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Pn SR, Balachander B. Care of Healthy as well as Sick Newborns in India: A Narrative Review. Indian J Pediatr 2023; 90:29-36. [PMID: 37642888 DOI: 10.1007/s12098-023-04752-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 06/23/2023] [Indexed: 08/31/2023]
Abstract
Majority of neonatal deaths occur in developing countries. There is an increase in the proportion of neonatal deaths as part of the under-5 mortality over the past decade. Hence we need to accelerate further to achieve the goal of single digit neonatal mortality rate (NMR) by 2030. The two major arms of NMR reduction include facility-based neonatal care (FBNC) and home-based neonatal care (HBNC). FBNC addresses care at birth, care of the normal newborn, and care of small and sick newborns. HBNC provides continuum of care for newborn and post-natal mothers facilitated by Accredited Social Health Activist (ASHA) workers. One of the main challenges is to maintain good quality of neonatal care. Zero separation, linkage of community & facility and roles of professional bodies are considered way forward to achieve India Newborn Action Plan (INAP) goals. This review summarizes existing programs for newborn health and diseases and provides an over-arching view of the way-forward.
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Affiliation(s)
- Suman Rao Pn
- Department of Neonatology, St. John's Medical College Hospital, Bangalore, Karnataka, 560038, India.
| | - Bharathi Balachander
- Department of Neonatology, St. John's Medical College Hospital, Bangalore, Karnataka, 560038, India
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Balachander B, Bhat BV. Hemodynamically Significant Patent Ductus Arteriosus (HsPDA) in a Preterm Infant - An Innocent Bystander or a Predilection for Disaster? Indian J Pediatr 2023; 90:1073-1074. [PMID: 37477862 DOI: 10.1007/s12098-023-04767-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 07/03/2023] [Indexed: 07/22/2023]
Affiliation(s)
- Bharathi Balachander
- Department of Neonatology, St John's Medical College, Bangalore, Karnataka, India
| | - Ballambattu Vishnu Bhat
- Medical Research and Publications, Aarupadai Veedu Medical College & Hospital, Vinayaka Mission's Research Foundation-DU, Kirumampakkam, Pondicherry, 607403, India.
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Bisanalli S, Balachander B, Shashidhar A, Raman V, Josit P, Rao SP. The beneficial effect of early and prolonged kangaroo mother care on long-term neuro-developmental outcomes in low birth neonates - A cohort study. Acta Paediatr 2023; 112:2400-2407. [PMID: 37543716 DOI: 10.1111/apa.16939] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 07/31/2023] [Accepted: 08/03/2023] [Indexed: 08/07/2023]
Abstract
AIM Kangaroo mother care (KMC) has immense short-term benefits, but data on long-term outcomes are scarce. Hence, this study aimed to compare the neurodevelopmental outcomes at 12 months of corrected age (CA) in infants <2000 g receiving early and prolonged KMC to a control group. METHODS This was a cohort study that was conducted from January 2017 to November 2018. All neonates<2000 g were eligible for the study. Neonates that received early initiation (<72 h of life) and prolonged KMC comprised the intervention group and were compared to neonates without the intervention. Bayley Scales of Infant and Toddler Development, Third edition (BSID-III) was done at 12 months of CA, and this was analysed using t-test and multi-linear regression analysis. RESULTS There were 75 neonates in the intervention and 69 in the control group. Baseline characteristics were comparable. We found higher composite scores for cognition (110.38 ± 9.89 vs. 105.44 ± 8.77, p value = 0.023), language (107.51 ± 10.72 vs. 101.05 ± 12.06, p value = 0.014) and adaptive behaviour (87.97 ± 9.97 vs. 80 ± 9.1, p value<0.001) in the early and prolonged KMC group in comparison to the control group. CONCLUSION Infants with early and prolonged KMC have better neurodevelopmental outcomes in terms of cognition, language and adaptive behaviour at 12 months of CA.
