Kangaroo Mother Care in Reducing Pain in Preterm Neonates on Heel Prick

Objectives

To determine the effect of Kangaroo Mother Care (KMC) of small duration of 15 min in decreasing pain in preterm neonates between 32–36 wk 6 d on heel prick by a 26 gauge needle.

Methods

Randomized controlled double masked crossover trial involving 50 neonates, between 32 wk and 36 wk 6 d gestation and weighing less than 2500 g, within 10 d of birth, vitally stable, breathing without assistance or on Continuous positive airway pressure (CPAP), without any clinically evident neurological signs, not having received analgesics/sedatives within last 24 h and not fed within last 30 min and requiring heel pricking were eligible. Outcome measured was the Premature Infant Pain Profile (PIPP). Analysis was done using independent sample t test, with Bonferroni correction applied for comparing individual components of PIPP score.

Results

The heart rate, behaviour and facial scores were statistically significant and lower in KMC group. But there was no statistically significant difference in oxygen saturation (SpO₂₎. The difference(4.85) in PIPP score was clinically and statistically significant (p?<?0.0001).

Conclusions

The findings suggest that short duration KMC (15 min) has stress reducing benefits. Preterm neonates above 32 wk gestational age can benefit from KMC to decrease pain from heel prick procedure.     

Role of Dexamethasone in Neonatal Meningitis: A Randomized Controlled Trial

Objectives

To evaluate the role of dexamethasone therapy in neonatal meningitis in a randomized placebo controlled trial.

Methods

The participants were eighty neonates with meningitis randomized to receive dexamethasone or saline placebo. Dexamethasone was started prior to the first dose of antibiotics in the dose of 0.15 mg/kg intravenous 6 hourly for 2 d. Primary outcome measure was mortality. Secondary outcome measures included progression of systemic inflammatory response syndrome (SIRS) up to 48 h, differences in cerebrospinal fluid (CSF) cytokines between baseline levels and 24 h after enrolment and brain stem auditory evoked response (BAER) after 4 to 6 wk of discharge.

Results

Baseline variables were comparable in both the groups. Mortality was significantly decreased in dexamethasone group (p?=?0.005) and the absolute risk difference was 27.5 % (95 % CI 9.5–45.8 %). There was a significant reduction in cells per mm³ (62.5 vs. 100) and proteins (162 vs. 217.5 mg/dl) after 24 h of treatment in the dexamethasone group. IL-1β was significantly reduced after 24 h in dexamethasone group (290 vs 665 pg/ml). TNF- α was significantly lower (157.5 vs 427.5 pg/ml) and sugar significantly higher (50 vs 38 mg/dl) in the dexamethasone group after 24 h. Significant difference was noted between dexamethasone and saline groups in the progression of SIRS.

Conclusions

Dexamethasone significantly reduced fatality, progression of SIRS and CSF inflammatory indices.     

Effect of kangaroo mother care Vs expressed breast milk administration on pain associated with removal of adhesive tape in very low birth weight neonates: A randomized controlled trial

Objective

To compare the pain relief effect of Kangaroo Mother Care (KMC) and Expressed Breast Milk (EBM) on the pain associated with adhesive tape removal in very low birth weight (VLBW) neonates.

Design

Randomized Controlled Trial.

Setting

Neonatal intensive care unit of a tertiary care teaching hospital.

Participants

15 VLBW neonates who needed adhesive tape removal for the first part and 50 VLBW neonates needing adhesive tape removal for the second part.

Methods

In first stage of the study, we studied whether adhesive tape removal in VLBW neonates was painful. In the second stage, eligible VLBW neonates were randomised to compare the efficacy of KMC and EBM in reducing the pain during the procedure of adhesive tape removal.

Outcome Variables

Premature Infant Pain Profile (PIPP) Score, heart rate, oxygen saturation.

Results

There was significant increase in pain associated with the removal of adhesive tape (Mean pre-procedure PIPP score 3.47 ± 0.74; post-procedure mean PIPP score 12.13 ± 2.59; P<0.0001). The post intervention mean PIPP pain score was not significantly different between the KMC and EBM groups (P= 0.62).

