scholarly journals A study on the comparison of minimally invasive surfactant therapy with insure technique of surfactant therapy in preterm babies with respiratory distress in a tertiary care hospital – A prospective cohort study

2021 ◽  
Vol 8 (10) ◽  
pp. 362-366
Author(s):  
Andra Akhila ◽  
Bhaswati Ghoshal ◽  
Nepal Chandra Mahapatra
Keyword(s):  
Cohort Study ◽  
Minimally Invasive ◽  
Respiratory Distress ◽  
Neonatal Intensive Care ◽  
Tertiary Care ◽  
Surfactant Therapy ◽  
Care Hospital ◽  
Significant Difference ◽  
Preterm Babies ◽  
Surfactant Administration

Background: Respiratory distress syndrome (RDS) is a common problem in preterm babies due to surfactant deficiency. Initially, babies were given surfactant therapy by intubation, surfactant administration, and extubation (INSURE) method. Minimally invasive surfactant therapy (MIST) is a novel method of surfactant administration without intubation to spontaneously breathing preterm babies with RDS without the removal of continuous positive airway pressure (CPAP). Aim: This study aims to compare the surfactant therapy in preterm babies with RDS through MIST and INSURE technique. Methods: This prospective, observational cohort study was conducted in the neonatology unit of Calcutta National Medical College and Hospital. A total of 212 preterm babies of <37 weeks of gestation with features of RDS, who require surfactant are taken and divided into two groups. Very sick babies with congenital anomalies are excluded from the study. In MIST group (n=102), 8 Fr feeding tube is used to deliver surfactant while the baby is on CPAP. In INSURE group (n=102), surfactant is given by intubation through endotracheal tube without CPAP and extubated. Results: Mean birth weight was 1.26 kg in MIST and 1.22 kg in INSURE. Mean gestational age was 31.33 weeks in MIST and 31.11 weeks in INSURE. It was observed that there is a significant difference in terms of duration of oxygen requirement, neonatal intensive care unit stay, and surfactant spillage during administration in MIST group compared to INSURE group. However, duration of mechanical ventilation, CPAP, number of doses of surfactant, sepsis, intraventricular hemorrhage, retinopathy of prematurity, pneumothorax, bronchopulmonary dysplasia, and mortality did not show significant difference in both the groups. Conclusion: MIST is safe, feasible, and more beneficial than INSURE technique.

13 Impact of Catheter Choice on Procedural Success of Minimally Invasive Surfactant Therapy

2021 ◽  
Vol 26 (Supplement_1) ◽  
pp. e8-e9
Author(s):  
Soume Bhattacharya ◽  
Brooke Read ◽  
Michael Miller ◽  
Orlando daSilva
Keyword(s):  
Adverse Effects ◽  
Minimally Invasive ◽  
Neonatal Intensive Care ◽  
Tertiary Care ◽  
Surfactant Therapy ◽  
P Value ◽  
Perinatal Medicine ◽  
Procedural Success ◽  
Multi Access ◽  
The Impact

Abstract Primary Subject area Neonatal-Perinatal Medicine Background Surfactant delivery via a thin endotracheal catheter during spontaneous breathing, a technique called minimally invasive surfactant therapy (MIST), is an alternative to intubation and surfactant administration. Procedural details among different centres vary, with marked differences in the choice of catheter to instill surfactant. Studies report use of feeding catheters, multi-access catheters, vascular catheters and, recently, custom-designed catheters for this purpose. The impact of choice of catheter on procedural success and adverse effects has not been reported. Objectives The objective of the present study was to compare the procedural success and adverse effects of MIST, using a semi-rigid vascular catheter (16G Angiocath-Hobart Method) versus a flexible multi-access catheter (MAC). Design/Methods This was a retrospective review of prospectively collected data at a tertiary care neonatal intensive care unit in southwestern Ontario. All neonates who received surfactant via MIST between May 1, 2016 and September 30, 2020 were included in the study. Relevant baseline characteristics, data on procedural details (premedication, type of catheter) were collected. The procedural success, number of attempts, and adverse effects between neonates who received MIST via MAC and 16G Angiocath were compared using a Chi Square test or Fisher’s test, as appropriate. A P value of less than 0.05 was considered significant. Results A total of 139 neonates received surfactant via MIST method during the study period. 93 neonates received the surfactant via MAC, while 46 received it via Angiocath. The baseline demographic characteristics in the two groups were similar (Table 1). A higher proportion of neonates in the Angiocath group received atropine (100% vs. 76%, P =.002] and fentanyl (98% vs. 36%; p&lt;0.001) than the MAC group. The procedural success was 91% in the Angiocath group and 89% in the MAC group (p &gt;.99). Multiple attempts were needed in 24% of neonates in the Angiocath group, and 37% in the MAC group (p=0.158). More episodes of desaturations were noted in the Angiocath group (89%) than the MAC group (69%) (P=0.012). Other rates of common adverse effects were similar between the two groups (Table 2). Conclusion The overall procedural success of MIST was similar in both catheter groups. The proportion of neonates requiring multiple attempts was lower with Angiocath use, though this difference was not statistically significant. Desaturation episodes were seen more frequently in the Angiocath group, possibly related to higher use of procedural sedation in this group.

