1 and Group 2, respectively,the difference was statistically significant (p &lt; 0.005). The mean duration of hospital stay was 27.47 ± 3.33 days in Group 1while in Group 2, the duration of stay was 23.15 ± 2.22 days, the difference was statistically significant. Conclusion: Ourstudy supports enteral nutrition by rapid enteral feeding regimen in stable preterm neonates with very low birth weight

Does the 3C (Counselling, Checking and Certification) Initiative Prevent Hypoglycemia Among At-Risk Stable Late Preterm and Term Neonates? - A Randomized Controlled Trial.

To evaluate whether the 3C (Counselling, Checking, Certification) initiative helps in preventing hypoglycemia among at-risk neonates compared to standard care. This randomised controlled trial included 222 mother-newborn dyads with risk factors for neonatal hypoglycemia-Small for gestational age (SGA) babies, infants of diabetic mothers (IDM), large for gestational age (LGA) babies and late preterm infants (LPI). They were randomized to two groups. Group A received standard care while mothers in group B were administered 3C intervention. Early initiation of breastfeeding, incidence of neonatal hypoglycemia within 24h, and exclusive breastfeeding rate at 6 mo were evaluated. Early initiation of breastfeeding was higher in the 3C group compared to standard care group (94.6% vs. 55.9% p <0.001). The incidence of hypoglycemia within 24h was lower in the intervention group compared to standard care (3.6% vs. 15.3%, p <0.05). However, there was no significant difference in exclusive breastfeeding rates at 6 mo between the two groups (61% and 66% in group A and B respectively). The 3C intervention decreases the incidence of hypoglycemia among at-risk neonates. Early initiation of breast-feeding is higher among mothers who receive the 3C intervention.

Impact of Kangaroo Mother Care on Heart Rate Variability and Pain Score with Heel Lance Pain in Preterm Neonates: A Cross-over Randomized Controlled Trial

Introduction: To evaluate the effect of kangaroo care on response to pain due to heel lance in preterm infants using premature infant pain profile (PIPP). Design: Randomized cross-over design. Methods: Stable preterm neonates ( n = 70) who had completed 28–36 weeks of gestational age received either kangaroo mother care or were kept under control (bassinet) conditions for 30 minutes prior to a heel lance. The neonates were observed, and responses were scored as per PIPP. They were then crossed over to the other condition and scored similarly. The PIPP scores in the two study arms were then compared using appropriate statistical tools. Results: A total of 342 neonates were admitted during the study period, of which 95 were assessed for eligibility, and finally, 70 were included and randomized to be in one of the two arms. The facial actions differed in the two groups; the brow bulge and eye squeeze scores were significantly better at each observation in the KMC group. The nasolabial furrow score was significantly better at 60 and 90 seconds. The baseline PIPP scores were similar. In the KMC group, the scores were significantly lower at 30, 60, and 90 seconds post–heel lance. Conclusions: Kangaroo mother care is an effective way of reducing the physiological and behavioral effects of pain in preterm neonates.

Clinical Outcomes of Slow versus Rapid Enteral Feeding Advancement in Very Low Birth Weight Neonates at a Tertiary Care Center

