Efficacy of Nasal Continuous Positive Airway Pressure versus Heated Humidified High-Flow Nasal Cannula as a Primary Mode of Respiratory Support in Preterm Infants with RDS

Objective: To determine the efficacy of nasal continuous positive airway pressure (NCPAP) versus heated humidified high-flow nasal cannula (HHHFNC) as a primary mode of respiratory support in preterm infants with respiratory distress. Methodology: This randomized controlled trial study was conducted at in-patient department of neonatology (Nursery & NICU) of Pakistan Insitute of Medical Sciences (PIMS) from July 2020 to Dec 2020. A total of 280 neonates randomly divided (140 in each study group) of both genders, with gestational age between 28-34 weeks and having mild-to-moderate respiratory distress within 1st 6 hours of birth requiring non-invasive ventilation were enrolled. Neonates in NCPAP Group (n=140) were given NCPAP whereas neonates in HHHFNC Group (n=140) were given HHHFNC. The efficacy of both groups were compared on the basis of treatment failure within 1st 3 days, total duration (hours) of non-invasive ventilator (NIV) required and total duration (hours) of supplementary oxygen required. Results: Overall, mean gestational age was noted to be 30.0+6.4 weeks. There were 144 (51.4%) neonates with birth weight between 1 to 1.4 kg, 90 (32.1%) between 1.5 to 1.9 kg and 46 (16.4%0 between 2.0 to 2.4 kg. Treatment failure was noted in 67 (47.6%) neonates in NCAP group while HHHFNC group reported 73 (52.4%) neonates with treatment failure (p=0.4733). No significant difference was observed in mean total duration of NIV support required (p=0.2598) or mean total duration of supplementary oxygen (p=0.1946) in between study groups. Conclusion: HHHFNC had similar efficacy when compared to NCPAP among neonates with RDS. In comparison to NCPAP, HHHFNC could be a simple, well-tolerated and effective alternative in terms of respiratory support. No major difference in terms of complication was observed between both treatment approaches

Outcome of Kangaroo Mother Care in Preterm, Low Birth Weight Neonates; A Randomized Control Trial

In a recent meta-analysis, based on 13 randomized control trials, the researchers concluded that the neonates care with KMC at least 6 hours per day got significant weight gain as compared to the Non-KMC group with a mean difference 8.99 gm per day. They also concluded that the infants received KMC for less or equal to 02 hours per day not showed a significant difference in weight gain as compared to controls.1

COMPARATIVE ANALYSIS OF INTERMITTENT BOLUS VERSUS CONTINUOUS NASOGASTRIC FEEDING IN PRETERM INFANTS

Objective: To compare the effectiveness and complications of bolus versus continuous tube feeding in pre-term newborns <1500 grams. Study Design: Quasi-experimental study Place and Duration of Study: Neonatology Department of Pakistan Institute of Medical Sciences Islamabad, from Nov 2014 to Mar 2016. Methodology: A total of 60 pre-terms; <34 weeks meeting the inclusion criteria, were included in the study and grouped according to birth weight; group A between 1000 to 1250 grams, and group B between 1250 to 1500 grams. Newborns from each group were randomly selected for bolus feeds given intermittently after every 2 hours, and continuous feed given with infusion pump. All infants were maintained in closed incubators until they weighed approximately 1800 g and the neonatal staff followed standard nursery protocols other than for feeding. Results: There were 10 patients (9 in the bolus group and 1 in the continuous group) who did not reach the end point of 150 mL/Kg/day. One was transferred to another hospital before completing the protocol; 2 were diagnosed with congenital syphilis and Rubella syndrome; 1 switched to breast feeding due to parental concerns; 1 required the surgery for intestinal malrotation, and 5 died. The number of days to achieve full feeding calculated from the initiation of feeding was not significantly different between the groups. The main daily gastric residual volumes were significantly lower in the continuous group than in the bolus group, as was the total number of patients with feeding interruptions. Conclusion: Birth weight was inversely related to days to achieve full enteral feeding. The method of feeding was not associated with differences in outcome when similar energy intakes were provided and when guidelines for discontinuation of feedings are followed