scholarly journals Mean platelet volume (MPV) as a diagnostic marker in neonatal sepsis

2019 ◽  
Vol 6 (3) ◽  
pp. 1036
Author(s):  
Prathyusha . ◽  
Shreekrishna G. N. ◽  
Sinchana Bhat ◽  
Sahana P.
Keyword(s):  
Neonatal Sepsis ◽  
Predictive Value ◽  
Neonatal Intensive Care ◽  
Diagnostic Marker ◽  
Tertiary Care ◽  
Study Groups ◽  
Care Hospital ◽  
Neonatal Deaths ◽  
Significant Difference ◽  
Group B

Background: Neonatal sepsis is a frequent and important cause of morbidity and mortality which accounts for one quarter of neonatal deaths. There are very few studies done in India to evaluate the role of MPV as diagnostic marker of neonatal sepsis.Methods: Prospective case control study in a tertiary care hospital. Neonates > 30 weeks gestation admitted to neonatal intensive care unit during the study period of 1 year with clinically suspected were included in the study. Neonates with Septic screen positive and culture positive sepsis were included in group A and normal neonates were included in Group B. MPV was done for all the subjects and values more than 10.2fl was considered positive. Newborns with congenital anomalies and who were already on antibiotics prior to admission were excluded from the study. Statistical analysis was done using Statistical Package of Social Sciences (SPSS) version 17.0.Results: 106 neonates were included in the study. MPV showed statistically significant difference between the study groups (mean 12.8±1.52, 10.82±1.20 respectively) at a cut of value of 10.2fl and a sensitivity of 93%, specificity of 84 % with a positive predictive value of 83% and negative predictive value of 94%.Conclusions: MPV can be used as an adjuvant marker along with established septic screen to ensure early diagnosis and treatment of neonatal sepsis with no additional expense.

scholarly journals Study Of The Outcome Of Early And Late Rescue Surfactant Administration In Preterm Babies

2014 ◽  
Vol 2 (2) ◽  
Author(s):  
Jayachandra Naidu T ◽  
Kireeti AS ◽  
Lokesh B ◽  
Shankar Reddy Dudala
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Surfactant Therapy ◽  
Preterm Neonates ◽  
P Value ◽  
Surfactant Replacement Therapy ◽  
Preterm Babies ◽  
Surfactant Administration

Introduction: Respiratory Distress Syndrome (RDS) is a common cause of mortality and morbidity in preterm. It is the commonest indication for ventilation in neonates in India. Surfactant Replacement Therapy (SRT) for RDS is a major breakthrough that has revolutionized the survival of premature infants worldwide. Randomized controlled trials have also demonstrated that prophylactic or early surfactant therapy compared with delayed surfactant treatment results in improved outcomes for preterm infants at high risk. Objective: To assess the outcome of early and late rescue surfactant administration by InSuRE (Intubation, Surfactant and Rapid Extubation) technic in managing preterm neonates with respiratory distress syndrome (RDS). Methodology: Study design: Prospective analytical study. Sample size: 144 preterm babies between 28-34 weeks of GA. Setting: Level III NICU at SVRR Government General Hospital, Tirupati, AP. Study Period: 1 year (Sep 2013 to Aug 2014). Method: All preterm babies between 28-34 weeks with respiratory distress were given surfactant with InSuRE technic immediately and categorized into early and late rescue group depending on the time of surfactant therapy i.e. within 2 hrs. of life and between 2-24 hrs. of life respectively. Results: In early rescue group there is significant reduction in mortality and lessen the need of mechanical ventilation with p value <0.05. Conclusion: Early routine surfactant administration within 2 hrs. of life as compared to late selective administration significantly reduced the need mechanical ventilation within 7th day of life and mortality among preterm with respiratory distress syndrome.

