A case-control study was conducted to study the Lipid profile of high risk children (age 2-10 yea... more A case-control study was conducted to study the Lipid profile of high risk children (age 2-10 years). There was a significant elevation of total cholesterol (P<0.001) and LDL (P< 0.001). Early dietary and lifestyle modifications can prevent this cascade.
To investigate the effect of umbilical cord milking on hematological parameters at 6 weeks of age... more To investigate the effect of umbilical cord milking on hematological parameters at 6 weeks of age in late preterm neonates. Randomized controlled trial. A tertiary care center of Northern India during 2013-14. 200 moderate to late preterm neonates randomly allocated to early cord clamping or umbilical cord milking group (100 in each). In milking group, 25 cm length of cord was milked towards the baby thrice after separating (within 30 s) it from placenta. Hemoglobin and serum ferritin at 6 weeks of age. Mean (SD) serum ferritin [428.9 (217.6) vs. 237.5 (118.6) ng/mL; P< 0.01] and hemoglobin [12.1 (1.5) vs. 10.4 (1.2) gm/dL; P<0.01] at 6 weeks were significantly higher in umbilical cord milking group. In early neonatal period, hemodynamic and hematological parameters were not significantly different. Higher incidence of jaundice with higher phototherapy rates (33% vs. 9%; P<0.01) were noted in umbilical cord milking group. In preterm neonates, umbilical cord milking at birth enhances iron stores at 6 weeks of age. Higher phototherapy rates with this intervention are a matter of concern.
... Reference. 1. Ramji S, Rasaily R, Mishra PK, Narang A, Jayam S, Kapoor AN, Kambo I, Mathur A,... more ... Reference. 1. Ramji S, Rasaily R, Mishra PK, Narang A, Jayam S, Kapoor AN, Kambo I, Mathur A, Saxena NC, Saxena BN. Resuscitation of asphyxiated newborns with room air or 100% oxygen at birth: A multicentric clinical trial. Indian Pediatr 2003; 40: 510-518. ...
Streptococcus agalactiae is still the most frequent causative agent of neonatal early-onset disea... more Streptococcus agalactiae is still the most frequent causative agent of neonatal early-onset disease. Rapid identification of GBS-colonized women on admission for delivery allows for an effective intrapartum antimicrobial prophylaxis.
This study was designed with objective to study pain response of infants to change in sequence of... more This study was designed with objective to study pain response of infants to change in sequence of administration of Hepatitis B and DTwP vaccines. This was a randomized parallel control trial. The study was carried out in the immunization clinic of the Department of Pediatrics, LLRM Medical College, Meerut. One hundred and thirty healthy term infants up to 4 months of age were injected either DTwP vaccine first or Hepatitis B vaccine first, followed one minute later by the other vaccine. Baseline characteristics did not differ between the groups. The mean (SD) of AUC of MFCS and NIPS was significantly more in DF group as compared to HF group (for MFCS 25.5±5.4 versus 22.5±5.5, p<0.01; for NIPS 31.77±5.5 versus 27.64±6.9, p<0.01). Similarly mean (SD) of AUC of Heart rate and saturation of oxygen showed significant variation in DF group as compared to HF group (for heart rate 591.6±55 versus 559.6±49, p<0.01; for SpO2 326.4±12 versus 335±8, p<0.01). These results showed th...
To investigate the effect of umbilical cord milking on hematological parameters at 6 weeks of age... more To investigate the effect of umbilical cord milking on hematological parameters at 6 weeks of age in late preterm neonates. Randomized controlled trial. A tertiary care center of Northern India during 2013-14. 200 moderate to late preterm neonates randomly allocated to early cord clamping or umbilical cord milking group (100 in each). In milking group, 25 cm length of cord was milked towards the baby thrice after separating (within 30 s) it from placenta. Hemoglobin and serum ferritin at 6 weeks of age. Mean (SD) serum ferritin [428.9 (217.6) vs. 237.5 (118.6) ng/mL; P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01] and hemoglobin [12.1 (1.5) vs. 10.4 (1.2) gm/dL; P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01] at 6 weeks were significantly higher in umbilical cord milking group. In early neonatal period, hemodynamic and hematological parameters were not significantly different. Higher incidence of jaundice with higher phototherapy rates (33% vs. 9%; P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01) were noted in umbilical cord milking group. In preterm neonates, umbilical cord milking at birth enhances iron stores at 6 weeks of age. Higher phototherapy rates with this intervention are a matter of concern.