In India, every year around 3.5 million babies are born premature, accounting for almost 13% of total livebirths in the country as compared to 5% to 7% incidence in the West. Preterm is defined as babies born before 37 weeks ofpregnancy. The rapidity of feed volume increments involves controversies like faster weight gain, shorter hospital stays, therisk of necrotizing enterocolitis and vice versa. Methods: The present study was a randomized controlled trial conducted fromJune 1, 2018 to October 31, 2019. All infants in the study were randomized to slow and rapid feeding protocols by a stratifiedblock randomization sequence of 2, 4, 6 blocks. Group 1 or the slow advancement group included 64 newborns babies andGroup 2 or the rapid advancement group included 69 newborns babies. Results: The average weight gain in Group 1 was4.41 ± 0.9 g and in Group 2 it was 6.33 ± 1.3 g, the difference was statistically significant (p &lt; 0.02). Sixty out of 64 newbornsregained birth weight within 16.87 ± 0.9 days in Group 1, while 64 out of 69 newborns regained birth weight within 13.63 ±0.9 days in Group 2. The difference was statistically significant. Increment in the mean occipitofrontal circumference perweek was 0.29 ± 0.27 cm Group 1, while in Group 2 it was 0.42 ± 0.05 cm; the difference was statistically significant. Meanaverage length increment per week was found to be 0.55 ± 0.04 cm and 0.69 ± 0.05 cm in Group 1 and Group 2, respectively,the difference was statistically significant (p &lt; 0.005). The mean duration of hospital stay was 27.47 ± 3.33 days in Group 1while in Group 2, the duration of stay was 23.15 ± 2.22 days, the difference was statistically significant. Conclusion: Ourstudy supports enteral nutrition by rapid enteral feeding regimen in stable preterm neonates with very low birth weight

Peripheral muscle fractional tissue oxygen extraction in stable term and preterm neonates during the first 24 h after birth.

Peripheral muscle fractional tissue oxygen extraction (pFTOE) represents the relative extraction of oxygen from the arterial to venous compartment, providing information about dynamic changes of oxygen delivery and oxygen consumption. The aim of the present study was to establish reference values of pFTOE during the first 24 h after birth in stable term and late preterm neonates. The present study is a post-hoc analysis of secondary outcome parameters of prospective observational studies. Only stable neonates without infection, asphyxia and any medical support were eligible for our analysis to obtain normal values. For measurements of peripheral muscle tissue oxygenation index (pTOI) during the first 24 h after birth in term and preterm neonates, the NIRO200/NIRO200NX was used. Arterial oxygen saturation (SpO2) was obtained by pulse oximetry. pFTOE was calculated out of pTOI and SpO2: pFTOE = (SpO2-pTOI)/SpO2. Measurements of neonates were stratified into four groups according to their respective measurement time point (6 h periods) after birth. Term and preterm neonates were analyzed separately. Mean values of measurements during the first time period (0-6 h after birth) were compared to measurements of the following time periods (second = 7-12 h, third = 13-18 h, fourth = 19-24 h after birth). Two-hundred-fourty neonates (55 term and 185 late preterm neonates) had at least one peripheral muscle NIRS measurements within the first 24 h after birth. Mean gestational age and birth weight were 39.4 ± 1.1 weeks and 3360 (2860-3680)g in term neonates and 34.0 ± 1.4 weeks and 2060 (1750-2350)g in preterm neonates, respectively. In term neonates pFTOE was 0.264 (0.229-0.300), 0.228 (0.192-0.264), 0.237 (0.200-0.274) and 0.220 (0.186-0.254) in the first, second, third and fourth time period. In preterm neonates pFTOE was 0.229 (0.213-0.246), 0.225 (0.209-0.240), 0.226 (0.210-0.242) and 0.238 (0.222-0.255) in the first, second, third and fourth time period. pFTOE did not show any significant changes between the time periods, neither in term nor in preterm neonates. We provide reference values of pFTOE for stable term and late preterm neonates within the first 24 h after birth, which were stable when comparing four 6-h periods. These normal values are of great need for interpreting pFTOE in scientific context as well as for potential future clinical applications.

The Urinary Concentrations of Neutrophil Gelatinase-Associated Lipocalin, Cystatin C and Osteopontin in the Healthy Term and Stable Preterm Neonates: A Pilot Study.