Impact of Catheter Choice on Procedural Success of Minimally Invasive Surfactant Therapy

2021 ◽  
Author(s):  
Soume Bhattacharya ◽  
Brooke Read ◽  
Michael Miller ◽  
Orlando da Silva
Keyword(s):  
Adverse Effects ◽  
Minimally Invasive ◽  
Neonatal Intensive Care ◽  
Tertiary Care ◽  
Surfactant Therapy ◽  
Positive Pressure ◽  
P Value ◽  
Chi Square ◽  
Procedural Success ◽  
The Impact

Objective Surfactant delivery via a thin endotracheal catheter during spontaneous breathing; a technique called minimally invasive surfactant therapy (MIST) is an alternative to intubation and surfactant administration. Procedural details among different centers vary, with marked differences in the choice of catheter to instill surfactant. Studies report use of feeding catheters, multiaccess suction catheters, vascular catheters, and more recently custom-built catheters for this purpose. The impact of choice of catheter on procedural success and procedural adverse effects has not been reported. Our present study compares the procedural success and adverse effects of MIST using a semirigid vascular catheter (16G Angiocath-Hobart Method) versus a flexible multiaccess catheter (MAC). Study Design This was a retrospective review of prospectively collected data at a tertiary care neonatal intensive care unit in Southwestern Ontario. All neonates who received surfactant via MIST between May 1, 2016 and September 30, 2020 were included in the study. Relevant baseline characteristics and data on procedural details (premedication, type of catheter, etc.) were collected. The procedural success, number of attempts, and adverse effects between neonates who received MIST via MAC and 16G Angiocath was compared by using Chi-square test or Fisher's test as appropriate. A p-value of less that 0.05 was considered significant. Results A total of 139 neonates received surfactant via MIST method during the study period. Moreover, 93 neonates received the surfactant via MAC, while 46 received it via Angiocath. The baseline demographic characteristics in the two group were similar. A higher proportion of neonates in Angiocath group received Atropine (100 vs. 76%, p = 0.002) and Fentanyl (98 vs. 36%, p < 0.001) than the MAC group.The procedural success was 91% in the Angiocath group and 89% in the MAC group (p > 0.99). Multiple attempts were needed in 24% of neonates in the Angiocath group and 37% in the MAC group (p = 0.158). More episodes of desaturations were noted in the Angiocath group (89%) than the MAC group (69%; p = 0.012). Other rates of common adverse effects were similar between the two groups. On exploratory analysis fentanyl use held significant association with less success, more desaturation, apneic episodes, and need of positive pressure ventilation /intubation. Conclusion The overall procedural success of MIST is similar in both catheter groups. The proportion of neonates requiring multiple attempts was lower with the Angiocath, though difference was not statistically significant. Desaturation episodes were seen more frequently in the Angiocath group, which was related to higher use of procedural sedation in this group. Key Points

scholarly journals Clinical Profile of Neonates with Respiratory Distress in a Tertiary Care Hospital

2019 ◽  
Vol 57 (220) ◽  
Author(s):  
Anita Lamichhane ◽  
Kiran Panthee ◽  
Sharmila Gurung
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Respiratory Distress ◽  
Sample Size ◽  
Neonatal Intensive Care ◽  
Tertiary Care Hospital ◽  
Perinatal Asphyxia ◽  
Tertiary Care ◽  
Care Hospital

Introduction: Respiratory distress in newborns is a very common reason for admission in Neonatal Intensive Care Unit which may be transient or pathological; morbidity is high if not prompted for early diagnosis and treatment. The present study is undertaken to find out the clinical profile of neonates with respiratory distress in infants in a tertiary care hospital in western Nepal. Methods: A descriptive cross-sectional study was carried out in a tertiary care hospital in the western region of Nepal from April 2017 to March 2018 after approval from the institutional review committee. Sample size was calculated and consecutive sampling was done to reach the sample size. Data were collected from the study population after taking consent and entered in a predesigned proforma. It was then entered in a Statistical Package for Social Sciences, data analysis was done to find frequency and proportion for binary data. Results: Tachypnea was the most common presentation 77 (69.36%). Out of 1694 live deliveries during the study period, the prevalence of respiratory distress was 6.55 % in the total live deliveries while 30.83 % in admitted cases in Neonatal Intensive Care Unit. Survival rate was 95.50% while mortality rate accounted for 4.50%. Conclusions: Perinatal asphyxia accounted for the commonest cause of respiratory distress. To lessen the morbidity and mortality of the neonates with respiratory distress it is advocated that we practice proper and timely neonatal resuscitation, recognize the risk factors as early as possible so that perinatal asphyxia can be minimized.      

