Post-discharge home kangaroo mother care follow-up study in rural Gujarat.

Background: Continuation of kangaroo mother care (KMC) at home is vital for improved infant survival and development. Hence, it is essential to understand potential enablers and barriers to home KMC provision. Methodology: This observational study was conducted in rural Gujarat. KMC was initiated for all low-birth-weight (LBW) neonates during the hospital stay and were advised to continue home KMC on discharge. The mothers of these LBW neonates were interviewed using a structured questionnaire during follow-up visits or via telephone. Results: A total of 100 mothers were interviewed, and 98 practiced home KMC. Mothers' mean age was 24.41 (±3.1) years, and infants' mean age was 3.48 (±1.81) months. The mean weight of neonates at discharge was 1.85 (±0.28) kg. Out of the 104 neonates (96 singleton pregnancies and four twins), 76 (73.07%) were pre-term. 31% mothers provided 4-6 hours of daily KMC. 60% provided KMC for less than 1 hour during each session, while 36% of mothers provided each KMC session for 1-3 hours. 74% of mothers received family support, and 62% faced difficulties in home KMC provision. 88% of mothers were homemakers, and 53% had other children to care for. 51% mothers pre-maturely discontinued KMC provision. 83% of the mothers reported fatigue or pain during KMC provision. Conclusion: Lack of family support, other household responsibilities, and other children to care for were major barriers leading to pre-mature discontinuation of home KMC.

Study of test anxiety amongst undergraduate medical students from the state of Gujarat.

BACKGROUND: Test anxiety is physiological and behavioral response that accompanies concerns about possible negative consequences of failure on an exam. Undergraduate medical students had their academics disrupted during COVID-19 pandemic. This study was done to assess levels of test anxiety among undergraduate medical students, its variance in relation to demography, COVID-19 pandemic, learning experiences, and individual factors. MATERIALS AND METHODS: Online questionnaire-based survey was done among undergraduate medical students from medical schools of Gujarat. Students from 1st, 2nd, and 3rd years who were about to appear in final exams from March to June 2021 and were asked to enroll on the survey. Apart from demography, COVID-19-related factors, learning experiences during lockdown, 10-item Westside test anxiety (WTA) scale was used to assess test anxiety levels and Kessler Psychological distress (K10) scale was used to assess level of psychological distress. RESULTS: Total of 370 students participated. Mean WTA Score was 3.15 ± 1; 60.2% of the respondents had moderate or higher levels of test anxiety. On bivariate analysis, WTA score was found significantly associated with year of study, coming from vernacular medium, various lockdown-related issues (poor internet connection, family financial problem, lack of information, worry about future), various learning experiences (self-rated proficiency with computers, feeling ill prepared for exams, feeling ill prepared for practical), and K10 score. Of these associations with K10 score, coming from vernacular medium and feeling ill-prepared for exams were maintained on multiple-linear regression. CONCLUSIONS: Vernacular medium of study during high school was found associated with test anxiety among medical students and can be a potential area of intervention. There may be merit in using WTA scale as a surrogate marker for distress in medical students.

Kangaroo mother care utilization at stepdown ward of a tertiary care teaching hospital: a quality improvement study.

PURPOSE: India has the highest burden of preterm/low birth weight newborns. To tackle this, Kangaroo Mother Care (KMC) needs to be scaled up. We did a quality improvement (QI) study to increase KMC coverage to 80% and its utilization to at least 4 h/infant/day. METHODS: This study was conducted at a stepdown ward (KMC ward) of a tertiary care teaching institute over a period of four months. All babies with birth weight <2.5 kg were eligible. The QI team included faculty in-charge, one senior resident and three senior staff nurses. Potential barriers were listed using fish-bone analysis. Four possible interventions were identified (daily documentation of total KMC hours by doctor, providing KMC during all the nursing duty shifts, counseling and education to mothers and family members), introduced, and then subsequently tested by four Plan-Do-Study-Act (PDSA) cycles and sustenance was assessed over three months. RESULTS: A total of 93 infants were included in this QI study. During baseline phase, the KMC coverage was 50% which increased to 100% by the end of fourth PDSA cycle and remained 100% during the sustenance phase. During baseline period, KMC was given for ≥ 4 h in 18.8% (28 of 149) patient days which increased to 88.96% (137 of 154) during the sustenance phase. The mean KMC utilization increased from 1.97 (1.57) h/infant/day to 5.65 (1.20) h/infant/day in the sustenance phase. CONCLUSION: QI study incorporating PDSA cycles helped improve coverage and utilization of KMC.

