Dysphagia intervention in NICU set up: a report of case studies in an Indian public hospital

<p class="abstract">A retrospective study was conducted in the Neonatal Intensive Care Unit (NICU) of a public hospital in Mumbai, India wherein 13 neonates with varying pathophysiologies were taken up for swallowing intervention. Of these, 7 neonates had history of prematurity, 1 was born of twin birth with prematurity, 3 had clefts of lip/palate and 2 had Pierre Robin Syndrome. For 7 neonates with prematurity, the swallowing regimen consisted of oro motor intervention (OMI) followed with therapeutic oral feeds. With improved tolerance of oral feeds while maintaining airway safety, they were graduated to oral feeds progressively increasing in volume until they reached optimum prescribed oral feeds. 6 out of 7(86%) progressed to breast feeds while1 succumbed to medical complications. 3 babies with CLP graduated to complete oral feeds through bondla, when they were fitted with obturators and had swallowing intervention but were unable to move to breastfeeds while in NICU. 2 babies with PRS could not tolerate oral feeds even after multiple sessions and had to be maintained on orogastric feeds. 1 infant, one of a twin delivery with prematurity although was showing improvement to OMI succumbed to medical complications. Among these neonates, those with prematurity showed the maximum improvement with swallowing intervention followed by infants with CLP. Co-morbidities such as prematurity in twin births worsened the prognosis as did a disorder such as PRS. This preliminary study, done on a small sample, stressed the importance of swallowing intervention in neonates with high risk factors by the SLP in the NICU in an Indian set up. </p>

P–785 Double versus sequential single blastocyst transfer in freeze all cycles?

Study question Is double blastocysts transfer (DET) better than sequential single blastocyst transfer (seq-SET) in freeze all cycles? Summary answer Sequential single blastocyst transfer provides a higher live birth rate (LBR) per cycle initiated and eliminates multiple births in freeze-all cycles. What is known already Improvements in cryopreservation technology helped freeze-all strategy gain much popularity. The new debate is whether guidance for single embryo transfer should also be applied to frozen-thawed embryo transfers in freeze-all cycles. Study design, size, duration We performed a retrospective cohort analysis of 860 women in whom the entire cohort of embryos frozen at the blastocyst stage for various indications. All women aged 19–43 years, who had at least two blastocysts frozen and subsequently thawed and transferred were included. Preimplantation genetic testing cycles were excluded.The study period ranged from January 2016 to May 2019. Participants/materials, setting, methods Data regarding female age, number of embryos transferred, multiple pregnancy and live birth rates (LBR) were extracted from the electronic database. Women were categorized based on their age and the mode of embryo transfer. Primary outcome was live birth rate LBR per cycle initiated. Secondary outcomes were LBR per embryo transfer and multiple birth rate. Groups were compared using Fisher’s test, generalized estimating equation model and logistic regression analysis to adjust for confounding factors. Main results and the role of chance The study group comprised of 666 women (371 Seq-SET and 295 DET) who underwent 837 embryo transfer cycles. Second embryo transfer was affected in 46.1% of women in the Seq-SET group. Age, indication for freeze-all, and mode of transfer were related with the LBR. For women ≤ 35 (n = 370), LBRs per embryo transfer were similar in single and double embryo transfers (53.9% versus 64.2% respectively, p = 0.006, aOR=0.65, 95% CI:0.41–1.01). However, LBR per cycle initiated was significantly higher in Seq-SET group (78.9% versus 64.2% respectively, p = 0.004, aHR=2.09, 95% CI:1.28–3.41). While only one monochorionic twin delivery was observed with Seq-SET (0.5%), 19 out of 70 (27.1%) live births after DET were twins. For women &gt;35 of age (n = 296) the likelihood of a live birth per embryo transfer was lower in single compared to double embryo transfers (33.2% versus 46.2%, respectively, p = 0.012, aOR=0.58 95% CI:0.38–0.88). Although LBR per cycle initiated was higher in Seq-SET (58.2%) than DET (46.2%), the difference did not reach statistical significance (p = 0.054, aHR=1.62, 95% CI:1.00–2.60). While no twin delivery was observed with Seq-SET, 8 out of 86 (9.3%) live births with DET were twins. Limitations, reasons for caution This was a retrospective study with small sample size performed at a single fertility center, which may limit the generalizability of our findings. Cost-efficiency was not studied. Wider implications of the findings: Seq-SET is associated with a comparable or higher likelihood of live birth per cycle initiated and a very low risk of twins when compared to DET. However, half of SET cases had to undergo two transfer cycles. Trial registration number NA

