Indian Journal of Neonatal Medicine & Research

Efficacy of Enhanced Dose of Expressed Breast Milk in Neonatal Procedural Pain Relief: A Randomised Placebo-controlled Study

Lata Jha, Vasanth N Kumar, Subho Banerjee, Chandreyi Bandhopadhyay

Introduction: Procedural pain remedies in neonates is an area of active research due to better understanding of short and long-term outcomes of neonatal painful exposures. Non pharmacological interventions are especially attractive as it avoids unnecessary drug exposure. While dextrose is known to be effective, results with small volumes (2 mL) of Expressed Breast Milk (EBM) are equivocal. There is recent theoretical evidence to show that larger doses of EBM may be more efficacious. Aim: To compare the efficacy of a larger volume of EBM 5 mL and 2 mL of 25% Dextrose (25D) in relief of procedural pain from venipuncture in term and preterm neonates. Materials and Methods: A single center randomised placebo-controlled study was conducted at Bokaro General Hospital, Bokaro Steel City, Jharkhand, India, between March 2014 and February 2016. Neonates ≥34 week gestation, requiring venipuncture in a neonatal care unit were randomly allocated into 3 equal groups using a random number table- Sterile Water (SW), 2mL 25D, 5 mL EBM was given two minutes prior to venipuncture. Video of facial response, cry times, Maximal Heart Rate (MHR), and minimum Oxygen Saturation (SpO2) were recorded till five minutes after venipuncture. The Premature Infant Pain Profile (PIPP) score was used to assess the effect of the interventions on procedural pain. Subgroup analysis was done in term and preterm neonates. Continuous variables were presented as mean±SD or median. Categorical variables were expressed as frequencies and percentages. The comparison of normally distributed continuous variables between the groups was performed using Analysis of Variance (ANOVA). Results: The PIPP score in the 25D group (2.94±1.41) was significantly lower than the EBM (7.42±1.69) and SW (10.56±1.69) groups (p-value<0.001). MHR was significantly lower in the 25D group, but no difference was found between the EBM and SW groups (p-value=0.23). SpO2 was significantly higher in the 25D group but for the initial 2.5 minutes only. Cry times were significantly lower in the intervention groups. There was no difference in outcomes in term vs. preterm infants. Conclusion: The use of 2 mL 25D was more effective in reducing procedural pain from venipuncture compared to 5 mL EBM. The return of physiological markers (MHR and SpO2) to baseline were faster and more complete in the 25D group.

Mid Upper Arm Circumference as the Best Surrogate Marker for Identification of Low Birth Weight in Newborns within the First 24 Hours of Life- A Cross-sectional Study

Jayashri Chandrakant Sawale, Leena Ajay Dhande, Pooja Bhimashankar Nagrale

Introduction: Birth weight is a very important determinant factor regarding perinatal morbidity and mortality. However, in developing countries like India weighing facility may not be available in rural areas where an alternative anthropometric parameter like Mid Upper Arm Circumference (MUAC) may be considered alternative to birth weight. Aim: To determine the accuracy of MUAC by comparing it with different anthropometric parameters for identification of LBW in neonates within the first 24 hours of life. Materials and Methods: The present study was a hospital based cross-sectional study conducted in labour ward, Postnatal Care (PNC) wards and Neonatal Intensive Care Unit (NICU) of Indira Gandhi Medical College, Nagpur. Total 640 babies were enrolled over a period of 2 years from September 2018 to September 2020. Anthropometric parameters like weight, length, head circumference, Chest Circumference (CC), MUAC, ponderal index were taken by a researcher using standard techniques within first 24 hours of life and correlated with birth weight by using Pearson’s correlation coefficient. The comparison of the quantitative and qualitative variables was analysed using independent t-test and chi-square test, respectively. Receiver Operating Characteristic (ROC) curve was used to find out cut-off point of anthropometric parameters for predicting birth weight (<2000 gm, <1500 gm, <1000 gm). DeLong test was used for comparison of area under curve between different anthropometric parameters for predicting birth weight (<2000 gm, <1500 gm, <1000 gm). Univariate linear regression was used to assess the effect of anthropometric parameters on birth weight. The data entry was done in the Microsoft EXCEL spreadsheet and final analysis was done with the use of Statistical Package for Social Sciences (SPSS) software version 21.0. Results: Among 640 newborns, 334 (59.19%) were females and 306 (47.81%) were males. The mean birth weight was 1903.93 grams and MUAC of 8.3cm. All the chosen parameters showed significant correlation with birth weight (p<0.001). However, MUAC showed strongest correlation (r=0.890) with birth weight and easy to measure. Cut-offs of MUAC ≤8.45 cm, ≤7.5 cm, ≤6.8 cm predict birth weight of <2000gm, <1500gm, <1000gm with sensitivity of 91.22%, 92.81%, 100% and specificity of 88.95%, 89.12%, 89.35%, respectively. Conclusion: MUAC is the most simple and best surrogate measure that can be used in domiciliary outreach when it is impossible to record weight of baby at birth.

