Effect of Kangaroo Mother Care plus Touch Therapy versus Kangaroo Mother Care Alone on the Low-Birth-Weight Infant’s Growth and Physiologic Responses: Randomized Controlled Trial

Background. Kangaroo Mother Care (KMC) has facilitated infant growth and decreased morbidities and hospital stay. Adding touch therapy (TT) may potentiate the KMC benefits. Objective. To compare the effectiveness of KMC+TT versus KMC alone in improving anthropometric and physiologic parameters and decreasing morbidities and hospital stay in low birth weight (LBW) infants. Methods. Stable LBW infants (<2000 g) admitted in the KMC ward were randomized to either intervention (KMC+TT) or control (KMC only) group. The KMC+TT group underwent thrice daily touch therapy sessions until discharge. Results. A total of 50 infants were included in the study. Baseline characteristics between the two groups were comparable. There was a significant increase in weight gain (grams/kg/day) in the KMC+TT group compared to KMC only. Physiologic parameters like heart rate, respiratory rate, and temperature were significantly better in the KMC+TT group. More infants in the KMC only group were transferred to NICU care, while more KMC+TT infants went home against advice. Hospital stay was similar between the two groups. Conclusion. Touch therapy added to KMC is more effective than KMC alone in improving weight gain and physiologic parameters. It is associated with lower morbidities, although it did not affect the hospital stay.

Influence of parental anxiety on children’s behaviour during their visits to dental clinic: a short clinical study

Background Anxiety and fear of dental treatment in children have been recognized as sources of serious health problems. Parents are known to subtly transmit feelings of fear and anxiety to their children Commonly which has influence on children’s dental anxiety are maintenance of general health of the child, past dental history, oral hygiene practices and attitudes in the family towards oral health and high dental anxiety of parents, all of these contributed to sustained and elevated levels of children’s dental anxiety. Aim This study was undertaken to evaluate the influence of parental anxiety on their children during their visit to dental clinics. Objective To determine the relationship between parental anxiety level and that of a child. Methods A short clinical study was performed to assess the influence of parental anxiety on their children during their visit to dental clinics. Twenty subjects were randomly selected and their parents were given the Modified Dental Anxiety Scale Questionnaire (MDAS) and their physiologic parameters were measured during each visit. Similarly, the children’s responses were analyzed using the Facial Image Scale (FIS) and their physiologic parameters were measured. Results The values show a positive correlation (P < 0.05) between the scores (MDAS and FIS) and physiologic parameters (blood pressure and heart rate) of parents and their children. Conclusion The dental anxiety levels in parents influence the anxiety levels in children.

Early prediction of hemodynamic interventions in the intensive care unit using machine learning

Background Timely recognition of hemodynamic instability in critically ill patients enables increased vigilance and early treatment opportunities. We develop the Hemodynamic Stability Index (HSI), which highlights situational awareness of possible hemodynamic instability occurring at the bedside and to prompt assessment for potential hemodynamic interventions. Methods We used an ensemble of decision trees to obtain a real-time risk score that predicts the initiation of hemodynamic interventions an hour into the future. We developed the model using the eICU Research Institute (eRI) database, based on adult ICU admissions from 2012 to 2016. A total of 208,375 ICU stays met the inclusion criteria, with 32,896 patients (prevalence = 18%) experiencing at least one instability event where they received one of the interventions during their stay. Predictors included vital signs, laboratory measurements, and ventilation settings. Results HSI showed significantly better performance compared to single parameters like systolic blood pressure and shock index (heart rate/systolic blood pressure) and showed good generalization across patient subgroups. HSI AUC was 0.82 and predicted 52% of all hemodynamic interventions with a lead time of 1-h with a specificity of 92%. In addition to predicting future hemodynamic interventions, our model provides confidence intervals and a ranked list of clinical features that contribute to each prediction. Importantly, HSI can use a sparse set of physiologic variables and abstains from making a prediction when the confidence is below an acceptable threshold. Conclusions The HSI algorithm provides a single score that summarizes hemodynamic status in real time using multiple physiologic parameters in patient monitors and electronic medical records (EMR). Importantly, HSI is designed for real-world deployment, demonstrating generalizability, strong performance under different data availability conditions, and providing model explanation in the form of feature importance and prediction confidence.

One-session bilateral sequential whole lung lavage (OSBSWLL) for the management of pulmonary alveolar proteinosis

Background Whole Lung Lavage (WLL) has been an important part in the management of Pulmonary Alveolar Proteinosis (PAP) since it improves radiologic and clinical parameters. Bilateral WLL is usually performed in two sessions on different days. Few case reports have described one-session bilateral sequential lung lavage (OSBSWLL), and none have described ambulatory management (same-day discharge). Methods Demographic characteristics, physiologic parameters, procedure details and outcomes were retrospectively collected on consecutive patients who underwent OSBSWLL for PAP following an ambulatory protocol stablished in our institution. Results A total of 13 patients underwent 30 OSBSWLL (61.5% male; mean age 40). The mean SpO2 was 90% (IQR 9) and 94% (IQR 6), before and after OSBSWLL respectively. In 63.3% of cases, patients were discharged home the same day of procedure. Only in two cases (6.6%), patients required post-procedure prolonged mechanical ventilation (> 4 h) due to persistent hypoxia. Conclusions OSBSWLL can be performed with same-day discharge.

