Ashok Deorari - Academia.edu (original) (raw)

Papers by Ashok Deorari

Indian Pediatrics, May 20, 2021

Algorithms for predicting retinopathy of prematurity (ROP) requiring treatment need to be validat... more Algorithms for predicting retinopathy of prematurity (ROP) requiring treatment need to be validated in Indian settings to determine if the burden of screening can be reduced without compromising the sensitivity of existing gestation and weight-based cut offs. To evaluate the performance of the available algorithms namely, WINROP (Weight, Insulin-like growth factor I, Neonatal, ROP), CHOP-ROP (Children's Hospital of Philadelphia ROP) and ROPScore in predicting type 1 ROP and time from alarm to treatment by each algorithm. Ambispective observational. Tertiary care neonatal intensive care unit in India. Neonates less than 32 weeks or less than 1500 gm born between July 2013 to June 2019 (n=578) who underwent ROP screening. Sensitivity, specificity and time from alarm to treatment by each algorithm. The sensitivity and specificity of WINROP was 85% and 36%, CHOP-ROP was 54% and 71% and ROPScore was 73% and 67% respectively in detecting type 1 ROP. A total of 50/51 (98%) of neonates ...

Downloaded from www.newbornwhocc.org 1 AIIMS- NICU protocols 2007 Inspite of major advances in mo... more Downloaded from www.newbornwhocc.org 1 AIIMS- NICU protocols 2007 Inspite of major advances in monitoring technology and knowledge of fetal and perinatal medicine, Perinatal asphyxia is one of the significant causes of mortality and long term morbidity. Data from National Neonatal Perinatal database suggests that perinatal asphyxia contributes to almost 20 % of neonatal deaths in India. “Failure to initiate or sustain respiration after birth ” has been defined as criteria for the diagnosis of asphyxia by WHO. Perinatal asphyxia results in hypoxic injury to various organs including kidneys, lungs and liver but the most serious effects are seen on the central nervous system. Levene’s classification is a useful clinical tool for grading the severity of hypoxic ischemic encephalopathy. Good supportive care is essential in the first 48 hours after asphyxia to prevent ongoing brain injury in the penumbra region. Strict monitoring and prompt correction is needed for common problems includi...

Systemic infection in the newborn is the commonest cause of neonatal mortality. Data from Nationa... more Systemic infection in the newborn is the commonest cause of neonatal mortality. Data from National Neonatal Perinatal Database 2000 suggests that Klebsiella pneumoniae and Staphylococcus aureus are the commonest causes of neonatal sepsis in India. Two forms of clinical presentations have been identified. Early onset sepsis, probably related to perinatal risk factors, usually presents with respiratory distress and pneumonia within 72 hours of age. Late onset sepsis, related to hospital acquired infections, usually presents with septicemia and pneumonia after 72 hours of age. Clinical features of sepsis are non-specific in neonates and a high index of suspicion is required for the timely diagnosis of sepsis. Although blood culture is the gold standard for the diagnosis of sepsis, reports are available after 48-72 hours. A practical septic screen for the diagnosis of sepsis has been described and some suggestions for antibiotic use have been included in the protocol. 2 Sepsis in the Ne...

The National medical journal of India, 2008

These two studies, called the ORACLE Children Studies (OCS)-I and II, are the culmination of 7 ye... more These two studies, called the ORACLE Children Studies (OCS)-I and II, are the culmination of 7 years' follow up of the original trials that evaluated the use of erythromycin and/or amoxicillin-clavulanate (co-amoxiclav) in 2 groups of pregnant women using a factorial randomized design. The first group (ORACLE I trial) consisted of pregnant women with preterm premature rupture of membranes (PPROM) and the second group (ORACLE II trial) consisted of those presenting with spontaneous preterm labour (SPL). These trials found that:

Indian pediatrics, 2004

OBJECTIVE To evaluate the efficacy of oral phenobarbitone in "at risk " term neonates (... more OBJECTIVE To evaluate the efficacy of oral phenobarbitone in "at risk " term neonates (with high cord bilirubin) in decreasing hyperbilirubinemia. DESIGN Double blind, placebo-control, randomized trial. SETTING Tertiary level neonatal unit. OUTCOME Primary-hyperbilirubinemia defined as total serum bilirubin (TSB) greater than 13 mg/dL. Secondary-TSB at 72 +/- 12 hr, need for phototherapy or exchange transfusion and side effects of phenobarbitone therapy. METHODS All consecutively born term healthy neonates with cord bilirubin > or = 2.5 mg/dL were randomly assigned to receive either phenobarbitone (n = 37) or placebo (n = 38) after obtaining informed consent. Phenobarbitone was administered orally (5 mg/kg/day) for 3 days starting within 12 hours of birth. The neonates were followed up till seven days of life. TSB was estimated in neonates who developed jaundice with clinically assessed level of 8-10 mg/dL and at 72 +/-12 hours of age in 55 neonates. RESULTS The baselin...