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Affiliation(s)
- Shridevi Bisanalli
- Department of Neonatology, St. John's Medical College Hospital, Bangalore, Karnataka, India
| | - Bharathi Balachander
- Department of Neonatology, St. John's Medical College Hospital, Bangalore, Karnataka, India
| | - A Shashidhar
- Department of Neonatology, St. John's Medical College Hospital, Bangalore, Karnataka, India
| | - Vijaya Raman
- Department of Psychiatry, St. John's Medical College Hospital, Bangalore, Karnataka, India
| | - Pavitra Josit
- St.John's Research Institute, Bangalore, Karnataka, India
| | - Suman Pn Rao
- Department of Neonatology, St. John's Medical College Hospital, Bangalore, Karnataka, India
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Priyadarshi M, Kumar V, Balachander B, Gupta S, Sankar MJ. Effect of whole-body massage on growth and neurodevelopment in term healthy newborns: A systematic review. J Glob Health 2022; 12:12005. [PMID: 36254378 PMCID: PMC9577283 DOI: 10.7189/jogh.12.12005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Infant massage is commonly practiced in many parts of the world. However, the effectiveness of this intervention has not been reviewed for term, healthy newborns. Methods This systematic review of randomized and quasi-randomized controlled trials assessed the effect of whole-body massage with or without oil, compared to no massage in term healthy newborns. Key outcomes were neonatal mortality, systemic infections, growth, behaviour (crying or fussing time, sleep duration), and neurodevelopment. We searched MEDLINE via PubMed, Cochrane CENTRAL, EMBASE, and CINAHL (updated till November 2021), and clinical trials databases and reference lists of retrieved articles. Two authors separately evaluated the risk of bias, extracted data, and synthesized effect estimates using mean difference (MD) and standardized mean difference (SMD). The GRADE approach was used to assess the certainty of evidence. Results We included 31 randomized and quasi-randomized trials involving 3860 participants. Infant massage was performed by different care providers starting in the neonatal period and continuing for 1-2 months in most studies. Thirteen studies reported the use of oil with body massage. No study reported neonatal mortality or systemic infections. Meta-analyses suggested that whole-body massage may increase infant length at the end of the intervention period (median assessment age 6 weeks; mean difference (MD) = 1.6 cm, 95% confidence interval (CI) = 1.4 to 1.7 cm; low certainty evidence), but the effect on weight (MD = 340 g, 95% CI = 240 to 441 g), head circumference (MD = 0.8 cm, 95% CI = 0.6 to 1.1 cm), sleep duration (MD = 0.62 hours/d, 95% CI = 0.12 to 1.12 hours/d) and bilirubin levels (MD = -31.8 mmol/L or -1.8 mg/dL, 95% CI = -23.5 to -40.0 mmol/L) was uncertain. The effect on crying/fussing time at median 3 months of age, sleep duration at 6 months of age, weight, length, and head circumference at 6-12 months follow-up, and neurodevelopment outcomes, both at the end of the intervention period and follow-up was uncertain. Conclusions Whole-body massage may improve the infant length at the end of the intervention period (median age 6 weeks, range 1-6 months) but the effect on other short- or long-term outcomes is uncertain. There is a need for further well-designed trials in future. Registration Priyadarshi M, Balachander B, Rao S, Gupta S, Sankar MJ. Effect of body massage on growth and neurodevelopment in term healthy newborns: a systematic review. PROSPERO 2020 CRD42020177442.
