Frequency of Thrombocytopenia in Neonates Following Phototherapy in Neonatology Unit of Tertiary Care Hospital

Aim: To determine the frequency of thrombocytopenia and its severity in relation to level of indirect hyperbilirubinemia in neonates following phototherapy at tertiary care hospital. Study Design: Descriptive study Place and duration: This study was conducted at Paediatric department (neonatal ward), Liaquat University Hospital, Hyderabad, from 1st August 2020 till 31st Jan 2021 Methodology: All neonates who fulfilled the inclusion criteria presented at pediatric department (neonatal ward), Liaquat University Hospital Hyderabad were included in the study. After written consent, brief history was taken from the mother or family member and complete blood count (CBC) was sent to check the baseline platelet count along with total serum bilirubin, it was repeated after 48 hours of phototherapy. Results: Out of 231 neonates 70 (30.3%) developed thrombocytopenia after phototherapy. In our study 117 neonates (50.6%) were males & 114 neonates (49.4%) were females with the mean age of 5.9307+1.6640 days. The thrombocytopenia was seen in 70 neonates (30.3%) and type of severity was mild, moderate & severe in 52(22.5%), 13(5.6%) & 5(2.2%) respectively. Conclusion: There was a decline in mean platelet count after phototherapy but it was not statistically significant. The treating doctor should also keep in mind, other causes of thrombocytopenia when the patient is receiving phototherapy.

A Comparative Analysis of Intermittent and Continuous Phototherapy in Patients with Neonatal Jaundice

Aim: To compare the outcome of intermittent phototherapy versus continuous phototherapy in treatment of neonatal jaundice. Study Design: Randomized clinical trial (RCT). Place and Duration: This study was conducted at Department of pediatrics, neonatal ward, Liaquat university hospital Hyderabad/Jamshoro, from 8 January to 7 July 2020 Methodology: There were 222 neonate with jaundice, which were randomly allocated into two groups. One hundred and one neonates were in group “A” who received continuous phototherapy while 111 neonates were treated with intermittent phototherapy called group B. Phototherapy units were identical regarding their manufacture and radiance with 5 blue light tubes at a distance of 15-20 cm above neonate that produced the irradiance of 20µW/cm2/nm at 420-470 nm. Serum bilirubin levels were measured every 12 hourly after starting phototherapy up to 48 hours. SPSS version 22 was used for data analysis. Results: The average age of the neonates was 2.23±1.45 days. In this study, the reduction of bilirubin level in both groups after 12, 24, 36, 48 hours of phototherapy and at the time of discharge was not different between groups. Conclusion: Intermittent and continuous phototherapies were found to be equally effective. Because of its additional benefits, intermittent phototherapy can be adopted as a routine procedure instead of continuous phototherapy in neonatal care units, however, it needs to be confirmed by large scale RCTs.

Role of Short Duration Double Phototherapy in The Treatment of Unconjugated Hyperbilirubinemia

Objective: To determine the role of short duration double phototherapy in the treatment of unconjugated hyperbilirubinemia. Materials and Methods: This prospective cases series study was conducted at pediatric department of CMH hospital at Malir Karachi. All the neonates diagnosed with unconjugated hyperbilirubinemia admitted to the neonatal ward were included. All the cases underwent short duration double phototherapy. Babies were observed for side-effects of phototherapy, like skin reaction and dehydration. Serum bilirubin was checked by bilirubinometre after 6 hourly of the treatment. Al the data was collected via study proforma. Data was analyzed by using SPSS version 20 Results: Total 74 neonates were studied, most of the neonates presented within 48-72 hours after birth. Majority of the term babies as 59.5% had history of 37-40 weeks of gestation and 28.4% had gestational age history >40 weeks. Out of all, males’ babies were 58.1% and female babies were 41.9%. Neonatal bilirubin level was significantly decreased from bassline 18.35+0.97 after 6 hours of double phototherapy as 14.66+1.18 with mean difference of 3.68+1.37 (p-value 0.001). Conclusion: Short duration double phototherapy found to be the effective, reliable and safe for skin reaction in the treatment of unconjugated hyperbilirubinemia. Key words: Hyperbilirubinemia, double phototherapy, six hours

Adherence to the ABCDE approach in relation to the method of instruction: a randomized controlled simulation study

