Role of learning material delivered by short message service in addressing to the gaps in the knowledge of nursing personnel related to newborn care by one of the reviewers in a selected neonatal intensive care unit of tertiary care facility

Objectives: The present study was undertaken (i) to evaluate the role of short message service (SMS) in improving the knowledge scores of nurses in the key areas of newborn care (NBC) and (ii) to explore the perception of nurses regarding the delivery of SMS on NBC. Methods: This pre-experimental (one group pre-test post-test) study was conducted on 30 nurses working in a tertiary level neonatal intensive care unit (NICU). The effectiveness of SMS delivery in reducing the gaps in the knowledge of nurses related to NBC was measured in terms of gain in knowledge scores using a structured knowledge questionnaire. The perception of nurses toward the delivery of information on NBC using SMS was also assessed on 5 point likert scale. Results: The knowledge scores of nurses improved significantly after the SMS delivery on NBC (pre and post, 9.6±2.2, 17.13±1.2; p<0.005). The nurses’ overall perception about SMS delivery on NBC was good. Conclusion: SMS delivery on NBC has a potential role in updating and refreshing the knowledge of nurses working in NICU

Limb splinting for intravenous cannulae in neonates: A randomised controlled trial

Objective: To evaluate the efficacy of peripheral intravenous (IV) cannula site joint immobilisation by splint application on functional duration of peripheral IV cannula in neonates. Design: Randomised controlled trial. Setting: Neonatal intensive care unit of a tertiary care hospital. Participants: Neonates requiring continuous IV infusion for an expected duration of more than or equal to 72 hours. Intervention: Eligible cannulations were randomised to either “splint” or “no-splint” group. In the splint group, a cardboard splint was used to immobilise the joint at peripheral IV cannula site. No attempt was made to immobilise the limb in the no-splint group. Outcome measure: Functional duration of a peripheral IV cannula measured as interval from time of insertion to the development of predefined sign of removal (extravasation, blockage, inflammation). Results: A total of 69 peripheral IV cannulations in 54 neonates were randomised to either the splint (n = 33) or no-splint group (n = 36). Both groups were comparable in birth weight, gestation, site of cannulation and nature of fluids administered. Mean functional duration of cannula was lesser in the splint group compared to the no-splint group (h; 23.5 (SD15.9) vs 26.9 (SD15.5), mean difference: −3.3 h, 95% CI −11.02 to 4.3 h) although the difference was not statistically significant (p = 0.38). Extravasation at cannula site was found be the commonest indication for cannula removal in both the groups (84% vs 76.5%). Conclusion: Joint immobilisation with splint at cannula site did not improve the functional duration of peripheral IV cannula

Complementary feeding at 4 versus 6 months of age for preterm infants born at less than 34 weeks of gestation: a randomised, open-label, multicentre trial

Background Evidence on the optimal time to initiation of complementary feeding in preterm infants is scarce. We examined the effect of initiation of complementary feeding at 4 months versus 6 months of corrected age on weight for age at 12 months corrected age in preterm infants less than 34 weeks of gestation. Methods In this open-label, randomised trial, we enrolled infants born at less than 34 weeks of gestation with no major malformation from three public health facilities in India. Eligible infants were tracked from birth and randomly assigned (1:1) at 4 months corrected age to receive complementary feeding at 4 months corrected age (4 month group), or continuation of milk feeding and initiation of complementary feeding at 6 months corrected age (6 month group), using computer generated randomisation schedule of variable block size, stratified by gestation (30 weeks or less, and 31–33 weeks). Iron supplementation was provided as standard. Participants and the implementation team could not be masked to group assignment, but outcome assessors were masked. Primary outcome was weight for age Z-score at 12 months corrected age (WAZ12) based on WHO Multicentre Growth Reference Study growth standards. Analyses were by intention to treat. The trial is registered with Clinical Trials Registry of India, number CTRI/2012/11/003149. Findings Between March 20, 2013, and April 24, 2015, 403 infants were randomly assigned: 206 to receive complementary feeding from 4 months and 197 to receive complementary feeding from 6 months. 22 infants in the 4 month group (four deaths, two withdrawals, 16 lost to follow-up) and eight infants in the 6 month group (two deaths, six lost to follow-up) were excluded from analysis of primary outcome. There was no difference in WAZ12 between two groups: –1·6 (SD 1·2) in the 4 month group versus –1·6 (SD 1·3) in the 6 month group (mean difference 0·005, 95% CI –0·24 to 0·25; p=0·965). There were more hospital admissions in the 4 month group compared with the 6 month group: 2·5 episodes per 100 infant-months in the 4 month group versus 1·4 episodes per 100 infant-months in the 6 month group (incidence rate ratio 1·8, 95% CI 1·0–3·1, p=0·03). 34 (18%) of 188 infants in the 4 month group required hospital admission, compared with 18 (9%) of 192 infants in the 6 month group. Interpretation Although there was no evidence of effect for the primary endpoint of WAZ12, the higher rate of hospital admission in the 4 month group suggests a recommendation to initiate complementary feeding at 6 months over 4 months of corrected age in infants less than 34 weeks of gestation

