Rationalising oxygen usage in a level II special newborn care unit in Madhya Pradesh, India

Etiology, Diagnosis and Management of Persistent Pulmonary Hypertension of the Newborn in Resource-limited Settings

Persistent Pulmonary Hypertension of the Newborn (PPHN) is more common in Low and middle income countries (LMICs) due to high incidence of sepsis, perinatal asphyxia and meconium aspiration syndrome. Presence of hypoxic respiratory faillure and greater than 5% difference in preductal and post ductal saturation increases clinical sucipision for PPHN. The availability of Inhaled nitric oxide and extracorporaeal membrane oxygenation is limited but pulmonary vasodilators such as sildenafil are readily available in most LMICs.

Knowledge, Practice, and Associated Factors Towards Supplemental Oxygen Therapy Among Nurses Working in Neonatal Intensive Care Units in Public Hospitals of Addis Ababa, Ethiopia, 2022: A Cross-Sectional Study

Purpose

Proper administration of oxygen therapy for hospitalized newborns is undoubtedly essential. World Health Organization estimates that approximately 1.4 million deaths worldwide each year are due to inappropriate administration of oxygen, but its administration in clinical practice is usually inappropriate due to lack of knowledge and practice. Therefore, the aim of this study was to determine the level of knowledge, practice and associated factors related to supplemental oxygen therapy among nurses working in neonatal intensive care units.

Methods

An institutional cross-sectional study was conducted with 166 randomly selected respondents using a self-administered questionnaire for data collection. Bivariate and multivariable analyses were performed using SPSS version 26. Variables with a p-value of <0.25 in the bivariate analysis were included in the multivariable logistic regression, and statistical significance was ensured by a p-value <0.05 with 95% CI.

Results

One hundred and sixty-six nurses took part in this study, with a response rate of 96%. Of these, 60.8% had good knowledge and 54.2% had good practice in supplemental oxygen therapy. In the multivariable logistic regression analysis, work experience was significantly associated with knowledge (AOR: 5.40; 95% CI: 2.12-13.73)) and practice (AOR = 3.69, 95% CI: 1.30-10.44)) of supplemental oxygen therapy. Level of knowledge (AOR=2.92, 95% CI: (1.24-6.86)) and educational status (AOR=6.51, 95% CI (1.34-31.55)) were also significantly associated with the practice of supplemental oxygen therapy with a p < 0.05.

Conclusion

Approximately 40% and 46% of nurses in this study had poor knowledge and practice of supplemental oxygen therapy. This figure is shocking and shows a large gap in the knowledge and practice of supplemental oxygen therapy that requires urgent action. Educational status, professional experience and level of knowledge were found to be associated with good knowledge and professional experience with good practice in relation to supplemental oxygen therapy.

Retinopathy of prematurity in India - what can we learn from the polio legacy?

Retinopathy of prematurity (ROP) is a vasoproliferative disease of the preterm retina that has the potential to cause vision impairment and blindness. Timely screening and treatment are hence critical for infants at risk for ROP. Screening for ROP is challenging in India owing to the limited resources, a vast at-risk population and lack of awareness among paediatricians and the public. Addressing ROP in India requires a comprehensive approach involving multiple sectors, considering the magnitude of the problem and the expected increase in need for ROP services due to the increased survival of preterm infants following improvements in neonatal care. The success of the Global Polio Eradication Initiative (GPEI) offers valuable lessons for improving ROP services in developing nations by applying its strategies. An approach for primary and secondary prevention of ROP is proposed, and the current challenges and a neonatal-led care model for ROP are discussed.

Comparative efficacy and safety of restrictive versus liberal transfusion thresholds in anemic preterm infants: a meta-analysis of 12 randomized controlled trials

The comparative efficacy and safety of restrictive with liberal transfusion thresholds remain controversial in anemic preterm infants. This meta-analysis aimed to compare the efficacy and safety of these two transfusion thresholds for anemic preterm infants. We searched PubMed, Embase, Cochrane Library, and China National Knowledge Infrastructure (CNKI) for relevant randomized controlled trials (RCTs) comparing restrictive with liberal transfusion thresholds in anemic preterm infants through April 30, 2022. Two independent investigators screened literature, extracted data, and appraised the methodological quality of eligible studies. Meta-analysis was conducted using RevMan version 5.3.5. Twelve RCTs with 4380 preterm infants were included. Liberal transfusion threshold significantly increased the level of hemoglobin after transfusion (mean difference (MD): -10.03; 95% confidence interval (CI): -15.98 to -4.08; p=0.001; I²=94%) and hematocrit (MD: -3.62; 95%CI: -6.78 to -0.46; p=0.02; I²=80%) compared with restrictive transfusion. Infants' age at first transfusion in restrictive transfusion group was higher than that of infants in liberal transfusion group (MD: 5.08; 95%CI: 2.27 to7.89; p=0.004; I²=54%); however, restrictive transfusion was associated with more time on supplemental oxygen (MD: 3.56; 95%CI: 1.93 to 5.18; p<0.001; I²=62%) and ventilator or CPAP (MD: 3.31; 95%CI: 1.42 to 5.20; p=0.006; I²=75%). For the remaining outcomes, two transfusion strategies were comparable. Furthermore, a series of sensitivity analyses confirmed the robustness of the level of hemoglobin after transfusion, age at first transfusion, time on ventilator or CPAP, and safety outcomes. Evidence with substantial heterogeneity indicates that liberal and restrictive transfusion thresholds are effective and safe blood cell transfusion strategies in anemic preterm infants, but the liberal strategy may be more effective in shortening the length of necessary respiratory support.