In neonates, the assessment of kidney function with serum creatinine is limited; therefore, more effective biomarkers are needed. The study aimed at analyzing the concentrations of renal biomarkers (osteopontin, cystatin C, and NGAL) in neonates. The study included 80 term and 20 preterm neonates aged 28-33 weeks of gestation. Biomarkers were measured in urine. Term neonates' urine was collected on the 1st day of life. Preterm neonates' urine was collected on the 1st, 8th, 15th, 22nd day of life. Biomarkers' concentrations were normalized to urinary creatinine (cr.) and presented as urinary biomarker/cr. ratios. Median values of biomarker/creatine ratios in term and preterm neonates were the following: cystatin C/cr.: 7.26 and 439.49; osteopontin/cr.: 135.86 and 1633.37; NGAL/cr. in girls: 212.14 and 256.93; and NGAL/cr. in boys 27.123 and 65.29 ng/mg cr. In preterm neonates the cystatin C/cr. ratio was higher on the 1st than on the 8th day. The osteopontin/cr. ratio did not differ between the days. The NGAL/cr. ratio in girls was higher on the 8th than on the 22nd day, and in boys, the lowest was on the 22nd day. Prematurity in stable, Caucasian neonates might cause higher osteopontin and cystatin C excretion, but not NGAL. The excretion of NGAL and cystatin C, but not osteopontin, may change during first weeks of premature neonate's life.

Insights into Neonatal Cerebral Autoregulation by Blood Pressure Monitoring and Cerebral Tissue Oxygenation: A Qualitative Systematic Review.

The aim of this qualitative systematic review was to identify publications on blood pressure monitoring in combination with cerebral tissue oxygenation monitoring during the first week after birth focusing on cerebral autoregulation. A systematic search was performed on PubMed. The following search terms were used: infants/newborn/neonates, blood pressure/systolic/diastolic/mean/MAP/SAP/DAP, near-infrared spectroscopy, oxygenation/saturation/oxygen, and brain/cerebral. Additional studies were identified by a manual search of references in the retrieved studies and reviews. Only human studies were included. Thirty-one studies focused on preterm neonates, while five included preterm and term neonates. In stable term neonates, intact cerebral autoregulation was shown by combining cerebral tissue oxygenation and blood pressure during immediate transition, while impaired autoregulation was observed in preterm neonates with respiratory support. Within the first 24 h, stable preterm neonates had reduced cerebral tissue oxygenation with intact cerebral autoregulation, while sick neonates showed a higher prevalence of impaired autoregulation. Further cardio-circulatory treatment had a limited effect on cerebral autoregulation. Impaired autoregulation, with dependency on blood pressure and cerebral tissue oxygenation, increased the risk of intraventricular hemorrhage and abnormal neurodevelopmental outcomes. Integrating blood pressure monitoring with cerebral tissue oxygenation measurements has the potential to improve treatment decisions and optimizes neurodevelopmental outcomes in high-risk neonates.

The Urinary Concentration of Trefoil Factor 3 (TFF3) in the Term and Preterm Neonates.

Distinguishing between a pathologic state and renal development is important in neonatology. Because the assessment of serum creatinine in neonates is not reliable, better biomarkers are needed. Trefoil factor 3 (TFF3) is proposed as a biomarker of kidney injury. The study aimed to assess its urinary concentration in healthy term and stable preterm neonates. The study included 80 term and 20 preterm neonates born in the Department of Perinatology of the University Clinical Hospital in Bialystok. Urine was obtained from the term neonates on the 1st day of life and from the preterm neonates on the 1st, 8th, 15th and 22nd day of life. The urinary concentration of TFF3 was determined using a commercially available immunoassay and was normalized for the urinary creatinine concentration (cr.). The values of TFF3/cr. were higher in the preterm than in the term neonates (p < 0.05) (median (Q1-Q3): 1486.85 (614.92-3559.18) and 317.29 (68.07-671.40) ng/mg cr.). They did not differ in the subsequent days of the preterm neonates' lives. The ROC curve for TFF3/cr. in the preterm and term neonates showed AUC = 0.751 (cut-off value = 1684.25 ng/mg cr.). Prematurity is associated with higher urinary excretion of TFF3. Male gender is associated with an increased urinary TFF3 excretion in term neonates.