Comparison of Sucrose vs. Swaddling in Pain Management during Birth Dose of Hepatitis B Vaccine: A Randomized Control Trial.

OBJECTIVES: To evaluate the efficacy of pain management of 1 ml of 24% sucrose given orally compared to routine care given one minute before vaccination for reduction of pain. METHODS: This double-blind randomized controlled trial included term neonates visiting Pediatric OPD for immunization. Neonates were randomly assigned into two groups (Group A- Sucrose, Group B- Swaddling). Commercially available sucrose solution (StayHappi solution 24%) was given in a dose of 1 ml to the neonates. Video recording of the neonate's facial expression was done during the procedure. Duration of cry, latency of onset of cry as well Modified Neonatal Facial Coding Score (MFCS) were the outcome variables. RESULTS: The mean (SD) of birth weight and gestational age was 2729 (321.6) g and 38.24 (0.84) d, respectively. Analysis showed significant difference in total MFCS across the groups (P <0.001). Total MFCS was significantly lower in sucrose group [4.88 (1.07) vs. 7.17 (0.95)]. The duration of cry (in seconds) was also found to be significantly lower in sucrose group. CONCLUSIONS: Administration of 1 ml 24% sucrose one minute prior to immunization is efficacious in pain management during injectable immunization.

Insights from a cross-sectional survey of neonatal resuscitation instructors from India.

Neonatal resuscitation training can change outcomes of neonatal mortality due to perinatal asphyxia. Recently, in 2021, the advanced NRP course material was changed, and for Basic NRP, a hybrid course was introduced in India. We assessed the instructor's feedback to improve the conduct of the IAP NNF NRP Program as well as get their perception of the effectiveness, usefulness, and pitfalls of the new hybrid Basic NRP course (offline + online). A cross-sectional survey was conducted amongst instructors across India with current status with IAP NRP FGM Office. The data were exported to a Microsoft Excel Spreadsheet. STATA 14.2 was used for descriptive [Frequency (percent) analysis. 827 basic and 221 advanced NRP instructors responded. Bag and mask ventilation was identified as the most important step in basic 468 (56.6%) and advanced 147 (66.5%) courses. In the basic NRP, almost two third (71.0%) participants believe that it is challenging to conduct a case scenario for bag and mask ventilation, whereas, in the advanced course, intubation 116 (52.5%) was considered the most difficult step to teach and medication 80(36.2%) followed by intubation 62(28.1%) are the most difficult steps to conduct case scenario. 725(87.7%) reported that it would be easy to explain them in an offline course after completion of an online course. Most of the instructors were satisfied with the course structure, material, overall quality of the workshop, and support from the IAP NRP office. Constructive suggestions were obtained from the instructors for improvement of the course.

Impact of hypothermia alert device (BEMPU) on improvement of duration of Kangaroo Mother Care (KMC) provided at home: parallel-group randomized control trial.

The objective of the study was to determine if using the hypothermia-detecting bracelet (named BEMPU) improves the duration of Kangaroo Mother Care (KMC) at home by one hour. This parallel-group randomized controlled trial was conducted at a step-down nursery of a teaching hospital. Neonates between 1000 and 2000 g were randomized to BEMPU and control groups at the time of discharge. BEMPU was applied at the wrist of each newborn in the BEMPU (intervention) group. Parents were advised to keep the BEMPU in place till 4 weeks post-discharge. The BEMPU generates a beep sound as an alarm when a newborn's temperature drops below 36.5 °C. Parents in both groups were trained to provide KMC at home. Parents in the BEMPU group received the "KMC chart" and "BEMPU beep chart," while the control group received the "KMC chart" only. In the "KMC chart," parents entered information about KMC hours on a real-time basis, and in the "BEMPU beep chart," they entered information about alarm beeps from BEMPU on a real-time basis till 4 weeks post-discharge. Independent samples t-test was used to compare mean KMC hours between the two groups. A total of 128 neonates participated in the study (64 in BEMPU and 64 in Control groups). The mean(SD) gestational age for the BEMPU group was 34.04(2.84) weeks vs 34.75(2.70) weeks for the control group. In BEMPU group, mean(SD) daily time spent doing KMC was significantly higher in 1st week [4.78(2.93) vs. 3.22(2.44) h, p = 0.003], in 2nd week [4.52(3.43) vs. 2.84(2.95) h, p = 0.008], in 3rd week [4.23(3.71) vs. 2.30(2.70) h, p = 0.003], in 4th week [3.72(3.30) vs. 1.95(2.65) h, p = 0.003] as compared to control group. BEMPU improved the daily duration of KMC hours at home compared to the control group over four weeks. Clinical Trial Registration: This trial is registered at Clinical Trials Registry India with registration number: CTRI/2018/08/015154 and accessible at http://ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=27600&EncHid=&modid=&compid=%27,%2727600det%27 Registered on 01/08/2018.