Clinico-aetiological Profile of Neonatal Hypertension: An Observational Study

Ashwini Sankannavar, M Soumya, Balavanthraya Masali

Introduction: The incidence of hypertension among neonates admitted to the Neonatal Intensive Care Unit (NICU) is increasing. The reported incidence is between 0.2% and 3%. Blood Pressure (BP) among neonates varies considerably in the immediate postnatal period. The BP in neonates determined by birthweight, gestational age at birth and postnatal age. This variability in BP makes it challenging to diagnose neonatal hypertension. There is a paucity of Indian studies on neonatal hypertension. A systematic diagnostic evaluation of neonatal hypertension aids in early identification of the aetiology and further management. Aim: To assess the incidence of hypertension in neonates in the NICU and to evaluate the aetiology and clinical profile of neonatal hypertension. Materials and Methods: This was a hospital-based prospective observational study done at Sri Dharmasthala Manjunatheswara College of Medical Sciences and Hospital, Dharwad, Karnataka, India, between August 2016 and August 2021. A total of 29 neonates who had neonatal hypertension were included in the study after obtaining ethical committee clearance. All relevant data regarding demographic details, risk factors for hypertension, clinical features, probable aetiology, and relevant investigations were collected in a predesigned proforma. These neonates were followed-up once a month until six months of age. All the data were entered in Microsoft Excel version 2203 and analysed using the Statistical Package for Social Sciences (SPSS) software version 20.0. The categorical variables were described as percentages. The numerical variables were compared using a Student’s t-test and a Chi-square test. A p-value of 0.05 was considered statistically significant. Results: In the present study, out of 13,345, a total of 29 (0.22%)neonates had hypertension. Hypertension was more prevalent among term (82.7%). Of the 29 neonates, 19 (65.5%) had an antenatal risk for hypertension. A total of 14 (48.3%) of neonates had an antenatally diagnosed renal and/or cardiac anomaly. The most common presentation of hypertension is asymptomatic. Thirteen (44.8%) neonates had transient hypertension, which resolved at the time of discharge, and 16 (55.2%) neonates had persistent hypertension, requiring antihypertensive medication and follow-up. The most common aetiology for hypertension was renal and renovascular causes (44.8%). Mortality in the present study was 10.3% (n=3). Conclusion: Hypertension is an uncommon yet important problem in the NICU. In the majority of neonates, the presentation of hypertension is asymptomatic. Most common aetiology of hypertension being renal cause. Neonates with persistent hypertension may require long-term antihypertensive treatment and regular follow-up.

Effect of Hypoxic Ischaemic Encephalopathy on Coagulation Profile in Neonates in a Tertiary Care Center, Agra- A Prospective Clinical Study