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Affiliation(s)
- Mayank Priyadarshi
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Vivek Kumar
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Bharathi Balachander
- Department of Neonatology, St. Johns Medical College Hospital, Bangalore, Karnataka, India
| | | | - Mari Jeeva Sankar
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
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Priyadarshi M, Balachander B, Gupta S, Sankar MJ. Timing of first bath in term healthy newborns: A systematic review. J Glob Health 2022; 12:12004. [PMID: 35972992 PMCID: PMC9380966 DOI: 10.7189/jogh.12.12004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background This systematic review of intervention trials and observational studies assessed the effect of delaying the first bath for at least 24 hours after birth, compared to conducting it within the first 24 hours, in term healthy newborns. Methods We searched MEDLINE via PubMed, Cochrane CENTRAL, Embase, CINAHL (updated till November 2021), and clinical trials databases and reference lists of retrieved articles. Key outcomes were neonatal mortality, systemic infections, hypothermia, hypoglycaemia, and exclusive breastfeeding (EBF) rates. Two authors separately evaluated the risk of bias, extracted data, and synthesized effect estimates using relative risk (RR) or odds ratio (OR). The GRADE approach was used to assess the certainty of evidence. Results We included 16 studies (two trials and 14 observational studies) involving 39 020 term or near-term healthy newborns. Delayed and early baths were defined variably in the studies, most commonly as >24 hours (six studies) and as ≤6 hours (12 studies), respectively. We performed a post-hoc analysis for studies that defined early bath as ≤6 hours. Low certainty evidence suggested that bathing the newborn 24 hours after birth might reduce the risk of infant mortality (OR = 0.46, 95% confidence interval (CI) = 0.28 to 0.77; one study, 789 participants) and neonatal hypothermia (OR = 0.50, 95% CI = 0.28-0.88; one study, 660 newborns), compared to bathing within first 24 hours. The evidence on the effect on EBF at discharge was very uncertain. Delayed bath beyond 6 hours (at or after nine, 12, or 24 hours) after birth compared to that within 6 hours might reduce the risk of hypothermia (OR = 0.47, 95% CI = 0.36-0.61; four studies, 2711 newborns) and hypoglycaemia (OR = 0.39, 95% CI = 0.23-0.66; three studies, 2775 newborns) and improve the incidence of EBF at discharge (OR = 1.12, 95% CI = 1.08-1.34; six studies, 6768 newborns); the evidence of the effect on neonatal mortality was very uncertain. Conclusion Delayed first bath for at least 24 hours may reduce infant mortality and hypothermia. Delayed bath for at least 6 hours may prevent hypothermia and hypoglycaemia and improve EBF rates at discharge. However, most of these conclusions are limited by low certainty evidence. Registration PROSPERO 2020 CRD42020177430.
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Affiliation(s)
- Mayank Priyadarshi
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Bharathi Balachander
- Department of Neonatology, St. Johns Medical College Hospital, Bangalore, Karnataka, India
| | | | - Mari Jeeva Sankar
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
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Priyadarshi M, Balachander B, Gupta S, Sankar MJ. Topical emollient application in term healthy newborns: A systematic review. J Glob Health 2022; 12:12002. [PMID: 35871408 PMCID: PMC9308984 DOI: 10.7189/jogh.12.12002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Mayank Priyadarshi
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Bharathi Balachander
- Department of Neonatology, St. Johns Medical College Hospital, Bangalore, Karnataka, India
| | | | - Mari J Sankar
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
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Priyadarshi M, Balachander B, Sankar MJ. Effect of sleep position in term healthy newborns on sudden infant death syndrome and other infant outcomes: A systematic review. J Glob Health 2022; 12:12001. [PMID: 35838069 PMCID: PMC9284601 DOI: 10.7189/jogh.12.12001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background Though recommended by numerous guidelines, adherence to supine sleep position during the first year of life is variable across the globe. Methods This systematic review of randomized trials and observational studies assessed the effect of the supine compared to non-supine (prone or side) sleep position on healthy newborns. Key outcomes were neonatal mortality, sudden infant death syndrome (SIDS), sudden unexpected death in infancy (SUDI), acute life-threatening event (ALTE), neurodevelopment, and positional plagiocephaly. We searched MEDLINE via PubMed, Cochrane CENTRAL, EMBASE, and CINAHL (updated till November 2021). Two authors separately evaluated the risk of bias, extracted data, and synthesised effect estimates using relative risk (RR) or odds ratio (OR). The GRADE approach was used to assess the certainty of evidence. Results We included 54 studies (43 observational studies and 11 intervention trials) involving 474 672 participants. A single study meeting the inclusion criteria suggested that the supine sleep position might reduce the risk of SUDI (0-1 year; OR = 0.39, 95% confidence interval (CI) = 0.23-0.65; 384 infants), compared to non-supine position. Supine sleep position might reduce the risk of SIDS (0-1 year; OR = 0.51, 95% CI = 0.42-0.61; 26 studies, 59332 infants) and unexplained SIDS/severe ALTE (neonatal period; OR = 0.16, 95% CI = 0.03-0.82; 1 study, 119 newborns), but the evidence was very uncertain. Supine sleep position probably increased the odds of being 0.5 standard deviation (SD) below mean on Gross Motor Scale at 6 months (OR = 1.67, 95% CI = 1.22-2.27; 1 study, 2097 participants), but might have little to no effect at 18 months of age (OR = 1.16, 95% CI = 0.96, 1.43; 1 study, 1919 participants). An increase in positional plagiocephaly at 2-7 months of age with supine sleep position is possible (OR = 2.77, 95% CI = 2.06-3.72; 6 studies, 1774 participants). Conclusions Low- to very low-certainty evidence suggests that supine sleep position may reduce the risk of SUDI (0-1 year) and SIDS (0-1 year). Limited evidence suggests that supine sleeping probably delays short-term ‘gross motor’ development at 6 months, but the effect on long-term neurodevelopment at 18 months may be negligible.