Background & objectives: Randomized controlled trials in developed countries have reported benefi... more Background & objectives: Randomized controlled trials in developed countries have reported benefits of Lactobacillus GG (LGG) in the treatment of acute watery diarrhoea, but there is paucity of such data from India. The study was aimed to evaluate the efficacy and safety of Lactobacillus GG in the treatment of acute diarrhoea in children from a semi-urban city in north India. Methods: In this open labelled, randomized controlled trial 200 children with acute watery diarrhoea, aged between 6 months to 5 years visiting outpatient department and emergency room of a teaching hospital in north India were enrolled. The children were randomized into receiving either Lactobacillus GG in dose of 10 billion cfu/day for five days or no probiotic medication in addition to standard WHO management of diarrhoea. Primary outcomes were duration of diarrhoea and time to change in consistency of stools. Results: Median (inter quartile range) duration of diarrhoea was significantly shorter in children ...
Purpose: To investigate the effect of umbilical cord milking as compared to early cord clamping o... more Purpose: To investigate the effect of umbilical cord milking as compared to early cord clamping on haematological parameters at 6 weeks of age among term and near term neonates. Methods: Design: A randomised controlled trial. Subjects: The subjects were term & near term newborns randomized in two groups (100 each). Group 1: Umbilical cord milking(UCM) group, Group 2 (Control) No milking of umbilical cord (Control group). Newborn management other than cord milking was identical in both the groups. Method of cord milking: After delivery, baby was held at the level of introitus. The umbilical cord was clamped and cut at placental end within 30 seconds (early cord clamping) after leaving at least 25 cm length from umbilical end of cord. The baby was then placed under radiant warmer and the umbilical cord was milked from cut end towards the umbilical end 3 times, with speed of 10 cm/sec and then clamped 2-3 cm above from umbilicus. Primary Outcome variables were Haemoglobin & Serum ferri...
This study was conducted at a tertiary care center in northern India to evaluate the validity of ... more This study was conducted at a tertiary care center in northern India to evaluate the validity of non-invasive transcutaneous hemoglobin estimation in healthy and sick children in comparison to hemoglobin estimation by traditional lab method. A method comparison study was conducted including 150 subjects. Enrolled patients included 80 neonates with average age of 3.9 ± 2.1 days, and 70 children with average age of 5.8 ± 2 years. Each population (newborn and children) comprised of almost equal numbers of healthy and critically ill patients with shock. Hemoglobin (Hb) was estimated on enrolment by transcutaneous spectrophotometry (SpHb) and traditional automated lab analyzer (Hb-Lab). Difference between Hb levels by the two methods (called bias) was measured and analyzed using Bland-Altman method. Out of 148 data pairs analyzed, bias between SpHb and Hb-Lab was -1.52 ± 1.91 g/dl (mean ± SD). SpHb showed excellent positive correlation with Hb-Lab (r = 0.94 (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001)) and good visual agreement on Bland-Altman plots. Bias was higher in sick subjects with shock as compared to healthy ones in both neonatal and pediatric population (-2.31 ± 2.21 g/dl versus -0.77 ± 1.2 g/dl, respectively). SpHb showed good accuracy and correlated well with lab estimated Hb levels in healthy children. However, in children with impaired peripheral perfusion, its diagnostic accuracy was inadequate to justify routine use for quantification of severity of anemia and making transfusion decisions solely on non-invasive estimation of hemoglobin. What is Known: • Non-invasive hemoglobin estimation is a relatively new and novel method which has given mixed results regarding its potential efficacy in adults. • There is limited data regarding usefulness and accuracy of non-invasive Hb estimation by SpHb in sick neonates and children. What is New: • Non-invasive Hb estimation by SpHb monitor is reasonably accurate in healthy neonates and children. • It can be used in critically ill children and neonates, but in conjunction with lab confirmation of Hb values.