Indian pediatrics, 2008

INDIAN PEDIATRICS 650 VOLUME 45__AUGUST 17, 2008 1.0 g/kg(5). Given the possible side-effects it ... more INDIAN PEDIATRICS 650 VOLUME 45__AUGUST 17, 2008 1.0 g/kg(5). Given the possible side-effects it is important to identify the lowest possible efficacious dose. In this issue of the journal, Girish and colleagues(6) have compared the outcome of Rh isoimmunized infants (>31 weeks of gestational age) given 0.5 g/kg or 1.0 g/kg HDIVIG. They conclude that the two regimes of HDIVIG had comparable effects on the duration of phototherapy, duration of hospital stay and need for exchange transfusion. The study, however, was powered only to detect a difference in the duration of phototherapy between the two groups of 24 hours and not to confidently assess differences in other outcomes reported. The authors found the mean duration of phototherapy was 77.3 hours in the low dose group and 55.4 hours in the high dose group (mean difference 21.9, 95% CI-13.1 to 56.9), even though the high dose group was disadvantaged by containing more infants who were hydropic at birth (1/19 versus 6/19) and ha...

BMJ Open, 2021

Objectives To investigate if intravenous fentanyl or intravenous ketamine can provide adequate an... more Objectives To investigate if intravenous fentanyl or intravenous ketamine can provide adequate analgesia in preterm infants undergoing laser photocoagulation for retinopathy of prematurity (ROP). Design Open-label randomised trial. Setting Tertiary care institution. Participants Preterm infants who underwent laser photocoagulation for ROP. Interventions Infants were randomised to receive fentanyl as intravenous bolus dose of 2 µg/kg, followed by an intravenous infusion of 1 µg/kg/hour increased to a maximum of 3 µg/kg/hour or intravenous ketamine as bolus dose of 0.5 mg/kg, followed by further intermittent intravenous bolus doses of 0.5 mg/kg to a maximum of 2 mg/kg in the initial phase and intravenous fentanyl (bolus of 2 µg/kg followed by infusion of 2 µg/kg/hour to a maximum of 5 µg/kg/hour) or intravenous ketamine (bolus dose of 1 mg/kg followed by intermittent bolus doses of 0.5 mg/kg to a maximum of 4 mg/kg) in the revised regimen phase. Main outcome measures Proportion of inf...

Indian pediatrics, 2008

OBJECTIVE To compare the effect of two dose regimes of IVIg (0.5 g/kg vs. 1g/kg given soon after ... more OBJECTIVE To compare the effect of two dose regimes of IVIg (0.5 g/kg vs. 1g/kg given soon after birth) on duration of phototherapy in Rh-isoimmunized neonates 32 week and above gestation. DESIGN Randomized controlled trial. SETTING Tertiary care hospital. SUBJECTS Rh positive blood group neonates of gestation 32 weeks and above born to Rh negative mothers having positive Direct Coombs test and without any major malformation. INTERVENTION Intravenous immunoglobulin (IVIg) infusion over 2 h either 0.5 g/kg (low dose group, n=19) or 1.0 g/kg (high dose group, n=19). PRIMARY OUTCOME VARIABLE Duration of phototherapy. RESULTS The mean duration of phototherapy was 77.3+/-57.2 h in low dose group versus 55.4+/-49 h in high dose group (mean difference=21.9; 95% CI-13.1 to 56.9). There was no difference in need for exchange transfusion (21% in both the groups) and requirement of packed red blood cells transfusion (12 transfusions in both groups). The duration of hospital stay was similar [8...