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Affiliation(s)
- Mayank Priyadarshi
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Bharathi Balachander
- Department of Neonatology, St. Johns Medical College Hospital, Bangalore, Karnataka, India
| | - Mari J Sankar
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
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Mathias S, Balachander B, Bosco A, Britto C, Rao S. The effect of exchange transfusion on mortality in neonatal sepsis: a meta-analysis. Eur J Pediatr 2022; 181:369-381. [PMID: 34351474 DOI: 10.1007/s00431-021-04194-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/15/2021] [Accepted: 06/28/2021] [Indexed: 11/27/2022]
Abstract
Although antimicrobials are the cornerstone of neonatal sepsis management, adjunctive therapies are required to improve outcomes. The aim of our study was to evaluate the effect of exchange transfusion (ET) on mortality (primary outcome) in neonatal sepsis, as well as on immunoglobulin, complement and neutrophil levels and assess its complications (secondary outcomes). Databases searched include PubMed, NCBI, Google Scholar, CINHAL, Ovid and Scopus. Randomized controlled trials (RCTs), controlled observational studies (COSs) and uncontrolled observational studies (UOSs) reporting mortality data from using ET in neonatal sepsis were included. Studies with additional interventions, non-septic ET indications and populations aged > 28 days were excluded. Data extracted include demographics, features of study, sepsis and ET, as well as mortality rates, immunological and laboratory changes and complications. Data was meta-analysed and displayed using forest plots. The meta-analysis of 14 studies (3 RCTs, 11 COSs) revealed a mortality benefit in septic neonates who underwent ET-RR 0.72 (CI 0.61-0.86, p = 0.01) and a significant increase in pooled immunological parameters (immunoglobulin, complement levels) (SMD 1.13, [0.25, 2.02], p = 0.02) and neutrophil levels (SMD 1.07 [0.04, 2.11], p = 0.03) compared to controls. The descriptive analysis of 9 UOSs revealed thrombocytopenia as the most frequently reported complication (n = 48). Moderate-high risk of bias was largely due to inadequate sample sizes and follow-up durations.Conclusion: Currently, the use of ET in neonatal sepsis is not directly recommended due to low certainty of evidence, inadequate power and moderate-high risk of bias and heterogeneity.Trial registration: PROSPERO (CRD42020176629) ( https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=176629 ) What is Known: • Exchange transfusion is one of the adjunctive methods for treatment of neonatal sepsis. What is New: • The pooled analysis of all studies shows that exchange transfusion has a low certainty of evidence in the context of neonatal mortality. However, at this point, this intervention cannot be refuted or recommended due to heterogeneity of studies and inadequate power.
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Affiliation(s)
- Sitarah Mathias
- St. John's Medical College, St. John's National Academy of Health Sciences, Bangalore, India
| | - Bharathi Balachander
- St. John's Medical College, St. John's National Academy of Health Sciences, Bangalore, India.