Journal of perinatology : official journal of the California Perinatal Association, Jan 18, 2015
To compare the effect of combined delayed cord clamping and umbilical cord milking to either of t... more To compare the effect of combined delayed cord clamping and umbilical cord milking to either of them had done alone, on hematological parameters at 6 weeks of age in term neonates. It was a randomized controlled trial, conducted during January to December 2014. Three hundred eligible neonates were randomly allocated to three parallel groups. Primary outcome was hemoglobin and serum ferritin at 6 weeks of age. Data were analyzed using analysis of variance and Kruskal-Wallis test. Baseline characteristics and hemodynamic parameters were comparable in all the three groups. The median serum ferritin level at 6 weeks was significantly higher in the group receiving both delayed cord clamping and milking the cut cord group (295.49 (233.5 to 346.54) ng ml(-1)) as compared with the group that received only milking of the cut cord (184.55 (131.22 to 256.5) ng ml(-1)) or only delayed cord clamping (268.8 (189.4 to 315.44) ng ml(-1)). Delayed cord clamping with milking the cut cord improved iro...
To compare the effect of umbilical cord milking (UCM) and delayed cord clamping (DCC) on cerebral... more To compare the effect of umbilical cord milking (UCM) and delayed cord clamping (DCC) on cerebral blood flow in term neonates. This randomized controlled trial was conducted at a teaching hospital in India during 2012 to 2013. Two hundred newborns (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;36wk) were randomized to UCM and DCC groups. UCM was done on 25cm of cord length. In DCC group, clamping was delayed by 60 to 90s. Resistive Index (RI), Pulsatility Index (PI) and cerebral blood flow velocities of middle cerebral artery (MCA) were measured at 24 to 48h of life. Baseline characteristics and hemodynamic parameters were comparable. Mean PI [1.18 (0.26)] and RI [0.65 (0.08)] in UCM group was comparable to mean PI [1.18 (0.25)] and RI [0.65 (0.08)] in DCC group. The peak systolic velocity and end diastolic velocity (cm/s) of blood flow in MCA for UCM group were 34.94 (11.82) and 11.71 (4.75) respectively, while in DCC group they were 37.24 (12.63) and 13.07 (4.78) (p 0.23 and 0.07) respectively. Indices among growth retarded babies were not different. DCC and UCM had similar effect on cerebral blood flow velocities and Doppler indices in MCA, in term neonates.
Highly active antiretroviral therapy is beyond reach of most HIV-infected children in developing ... more Highly active antiretroviral therapy is beyond reach of most HIV-infected children in developing countries. There is paucity of data on more affordable regimens such as ones based on nevirapine and 2 nucleoside reverse transcriptase inhibitors. We report our experience with the use of antiretroviral therapy in children with HIV-1 infection at a tertiary care hospital in north India. The study subjects were HIV-1 infected children, who were receiving 3-drug antiretroviral therapy for a period of three or more months. The children were regularly followed up for any complications, changes in anthropometry, and changes in CD4 counts. The mean age of children at diagnosis (n=26; 22 boys) was 68.5 +- 33.4 months. These children were followed up for a mean of 19.7 +- 18.7 months. Twenty four children received nevirapine based regimen. There was statistically significant improvement in weight for height and body mass index on follow up. The mean CD4 count changed from baseline (n=24) of 584...