Payal Mittal, Shehraz Firoz, Digvijay Ghangas, Sonia Bhatt

Introduction: Perinatal asphyxia is very common in developing countries. Coagulopathy occurs as a part of spectrum of multiorgan dysfunction following hypoxic insult. In asphyxiated neonate, bleeding due to coagulation abnormality is common and potentially life threatening. There are very few studies done on coagulation profile with perinatal asphyxia in last few decades. Aim: To evaluate the coagulation profile in neonates with hypoxic ischaemic encephalopathy in a tertiary care center, Agra. Materials and Methods: This was a prospective clinical study undertaken in Neonatal Intensive Care Unit (NICU) FH Medical College Agra, a tertiary care center catering rural and urban population. Total 60 neonates admitted with history of birth asphyxia between January 2022 to June 2022 were enrolled. Neonates were classified into Hypoxic Ischaemic Encephalopathy (HIE) stage 1, 2 and 3 (according to Sarnat and Sarnat staging). Parameters such as Prothrombin Time (PT)/ International Normalised Ratio (INR) and platelet count was analysed. For describing continuous variables means and standard deviations and for comparison Analysis of Variance (ANOVA) test and Chi-square test were used. Results: In this study, total 60 neonates were enrolled. Out of these 43 (71.61%) were male and 17 (28.33%) female. Highest number of cases 34 (56.7%) were from HIE stage 3 followed by 22 (36.7%) HIE stage 2 and 4 (6.7%) from HIE stage 1. Among them 14 newborns with HIE stage 3 were died. PT and INR was significantly deranged in HIE stage 3 and 2 (p-value <0.05). HIE stage 3 has highest mortality and morbidity. Platelet count were normal in HIE stage 1 followed by decreased in HIE stage 2 and 3 and also statistically significant. Conclusion: Coagulation derangement is very common in babies with HIE and evident before clinical bleeding and this derangement is associated with poor outcome. Hence, timely intervention and appropriate management can improve the clinical outcome.

Transcranial Ultrasonography Doppler in Detecting Clinical Outcome of Term Neonates with Perinatal Asphyxia: A Longitudinal Study

Jayesh R Solanki, Janakiram

Introducton: Perinatal asphyxia is one of the most important causes of mortality and morbidity in full-term neonates, where due to the hypoxic insult, mortality and various morbidities happens. So, it is important to predict both the outcomes to aid in patient management, as well as to counsel the caregivers regarding the outcome of the patient, especially the neurological outcome. Aim: To determine the usefulness of abnormal Resistive Index (RI) values on transcranial USG doppler and its association with clinical outcomes in term neonates with perinatal asphyxia. Materials and Methods: This prospective longitudinal study was conducted in the extramural Neonatal Intensive Care Unit (NICU) and Rukmani Chainani NICU of Sir Sayaji General (SSG) Hospital, Vadodara, Gujarat, India, from June 2020 to November 2021. Study was conducted among a cohort of 174 term newborns with perinatal asphyxia admitted in both intramural and extramural NICU of SSG Hospital Vadodara. Neurodevelopmental assessment was done by Amiel-tison scoring system, done at birth, at the time of discharge, at three and six months of age with simultaneous RI value monitoring by a trained radiology resident. The clinical association was done in terms of mortality at birth, morbidities encountered during the NICU stay and neurological outcome at six months of age. Development assessment was done by history taking and clinical examination, patients with delay in two or more domains were classified as global developmental delay, patients with delay in less than two domains were classified as mild developmental delay. Continuable variables were analysed using one-way Analysis of Variance (ANOVA). Categorical data were analysed with Pearson’s Chi-square test. Significance was defined by p-values less than 0.05 using a two-tailed test. Results: Out of 174 newborns enrolled, 97 patients had normal RI values at birth, and 77 patients had abnormal RI values. Forty-eight patients expired after birth, with 27% mortality, and among which 43 patients had abnormal RI values at birth, which was statistically significant (p-value <0.0001). The majority of the newborns with abnormal RI required invasive mechanical ventilation (n=62) and had persistent pulmonary hypertension of newborn (n=40), ventricular dysfunction (n=33), feed intolerance (n=17), acute kidney injury (n=19) and sepsis (n=27). Conclusion: Transcranial Ultrasonography (USG) doppler in the calculation of RI at birth is a useful non invasive point of care method to determine immediate short-term outcomes in the form of mortality and short-term morbidities encountered during NICU stay.