12 McLaws ML, Pantle AC, Fitzpatrick KR, Hughes CF. More than hand hygiene is needed to affect me... more 12 McLaws ML, Pantle AC, Fitzpatrick KR, Hughes CF. More than hand hygiene is needed to affect methicillin-resistant Staphylococcus aureus clinical indicator rates: Clean hands save lives, part IV. Med J Aust 2009;191 (8 Suppl):S26–S31. 13 Jain R, Kralovic SM, Evans ME, Ambrose M, Simbartl LA, Obrosky DS, et al. Veterans Affairs initiative to prevent methicillin-resistant Staphylococcus aureus infections. N Engl J Med 2011;364:1419–30. 14 Chalfine A, Kitzis MD, Bezie Y, Benali A, Perniceni L, Nguyen JC, et al. Ten-year decrease of acquired methicillin-resistant Staphylococcus aureus (MRSA) bacteremia at a single institution: The result of a multifaceted program combining crosstransmission prevention and antimicrobial stewardship. Antimicrob Resist Infect Control 2012;1:18. 15 Silvestri L, de la Cal MA, van Saene HK. Selective decontamination of the digestive tract: The mechanism of action is control of gut overgrowth. Intensive Care Med 2012;38:1738–50. 16 Wittekamp BH, Bonten MJ. A...

OBJECTIVE To evaluate the efficacy of white reflecting material (slings) hung from the sides of c... more OBJECTIVE To evaluate the efficacy of white reflecting material (slings) hung from the sides of compact fluorescent lamp (CFL) phototherapy equipment in reducing the duration of phototherapy in healthy term neonates with non-hemolytic jaundice. DESIGN Randomized controlled trial. SETTING Postnatal ward of a tertiary level neonatal unit. PARTICIPANTS AND INTERVENTION Healthy term neonates with non-hemolytic jaundice between 24 hours and 10 days of age were randomly assigned to receive single surface phototherapy with (n=42) or without slings (n=42). OUTCOME MEASURE Duration of phototherapy in hours (h) and the requirement of exchange transfusion. RESULTS Birthweight (2790+/-352 vs. 2923+/-330 g), gestation (38+/-1.3 vs. 37+/-1.0 wk) and initial serum total bilirubin (STB) (16.6+/-2.4 vs. 16.1+/-2.2 mg/dL) were comparable between the two groups. There was no significant difference in the duration of phototherapy (mean+/-SD) between the Sling (23.3+/-12.9 h) and No sling (24.9+/-15.4 h...

BACKGROUND Periventricular leucomalacia (PVL) is the most important neuropathologic lesion underl... more BACKGROUND Periventricular leucomalacia (PVL) is the most important neuropathologic lesion underlying major neuro-motor deficits of pre-term very low birth weight (VLBW) infants. Published data regarding PVL is not available from our country. OBJECTIVES A study was planned with main objectives to estimate incidence and describe natural history of PVL among a very low birth weight cohort. STUDY DESIGN A cohort study was performed on inborn VLBW babies over one year period at a tertiary neonatal intensive care unit. Serial weekly cranial ultrasounds were performed on 97 enrolled subjects until discharge, to diagnose and describe natural history of PVL. RESULTS 31 out of 97 enrolled subjects developed PVL. No case of PVL developed beyond 19 days of postnatal life. Serial ultrasounds for each baby were tracked until discharge or death. Majority of lesions at onset were flares. Cysts tended to develop in over one third of cases during course of hospital stay. About 50% of ultrasound had ...

Objective: To compare efficacy of intramuscular phytomenadione (fat soluble vitamin K or vitamin ... more Objective: To compare efficacy of intramuscular phytomenadione (fat soluble vitamin K or vitamin K1) with menadione (water soluble vitamin K or vitamin K3) in prevention of subclinical vitamin K deficiency. Design: A double-blind randomized controlled trial. Settings: Tertiary care hospital. Methods: Healthy term neonates were randomized to receive 1 mg of either phytomenadione (Group I, n = 85) or menadione (Group II, n = 85) intramuscularly within 2 hours of birth. PIVKA-II, a sensitive and specific marker of vitamin K deficiency was measured by ELISA method (Diagnostica Stago, France). Plasma level >2 ng/mL was labeled as detectable PIVKA-II. Results: Birth weight (2914 ± 318 vs 2958 ± 312 g), gestation (38.4 ± 1.2 vs 38.4 ± 1.0 wk) and other baseline variables were comparable between the two groups. 48.2% (41/ 85) neonates in Group I and 44.7% (38/85) neonates in Group II had ‘detectable’ PIVKA-II levels ([Relative Risk (95% confidence interval): 1.1 (0.8-1.5); P = 0.76]). Me...