- Department of Neonatology, St. John's Medical College and Hospital, St. John's National Academy of Health Sciences, Bangalore, 560034, India.
| | - Ashish Bosco
- St. John's Medical College, St. John's National Academy of Health Sciences, Bangalore, India
| | - Carl Britto
- Department of Infectious Disease, St. John's Research Institute, Bangalore, India
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
- Boston Children's Hospital, Boston, USA
| | - Suman Rao
- St. John's Medical College, St. John's National Academy of Health Sciences, Bangalore, India
- Department of Neonatology, St. John's Medical College and Hospital, St. John's National Academy of Health Sciences, Bangalore, 560034, India
- Consultant, Division of Department of Maternal, Newborn and Adolescent Health, World Health Organisation, Geneva, Switzerland
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Shubha AM, Hegde S, Mohanty S, Balachander B. Recurrent, persistent pneumothorax in a neonate: A cryptic cause. J Clin Neonatol 2022. [DOI: 10.4103/jcn.jcn_133_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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KS D, Balachander B, Rao PN S. Feeding Practices, Lines, and Hospital-Acquired Infection during the Sustenance Phase of Infection Control Quality Improvement. J PEDIAT INF DIS-GER 2020. [DOI: 10.1055/s-0040-1721445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Abstract
Objectives Nosocomial infections are a significant threat to the survival and neurodevelopment of neonates .The present study attempts to correlate enteral feeding practices as measured by nil per oral (NPO days) with bloodstream infection (BSI) rates and central line-associated bloodstream infection (CLABSI) over a period of 2 years and 3 months.
Methods This was a prospective observational study done in a tertiary level neonatal intensive care unit (NICU). Data were recorded on the presence of central lines or peripheral intravenous (IV) lines, receipt of intravenous fluids (IVF), total parenteral nutrition (TPN) or IV antibiotics, and mechanical ventilation status. BSI and CLABSI, regarded as sentinel events, were recorded and root cause analysis done.
Results A total of 3,448 infants constituting 17,846 patient days with mean gestational age and birth weight of 34.3 ± 3 weeks and 1,868 ± 434 g, respectively were studied. NPO per 1,000 days shows a significant positive correlation with BSI (ρ = 0.513; p = 0.004), CLABSI (ρ = 0.425; p = 0.021), antibiotic days (ρ = 0.7; p < 0.000), IV fluid days (ρ = 0.459; p = 0.014), and central line days (ρ = 0.634; p < 0.001). The IV fluid days showed correlation with BSI (ρ = 0.4, p ≤ 0.03) and CLABSI (ρ = 0.43, p = 0.02).
Conclusion BSI in NICU correlates with higher NPO and IV fluid days. Strengthening of enteral feeding practices reduces health care-associated infections.
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Affiliation(s)
- Deepa KS
- St. Johns National Academy of Health Sciences, Bangalore, Karnataka, India
| | | | - Suman Rao PN
- Department of Neonatology, St. Johns National Academy of Health Sciences, Bangalore, Karnataka, India
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Jayaraj D, Rao S, Balachander B. Predisposing factors for excessive loss of weight in exclusively breastfed term and late preterm neonates - a case control study. J Matern Fetal Neonatal Med 2020; 35:3083-3088. [PMID: 32862736 DOI: 10.1080/14767058.2020.1808617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Exclusively breastfed healthy neonates can lose weight excessively due to poor milk production, inadequate enteral intake or due to poor milk transfer. The studies assessing risk factors for infants to lose weight excessively are diverse and results are highly varied. OBJECTIVES We aimed to determine the risk factors for weight loss of over 10% in term and late preterm newborns who were exclusively breastfed. METHODS This was a case-control study which was conducted in a tertiary care hospital. Exclusively breastfed neonates of ≥34 weeks having weight loss of >10% in the first 14 days of life comprised the study group with gestational age and weight-matched neonates without significant weight loss forming the control group. Demographic details, LATCH score, maternal EPDS (Edinburg postpartum depression score) and neonatal morbidities were assessed. RESULTS Of the 53 mother-infant dyad in each group, baseline characteristics were similar. Gestational Diabetes Mellitus (GDM), Lower segment Caesarean section (LSCS) delivery, higher EPDS score, low LATCH score, absence of immediate skin to skin contact were associated with excessive weight loss and was found to be significant statistically. Babies in the study group had higher incidence of jaundice and hypernatremia and had longer duration of stay in hospital. CONCLUSION Lack of early skin to skin contact, higher EPDS scores and lower LATCH scores are predisposing factors for exclusively breastfed infants to lose weight excessively.