Noise Levels of Invasive and Non Invasive Respiratory Support used in Neonatal Intensive Care Unit of Northern India: A Cross-sectional Study

Prabha Verma, Vasanthan Tanigasalam, Girish Gupta

Introduction: The average noise level exposure inside Neonatal Intensive Care Unit (NICU) is more than the recommended guidelines. The source of noise exposure inside NICU is multifactorial. There is need of studies to assess the noise levels of respiratory equipment used inside the NICU. Aim: To assess the noise levels of invasive versus non invasive and respiratory support in preterm neonates admitted to NICU. Materials and Methods: This cross-sectional descriptive study was done in NICU of a tertiary health care center of Sanjay Gandhi Postgraduate Institute, Lucknow, Uttar Pradesh, India over one year duration from December 2019 to December 2020. A sample of 85 eligible neonates without major congenital anomalies (26-36+6 weeks gestation) was enroled in this study after obtaining informed consent from parents. The noise levels of Heated Humidified High Flow Nasal Cannula (HHHFNC), Continuous Positive Airway Pressure (CPAP), conventional ventilation and High-Frequency Ventilation (HFV) were measured using a sound level meter for a period of first 24 hours of life. The median sound level from non invasive ventilation is compared with invasive ventilation. The continuous variables were expressed as median with range, while categorical data were expressed as frequencies and percentages. Results: A total of 85 neonates were enroled majority of them were born in 32-34 weeks of gestation and were with birth weight of 1501-2500 grams. The sound level exposure of HHHFNC support was 56.1 dB (52.6-60 dB) from warmer and 47.3 dB (44.6-50.8 dB) from the incubator. The median sound level exposure per hour of bubble CPAP was 59 dB (55.2-61.9 dB) with warmer and 51.4 dB (47-55 dB) with incubator. The median sound level exposure per hour of the conventional ventilator was 60 dB (57.4-63.9 dB) with warmer and 53 dB (50.2-56.1 dB) with incubator. The median sound level exposure per hour of high-frequency ventilator was 69.1 dB (66.3-71.8 dB) with warmer and 67.3 dB (66.2-68.9 dB) with incubator. Conclusion: Non invasive ventilation (HHHFNC and bubble CPAP) was less noisy than invasive ventilation. The lowest measured noise exposure was higher than the American Academy of Paediatrics (AAP) recommendation of 45 dB, even after isolation with physical barrier.

Utility of Lung Ultrasound in Diagnosis of Respiratory Distress Syndrome in Neonates: A Cross-sectional Study

Sinchana Bhat, GN Shreekrishna, G Shwetha

Introduction: Respiratory Distress Syndrome (RDS) is one of the most common conditions leading to significant morbidity and mortality. Early diagnosis with a non-invasive imaging tool such as ultrasound, with no radiation hazard will be beneficial for timely intervention in neonates. Aim: To evaluate the utility of Lung Ultrasound (LUS) in diagnosing RDS in neonates and to compare it with chest X-ray (CXR). Materials and Methods: A cross-sectional study was conducted at a tertiary care hospital in Department of Pediatrics, AJ Institute of Medical Sciences, Mangalore, Karnataka, India, from June 2017 to December 2018. Forty neonates (preterm and term) admitted to Neonatal Intensive Care Unit (NICU) with symptoms of respiratory distress within six hours of life and fulfilling clinical criteria of RDS were included in the study. CXR and LUS were performed and interpreted by the same radiologist. The disease was graded as mild and severe by LUS based on the indices like B (Beam like comet-tail pattern) lines, alveolar consolidation, air bronchogram and white lung and it was compared with CXR in terms of sensitivity and specificity to diagnose RDS. Data were statistically analysed using Kendall’s tau-b test. Results: Eighteen (45%) neonates were <32 weeks, 19 (47%), between 32-34 weeks and 3 (7.5%) were >34 weeks of gestation. Twenty-six (65%) were males and 14 (35%) were females. Mean gestational age of the study cohort was 32±2 weeks. Mean birth weight in the study group was 1.7±0.5 kg. 14 out of the 40 neonates (65%) received steroids prior to delivery. LUS detected signs of RDS in all the 40 cases (100% sensitivity). Sixteen out of 40 (40%) neonates were graded as mild RDS and 24 out of 40 neonates (60%) as severe RDS. The sensitivity to detect severe cases was 100% when compared to CXR but specificity to detect mild cases was found to be 59%. The Positive Predictability Value (PPV) was found to be 54% and the Negative Predictable Value (NPV) was found to be 100%. Conclusion: LUS can be used as a reliable, bed side screening tool for the early diagnosis of RDS in NICU without side-effects of radiation.