The objective of the study was to compare the effect of umbilical cord milking (UCM) and delayed ... more The objective of the study was to compare the effect of umbilical cord milking (UCM) and delayed cord clamping (DCC) on hematological parameters (serum ferritin and hemoglobin) at 6 weeks of life in term neonates. It was a randomized controlled trail conducted at a teaching hospital in North India during August 2012 to August 2013. Babies born at &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;36 weeks of gestation were randomized in two groups, UCM and DCC (100 in each group). Umbilical cord milking was done after cutting and clamping the cord at 25 cm from the umbilicus. In DCC group, clamping was delayed by 60 to 90 s before cutting the cord. The baseline characteristics were comparable in the two groups. Mean serum ferritin (134.0 ng/ml [89.8]) and mean hemoglobin (11.0 gm/dl [2.4]) in umbilical cord milking group was comparable to mean serum ferritin (142.7 ng/ml [87.1]) and hemoglobin (11.3 gm/dl [2.6]) in DCC group at 6 weeks of age. There was no difference in hemodynamic status, cranial Doppler indices, and adverse neonatal outcomes among the two groups. In term neonates, the DCC and UCM had comparable effect on hematological parameters at 6 weeks of life. What is Known: • Delayed cord blood clamping improves certain hematologic parameters for neonates, which is potentially important in populations with high rates of neonatal and childhood anemia, but that delayed cord blood clamping may not be feasible in clinical situations when neonatal resuscitation is urgent. What is New: • There is no significant difference in ferritin and hemoglobin levels at 6 weeks among term, Indian neonates who had UCM and DCC and that this study may give support to the practice of UCM in term deliveries when DCC is not feasible.
We report the morbidity and mortality in extremely low birth weight neonates (ELBW) from a tertia... more We report the morbidity and mortality in extremely low birth weight neonates (ELBW) from a tertiary care hospital over seven years (1994-2000). Data regarding maternal and neonatal details was obtained from old records, computer database and medical files. Of the 12,807 live births during this period, 137 (1.07%) were ELBW infants. All of them were managed without surfactant. Overall, 67 infants (48.7%) survived to discharge. The most commonly encountered morbidities were hyperbilirubinemia(65%), respiratory distress(65%), sepsis(52%), intraventricular hemorrhage(29%), pneumonia (25%) and retinopathy of prematurity(24%). Need for resuscitation, pulmonary hemorrhage, seizures, acute renal failure, sclerema and air leak syndromes were significantly associated with mortality. Sepsis accounted for 41% of all deaths while immaturity was the second most important cause, accounting for 24% deaths. The average length of stay for survivors was 49 days (SD +/- 15.9 days)
Randomized controlled trials in developed countries have reported benefits of Lactobacillus GG (L... more Randomized controlled trials in developed countries have reported benefits of Lactobacillus GG (LGG) in the treatment of acute watery diarrhoea, but there is paucity of such data from India. The study was aimed to evaluate the efficacy and safety of Lactobacillus GG in the treatment of acute diarrhoea in children from a semi-urban city in north India. In this open labelled, randomized controlled trial 2000 children with acute watery diarrhoea, aged between 6 months to 5 years visiting outpatient department and emergency room of a teaching hospital in north India were enrolled. The children were randomized into receiving either Lactobacillus GG in dose of 10 billion cfu/day for five days or no probiotic medication in addition to standard WHO management of diarrhoea. Primary outcomes were duration of diarrhoea and time to change in consistency of stools. Median (inter quartile range) duration of diarrhoea was significantly shorter in children in LGG group [60 (54-72) h vs. 78 (72-90) ...
Congenital stridor is one of the rare presentations of respiratory distress at birth. The commone... more Congenital stridor is one of the rare presentations of respiratory distress at birth. The commonest cause of congenital stridor is laryngomalacia, which accounts for 60% of the causes. The other common causes are congenital subglottic stenosis and vocal cord palsy (VCP). VCP is usually unilateral and most often linked with birth trauma, and is temporary. Bilateral palsy can be associated with other congenital anomalies. The current report describes a case of congenital bilateral VCP, not related to birth trauma and severe enough to require tracheostomy.