Objectives: To describe the clinical and epidemiological profile of young infants reporting to a ... more Objectives: To describe the clinical and epidemiological profile of young infants reporting to a hospital and assess previously proposed simple clinical signs for their value in enabling health workers to detect young infants with severe illness warranting hospital admission. Methods: Observational study of infants less than 2 months of age presenting consecutively to a large public hospital in South Delhi who were evaluated by a health worker (nurse), on a standardized list of signs and symptoms, and the ability of these were evaluated against the need for hospital admission which was assessed by an independent pediatrician. Results: Of the 1624 young infants triaged, 878 were enrolled into the study. Of these 100 (11%) were below 7 days of age, for whom the common reasons for seeking care were jaundice (52%), not feeding well (6%) and fever (5%). The remaining 778 (89%) were 7-59 days of age with respiratory symptoms as the main presenting complaints (29.1 %). The primary clinical...

Indian Pediatrics

Note: This early-online version of the article is an unedited manuscript that has been accepted f... more Note: This early-online version of the article is an unedited manuscript that has been accepted for publication. It has been posted to the website for making it available to readers, ahead of its publication in print. This version will undergo copy-editing, typesetting, and proofreading, before final publication; and the text may undergo minor changes in the final version. MANTOO ET AL.

The British Journal of Ophthalmology, Oct 1, 2002

BMC medical education, Jan 8, 2016

There has been an increased emphasis on institutional births, and thus an increasing clinical wor... more There has been an increased emphasis on institutional births, and thus an increasing clinical work load for health care professionals in the recent past. Hence, continuing education, training, ongoing supervision, and mentorship of health care professionals working in these health facilities with easy access to guidelines in a cost effective manner has become a challenging task. With the increased emphasis on institutional births, and an increasing clinical work load, continuing education and training of health care professional managing these health facilities, their ongoing supervision, mentorship, with ready availability of guidelines in a cost effective manner becomes imperative and is a challenging task. Training opportunities can be linked to mobile electronic devices and 'Apps' to improve the care of seriously ill newborn. The aim of this study was to evaluate the efficacy of an innovative point of care tool- Android based App- 'AIIMS-WHO CC STPs' on the knowl...

Evidence-based Ophthalmology, 2005

The etiology of retinopathy of prematurity (ROP) is multifactorial while ROP is also frequently a... more The etiology of retinopathy of prematurity (ROP) is multifactorial while ROP is also frequently associated with other co-morbidity characteristics in former preterm infants. We describe the current risk factors associated with the development of pre-threshold ROP in a cohort of 267 ELBW (extreme low birth weight, i.e. < 1 000 g) infants. We hereby confirm the combined risk associated with immaturity and disease severity. When compared to earlier reported cohorts of the same unit, we document a minor reduction in incidence, with an overall high incidence in neonates at threshold of viability (≤ 26 weeks gestational age). Finally, specific observations on analgosedation and tolerance during screening for ROP or laser surgery are discussed.

Journal of Perinatology, 2013

To evaluate the effect of supine position when compared with periodic change of position during p... more To evaluate the effect of supine position when compared with periodic change of position during phototherapy in late preterm and term neonates (35 to 42 weeks) with hyperbilirubinemia on the duration of phototherapy. STUDY DESIGN: We randomly allocated enrolled neonates with hyperbilirubinemia to either no change in position (supine group (SG); n ¼ 54) or two-hourly change of position from supine to prone and vice versa (turning group (TG); n ¼ 46). All the infants received single surface phototherapy by two dedicated compact fluorescent light units. Total serum bilirubin (TSB) was measured at the start of phototherapy and then every 12 ± 2 h until the end of phototherapy. Phototherapy was stopped when two values were below the cutoff for age and gestational age as per the American Academy of Pediatrics Subcommittee on Hyperbilirubinemia guidelines nomogram for the management of hyperbilirubinemia in infants 435 weeks of gestation. The primary outcome was duration of phototherapy and secondary outcome was rate of fall of bilirubin within the first 24 ± 2 h after the initiation of phototherapy. RESULT: Baseline characteristics including birth weight (g, 2752±478 vs 2748±416 P ¼ 0.96), gestation (week, 37.1±1.2 vs 37.4 ± 1.3, P ¼ 0.26) were similar in the two groups. There was no difference in the duration of phototherapy between the SG (mean ± s.d., hour, 25.5 ± 8) and TG (mean ± s.d., hour, 24.8 ± 5), mean difference (95% confidence interval), hour, 0.7 (À 2.03, 3.44, P ¼ 0.6). Rate of fall of bilirubin was also similar in both supine and turning groups with mean difference of À 0.020 (95% confidence interval: À 0.061, 0.021, P ¼ 0.34). CONCLUSION: Nursing babies in supine position when compared with periodic position change during phototherapy does not decrease the duration of phototherapy.

