Conductive thermal mattress versus routine care to reduce neonatal hypothermia during transport among low-birthweight neonates: An experimental study with historical controls.

Background: Neonatal hypothermia at delivery, during transport and in the postnatal wards is common, under-recognized and infrequently monitored with prevalence ranging from 32% to 85%. This study compared conductive thermal mattress to routine care for prevention of hypothermia among low-birthweight (LBW) neonates during transport. Methods: From July 2015 to November 2016 (historical controls), all eligible LBW neonates (1500-2499 g) were transported from the labour room/operation theatre to the neonatal intensive care unit (NICU)/postnatal wards using routine care (towels, blankets, cap, mittens and socks) and from December 2016 to December 2018 using conductive thermal mattress (EMBRACETM) Axillary temperature was measured before transport and at arrival in the NICU/postnatal wards using a digital thermometer. Results: A total of 154 and 102 neonates were transported using conductive thermal mattress and routine care, respectively. The mean standard deviation (SD) axillary temperature at arrival in the postnatal wards in conductive thermal mattress and routine care group was 36.6 (0.6) °C and 36.4 (0.5) °C, respectively (p-value 0.005). Relative Risk (RR) of mild and moderate neonatal hypothermia among neonates transported using conductive thermal mattress compared to routine care group was 0.59 (0.33,1.07), number needed to treat (NNT) of 13 and 0.22 (0.04,1.07), NNT 22 respectively. Conclusions: Use of conductive thermal mattress for transport among LBW neonates led to a significant, although clinically small improvement in admission temperatures at the NICU/postnatal ward and non-significant decrease in the incidence of hypothermia.

Favourable outcome in a child with presumed tubercular pancarditis treated with empirical antitubercular therapy.

Cardiac tuberculosis (TB) as an extrapulmonary manifestation of TB is rare. Pericarditis is a common manifestation while myocarditis and endocarditis are less common. Tubercular pancarditis is extremely rare. Endomyocardial involvement of TB is generally clinically silent and present as sudden death due to arrhythmias. It is recommended that empirical antitubercular therapy (ATT) on the basis of clinical suspicion should be avoided in countries where TB is highly prevalent. However, delaying ATT in endomyocardial TB and extensive investigations for demonstration or culture of acid-fast bacilli (AFB) may be associated with morbidity and may lead to catastrophic consequences, especially in a sick child. We present a child with TB pancarditis who presented with congestive cardiac failure and empirical ATT was started after extensive efforts to demonstrate AFB failed and the outcome was good.