Effect of Induction of Early Meconium Evacuation using Glycerin Suppositories in Promoting Feeding Tolerance in Low Birth Weight Infants

ABSTRACTObjective: To determine the effect of Induction of early meconium evacuation using glycerin suppository in promoting feeding tolerance in low birth weight infants Methodology: This quasi experimental study was conducted in the department of neonatalogy, Pakistan Institute of Medical Sciences (PIMS), Islamabad. 120 neonates were included in both groups of the study. Standard treatment was given in control group whereas in intervention group along with standard treatment glycerin suppository was used. Preterm neonates who were low birth weight and of either gender were included in the study. The neonates with major congenial malformation, hemodynamic unstable, known cases of metabolic disease and confirmed cases of coagulopathy were excluded in the study. SPSS version 26 was used to analyze the data. Independent sample t test was used to compare the time to achieve full feed and time to achieve complete evacuation of meconium between two 2 groups. p value 0.05 was considered as significant. Results: The mean gestational age was 30.30±1.19 weeks. Out of 240, 127 (52.9%) neonates were male. All neonates included in the study have a very low birth weight range from 1 to 1.6 kg with a mean weight of 1.32±1.29 kg. The intervention group showed a significant low time to achieve full feed and low time to achieve complete evacuation of meconium 11.21±1.54 and 4.99±1.16 days as compared to the control group 12.73±1.46 and 5.97±1.1 days, with p value 0.000. Conclusion: Glycerin suppository helps to reduce the time to achieve full evacuation of meconium. Keywords: Full Enteral Feed (FEF), Glycerin Suppository, Meconium, Preterm Birth, Very Low Birth Weight (VLBW

Impact of the COVID-19 pandemic on patients with paediatric cancer in low-income, middle-income and high-income countries: a multicentre, international, observational cohort study

OBJECTIVES: Paediatric cancer is a leading cause of death for children. Children in low-income and middle-income countries (LMICs) were four times more likely to die than children in high-income countries (HICs). This study aimed to test the hypothesis that the COVID-19 pandemic had affected the delivery of healthcare services worldwide, and exacerbated the disparity in paediatric cancer outcomes between LMICs and HICs. DESIGN: A multicentre, international, collaborative cohort study. SETTING: 91 hospitals and cancer centres in 39 countries providing cancer treatment to paediatric patients between March and December 2020. PARTICIPANTS: Patients were included if they were under the age of 18 years, and newly diagnosed with or undergoing active cancer treatment for Acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin lymphoma, Wilms' tumour, sarcoma, retinoblastoma, gliomas, medulloblastomas or neuroblastomas, in keeping with the WHO Global Initiative for Childhood Cancer. MAIN OUTCOME MEASURE: All-cause mortality at 30 days and 90 days. RESULTS: 1660 patients were recruited. 219 children had changes to their treatment due to the pandemic. Patients in LMICs were primarily affected (n=182/219, 83.1%). Relative to patients with paediatric cancer in HICs, patients with paediatric cancer in LMICs had 12.1 (95% CI 2.93 to 50.3) and 7.9 (95% CI 3.2 to 19.7) times the odds of death at 30 days and 90 days, respectively, after presentation during the COVID-19 pandemic (p<0.001). After adjusting for confounders, patients with paediatric cancer in LMICs had 15.6 (95% CI 3.7 to 65.8) times the odds of death at 30 days (p<0.001). CONCLUSIONS: The COVID-19 pandemic has affected paediatric oncology service provision. It has disproportionately affected patients in LMICs, highlighting and compounding existing disparities in healthcare systems globally that need addressing urgently. However, many patients with paediatric cancer continued to receive their normal standard of care. This speaks to the adaptability and resilience of healthcare systems and healthcare workers globally

Twelve-month observational study of children with cancer in 41 countries during the COVID-19 pandemic

Childhood cancer is a leading cause of death. It is unclear whether the COVID-19 pandemic has impacted childhood cancer mortality. In this study, we aimed to establish all-cause mortality rates for childhood cancers during the COVID-19 pandemic and determine the factors associated with mortality