A case-control study was conducted to study the Lipid profile of high risk children (age 2-10 yea... more A case-control study was conducted to study the Lipid profile of high risk children (age 2-10 years). There was a significant elevation of total cholesterol (P&amp;amp;amp;amp;amp;amp;lt;0.001) and LDL (P&amp;amp;amp;amp;amp;amp;lt; 0.001). Early dietary and lifestyle modifications can prevent this cascade.
To investigate the effect of umbilical cord milking on hematological parameters at 6 weeks of age... more To investigate the effect of umbilical cord milking on hematological parameters at 6 weeks of age in late preterm neonates. Randomized controlled trial. A tertiary care center of Northern India during 2013-14. 200 moderate to late preterm neonates randomly allocated to early cord clamping or umbilical cord milking group (100 in each). In milking group, 25 cm length of cord was milked towards the baby thrice after separating (within 30 s) it from placenta. Hemoglobin and serum ferritin at 6 weeks of age. Mean (SD) serum ferritin [428.9 (217.6) vs. 237.5 (118.6) ng/mL; P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01] and hemoglobin [12.1 (1.5) vs. 10.4 (1.2) gm/dL; P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01] at 6 weeks were significantly higher in umbilical cord milking group. In early neonatal period, hemodynamic and hematological parameters were not significantly different. Higher incidence of jaundice with higher phototherapy rates (33% vs. 9%; P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01) were noted in umbilical cord milking group. In preterm neonates, umbilical cord milking at birth enhances iron stores at 6 weeks of age. Higher phototherapy rates with this intervention are a matter of concern.
... Reference. 1. Ramji S, Rasaily R, Mishra PK, Narang A, Jayam S, Kapoor AN, Kambo I, Mathur A,... more ... Reference. 1. Ramji S, Rasaily R, Mishra PK, Narang A, Jayam S, Kapoor AN, Kambo I, Mathur A, Saxena NC, Saxena BN. Resuscitation of asphyxiated newborns with room air or 100% oxygen at birth: A multicentric clinical trial. Indian Pediatr 2003; 40: 510-518. ...
Streptococcus agalactiae is still the most frequent causative agent of neonatal early-onset disea... more Streptococcus agalactiae is still the most frequent causative agent of neonatal early-onset disease. Rapid identification of GBS-colonized women on admission for delivery allows for an effective intrapartum antimicrobial prophylaxis.
This study was designed with objective to study pain response of infants to change in sequence of... more This study was designed with objective to study pain response of infants to change in sequence of administration of Hepatitis B and DTwP vaccines. This was a randomized parallel control trial. The study was carried out in the immunization clinic of the Department of Pediatrics, LLRM Medical College, Meerut. One hundred and thirty healthy term infants up to 4 months of age were injected either DTwP vaccine first or Hepatitis B vaccine first, followed one minute later by the other vaccine. Baseline characteristics did not differ between the groups. The mean (SD) of AUC of MFCS and NIPS was significantly more in DF group as compared to HF group (for MFCS 25.5±5.4 versus 22.5±5.5, p<0.01; for NIPS 31.77±5.5 versus 27.64±6.9, p<0.01). Similarly mean (SD) of AUC of Heart rate and saturation of oxygen showed significant variation in DF group as compared to HF group (for heart rate 591.6±55 versus 559.6±49, p<0.01; for SpO2 326.4±12 versus 335±8, p<0.01). These results showed th...
To investigate the effect of umbilical cord milking on hematological parameters at 6 weeks of age... more To investigate the effect of umbilical cord milking on hematological parameters at 6 weeks of age in late preterm neonates. Randomized controlled trial. A tertiary care center of Northern India during 2013-14. 200 moderate to late preterm neonates randomly allocated to early cord clamping or umbilical cord milking group (100 in each). In milking group, 25 cm length of cord was milked towards the baby thrice after separating (within 30 s) it from placenta. Hemoglobin and serum ferritin at 6 weeks of age. Mean (SD) serum ferritin [428.9 (217.6) vs. 237.5 (118.6) ng/mL; P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01] and hemoglobin [12.1 (1.5) vs. 10.4 (1.2) gm/dL; P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01] at 6 weeks were significantly higher in umbilical cord milking group. In early neonatal period, hemodynamic and hematological parameters were not significantly different. Higher incidence of jaundice with higher phototherapy rates (33% vs. 9%; P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01) were noted in umbilical cord milking group. In preterm neonates, umbilical cord milking at birth enhances iron stores at 6 weeks of age. Higher phototherapy rates with this intervention are a matter of concern.
