Apollo Cradle For Women & Children

To evaluate whether a strategy of oropharyngeal administration of colostrum reduces morbidity and mortality in very preterm infants. A total of 260 neonates with gestational age 26-31 weeks at birth were randomised between August 2017 and August 2018 to receive 0.2mL of human milk or placebo respectively via the oropharyngeal route, beginning within 24 h after birth, and continued every 3h until oral feeds were initiated. The primary outcome was a composite of death, late-onset sepsis (LOS) or necrotising enterocolitis (NEC) in the neonatal period. A total of 260 infants (mean gestational age 29.5 weeks, and mean birthweight 1201.7g) were included in the primary analysis. The composite primary outcome occurred in 43 (33.6%) infants in the colostrum group and 38 infants (29.7%) in the placebo group, and the difference was not statistically significant (P= 0.50). Secondary outcomes including the incidence of death, NEC, LOS, probable sepsis, intraventricular haemorrhage, ventilator-associated pneumonia, retinopathy of prematurity, bronchopulmonary dysplasia, time to full feeds, time to regain birthweight, duration of hospital stay and survival to 6months without major neurosensory impairment were also comparable between the two groups. A strategy of oropharyngeal administration of colostrum in very preterm and extremely preterm neonates did not decrease the composite primary outcome of death, LOS or NEC. This finding is consistent with most published literature in the area.

Our objective in this study was to determine if machine learning (ML) can automatically recognize neonatal manipulations, along with associated changes in physiological parameters. A retrospective observational study was carried out in two Neonatal Intensive Care Units (NICUs) between December 2019 to April 2020. Both the video and physiological data (heart rate (HR) and oxygen saturation (SpO2)) were captured during NICU hospitalization. The proposed classification of neonatal manipulations was achieved by a deep learning system consisting of an Inception-v3 convolutional neural network (CNN), followed by transfer learning layers of Long Short-Term Memory (LSTM). Physiological signals prior to manipulations (baseline) were compared to during and after manipulations. The validation of the system was done using the leave-one-out strategy with input of 8 s of video exhibiting manipulation activity. Ten neonates were video recorded during an average length of stay of 24.5 days. Each neonate had an average of 528 manipulations during their NICU hospitalization, with the average duration of performing these manipulations varying from 28.9 s for patting, 45.5 s for a diaper change, and 108.9 s for tube feeding. The accuracy of the system was 95% for training and 85% for the validation dataset. In neonates <32 weeks’ gestation, diaper changes were associated with significant changes in HR and SpO2, and, for neonates ≥32 weeks’ gestation, patting and tube feeding were associated with significant changes in HR. The presented system can classify and document the manipulations with high accuracy. Moreover, the study suggests that manipulations impact physiological parameters.