Background The Airway, Breathing, Circulation, Disability, and Exposure (ABCDE) approach is widely recommended and taught in many resuscitation courses. This study assessed the adherence to the ABCDE algorithm and whether this was affected by the instruction method used to teach this approach. Methods Randomized controlled trial in which simulation was used as investigational method. Between June 2017 and January 2018, neonatal healthcare providers routinely participated in simulated neonatal advanced life support (NALS) scenarios, using a high-fidelity manikin. They were randomly assigned to a video-based instruction (intervention group) or a conventional lecture (control group) as the method of instruction. One blinded researcher evaluated the adherence to the ABCDE approach on video with an assessment tool specifically designed and tested for this study. The primary outcomes were: 1) the overall adherence and 2) the between-group difference in individual adherence to the ABCDE approach, both expressed as a percentage score. Secondary outcomes were: 1) the scores of each profession category (nurses, neonatal ward clinicians, fellows/neonatologists) and 2) the scores for the separate domains (A, B, C, D, and E) of the algorithm. Results Seventy-two participants were assessed. Overall mean (SD) percentage score (i.e. overall adherence) was 31.5% (19.0). The video-based instruction group (28 participants) adhered better to the ABCDE approach than the lecture group (44 participants), with mean (SD) scores of 38.8% (18.7) and 27.8% (18.2), respectively (p = 0.026). The difference in adherence between both groups could mainly be attributed to differences in the adherence to domain B (p = 0.023) and C (p = 0.007). Neonatal ward clinicians (39.9% (18.2)) showed better adherence than nurses (25.0% (15.2)), independent of the study group (p = 0.010). Conclusions Overall adherence to the ABCDE algorithm was rather low. Video-based instruction resulted in better adherence to the ABCDE approach during NALS training than lecturing. Trial registration ISRCTN registry, trial ID ISRCTN95998973, retrospectively registered on October 13th, 2020.

Automatic Separation of Respiratory Flow from Motion in Thermal Videos for Infant Apnea Detection

Both Respiratory Flow (RF) and Respiratory Motion (RM) are visible in thermal recordings of infants. Monitoring these two signals usually requires landmark detection for the selection of a region of interest. Other approaches combine respiratory signals coming from both RF and RM, obtaining a Mixed Respiratory (MR) signal. The detection and classification of apneas, particularly common in preterm infants with low birth weight, would benefit from monitoring both RF and RM, or MR, signals. Therefore, we propose in this work an automatic RF pixel detector not based on facial/body landmarks. The method is based on the property of RF pixels in thermal videos, which are in areas with a smooth circular gradient. We defined 5 features combined with the use of a bank of Gabor filters that together allow selection of the RF pixels. The algorithm was tested on thermal recordings of 9 infants amounting to a total of 132 minutes acquired in a neonatal ward. On average the percentage of correctly identified RF pixels was 84%. Obstructive Apneas (OAs) were simulated as a proof of concept to prove the advantage in monitoring the RF signal compared to the MR signal. The sensitivity in the simulated OA detection improved for the RF signal reaching 73% against the 23% of the MR signal. Overall, the method yielded promising results, although the positioning and number of cameras used could be further optimized for optimal RF visibility.

Validity of eosinophil count and monocyte-lymphocyte ratio for early detection of neonatal sepsis

Background: Sepsis is a major cause of mortality in neonatal. Diagnosing neonatal sepsis is a challenge, as its clinical symptoms are not specific. Various studies have been conducted to identify infection markers for early identification of neonatal sepsis, but none have shown satisfactory results. Therefore, we aimed to determine the validity of eosinophil count and monocyte lymphocyte ratio (MLR) for the early detection of neonatal sepsis. Objective: To determine the validity of eosinophil count and monocyte lymphocyte ratio (MLR) for the early detection of neonatal sepsis. Methods: This study was a retrospective study with a diagnostic test. Data were collected from medical records of neonates with early-onset neonatal sepsis (EONS) or clinically EONS who were admitted to Neonatal Ward in Sanglah Hospital between April 2020 and December 2020. The ROC curve was used to determine the cut-off point of eosinophil count and MLR. Furthermore, a chi-squared test was used to determine sensitivity, specificity, PPV, and NPV Results: The total sample was 100 subjects, and 28 subjects had positive blood culture (28%). The eosinophil count (cut-off of 0.16x103/µL or 160 cell/mm3) produced a sensitivity of 57.14%, specificity of 65.28%, PPV of 39.02%, and NPV of 79.66%. At a cut-off value of 0.38, MLR had a sensitivity of 67.86%, specificity of 72.22%, PPV of 48.72%, and NPV of 85.25%. Conclusion: Children with obesity were found to be significantly related to elevated blood pressure (hypertension).