Conclusions

Removal of adhesive tape is a painful procedure for VLBW neonates. There was no difference between KMC and EBM in relieving pain associated with adhesive tape removal.     

Treatment of Iron Deficiency Anemia in Children: A Comparative Study of Ferrous Ascorbate and Colloidal Iron

Objective

To compare the efficacy of ferrous ascorbate and colloidal iron in the treatment of iron deficiency anemia in children.

Methods

Eighty one children, aged 6 mo to 12 y, were screened for iron deficiency anemia (IDA) and those diagnosed with IDA were randomized to receive ferrous ascorbate or colloidal iron for a period of 12 wk, such that each child received elemental iron 3 mg/kg body weight/d. Increase in hemoglobin (Hb) level was the primary outcome measure. Assessment was performed at baseline, wk 4, wk 8 and wk 12.

Results

Of 81 children screened, 73 were included in the study. The mean rise in Hb at the end of the 12 wk was significantly higher in ferrous ascorbate group than the colloidal iron group [3.59?±?1.67 g/dl vs. 2.43?±?1.73 g/dl; P?<?0.01]. Significantly higher proportion of children receiving ferrous ascorbate (64.86 % vs. 31.03 %; P?<?0.01) became non-anemic in comparison to colloidal iron.

Conclusions

Ferrous ascorbate provides a significantly higher rise in hemoglobin levels in comparison to colloidal iron. The study supports the use of ferrous ascorbate in the pediatric age group, providing evidence for its role as an efficient oral iron supplement in the treatment of iron deficiency anemia.     

Effect of Multisensory Stimulation on Neuromotor Development in Preterm Infants

Objective

To investigate the effect of Auditory, Tactile, Visual and Vestibular stimulus (ATVV) on neuromotor development in preterm infants.

Methods

Fifty preterm infants born at 28–36 wk with a birth weight ranging from 1,000–2,000 g were recruited for the study. They were block randomized into a control group (n?=?25) and study group (n?=?25). New Ballard score was used for the baseline measurement of neuromaturity in both groups. In neonatal intensive care unit (NICU), the study group received multisensory stimulation for 12 min per session, 5 sessions per wk along with routine NICU care either from 33 wk corrected gestational age for infants born at 28–32 wk or from 48 h of birth for infants born at 33–36 wk until discharge from the hospital. The control group received the routine NICU care. At term age the preterm infants were assessed using Infant Neurological International Battery (INFANIB) and the groups were compared using independent t test.

Results

The multisensory stimulated infants showed higher neuromotor score (p?=?0.001) compared to the control group. The french angle components of INFANIB including heel to ear (p?=?0.016) and popliteal angle (p?=?0.001) were statistically significant between the groups.

Conclusions

Multisensory stimulation appears to have a beneficial effect on the tonal maturation in preterm infants. However, further studies are warranted to investigate the long-term effects of multisensory stimulation on neurodevelopmental outcome in preterm infants.     

Oral zinc supplementation for reducing mortality in probable neonatal sepsis: A double blind randomized placebo controlled trial

Objective

To study the role of Zinc in the treatment of neonatal sepsis.

Design

Double blind, randomized, placebo controlled trial.

Setting

Tertiary Care Hospital.

Participants

614 neonates with probable neonatal sepsis.

Intervention

The drug group (n=307) received 1mg/kg/day of elemental zinc, and placebo group (n=307) received the placebo, in addition to antibiotic therapy and supportive care, till the final outcome (discharge/death).

Outcome Measures

Decrease in mortality rates (primary outcome), duration of hospital stay and need of higher lines of antibiotic therapy (secondary outcomes) were tested.

Results

Baseline characteristics of the two groups were similar. No statistically significant differences between drug and placebo group were found in mortality rate (9.77% vs 7.81 %; P=0.393), mean duration of hospital stay (142.85±69.41 hrs, vs. 147.99±73.13 hrs; P=0.841), and requirement of higher lines of antibiotic therapy (13.35% vs 12.05%, P=0.628) after supplementation.