Management of infants with intra-uterine growth restriction

Intra-uterine growth restriction (IUGR) contributes to almost two-thirds of LBW infants born in India. Poor nutritional status and frequent pregnancies are common pre-disposing conditions in addition to obstetric and medical problems during pregnancy. Growth restriction may be symmetrical or asymmetrical depending on the time of insult during pregnancy. The pathological insult in an asymmetrical IUGR occurs during the later part of the pregnancy and has a brain-sparing effect. Common morbidities are more frequent in < 3rd percentile group as compared to 3rd–10th percentile group. Guidelines for management of IUGR neonates in these two groups have been provided in the protocol

Patent ductus arteriosus in preterm neonates

Failure of the ductus arteriosus to close within 48–96 hours of postnatal age results in a left to right shunt across the ductus and overloading of the pulmonary circulation. This is more likely to happen in premature neonates with respiratory distress syndrome. Deterioration in the respiratory status on day 3–4 in a ventilated neonate and unexplained metabolic acidosis may be the earliest indicators of a patent ductus arteriosus (PDA). Indomethacin is the main stay of medical management of PDA in preterm neonates. Guidelines for administration of indomethacin have been described in the protocol. Restricted fluid therapy may be beneficial in the prevention of PDA in preterm neonates. Presence of PDA in a term neonate should be investigated to rule out an underlying congenital heart disease

Clinical aspects of meningococcal infections

This article does not have an Abstract

Do neonates with meconium aspiration syndrome require antibiotics?

A randomized clinical trial was conducted to evaluate the utility of antibiotics in the routine management of Meconium Aspiration Syndrome (MAS). Neonates diagnosed to have MAS were randomly allocated to either the antibiotic group (n=20) receiving gentamicin for 7 days, or the control group (n=20), receiving no antibiotic. All infants were given identical supportive care. The two groups were comparable with respect to birth weight, gestation, sex distribution, mode of delivery, Apgar scores, and initial clinical and radiological severity of the illness. Results showed that the mean duration and the severity of respiratory distress at 24 hours and 48 hours were similar in the two groups. No secondary infection was documented in either group. A single death occurred in the antibiotic group. It is concluded that empirical use of antibiotics in the routine management of meconium aspiration syndrome is of no benefit

High dose intravenous immunoglobulin therapy in the treatment of rhesus hemolytic disease

This article does not have an Abstract

Minimal enteral nutrition

Although parenteral nutrition has been used widely in the management of sick very low birth weight (VLBW) infants, a smooth transition to the enteral route is most desirable. Animal studies have shown that long periods of starvation are associated with mucosal atrophy and reduction of enzymatic activity. Studies have shown that giving small volumes of feeds frequently exerts a trophic effect on the gut mucosa. This concept has been termed as Minimal Enteral Nutriton (MEN). Clinical benefits of MEN include faster progression to full enteral feeds, lesser episodes of feed intolerance and reduction in hospital stay without a concomitant increase in the risk of necrotizing enterocolitis. MEN may be commenced in neonates on ventilation and total parenteral nutrition. A protocol for giving MEN has been described