scholarly journals Recommendation of an ideal mixed fluid preparation to be used as partial parenteral nutrition in surgical Neonatal Intensive Care Unit

2020 ◽  
Vol 7 (6) ◽  
pp. 1406
Author(s):  
Arindam Ghosh ◽  
Anirudhdha Basak ◽  
Dibyarup Datta Pramanik ◽  
Prafulla Kumar Mishra
Keyword(s):  
Body Weight ◽  
Parenteral Nutrition ◽  
Neonatal Intensive Care ◽  
Tertiary Care ◽  
Cost Effective ◽  
Duodenal Atresia ◽  
Randomised Control Trial ◽  
Tertiary Care Centre ◽  
Maintenance Fluid ◽  
Mixed Fluid

Background: This study was conducted to assess the role of Partial Parenteral Nutrition (PPN) and a specially prepared “mixed fluid formula” used as PPN in sick surgical neonates.Methods: This single institution based Randomised Control Trial was performed in Surgical NICU of a tertiary care Centre. Surgical neonates who required bowel rest for >3 days like Esophageal Atresia (22), Duodenal Atresia (38), Jejuno-Ileal Atresia (50), Necrotising Enterocolitis (29) and others (11), were chosen. As a CONTROL population half (75) neonates were allowed maintenance fluid only (Isolyte P) and rest (75) were given a combination of maintenance fluid (Isolyte P) and PPN (specially prepared mixed fluid). This mixed fluid each 100 ml was prepared with 65ml Isolyte P, 15 ml 25% Dextrose, 10 ml Normal Saline, 7 ml Astymin 3, 2 ml Multivitamin and 1 ml Injection KCl. Fluid was continued till enteral feeding was established.Results: Neonates according to their body weight were divided in three groups <1 kg (50), 1-2.5 kg (71) and >2.5 kg (29) and their post-operative outcome was assessed as Clinical Positive/Negative and Laboratory Positive/Negative. Results were separately assessed in 3 body weight groups under “Control” and “Study” which showed both Clinical and Biochemical improvement in “Study group”.Conclusions: The composition of mixed fluid, its nutritional value, calorie supplementation, compatible osmolarity for peripheral venous administration and most importantly its easy and cost-effective preparation were assessed thoroughly and we recommend this “mixed fluid” preparation as a very useful PPN for sick surgical neonates.

scholarly journals Establishing an alternative accommodation for stable hospitalised antepartum patients: barriers and challenges

2022 ◽  
Vol 11 (1) ◽  
pp. e001625
Author(s):  
M Brad Sullivan ◽  
Abby Rentz ◽  
Pamela Mathura ◽  
Megan Gleddie ◽  
Tania Luthra ◽  
...  
Keyword(s):  
Neonatal Intensive Care ◽  
Swot Analysis ◽  
Tertiary Care ◽  
Physical Space ◽  
Patient Discharge ◽  
Cost Effective ◽  
Premature Delivery ◽  
Care Centre ◽  
Outpatient Management ◽  
Tertiary Care Centre

BackgroundPatients in remote communities who risk premature delivery require transfer to a tertiary care centre for obstetric and neonatal care. Following stabilisation, many patients are candidates for outpatient management but cannot be discharged to their home communities due to lack of neonatal intensive care unit (ICU) support.ProblemWithout outpatient accommodation proximal to neonatal ICU, these patients face prolonged hospitalisation—an expensive option with medical, social and psychological consequences. Therefore, we sought to establish an alternative accommodation for out-of-town stable antepartum patients.MethodsQuality Improvement approaches were used to identify process strengths and opportunities for improvement on the antepartum ward in a tertiary care centre. Physician and patient surveys informed outpatient accommodation programme development by a multidisciplinary team. The intervention was implemented using a plan–do–study–act cycle. Barriers to patient discharge and enrolment in the programme were analysed by completing thematic and strengths–weaknesses–opportunities–threats (SWOT) analysis.ResultsPhysicians broadly supported safe outpatient management, whereas patients were hesitant to leave the hospital even when physicians assured safety. Our alternative accommodation was pre-existing and cost-effective, however, we encountered significant barriers. The physical space limited family visits and social interaction, lacked desired amenities,and the programme proved inconvenient to patients. The thematic and SWOT analysis identified aspects of the intervention which can be optimised to develop future actionable strategies.ConclusionThe utilisation of acute care beds is costly for the healthcare system and must be allocated judiciously. Patient needs, experience and health system barriers need to be considered when establishing alternative outpatient accommodations and strategies for stable antepartum patients.