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Affiliation(s)
- Dhanya Jayaraj
- Department of Neonatology, St. John's Medical College Hospital, Bengaluru, India
| | - Suman Rao
- Department of Neonatology, St. John's Medical College Hospital, Bengaluru, India
| | - Bharathi Balachander
- Department of Neonatology, St. John's Medical College Hospital, Bengaluru, India
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Balachander B, Rajesh D, Pinto BV, Stevens S, Rao Pn S. Simulation training to improve aseptic non-touch technique and success during intravenous cannulation-effect on hospital-acquired blood stream infection and knowledge retention after 6 months: The snowball effect theory. J Vasc Access 2020; 22:353-358. [PMID: 32667233 DOI: 10.1177/1129729820938202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Intravenous cannulation is a common procedure and a valuable skill in the neonatal intensive care unit. Standardized procedure and personnel training are needed in the unit to prevent hospital-acquired blood stream infections. Hence, we evaluated the effect of training using a low-fidelity simulation on the improvement of the aseptic non-touch technique during intravenous cannulation and knowledge retention after 6 months. METHODS The study was conducted in a tertiary care neonatal unit from June 2017 to July 2018. All the staff nurses and junior resident doctors posted in the neonatal intensive care were included in the study. A protocol and checklist score sheet was developed. The score sheet consisted of 23 items with a total score of 46. Participants were expected to obtain a minimum of 80%. A pre-test was conducted initially, followed by a formal training and then a post-test. The NITA newborn venous access mannequin was used to facilitate the training. A re-training for new nurses was conducted after 6 months. Data were analyzed using paired t-test. RESULTS A total of 29 doctors and nurses were enrolled in the training. The mean pre-test score was 29.93 compared to 42.66 in the post-test scores (mean difference 12.24(95% confidence interval: 9.39-16.05), p < 0.01. The mean scores were higher when the simulation was conducted after 6 months. There was a significant decline in blood stream infection rates from 5.5 to 1.65 per 1000 patient days (p = 0.05). CONCLUSION Simulation-based training of health care personnel is a good modality to improve aseptic non-touch technique during intravenous cannulation in the neonatal intensive care unit. Simulation-based training also helps in knowledge retention and standardization of training procedures.
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Affiliation(s)
- Bharathi Balachander
- Department of Neonatology, St. John's Medical College Hospital, Bengaluru, India
| | - Deepa Rajesh
- Department of Neonatology, St. John's Medical College Hospital, Bengaluru, India
| | - Bonita Viona Pinto
- Department of Neonatology, St. John's Medical College Hospital, Bengaluru, India
| | - Sofia Stevens
- Department of Neonatology, St. John's Medical College Hospital, Bengaluru, India
| | - Suman Rao Pn
- Department of Neonatology, St. John's Medical College Hospital, Bengaluru, India
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Balachander B, Rajesh D, Pinhero CL, Paul S, Stevens S, Rao S. Response Measures to Infection Outbreaks During the Second Year of Sustenance Phase of Infection Control Quality Improvement. Indian J Pediatr 2020; 87:333-338. [PMID: 32036600 PMCID: PMC7223971 DOI: 10.1007/s12098-020-03201-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 01/14/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To analyze the infection outbreaks, control measures and outcomes of the outbreak in the NICU of a tertiary care centre in the year 2018. METHODS This study was conducted in a 30 bedded tertiary care NICU from January 2018 through December 2018. The study design was an Outbreak investigation, based on a program of prospective surveillance for nosocomial infection. All neonates admitted to the NICU formed part of the the study. An Infection Control Quality Improvement (QI) team was available to analyze the infection and initiate response action to outbreaks. RESULTS Three outbreaks were reported in the year 2018. The first was in May 2018 and comprised of colonization with rectal Multi-drug resistant gram negative bacilli (MDR GNB). The outbreak was controlled by using Aseptic non-touch technique (ANTT) for fortification of milk and using distilled water for cleaning of diaper area. The second outbreak in August 2018 was Methicillin resistant Staphylococcus aureus (MRSA) whose source was a maternal Lower segment cesarean section (LSCS) wound. The third outbreak in October 2018 was MDR Acinetobacter. The source was from an outborn having the same organism. All infants were in close proximity to the index case. This outbreak was controlled with cohorting, hand hygiene and strengthening of bundle care. CONCLUSIONS Surveillance aids in early detection and successful control of outbreaks. A systematic search for the source and meticulous containment of spread can successfully control an outbreak.