Indian Pediatrics, May 20, 2021

Algorithms for predicting retinopathy of prematurity (ROP) requiring treatment need to be validat... more Algorithms for predicting retinopathy of prematurity (ROP) requiring treatment need to be validated in Indian settings to determine if the burden of screening can be reduced without compromising the sensitivity of existing gestation and weight-based cut offs. To evaluate the performance of the available algorithms namely, WINROP (Weight, Insulin-like growth factor I, Neonatal, ROP), CHOP-ROP (Children's Hospital of Philadelphia ROP) and ROPScore in predicting type 1 ROP and time from alarm to treatment by each algorithm. Ambispective observational. Tertiary care neonatal intensive care unit in India. Neonates less than 32 weeks or less than 1500 gm born between July 2013 to June 2019 (n=578) who underwent ROP screening. Sensitivity, specificity and time from alarm to treatment by each algorithm. The sensitivity and specificity of WINROP was 85% and 36%, CHOP-ROP was 54% and 71% and ROPScore was 73% and 67% respectively in detecting type 1 ROP. A total of 50/51 (98%) of neonates ...

Downloaded from www.newbornwhocc.org 1 AIIMS- NICU protocols 2007 Inspite of major advances in mo... more Downloaded from www.newbornwhocc.org 1 AIIMS- NICU protocols 2007 Inspite of major advances in monitoring technology and knowledge of fetal and perinatal medicine, Perinatal asphyxia is one of the significant causes of mortality and long term morbidity. Data from National Neonatal Perinatal database suggests that perinatal asphyxia contributes to almost 20 % of neonatal deaths in India. “Failure to initiate or sustain respiration after birth ” has been defined as criteria for the diagnosis of asphyxia by WHO. Perinatal asphyxia results in hypoxic injury to various organs including kidneys, lungs and liver but the most serious effects are seen on the central nervous system. Levene’s classification is a useful clinical tool for grading the severity of hypoxic ischemic encephalopathy. Good supportive care is essential in the first 48 hours after asphyxia to prevent ongoing brain injury in the penumbra region. Strict monitoring and prompt correction is needed for common problems includi...

Systemic infection in the newborn is the commonest cause of neonatal mortality. Data from Nationa... more Systemic infection in the newborn is the commonest cause of neonatal mortality. Data from National Neonatal Perinatal Database 2000 suggests that Klebsiella pneumoniae and Staphylococcus aureus are the commonest causes of neonatal sepsis in India. Two forms of clinical presentations have been identified. Early onset sepsis, probably related to perinatal risk factors, usually presents with respiratory distress and pneumonia within 72 hours of age. Late onset sepsis, related to hospital acquired infections, usually presents with septicemia and pneumonia after 72 hours of age. Clinical features of sepsis are non-specific in neonates and a high index of suspicion is required for the timely diagnosis of sepsis. Although blood culture is the gold standard for the diagnosis of sepsis, reports are available after 48-72 hours. A practical septic screen for the diagnosis of sepsis has been described and some suggestions for antibiotic use have been included in the protocol. 2 Sepsis in the Ne...

The National medical journal of India, 2008

These two studies, called the ORACLE Children Studies (OCS)-I and II, are the culmination of 7 ye... more These two studies, called the ORACLE Children Studies (OCS)-I and II, are the culmination of 7 years' follow up of the original trials that evaluated the use of erythromycin and/or amoxicillin-clavulanate (co-amoxiclav) in 2 groups of pregnant women using a factorial randomized design. The first group (ORACLE I trial) consisted of pregnant women with preterm premature rupture of membranes (PPROM) and the second group (ORACLE II trial) consisted of those presenting with spontaneous preterm labour (SPL). These trials found that:

Indian pediatrics, 2004

OBJECTIVE To evaluate the efficacy of oral phenobarbitone in "at risk " term neonates (... more OBJECTIVE To evaluate the efficacy of oral phenobarbitone in "at risk " term neonates (with high cord bilirubin) in decreasing hyperbilirubinemia. DESIGN Double blind, placebo-control, randomized trial. SETTING Tertiary level neonatal unit. OUTCOME Primary-hyperbilirubinemia defined as total serum bilirubin (TSB) greater than 13 mg/dL. Secondary-TSB at 72 +/- 12 hr, need for phototherapy or exchange transfusion and side effects of phenobarbitone therapy. METHODS All consecutively born term healthy neonates with cord bilirubin > or = 2.5 mg/dL were randomly assigned to receive either phenobarbitone (n = 37) or placebo (n = 38) after obtaining informed consent. Phenobarbitone was administered orally (5 mg/kg/day) for 3 days starting within 12 hours of birth. The neonates were followed up till seven days of life. TSB was estimated in neonates who developed jaundice with clinically assessed level of 8-10 mg/dL and at 72 +/-12 hours of age in 55 neonates. RESULTS The baselin...