Conclusions

This study does not report decrease in mortality rates, duration of hospital stay and requirement of higher lines of antibiotic therapy following zinc supplementation in neonatal sepsis.     

Expressed breast milk vs 25% Dextrose in procedural pain in neonates: A double blind randomized controlled trial

Objective

To compare the effect of expressed breast milk (EBM), 25% dextrose (25 D) and sterile water (SW) on procedural pain in neonates as assessed by the premature infant pain profile (PIPP), changes in heart rate (HR), oxygen saturation (SpO₂) and duration of crying.

Design

Prospective, double blind, randomized controlled trial.

Setting

Postnatal ward of a tertiary-care hospital.

Participants

210 babies who required venipuncture for blood sampling and who were on oral feeds were recruited into the study after parental informed consent.

Methods

The enrolled babies were randomized into intervention groups (EBM, 25% dextrose) and control group (sterile water). Two ml of test solution was given to baby by paladay (a traditional cup with a spout) 2 min before venipuncture. The face and crying of baby were video graphed by an independent, blinded observer. The facial response to pain (brow bulge, eye squeeze, nasolabial furrow) was analysed from the video. Maximum HR and minimum SpO₂ were recorded during, and 1, 3 and 5 min after venipuncture by another blinded observer.

Outcome variable

PIPP score, HR, SpO₂ and crying time at 0/1/3/5 min after sampling.

Results

160 babies were considered for final analysis with 50 in 25 D, 62 in EBM and 48 in SW group. The mean PIPP score in the 3 groups were 5.22, 6.84 and 11.22 at 0–30 sec after venipuncture; 4.52, 6.34, and 10.88 at 1–1 ½ min; 3.96, 6.15 and 9.35 at 3–3 ½ min; and 3.12, 4.68 and 7.83 at 5–5 ½ min; respectively (P< 0.001). The median crying time was 10,37.5 and 162 seconds in 25 D, EBM and SW groups, respectively (P< 0.001).

Conclusions

EBM significantly reduces procedural pain in neonates though to a lesser extent as compared to 25% dextrose.     

Does Mesenchymal Stem Cell Population in Umbilical Cord Blood Vary at Different Gestational Periods?

Objective

To identify and quantitatively determine Mesenchymal stem cells (MSCs) in the umbilical cord blood (UCB) of neonates born at different gestational periods.

Methods

UCB was collected at birth in neonates of three different gestational groups. The mononuclear cells (MNCs) were phenotypically analyzed by flow cytometer.

Results

The yield of total MNCs did not differ much with gestation; the average values were 22.6?±?6.48?×?106 cells/ml. The MSCs were significantly higher in the lower gestation group. These were 0.0219?±?0.012 %, 0.0044?±?0.003 % and 0.0022?±?0.003 % in 28 to 31 wk, 32 to 35 wk and >36 wk, respectively (P?=?0.00). There was a significant inverse correlation between the gestational age and the presence of MSCs with a correlation co-efficient of ?0.54 (P?=?0.0001).

Conclusions

The MSCs population was significantly higher in infants born at lesser gestation than those born at term gestation.     

Factors affecting postoperative respiratory tract function in type-C esophageal atresia. Thoracoscopic versus open repair

Aim

We assessed the outcome of 72 cases of type-C esophageal atresia (EAc) treated by open (OR) or thoracoscopic (TR) repair from 2000 to 2013. During OR, direct lung retraction (DLR) is required but during TR, CO₂ insufflation causes lung collapse so DLR is unnecessary.

Methods

Patient demographics, operative time, respiratory tract impact (RTI: incidence of atelectasis, timing of extubation, need for reintubation, and duration of chest tube insertion), narcotic usage, commencement of oral feeding, and length of hospitalization (LOH) were compared.

Results

Seven long-gap cases were excluded, leaving 65 EAc subjects (TR = 25, OR = 40). Patient demographics, operative time, and duration of chest tube insertion were similar. No TR case required DLR. Significant differences were found in TR for narcotic usage (1.6 vs. 3.1 days), commencement of feeding (7.8 vs. 10.5 days), incidence of atelectasis (8 vs. 30 %), initial extubation (2.8 vs. 5.6 days), and LOH (33 vs. 46 days), (all p < 0.05, respectively). Postoperative tracheal tube blockage caused by excessive secretions (4 vs. 10 %) and reintubation (4 vs. 17.5 %) were less in TR but not significant. There were three anastomotic leakages in TR, one in OR.