P.186 Transcranial Doppler Based Continuous Assessment of Cerebrovascular Reactivity in Adult Traumatic Brain Injury: A Scoping Review of Associations with Outcomes

Background: Disruption in cerebrovascular reactivity following traumatic brain injury (TBI) is a known phenomenon that may hold prognostic value. Transcranial Doppler (TCD) has been employed to evaluate cerebrovascular reactivity following injury utilizing a continuous time-series approach. Methods: A systematically conducted scoping review of the literature on the association of continuous time-domain TCD based indices of cerebrovascular reactivity, with outcomes following moderate and severe TBI was performed. Multiple databases were searched from inception to November 2020 for relevant articles. Results: Thirty-six relevant articles were identified. There was significant evidence supporting an association with continuous time-domain TCD based indices and functional outcomes following TBI. Physiologic parameters such as intracranial pressure, cerebral perfusion pressure, Carbon Dioxide (CO2) reactivity as well as more established indices of cerebrovascular reactivity have all been associated with these TCD based indices. The literature has been concentrated in a few centres and is further limited by the lack of multivariate analysis. Conclusions: There is a substantial body of evidence that cerebrovascular reactivity as measured by time-domain TCD based indices have prognostic utility following TBI. The literature supports some associations between these indices and cerebral physiologic parameters. Further validation in multi-institution studies is required before these indices can be widely adopted clinically.

Chest X-ray Severity and its Association with Outcomes in Patients with COVID-19 Presenting to the Emergency Department

Background: Severity of radiographic abnormalities on chest X-ray (CXR) in patients with COVID-19 has been shown to be associated with worse outcomes, but studies are limited by different scoring systems, sample size, patient age and study duration. Data regarding the longitudinal evolution of radiographic abnormalities and its association with outcomes is scarce. We sought to evaluate these questions using a well-validated scoring system (the Radiographic Assessment of Lung Edema [RALE] score) using data over 6 months from a large, multi-hospital healthcare system. Methods: We collected clinical and demographic data and quantified radiographic edema on CXRs obtained in the emergency department (ED) as well as on days 1-2 and 3-5 (in those admitted) in patients with a nasopharyngeal swab positive for SARS-CoV-2 PCR visiting the ED for COVID-19-related complaints between March and September 2020. We examined the association of baseline and longitudinal evolution of radiographic edema with severity of hypoxemia and clinical outcomes. Results: 870 patients were included (median age 53.6, 50.8% female). Inter-rate agreement for RALE scores was excellent (ICC = 0.84, 95% CI 0.82 - 0.87, p < 0.0001). RALE scores correlated with hypoxemia as quantified by SpO2-FiO2 ratio (r = -0.42, p < 0.001). Admitted patients had higher RALE scores than those discharged (6 [2, 11] vs 0 [0, 3], p < 0.001). An increase of RALE score of 4 or more was associated with worse 30-day survival (p < 0.01). Larger increases in the RALE score were associated with worse survival. Conclusions: The RALE score is reproducible and easily implementable in adult patients presenting to the ED with COVID-19. Its association with physiologic parameters and outcomes at baseline and longitudinally makes it a readily available tool for prognostication and early ICU triage, particularly in patients with worsening radiographic edema.

Anthropometric and Physiologic Parameters in Cleft Neonates: A Hospital-Based Study

The oro-facial morphology is greatly affected in neonates with a cleft lip and palate. The initial evaluation of neonate’s body and maxillary arch dimensions is important for treatment planning and predicting growth in cleft patients. The objective of this study was comparative evaluation of the anthropometric and physiologic parameters of cleft and non-cleft neonates in a hospital-based set up. This cross sectional study was conducted on 88 cleft and non-cleft neonates (n = 44 in each group) aged between 0 and 30 days after obtaining approval from the institutional ethics committee and positive written informed consent from their parents. Neonates’ body weight, body length, head length, head circumference, and maxillary arch dimensions were measured. Maxillary arch dimensions were measured on dental casts with digital sliding calipers. Statistical analyses performed using the independent t-test and one-way ANOVA analysis were followed by Bonferroni correction for post-hoc comparison. The results showed statistically significant differences in birth weight (p < 0.0001), head length (p < 0.01), head circumference (p < 0.007), and maxillary arch dimensions (p < 0.0001) between cleft and non-cleft neonates. These findings suggest that cleft neonates had significant anthropometric and physiologic variations than non-cleft neonates.