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Affiliation(s)
- Bharathi Balachander
- Department of Neonatology, St. John's Medical College Hospital, Bangalore, Karnataka, India
| | - Deepa Rajesh
- Department of Neonatology, St. John's Medical College Hospital, Bangalore, Karnataka, India
| | - Cycil Lillian Pinhero
- Department of Neonatology, St. John's Medical College Hospital, Bangalore, Karnataka, India
| | - Sunu Paul
- Department of Neonatology, St. John's Medical College Hospital, Bangalore, Karnataka, India
| | - Sophia Stevens
- Department of Neonatology, St. John's Medical College Hospital, Bangalore, Karnataka, India
| | - Suman Rao
- Department of Neonatology, St. John's Medical College Hospital, Bangalore, Karnataka, India.
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Tanigasalam V, Vishnu Bhat B, Adhisivam B, Balachander B, Kumar H. Hypothermia detection in low birth weight neonates using a novel bracelet device. J Matern Fetal Neonatal Med 2019; 32:2653-2656. [PMID: 29463144 DOI: 10.1080/14767058.2018.1443072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 02/16/2018] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The objective of this study is to assess the diagnostic accuracy of a novel hypothermia monitoring and alert bracelet device (BEMPU Bracelet) in low birth weight (LBW) neonates weighing less than 2000 g. DESIGN This was a controlled prospective study. SETTING This study was done in the step-down nursery of a tertiary level newborn unit of a major teaching hospital in India. METHODS Eligible cases fulfilling inclusion criteria were given BEMPU Bracelets for a period of 24 h. A comparison was made between skin temperatures taken at the axilla by a mercury thermometer and skin temperatures taken at the wrist by the BEMPU Bracelet. Temperatures were taken every 6 h and every time the BEMPU Bracelet alarmed. Trained nurses obtained temperature measurements on newborns during their 24-h stay in the hospital step-down nursery. RESULTS A total of 461 neonates were screened for hypothermia, giving 2428 temperature readings. Three hundred and eleven of 461 babies experienced hypothermia at some point. The 461 babies studied experienced 495 episodes of hypothermia in total. The sensitivity and the specificity of the bracelet in diagnosing hypothermia were 98.6% and 95% respectively. The positive and negative predictive values of the bracelet were 83.6% and 99.6%, respectively. The accuracy of the bracelet in diagnosing hypothermia was 95.8%. CONCLUSION The BEMPU Bracelet is an accurate screening tool to detect and alert for neonatal hypothermia, thereby facilitating prompt management, which could prevent complications.
