Niloufer Hospital

In preterm neonates of ≥ 30weeks' gestation with RDS, NHFOV delivered through NM at equivalent pressures is non-inferior to CPAP when used as primary NRS. The finding of shorter NRS duration with NHFOV needs to be proven in adequately powered trials. Use of NM interface with equivalent pressures addresses the lacunae in the current literature on NHFOV and provides a rigorous comparison between the two NRS modes. www.ctri.nic.in , id CTRI/2024/10/074939, registered on 8 October 2024. • CPAP as initial respiratory support for preterm neonates with RDS is the standard of care in LMICs. • NHFOV is more efficacious than CPAP when used as a post-extubation respiratory support modality, evidence for the same being uncertain when used as primary support. • NHFOV is non-inferior to CPAP as primary support in preterm neonates ≥ 30weeks with RDS for the outcomes of treatment failure and IMV requirement with equivalent pressures after lung recruitment and nasal mask interface. • A superiority design RCT comparing these two non-invasive respiratory support modalities in this subgroup of preterm neonates may not be feasible. The low baseline event rate of IMV necessitates an impractically large sample size to achieve adequate power.

Objective: Supraglottic airway devices are pivotal tools for airway management in anesthesia. The I-gel, a widely used second-generation airway device, is recognized for ease of insertion and low complication rate. This study aims to compare the ease of insertion of I-gel and associated insertion conditions when used with Fentanyl and Dexmedetomidine in combination with Propofol. Methods: After obtaining approval of ethical committee, a total of 60 patients were enrolled a tertiary care hospital and divided into two groups. Group F received 2 mcg/kg of intravenous fentanyl and propofol; Group D received 1 mcg/kg of intravenous dexmedetomidine infusion in 10 minutes and propofol. The ease of I-gel insertion and jaw relaxation was assessed using the modified Lund and Stovener criteria and Young’s criteria, respectively. The physiologic variables, adverse events like apnea, desaturation, cough, jaw movement; and additional requirement of propofol bolus doses were recorded at baseline, first, third, fifth and tenth minutes after insertion. Results: No significant differences were observed in jaw relaxation, ease of I-gel insertion, and adverse events. The apnea duration was shorter in Group D (12.1±2.3 min vs 15.1±2.8, p<0.001). Respiratory rate was significantly lower in Group F. It was easier to insert I-gel in Group D (p=0.213). Ramsay Score was higher and Aldrete score was lower in Group D (p<0.001). Conclusion: Dexmedetomidine as an adjuvant to propofol is a safe alternative to combination of propofol and fentanyl in pediatric surgeries. Although both drugs maintain a stable hemodynamic profile, dexmedetomidine demonstrates superior efficacy in preserving respiratory stimulus.

Typhoid fever, measles, and rubella continue to contribute significantly to childhood morbidity and mortality in India. In line with WHO recommendations for co-administration of Typhoid Conjugate Vaccine (TCV) and measles–rubella (MR) vaccine at 9 months of age, this phase IV, randomized, open-label, multicenter clinical trial was conducted to assess their immunological compatibility and safety when administered concomitantly. A total of 900 healthy Indian infants aged 9–10 months were randomized into three groups: Group A received TCV and MR vaccine concomitantly; Group B received MR on Day 0 and TCV on Day 28; Group C received TCV on Day 0 and MR on Day 28. Subjects were followed for 6 months after concomitant/last vaccination. Seroconversion rates (SC) in Groups A/B/C at Day 28 were 90.2%/75.3%/89.5% for anti-Vi; 80.4%/75.2%/77.7% for anti-measles, and 87.7%/84.0%/85.2% for anti-rubella antibodies. By study end, SC for anti-Vi was 87.1%/71.6%/83.0%, while SC for anti-measles and anti-rubella reached ~90% and ≥98%, respectively, across all groups. Geometric mean titers increased significantly for all antigens, with no evidence of immunological interference. Safety assessments showed adverse events in 23.9%/32.0%/32.7% participants in Group A/B/C. Most adverse events were mild, and only one serious adverse event was reported. These findings support the co-administration of TCV and MR vaccine as a safe and effective strategy.

The author declares no conflicts of interest.

Background and Aim: Patients with severe illness are at an elevated risk of experiencing multiple organ failure, which in turn increases their likelihood of mortality. Hyperlactatemia is recognized as a distinct risk factor for the onset of organ dysfunction and mortality, as well as morbidity in children’s. Present study aims to to determine threshold values for the prediction of in-hospital mortality in the larger cohort of critically ill children and to evaluate the predictive value of blood lactate levels at admission. Methods: This prospective observational study was conducted with 202 critically ill children, ranging in age from one month to 18 years, admitted to the Pediatric Intensive Care Unit (PICU). Arterial blood samples were obtained upon admission, and subsequent measurements of lactate levels were conducted. The demographical data, clinical status and organ involvement were recorded. Statistical analysis was performed by using SPSS Version 21.0 and P < 0.05 was considered to be significant. Results: Survivors geometric mean lactate levels at admission were lower (1.2 mmol/L) than non-survivors' (4.8 mmol/L), and higher lactate levels at admission were substantially linked to both mortality and morbidity (length of hospital stay, need for ventilator and inotropic support). The sensitivity and specificity of the blood lactate levels were 93.6% and 89.7%, achieved at the optimal cut-off value of 4.05 mmol/L. The incidence of multi organ dysfunction, need for ventilator and inotropic support, duration of hospital stay in critically ill children was significantly associated with increased blood lactate levels at admission (P<0.01). Conclusion: A high level of blood lactate upon admission was independently predictive of in-hospital mortality in the pediatric population. The early identification of children who are at a high risk for mortality allows for prompt intervention, thereby enhancing the overall outcomes.