Effect of Kangaroo Mother Care Transport in Preventing Moderate Hypothermia in Low Birth Weight Babies During Transportion to Home After Discharge: A Randomized Controlled Trial.

BACKGROUND: Transport of neonates is often neglected, which results in high mortality of neonates during transport. OBJECTIVES: To determine the effectiveness of kangaroo mother care (KMC) in terms of hypothermia prevention during transport from hospital to home for low birth weight neonates. STUDY DESIGN: Randomized controlled trial. PARTICIPANTS: A total of 152 low birth weight neonates being discharged from the neonatal intensive care unit of our hospital between March, 2021 and August, 2022. INTERVENTION: Neonates in the study group (n=76) received KMC during transport from the hospital to home, while the control group (n=76) did not receive KMC during transport. Axillary temperature was recorded in both groups at the time of discharge, every 5 minutes during transport, and on reaching home. OUTCOMES: Hypothermia episodes in neonates while receiving KMC compared to neonates not receiving KMC. RESULTS: Primary endpoint of the study was moderate hypothermia. During transport, 23 (30.3%) neonates in the control group experienced moderate hypothermia during transport, which was statistically significant [0% vs 30.3%; P<0.001]. From 10 minutes of transport till the neonates reached home, the mean (SD) temperature in the study group was significantly higher than in the control group [ 36.8 (0.23) °C vs 36.6 (0.3) °C; P<0.001] at time 15 minutes. Similar results were noted in preterm neonates [36.7 (0.25) °C vs 36.5 (0.29) °C; P<0.001] at time 15 minutes. The number of hypothermia episodes was more in the control group than in the study group during most of the transport time [7.6% vs 43.2%; P<0.001] at time 15 minutes. CONCLUSIONS: Low birth weight neonates receiving KMC showed optimal thermoregulation, whereas a high incidence of moderate hypothermia was seen among neonates receiving conventional care during transport.

Efficacy of skin-to-skin vs. cloth-to-cloth contact for thermoregulation in low birth weight newborns: a randomized crossover trial.

OBJECTIVE: Skin-to-skin contact (SSC) is effective to maintain normal temperature in low birth weight (LBW) newborns. However, there are several barriers related to privacy and space availability for its optimum utilization. We used cloth-to-cloth contact (CCC), i.e. placing the newborn in Kangaroo position without removing cloths as an innovative alternative to SSC to test its efficacy for thermoregulation and feasibility as compared to SSC in LBW newborns. METHODS: The newborns eligible for Kangaroo Mother Care (KMC) in step-down nursery were included in this randomized crossover trial. Newborns received SSC or CCC as per randomization on the first day and then crossed over to other group on the next day and so on. A feasibility questionnaire was asked to the mothers and the nurses. Axillary temperature was measured at various time intervals. Group comparisons were made by either using independent sample t-test or Chi-square test. RESULTS: A total of 23 newborns received KMC for total 152 occasions in the SSC group and 149 times in the CCC group. There was no significant temperature difference between the groups at any time-point. Mean (standard deviation) gain of temperature at 120 min in the CCC group [0.43 (0.34)°C] was comparable to the SSC group [0.49 (0.36)°C] (p = 0.13). We did not observe any adverse effect of CCC. Most mothers and nurses perceived CCC feasible in hospital settings and felt that it could be feasible in-home settings too. CONCLUSION: CCC was safe, more feasible and not inferior to SSC for maintaining thermoregulation in LBW newborns.