Maternal Participation in Sensory Care of Preemies: A Pilot Study Examining the Effect on Neonatal Outcome in NICU

Abstract Background Hospitalization with specialized medical care and equipment in neonatal intensive care unit (NICU) can help preterm infants survive and thrive; negatively it can lead to separation from the mother with an impact on their growth and behavior. It is critical to assess the interventions that are more beneficial for their development at this particular period. The study's objective was to examine the effectiveness of maternal-directed multisensory stimulation in premature neonates admitted to NICU on neonatal outcomes. Methods A pilot, quasi-experimental research was designed where 31mother-preterm newborn dyads were enrolled in the intervention and control group, respectively, using a purposive sampling technique. The study included medically stable preterm neonates admitted to NICU between 30 and 36 weeks of gestation weighing 1 to 2.5kg. The preterm in the study group was given ATVV (Auditory, Tactile, Vestibular, and Visual) stimulation for 10 days by the mother, whereas the preterm in the comparison group received the standard treatment. The neonatal outcomes evaluated were weight, physiological parameters, and behavioral assessment of preterm neonates. Results Preterm newborns who received the intervention scored significantly better than the comparison group on the parameters of heart and respiratory rate, blood oxygen levels, weight, and preterm assessment behavior between the 7th and 10th day of the intervention that suggests the effectiveness of the intervention in improving these parameters of preterm newborns. Conclusion Maternal guidance and participation in the care of a preterm newborn have a beneficial neonatal outcome in stabilizing the physiological parameters, and improving the weight and preterm infant behavioral characteristics.

Effect of Kangaroo Care Following Immersion Bath on Body Temperature in Preterm Neonates

Objectives One of the aspects of routine care in stable preterm in the ward is bathing. However, during and after bath, drop in body temperature has been observed. Providing Kangaroo Mother Care (KMC) instead of routinely covering the baby with clothes following bath helps in better thermoregulation. The purpose of this study was to compare the effectiveness of standard care and KMC following immersion bathing in stable preterm neonates in postnatal ward. Patients and Methods Prospective nonrandomized interventional study done in the postnatal ward of a tertiary referral hospital. All consecutively born preterm neonates with corrected gestational age between 34 weeks and 37 weeks (mean 35 weeks +5) were enrolled in the study. Neonates received immersion bath in a tub using water temperature adjusted to 37 to 38℃. Neonates in this group were allocated to receive standard care and KMC immediately after bath on Day 1 and Day 2, respectively. Axillary temperature was recorded before bath (baseline), immediately after bath and subsequently at 15 min, 30 min, 45 min, and 60 min after bath. Data was analyzed to compare the effect of standard care and KMC immediately after bath. Results The pre-bath mean temperature between standard care and KMC were 36.27℃ and 36.47℃, respectively. In both standard care and KMC group immediately after bath there was no fall in temperature from baseline. Mean difference from baseline temperature between standard care and KMC group at 30 min, 45 min, and 60 min were 0.2℃, 0.25℃, and 0.18℃, respectively, all of which were statistically significant ( P &lt; .05). Conclusions In this pilot study on immersion bathing followed by KMC, temperature regulation was better with KMC after bathing, with a mean temperature difference ranging between 0.18 ℃ and 0.25℃ (95% CI –0.103 to0.374) between 30 min and 60 min of bathing.

Cardiac output and regional-cerebral-oxygen-saturation in preterm neonates during immediate postnatal transition - an observational study.

To examine potential correlations between cardiac output (CO) with cerebral-regional-oxygen-saturation (crSO2 ) and cerebral-fractional-tissue-oxygen-extraction (cFTOE) during immediate fetal-to-neonatal transition in term and preterm neonates with and without respiratory support. Post-hoc analyses of secondary outcome parameters of prospective observational studies were performed. We included neonates with cerebral near-infrared-spectroscopy (NIRS) monitoring and an oscillometric blood pressure measurement at minute 15 after birth. Heart rate (HR) and arterial oxygen saturation (SpO2 ) were monitored. CO was calculated with Liljestrand and Zander formula and correlated with crSO2 and cFTOE. Seventy-nine preterm neonates and 207 term neonates with NIRS measurements and calculated CO were included. In 59 preterm neonates (mean gestational age (GA): 29.4±3.7 weeks) with respiratory support CO correlated significantly positively with crSO2 and significantly negatively with cFTOE. In 20 preterm neonates (GA 34.9±1.3 weeks) without respiratory support and in 207 term neonates with and without respiratory support CO correlated neither with crSO2 nor with cFTOE. In compromised preterm neonates with lower gestational age and in need of respiratory support CO was associated with crSO2 and cFTOE whereas in stable preterm neonates with higher gestational age as well as in term neonates with and without respiratory support no associations were observed.

