Performance of smartphone application to accurately quantify hyperbilirubinemia in neonates: a systematic review with meta-analysis.

Neonatal jaundice is a common clinical condition that can progress to severe hyperbilirubinemia if identification and intervention are delayed. In this study, we aimed to analyze the current evidence on the accurate performance of smartphone applications to quantify bilirubin levels. PubMed, Embase, Emcare, MEDLINE, the Cochrane Library, and Google Scholar were searched from inception until July 2022. Grey literature was searched on "OpenGrey" and "MedNar" databases. We included prospective and retrospective cohort studies that recruited infants with a gestation of ≥ 35 weeks and reported paired total serum bilirubin (TSB) and smartphone app-based bilirubin (ABB) levels. We conducted the review using the guidelines of the Cochrane Collaboration Diagnostic Test Accuracy Working Group and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-diagnostic test accuracy (PRISMA-DTA) statement. The data were pooled using the random effects model. The outcome of interest was agreement between ABB and TSB measurements, provided as correlation coefficient, mean difference, and standard deviation. Certainty of evidence (COE) was assessed based on GRADE guidelines. Fourteen studies were included in the meta-analysis. The number of infants in individual studies ranged between 35 and 530. The pooled correlation coefficient (r) between ABB and TSB was 0.77 (95% CI 0.69 to 0.83; p < 0.01). Reported sensitivities for predicting a TSB of 250 µmol/L in individual studies ranged between 75 and 100% and specificities ranged from 61 to 100%. Similarly, a sensitivity of 83 to 100% and a specificity of 19.5 to 76% were reported for predicting a TSB of 205 µmol/L. Overall COE was considered moderate.    Conclusion: Smartphone app-based bilirubin estimation showed a reasonable correlation to TSB levels. Well-designed studies are required to determine its utility as a screening tool for various TSB cut-off levels. What is Known: • Neonatal jaundice is a common clinical condition. Timely screening and intervention are necessary to prevent neurological morbidities • Transcutaneous bilirubinometer is a widely used non-invasive screening device but is mostly available in hospital settings and has cost limitations. Researchers have recently explored the utility of smartphone applications to estimate bilirubin levels in neonates. What is New: • This is the first systematic review and meta-analysis conducted to assess the performance of smartphone applications to detect neonatal hyperbilirubinemia. • Bilirubin estimates of newborn infants obtained through smartphone applications had a reasonable correlation with serum bilirubin levels.

Developmental dysplasia of the hip in preterm breech infants.

BACKGROUND: Whether preterm infants born with breech presentation are at similar risk of developmental dysplasia of the hip (DDH) as the term breech infants is not known. The information will be vital for DDH screening guidelines. METHODS: A retrospective audit of infants born in the breech position was performed to compare the incidence of DDH in the following gestational age groups: 23-27, 28-31, 32-36 and ≥37 weeks. RESULTS: A total of 1144 neonates were included in the study. The incidence of DDH did not differ between the groups (11.6%, 9.4%, 13.6% and 11.5%, in 23-27, 28-31, 32-36 and ≥37 weeks, respectively, p=0.40). Sixty infants required intervention for DDH. Multiple logistic regression after correcting for potential confounders showed that gestational age group did not influence the risk of DDH, and requirement of therapy. CONCLUSION: Preterm infants born with breech presentation appear to have a similar incidence of DDH to term breech infants. .

Prefeeding Oromotor Stimulation Program for Improving Oromotor Function in Preterm Infants - A Randomized Controlled Trial.

OBJECTIVE: To determine effect of Premature Infant Oral Motor Intervention program on oro-motor function and time to full independent wati spoon feeds in preterm infants. METHODS: 30 preterm infants between 28-32 weeks of gestation on full gavage feeds of 150 mL/kg/day were randomized to receive either pre-feed oro-motor stimulation using Premature Infant Oral Motor Intervention (structured stimulation) or sham intervention (unstructured stimulation). RESULTS: Improvement in mean (SD) Neonatal Oro-Motor Assessment Scale (NOMAS) over 7 days from baseline was significantly higher in the study group infants as compared to control group (9.25 (1.73) vs 4.79 (1.52), P=0.001). Infants in the study group reached full independent wati spoon feeds significantly earlier than the infants in control group (4.0 (0.8) d; vs 6.64 (1.0) d; P=0.001). There was significant increase in weight gain after enrolment in infants in study group compared to those in control group. CONCLUSION: Oral stimulation program improves the oro-motor skills and growth velocity in 28-32 week preterm infants. There is decreased transition time from gavage to full independent feeds by mouth.

Neonatal bartter syndrome in an extremely low birth weight baby.

Early diagnosis of Bartter syndrome (BS) in the neonatal period is a clinical challenge, more so in an extremely low birth weight (ELBW) baby because of the inherent renal immaturity and the associated difficulty in fluid management. However, once a diagnosis is made, the disorder is known to respond well to fluid and electrolyte management, prostaglandin inhibitors, and potassium-sparing diuretics. Herein, we report a case of neonatal BS in a very premature ELBW infant.

Heated Humidified High Flow Nasal Cannula versus Nasal Continuous Positive Airway Pressure as Primary Mode of Respiratory Support for Respiratory Distress in Preterm Infants.

