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Krithika MV, Balakrishnan U, Amboiram P, Shaik MSJ, Chandrasekaran A, Ninan B. Early calcium and phosphorus supplementation in VLBW infants to reduce metabolic bone disease of prematurity: a quality improvement initiative. BMJ Open Qual 2022; 11:bmjoq-2022-001841. [PMID: 35995540 PMCID: PMC9403146 DOI: 10.1136/bmjoq-2022-001841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 08/08/2022] [Indexed: 11/15/2022] Open
Abstract
Objective To reduce the incidence of metabolic bone disease (MBD) among very low birthweight (VLBW) infants admitted to neonatal intensive care unit from baseline of 35% by 50% over 2 years by implementing a quality improvement (QI) initiative. Methods A multidisciplinary QI team used evidence-based interventions and the healthcare improvement model to reduce MBD rate in VLBW infants. The specific interventions included routine enteral supplementation of calcium and phosphorus using Human Milk Fortifier (HMF) to expressed breast milk by day 14 of life (Plan/Do/Study/Act (PDSA) cycle 1), parenteral and early enteral supplementation of calcium and phosphorus (PDSA cycles 2 and 3). We included VLBW infants admitted within the study period at birth and excluded babies with congenital malformations, skeletal disorders and those who died before 2 weeks of age. Compliance with adding HMF by day 14, compliance with adding calcium and phosphorus in total parenteral nutrition (TPN) from day 1 of life and compliance with starting HMF when the baby reached 100 mL/kg/day of feeds were used as process indicators. The incidence of MBD was used as an outcome indicator during the study. The incidence of MBD was tracked using the Statistical Process Control methodology. Results The baseline MBD rate in 2015 was 35%. After the first PDSA cycle, 20% developed MBD (p=0.02). The same was sustained for a period of 1 year with the rate of 22%. After the second and third PDSA cycles, there was a drop in the MBD rate to 17%, and sustained for 3 months with 21%. Conclusion Implementation of QI initiatives decreased the MBD rate from 35% to <20%. Early parenteral calcium and phosphorus supplementation in TPN and optimising enteral supplementation with multicomponent fortifiers appear to have significant reduction in the incidence of MBD.
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Affiliation(s)
- M V Krithika
- Neonatology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
- Neonatology, MS Ramaiah Medical College, Bangalore, Karnataka, India
| | | | - Prakash Amboiram
- Neonatology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Mohammed Shafi Jan Shaik
- Neonatology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Ashok Chandrasekaran
- Neonatology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
- Neonatology, SRM Medical College Hospital and Resrearch Centre, Kattankulathur, Tamilnadu, India
| | - Binu Ninan
- Neonatology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
- Pediatrics and Neonatology, MGM Healthcare, Chennai, Tamilnadu, India
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Babji S, Sindhu KN, Selvarajan S, Ramani S, Venugopal S, Khakha SA, Hemavathy P, Ganesan SK, Giri S, Reju S, Gopalakrishnan K, Ninan B, Iturriza-Gomara M, Srikanth P, Kang G. Persistence of G10P[11] neonatal rotavirus infections in southern India. J Clin Virol 2021; 144:104989. [PMID: 34607240 PMCID: PMC8556361 DOI: 10.1016/j.jcv.2021.104989] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 09/06/2021] [Accepted: 09/23/2021] [Indexed: 12/16/2022]
Abstract
Background: Neonatal rotavirus infections are predominantly caused by distinct genotypes restricted to this age-group and are mostly asymptomatic. Method: Stool samples from neonates admitted for >48 h in neonatal intensive care units (NICUs) in Vellore (2014–2015) and Chennai (2015–2016) in southern India, and from neonates born at hospitals in Vellore but not admitted to NICUs (2015–2016) were tested for rotavirus by ELISA and genotyped by hemi-nested RT-PCR. Results: Of 791 neonates, 150 and 336 were recruited from Vellore and Chennai NICUs, and 305 were born in five hospitals in Vellore. Positivity rates in the three settings were 49.3% (74/150), 29.5% (99/336) and 54% (164/305), respectively. G10P[11] was the commonly identified genotype in 87.8% (65/74), 94.9% (94/99) and 98.2% (161/164) of the neonates in Vellore and Chennai NICUs, and those born at Vellore hospitals, respectively. Neonates delivered by lower segment cesarian section (LSCS) at Vellore hospitals, not admitted to NICUs, had a significantly higher odds of acquiring rotavirus infection compared to those delivered vaginally [p = 0.002, OR = 2.4 (1.4–4.3)]. Conclusions: This report demonstrates the persistence of G10P[11] strain in Vellore and Chennai, indicating widespread neonatal G10P[11] strain in southern India and their persistence over two decades, leading to interesting questions about strain stability.
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Affiliation(s)
- Sudhir Babji
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | | | - Sribal Selvarajan
- Department of Microbiology, Sri Ramachandra Medical College and Research Institute, Chennai, India
| | - Sasirekha Ramani
- Baylor College of Medicine, Houston, TX, United States of America
| | - Srinivasan Venugopal
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Shainey Alokit Khakha
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Priya Hemavathy
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Santhosh Kumar Ganesan
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Sidhartha Giri
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Sudhabharathi Reju
- Department of Microbiology, Sri Ramachandra Medical College and Research Institute, Chennai, India
| | - Krithika Gopalakrishnan
- Department of Microbiology, Sri Ramachandra Medical College and Research Institute, Chennai, India
| | - Binu Ninan
- Department of Neonatology, Sri Ramachandra Medical College and Research Institute, Chennai, India
| | - Miren Iturriza-Gomara
- NIHR Health Protection Research Unit in Gastrointestinal Infections at University of Liverpool, Liverpool, United Kingdom of Great Britain
| | - Padma Srikanth
- Department of Microbiology, Sri Ramachandra Medical College and Research Institute, Chennai, India
| | - Gagandeep Kang
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India.
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Seethapathy J, Boominathan P, Uppunda AK, Ninan B. Distortion product otoacoustic emissions in very preterm infants: A longitudinal study. Int J Pediatr Otorhinolaryngol 2021; 146:110745. [PMID: 33940313 DOI: 10.1016/j.ijporl.2021.110745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 03/30/2021] [Accepted: 04/24/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Very preterm infants are at a greater risk of developing neurodevelopmental impairments such as neuro-motor delays, vision and hearing deficits (Roze and Breart, 2004; Saigal and Doyle, 2008) [1,2]. The hearing difficulties in preterm infants vary depending on the co-morbid conditions. However, prematurity itself is considered as a risk factor that influence the functioning of auditory system. AIM The current study aims to compare the DPOAEs in very preterm infants and term infants at 1 month, 3 months and 6 months of age (corrected age in preterm infants). METHOD DPOAEs were recorded in 72 very preterm infants and 30 term infants at 1 month, 3 months and 6 months of age. All these infants had obtained 'pass' results in newborn hearing screening using ABR. DPOAE f2 test frequency was measured at six frequencies (1500 Hz, 2000 Hz, 3000 Hz, 4500 Hz, 6000 Hz and 8000 Hz) with primary tone stimulus intensity L1 equal to 65 dBSPL and L2 equal to 55 dBSPL with primary tone f2/f1 frequency ratio of 1.2. Otoscopic examination and tympanometry was performed prior to DPOAE testing, to ascertain normal middle ear status. RESULTS DPOAE amplitude did not change significantly between two groups from 1 month till 6 months of age (p > 0.05). DPOAE amplitude and noise floor in very preterm infants were not different from term infants and DPOAE amplitude did not vary significantly across f2 frequencies at various time periods. CONCLUSION The current study findings provided evidence that prematurity did not constitute as a factor to influence the results of DPOAE in very preterm infants who passed newborn hearing screening test. Any significant reduction in DPOAE amplitude or absence of DPOAE in very preterm infants has to be considered and monitored effectively, as it may not reflect a developmental process of cochlear function; instead it could indicate the presence of inner ear or middle ear pathology.