scholarly journals Neonatal candidiasis: clinical spectrum and epidemiology in a tertiary care centre

2017 ◽  
Vol 4 (2) ◽  
pp. 438
Author(s):  
Bhavana Koppad ◽  
Kulkarni Poornima Prakash
Keyword(s):  
Candida Albicans ◽  
Intensive Care ◽  
Neonatal Intensive Care ◽  
Tertiary Care ◽  
Neonatal Morbidity ◽  
Candida Guilliermondii ◽  
Clinical Spectrum ◽  
Tertiary Care Centre ◽  
Mortality And Morbidity ◽  
Neonatal Candidiasis

Background: Candidial infections are a serious problem in neonatal intensive care units (NICU) which increases the mortality and morbidity in addition to increasing health care costs. Confirming the diagnosis by laboratory tests is difficult and a high index of suspicion is required. The objective of this study was to identify the clinical spectrum and epidemiology of neonatal candidiasis in a tertiary care NICU.Methods: The present study was carried out in the NICU of SDM medical college and hospital, Dharwad. All babies who were admitted to NICU and who had positive blood culture for Candida were included in the study. One year Data (1st December 2015 to 31st November 2016) was collected retrospectively from NICU case records. Statistical test used was chi square test.Results: Total admissions to the NICU during the study period were 2591. Blood cultures were positive in 132 babies. Among these, Candidial sepsis was noted in 39.39% (52) babies. Out of the 52 positive fungal cultures, 15 were Candida albicans, 35 were Candida non albicans and 2 were mixed cultures (Candida albicans and non albicans) showing an increasing incidence of non-albicans Candida infections. Among the non albicans Candida, Candida tropicalis and Candida guilliermondii were the predominant species (11 each) followed by Candida famata (6), Candida krusei (6) and Candida parapsilosis (3). Candidial sepsis was seen to be more common among preterm and low birth weight babies. Usage of antibiotics, Total parenteral nutrition (TPN) and mechanical ventilation were common risk factors noted in our study.Conclusions: Systemic Candidiasis is a disease of modern neonatal intensive care. It deserves urgent attention for its prevention as well as effective treatment in order to minimize neonatal morbidity and mortality.

Hearing screening outcome in neonatal intensive care unit graduates from a tertiary care centre in Singapore

2019 ◽  
Vol 46 (1) ◽  
pp. 104-110 ◽  
Author(s):  
Pooja Agarwal Jayagobi ◽  
Annie Yeoh ◽  
Karen Y.M. Hee ◽  
Lim Sok Bee Lim ◽  
Khoo Poh Choo ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Tertiary Care ◽  
Hearing Screening ◽  
Care Centre ◽  
Tertiary Care Centre

scholarly journals Clinical Profile and Outcome of Neonates Admitted to Neonatal Intensive Care Unit (NICU) at a Tertiary Care Centre in Eastern Nepal

2013 ◽  
Vol 33 (3) ◽  
pp. 177-181 ◽  
Author(s):  
Gauri Shankar Shah ◽  
Satish Yadav ◽  
Anil Thapa ◽  
Lokraj Shah
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Tertiary Care ◽  
Birth Asphyxia ◽  
Clinical Profile ◽  
Tertiary Care Centre ◽  
Mortality And Morbidity ◽  
Development Goals

Introduction: Neonatal period is the most susceptible period of life due to different causes, which in most cases are preventable. Every year millions of neonates are born and a large proportion of them are admitted to the neonatal intensive care unit (NICU) for various indications. One of the Millennium Development Goals is to reduce under five mortality by two thirds by 2015. Therefore, this study was conducted to identify the clinical profile, pattern of diseases and common causes of mortality and morbidity in neonates admitted to NICU. Materials and Methods: A retrospective study was conducted at level III Neonatal NICU of a tertiary -care teaching hospital from January, 2012 to December, 2012. Results: Total of 361 neonates were admitted in NICU. Eighty six neonates (23.8%) were admitted due to prematurity and 73 (20.2%) with birth asphyxia. Among birth asphyxia, 40(54.8%)were in HIE III, 27.4% and 17.8% in HIE II and HIE I, respectively. One hundred eighteen (32.6%) cases were diagnosed as sepsis. The overall mortality was 20.2% during hospital stay. Conclusions: Sepsis, prematurity and birth asphyxia were major causes for admission in NICU. All these etiologies are preventable up to some extent and, if detected earlier, can be effectively treated in order to reduce morbidity and mortality. DOI: http://dx.doi.org/10.3126/jnps.v33i3.8447   J. Nepal Paediatr. Soc. 2013;33(3):177-181