Background & objectives: Randomized controlled trials in developed countries have reported benefi... more Background & objectives: Randomized controlled trials in developed countries have reported benefits of Lactobacillus GG (LGG) in the treatment of acute watery diarrhoea, but there is paucity of such data from India. The study was aimed to evaluate the efficacy and safety of Lactobacillus GG in the treatment of acute diarrhoea in children from a semi-urban city in north India. Methods: In this open labelled, randomized controlled trial 200 children with acute watery diarrhoea, aged between 6 months to 5 years visiting outpatient department and emergency room of a teaching hospital in north India were enrolled. The children were randomized into receiving either Lactobacillus GG in dose of 10 billion cfu/day for five days or no probiotic medication in addition to standard WHO management of diarrhoea. Primary outcomes were duration of diarrhoea and time to change in consistency of stools. Results: Median (inter quartile range) duration of diarrhoea was significantly shorter in children ...
Purpose: To investigate the effect of umbilical cord milking as compared to early cord clamping o... more Purpose: To investigate the effect of umbilical cord milking as compared to early cord clamping on haematological parameters at 6 weeks of age among term and near term neonates. Methods: Design: A randomised controlled trial. Subjects: The subjects were term & near term newborns randomized in two groups (100 each). Group 1: Umbilical cord milking(UCM) group, Group 2 (Control) No milking of umbilical cord (Control group). Newborn management other than cord milking was identical in both the groups. Method of cord milking: After delivery, baby was held at the level of introitus. The umbilical cord was clamped and cut at placental end within 30 seconds (early cord clamping) after leaving at least 25 cm length from umbilical end of cord. The baby was then placed under radiant warmer and the umbilical cord was milked from cut end towards the umbilical end 3 times, with speed of 10 cm/sec and then clamped 2-3 cm above from umbilicus. Primary Outcome variables were Haemoglobin & Serum ferri...
This study was conducted at a tertiary care center in northern India to evaluate the validity of ... more This study was conducted at a tertiary care center in northern India to evaluate the validity of non-invasive transcutaneous hemoglobin estimation in healthy and sick children in comparison to hemoglobin estimation by traditional lab method. A method comparison study was conducted including 150 subjects. Enrolled patients included 80 neonates with average age of 3.9 ± 2.1 days, and 70 children with average age of 5.8 ± 2 years. Each population (newborn and children) comprised of almost equal numbers of healthy and critically ill patients with shock. Hemoglobin (Hb) was estimated on enrolment by transcutaneous spectrophotometry (SpHb) and traditional automated lab analyzer (Hb-Lab). Difference between Hb levels by the two methods (called bias) was measured and analyzed using Bland-Altman method. Out of 148 data pairs analyzed, bias between SpHb and Hb-Lab was -1.52 ± 1.91 g/dl (mean ± SD). SpHb showed excellent positive correlation with Hb-Lab (r = 0.94 (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001)) and good visual agreement on Bland-Altman plots. Bias was higher in sick subjects with shock as compared to healthy ones in both neonatal and pediatric population (-2.31 ± 2.21 g/dl versus -0.77 ± 1.2 g/dl, respectively). SpHb showed good accuracy and correlated well with lab estimated Hb levels in healthy children. However, in children with impaired peripheral perfusion, its diagnostic accuracy was inadequate to justify routine use for quantification of severity of anemia and making transfusion decisions solely on non-invasive estimation of hemoglobin. What is Known: • Non-invasive hemoglobin estimation is a relatively new and novel method which has given mixed results regarding its potential efficacy in adults. • There is limited data regarding usefulness and accuracy of non-invasive Hb estimation by SpHb in sick neonates and children. What is New: • Non-invasive Hb estimation by SpHb monitor is reasonably accurate in healthy neonates and children. • It can be used in critically ill children and neonates, but in conjunction with lab confirmation of Hb values.