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Affiliation(s)
- Jayashree Seethapathy
- Department of Speech, Language and Hearing Sciences. Sri Ramachandra Institute of Higher Education and Research (DU). Chennai, 600 116, India.
| | - Prakash Boominathan
- Department of Speech, Language and Hearing Sciences. Sri Ramachandra Institute of Higher Education and Research (DU). Chennai, 600 116, India
| | - Ajith Kumar Uppunda
- Department of Audiology. All India Institute of Speech and Hearing. Mysore, 570 006, India
| | - Binu Ninan
- Department of Neonatology. Sri Ramachandra Institute of Higher Education and Research (DU). Chennai, 600 116, India; Department of Pediatrics and Neonatology, MGM Healthcare, Chennai, 600029, India.
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Balakrishnan U, Chandrasekaran A, Amboiram P, Ninan B, Ignatious S. Outcome of Inherited Metabolic Disorders Presenting in the Neonatal Period. Indian J Pediatr 2021; 88:455-462. [PMID: 33051787 DOI: 10.1007/s12098-020-03522-6] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 09/28/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To assess the outcome of infants who were diagnosed to have Inborn errors of metabolism (IEM) during neonatal period from a single center in South India. METHODS This retrospective cohort study included consecutive neonates diagnosed to have IEM by biochemical testing or those detected using newborn screening (NBS) between November 2014 and July 2018. Disorders were categorized into intoxication and non-intoxication groups. Their presentation and outcome were described. Development at 12 mo was assessed objectively using DASII (Developmental assessment scale for Indian infants). Developmental quotient <70 was considered as delay. Mortality was analyzed using Kaplan Meier survival analysis. RESULTS Among the total of 33 (14 intoxication and 19 non-intoxication groups), 7 died in neonatal period, 3 were lost to follow-up, 9 expired during varying period leaving 14 under regular follow-up. NBS detected 3 of them, others presented symptomatically unwell during neonatal period. Median survival was 18 mo (95% CI 3.7 to 32.2). Kaplan Meier survival analysis revealed a significant difference in mortality in intoxication compared to non-intoxication group. Among 14 survivors, 7 (50%) had developmental delay; 5 (35%) had seizures; 6 (43%) had growth failure. Infants with encephalopathy as initial presentation had poorer prognosis. NBS detection rate was 1 in 1060 live births (3 positives out of 3180 NBS samples). Those detected by NBS remained well. CONCLUSIONS Morbidity and mortality remain high in those diagnosed as IEM during neonatal period. Despite the small sample size, this study calls attention to implement NBS wherever feasible.
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Affiliation(s)
- Umamaheswari Balakrishnan
- Department of Neonatology, Sri Ramachandra Institute of Higher Education and Research, Chennai, 600116, India. .,Sri Ramachandra Center of Excellence in Perinatal Health (SCOPE), Sri Ramachandra Institute of Higher Education and Research, Chennai, 600116, India.
| | - Ashok Chandrasekaran
- Department of Neonatology, Sri Ramachandra Institute of Higher Education and Research, Chennai, 600116, India.,Sri Ramachandra Center of Excellence in Perinatal Health (SCOPE), Sri Ramachandra Institute of Higher Education and Research, Chennai, 600116, India
| | - Prakash Amboiram
- Department of Neonatology, Sri Ramachandra Institute of Higher Education and Research, Chennai, 600116, India.,Sri Ramachandra Center of Excellence in Perinatal Health (SCOPE), Sri Ramachandra Institute of Higher Education and Research, Chennai, 600116, India
| | - Binu Ninan
- Department of Neonatology, Sri Ramachandra Institute of Higher Education and Research, Chennai, 600116, India.,Sri Ramachandra Center of Excellence in Perinatal Health (SCOPE), Sri Ramachandra Institute of Higher Education and Research, Chennai, 600116, India
| | - Sebatini Ignatious
- Department of Clinical Nutrition, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
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Chandrasekaran A, Amboiram P, Balakrishnan U, Abiramalatha T, Rao G, Jan SMS, Rajendran UD, Sekar U, Thiruvengadam G, Ninan B. Disposable low-cost cardboard incubator for thermoregulation of stable preterm infant - a randomized controlled non-inferiority trial. EClinicalMedicine 2021; 31:100664. [PMID: 33554076 PMCID: PMC7846710 DOI: 10.1016/j.eclinm.2020.100664] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/12/2020] [Accepted: 11/13/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Incubators and radiant warmers are essential equipment in neonatal care, but the typical 1,500 to 35,000 USD cost per device makes it unaffordable for many units in low and middle-income countries. We aimed to determine whether stable preterm infants could maintain thermoregulation for 48 h in a low-cost incubator (LCI). METHODS The LCI was constructed using a servo-heater costing 200 USD and cardboard infant-chamber. We conducted this open-labeled non-inferiority randomized controlled trial in a tertiary level teaching hospital in India from May 2017 to March 2018. Preterm infants on full feeds and receiving incubator or radiant warmer care were enrolled at 32 to 36 weeks post-menstrual age. We enrolled 96 infants in two strata (Strata-1< 33 weeks, Strata-2 ≥ 33 weeks at birth). Infants were randomized to LCI or standard single-wall incubator (SSI) after negative incubator cultures and monitored for 48 h in air-mode along with kangaroo mother care. The incubator temperature was adjusted manually to maintain skin and axillary temperatures between 36.5 °C and 37.5 °C. During post-infant period after 48 h, SSI and LCI worked for 5 days and incubator temperatures were measured. The primary outcome was maintenance of skin and axillary temperatures with a non-inferiority margin of 0.2 °C. Failed thermoregulation was defined as abnormal axillary temperature (< 36.5 °C or >37.5 °C) for > 30 continuous-minutes. Secondary outcomes were incidence of hypothermia and required incubator temperature. Trial registration details: Clinical Trial Registry - India (CTRI/2015/10/006316). FINDINGS Prior to enrollment 79(82%) infants were in radiant warmer and 17(18%) infants were in incubator care. Median weight at enrollment in Strata-1 and Strata-2 for SSI vs. LCI was 1355(IQR 1250-1468) vs. 1415(IQR 1280-1582) and 1993(IQR 1595-2160) vs. 1995(IQR 1632-2237) grams. Mean skin temperature in Strata-1 and Strata-2 for SSI vs. LCI was 36.8 °C ± 0.2 vs. 36.7 °C ± 0.18 and 36.8 °C ± 0.22 vs. 36.7 °C ± 0.19. Mean axillary temperature in Strata-1 and Strata-2 for SSI vs. LCI was 36.9 °C ± 0.19 vs. 36.8 °C ± 0.16 and 36.8 °C ± 0.2 vs. 36.8 °C ± 0.19. Mixed-effect model done for repeated measures of skin and axillary temperatures showed the estimates were within the non-inferiority limit; -0.07 °C (95% CI -0.11 to -0.04) and -0.06 °C (95% CI -0.095 to -0.02), respectively. Failed thermoregulation did not occur in any infants. Mild hypothermia occurred in 11 of 48(23%) of SSI and 16 of 48(33%) of LCI, OR 1.28 (95%CI 0.85 to 1.91). Incubator temperature in LCI was higher by 0.7 °C (95%CI 0.52 to 0.91). In the post-infant period SSI and LCI had excellent reliability to maintain set-temperature with intra-class correlation coefficient of 0.93 (95%CI 0.92 to 0.94) and 0.96 (95%CI 0.96 to 0.97), respectively. INTERPRETATION Maintenance of skin and axillary temperature of stable preterm infants in LCI along with kangaroo mother care was non-inferior to SSI, but at a higher incubator temperature by 0.7 °C. No adverse events occurred and LCI had excellent reliability to maintained set-temperature. FUNDING Food and Drug Administration (Award number P50FD004895).