A 2.34-kg male infant is born to a gravida 3 woman with 2 previous abortions at 37.1 weeks of gestation. A cesarean delivery is performed because of fetal distress with oligohydramnios and abnormal Doppler ultrasonography findings. The antenatal period is largely uneventful, with second-trimester antenatal anatomy ultrasound scan reported as normal. However, fetal growth is noted to be poor (lag of 2 weeks) on antenatal ultrasonography at 34 weeks and abnormal Doppler findings are reported at 37 weeks. The neonate does not require any active resuscitation at birth and is transferred to the NICU for low-birthweight care. Intravenous fluids are started initially in view of abnormal antenatal Doppler ultrasonography findings and feedings are introduced at around 21 hours after birth. First meconium is passed at 6 hours of age. The neonate, however, develops feeding intolerance in the form of bilious vomiting and abdominal distention on the second day. Sepsis screening result is negative (total white blood cell count: 7,500/μL [7.5×109/L]; absolute neutrophil count: 2,850/μL [2.85×109/L]; C-reactive protein: 0.1 mg/dL [9.5 nmol/L]; platelet count: 230×103/μL [230×109/L]; peripheral smear: no toxic granules).In view of the bilious vomiting, volvulus, malrotation, and intestinal obstruction are included in the differential diagnosis and abdominal radiography is ordered. Supine radiography (Fig 1) suggests the presence of a large cystic structure in the right iliac fossa, which persists on serial radiography. Pediatric surgery consultation is sought and a conservative approach is advised. The neonate is now kept nil per os (nothing by mouth) with the addition of a prokinetic agent (domperidone). Feedings are reintroduced after 24 hours (day 3 after birth) but it again leads to bilious vomiting; repeat radiography suggests persistence of the same cystic shadow in the right iliac fossa. Exploratory laparotomy is planned for the neonate on the 4th day after birth.Laparotomy reveals cystic dilation of the ileum with malrotation, along with an incidental finding of an asymptomatic annular pancreas. The dilated ileal segment is 5×4 cm in size with continuation of normal ileum on either side of the dilated segment (Fig 2). Because the primary pathology is cystic dilation of ileum, which is causing intestinal obstruction, resection of the dilated bowel along with end-to-end ileal anastomosis is performed. Malrotation can cause problems later on, so the Ladd procedure is performed, which includes surgical division of the Ladd band and widening of small intestine mesentery (Fig 2). An appendectomy is also performed at the same time, followed by reorientation of the small bowel on the right side and caecum and colon on the left side. Annular pancreas is left intact because it is not found to be causing any duodenal obstruction. Histopathology (Fig 3) shows all layers of intestine with normal intestinal mucosa and without any heterotopic tissue, consistent with the diagnosis of congenital segmental dilation (CSD) of the ileum.Also known as “segmental dilation of the ileum,” CSD is a dilated full-thickness segment of the ileum with normal‐caliber ileum on either side. It is a rare condition of unknown etiology with about half of the cases presenting in the neonatal period. (1) CSD is characterized by the Swenson and Rathauser criteria as: 1) limited bowel dilation with a 3‐ to 4-fold increase in caliber, 2) an abrupt transition between dilated and normal bowel, 3) no internal/external barrier distal to the dilation, 4) a clinical picture of intestinal obstruction (complete or partial) 5) a normal neuronal plexus, and 6) complete recovery after resection of affected segment. (2) The cause of CSD remains unknown. Postulated mechanisms include surrounding structures such as vitelline vessels and omphaloenteric bands compressing on the bowel loops at both ends, leading to focal segmental dilation without altering the bowel histology. (3)It can present as an isolated entity or can be associated with other congenital malformations as seen in the current case, where it was associated with malrotation. To our knowledge, this is the first case in the literature in which CSD coexisted with asymptomatic annular pancreas. The clinical presentation is generally nonspecific, with the affected neonate developing features of bowel obstruction in the form of abdominal distention and bilious vomiting. Differential diagnoses include malrotation, volvulus, and intestinal obstruction because of other causes. Constipation can sometimes be associated, in which case Hirschprung disease also becomes a possibility in the differential diagnosis.Antenatal ultrasonography can sometimes suggest a dilated bowel loop. Waters et al (4) and Paradiso et al (5) described the antenatal ultrasonographic features associated with CSD. In the current case though, antenatal ultrasonography findings were reported as normal. Postnatal diagnosis requires a high index of suspicion but the diagnosis is usually made only during exploratory laparotomy performed for clinical intestinal obstruction. Supine and erect radiography suggests a dilated loop of bowel in right iliac fossa (as seen in the current case) with or without air fluid levels but with an otherwise normal gas pattern in the rest of the bowel. (6) Rarely, barium enema studies are also ordered but usually reveal findings similar to those seen on plain radiography.Definitive treatment is resection of the dilated segment, followed by end-to-end anastomosis of the pre- (proximal) and post- (distal) ends. Prognosis is usually excellent after surgical resection. In the current case also, the surgery was well tolerated and the infant remained stable in the postoperative period. He continued to receive parenteral nutrition support for the next 3 days, after which feedings were initiated and gradually increased as tolerated. Full feedings were reached on the 10th postoperative day. The infant was discharged from the hospital on day 18 after birth, breastfeeding and doing well on follow-up and gaining adequate weight.

Recurrent implantation failure (RIF) is often encountered in patients undergoing ART leading to severe emotional, financial and physical distress. Thorough investigations should be carried out to ascertain whether there is any underlying cause of the condition. Endometrial receptivity (ER) remains a major stumbling block in IVF success as most available tests for diagnosis lack accuracy and predictive value. Microarray technology allows identification of the transcriptomic signature of the window of implantation, hence the development of an ER assay (ERA) for the diagnosis of an altered ER. ERA evaluates 238 genes expressed during WOI using RNA sequencing. Use of ERA test in patients with RIF has shown that window of implantation (WOI) is displaced in a quarter of these patients and use of a personalized embryo transfer (pET) significantly improves reproductive performance. We report three cases of RIF all of whom had failed IVF cycles despite good quality blastocysts transfer with apparently, no identifiable cause of implantation failure (uterine factores, embryonic, immunological factors ruled out). Two patients though had ERA testing done outside which showed displaced WOI, but however pET was not carried out leading to RIF. Subsequently pET carried out at our centre led to successful implantation and clinical pregnancy in both the patients.