Conclusion

TR is less traumatic than OR because DLR is unnecessary, resulting in lower RTI and smooth recovery.     

Head injury pattern in children can help differentiate accidental from non-accidental trauma

Objectives

Our aim was to define the radiographic findings that help differentiate abusive head trauma (AHT) from accidental head injury.

Methods

Our trauma registry was queried for all children ≤5 years of age presenting with traumatic brain injury (TBI) from 1996–2011.

Results

Of 2,015 children with TBI, 71 % had accidental injury and 29 % had AHT. Children with AHT were more severely injured (ISS 22.1 vs 14.4; p < 0.0001) and had a higher mortality rate (15 vs 5 %; p < 0.0001). Patients with AHT had higher rates of diffuse axonal injury (14 vs 8 %; p < 0.0001) and subdural hemorrhage (76 vs 23 %; p < 0.0001). Children with accidental injury had higher rates of skull fractures (52 vs 21 %; p < 0.0001) and epidural hemorrhages (11 vs 3 %).

Conclusions

AHT occurred in 29 % of children and resulted in increased mortality rates. These children had higher rates of subdural hemorrhages and diffuse axonal injury. Physicians initially evaluating injured children must maintain a high index of suspicion for abuse in those who present with subdural hematoma or diffuse axonal injury.     

Role of Gastric Lavage in Vigorous Neonates Born with Meconium Stained Amniotic Fluid

Objective

To compare reduction in incidence of feed intolerance in neonates born with meconium stained amniotic fluid (MSAF) by use of gastric lavage to those who did not receive lavage.

Methods

This Randomized controlled trial was conducted in all vigorous newborns delivered through MSAF, with birth weight ≥1800 g and gestation ≥34 wk. In the lavage group, gastric lavage with 10 ml/kg of normal saline was done.

Results

Twelve neonates in the lavage group (n?=?124) developed feed intolerance compared to 16 neonates in control group (n?=?120), (p?=?.309; OR 0.69; 95%CI 0.27–1.58). No difference in any other morbidity was noted.

Conclusions

Gastric lavage in neonates with MSAF does not reduce feed intolerance, irrespective of thickness of MSAF and it confers no advantages.     

Serum Fructosamine and Retinopathy of Prematurity

Objective

To determine whether serum fructosamine which is a good marker for detecting hyperglycemia during the previous 2 to 3 wk in infants could predict the development of retinopathy of prematurity in very low birth weight infants.

Methods

One hundred sixty seven premature infants who had a birth weight of <1500 g and a gestational age of less than 32 wk were investigated in the present study. Blood glucose was measured at the bedside and infants were recorded as hyperglycemic if their mean blood glucose levels were higher than 150 mg/dL. Serum corrected fructosamine level was obtained from the cord blood at birth and after the first month of life. The infants’ eyes were examined by ophthalmologists to detect retinopathy of prematurity at the gestational age of 32 wk or at four wk after birth, whichever came first.

Results

Corrected fructosamine was 319.6?±?59.6 and 272.8?±?50.6 mmol/l for group1 on 1^st and 30^th day respectively; 320?±?61.7 and 268.2?±?47.3 mmol/l for groups 2?+?3 on 1^st and 30^th day respectively which did not differ between groups (p?=?0.766 and p?=?0.665), whereas duration of hyperglycemia was 1.69?±?1.1 day in group 1 compared with 3.05?±?2.4 day in groups 2?+?3 which was significantly different (p?=?0.019). The multivariate regression analysis indicated that the duration of hyperglycemia in days was significantly correlated with the development of retinopathy of prematurity (OR 3.26; 95% CI 1.09–9.80; p?=?0.035).

Conclusions

Although the duration of hyperglycemia may contribute to the development of retinopathy of prematurity, serum corrected fructosamine does not have a good predictive value in developing retinopathy of prematurity in very-low-birth-weight (VLBW) infants.     