Journal of perinatology : official journal of the California Perinatal Association, Jan 18, 2015
To compare the effect of combined delayed cord clamping and umbilical cord milking to either of t... more To compare the effect of combined delayed cord clamping and umbilical cord milking to either of them had done alone, on hematological parameters at 6 weeks of age in term neonates. It was a randomized controlled trial, conducted during January to December 2014. Three hundred eligible neonates were randomly allocated to three parallel groups. Primary outcome was hemoglobin and serum ferritin at 6 weeks of age. Data were analyzed using analysis of variance and Kruskal-Wallis test. Baseline characteristics and hemodynamic parameters were comparable in all the three groups. The median serum ferritin level at 6 weeks was significantly higher in the group receiving both delayed cord clamping and milking the cut cord group (295.49 (233.5 to 346.54) ng ml(-1)) as compared with the group that received only milking of the cut cord (184.55 (131.22 to 256.5) ng ml(-1)) or only delayed cord clamping (268.8 (189.4 to 315.44) ng ml(-1)). Delayed cord clamping with milking the cut cord improved iro...
To compare the effect of umbilical cord milking (UCM) and delayed cord clamping (DCC) on cerebral... more To compare the effect of umbilical cord milking (UCM) and delayed cord clamping (DCC) on cerebral blood flow in term neonates. This randomized controlled trial was conducted at a teaching hospital in India during 2012 to 2013. Two hundred newborns (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;36wk) were randomized to UCM and DCC groups. UCM was done on 25cm of cord length. In DCC group, clamping was delayed by 60 to 90s. Resistive Index (RI), Pulsatility Index (PI) and cerebral blood flow velocities of middle cerebral artery (MCA) were measured at 24 to 48h of life. Baseline characteristics and hemodynamic parameters were comparable. Mean PI [1.18 (0.26)] and RI [0.65 (0.08)] in UCM group was comparable to mean PI [1.18 (0.25)] and RI [0.65 (0.08)] in DCC group. The peak systolic velocity and end diastolic velocity (cm/s) of blood flow in MCA for UCM group were 34.94 (11.82) and 11.71 (4.75) respectively, while in DCC group they were 37.24 (12.63) and 13.07 (4.78) (p 0.23 and 0.07) respectively. Indices among growth retarded babies were not different. DCC and UCM had similar effect on cerebral blood flow velocities and Doppler indices in MCA, in term neonates.
Highly active antiretroviral therapy is beyond reach of most HIV-infected children in developing ... more Highly active antiretroviral therapy is beyond reach of most HIV-infected children in developing countries. There is paucity of data on more affordable regimens such as ones based on nevirapine and 2 nucleoside reverse transcriptase inhibitors. We report our experience with the use of antiretroviral therapy in children with HIV-1 infection at a tertiary care hospital in north India. The study subjects were HIV-1 infected children, who were receiving 3-drug antiretroviral therapy for a period of three or more months. The children were regularly followed up for any complications, changes in anthropometry, and changes in CD4 counts. The mean age of children at diagnosis (n=26; 22 boys) was 68.5 +- 33.4 months. These children were followed up for a mean of 19.7 +- 18.7 months. Twenty four children received nevirapine based regimen. There was statistically significant improvement in weight for height and body mass index on follow up. The mean CD4 count changed from baseline (n=24) of 584...