Ceftazidime as an empiric therapy for neonatal sepsis

Background Sepsis is still the leading cause of death in neonates in developing countries. Proper administration of antibiotics is important for managing neonatal sepsis. The microorganisms that cause neonatal sepsis, as well as their sensitivity patterns, change over time and differ from one place to another. Since 2001, ceftazidime has been used as an empirical antibiotic for managing neonatal sepsis at Dr. Mohammad Hoesin Hospital, Palembang, South Sumatera, but its effectiveness is questionable. Objective To evaluate the effectiveness of ceftazidime as an empiric therapy for neonatal sepsis. Methods This study was pre-experimental, for one group, pre- and post-test, was conducted in 49 neonates with neonatal sepsis in the Neonatal Ward at Dr. Mohammad Hoesin Hospital, Palembang, South Sumatera, from April to September 2019. The effectiveness of ceftazidime was determined based on clinical and laboratory improvements 72 hours after ceftazidime administration. Results Of 49 neonates, 28 experienced clinical and laboratory improvement, while 21 experienced improvement in only one parameter, either clinical or laboratory. Gram positive bacteria were found in 22/49 subjects. Conclusion There is a significant difference on white blood cell count and CRP level between before and after ceftazidime administration but overall ceftazidime is no longer effective as empiric antibiotic therapy in neonatal sepsis.

A Review of Blood and Blood Products Requisition and Utilization in Post-neonatal Ward of a Tertiary Hospital in South Western Nigeria

Background: Blood and its products ordering is a common practice in paediatrics. The ready availability of blood and blood components has resulted in liberal use. Inappropriate use of blood and blood products exposes patients to the risk of transfusion transmissible diseases and allergic and haemolytic reactions. Objective: To assess blood and blood products requisition and utilization in a post-neonatal ward in a semi-urban tertiary hospital in Nigeria Methods: Retrospective analysis of medical records of all transfused post-neonatal patients during the study period from 1st July 2015 to¬ 31st December 2016 to calculate the cross-match to transfusion ratio, transfusion probability and transfusion index. Results: The units of blood cross-matched were 98 and 90 blood units transfused. The cross-match to transfusion ratio was 1.09 indicative of significant blood usage. The transfusion probability was 100% indicative of significant blood usage. The transfusion index was 1.10 indicative of significant blood utilization. Conclusion: Transfusion of blood and blood products in the post-neonatal ward of our setting meet the standard criteria for quality indicators for blood utilization.

Bacteriological Profile and Antimicrobial Sensitivity Pattern of Neonatal Sepsis

Introduction: Neonatal sepsis (NS) is one of the important causesof neonatal morbidity anddeath in neonatal ward and neonatal medical care unit,especiallyin emergent nations. Frequent monitoring on pathogens with recent updates and their antimicrobial sensitivity pattern is compulsory for more satisfactory management. Methods: This cross sectionalstudy was outlined to evaluate the bacteriological profile and antimicrobialsensitivity pattern of NS in neonatal ward and neonatal intensive care unit (NICU)of Sylhet Women’s Medical College and Hospital, Sylhet, Bangladeshfrom October 2019 to December 2020. Blood samples from 90 clinically suspected neonatal sepsis cases were accumulated and processed in the microbiological protocol and their antimicrobial sensitivity pattern were determined. Results: Among the90 cases, two third (61, 67.78%) showed positive blood culture. Among the positive blood culture, 38(62.29%) were gram positive isolates and gram negative isolates were 23(37.7%). This study showed Staphylococcus aureuswas the most common organism (59.01%) followed by Escherichia coli (E. Coli)(27.87%), Klebsiella pneumonia (9.87%) and Streptococcus pneumonia (3.28%) among the isolates. Gram positive isolates were highly reactive to Amikacin and Amoxicillin and Clavulenic acid whereas gram negative isolates were highly reactive to Gentamicin and Meropenem. Conclusion: Gram positive organism are the predominant source of NS which was highlighted in our study,though gram negative organism also plays an important role in the mortality cause by neonatal sepsis.