Kangaroo father care to reduce paternal stress levels: A prospective observational before-after study.

OBJECTIVE: The objective was to assess stress in fathers of preterm infants and use of "Kangaroo Father Care (KFC)" to mitigate it. STUDY DESIGN: Stress levels of 30 fathers of preterm infants admitted in the NICU were assessed using the parental stressor scale: neonatal intensive care unit (PSS: NICU) before and after three sessions of KFC. The data was analysed using Wilcoxon signed rank sum test. RESULT: There was a statistically significant reduction in stress levels after KFC (p = 0.006). Amongst all the four subscales, stress levels were found to be reduced in 'staff behaviour and communication' (p = 0.001) domain and 'baby looks and behaves' domain (p = 0.05). CONCLUSION: Fathers of preterm infants admitted in the NICU experience a lot of stress, which can adversely affect their mental health. Kangaroo care is very effective in reducing this paternal stress levels.

Human leukocyte antigen (HLA)-C and its association with HIV-1 transmission in discordant couple and mother-to-child cohorts.

Human leukocyte antigen (HLA) molecules play a key role in regulating the immune response towards infectious agents like human immunodeficiency virus type-1 (HIV-1). They have been shown to influence transmission as well as the progression of HIV-1 towards acquired immune deficiency syndrome (AIDS). Roles of HLA-A and HLA-B have been documented extensively; however, HLA-C has been poorly studied. In the present study, we have evaluated the role of HLA-C in discordant couple and mother-to-child cohorts. HLA-C*07 was higher both in HIV-1-infected spouses and infants as compared to exposed uninfected spouses and infants. However, this was not significant. HLA-C*15 was significantly higher in HIV-1-exposed uninfected babies as compared to infected babies. Lack of treatment in mothers and breastfeeding were significantly associated with HIV-1 transmission. HLA-C*07 may be a susceptible allele in HIV-1 transmission, whereas HLA-C*15 may be a protective allele in mother-to-child cohorts, independent of feeding options and treatment. These findings could be important in targeting immune responses via population-specific vaccine strategies against HIV-1.

Physiological effects of a single chest physiotherapy session in mechanically ventilated and extubated preterm neonates.

OBJECTIVE: To assess the changes on various physiological cardio-respiratory parameters with a single chest physiotherapy session in mechanically ventilated and extubated preterm neonates with respiratory distress syndrome. STUDY DESIGN: This is a prospective observational study in a neonatal intensive care unit setting. Sixty preterm neonates with respiratory distress syndrome, thirty mechanically ventilated and thirty extubated preterm neonates requiring chest physiotherapy were enrolled in the study. Parameters like heart rate (HR), respiratory rate (RR), Silverman Anderson score (SA score in extubated), oxygen saturation (SpO2) and auscultation findings were noted just before, immediately after chest physiotherapy but before suctioning, immediately after suctioning and after 5 minutes of the session. RESULTS: The mean age of neonates was 9.55±5.86 days and mean birth weight was 1550±511.5 g. As there was no significant difference in the change in parameters on intergroup comparison, further analysis was done considering two groups together (n = 60) except for SA score. As SA score was measured only in extubated neonates. HR did not change significantly during chest physiotherapy compared to the baseline but significantly decreased after 15 minutes (p = 0.01). RR and SA score significantly increased after suctioning (p = 0.014) but reduced after 15 minutes (p = <0.0001). SpO2 significantly reduced post-suctioning compared to the baseline and increased after positioning and 15 minutes of chest physiotherapy (p = <0.0001). Clinically, there was a reduction in HR, RR and SA score with an improvement in SpO2. This signifies that chest physiotherapy may help facilitate the overall well-being of a fragile preterm neonate. Lung auscultation finding suggests that after suctioning, there was a significant reduction in crepitation (p = 0.0000) but significant increase in crepitation after 15 minutes (p = <0.01), suggesting the importance of around-the-clock chest physiotherapy. CONCLUSION: Chest physiotherapy is safe in preterm neonates. Suctioning causes significant cardio-respiratory parameter changes, but within normal physiological range. Thus, chest physiotherapy should be performed with continuous monitoring only when indicated and not as a routine procedure. More research is needed to study the long term effects of chest physical therapy.

An appropriately performed conventional blood culture can facilitate choice of therapy in resource-constrained settings-comparison with BACTEC 9050.

AIMS: Comparison of conventional blood culture with BACTEC 9050 for rate and time to detection of microorganisms. SETTINGS AND DESIGN: A prospective study was carried out in a multispecialty tertiary care teaching hospital. SUBJECTS AND METHODS: A total of 835 paired specimens (797 blood and 38 nonblood specimens) were collected and processed according to standard microbiological procedures by both conventional method as well as by BACTEC 9050 automated culture system. Clinical details of patients were recorded. Data were analyzed for time to detection and isolation rate by the two systems and compared. RESULTS: Overall culture positivity for BACTEC 9050 and the conventional system was 32% and 19.88%, respectively. Eighty-five demonstrated concordant growth, 136 specimens were culture positive by BACTEC only, and 38 specimens were culture positive by conventional only. Twelve contaminants in BACTEC and nine contaminants in conventional system were detected. Using BACTEC 9050, higher isolation was observed for Acinetobacter spp., coagulase negative Staphylococcus spp., Streptococcus spp., and Candida spp. A total of 410 patients were on antimicrobial treatment and culture positivity was significantly higher with BACTEC 9050 (P < 0.0001). There was a significant difference in the mean time to detection with BACTEC 9050 recovering 86.8% of isolates within 48 h (P < 0.0001). CONCLUSIONS: Although BACTEC 9050 demonstrated a significantly higher recovery of microorganisms from blood, an appropriately performed conventional blood culture can facilitate the choice of therapy.