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Affiliation(s)
- Ashok Chandrasekaran
- Department of Neonatology, Sri Ramachandra Medical College and Research Institute, Porur, Chennai, India
| | - Prakash Amboiram
- Department of Neonatology, Sri Ramachandra Medical College and Research Institute, Porur, Chennai, India
| | - Umamaheswari Balakrishnan
- Department of Neonatology, Sri Ramachandra Medical College and Research Institute, Porur, Chennai, India
| | - Thangaraj Abiramalatha
- Department of Neonatology, Sri Ramachandra Medical College and Research Institute, Porur, Chennai, India
| | - Govind Rao
- Center for Advanced Sensor Technology, Technology Research Center, University of Maryland, Baltimore County, Baltimore, United States
| | - Shaik Mohammad Shafi Jan
- Department of Neonatology, Sri Ramachandra Medical College and Research Institute, Porur, Chennai, India
| | - Usha Devi Rajendran
- Department of Neonatology, Sri Ramachandra Medical College and Research Institute, Porur, Chennai, India
| | - Uma Sekar
- Department of Microbiology, Sri Ramachandra Medical College and Research Institute, Porur, Chennai, India
| | - Gayathri Thiruvengadam
- Allied Health Sciences, Sri Ramachandra Medical College and Research Institute, Porur, Chennai, India
| | - Binu Ninan
- Department of Neonatology, Sri Ramachandra Medical College and Research Institute, Porur, Chennai, India
- Corresponding author.
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Abiramalatha T, Radhakrishnan K, Panicker VK, Ninan B, Godla U, Chandrasekaran A, Balakrishnan U, Amboiram P. Autologous umbilical cord blood for red cell concentrate transfusion in preterm infants in the era of delayed cord clamping: An uncontrolled clinical trial. Transfus Med 2020; 30:391-395. [PMID: 32743837 DOI: 10.1111/tme.12706] [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] [Received: 04/07/2020] [Revised: 06/25/2020] [Accepted: 06/29/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the utility of autologous umbilical cord blood (UCB) for red cell concentrate (RCC) transfusion in preterm infants. METHODS We recruited preterm infants born at ≤30 weeks' gestation or have an estimated fetal weight <1,200 g. We intended to perform delayed cord clamping (DCC) and to collect UCB following DCC. The quality parameters used included blood culture performed once, and biochemical and haematological parameters assessed weekly. RESULTS Of the 46 recruited neonates, DCC could be performed for 1 minute in 11 (23.9%) and for 30-59 seconds in 10 (21.7%) infants. The success rate of UCB collection was significantly lower in infants who underwent DCC for 1 minute (27%) compared to those who underwent DCC for 30-59 seconds (70%) or immediate cord clamping (72%) (p value 0.031). Twenty-five UCBs were stored after eliminating three that had positive culture. UCB had satisfactory quality for transfusion from day 3 (when blood culture report was available) to 14 (after which pH decreased to <6.5). Thirteen infants required 27 RCC transfusions. Autologous UCB could be used for only five (18.5%) transfusions. CONCLUSION The success rate of UCB collection after DCC for 1 minute is low. Autologous UCB meets less than one-fifth of transfusion requirements. Hence, autologous UCB transfusion is not a workable option in preterm infants.
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Affiliation(s)
- Thangaraj Abiramalatha
- Department of Neonatology and Perinatology (SCOPE), Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | | | - Vinod Kumar Panicker
- Department of Transfusion Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Binu Ninan
- Department of Neonatology and Perinatology (SCOPE), Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Usharani Godla
- Department of Obstetrics and Gynecology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Ashok Chandrasekaran
- Department of Neonatology and Perinatology (SCOPE), Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Umamaheswari Balakrishnan
- Department of Neonatology and Perinatology (SCOPE), Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Prakash Amboiram
- Department of Neonatology and Perinatology (SCOPE), Sri Ramachandra Institute of Higher Education and Research, Chennai, India
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Ninan B, Balakrishnan U, Mohamed A, Manjula M, Abiramalatha T, Chandrasekaran A, Amboiram P. Impact of Lactation Support Program on Initiation of Breastfeeding in Term Infants. Asian Pac Isl Nurs J 2019; 4:108-115. [PMID: 31583265 PMCID: PMC6753849 DOI: 10.31372/20190403.1059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Purpose: Early initiation of breastfeeding (EIBF) significantly decreases neonatal mortality and improves exclusive breastfeeding. The objective of the present study was to assess the effect of lactation support program (LSP) on early initiation of breastfeeding (BF) among term well infants. Methods: A “before-and-after” design was used to study the effect of the LSP on EIBF at a tertiary care institute in India over a period of two and half years. EIBF was defined as BF initiated <1 hour in vaginal delivery (VD) and <2 hours in cesarean section (CS). Impact of LSP was assessed by comparing baseline data (control group) with data after initiation of LSP (study group). Even after 1 year of initiation of LSP, EIBF in CS remained low, hence a hospital policy was implemented to alter a modifiable factor to promote EIBF in CS. Data of the study group was analyzed over two time periods, as study group A (prior to implementation of hospital policy) and study group B (following the commencement of hospital policy). Results: A total of 2,769 postnatal mothers were included for the study with 537 in the control group, 1,157 in study group A, and 1,075 in study group B. In VD, EIBF rate increased significantly from 92.6% at baseline to 99.8% and 99.6%, in study group A and study group B, respectively (p value < 0.001). In CS, EIBF rate increased from 0.4% at baseline to 1.9% and 92.7% in study group A and study group B, respectively (p < 0.001). The time of initiation of BF reduced from 1.3 (0.9) to 0.7 (0.3) hours in VD and from 4.2 (0.71) to 1.8 (0.66) hours in CS with both having a p value of < 0.001. Conclusion: Lactation support program is a simple but effective way of implementing appropriate steps towards promotion of exclusive BF.