The objective of the study was to compare the effect of umbilical cord milking (UCM) and delayed ... more The objective of the study was to compare the effect of umbilical cord milking (UCM) and delayed cord clamping (DCC) on hematological parameters (serum ferritin and hemoglobin) at 6 weeks of life in term neonates. It was a randomized controlled trail conducted at a teaching hospital in North India during August 2012 to August 2013. Babies born at &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;36 weeks of gestation were randomized in two groups, UCM and DCC (100 in each group). Umbilical cord milking was done after cutting and clamping the cord at 25 cm from the umbilicus. In DCC group, clamping was delayed by 60 to 90 s before cutting the cord. The baseline characteristics were comparable in the two groups. Mean serum ferritin (134.0 ng/ml [89.8]) and mean hemoglobin (11.0 gm/dl [2.4]) in umbilical cord milking group was comparable to mean serum ferritin (142.7 ng/ml [87.1]) and hemoglobin (11.3 gm/dl [2.6]) in DCC group at 6 weeks of age. There was no difference in hemodynamic status, cranial Doppler indices, and adverse neonatal outcomes among the two groups. In term neonates, the DCC and UCM had comparable effect on hematological parameters at 6 weeks of life. What is Known: • Delayed cord blood clamping improves certain hematologic parameters for neonates, which is potentially important in populations with high rates of neonatal and childhood anemia, but that delayed cord blood clamping may not be feasible in clinical situations when neonatal resuscitation is urgent. What is New: • There is no significant difference in ferritin and hemoglobin levels at 6 weeks among term, Indian neonates who had UCM and DCC and that this study may give support to the practice of UCM in term deliveries when DCC is not feasible.
We report the morbidity and mortality in extremely low birth weight neonates (ELBW) from a tertia... more We report the morbidity and mortality in extremely low birth weight neonates (ELBW) from a tertiary care hospital over seven years (1994-2000). Data regarding maternal and neonatal details was obtained from old records, computer database and medical files. Of the 12,807 live births during this period, 137 (1.07%) were ELBW infants. All of them were managed without surfactant. Overall, 67 infants (48.7%) survived to discharge. The most commonly encountered morbidities were hyperbilirubinemia(65%), respiratory distress(65%), sepsis(52%), intraventricular hemorrhage(29%), pneumonia (25%) and retinopathy of prematurity(24%). Need for resuscitation, pulmonary hemorrhage, seizures, acute renal failure, sclerema and air leak syndromes were significantly associated with mortality. Sepsis accounted for 41% of all deaths while immaturity was the second most important cause, accounting for 24% deaths. The average length of stay for survivors was 49 days (SD +/- 15.9 days)
Randomized controlled trials in developed countries have reported benefits of Lactobacillus GG (L... more Randomized controlled trials in developed countries have reported benefits of Lactobacillus GG (LGG) in the treatment of acute watery diarrhoea, but there is paucity of such data from India. The study was aimed to evaluate the efficacy and safety of Lactobacillus GG in the treatment of acute diarrhoea in children from a semi-urban city in north India. In this open labelled, randomized controlled trial 2000 children with acute watery diarrhoea, aged between 6 months to 5 years visiting outpatient department and emergency room of a teaching hospital in north India were enrolled. The children were randomized into receiving either Lactobacillus GG in dose of 10 billion cfu/day for five days or no probiotic medication in addition to standard WHO management of diarrhoea. Primary outcomes were duration of diarrhoea and time to change in consistency of stools. Median (inter quartile range) duration of diarrhoea was significantly shorter in children in LGG group [60 (54-72) h vs. 78 (72-90) ...
Congenital stridor is one of the rare presentations of respiratory distress at birth. The commone... more Congenital stridor is one of the rare presentations of respiratory distress at birth. The commonest cause of congenital stridor is laryngomalacia, which accounts for 60% of the causes. The other common causes are congenital subglottic stenosis and vocal cord palsy (VCP). VCP is usually unilateral and most often linked with birth trauma, and is temporary. Bilateral palsy can be associated with other congenital anomalies. The current report describes a case of congenital bilateral VCP, not related to birth trauma and severe enough to require tracheostomy.
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