Normative values of renin and aldosterone in clinically stable preterm neonates

BackgroundThere is a paucity of literature on the normative levels of plasma renin concentration (PRC) and serum aldosterone (SA) in premature neonates. This study aims to provide normative data on PRC and SA levels in preterm neonates in the first 2 weeks after birth and explore associations with maternal, perinatal, or postnatal factors.MethodsNeonates born at 26- to 34-week gestation were recruited from two neonatal intensive care units in Canada and Australia. The direct renin assay PRC and SA were analyzed on day 1 and days 14–21 after birth to compare across categorical variables and to produce normative values.ResultsA total of 262 subjects were enrolled from the Canadian (29%) and Australian (71%) sites. The mean gestational age was 30 weeks, with a mean birth weight of 1457 g. The normative values of PRC and SA for neonates born between 26 + 0 and 29 + 6 weeks and 30 + 0 and 34 + 0 weeks of gestation were produced for day 1 and day 14–21 after birth. Both PRC and SA increased from day 1 to day 14–21. The more premature neonates reached a higher PRC on days 14–21 after birth but exhibited lower SA levels on day 1 after birth. When comparing gender, birth weight, and maternal risk factor categories, no statistical differences in PRC or SA were found. A small but significant decrease in PRC, but not SA, was noted for neonates with placental pathology.ConclusionsThis study produced normative values of PRA and SA in clinically stable preterm neonates that can be referenced for use in clinical practice.Graphical A higher resolution version of the Graphical abstract is available as Supplementary information

Effect of Kangaroo Mother Care on Cerebral Hemodynamics in Preterm Neonates Assessed by Transcranial Doppler Sonography in Middle Cerebral Artery

To study the effect of KMC in premature newborns on cerebral hemodynamics in the middle cerebral artery (MCA) using transcranial doppler sonography. In this descriptive study, 40 clinically stable preterm neonates admitted to the neonatal intensive care unit of our institute and undergoing Kangaroo mother care (KMC) were enrolled. Physiological and cerebral blood flow parameters of MCA were obtained by using transcranial doppler sonography at baseline, at 60 minutes of KMC, and after 60 minutes of stopping KMC. Of the 40 enrolled neonates (24 males), the mean (SD) birth weight, gestation age, and postnatal age were 1698.25 (495.44) g, 33.00 (1.67) wk, and 6.80 (4.51) days, respectively. The mean (SD) cerebral blood flow velocities increased (peak systolic velocity (PSV), P=0.03; end diastolic velocity, P<0.001; mean velocity, P<0.001) and doppler indices decreased (resis-tive index, P=0.001; pulsatility index, P<0.001) significantly; whereas, heart rate (P<0.001) decreased but SpO2 (P=0.001) and mean blood pressure (P=0.003) increased significantly at 60 minutes of KMC as compared to baseline. Sixty minutes after stopping KMC, all parameters (except PSV) were higher than baseline, indicating post KMC effect. KMC improves cerebral hemodynamics in clinically stable preterm neonates.