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Affiliation(s)
- Binu Ninan
- Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | | | - Asiff Mohamed
- Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Munusamy Manjula
- Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | | | | | - Prakash Amboiram
- Sri Ramachandra Institute of Higher Education and Research, Chennai, India
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Natarajan K, Narayanan A, Hemapriya R, Swetha S, Jayashree R, Ninan B. Impact of elevated glycosylated hemoglobin (HbA1c) on the outcome following coronary artery bypass graft surgery. J Cardiothorac Vasc Anesth 2019. [DOI: 10.1053/j.jvca.2019.07.037] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
BACKGROUND Routine monitoring of gastric residual in preterm infants on gavage feeds is a common practice that is used to guide initiation and advancement of feeds. Some literature suggests that an increase in/or an altered gastric residual may be predictive of necrotising enterocolitis. Withholding monitoring of gastric residual may take away the early indicator and thus may increase the risk of necrotising enterocolitis. However, routine monitoring of gastric residual as a guide, in the absence of uniform standards, may lead to unnecessary delay in initiation and advancement of feeds and delay in reaching full enteral feeds. This in turn may increase the duration of parenteral nutrition and central venous line usage, increasing their complications. Delay in achieving full enteral feeds increases the risk of extrauterine growth restriction and neurodevelopmental impairment. OBJECTIVES • To assess the efficacy and safety of routine monitoring of gastric residual versus no monitoring of gastric residual in preterm infants• To assess the efficacy and safety of routine monitoring of gastric residual based on two different criteria for interrupting feeds or decreasing feed volume in preterm infantsWe planned to undertake subgroup analysis based on gestational age (≤ 27 weeks, 28 weeks to 31 weeks, ≥ 32 weeks), birth weight (< 1000 g, 1000 g to 1499 g, ≥ 1500 g), small for gestational age versus appropriate for gestational age infants (classified using birth weight relative to the reference population), type of feed the infant is receiving (human milk or formula milk), and frequency of monitoring of gastric residual (before every feed, before every third feed, etc.) (see "Subgroup analysis and investigation of heterogeneity"). SEARCH METHODS We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 1), MEDLINE via PubMed (1966 to 19 February 2018), Embase (1980 to 19 February 2018), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1982 to 19 February 2018). We also searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials. SELECTION CRITERIA We selected randomised and quasi-randomised controlled trials that compared routine monitoring of gastric residual versus no monitoring or two different criteria of gastric residual to interrupt feeds in preterm infants. DATA COLLECTION AND ANALYSIS Two review authors assessed trial eligibility and risk of bias and independently extracted data. We analysed treatment effects in individual trials and reported the risk ratio and the risk difference for dichotomous data, and the mean difference for continuous data, with respective 95% confidence intervals. We used the GRADE approach to assess the quality of evidence. MAIN RESULTS Two randomised controlled trials with a total of 141 preterm infants met the inclusion criteria for the comparison of routine monitoring versus no monitoring of gastric residual in preterm infants. Both trials were done in infants with birth weight < 1500 g.Routine monitoring of gastric residual may have little or no effect on the incidence of necrotising enterocolitis (risk ratio (RR) 3.07, 95% confidence interval (CI) 0.50 to 18.77; participants = 141; studies = 2; low-quality evidence). Routine monitoring may increase the risk of feed interruption episodes (RR 2.07, 95% CI 1.39 to 3.07; participants = 141; studies = 2; low-quality evidence); the number needed to treat for an additional harmful outcome (NNTH) was 3 (95% CI 2 to 6).Routine monitoring of gastric residual may increase time taken to establish full enteral feeds (mean difference (MD) 3.92, 95% CI 2.06 to 5.77 days; participants = 141; studies = 2; low-quality evidence), time taken to regain birth weight (MD 1.70, 95% CI 0.01 to 3.39 days; participants = 80; studies = 1; low-quality evidence), and number of total parenteral nutrition days (MD 3.29, 95% CI 1.66 to 4.92 days; participants = 141; studies = 2; low-quality evidence).We are uncertain as to the effect of routine monitoring of gastric residual on other outcomes such as incidence of surgical necrotising enterocolitis, extrauterine growth restriction at discharge, parenteral nutrition-associated liver disease, duration of central venous line (CVL) usage, incidence of invasive infection, mortality before discharge, and duration of hospital stay. We found no data for outcomes such as aspiration pneumonia, gastroesophageal reflux, growth measures following discharge, and neurodevelopmental outcome.Only one trial with 87 preterm infants met the inclusion criteria for the comparison of using two different criteria of gastric residual to interrupt feeds while monitoring gastric residual. The trial was done in infants with birth weight of 1500 to 2000 g. We are uncertain as to the effect of using two different criteria of gastric residual on outcomes such as incidence of necrotising enterocolitis or surgical necrotising enterocolitis, time to establish full enteral feeds, time to regain birth weight, number of total parenteral nutrition days, number of infants experiencing feed interruption episodes, extrauterine growth restriction at discharge, parenteral nutrition-associated liver disease, incidence of invasive infection, and mortality before discharge (very low quality evidence). We found no data on duration of CVL usage, aspiration pneumonia, gastroesophageal reflux, duration of hospital stay, growth measures following discharge, and neurodevelopmental outcome. AUTHORS' CONCLUSIONS Review authors found insufficient evidence as to whether routine monitoring of gastric residual reduces the incidence of necrotising enterocolitis because trial results are imprecise. Low-quality evidence suggests that routine monitoring of gastric residual increases the risk of feed interruption episodes, increases the time taken to reach full enteral feeds and to regain birth weight, and increases the number of total parenteral nutrition (TPN) days.Available data are insufficient to comment on other major outcomes such as incidence of invasive infection, parenteral nutrition-associated liver disease, mortality before discharge, extrauterine growth restriction at discharge, number of CVL days, and duration of hospital stay. Further randomised controlled trials are warranted to provide more precise estimates of the effects of routine monitoring of gastric residual on important outcomes, especially necrotising enterocolitis, in preterm infants.
