Improving clinical outcomes of very low birth weight infants: Implementation of standardized management guidelines in tertiary care hospital in Haryana.

BACKGROUND: Standardized written guidelines and protocols in NICU are known to impact neonatal outcomes and improve survival. OBJECTIVE: To study and compare the morbidity and mortality outcomes of very low birth weight (VLBW) neonates before and after introduction of structured approach to standardized management guidelines on four interventions in a tertiary care hospital in North India. METHODOLOGY: Structured approach to standardized management guidelines on four interventions were implemented for VLBW infants in NICU. a) Humidified and Heated High Flow Nasal Cannula (HHHFNC) as the initial mode of ventilator support in preterm VLBW babies. b) Expressed breast milk for feeding preterm VLBW babies and absolutely no formula milk. c) Hand washing and following "Bundle Care Approach" for Central lines as the cardinal cornerstones for maintaining strict asepsis. d) Development and supportive care to be regularly followed. Data was collected prospectively from July 2015 to December 2016 (Intervention Group) and compared with retrospective matched controls from the previous year (July 2014-June 2015) (Control Group). RESULTS: There was a significant decrease in culture positive sepsis in the intervention group compared to control group (3 (2.97%) CI:0.006-0.08 vs 11 (19.64%) CI:0.10-0.32; P = .0004). There was no significant difference in the mortality (5.35% vs3.96% P = .74) amongst the two groups. CONCLUSION: Implementing structured approach to above mentioned interventions in the form of standardized management guidelines for preterm VLBW neonates was associated with significant reduction in culture proven sepsis and mechanical ventilation days without affecting mortality or other co-morbidities.

Abortion may be associated with elevated risk of future hypothyroidism.

OBJECTIVE: Fetal microchimerism during pregnancy and abortion has been linked with autoimmune hypothyroidism in females. We conducted a case-control study to investigate the odds of "abortion in the past" in the newly diagnosed hypothyroid females compared to their age-matched euthyroid controls. METHODS: All consecutive newly diagnosed hypothyroid females, over 1 year, were enrolled as cases. Age-matched euthyroid controls were selected from the same region. The exposure variable tested was "past history of abortion (elective or therapeutic)." RESULTS: Totally, 120 cases and 172 controls were recruited over 1 year with a mean age of 42.2 ± 9.8 years and 41.1 ± 12.4 years, respectively. The exposure variable (abortion) was present in 71 (59%) cases and 10 (6%) controls. Odds ratio (OR): 23.5 (12.2-48.9) P < 0.0001. Autoimmunity, based on thyroid peroxidase (TPO) positivity (TPO levels ≥30 U/ml), was present in 92 (77%) of the cases; TPO was negative in 28 (33%) of cases. The exposure variable was documented in 62.4% and 50% of TPO positive and negative cases, respectively (P = 0.28). DISCUSSION AND CONCLUSION: The study suggests that abortion (elective or therapeutic) in the past is strongly associated with newly diagnosed hypothyroidism in females aged 42.2 ± 9.8 years; OR: 23.5 (P < 0.0001). Interestingly, abortion was associated with both, TPO positive and negative hypothyroidism.