Early Electroencephalogram as Predictor of Neuromotor Outcome in a Term Newborn with Hypoxic Ischaemia Encephalopathy- A Prospective Cohort Study

Sheela Aglecha, Deepak Dwivedi, Jeetendra Singh, Naresh Bajaj

Introduction: Birth asphyxia is the leading cause of neonatal morbidity and mortality globally. Early prediction of neuromotor problems in babies with Hypoxic Ischaemic Encephalopathy (HIE) allows parental counseling regarding treatment continuation, better utilisation of limited resources and prompt referral for early intervention services to so that the best possible outcomes can be achieved. Aim: To investigate the role of early Electroencephalogram (EEG) background activity in prediction of cerebral palsy, epilepsy and developmental delay in term newborn with HIE and also to check the association of EEG background activity with Hammersmith Neonatal Neurological Examination (HNNE), Hammersmith Infant Neurological Examination (HINE) score and various short-term and long-term outcome. Materials and Methods: This prospective clinical study was conducted in Neonatal Intensive Care Unit (NICU) of Department of Paediatrics, Shyam Shah Medical college and associated Gandhi Memorial Hospital, Rewa (MP) during April 2019 to June 2020. Total 81 term neonates with HIE underwent conventional EEG within six hours of birth using International 10-20 system, (modified for neonate) for electrode placement. At the time of discharge HNNE was performed. On follow-up (6 to 12 months), cerebral palsy was evaluated using HINE and modified Ashworth score, Developmental delay by Development Assessment Scale for Indian Infant (DASII) scale and for epilepsy by clinical history and EEG background activity. Association between EEG background activity, HNNE, HINE score and various short-term and long-term outcome was calculated using Chi-square test and Fisher’s-exact test. Results: In present study, out of 81 cases, 58 (71.6%) cases were male and 23 (28.4%) cases were female with mean Gestational Age (GA) of 39 weeks. A total of 57 neonates were discharged successfully after stay of mean duration 13.8 days in NICU. All neonates with normal/mildly abnormal EEG background activity had 100% survival rates whereas only 68.2% (15) and 37% (10) could be discharged from moderately abnormal and severely abnormal EEG background activity group. Out of discharged patients none with severely abnormal background had optimal HNNE whereas 75% (24) of mildly abnormal EEG had optimal HNNE score. Mean HNNE and HINE score was significantly lower in newborns with severely abnormal EEG (mean score 20.8) as compared to normal EEG group (mean score 30.3). Severely abnormal EEG at birth had significant association with cerebral palsy (p-value<0.0001), epilepsy (p-value= 0.003) and developmental delay (p-value<0.001) as compared to moderately and mildly abnormal EEG background activity in newborns with HIE. Conclusion: EEG within six hours of birth in term neonate with HIE has very high sensitivity and Negative Predictive Value (NPV) in predicting short-term outcome as death, poor neurological outcome and long-terms outcome as cerebral palsy, epilepsy and developmental delay.

Growth Pattern of Preterm Newborns under 34 Weeks of Gestation in a Tertiary Care Hospital, Tamil Nadu, India: A Retrospective Study