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Affiliation(s)
- Thangaraj Abiramalatha
- Sri Ramachandra Institute of Higher Education and ResearchNeonatologyChennaiTamil NaduIndia
| | - Sivam Thanigainathan
- Jawaharlal Institute of Postgraduate Medical Education and Research PuducherryNeonatologyPuducherryPuducherryIndia605006
| | - Binu Ninan
- Sri Ramachandra Institute of Higher Education and ResearchNeonatologyChennaiTamil NaduIndia
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Sreedhara MS, Ninan B, Prakash A, Visvanathan K, Shekhar R, Usha Devi R. First case report of spontaneous posterior fossa subdural hemorrhage - A rare cause of neonatal encephalopathy. J Clin Neurosci 2019; 67:277-279. [PMID: 31221575 DOI: 10.1016/j.jocn.2019.05.047] [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] [Received: 03/25/2019] [Accepted: 05/27/2019] [Indexed: 11/25/2022]
Abstract
Posterior fossa subdural hemorrhage (PFSDH) in term neonates is rare and unknown in the absence of obvious trauma. Its management is challenging and decided case to case basis. Here we report two cases of posterior fossa subdural hemorrhage in term babies with normal transition at birth and presenting later with neonatal encephalopathy. First baby was born by elective caesarean section and the second baby by assisted vaginal delivery. They presented at 60 h and 48 h respectively. Both babies had similar clinical presentation in the form of poor feeding, shrill cry and posturing. But they had contrasting clinical course with features of brainstem compression in the first baby requiring ventilation. Coagulation workup was normal in the first baby but fibrinogen level was low in the second baby. Magnetic resonance imaging of the first baby showed PFSDH with tonsillar herniation while in the second baby, there was no midline shift or herniation associated with the PFSDH. Management was tailor made to suit the clinical course and imaging findings. Craniotomy and clot evacuation was done in the first case and in the second baby, management was conservative. Neurological examination was normal at discharge. Both are developmentally normal on follow up. There is no evidence of hydrocephalus in both. Management of PFSDH depends on clinical course and MRI findings. Timely intervention leads to good outcome.
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Affiliation(s)
- M S Sreedhara
- Department of Neonatology, Sri Ramachandra Institute of Higher Education & Research, Porur, Chennai, India
| | - Binu Ninan
- Department of Neonatology, Sri Ramachandra Institute of Higher Education & Research, Porur, Chennai, India
| | - A Prakash
- Department of Neonatology, Sri Ramachandra Institute of Higher Education & Research, Porur, Chennai, India
| | - K Visvanathan
- Department of Neurosurgery, Department of Neurosurgery, Sri Ramachandra Institute of Higher Education & Research, Porur, Chennai, India
| | - Ravi Shekhar
- Department of Neurosurgery, Department of Neurosurgery, Sri Ramachandra Institute of Higher Education & Research, Porur, Chennai, India
| | - R Usha Devi
- Department of Neonatology, Sri Ramachandra Institute of Higher Education & Research, Porur, Chennai, India.
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Seethapathy J, Boominathan P, Uppunda AK, Ninan B. Changes in Auditory Brainstem Response in very preterm and late preterm infants. Int J Pediatr Otorhinolaryngol 2019; 121:88-94. [PMID: 30878558 DOI: 10.1016/j.ijporl.2019.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 02/26/2019] [Accepted: 03/06/2019] [Indexed: 11/19/2022]
Abstract
AIM Aim of this study was to compare the absolute and interpeak latencies of Auditory Brainstem Responses (ABR) in very preterm and late preterm infants at 1 month and 3 months of corrected age. METHOD ology: ABR traces were obtained from 80 preterm infants (40 very preterm and 40 late preterm) at 1 month and 3 months of corrected age in a prospective, comparative cohort study. Auditory click stimuli at 70 dBnHL and 30 dBnHL, with repetition rate of 11.1/s were used. Absolute latencies of peak I, III, V and interpeak latencies of peak I-V, I-III and III-V were analyzed and compared between preterm groups at 1 month and 3 months of corrected age. Wilcoxon Signed Ranks test was used to compare the ABR variables. Mann Whitney test was used to make inferences between groups. RESULTS There was a statistically significant difference in absolute latencies and interpeak latencies between very preterm and late preterm infants at 1 month of corrected age (p < 0.05). Absolute latency of peak I was similar among both groups of preterms. Absolute latencies of peak III, V and interpeak latencies I-III, III-V and I-V were prolonged in very preterm infants at 1 month of corrected age. However, these latencies were significantly reduced at 3 months of corrected age. This indicated accelerated maturation/myelination of the central auditory nervous system in very preterm infants. Absolute latencies of peak III and V and interpeak interval I-V was reduced in late preterm infants at 3 months of corrected age and this was statistically significant. This reduction in latency was considered to be a normal age dependent change. CONCLUSION Findings of the current study revealed that there was no deviation in the pattern of auditory maturation among preterms; it followed the typical 'caudal to rostral' form of maturation. Very preterm infants have less mature neuronal development compared with late preterm infants at 1 month of corrected age which catches up at 3 months of corrected age.
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Affiliation(s)
- Jayashree Seethapathy
- Department of Speech, Language and Hearing Sciences, Sri Ramachandra Institute of Higher Education and Research (DU), Chennai, India.
| | - Prakash Boominathan
- Department of Speech, Language and Hearing Sciences, Sri Ramachandra Institute of Higher Education and Research (DU), Chennai, India
| | - Ajith Kumar Uppunda
- Department of Audiology, All India Institute of Speech and Hearing, Mysore, India
| | - Binu Ninan
- Department of Neonatology, Sri Ramachandra Institute of Higher Education and Research (DU), Chennai, India
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Balakrishnan U, Amboiram P, Ninan B, Chandrasekharan A, Rangaswamy R, Subramanian L. MRI at term equivalent age for predicting long-term neurodevelopmental outcome in preterm infants - a cohort study. J Matern Fetal Neonatal Med 2018; 33:1867-1873. [PMID: 30282505 DOI: 10.1080/14767058.2018.1532498] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 10/28/2022]
Abstract
Purpose: Preterm infants are at increased risk of adverse neurodevelopmental outcome (NDO). Cranial ultrasound has limited predictability. The purpose of the study is to evaluate whether magnetic resonance imaging (MRI) done at term equivalent age (TEA) predicts NDO at 18-22 months of corrected gestational age (CGA).Materials and methods: This cohort study of preterm infants born at ≤32 weeks of gestation and/or birth weight <1500 grams between April 2011 and August 2012 was conducted in a tertiary care institute in India. MRI done at TEA was reported using objective scoring. NDO at 18-22-month CGA was assessed using Bayley Scale of Infant Development (BSID) version III. Composite score (CS) < 85 in motor, language, or cognition domain was taken as adverse NDO. Association between individual MRI subscores and NDO was evaluated using multiple linear regressions by backward elimination method. Validity of MRI abnormality in predicting adverse NDO was assessed.Results: Out of 94 infants who had MRI at TEA, 56 (60%) underwent BSID III. Mean gestational age was 29.8 ± 2.1 weeks. Median CS of all domains was lower with higher total MRI score. Predictive accuracy for various subscores ranged from 55 to 73%. By multiple regression analysis, signal abnormality was associated with motor delay (β -8.4; p .02) and cystic white matter (WM) changes with motor delay (β -7.3; p .003) and cognitive delay (β -6.1; p .005).Conclusions: Although specificity and negative predictive value were moderate to high across all subscores in MRI to predict the NDO, the accuracy has been only low to moderate, which limits its use as sole predictor.