Laparoscopic distal pancreatectomy to treat solid pseudopapillary tumors in children: transition from open to laparoscopic approaches in suitable cases

Purpose

The aim of this study was to evaluate the outcomes of open and laparoscopic distal pancreatectomy (LDP) in the treatment of solid pseudopapillary tumors (SPT) in children.

Methods

This was a retrospective study of 22 patients under 18 years of age who underwent a distal pancreatectomy for SPT between January 1995 and December 2012.

Results

Fourteen patients and eight patients underwent LDP and open distal pancreatectomy (ODP), respectively, and 71.4 % of the LDP and 25.0 % of the ODP procedures were spleen-sparing operations. The median duration of surgery in the LDP group was shorter than that in the ODP group [175 (range 120–540) vs. 257 (range 200–305) min, p = 0.024]. There were no differences in postoperative complications. The LDP patients commenced oral intake earlier than the ODP patients [2.0 (range 1.0–7.0) vs. 4.0 (range 3.0–12.0) days, p = 0.010], and had an earlier discharge from hospital [7.0 (range 5.0–20.0) vs. 13.0 (range 7.0–22.0) days, p = 0.009].

Conclusion

LDP treatment for SPT in children is associated with a shorter hospitalization and a shorter time to oral intake compared to ODP. LDP is a safe and feasible option for SPT in select pediatric patients.     

Pain Control Interventions in Preterm Neonates: <Emphasis Type="Italic">A Randomized Controlled Trial</Emphasis>

Objectives

To compare individual efficacy and additive effects of pain control interventions in preterm neonates.

Design

Randomized controlled trial

Setting

Level-3 University affiliated neonatal intensive care unit.

Participants

200 neonates (26-36 wk gestational age) requiring heel-prick for bedside glucose assessment. Exclusion criteria were neurologic impairment and critical illness precluding study interventions.

Intervention

Neonates were randomly assigned to Kangaroo mother care with Music therapy, Music therapy, Kangaroo Mother care or Control (no additional intervention) groups. All groups received expressed breast milk with cup and spoon as a baseline pain control intervention.

Main outcome measure

Assessment of pain using Premature Infant Pain Profile (PIPP) score on recorded videos.

Results

The mean (SD) birth weight and gestational age of the neonates was 1.9 (0.3) kg and 34 (2.3) wk, respectively. Analysis of variance showed significant difference in total PIPP score across groups (P<0.001). Post-hoc comparisons using Sheffe’s test revealed that the mean (SD) total PIPP score was significantly lower in Kangaroo mother care group [7.7 (3.9) vs. 11.5 (3.4), 95% CI(–5.9, –1.7), P<0.001] as well as Kangaroo mother care with Music therapy group [8.5 (3.2) vs. 11.5 (3.4), 95%CI (–5.1, –0.9), P=0.001] as compared to Control group. PIPP score was not significantly different between Control group and Music therapy group.

Conclusions

Kangaroo mother care with and without Music therapy (with expressed breast milk) significantly reduces pain on heel-prick as compared to expressed breast milk alone. Kangaroo mother care with expressed breast milk should be the first choice as a method for pain control in preterm neonates.

     

Prophylactic Saccharomyces boulardii versus nystatin for the prevention of fungal colonization and invasive fungal infection in premature infants

Aim

This study aims to compare the efficacy of orally administered Saccharomyces boulardii versus nystatin in prevention of fungal colonization and invasive fungal infections in very low birth weight infants.

Method

A prospective, randomized comparative study was conducted in preterm infants with a gestational age of ≤32 weeks and birth weight of ≤1,500 g. They were randomized into two groups, to receive S. boulardii or nystatin. Skin and stool cultures were performed for colonization and blood cultures for invasive infections, weekly.

Results

A total of 181 infants were enrolled (S. boulardii group, n?=?91; nystatin group, n?=?90). Fungal colonization of the skin (15.4 vs 18.9 %, p?=?0.532) and the stool (32.2 vs 27 %, p?=?0.441) were not different between the probiotic and nystatin groups. Two patients had Candida-positive blood culture in the nystatin group whereas none in the probiotic group. Feeding intolerance, clinical sepsis, and number of sepsis attacks were significantly lower in the probiotics group than in the nystatin group.