Indian pediatrics, 2008

INDIAN PEDIATRICS 650 VOLUME 45__AUGUST 17, 2008 1.0 g/kg(5). Given the possible side-effects it ... more INDIAN PEDIATRICS 650 VOLUME 45__AUGUST 17, 2008 1.0 g/kg(5). Given the possible side-effects it is important to identify the lowest possible efficacious dose. In this issue of the journal, Girish and colleagues(6) have compared the outcome of Rh isoimmunized infants (>31 weeks of gestational age) given 0.5 g/kg or 1.0 g/kg HDIVIG. They conclude that the two regimes of HDIVIG had comparable effects on the duration of phototherapy, duration of hospital stay and need for exchange transfusion. The study, however, was powered only to detect a difference in the duration of phototherapy between the two groups of 24 hours and not to confidently assess differences in other outcomes reported. The authors found the mean duration of phototherapy was 77.3 hours in the low dose group and 55.4 hours in the high dose group (mean difference 21.9, 95% CI-13.1 to 56.9), even though the high dose group was disadvantaged by containing more infants who were hydropic at birth (1/19 versus 6/19) and ha...

BMJ Open, 2021

Objectives To investigate if intravenous fentanyl or intravenous ketamine can provide adequate an... more Objectives To investigate if intravenous fentanyl or intravenous ketamine can provide adequate analgesia in preterm infants undergoing laser photocoagulation for retinopathy of prematurity (ROP). Design Open-label randomised trial. Setting Tertiary care institution. Participants Preterm infants who underwent laser photocoagulation for ROP. Interventions Infants were randomised to receive fentanyl as intravenous bolus dose of 2 µg/kg, followed by an intravenous infusion of 1 µg/kg/hour increased to a maximum of 3 µg/kg/hour or intravenous ketamine as bolus dose of 0.5 mg/kg, followed by further intermittent intravenous bolus doses of 0.5 mg/kg to a maximum of 2 mg/kg in the initial phase and intravenous fentanyl (bolus of 2 µg/kg followed by infusion of 2 µg/kg/hour to a maximum of 5 µg/kg/hour) or intravenous ketamine (bolus dose of 1 mg/kg followed by intermittent bolus doses of 0.5 mg/kg to a maximum of 4 mg/kg) in the revised regimen phase. Main outcome measures Proportion of inf...

Indian pediatrics, 2008

OBJECTIVE To compare the effect of two dose regimes of IVIg (0.5 g/kg vs. 1g/kg given soon after ... more OBJECTIVE To compare the effect of two dose regimes of IVIg (0.5 g/kg vs. 1g/kg given soon after birth) on duration of phototherapy in Rh-isoimmunized neonates 32 week and above gestation. DESIGN Randomized controlled trial. SETTING Tertiary care hospital. SUBJECTS Rh positive blood group neonates of gestation 32 weeks and above born to Rh negative mothers having positive Direct Coombs test and without any major malformation. INTERVENTION Intravenous immunoglobulin (IVIg) infusion over 2 h either 0.5 g/kg (low dose group, n=19) or 1.0 g/kg (high dose group, n=19). PRIMARY OUTCOME VARIABLE Duration of phototherapy. RESULTS The mean duration of phototherapy was 77.3+/-57.2 h in low dose group versus 55.4+/-49 h in high dose group (mean difference=21.9; 95% CI-13.1 to 56.9). There was no difference in need for exchange transfusion (21% in both the groups) and requirement of packed red blood cells transfusion (12 transfusions in both groups). The duration of hospital stay was similar [8...