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Affiliation(s)
| | - Prakash Amboiram
- Department of Neonatology, Sri Ramachandra Medical College and Research Institute, Chennai, India
| | - Binu Ninan
- Department of Neonatology, Sri Ramachandra Medical College and Research Institute, Chennai, India
| | - Anupama Chandrasekharan
- Department of Radiology, Sri Ramachandra Medical College and Research Institute, Chennai, India
| | - Rajeswaran Rangaswamy
- Department of Radiology, Sri Ramachandra Medical College and Research Institute, Chennai, India
| | - Lalitha Subramanian
- Department of Clinical Psychology, Sri Ramachandra Medical College and Research Institute, Chennai, India
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Babu R, Ninan B, Sai V. Evaluating Neonates With Antenatal Hyderonephrosis Using a Standard Protocol: An Audit of Hospital Records. Indian Pediatr 2018; 55:966-968. [PMID: 29941698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
AIMS To audit the extent of evaluation of neonates with antenatal hydronephrosis. METHODS Records of all neonates with antenatal hydronephrosis between January 2013 and December 2016 were audited to look for patient factors and investigation results. RESULTS 290 records were evaluated, 93 (32%) of which had abnormalities detected on voiding cystourethrogram. In the presence of hydroureter, 65% had an abnormality while in the absence only 11% were abnormal. In the presence of pelvis ≥20 mm, 93% had abnormal diuretic renogram, while with pelvis <20 mm, only 1.5% were abnormal (P=0.001). Numbers needed to harm calculation revealed 1 in 2 patients would receive an unnecessary voiding cystourethrogram in the absence of hydroureter, and unnecessary diuretic renogram when pelvis <20 mm. CONCLUSIONS While evaluating neonates with antenatal hydronephrosis invasive tests can be limited, if evaluation is guided by ultrasonographic criteria.
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Affiliation(s)
- Ramesh Babu
- Department of Pediatric Urology, Sri Ramachandra University, Porur, Chennai, India. Correspondence to:Dr Ramesh Babu, Professor of Pediatric Urology, Sri Ramachandra University, Porur, Chennai 600 106, India.
| | - Binu Ninan
- Department of Neonatology, Sri Ramachandra University, Porur, Chennai, India
| | - Venkata Sai
- Department of Radiology, Sri Ramachandra University, Porur, Chennai, India
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Shafijan SM, Chandrasekaran A, Balakrishnan U, Ninan B, Abiramalatha T. Continuous Temperature Monitoring Using Bluetooth- enabled Thermometer in Neonates. Indian Pediatr 2018; 55:914-915. [PMID: 30426962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
We aimed to compare continuous temperature-monitoring using Bluetooth-enabled thermometer (BET) and intermittent monitoring by digital thermometer (DT) in neonates. Continuous monitoring using BET identified 377 episodes of hypo/hyperthermias in 90 baby-days; 316 (83.8%) episodes were confirmed by DT and 61 (16.2%) were false alarms. Five episodes were missed by BET. The agreement between digital thermometer and BET was good. Continuous temperature monitoring helps in early identification of hypo/hyperthermia in neonates.
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Affiliation(s)
- Shaik Mohammad Shafijan
- Department of Neonatology, Sri Ramachandra Medical College and Research Institute, Porur, Chennai, Tamil Nadu, India
| | - Ashok Chandrasekaran
- Department of Neonatology, Sri Ramachandra Medical College and Research Institute, Porur, Chennai, Tamil Nadu, India
| | - Umamaheswari Balakrishnan
- Department of Neonatology, Sri Ramachandra Medical College and Research Institute, Porur, Chennai, Tamil Nadu, India
| | - Binu Ninan
- Department of Neonatology, Sri Ramachandra Medical College and Research Institute, Porur, Chennai, Tamil Nadu, India
| | - Thangaraj Abiramalatha
- Department of Neonatology, Sri Ramachandra Medical College and Research Institute, Porur, Chennai, Tamil Nadu, India.
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Shanmugha Priya RA, Krishnamoorthy R, Panicker VK, Ninan B. Transfusion support in preterm neonates <1500 g and/or <32 weeks in a tertiary care center: A descriptive study. Asian J Transfus Sci 2018; 12:34-41. [PMID: 29563673 PMCID: PMC5850695 DOI: 10.4103/ajts.ajts_148_16] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND: Lack of recent studies focusing on indications, pattern, and benefits of transfusions in low birth weight (B.Wt) and low gestational age (GA) preterm neonates prompted us to undertake this study. AIM: To estimate the transfusion requirements and outcomes in preterm neonates <1500 g and/or <32 weeks. SETTINGS AND DESIGN: This is a cross-sectional study conducted over a period of 2 years in a tertiary care center. MATERIALS AND METHODS: This study was conducted with 101 preterm neonates <1500 g and/or <32 weeks who received blood transfusions in the Neonatal Intensive Care Unit. Restrictive pattern of transfusion was followed. Demographic details and antenatal, neonatal, laboratory, and transfusion parameters were collected. STATISTICAL ANALYSIS USED: Statistical analyses were performed using SPSS 16. RESULTS: The study participants received 311 transfusions. Transfusion requirements decreased with increasing GA and B.Wt. Majority of blood transfusions occurred during the first 2 weeks of life. Packed red blood cells (PRBCs) were the most frequent blood components transfused. Ninety-six percent of the study population had an uneventful transfusion. Mean hemoglobin improvement after PRBC transfusions was 2.3 ± 2.1 g/dl. Improvement in apnea occurred in 76% PRBC transfusions. Infants with sepsis, patent ductus arteriosus, bronchopulmonary dysplasia, disseminated intravascular coagulation, and dyselectrolytemia received more number of transfusions. CONCLUSION: This study would serve as an audit for neonatal blood transfusion therapy. Close adherence to neonatal transfusion policy and restrictive transfusion guidelines helps reduce inappropriate use of blood products and adverse transfusion reactions.
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Affiliation(s)
- R A Shanmugha Priya
- Department of Transfusion Medicine, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
| | - R Krishnamoorthy
- Department of Transfusion Medicine, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
| | - Vinod Kumar Panicker
- Department of Transfusion Medicine, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
| | - Binu Ninan
- Department of Neonatology, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
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Abiramalatha T, Thanigainathan S, Ninan B. Routine monitoring of gastric residual for prevention of necrotising enterocolitis in preterm infants. Hippokratia 2018. [DOI: 10.1002/14651858.cd012937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Thangaraj Abiramalatha
- Sri Ramachandra Medical College and Research Institute; Neonatology; Chennai Tamil Nadu India
| | | | - Binu Ninan
- Sri Ramachandra Medical College and Research Institute; Neonatology; Chennai Tamil Nadu India
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Balakrishnan U, Amboiram P, Ninan B, Chandrasekar A, Rangasami R. Correlation among Magnetic Resonance Imaging Parameters of Brain in Preterm Neonates at Term Equivalent Age. Indian J Pediatr 2017; 84:13-19. [PMID: 27619814 DOI: 10.1007/s12098-016-2215-y] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 08/03/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To assess the spectrum of Magnetic Resonance Imaging (MRI) abnormalities among preterm babies at term equivalent age using objective scoring and to study the association among MRI variables. METHODS Ninety-four preterm babies born at ≤32 wk of gestation and / or birth weight ≤ 1500 g at term equivalent age who underwent cranial MRI between April 2011 and August 2012 and the MRI interpreted by experienced radiologists were studied. In 2014, the MRI was retrospectively re-interpreted by the same radiologists using an objective scoring system described by Kidokoro. Spectrum of MRI abnormalities, their association with perinatal variables and correlation among white matter (WM), grey matter and cerebellar scores were analyzed. RESULTS MRI abnormalities observed were WM signal abnormality (24 %), lateral ventricular dilatation (16 %), WM cystic abnormality (13 %), deep grey matter signal abnormality (9 %), cerebellar volume reduction (9 %) and deep grey matter volume reduction (8 %). Sepsis was significantly associated with occurrence of WM and cerebellar abnormalities (p < 0.05). WM scores did not show significant correlation with cortical grey matter and deep grey matter scores while cerebellar scores showed a weak positive correlation with WM (r = 0.33), cortical grey matter (r = 0.27) and deep grey matter scores (r = 0.22). CONCLUSIONS MRI abnormalities are common in preterm infants, with 60 % showing some abnormality at term equivalent age. Among perinatal characteristics, sepsis was identified as risk factor for WM and cerebellar injury. Grey matter abnormality occurs independent of WM abnormality. Cerebellar abnormalities appear to coexist with either WM or grey matter changes.