Kirankumar Haridas, Manikumar Solaippan, Ramya Shanmugam, Muthukumaran Natarajan

Introduction: The proportion of preterm babies is increasing now a days and these babies are more prone to short and long term disabilities. Hence, growth monitoring is essential, to identify the premature infants, who are at increased risk of growth lag and poor neurodevelopmental outcomes. Aim: To assess the growth pattern of infants, who are born ≤34 weeks of gestational age using the intergrowth-21st growth charts. Materials and Methods: This retrospective study was conducted in the Department of Neonatology at Chengalpattu Medical College and Hospital, a Tertiary Care Center Chengalpattu, Tamil Nadu, India. The duration of the study was one year, from January 2020 to December 2020. A total of 118 neonates born at ≤34 weeks gestational age, who were admitted in the hospital and stayed for 14 days and more were included in the study. The data was collected from discharge sheets and an electronic database. Intergrowth-21st growth charts are used to assess growth. Weight, duration of hospital stay and Extrauterine Growth Restriction (EUGR) were assessed for all the newborns. At discharge, the EUGR status of the babies was determined using a weight ≤-1.28 Standard Deviation (SD) criterion. Continuous variables were presented as means with SD. The data was analysed using Statistical Package for Social Sciences (SPSS) version 24.0. Results: The mean maternal and gestational age of the study participants was 24.9±4.14 years and 31.6 ±1.42 weeks and birth weight of babies were 1608.06 gm (±275), respectively. The proportions of Appropriate for gestational age (AGA) and Small For Gestational Age (SGA) were 95 (80.5%) and 18 (15.2%), respectively. The mean time to reach full feeds was 10.4 days (±2.7days), and the duration of stay in the hospital was 24.8 days (±9.6 days). The mean discharge weight and gestational age of babies were 1732 gm (±226 gm) and 35.4 weeks (±1.47 weeks), respectively. The common complications observed, were those requiring antibiotics (73.7%), respiratory support (61.01%), and Respiratory Distress Syndrome (RDS) (22.8%). Conclusion: Preterm newborns are more vulnerable to EUGR. The EUGR proportion in present study was 72.8%. The issues that raise the risk of EUGR, during the hospital stay must be adequately addressed in order to ensure that, preterm neonates develops normally.

Physical Growth of Low Birth Weight Infants in First Six Months of Life: A Prospective Cohort Study

Introduction: Low Birth Weight (LBW) is a commonly encountered problem in developing countries. Growth is the single most important predictor of morbidity and mortality in a LBW infant. LBW babies show a pattern of growth, different from normal weighing babies. Aim: To assess the growth pattern of LBW infants in first six months of life. Materials and Methods: This prospective cohort study was done in Department of Paediatrics, of Kilpauk Medical College and Hospital, a tertiary care hospital in Southern India, from September 2019 to August 2020. Total 310 LBW infants, of which 200 were term and rest preterm were included and followed-up at the ages of three and six months. Clinical details including gender, gestational age, order of birth, length of stay in nursery, maternal and neonatal morbidities, type of feeding and intercurrent illness were noted. The weight, length and head circumference of the infants were measured by standard methods and interpreted using appropriate charts. The anthropometric measures were converted into z-score and compared. The outcome variables were statistically analysed using Chi-square test. Results: Out of 310 babies, 172 (55.5%) were girls and 200 (64.5%) were term babies. Six month follow-up rate was 92%. A total of 228 (79%) infants were on exclusive breastfeeding while the remaining 21% were partially breastfed. The prevalence (95% confidence interval) of undernutrition, short stature and microcephaly at six months were 54.9% (48.93-60.76), 62.2% (56.34-67.88) and 30.7% (25.47-36.47), respectively. Fall in standard deviation score of length, weight and head circumference was observed which was more pronounced in preterm than in term infants (p<0.05). Conclusion: Growth faltering is commonly encountered in more than half of LBW infants on six months follow-up, with the effect being more pronounced in preterm more than term infants.

Clinical Features of Urinary Tract Infection in Neonates with Hyperbilirubinemia: A Cross-sectional Study

