Nonsynchronized nasal intermittent positive pressure ventilation versus continuous positive airway pressure as a primary mode of respiratory support in neonates (26-40 weeks) admitted in a tertiary care center: A randomized controlled trial.

INTRODUCTION: Continuous positive airway pressure (CPAP) is a standard respiratory care for neonates for last few decades but it too has a high failure rate. Nasal intermittent positive pressure ventilation (NIPPV) is proven to be superior to CPAP in maintaining higher mean airway pressure in neonates with Respiratory Distress Syndrome. The main objective of this study was to compare failure within 72 h of initiation of primary respiratory support between nonsynchronized NIPPV and CPAP in all causes of respiratory distress in newborn infants. Secondarily feed intolerance, Necrotizing enterocolitis (NEC > stage II), hemodynamically significant patent ductus arteriosus, intraventricular hemorrhage (IVH > gradeIII), retinopathy of prematurity (ROP), bronchopulmonary dysplasia (BPD), duration of support and mortality were also compared. METHODS: This was a single center randomized controlled trial. Stratified randomization was done for 216 neonates, based on the gestational age in two subgroups 26-33 weeks and 34-40 weeks whopresented with respiratory distress within 5 days of birth, to receive either NIPPV or CPAP. Primary and secondary outcomes were documented. RESULTS: Statisticalsignificant difference was noted for primary outcome (RR 0.48 [confidence interval = 0.301-0.786], p = 0.003) but not for other secondary outcomes. NIPPV appeared superior in respect to noninvasiveventilation days, BPD occurrence and hospitalization duration. CONCLUSION: As a primary mode, nonsynchronized NIPPV was more efficacious than CPAP in preventing intubation within 72 h of initiation of respiratory support. Further multicenter studies are warranted to explore the benefits of this respiratory support.

Caudal duplication syndrome.

Caudal duplication syndrome is a rare entity in which structures derived from the embryonic cloaca and notochord are duplicated to various extents. Its prevalence at birth is less than 1 per 100,000. The term caudal duplication encompasses a spectrum of anomalies and is often used to describe incomplete separation of monovular twins or referred to as part of the spectrum of anomalies associated with conjoined twinning. It usually includes multiple rare malformations and duplications of distal organs derived from the hindgut, neural tube, and caudal mesoderm. It was postulated that the disorder is related to misexpression of one or more of the distal HOX genes, potentially HOX10 or HOX11, leading to abnormal proliferation of caudal mesenchyme. The malformations are usually diagnosed by anomaly scan in the second trimester. Here we report the case of a baby presenting on the first day of life with complete duplication of caudal structures below the dorsolumbar level.

Congenital Sternal Cleft along with Persistent Left-Sided Superior Vena Cava: A Rare Presentation.

Congenital sternal cleft is a rare abnormality resulting from fusion failure of sternum. It occurs in isolation or along with defects of abdominal wall, diaphragm, pericardium, and heart. Early surgical correction is required to protect the underlying structures for risk of cardiac compression. Here we report a case of 20-day female child presenting with congenital sternal cleft associated with multiple congenital heart disease and left-sided superior vena cava. She was operated by the cardiothoracic surgical team successfully and is doing well on followup. We discuss this rare case, imaging studies, and surgical strategy.

Left sided oesophageal lung: a diagnostic challenge.

Bronchopulmonary foregut malformations (BPFMs) include a wide variety of malformations such as intralobar or extralobar pulmonary sequestration, foregut duplication cysts, and diverticula of the gastrointestinal or pulmonary tree (Srikanth et al., 1992). Those anomalies in which a tract between the respiratory and alimentary systems exists are termed communicating bronchopulmonary foregut malformations (CBPFMs). Most infants with CBPFMs suffer from respiratory distress, and an accurate diagnosis may be difficult to make at the patient's initial presentation. Herein we report such a case which posed a diagnostic challenge to us. This baby however survived and is doing well on a 2-year followup.

Remission of congenital complete heart block without anti-Ro/La antibodies: A case report.

Anti-Ro/La negative congenital heart block (CHB) is uncommon. We report one such case of CHB, with no associated structural heart disease or maternal autoantibodies. The heart block reverted to sinus rhythm spontaneously at two weeks of age, and the patient remains in sinus rhythm at a one year followup. Whether patients with antibody negative complete heart block have a different clinical course is conjectural.