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Affiliation(s)
- Umamaheswari Balakrishnan
- Department of Neonatology, Sri Ramachandra Medical College and Research Institute, Porur, Chennai, 600116, India.
| | - Prakash Amboiram
- Department of Neonatology, Sri Ramachandra Medical College and Research Institute, Porur, Chennai, 600116, India
| | - Binu Ninan
- Department of Neonatology, Sri Ramachandra Medical College and Research Institute, Porur, Chennai, 600116, India
| | - Anupama Chandrasekar
- Department of Radiology, Sri Ramachandra Medical College and Research Institute, Porur, Chennai, 600116, India
| | - Rajeswaran Rangasami
- Department of Radiology, Sri Ramachandra Medical College and Research Institute, Porur, Chennai, 600116, India
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Gupta G, Vijay Kumar KV, Anitha R, Ninan B. Feeding Performance in Preterm Infants and Full Term Infants at 40 Weeks Postmenstrual Age. J Nepal Paedtr Soc 2016. [DOI: 10.3126/jnps.v36i2.14621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction: Feeding problems are commonly reported among preterm infants. As premature infants are born before adequate maturation, inadequate feeding capabilities are common among preterm infants. Feeding is an innate behaviour in a new born. Swallowing is evident in a foetus by 16th week of gestation (Tuchman, 1994). By 40th week of gestation, neural processes are expected to mature completely. Feeding is an innate behaviour in a new born. Swallowing is evident in a foetus by 16th week of gestation. By 40th week of gestation, neural processes are expected to mature completely. Since the premature infants are born before adequate maturation of the systems, it is not unusual for them to have inadequate feeding capabilities.Material and Methods: This study aimed to compare feeding performance in preterm (between 30 and 34 weeks GA) and full term infants at 40 weeks Post menstrual age. Seventy infants and their mothers served as participants. A close ended questionnaire documented the oral reflexes, oro-motor skills, oro-sensory skills and feeding history in infants.Results: Results were tabulated under feeding history, (viz; history of use of nasogastric feeding, duration of feeding, episodes of coughing/ choking and vomiting, fussing during feeding, noisy breathing) and oral skills. Significant difference in feeding behaviour was observed between the term and preterm infants at 40 weeks post menstrual age. Conclusion: Hence the need for Speech Language Pathologist to evaluate feeding behaviour at 40 weeks post menstrual age becomes necessary.
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Natarajan K, Jeeva G, Sophia I, Ramachandran V, Vishwanathan B, Ninan B. Is pulsatile perfusion has significant effects on renal function in patients undergoing cardiac surgery? An observational study. J Cardiothorac Vasc Anesth 2016. [DOI: 10.1053/j.jvca.2016.03.064] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Krithika MV, Amboiram P, Latha SM, Ninan B, Suman FR, Scott J. Neonate with haemophagocytic lymphohistiocytosis secondary to dengue infection: a case report. Trop Doct 2016; 47:253-255. [PMID: 27083493 DOI: 10.1177/0049475516644102] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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] [Indexed: 11/15/2022]
Abstract
We report the first case of haemophagocytic lymphohistiocytosis (HLH) in a neonate secondary to primary Dengue virus infection. This neonate presented in the third week of life with fever, shock and hepatosplenomegaly and was diagnosed to have Dengue infection by serology and HLH was confirmed on bone marrow.
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Affiliation(s)
- M V Krithika
- 1 Senior Resident, Department of Neonatology, Sri Ramachandra Medical College and Research Institute, Chennai, India
| | - Prakash Amboiram
- 2 Associate Professor, Department of Neonatology, Sri Ramachandra Medical College and Research Institute, Chennai, India
| | - Sneha M Latha
- 3 Assistant Professor, Department of Paediatrics, Sri Ramachandra Medical College and Research Institute, Chennai, India
| | - Binu Ninan
- 4 Professor, Department of Neonatology, Sri Ramachandra Medical College and Research Institute, Chennai, India
| | - Febe Renjitha Suman
- 5 Professor, Department of Pathology, Sri Ramachandra Medical College and Research Institute, Chennai, India
| | - Julius Scott
- 6 Professor, Division of Paediatric Hemato Oncology, Sri Ramachandra Medical College and Research Institute, Chennai, India
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Ravindran M, Amborium P, Umamaheswari B, Ramani G, Ninan B. Does diffusion restriction changes in magnetic resonance imaging predict neurological outcome in neonatal seizures? J Pediatr Neurosci 2016; 10:326-30. [PMID: 26962336 PMCID: PMC4770642 DOI: 10.4103/1817-1745.174434] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Neonatal seizures are a common manifestation of brain dysfunction. Neonatal magnetic resonance imaging (MRI) has rapidly become the study of choice for the evaluation of central nervous systems disorders in newborns. According to a study conducted in Wilhelmina Children's Hospital, University Medical Center Utrecht, diffusion Restriction (DR) changes in the MRI is a good indicator of cell dysfunction (reversible or irreversible) within one week of insult. OBJECTIVES The main aim of this study was to find the association of DR changes in MRI of brain for neonatal seizures with long term neurodevelopment outcome. METHODS This is a retrospective observational study conducted in Sri Ramachandra University. Retrospective data was collected for the time period of January 2010 to December 2011 from medical records department (MRD) for patient data, neonatal intensive care unit and reports from PACS for MRI images and the Karthikeyan child development unit for their developmental follow up reports. RESULTS Comparison of composite score for various domains with DR changes was done with a t-test and comparison of babies with developmental delay and DR changes with Chi-square test. MRI DR changes with developmental outcome in different domains namely cognition, language-receptive/expressive, fine and gross motor was studied. There is no statistical significance among those who have DR changes and with those who do not have DR changes. CONCLUSION Though diffusion restriction changes in MRI may not predict adverse long term neuro developmental outcome, they can be of use with regards to individual etiological profile as in stroke. Larger group study and long term follow up is required to substantiate these findings.