Skin-to-skin contact (SSC) helps in maintaining optimum temperature of low birth weight (LBW) newborns. It is an important component of Kangaroo Mother Care (KMC), which is standard of care and reduces several neonatal morbidities and mortality. However, there are several barriers for the optimum utilization of KMC. One of the major barriers is privacy issues while putting newborn in SSC. To overcome this barrier for increasing KMC uptake, we innovatively thought of keeping the newborn on mother's chest without removing the cloths of both the mother and the newborn. We called it cloth-to-cloth contact (CCC). We compared SSC and CCC for temperature regulation in the newborns weighing between 1500 and 2499 g at the time of enrollment using a crossover design. We observed that mean temperature steadily increased in newborns while receiving SSC or CCC for 2 h. There were no significant differences in mean temperature readings between these two groups at various time points. Thus, CCC was not inferior to SSC in maintaining temperature. We did not observe any adverse effect of CCC. CCC may overcome the barrier of privacy issues of SSC. Thus, CCC was equally efficacious, safe and more feasible for maintaining thermoregulation in LBW newborns.

Effect of Kangaroo Mother Care on Cerebral Hemodynamics in Preterm Neonates Assessed by Transcranial Doppler Sonography in Middle Cerebral Artery.

OBJECTIVE: To study the effect of KMC in premature newborns on cerebral hemodynamics in the middle cerebral artery (MCA) using transcranial doppler sonography. METHODS: In this descriptive study, 40 clinically stable preterm neonates admitted to the neonatal intensive care unit of our institute and undergoing Kangaroo mother care (KMC) were enrolled. Physiological and cerebral blood flow parameters of MCA were obtained by using transcranial doppler sonography at baseline, at 60 minutes of KMC, and after 60 minutes of stopping KMC. RESULTS: Of the 40 enrolled neonates (24 males), the mean (SD) birth weight, gestation age, and postnatal age were 1698.25 (495.44) g, 33.00 (1.67) wk, and 6.80 (4.51) days, respectively. The mean (SD) cerebral blood flow velocities increased (peak systolic velocity (PSV), P=0.03; end diastolic velocity, P<0.001; mean velocity, P<0.001) and doppler indices decreased (resis-tive index, P=0.001; pulsatility index, P<0.001) significantly; whereas, heart rate (P<0.001) decreased but SpO2 (P=0.001) and mean blood pressure (P=0.003) increased significantly at 60 minutes of KMC as compared to baseline. Sixty minutes after stopping KMC, all parameters (except PSV) were higher than baseline, indicating post KMC effect. CONCLUSION: KMC improves cerebral hemodynamics in clinically stable preterm neonates.

Natural Versus Synthetic Surfactant Therapy in Respiratory Distress Syndrome of Prematurity.

OBJECTIVES: To compare the clinical efficacy and the cost of treatment between the newborns who received either a natural or a protein-free synthetic surfactant for respiratory distress syndrome (RDS) of prematurity. METHODS: This is a retrospective analytical study incorporating comparisons of clinical parameters and cost in newborns having RDS of prematurity who received either Survanta (bovine lung extract), a natural surfactant or Surfact (protein-free colfosceril palmitate), a synthetic surfactant. RESULTS: There were 100 newborns who received either of the natural (n = 52) or synthetic (n = 48) surfactant with mean (SD) gestational age and mean (SD) birth weight of 31.5 (2.6) wk, 1425 (461) g and 32.2 (2.2) wk, 1519 (413) g, respectively. Majority of the newborns (> 90%) received endotracheal surfactant within the first 24 h of life and had similar baseline characteristics in either group. No differences were noted in ventilator settings on admission and 24 h after surfactant/admission. Oxygen requirement, extubation age, complications, hospital stay, and mortality were similar across groups, except that the necrotizing enterocolitis was noted only in natural surfactant group. There was a significant pharmacy cost savings in synthetic surfactant group. CONCLUSION: Synthetic surfactant was comparable to natural surfactant with regard to outcomes, like ventilator settings, hospital stay, and mortality. Pharmacy cost was less in synthetic surfactant group.

Evaluation of Pulse Rate, Oxygen Saturation, and Respiratory Effort after Different Types of Feeding Methods in Preterm Newborns.

Background: During the initial days of hospitalization, preterm newborns are given combinations of breastfeeding, spoon/paladai feeding, and/or gavage feeding. Each method of feeding may have a different effect on vital parameters. Objective: To study changes in vital parameters in relation to different feeding methods and postmenstrual age (PMA) in preterm newborns. Study Design. This prospective observational study was carried out at a tertiary care neonatal unit. Participants. Physiologically stable preterm newborns with PMA less than 37 weeks on full enteral feeds were included in the study. Intervention. None. Outcomes. Respiratory rate (RR), pulse rate (PR), oxygen saturation (SPO2), nasal flaring, and lower chest indrawing were monitored before and up to 3 h after the breastfeeding/spoon (paladai) feeding/gavage feeding or their combinations. These vital parameters were assessed in relation to the feeding methods and PMA groups using ANOVA. Results: A total of 383 records were analyzed from 110 newborns. No infant developed chest indrawing or nasal flaring after any feeding method. During the 3 h period of monitoring, vital parameters changed significantly except in the gavage feeding group. The mean PR did not change, but the mean RR and SPO2 changed significantly at different PMA. Conclusion: Vital parameters changed after different types of feeding methods and at different PMA. A further multicentric prospective study is needed to understand the effect of different feeding methods and PMA on vital parameters.