Quality improvement initiative approach to increase the duration of Kangaroo Mother Care in a neonatal intensive care unit of a tertiary care institute in South India during the COVID-19 pandemic

IntroductionKangaroo mother care (KMC) provided to stable babies in hospitals is associated with 40% relative risk reduction in death, 65% risk reduction in nosocomial infections. Despite clear existing evidence of advantages of KMC, its implementation remains limited.This study aimed to improve the median KMC practice hours in eligible preterm and low birth weight (LBW) neonates by 50% from the baseline practice. MethodsThis was a Quality Improvement study conducted at Neonatal unit of a tertiary care institute in South India. All stable preterm and LBW neonates were included after obtaining written informed consent from mother. Those who needed interruption in KMC due to medical reason were excluded. A team comprising of 2 principal investigators (UG students), 2 consultants and 2 in-charge nurses was formed. Baseline data were collected between January and February 2021 to find out the median duration of KMC practice and to identify limiting factors (barriers) and the facilitating ones through in-depth interviews and team meetings. The study was conducted over a 10 month period. Steps were taken to tackle these in two PDSA cycles, each lasting for 3 weeks (1st PDSA: Education of Mothers and Nurses; 2nd PDSA: KMC technique, orders by residents). The PDSA was followed by monitoring for 10 weeks for sustenance. ResultsThe baseline data showed that the median duration (in hours) of KMC practice was 2.6 which increased to 5.0 and 5.5 h by the end of first and second PDSA cycle, respectively and showed a lasting change, peaking at a median value of 6.1 h during the sustenance phase over the next 10 weeks. ConclusionThrough simple measures and closing the communication gap between health care workers and mothers, we were able to increase the duration of KMC, which remained high during the 10 week follow up period.

Core Temperature Within First Seven Days After Birth, of Hemodynamically Stable Preterm Neonates Born Before 34 Weeks of Gestation: A Prospective Study

Background Prematurity contributes to neonatal mortality and morbidity. There are many complications that can contribute to preterm morbidity and mortality. One of the complications is an alteration in temperature. Objective To assess the core temperature within the first seven days after birth, of hemodynamically stable preterm neonates born before 34 weeks of gestation. Methodology A total of 120 neonates were enrolled by using the total enumeration technique from the various neonatal units of PGIMER, Chandigarh. Permission from Institutes Ethic Committee was obtained, and consent was taken from parents of preterm neonates. The tools used for data collection were: (a) Interview schedule—it comprised of sociodemographic profile. (b) Temperature monitoring sheet. Protocol for recording core temperature was developed and validated by experts in nursing and pediatrics. Demographic profile of neonates was collected. Core temperature was recorded as per protocol in three shifts, i.e., morning, evening, and night time, by using a digital thermometer for the first seven days after birth. Temperature recording sheet was used to record the core temperature. Results Out of the total 120 hospitalized preterm neonates, 55.8% of the study participants were females, and the mean gestational age of the study participants was 31.5 ± 1.79 weeks. The mean values of core temperature of hemodynamically stable preterm neonates recorded in the morning, evening, and night of day 1 and day 2 were less than 36.5°C. From day 3 to day 7, the mean value of core temperature in morning, evening, and night was more than 36.5°C. Conclusion The study findings suggest that the core temperature, when monitored for first seven days after birth in hemodynamically stable preterm neonates, was low for the first two days, but normal for the next five days.

Mitral valve Doppler for cardiac output assessment in preterm neonates.

Cardiac output (CO) assessment in neonates is commonly done by echocardiography. It is unclear which is the best site to measure the left ventricular (LV) outflow tract for CO assessment (the aortic valve [AV] aortic sinus [AS] or the sinotubular junction [STJ]). In the normal heart, the blood flow entering the LV equals the blood ejected from it. Therefore, measuring the blood flow into the LV through the mitral valve (MV) is an alternative way to measure CO. In stable preterm infants the MV CO was compared with the right ventricular (RV) CO and the three ways to measure LV CO, in 30 stable preterm neonates. Interobserver variability for MV CO was established. In the 30 neonates studied, MV CO was best correlated and had a minimal bias to the RV CO and LV CO measured at the STJ. Left ventricular CO measured at the AV and AS had significant bias relative to RV CO and MV CO. MV CO inter-observer variability was similar to other echocardiographic CO assessment methods. MV CO may be used as an alternative way to assess CO. The STJ may be the optimal site to measure LV outflow tract.