scholarly journals Antimicrobial usage and its quantification for neonatal sepsis at a tertiary care hospital neonatal intensive care unit

2019 ◽  
Vol 8 (9) ◽  
pp. 2046
Author(s):  
Manjari Kumari ◽  
Suparna Chatterjee ◽  
Tapas Som ◽  
Pinaki Chattopadhyay
Keyword(s):  
Intensive Care ◽  
Neonatal Sepsis ◽  
Neonatal Intensive Care ◽  
Tertiary Care ◽  
Care Hospital ◽  
Sensitivity Pattern ◽  
Prescribing Trends ◽  
Days Of Therapy ◽  
Significant Difference ◽  
Culture Positive

Background: Antimicrobial therapy for neonatal sepsis is challenging as its judicious use can save neonates while its inappropriate use can lead to rapid emergence of resistant strains. Quantification of consumption of antimicrobial agents (AMA) has not been undertaken in Indian neonatal intensive care units (NICU) setting. This prospective observational study evaluated the antimicrobial prescribing pattern and quantified its consumption in clinically suspected neonatal sepsis (NS) cases.Methods: Clinically suspected NS cases admitted over study period of 18 months in a tertiary care level III NICU were enrolled. Data of antimicrobials prescribed, its consumption, culture sensitivity profile of organisms isolated were collected.Consumption was quantified by computing the days of therapy (DOT) per 1000 patient-days (PD).Results: 150 clinically suspected NS cases were enrolled; 37.33% were culture positive. The most common AMA prescribed were netilmicin (94.67%), piperacillin-tazobactam (88.67%). Only 0.67% cases received reserve antimicrobials like colistin, vancomycin and linezolid. 58% received 2 AMA, 39.33% received ≥3 agents. Total antimicrobial consumption was 614.86 DOT/1000 PD and 21.68 DOT/ neonate. Statistically significant difference in total AMA consumption amongst culture positive versus negative cases (p <0.001) was observed but difference was not significant in EOS versus LOS (p=0.95).Conclusion: Usage of antimicrobials for neonatal sepsis was guided by sensitivity pattern of local prevalent flora and clinical response. Usage of reserve antimicrobials were restricted. However, consumption of AB was higher compared to developed countries and we intend to use the study outcome data for antibiotic stewardship program to reduce antibiotic consumption and modify prescribing trends at the study setting.

scholarly journals Pattern of growth and neurodevelopmental outcome of preterm babies born ≤34 weeks of gestation in a South Indian tertiary care hospital

2018 ◽  
Vol 5 (2) ◽  
pp. 467
Author(s):  
Mohandas Nair ◽  
Gireesh S. ◽  
M. Vijayakumar ◽  
Anjana B.
Keyword(s):  
Neonatal Intensive Care ◽  
Tertiary Care ◽  
Neurodevelopmental Outcome ◽  
Care Hospital ◽  
Middle Income ◽  
Motor Delay ◽  
South Indian ◽  
Cognitive Delay ◽  
Preterm Babies ◽  
Catch Up

Background: Advances in neonatal care since the early days have led to an increase of survival in preterm infants. Developmental sequelae, however are still a major problem mostly because babies who would previously have been expected to die are now surviving due to neonatal intensive care. There is scarcity of data regarding the outcome of prematurity from low and middle-income countries like India in literature.Methods: 140 preterm babies born at or before 34 weeks of gestation were enrolled and followed up for 1 year. All babies were screened for retinopathy of prematurity and hearing impairment. Anthropometric measurements were taken at 40 weeks, 3 months, 6 months, 9 months and 12 months of corrected age. Neurodevelopmental assessment was done using the Bayley scales of infant and toddler development III at 1 year of age.Results: Among 140 preterm babies, 6 babies expired before 1 year. Majority had catch up growth by 1 year of age. Growth and neurodevelopment were inversely proportional to birth weight and gestational age. Incidence of severe ROP requiring intervention was 8.6% and hearing aid was needed in 4%. At 1 year 24% had cognitive delay, 27% had language delay and 29% had motor delay. Intraventricular hemorrhage, culture proven sepsis, shock and DIC in newborn period were strong predictors of neurodevelopmental impairment.Conclusions: Majority of preterm babies showed catch up growth and had good neuro developmental outcome at 1 year of corrected age.

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