12 McLaws ML, Pantle AC, Fitzpatrick KR, Hughes CF. More than hand hygiene is needed to affect me... more 12 McLaws ML, Pantle AC, Fitzpatrick KR, Hughes CF. More than hand hygiene is needed to affect methicillin-resistant Staphylococcus aureus clinical indicator rates: Clean hands save lives, part IV. Med J Aust 2009;191 (8 Suppl):S26–S31. 13 Jain R, Kralovic SM, Evans ME, Ambrose M, Simbartl LA, Obrosky DS, et al. Veterans Affairs initiative to prevent methicillin-resistant Staphylococcus aureus infections. N Engl J Med 2011;364:1419–30. 14 Chalfine A, Kitzis MD, Bezie Y, Benali A, Perniceni L, Nguyen JC, et al. Ten-year decrease of acquired methicillin-resistant Staphylococcus aureus (MRSA) bacteremia at a single institution: The result of a multifaceted program combining crosstransmission prevention and antimicrobial stewardship. Antimicrob Resist Infect Control 2012;1:18. 15 Silvestri L, de la Cal MA, van Saene HK. Selective decontamination of the digestive tract: The mechanism of action is control of gut overgrowth. Intensive Care Med 2012;38:1738–50. 16 Wittekamp BH, Bonten MJ. A...

OBJECTIVE To evaluate the efficacy of white reflecting material (slings) hung from the sides of c... more OBJECTIVE To evaluate the efficacy of white reflecting material (slings) hung from the sides of compact fluorescent lamp (CFL) phototherapy equipment in reducing the duration of phototherapy in healthy term neonates with non-hemolytic jaundice. DESIGN Randomized controlled trial. SETTING Postnatal ward of a tertiary level neonatal unit. PARTICIPANTS AND INTERVENTION Healthy term neonates with non-hemolytic jaundice between 24 hours and 10 days of age were randomly assigned to receive single surface phototherapy with (n=42) or without slings (n=42). OUTCOME MEASURE Duration of phototherapy in hours (h) and the requirement of exchange transfusion. RESULTS Birthweight (2790+/-352 vs. 2923+/-330 g), gestation (38+/-1.3 vs. 37+/-1.0 wk) and initial serum total bilirubin (STB) (16.6+/-2.4 vs. 16.1+/-2.2 mg/dL) were comparable between the two groups. There was no significant difference in the duration of phototherapy (mean+/-SD) between the Sling (23.3+/-12.9 h) and No sling (24.9+/-15.4 h...

BACKGROUND Periventricular leucomalacia (PVL) is the most important neuropathologic lesion underl... more BACKGROUND Periventricular leucomalacia (PVL) is the most important neuropathologic lesion underlying major neuro-motor deficits of pre-term very low birth weight (VLBW) infants. Published data regarding PVL is not available from our country. OBJECTIVES A study was planned with main objectives to estimate incidence and describe natural history of PVL among a very low birth weight cohort. STUDY DESIGN A cohort study was performed on inborn VLBW babies over one year period at a tertiary neonatal intensive care unit. Serial weekly cranial ultrasounds were performed on 97 enrolled subjects until discharge, to diagnose and describe natural history of PVL. RESULTS 31 out of 97 enrolled subjects developed PVL. No case of PVL developed beyond 19 days of postnatal life. Serial ultrasounds for each baby were tracked until discharge or death. Majority of lesions at onset were flares. Cysts tended to develop in over one third of cases during course of hospital stay. About 50% of ultrasound had ...

Objective: To compare efficacy of intramuscular phytomenadione (fat soluble vitamin K or vitamin ... more Objective: To compare efficacy of intramuscular phytomenadione (fat soluble vitamin K or vitamin K1) with menadione (water soluble vitamin K or vitamin K3) in prevention of subclinical vitamin K deficiency. Design: A double-blind randomized controlled trial. Settings: Tertiary care hospital. Methods: Healthy term neonates were randomized to receive 1 mg of either phytomenadione (Group I, n = 85) or menadione (Group II, n = 85) intramuscularly within 2 hours of birth. PIVKA-II, a sensitive and specific marker of vitamin K deficiency was measured by ELISA method (Diagnostica Stago, France). Plasma level >2 ng/mL was labeled as detectable PIVKA-II. Results: Birth weight (2914 ± 318 vs 2958 ± 312 g), gestation (38.4 ± 1.2 vs 38.4 ± 1.0 wk) and other baseline variables were comparable between the two groups. 48.2% (41/ 85) neonates in Group I and 44.7% (38/85) neonates in Group II had ‘detectable’ PIVKA-II levels ([Relative Risk (95% confidence interval): 1.1 (0.8-1.5); P = 0.76]). Me...