Ubiquitin-specific protease 53 (USP53) is essential for formation of cellular tight junctions and variations in this gene disrupt the tight junctions, resulting in cholestasis. We describe the clinical manifestations and outcomes of patients with USP53 mutations from the Indian progressive familial intrahepatic cholestasis registry. All 29 patients who harbored mutations in the USP53 gene either in the homozygous, compound heterozygous, or heterozygous state and presented with cholestasis were included. USP53 variants related to cholestasis had good outcomes, with native liver survival in 82.7%, whereas 17.3% required liver transplantation. Jaundice developed in 93% and within 3 months of age in 48.8%. Jaundice resolved in 21 (72.4%). Pruritus 76% at a median age of 7 months (severe in 10/22, 45% and refractory to medical therapy in 4, 18.1%). Majority of them (82.7%) had biallelic mutations. Protein-truncating mutations were present in 20 (69%) and missense mutations in 9 (31%). No correlation was found between the genotype and the outcome.

Introduction: The proximity of the mother to the newborn following delivery is essential for the early initiation and establishment of exclusive breast feeding. It leads to the conditioning of the oxytocin reflex, allowing the expression of breast milk. However, preterm and sick babies are nursed in an environment away from their mothers in the NICU, thus leading to delayed initiation and inadequate expression of breast milk. Objective: To estimate the volume of breastmilk expressed close to the baby in comparison to breastmilk expressed away from her baby. Method: This quasi-experimental study was conducted in a tertiary healthcare hospital in Hyderabad over a duration of one month. Postpartum mothers of newborns delivered in this hospital and admitted to the NICU were included in the study. The enrolled mothers were shown a video and poster on manual expression of breast milk and were assisted by lactational counselors for support. The enrolled mothers initially expressed milk in the mother’s room, and an average of three expressions was taken. The next day, the mother was asked to go near the baby in the NICU and express milk in front of her baby, and the average of three feeds was determined in a similar fashion. Data analysis was done using a paired t-test. Results: A total of 30 postnatal mothers were enrolled in the study. The mean volume of breast milk expressed by the mother in the mother’s room was 9.9 ± 2.5ml and the mean volume of breast milk obtained when expressed close to her baby in the newborn care unit was 11.2 ± 2.7ml. The volume of milk expressed near the baby was significantly higher when compared to milk expressed away from the newborn (p<0.001). Conclusions: This study showed that mothers who expressed their feed near their admitted newborns in the newborn care unit had a significant increase in the volume of expressed breastmilk in comparison to expressing the milk away from their babies.

When infants are incapable of achieving satisfactory gas exchange independently, the provision of respiratory assistance becomes imperative. For neonates exhibiting respiratory insufficiency, the utilization of mechanical ventilation plays a vital role in enhancing oxygenation and facilitating the elimination of carbon dioxide. While a majority of infants necessitate ventilation because of pulmonary issues particularly due to respiratory acidosis, there are also instances where other conditions, such as seizures, metabolic acidosis, and shock, contribute to the need for respiratory support. Each ventilation strategy is designed with the objective of bolstering the respiratory systems of infants while concurrently safeguarding both the lungs and the brain against potential damage. It is important to note that brain damage incurred is irreversible. In this concise overview, we will explore the fundamental aspects and provide an overview of ventilation, as well as touch upon a few concepts that are not commonly discussed.

A 10-day-old male child was referred to our tertiary care center from a primary health center for further management.The baby was born in a non-consanguineous marriage.No antenatal, natal, or postnatal complications were present.The baby was born by normal vaginal delivery, cried immediately after birth, and breastfed within half an hour.Her mother informed us that her second-trimester scan revealed a few abnormalities in the infant's right limb.There was no history of drug intake.There is no history of any oligo and polyhydramnios present.There was no history of alcohol consumption or sickle cell disease in the mother.Family history was not significant.The baby had an appropriate weight of 3 kg and a height of 50 cm.Birth vaccinations was taken.The baby was neurologically normal, and muscle tone and power were normal.On closer inspection, the right lower limb was shorter and had a bony protrusion in the lowest portion of the limb (Fig. 1).We can detect a bone deficit through palpation.The joint movement was not bothersome.On the right limb, there were only three digits, and the first and second toes had syndactyly.No other anomalies were present in the baby.Despite its rarity, it is the most common type of congenital lack of long bones in the limbs, followed by the tibia, ulna, radius, and femur [1].According to estimates, there are between 5.7 and 20 occurrences per 1 million live births [2].Boys are twice as likely as females to be afflicted with this illness.There is no genetic link at this point.A fibular hemimelia is a congenital lower limb anomaly that encompasses a spectrum from mild fibular hypoplasia to full fibular aplasia and is characterized by the partial or complete absence of the fibula.Achterman and Kalamchi classified it based on the amount of fibula present.As per classification, ours is type II [3].Due to the absence of the anterior tibial artery, amniotic bands are the probable cause of this condition.The long fetal bones can be measured from 11 weeks onward [4].In embryological life, the lower extremities are sonographically seen before the upper extremities, whereas the movement of the upper extremities is seen before the movement of the lower extremities.Early antenatal scans will give you a chance to select whether to continue the pregnancy or not.The diagnosis is usually made by clinical examination and X-rays.MRI is useful for finding soft-tissue attachments.In the present instance, the X-ray showed that the entire fibula was absent (Fig. 2).In tibial hemimelia, the foot is in a varus position, and the fibula will not bow.Whereas in fibular hemimelia, the tibia will be bowed and the foot will be in a valgus position.The tibia is usually articulated with the femur, unlike the fibula.That's why X-ray interpretation is very cautious.Absent phalanges are also common, like in our case.It is associated with proximal focal femoral deficiency and tibial abnormalities.Surgery is the primary form of treatment, particularly limb-lengthening treatments