Syed Mustafa Hasan, Gaurav Jain, J Meena, Sameer Punia

Introduction: Neonatal hyperbilirubinemia is a common physiological finding in neonates but sometimes Urinary Tract Infections (UTI) can occur in these neonates and it can be asymptomatic or may lead to complications. Many causative factors are listed out for development of neonatal jaundice but the UTI is less mentioned in previous studies. Aim: To study the prevalence of UTI and its clinical features in the neonates with hyperbilirubinemia. Materials and Methods: This cross-sectional study was conducted in Aakash Healthcare super specialty Hospital, Dwarka, New Delhi, India, between June 2019 and May 2020. Total 116 infants with neonatal hyperbilirubinemia were included in the study. The demographic features including date and time of admission, age at presentation of jaundice, mode of parturition, type of assistance for delivery (if any used), presence of cephalohaematoma, bruising or caput succedaneum, weight at birth, age at onset of jaundice (days of life), baby’s and mother’s blood group, any metabolic diseases in mother and father etc. were studied. A thorough haematological work-up was done and urine was collected in a sterile container by catheterisation. All samples were sent to the laboratory for microscopic analysis and culture. Data was statistically analysed using Mann-Whitney U-test and level of significant p-value was considered as less than 0.05. Results: A total of 116 cases of neonatal hyperbilirubinemia were included in this study. Out of the 116 cases, 66 cases (56.89%) were male neonates and infants and 50 cases (43.11%) were female neonates and infants. In this study, out of 116 neonates with hyperbilirubinemia, only 20 babies showed pus cells >5 //hpf (high power field microscope) (suggesting UTI), out of the 20 babies, 08 babies showed culture negative and pus cells >5 /hpf and remaining 12 babies showed culture positive and pus cells >5 /hpf. Out of 12 cases of culture and sensitivity, 8 cases showed culture for Escherichia coli (E.coli) and remaining four cases, organism cultured was Klebsiella pneumonia. Conclusion: Hyperbilirubinemia may be the initial sign of UTI in neonates; it may be asymptomatic in jaundiced newborns. It is recommended that, evaluation of UTI should be made in cases of asymptomatic hyperbilirubinemia cases which helps the paediatrician for early detection and treatment of these affected newborns reducing the hospital stay and long term complications.

Comparison of 25% Dextrose versus Expressed Breast Milk in Reducing Pain while Heel Prick Procedure in Preterm Neonates in a Tertiary Care Hospital, Vadodara, Gujarat, India: A Randomised Clinical Trial

Priyanka Chauhan, Chitra Soni, Hinali Chauhan, Harish Kodnani

Introduction: Preterm infants undergo repeated painful procedures during a period of rapid brain development and programming of stress systems. Newborn babies including preterm infants do feel pain. Although different interventions, such as skin-to-skin contact, glucose solutions, breastfeeding, and local anaesthetic agents, have been evaluated to reduce infants’ pain, there is no clinical trial available to identify the best method. Aim: To compare the dectrose 25% versus Expressed Breast Milk (EBM) in reducing pain while heel prick procedure in preterm neonates in a tertiary care hospital. Materials and Methods: The present randomised clinical trial was conducted at Neonatal Intensive Care Unit (NICU) of Kashiben Gordhandas Patel Children Hospital, Vadodara, Gujarat, India, from September 2019 to May 2020. Total 125 neonates with Gestational age between 28 weeks to 36 weeks were included in the study. Babies were divided into two groups by randomisation: Group-A: EBM and Group-B: Dextrose 25%. Premature Infant Pain Profile (PIPP) score was calculated from worst state of individual recovery period (0-½ minute, 1-1½ minute, 3-3½ minute) and compared to baseline period PIPP. Results: Mean gestational age on examination in Group-A was 34.48±6.14 weeks and in Group-B were 34.51±5.89 weeks. Out of total 125 preterm babies (Group-A-62, group B-63), 71 (56.8%) were male and 54 (43.2 %) were females. Comparison of PIPP at 1-1½ min of heel prick in EBM and Dextrose 25% group was statistically significant (p-value <0.003) suggestive of continued analgesic effect of dextrose 25% better than EBM and PIPP scores after 3-3½ min of heel prick having no statistically significant difference. (p>0.05) Mean difference between the PIPP score in the dextrose 25% and EBM groups was -1.25 and -1.33 at 0 and 1 minute after procedure (p-value,<0.001), so pain relief was better in dextrose 25% group than EBM group. Conclusion: Dextrose 25% was better effective in reducing mean crying duration than EBM. Dextrose 25% had a better analgesic effect than EBM in 28 to 36 weeks gestational age neonates.