Concurrent surgeries in ENT: a cost-effective and safe approach in patients requiring multiple definitive procedures

2004 ◽  
Vol 118 (1) ◽  
pp. 31-33 ◽  
Author(s):  
Achamma Balraj ◽  
Mary Kurien ◽  
Anand Job
Keyword(s):  
Surgical Procedures ◽  
Tertiary Care ◽  
Case Series ◽  
Cost Effective ◽  
Definitive Treatment ◽  
Tertiary Care Centre ◽  
Retrospective Case ◽  
Average Hospital ◽  
Duration Of Surgery

Treatment of the predisposing factors that are identified in the nose and throat in several ENT diseases is mandatory prior to the definitive management of the latter. When surgical management is indicated it has been traditional to use staged procedures. This study was undertaken to assess the role of concurrent surgical procedures in ENT and evaluate their cost-effectiveness compared to similar staged procedures. This was a retrospective case series of 100 consecutive patients undergoing concurrent and similar staged ENT surgical procedures. On analysis, it was noted that the average duration of surgery, anaesthesia and hospital stay was significantly less in the concurrent procedures group than in the staged procedures (2.35/3.1.hours; 3.05/3.30.hours and 2.5/6.5 days, respectively). The average hospital bill for the concurrent procedures was also lower than for the staged procedures. Hence, in patients requiring multiple ENT surgical procedures for definitive treatment, concurrent procedures are more cost-effective than staged procedures and should be considered the treatment of choice in a tertiary care centre.

scholarly journals A STUDY OF HISTOCYTOLOGICAL FINDINGS OF LUNG LESIONS IN IMAGE GUIDED FNAC AND BIOPSY IN TERTIARY CARE CENTRE

2020 ◽  
pp. 1-3
Author(s):  
Renuka Gahine ◽  
Shashikala Kosam ◽  
Vivek Patre ◽  
Kiranlata Bhagat
Keyword(s):  
Cell Carcinoma ◽  
Predictive Value ◽  
Tertiary Care ◽  
Cost Effective ◽  
Diagnostic Procedures ◽  
Lung Lesion ◽  
Tertiary Care Centre ◽  
Predisposing Factor ◽  
Lung Lesions ◽  
Tertiary Referral Center

Aims and Objectives: To study the cytological and histological findings of lung masses and correlate findings with clinical and radiological findings. Material and methods: The study was an observational study, comprised of two years of prospective from December 2017 to September 2019 and five years of retrospective study between October 2012 to November 2017, conducted in Histopathology & Cytology laboratory, Department of Pathology, Pt. J.N.M. Medical College & Dr. B.R.A.M. Hospital, Raipur, (C.G.), a tertiary referral center. Result: Total 104 cases were studied . Out of 104 lung lesions 74 (71.2%) were males and 30 (28.8%) were females with M:F of 2.46:1. Majority of lung lesions were seen in the age group of 61-70 years i.e. 35 (33.66%) and 51-60 years i.e. 30 (28.85%) followed by 41-50 years 17 (16.35%). Mean age of the patients in our study was 56.4 years. Smoking was the most common predisposing factor for lung carcinoma observed in 58 (55.77%) cases followed by tobacco chewing. Clinically the most common complaint was cough in 65 (62.5%) cases, followed by weight loss. 10 cases were diagnosed as benign and 94 cases as malignant. Among benign lesions most common lung lesions were non-specific inflammatory lesions reported in 6 (5.77%) cases followed by granulomatous lesion in 3 (2.89%), hydatid cyst in 2 (1.93%) and aspergilloma in 1 (0.97%) case. Adenocarcinoma was the most common malignant lung lesion found in 52 (50%) cases followed by Squamous cell carcinoma 20 (24%), Small cell carcinoma 12 (13.04%) and Poorly differentiated carcinoma 6 (5.77%) cases. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of our study was 97.83%, 66.67%, 95.74%, 80.0% and 94.23% respectively. Conclusion: Guided FNAC and biopsy are safe, simple, less invasive, cost effective, well accepted and accurate diagnostic procedures with minimal complications and low morbidity rates.

