Clinical profile of late-preterm infants admitted to a tertiary care hospital

Background: Late-preterm babies account for nearly 10% of the total births. Understanding clinical profile of late-preterm infants is important for helping newborn care providers to anticipate and manage potential morbidity during the birth hospitalization and early follow-up. Objective: The objective of this study is to study the clinical profile of late-preterm newborns (340/7 to 366/7 weeks of gestation). Methods: This was a prospective observational study conducted in the neonatal unit of a tertiary care public hospital. All late-preterm babies delivered in the hospital from July 2016 to December 2016, who met the inclusion criteria, were enrolled after taking consent from parents. Detailed antenatal and natal history were noted along with neonatal morbidities and mortality, and the interventions and treatment required by the infants were noted in a structured pro forma. These late-preterm infants were followed up till death/discharge and readmission to hospital and reasons for readmission were evaluated. Results: We enrolled 110 late-preterm babies delivered in our center. The most common morbidity was jaundice requiring phototherapy (63.63%) followed by respiratory distress (24.54%). 25.45% of infants required respiratory support in the form of continuous positive airway pressure or mechanical ventilation. Hypocalcemia and sepsis were observed in 10% of the babies. Feed intolerance was also observed in 16.36% of the babies. The mortality in this group of late preterms was 4.54%. Conclusions: Late-preterm infants show a considerably high rate of medical complications, including need for respiratory support and prolonged hospital stay. Awareness about the neonatal morbidities in late-preterm newborns will facilitate better management of these neonates

Improving the recording of anthropometric parameters in NICU babies-A Quality improvement initiative

Meticulous and regular monitoring of anthropometry of sick babies in the NICU can be challenging in a busy NICU. Often, nurses and doctors tend to miss out on regular monitoring of anthropometry since importance is given to other clinical duties in a busy tertiary NICU. Objective: To improve anthropometry recording of babies admitted in a busy neonatal intensive care unit (NICU). Design: Quality improvement project over a period of twelve weeks Setting: Level IIINeonatal Intensive Care Unit. Participants: All patients admitted in neonatal intensive care unit (NICU). Methods: The Quality improvement project was designed as per Point of Care Quality Improvement (POCQI) model conducted over 12 weeks—6 weeks implementation phase & 6 weeks sustainability phase. After collection of baseline data, a quality improvement (QI) team was formed which conducted six PDSA cycles (PDSA) of 7days each, followed by a sustainability phase over 6 weeks. Results: Measurement of anthropometry parameters improved from 30% to 80% for head circumference,20% to 80% for length and 80% to 95%for weight during the implementation phase. In the sustainability phase too, the compliance to measurements remained above 80% respectively for head circumference and weight and also above 95% for weight. Conclusions: This Quality improvement initiative using POCQI modelresulted in a significant and sustained improvement in the recording of anthropometry parameters like head circumference, length and weight

Is there a Role of Palliative Care in the Neonatal Intensive Care Unit in India?

Recent advances in medical care have improved the survival of newborn babies born with various problems. Despite this death in the neonatal intensive care unit (NICU) is an inevitable reality. For babies who are not going to “get better,” the health care team still has a duty to alleviate the physical suffering of the baby and to support the family. Palliative care is a multidisciplinary approach to relieve the physical, psycho social, and spiritual suffering of patients and their families. Palliative care provision in the Indian NICU settings is almost nonexistent at present. In this paper we attempt to “build a case” for palliative care in the Indian NICU setting

Parental and professional perceptions of informed consent and participation in a time-critical neonatal trial: a mixed-methods study in India, Sri Lanka and Bangladesh

Introduction Time-critical neonatal trials in low-and-middle-income countries (LMICs) raise several ethical issues. Using a qualitative-dominant mixed-methods design, we explored informed consent process in Hypothermia for encephalopathy in low and middle-income countries (HELIX) trial conducted in India, Sri Lanka and Bangladesh.Methods Term infants with neonatal encephalopathy, aged less than 6 hours, were randomly allocated to cooling therapy or usual care, following informed parental consent. The consenting process was audio-video (A-V) recorded in all cases. We analysed A-V records of the consent process using a 5-point Likert scale on three parameters—empathy, information and autonomy. In addition, we used exploratory observation method to capture relevant aspects of consent process and discussions between parents and professionals. Finally, we conducted in-depth interviews with a subgroup of 20 parents and 15 healthcare professionals. A thematic analysis was performed on the observations of A-V records and on the interview transcripts.Results A total of 294 A-V records of the HELIX trial were analysed. Median (IQR) score for empathy, information and autonomy was 5 (0), 5 (1) and 5 (1), respectively. However, thematic analysis suggested that the consenting was a ceremonial process; and parental decision to participate was based on unreserved trust in the treating doctors, therapeutic misconception and access to an expensive treatment free of cost. Most parents did not understand the concept of a clinical trial nor the nature of the intervention. Professionals showed a strong bias towards cooling therapy and reported time constraints and explaining to multiple family members as key challenges.Conclusion Despite rigorous research governance and consent process, parental decisions were heavily influenced by situational incapacity and a trust in doctors to make the right decision on their behalf. Further research is required to identify culturally and context-appropriate strategies for informed trial participation

Transcriptomic profile of adverse neurodevelopmental outcomes after neonatal encephalopathy

A rapid and early diagnostic test to identify the encephalopathic babies at risk of adverse outcome may accelerate the development of neuroprotectants. We examined if a whole blood transcriptomic signature measured soon after birth, predicts adverse neurodevelopmental outcome eighteen months after neonatal encephalopathy. We performed next generation sequencing on whole blood ribonucleic acid obtained within six hours of birth from the first 47 encephalopathic babies recruited to the Hypothermia for Encephalopathy in Low and middle-income countries (HELIX) trial. Two infants with blood culture positive sepsis were excluded, and the data from remaining 45 were analysed. A total of 855 genes were significantly differentially expressed between the good and adverse outcome groups, of which RGS1 and SMC4 were the most significant. Biological pathway analysis adjusted for gender, trial randomisation allocation (cooling therapy versus usual care) and estimated blood leukocyte proportions revealed over-representation of genes from pathways related to melatonin and polo-like kinase in babies with adverse outcome. These preliminary data suggest that transcriptomic profiling may be a promising tool for rapid risk stratification in neonatal encephalopathy. It may provide insights into biological mechanisms and identify novel therapeutic targets for neuroprotection