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Affiliation(s)
- Manipriya Ravindran
- Department of Neonatology, Sri Ramachandra Medical College, Porur, Chennai, Tamil Nadu, India
| | - Prakash Amborium
- Department of Neonatology, Sri Ramachandra Medical College, Porur, Chennai, Tamil Nadu, India
| | - B Umamaheswari
- Department of Neonatology, Sri Ramachandra Medical College, Porur, Chennai, Tamil Nadu, India
| | - Gokul Ramani
- Department of Neonatology, Sri Ramachandra Medical College, Porur, Chennai, Tamil Nadu, India
| | - Binu Ninan
- Department of Neonatology, Sri Ramachandra Medical College, Porur, Chennai, Tamil Nadu, India
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Balakrishnan U, Shaik S, Manian N, Muthukumar M, Thomas M, Amboiram P, Ninan B, Chandrasekaran A, Ramaswamy S. Screening based on incidence of severe retinopathy of prematurity in a tertiary care center in India: are Indian infants different? ACTA ACUST UNITED AC 2016. [DOI: 10.18203/2349-3291.ijcp20162263] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Selvarajan H, Rajendran A, Ninan B, Rajagopalan R. Grandmothers′ perspective on hearing loss in children and newborn hearing screening. Indian J Otol 2014. [DOI: 10.4103/0971-7749.129803] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Osinaike O, Natarajan K, Ninan B. Predictors of 24-hour drain volume after coronary artery bypass graft. West Afr J Med 2014; 33:56-60. [PMID: 24872268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Excessive postoperative hemorrhage in cardiac surgery is a serious complication associated with adverse postoperative events. Also, its associated risk of re-exploration, places a high demand on hospital resources in terms of transfusion needs, ventilatory support requirements, intensive care support, and manpower requirements. OBJECTIVE To determine predictors of 24-hour drain volume (pleural and mediastinal) after coronary artery bypass graft (CABG), in order to focus on preventive measures for patients with identified risk factors. PATIENTS AND METHODS Fifty-four consecutive adult patients who had CABG at the Madras Medical Mission, Chennai, India in July 2008 were retrospectively studied. In order to determine risk factors for excessive post-operative bleeding, 11 pre-operative, and 13 operative and 2 post-operative variables were analyzed using univariate analysis and multiple linear regression. RESULTS Cardiopulmonary bypass was used for all the patients and anti-fibrinolytic in 13 (22.8%). No mortality was recorded. Mean 24-hour post-operative drain volume was 458 ± 270 ml (range 90-1230). Re-exploration for bleeding was required in 2 (3.5%) patients. Predictors of 24-hour drain volume were heparin therapy before commencement of CPB (p=0.024), intra-operative transfusion of fresh frozen plasma (p=0.010), and pre-operative serum ALT value (p=0.047). The strongest predictor was intra-operative transfusion of platelets (p=0.005). CONCLUSION To guard against excessive post-operative haemorrhage after CABG, pre-operative stabilisation and correction of coagulation should be achieved. Also the administration of heparin intra-operatively should be individualized and not only based on dose per body weight.
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Affiliation(s)
- O Osinaike
- Department of Anaesthesia,University College Hospital, P. M. B 5116,Ibadan
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Chakkarapani A, Ninan B, Sekar U, Amboiram P, Balakrishnan U. Pattern and antimicrobial susceptibility of carbapenem resistant organisms in tertiary care neonatal intensive care unit, India. J Clin Neonatol 2014. [DOI: 10.4103/2249-4847.144750] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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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Muthamilselvan S, Vinoth PN, Vilvanathan V, Ninan B, Amboiram P, Sai V, Anand V, Scott JX. Hepatic haemangioma of infancy: role of propranolol. ACTA ACUST UNITED AC 2011; 30:335-8. [PMID: 21118629 DOI: 10.1179/146532810x12858955921393] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
A newborn girl with a haemangioma of the liver failed to respond to cortico-steroid therapy. Ultrasonic evidence of the haemangioma disappeared after 2 months of treatment with propranolol. Propranolol, a non-selective beta-blocker, is a promising therapy in the management of haemangiomas.
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Affiliation(s)
- S Muthamilselvan
- Departments of Pediatrics, Sri Ramachandra Medical Centre, Porur, Chennai, India
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27
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Anbarasu M, Modi R, Ninan B, Kurian VM. Sub coronary implantation of autograft and homografts in aortic position—MMM experience. Indian J Thorac Cardiovasc Surg 2006. [DOI: 10.1007/s12055-006-0516-x] [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: 11/30/2022] Open
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Natarajan K, Patil S, Lesley N, Ninan B. Predictors of Prolonged Mechanical Ventilation After On-pump Coronary Artery Bypass Grafting. Ann Card Anaesth 2006. [DOI: 10.4103/0971-9784.37894] [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: 04/03/2023] Open
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29
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Singh V, Pillai S, Kulkarni S, Murthy KS, Coelho R, Ninan B, Cherian KM. Thrombolysis with percutaneous transluminal balloon angioplasty of a blocked modified Blalock-Taussig shunt. Indian Heart J 2004; 56:673-6. [PMID: 15751528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
Transcatheter balloon recanalization of occluded Blalock-Taussig shunts in the early post-operative period has been reported in the past but there are issues regarding the role of thrombolysis in this situation. We present our experience with such a procedure in an infant with blocked modified Blalock-Taussig shunt.
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Affiliation(s)
- V Singh
- Department of Pediatric Cardiology, Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai
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Sankar NM, Baruah AR, Ninan B, Rajan S, Cherian KM. Batista procedure as a bridge to cardiac transplantation. Indian Heart J 2001; 53:93-4. [PMID: 11456151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023] Open
Abstract
A 37-year-old male patient with dilated cardiomyopathy and end-stage heart failure underwent Batista procedure. After 6 months, he underwent orthotopic heart transplantation. Though he did not survive the procedure, we conclude that Batista procedure may serve as a cost-effective biological bridge to cardiac transplantation.
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Affiliation(s)
- N M Sankar
- Institute of Cardiovascular Diseases, Mogappair, Chennai.
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31
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Singh RK, Ninan B, Mohan CR. Haemostatic effects of crystalloid vs colloid prime in patients undergoing coronary artery bypass grafting. Ann Card Anaesth 1999; 2:22-6. [PMID: 17846487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
The controversy surrounding the use of a colloid or a crystalloid prime in the cardiopulmonary circuit still continues and is a matter of conjecture and an unresolved issue. To evaluate the effect of 4% modified fluid gelatin on haemostasis by measurement of haemostatic variables after cardiopulmonary bypass surgery, we studied 40 patients. They were randomly assigned to 2 groups of ringer lactate and 4% modified fluid gelatin priming solution. The study conclusively proved that 4% modified fluid gelatin has no significant effect on haemostasis and could be recommended as a priming fluid in cardiopulmonary bypass circuit.
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Affiliation(s)
- R K Singh
- Department of Cardiac Anaesthesia and Critical Care Medicine, Institute of Cardiovascular Diseases, Chennai, India
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