Objectives: To describe the clinical and epidemiological profile of young infants reporting to a ... more Objectives: To describe the clinical and epidemiological profile of young infants reporting to a hospital and assess previously proposed simple clinical signs for their value in enabling health workers to detect young infants with severe illness warranting hospital admission. Methods: Observational study of infants less than 2 months of age presenting consecutively to a large public hospital in South Delhi who were evaluated by a health worker (nurse), on a standardized list of signs and symptoms, and the ability of these were evaluated against the need for hospital admission which was assessed by an independent pediatrician. Results: Of the 1624 young infants triaged, 878 were enrolled into the study. Of these 100 (11%) were below 7 days of age, for whom the common reasons for seeking care were jaundice (52%), not feeding well (6%) and fever (5%). The remaining 778 (89%) were 7-59 days of age with respiratory symptoms as the main presenting complaints (29.1 %). The primary clinical...

Indian Pediatrics

Note: This early-online version of the article is an unedited manuscript that has been accepted f... more Note: This early-online version of the article is an unedited manuscript that has been accepted for publication. It has been posted to the website for making it available to readers, ahead of its publication in print. This version will undergo copy-editing, typesetting, and proofreading, before final publication; and the text may undergo minor changes in the final version. MANTOO ET AL.

The British Journal of Ophthalmology, Oct 1, 2002

BMC medical education, Jan 8, 2016

There has been an increased emphasis on institutional births, and thus an increasing clinical wor... more There has been an increased emphasis on institutional births, and thus an increasing clinical work load for health care professionals in the recent past. Hence, continuing education, training, ongoing supervision, and mentorship of health care professionals working in these health facilities with easy access to guidelines in a cost effective manner has become a challenging task. With the increased emphasis on institutional births, and an increasing clinical work load, continuing education and training of health care professional managing these health facilities, their ongoing supervision, mentorship, with ready availability of guidelines in a cost effective manner becomes imperative and is a challenging task. Training opportunities can be linked to mobile electronic devices and 'Apps' to improve the care of seriously ill newborn. The aim of this study was to evaluate the efficacy of an innovative point of care tool- Android based App- 'AIIMS-WHO CC STPs' on the knowl...

Evidence-based Ophthalmology, 2005

The etiology of retinopathy of prematurity (ROP) is multifactorial while ROP is also frequently a... more The etiology of retinopathy of prematurity (ROP) is multifactorial while ROP is also frequently associated with other co-morbidity characteristics in former preterm infants. We describe the current risk factors associated with the development of pre-threshold ROP in a cohort of 267 ELBW (extreme low birth weight, i.e. < 1 000 g) infants. We hereby confirm the combined risk associated with immaturity and disease severity. When compared to earlier reported cohorts of the same unit, we document a minor reduction in incidence, with an overall high incidence in neonates at threshold of viability (≤ 26 weeks gestational age). Finally, specific observations on analgosedation and tolerance during screening for ROP or laser surgery are discussed.

Journal of Perinatology, 2013

To evaluate the effect of supine position when compared with periodic change of position during p... more To evaluate the effect of supine position when compared with periodic change of position during phototherapy in late preterm and term neonates (35 to 42 weeks) with hyperbilirubinemia on the duration of phototherapy. STUDY DESIGN: We randomly allocated enrolled neonates with hyperbilirubinemia to either no change in position (supine group (SG); n ¼ 54) or two-hourly change of position from supine to prone and vice versa (turning group (TG); n ¼ 46). All the infants received single surface phototherapy by two dedicated compact fluorescent light units. Total serum bilirubin (TSB) was measured at the start of phototherapy and then every 12 ± 2 h until the end of phototherapy. Phototherapy was stopped when two values were below the cutoff for age and gestational age as per the American Academy of Pediatrics Subcommittee on Hyperbilirubinemia guidelines nomogram for the management of hyperbilirubinemia in infants 435 weeks of gestation. The primary outcome was duration of phototherapy and secondary outcome was rate of fall of bilirubin within the first 24 ± 2 h after the initiation of phototherapy. RESULT: Baseline characteristics including birth weight (g, 2752±478 vs 2748±416 P ¼ 0.96), gestation (week, 37.1±1.2 vs 37.4 ± 1.3, P ¼ 0.26) were similar in the two groups. There was no difference in the duration of phototherapy between the SG (mean ± s.d., hour, 25.5 ± 8) and TG (mean ± s.d., hour, 24.8 ± 5), mean difference (95% confidence interval), hour, 0.7 (À 2.03, 3.44, P ¼ 0.6). Rate of fall of bilirubin was also similar in both supine and turning groups with mean difference of À 0.020 (95% confidence interval: À 0.061, 0.021, P ¼ 0.34). CONCLUSION: Nursing babies in supine position when compared with periodic position change during phototherapy does not decrease the duration of phototherapy.