Oral paracetamol in treatment of closure of patent ductus arteriosus in preterm neonates.

We herewith report a case series of six premature neonates with hemodynamically significant paten ductus successfully treated with oral paracetamol. This is a first case series describing the use of oral paracetamol treatment patent ductus in preterm neonates from India. Further prospective randomized-controlled trials are needed to evaluate the efficacy and safety of oral paracetamol in the treatment of patent ductus in preterm neonates.

Antiretroviral treatment, viral load of mothers & perinatal HIV transmission in Mumbai, India.

BACKGROUND & OBJECTIVES: Mother-to-child transmission (MTCT) is the most significant route of HIV transmission in children below the age of 15 yr. In India, perinatal HIV transmission, even after treatment, accounts for 5.4 per cent of HIV cases. The present study was conducted to evaluate the efficacy of anti-retro viral therapy (ART) or prophylactic treatment (PT) to control maternal viral load in HIV positive women, and its effect on vertical HIV transmission to their infants. METHODS: A total of 58 HIV positive women were enrolled at the time of delivery and their plasma samples were obtained within 24 h of delivery for estimation of viral load. Viral load analysis was completed in 38 women. Infants received single dose nevirapine within 2 h of birth and zidovudine for 6 wk. At the end of 18 month follow up, HIV positive or negative status was available in 28 infants. RESULTS: Results revealed undetectable levels of viral load in 58.3 per cent of women with ART compared to 30.7 per cent of women with PT. No women on ART had viral load more than 10,000 copies/ml, whereas seven (26.9%, P=0.07) women receiving PT had this viral load. Median CD4 count of women on PT (483 cells/µl) was high compared to the women on ART (289 cells/ µl). At the end of 18 months follow up, only two children were HIV positive, whose mothers were on PT. One had in utero transmission; infection detected within 48 h of delivery, while the other child was infected post partum as HIV was detected at six months follow up. INTERPRETATION & CONCLUSIONS: Women who received a single dose of nevirapine during delivery had higher levels of viral load than women on ART. Combination drug therapy for pregnant women is now a standard of care in most of the western countries; use of nevirapine monotherapy at the time of delivery in our settings is not effective in controlling viral load. This highlights initiation of ART in pregnant women to control their viral load and thus to inhibit mother to child HIV transmission.

Noma neonatorum.

Noma Neonatorum is characterized by a gangrenous process involving mucocutaneous junctions of oral, nasal and anal area and occasionally, the eyelids and scrotum. It is seen during the first few weeks of neonatal life in premature and low birth weight babies. Noma Neonatorum is commonly described with pseudomonas aeruginosa septicemia. A case of Noma Neonatorum associated with E.coli sepsis is described for the first time.

Lactation management clinic-positive reinforcement to hospital breastfeeding practices.

Supportive breastfeeding policies in the hospital constitute the foundation for initiation of successful breastfeeding by mothers, constant reinforcement and support to all lactating mothers is however essential to maintain lactation. The objective, methodology and outcome of the Lactation Management Clinic which constitutes a hospital-based mother support group is described. The study was carried out over a period of 2 1/2 years and 519 mothers had attended this clinic. Analysis of the data revealed that at the time of the 1st visit to the clinic, 65.9% mothers had already started supplementary top feeds and the commonest reason encountered was mother's own assessment of inadequate milk seen in 73.6% mothers. Two-thirds (66.9%) of babies in our study were roomed in right from the first day of life, 75.3% of babies had received colostrum and 67.1% babies had not received any prelacteal feeds and yet faced problems at lactation. Mother and infant evaluation revealed no complications with 86.5% mothers and with 54.5% babies. Local breast problems were detected in 19.3% mothers. Faulty positioning was observed in 47.2% patients. Psychological support to mothers was the most important form of therapy given. Seventy eight per cent mothers practiced exclusive breastfeeding subsequently while 21.2% of mothers were partially successful in lactation. Only 3 mothers had lactation failure.

Time-variant conductance of bilayer membranes treated with monazomycin and alamethicin.

Experimental data obtained on bilayer membranes treated with either of two antibiotics, monazomycin or alamethicin, are presented showing the marked difference in the time course of the rise and subsequent decay of the conductance in response to a positive and negative step of potential established by means of a voltage-clamp feedback circuit. The variation of the conductance with time in these model systems qualitatively mimics the behavior of the "potassium conductance" of squid giant axons and other excitable biological systems; namely, the rise of the conductance to the steady state requires a longer time than its decay to the resting state. For the alamethicin system, the decay time becomes very brief-as short as 50 musec-as either the salt or the alamethicin concentration is reduced, while the rise time remains several seconds. This marked brevity of the decay time versus the rise time may have implications for the mechanism underlying the formation of conducting channels in such membranes.