Probiotics (Bacillus clausii) for Prevention of Late-onset Sepsis in Preterm Infants (&lt;34 weeks): A Randomised Controlled Trial

Introduction: Late-onset Sepsis (LOS) causes significant morbidity and mortality in preterm infants. Probiotics have been suggested to improve the integrity of mucosal barrier by modifying the enteric microflora and suppress the overgrowth and translocation of pathogens in the gut, thus preventing life- threatening infections. Although probiotics have a definite role in prevention of Necrotising Enterocolitis (NEC) in preterm neonates, their effect on prevention of LOS in preterm neonates is still uncertain. Aim: To evaluate the role of probiotics in reducing incidence of LOS in preterm neonates (&lt;34 weeks). Materials and Methods: A double blinded randomised control trial was conducted in a tertiary care Neonatal Intensive Care Unit (NICU) in Karnataka, India between 1st January 2019 to 31st December 2019. Seventy haemodynamically stable preterm neonates, &lt;34 weeks of Gestational Age (GA), were randomised into ‘Probiotic’ and ‘Placebo’ groups. The probiotic group (n=36) was prophylactically administered Bacillus clausii suspension at a dose of 2.5 mL per-oral (0.4×109 spores in 1 mL) BD with breast milk, from initiation of enteral feeds till seven days, discharge/ death/LOS, whichever was earlier. The placebo group (n=34) received breast milk with sterile water 2.5 mL per- oral BD. All the neonates were investigated and managed as per standard hospital protocol. Primary outcome of the study was to find the incidence of LOS. Student’s t-test, Mann-Whitney U test, Chi-square test and Fisher’s exact test were used for statistical analysis. Results: There was no significant difference between the probiotic vs placebo group, with respect to incidence of LOS (11.11% vs 17.64%; (p&gt;0.05)) and duration of hospital stay (10.86±3.19 vs 11.23±2.98 days; (p&gt;0.05)). However, incidence of feed intolerance in the probiotic group (11.11%) was significantly less than that the other (26%) (p&lt;0.05). Conclusion: Probiotics, prophylactically fed enterally, did not reduce the incidence of LOS but provide a promising strategy to prevent feed intolerance in premature neonates.

Kangaroo Mother Care versus Incubator in Transporting Stable Preterm Neonates: A Randomized Controlled Trial

Background. Transporting preterm neonates soon after birth entails risks. Only one study among many about the beneficial effects of Kangaroo Mother Care (KMC) had cited it as a safe and effective alternative to transport incubators.&#x0D; Objective. To determine if KMC transport could be an alternative to transport incubators by comparing the physiological outcomes of the two transport methods.&#x0D; Methods. This is a parallel non-blinded randomized-controlled trial funded by KMC Foundation, Philippines, Inc, of physiologically stable preterm neonates weighing ≤ 2200 grams delivered at a tertiary government hospital from September 10, 2011, to April 18, 2012. After obtaining written consent from their mothers, participants were randomly assigned to either the intervention or control group. The intervention groups were transported from the delivery room to the NICU while on skin-to-skin contact with the caregiver. In contrast, those in the control group were placed in a transport incubator. Vital signs, oxygen saturation, and blood glucose were measured before transport and upon NICU arrival. Adverse effects were monitored. Data were recorded using a standard database.&#x0D; Results. Ninety-two participants were recruited, forty-six in each arm. Two dropped out. The mean change in heart rate in the KMC transport decreased by 1.6 beats per minute; respiratory rate decreased by 0.18 breaths per minute, the temperature increased by 0.01°C, oxygen saturation decreased by 0.07%, blood glucose decreased by 5.07 mg/dL. The measured physiological parameters were not statistically significant between the two groups. In the KMC transport, there was a decreasing trend in the incidence of hypothermia, hypoglycemia, tachypnea, and tachycardia.&#x0D; Conclusion. There are no significant differences in the heart rate, respiratory rate, temperature, oxygen saturation, and blood glucose levels among preterm neonates on KMC transport compared with preterm neonates on transport incubators, which is the current standard of care. The study showed that KMC transport is equally effective as a transport incubator. Hence, in low-resource settings, KMC transport may be used as a safe and effective neonatal transport.