Role of oral erythromycin for feed intolerance in neonates - A randomized controlled trial

Objective: The objective of this study was to compare the effect of high and low dose of erythromycin with placebo and to determine the efficacy and safety of oral erythromycin for feed intolerance in neonates admitted to the neonatal intensive care unit. Methodology: The study was a double-blind, randomized, and placebo-controlled trial. Term and preterm babies having feed intolerance were included in the study, and babies with congenital malformations, necrotizing enterocolitis, and sepsis were excluded from the study. After parental consent, the subjects were randomized into Groups 1, 2, or 3 to receive low-dose (3 mg/kg/dose) or high-dose (10 mg/kg/dose) oral erythromycin estolate or the placebo (equal volume of 5% dextrose). Feeding of all the study neonates was managed as per the unit protocol and babies were monitored for the complications. The primary outcome was the time to reach full feeds of 150 ml/kg/day, without significant gastric residuals. Results: Of 58 eligible babies, 84.5% were preterm babies. The median time for reaching full feeds with placebo was 6 days with interquartile range

Effect of routine lactation consultant support to mothers on breastfeeding efficacy

Introduction: Studies have concluded that lactation consultant’s visit provides more face-to-face time and education than physician support alone in improving the breastfeeding efficacy and rates. Objectives: The objective is to study the effect of incorporating routine lactation consultant to daily postnatal rounds with the resident on (a) cumulative weight loss of postnatal neonates and (b) jaundice requiring phototherapy, number of breastfeedings per day, duration of hospital stay and NICU admission. Methodology: A cross-sectional study was carried out among all stable neonates admitted in postnatal wards weighing >2 kg and gestation >35 weeks. The babies whose mothers were trained on breastfeeding by the pediatric resident doctor, in the routine postnatal rounds, were considered as Group 1. Infants whose mothers were counseled by the lactation consultant and the resident doctor on the breastfeeding were considered as Group 2. The baseline characteristics of mother and the neonates were recorded by a structured proforma. Results: Of 158 eligible babies, during the study period, 84 babies were enrolled for the study. The mean gestation of the babies in Groups 1 and 2 was 38.1±1.9 and 38.2±1.8 weeks, and the mean weight was 2.95±0.42 and 2.87±0.04 kg, respectively. The cumulative weight loss was 5.43±2.53% and 5.59±2.35 % (p=0.75) in Groups 1 and 2, respectively. The duration of hospital stay was 5.6±1.98 and 5.1±0.81 days (p=0.09), jaundice requiring phototherapy 22 (47%) and 15 (37%) with p=0.56 and the number of breastfeedings per day was 10.2±2.98 and 10.5±1.2 times with p=0.60 between the Groups 1 and 2, respectively. Conclusion: Even though there was no difference in either the primary or secondary objective between the groups, postnatal lactation counseling is very essential for improving the breastfeeding efficacy with the support of either doctor or the lactation consultant. There was acceptable cumulative weight loss, urine output, number of breastfeedings per day, and NICU admissions

Glucose levels in first 3 days and neurodevelopmental outcome at 1 year in low birth weight infants: A cohort study

Background: Definition of neonatal hypoglycemia is still controversial. Objective: To find the effect of blood glucose (BG) levelsin the first 3 days of life, on developmental outcome at 1 year in low birth weight neonates <2000 g. Methods: A prospective cohortstudy was conducted in tertiary level neonatal intensive care unit and follow-up clinic in south India. Intramural neonates admittedfrom September 2009 to August 2010 were enrolled. Perinatal and neonatal variables were recorded. Respiratory support, fluids,and feeding management were based on the standard protocols. BG was measured within 2 h, then 6 hourly for 72 h by glucometerand BG <50 mg% was analyzed by hexokinase method. Infants were followed until 1 year corrected age and development age(DA) assessed by Developmental Assessment Scales for Indian Infants (DASII). Motor and mental DA at various BG levelswere compared. Composite outcome of motor or mental developmental delay; or cerebral palsy or hearing impairment or visualimpairment was analyzed, and logistic regression analysis was performed. Results: The mean birth weight and gestation of the studygroup (n=129) was 1493 g and 32.5 weeks. The 10th centile of BG in the first 72 h was 51 mg%. BG below 10th centile was seen in60 infants. The mean motor and mental DA of the infants by DASII assessment at 1 year was 11.3 and 11.5 months, respectively.The motor DA and mental DA were significantly higher until 50 mg% lowest BG level, and positive correlation was seen (r=0.26motor, 0.2 mental DA). Mean BG level, the presence of symptoms; number of episodes or small for gestation did not influence theDA. The adjusted odds for poor composite outcome when BG was below 51 mg% is 2.83 (0.65-12.3). Conclusion: Even thoughhigh-risk neonates with BG <51 mg% have a lower motor DA and mental DA at 1 year, than neonates with BG >50 mg%; othermorbidities do determine their composite outcome