Assessments of Birth Outcome of Twin Delivery and Associated Factors among Newborns in Dessie Referral Hospital, Dessie, Ethiopia, 2019

Background. There was a fast improvement of twin’s birth outcomes in the past decade, but it was average in developing countries. Stillbirth, preterm birth, low birth weight, and birth asphyxia are the major contributors to poor twin birth outcomes. This study was crucial to address the gaps and clarify the outcome of twin delivery. Objectives. To assess the birth outcome of twin delivery and associated factors among newborns who were delivered in Dessie Referral Hospital, Ethiopia, 2019. Methods. Institutional-based retrospective cross-sectional study was employed among 385 maternal records from Nov 10/2013 to Dec 10/2019. Data were selected by using a random sampling technique. Frequencies, proportion, and summary statics were used to describe the study population. The data were entered into Epi Info and exported in the SPSS version 20 for analysis. All variables with p value < 0.20 in bivariable logistic regression analysis were considered for multivariable logistic regression analysis; adjusted odds ratio with 95% confidence interval was used to measure the association variable with p value < 0.05 which was statistically significant. Results. This finding showed that the prevalence of twin birth outcome accounts 23.4% (95 % CI, 19.2–27.5). Low birth weight 9.1%, stillbirth 4.2%, Apgar score < 7 9.1%, and neonatal death 1 % were accounted. Hypertension disorder (95% CI, 6.01(2.43–14.87)), rural residence (95% CI 2.46(1.39–4.37)), PROM (95% CI 6.39(2.52–16.16)), and no ANC follow-up (95% CI, 13.47(2.49–72.85)) were significantly associated with adverse twin birth. Conclusions and Recommendations. Magnitude of twins’ adverse birth outcome was 23.4%. Hypertension disorder, rural residence, PROM, and no ANC follow-up were significant variables for twins’ adverse birth outcome. Therefore, all healthcare providers should give sustainable educations and instructions about the importance of sticking with the recommended ANC follow-up.

Bilateral scrotoshisis a rare entity: case report

Background Scrotoschisis is a rare anomaly in which the testis is lying outside scrotum congenitally. Only few cases have been reported in literature under different names most of which are unilateral. We have found only one case of bilateral scrotoschisis in literature. Case presentation Newborn presented to us after normal term twin delivery as a case of bilateral scrotoschisis in which both testes were lying outside the scrotum congenitally. Baby underwent uneventful bilateral orchiopexy and was discharged home the next day. Conclusion Scrotoschisis is a very rare genital anomaly with only a few cases reported in literature. This report would add to the literature which would help in studying the exact mechanism and embryopathogenesis of this anomaly which is not known yet.

Neonatal Outcomes Among Survivors of Twin-twin Transfusion Syndrome After Single Fetal Demise

Twin-twin transfusion syndrome (TTTS) is due to unbalanced inter-twin blood flow. We aimed to evaluate neonatal outcomes among surviving co-twins of TTTS without fetal laser photocoagulation after single-twin intrauterine fetal demise (sIUFD). All patients admitted between January 2014 and December 2017 to the neonatal intensive care unit of a medical center were recruited. Moreover, a comprehensive literature review of PubMed from 1993 to 2020 was performed. Medical records of 124 patients were retrieved, including 119 from published literature and five from our institution. Seventy-three (58.8%) patients were born prematurely. In addition, twenty-four (19.3 %) patients presented with anemia at birth, and seventeen (13.7%), four (3.2%), and four (3.2%) neonates had intracranial lesions, acute kidney injury, and gastrointestinal (GI) tract dysmotility, respectively. The overall survival rate was 69.4 %. Among our cases, we found that the hemoglobin level at birth was positively correlated with the duration between co-twin intrauterine fetal demise and the delivery time of the surviving co-twins (rs=0.9, p=0.037). Conclusions: High morbidity and mortality rates were observed among co-twins of TTTS after sIUFD without laser photocoagulation. The shorter duration between diagnosis of sIUFD and surviving twin delivery resulted in more severe anemia.