scholarly journals A study to assess vaccine wastage in an immunization clinic of tertiary care centre, Gwalior, Madhya Pradesh, India

2017 ◽  
Vol 5 (6) ◽  
pp. 2472 ◽  
Author(s):  
Ranjana Tiwari ◽  
Shatkratu Dwivedi ◽  
Piyush Swami ◽  
Rakesh Mahore ◽  
Sakshi Tiwari
Keyword(s):  
Hepatitis B ◽  
Tertiary Care ◽  
Cost Effective ◽  
Economic Benefits ◽  
Madhya Pradesh ◽  
Positive Health ◽  
Tertiary Care Centre ◽  
Tertiary Center ◽  
Wastage Rate ◽  
Key Factor

Background: Vaccines are one of the most successful and cost-effective health intervention. It becomes imperative that use of vaccine was done through a proper framework of practical decision-making that confers positive health and economic benefits to the society of which Vaccine Wastage was a key factor. The aim of the study is to assess “Vaccine Wastage Rate” and “Wastage Factor” of different vaccines given to beneficiaries in Immunization Clinic and based on the above data, recommend measures to reduce it in the Immunization clinic  Methods: The present study was a Record Based Retrospective study carried out in Immunization Clinic in Madhav Dispensary of tertiary center at Gajra Raja Medical College, Gwalior, Madhya Pradesh, India. The data was collected from 1 April 2015 - 31 March 2016.Results: Immunization Sessions were conducted in Immunization clinic during reference period and 7 vaccines BCG, OPV, DPT, Hepatitis B, pentavalent, measles and TT were given. Among individual vaccines, wastage rate and wastage factor in BCG (20.71 and 1.26), OPV (14.65 and 1.17), DPT (15.6 and 1.18), Hepatitis B (10.56 and 1.12), Pentavalent (5.2 and 1.05), Measles (21.68 and 1.28), TT (7.09 and 1.08), and IPV (10.49 and 1.12) was respectively.Conclusions: Vaccine wastage could be expected in all programmes and there should be an acceptable limit of wastage. Innovative techniques to be developed not only to reduce wastage but also the operational cost for convenience of children who were to be vaccinated and parents who bring their children for vaccination without compromising coverage. 

scholarly journals Morbidity and mortality profile of preterm neonates admitted in neonatal intensive care unit of a tertiary care centre in Western Uttar Pradesh, India

2019 ◽  
Vol 6 (5) ◽  
pp. 1859
Author(s):  
Najia Hassan ◽  
Sujaya Mukhopadhyay ◽  
Sneha Mohan
Keyword(s):  
Risk Factors ◽  
Neonatal Intensive Care ◽  
Tertiary Care ◽  
Preterm Neonates ◽  
Pregnancy Induced Hypertension ◽  
Care Centre ◽  
Maternal Risk Factors ◽  
Tertiary Care Centre ◽  
Maternal Risk ◽  
Induced Hypertension

Background: Preterm birth is a major cause of mortality and morbidity for newborns. Complications of prematurity are becoming more common as more survivors are spending time in Neonatal intensive care unit.Methods: A retrospective hospital based clinical observational study was conducted in NICU in Sharda hospital, a tertiary care centre in Greater Noida. Data regarding neonates′ age, sex, clinical presentation, maternal risk factors, complications and outcome were recorded.Results: A total of 133 preterm neonates were enrolled in the study. Maternal risk factors like Pregnancy induced hypertension (PIH) was seen in 19.5% cases, Urinary tract infection in 15% and Antepartum haemorrhage in 14.2% cases. Among the complications of prematurity, RDS was noted in 38.3% cases, Hyperbilirubinemia in 16.5% and feed intolerance in 15% cases. Sepsis was present in 3% of the preterm. Mortality rate was 7.5%. Most common cause of death was RDS.Conclusions: Pregnancy induced hypertension and Antepartum haemorrhage were important maternal risk factors for prematurity. Respiratory distress syndrome and perinatal asphyxia were the important causes of mortality in the present study.

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