Efficacy of Skin-to-Skin Care versus Swaddling for Pain Control Associated with Vitamin K Administration in Full-Term Neonates: A Randomized Controlled Trial.

OBJECTIVE: The objective of the study was to assess the efficacy of immediate skin-to-skin care (SSC) versus swaddling in pain response to intramuscular injection of vitamin K at 30 min of birth in neonates. METHODS: Healthy full-term newborns were enrolled immediately after normal vaginal delivery and randomized in two groups, SSC and swaddling. Neonatal Infant Pain Scale (NIPS) was measured before, immediately after and at 2 min after the injection. RESULTS: Total 100 newborns were enrolled in the study (50 in each group). The mean (SD) birth weight of newborns in the SSC and swaddling group was 2668 (256) and 2730 (348) g, respectively. NIPS was comparable between the SSC and swaddling at before [1.78 (0.58) vs. 1.96 (0.83), p = 0.21], and immediately after the injection [4.82 (0.72) vs. 5.08 (0.75), p = 0.08]. NIPS at 2 min after the injection was significantly low in the SSC group compared to the swaddling group [1.38 (0.70) vs. 2.88 (1.00), p < 0.001]. At 2 min after injection, the NIPS score was significantly lower than baseline in the SSC group (p = 0.002), while it was significantly higher in the swaddling group (p < 0.001). A significantly higher proportion of newborns had a NIPS score of more than three at 2 min after injection in the swaddling group as compared to the SSC group (22% vs. 2%, p < 0.001). CONCLUSION: Immediate SSC was more efficacious as compared to swaddling as a pain control intervention while giving vitamin K injection. CLINICAL TRIAL REGISTRATION: The trial is registered with the Clinical Trial Registry of India with Registration number: CTRI/2020/01/022984.

Skin-to-skin care and swaddling are commonly used non-pharmacological measures to reduce pain perception in neonates for invasive procedures like heel prick, venipuncture and vaccination. We did this randomized control trial to compare the efficacy of immediate skin-to-skin care after birth vs. swaddling for reducing neonatal pain associated with intramuscular injection of vitamin K at 30 min after birth. We observed that the immediate skin-to-skin care, a standard of care, is more efficacious in controlling pain compared to swaddling for giving routine intramuscular vitamin K injection within one hour of birth.

Compliance to antibiotic therapy at paediatric out-patient clinic.

Background: Poor compliance to antibiotic therapy leads to ineffective treatment. Objective: The objective of this study is to assess compliance to oral antibiotic therapy in paediatric patients and factors affecting it. Methods: Patients aged less than 18 years, coming to outpatient department, who were prescribed oral antibiotics in last 1 week, were eligible for participation in the study. Compliance to oral antibiotic therapy and factors affecting it were evaluated through verbal interview of their caretakers. Results: Out of total of 815 participants in the study, 241 (29.6%) were non-compliant either due to not completing the course [142 (17.4%)] or due to not complying with the frequency [99 (12.2%)]. Causes of incomplete course were adverse effects [28 (19.7%)], poor palatability [30 (21.1%)] and no improvement [84 (59.2%)]. Gender, religion, age, development of child and education or occupational status of caregiver did not affect the compliance. Multivariable logistic regression showed two or more drugs in addition to antibiotic therapy (odds ratio [OR] 1.73; 95% confidence interval [CI] 1.03-2.92); more frequency intake of antibiotic in a day, that is, either twice a day (OR 2.13; 95% CI 1.24-3.66) or thrice a day (OR 3.7; 95% CI 2.18-6.48), was significantly associated with non-compliance. Though syrup formulation and low cost of prescription were associated with better compliance on univariate analysis, they did not have any impact in multivariable logistic regression. Conclusions: Restricting use of unnecessary drugs with antibiotic therapy, preferring once-a-day frequency and carefully selecting antibiotic with minimal adverse effects and better palatability improve the compliance to oral antibiotic therapy in paediatric patients.