OBJECTIVE: To compare the outcomes of preterm infants with respiratory distress initiated on either Heated Humidified High Flow Nasal Cannula or Nasal Continuous Positive Airway Pressure as a primary mode of respiratory support. STUDY DESIGN: Prospective observational cohort study. SETTING: Tertiary care level III neonatal intensive care unit. PARTICIPANTS: 88 preterm infants between 28 to 34 weeks of gestation with mild to moderate respiratory distress within 6 hours of birth. INTERVENTION: Eligible infants were treated either with Heated Humidified High Flow Nasal Cannula (n=46) or Nasal Continuous Positive Airway Pressure (n=42). PRIMARY OUTCOME: Need for mechanical ventilation within 72 hrs of initiating support. RESULTS: Baseline demographic characteristics were comparable between the two groups. There was no difference in the requirement of mechanical ventilation between Heated Humidified High Flow Nasal Cannula (19.5%) and Nasal Continuous Positive Airway Pressure (26.2%) groups [RD-0.74 (95% CI 0.34-1.62; P =0.46)]. Moderate or severe nasal trauma occurred less frequently with Heated Humidified High Flow Nasal Cannula (10.9%) in comparison to Nasal Continuous Positive Airway Pressure (40.5%) (P= 0.004). CONCLUSIONS: Heated Humidified High Flow Nasal Cannula was comparable to Nasal Continuous Positive Airway Pressure as a primary respiratory support for preterm infants with respiratory distress, with lesser incidence of nasal trauma.

Nasal Mask Versus Nasal Prongs for Delivering Nasal Continuous Positive Airway Pressure in Preterm Infants with Respiratory Distress: A Randomized Controlled Trial.

OBJECTIVE: To compare the effectiveness of nasal continuous positive airway pressure delivered by Nasal mask vs Nasal prongs with respect to continuous positive airway pressure failure. STUDY DESIGN: Randomized, controlled, open label, trial. SETTING: Tertiary care level III neonatal unit. PARTICIPANTS: 118 preterm infants-gestational age (27-34 weeks) requiring nasal continuous positive airway pressure as a primary mode for respiratory distress, who were treated with either nasal mask (n=61) or nasal prongs (n=57) as interface. PRIMARY OUTCOME: Need for mechanical ventilation within 72 h of initiating support. RESULTS: Nasal continuous positive airway pressure failure occurred in 8 (13%) of Mask group and 14 (25%) of Prongs group but was statistically not significant (RR 0.53, 95% CI 0.24-1.17) (P = 0.15). The rate of pulmonary interstitial emphysema was significantly less in the Mask group (4.9% vs. 17.5%; RR 0.28, 95% CI 0.08-0.96; P = 0.03). Incidence of moderate nasal trauma (6.5% vs 21%) (P=0.03) and overall nasal trauma (36% vs 58%) (P=0.02) were significantly lower in mask group than in the prongs group. CONCLUSIONS: Nasal continuous positive airway pressure with mask as interface is as effective as prongs but causes less nasal trauma and pulmonary interstitial emphysema.

An unusual case of perinatal tuberous sclerosis.

We report a case of a neonate who presented to us with multiple rhabdomyomas of heart, cortical tubers in the brain and skeletal anomalies such as Pierre Robin sequence, bilateral clubfoot and lower small bowel obstruction. Though a diagnosis of neonatal tuberous sclerosis was made, the association of skeletal anomalies and intestinal obstruction was a rare and unusual finding.

Nucleated red blood cell in cord blood as a marker of perinatal asphyxia.

BACKGROUND: Perinatal asphyxia is a major cause of neurological morbidity and mortality in India. The purpose of this study was to investigate variations in nucleated red blood cell (NRBC) in blood associated with perinatal asphyxia and its relationship to both the severity and short term prognosis of asphyxia. METHODS: A prospective (case-control) study was undertaken at Gandhi Medical College and Associated Hospitals. A total of 100 neonates were included in the study. Levels of NRBC/100 white blood cells (WBC) and absolute NRBC counts in cord blood were compared for 50 asphyxiated (case group) and 50 normal neonates (control group). These parameters were also related to the severity of asphyxia and clinical outcome. RESULTS: The number of NRBC/100 WBC in the blood of 50 newborns each in the asphyxiated and in the control group were mean 29.5 ± 26.0, range 7-144 NRBCs/100 WBC and mean ± standard deviation 5.9 ± 2.6, range 3-14 NRBCs/100 WBC respectively (P < 0.01). Using quartile deviation, staging of hypoxic ischemic encephalopathy (HIE) was done on basis of NRBC count and there was 80% agreement between clinical and NRBC staging of HIE. There was a significant (P < 0.01) correlation of the number of NRBC\100 WBC with Apgar scoring, HIE staging and mortality. CONCLUSIONS: The NRBCs/100 WBCs can be used as a simple marker for the assessment of severity and early outcome of perinatal asphyxia.

Hemoglobin J--as a cause of congenital hemolytic anemia.

Hemoglobin-J is a rare hemoglobin variant known to be clinically silent most of the times, only to be detected accidentally. Herein, the authors report a case of Hemoglobin-J manifesting as unstable hemoglobin detected during evaluation of hemolytic anemia in an 8 month-old-infant. Cation Exchange-High Performance Liquid Chromatography(CE-HPLC) was used to identify this variant after Hb electrophoresis was reported to be normal.