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Affiliation(s)
- Vasanthan Tanigasalam
- a Department of Neonatology , Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER) , Pondicherry , India
- b Department of Biostatistics , Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER) , Pondicherry , India
| | - B Vishnu Bhat
- a Department of Neonatology , Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER) , Pondicherry , India
- b Department of Biostatistics , Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER) , Pondicherry , India
| | - B Adhisivam
- a Department of Neonatology , Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER) , Pondicherry , India
- b Department of Biostatistics , Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER) , Pondicherry , India
| | - Bharathi Balachander
- a Department of Neonatology , Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER) , Pondicherry , India
- b Department of Biostatistics , Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER) , Pondicherry , India
| | - Harichandra Kumar
- a Department of Neonatology , Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER) , Pondicherry , India
- b Department of Biostatistics , Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER) , Pondicherry , India
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15
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Balachander B, Mondal N, Bhat V, Adhisivam B, Kumar M, Satheesh S, Thulasingam M. Comparison of efficacy of oral paracetamol versus ibuprofen for PDA closure in preterms - a prospective randomized clinical trial. J Matern Fetal Neonatal Med 2018; 33:1587-1592. [PMID: 30227731 DOI: 10.1080/14767058.2018.1525354] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Background: Currently nonselective cyclooxygenase (COX) inhibitors, ibuprofen and indomethacin, are approved drugs for closure of patent ductus arteriosus but have potential toxicities. There are reports of the effectiveness of paracetamol in ductal closure. However, there is paucity of data comparing paracetamol to ibuprofen or indomethacin in relation to the efficacy and safety profile.Methods: This randomized clinical trial was done in our tertiary care neonatal unit from October 2014 to January 2016 after clearance from ethical committee. It was registered with clinical trial registry of India (CTRI/2016/09/007261) and drug controller general of India (CT/Drugs/56/2014). Preterm neonates with clinical suspicion of hemodynamically significant PDA after echo confirmation were included in the study. Randomization was done by stratified randomization through sealed opaque envelopes. A sample size of 150 was estimated with an expected difference in success of closure as 20% between the treatment groups at level of 5% significance and 80% power. The echocardiography was done 24 hours after completion of treatment by a cardiologist blinded to treatment.Results: The baseline parameters were comparable between two groups. One hundred and forty-six babies had hs-PDA, out of which 110 babies were randomized. No significant difference was found between the two groups with respect to PDA closure (RR 0.97, 95%CI 0.78-1.20, p = 1), mortality or cardio-respiratory morbidity. The babies who received ibuprofen had a higher occurrence of acute kidney injury (RR 0.33, 95%CI 0.13-0.85, p = 0.024).Conclusions: Paracetamol is as effective as ibuprofen for PDA closure in preterm neonates. Ibuprofen used for PDA closure in preterms poses an increased risk for acute kidney injury compared to paracetamol.
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Affiliation(s)
- Bharathi Balachander
- Department of Neonatology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Pondicherry, India
| | - Nivedita Mondal
- Department of Neonatology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Pondicherry, India
| | - Vishnu Bhat
- Department of Neonatology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Pondicherry, India
| | - Bethou Adhisivam
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Pondicherry, India
| | - Mahesh Kumar
- Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Pondicherry, India
| | - Santhosh Satheesh
- Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Pondicherry, India
| | - Mahalakshmi Thulasingam
- Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Pondicherry, India
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Francis F, Bhat V, Balachander B, Khare C, Bethou A, Dalal A, Ponnala R. Look Up to Diagnose Down! Indian J Pediatr 2017; 84:961-962. [PMID: 28755174 DOI: 10.1007/s12098-017-2421-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Accepted: 07/05/2017] [Indexed: 11/24/2022]
Affiliation(s)
- Febi Francis
- Department of Neonatology, Jawaharlal Institute of Post Graduate Medical Education & Research (JIPMER), Puducherry, 605006, India
| | - Vishnu Bhat
- Department of Neonatology, Jawaharlal Institute of Post Graduate Medical Education & Research (JIPMER), Puducherry, 605006, India.
| | - Bharathi Balachander
- Department of Neonatology, Jawaharlal Institute of Post Graduate Medical Education & Research (JIPMER), Puducherry, 605006, India
| | - Chetan Khare
- Department of Neonatology, Jawaharlal Institute of Post Graduate Medical Education & Research (JIPMER), Puducherry, 605006, India
| | - Adhisivam Bethou
- Department of Neonatology, Jawaharlal Institute of Post Graduate Medical Education & Research (JIPMER), Puducherry, 605006, India
| | - Ashwin Dalal
- Centre for DNA Fingerprinting and Diagnostics, Molecular Genetics Laboratory(CDFD), Hyderbad, India
| | - Rajitha Ponnala
- Centre for DNA Fingerprinting and Diagnostics, Molecular Genetics Laboratory(CDFD), Hyderbad, India
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Bharadwaj SK, Mondal N, Balachander B, Bhat BV. Negative Urine Benedict's Test in a Child with Galactosemia: A Diagnostic Challenge. Indian J Pediatr 2015; 82:765-6. [PMID: 25680784 DOI: 10.1007/s12098-015-1703-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 01/14/2015] [Indexed: 10/24/2022]
Affiliation(s)
- Shruthi K Bharadwaj
- Division of Neonatology, Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, 605006, India
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