Conclusion

Prophylactic S. boulardii supplementation is as effective as nystatin in reducing fungal colonization and invasive fungal infection, more effective in reducing the incidence of clinical sepsis and number of sepsis attacks and has favorable effect on feeding intolerance.     

Fluoroscopy-guided insertion of nasojejunal tubes in children – setting local diagnostic reference levels

Background

Little is known about the radiation burden from fluoroscopy-guided insertions of nasojejunal tubes (NJTs) in children. There are no recommended or published standards of diagnostic reference levels (DRLs) available.

Objective

To establish reference dose area product (DAP) levels for the fluoroscopy-guided insertion of nasojejunal tubes as a basis for setting DRLs for children. In addition, we wanted to assess our local practice and determine the success and complication rates associated with this procedure.

Materials and methods

Children who had NJT insertion procedures were identified retrospectively from the fluoroscopy database. The age of the child at the time of the procedure, DAP, screening time, outcome of the procedure, and any complications were recorded for each procedure. As the radiation dose depends on the size of the child, the children were assigned to three different age groups. The sample size, mean, median and third-quartile DAPs were calculated for each group. The third-quartile values were used to establish the DRLs.

Results

Of 186 procedures performed, 172 were successful on the first attempt. These were performed in a total of 43 children with 60% having multiple insertions over time. The third-quartile DAPs were as follows for each age group: 0–12 months, 2.6 cGy cm²; 1–7 years, 2.45 cGy cm²; >8 years, 14.6 cGy cm². High DAP readings were obtained in the 0–12 months (n?=?4) and >8 years (n?=?2) age groups. No immediate complications were recorded.

Conclusion

Fluoroscopy-guided insertion of NJTs is a highly successful procedure in a selected population of children and is associated with a low complication rate. The radiation dose per procedure is relatively low.     

Body Temperature Changes of Newborns Under Fluorescent Versus LED Phototherapy

Objective

To determine changes in body temperature (BT) of hyperbilirubinemic newborns under conventional phototherapy with fluorescent lamps and light emitting diodes (LED) at different irradiances.

Methods

Otherwise healthy newborn infants >34 wk gestational age (GA) hospitalized for indirect hyperbilirubinemia, requiring phototherapy in the first 10 d of life were enroled. Infants who received conventional phototherapy with fluorescent lamps (10–15 μW/cm²/nm irradiance) were defined as group 1, LED phototherapy of 26–60 μW/cm²/nm irradiance as group 2, and LED phototherapy of 60–120 μW/cm²/nm irradiance as group 3. Primary outcome measure was mean BT which was defined as arithmetical mean of axillary BT measured at 2 h intervals during the first day of phototherapy.

Results

Thirty patients were enroled in each group. Mean birth weight and GA of the total cohort was 2800?±?530 g and 36.6?±?2 wk, respectively. Baseline demographic variables and serum total bilirubin levels were similar among groups. Mean BT was 36.7?±?0.1 °C in group 1, 36.6?±?0.2 °C in group 2, 37.7?±?0.2 °C in group 3. Mean BT was higher in group 3 compared to group 1 (p?<?0.001) and group 2 (p?<?0.001). Group 1 and group 2 had similar mean BT measurements (p?=?0.09). During phototherapy all the patients in group 3 had at least one BT measurement ≥37.5 °C and 77 % had BT ≥38 °C. Only one patient in group 2 had BT?≥?37.5 °C which was also ≥38 °C. During phototherapy all BT measurements were <37.5 °C in group 1.

Conclusions

LED phototherapy of ≥60 μW/cm²/nm intensity significantly increases BT in hyperbilirubinemic newborns.     

Pediatric chest CT at 70 kVp: a feasibility study in 129 children

Background

Before introducing 70-kVp settings in the low-kilovoltage strategies for pediatric examinations, it was mandatory to demonstrate, at similar dose levels, an equivalence of image quality at 70 kVp and 80 kVp.

Objective

To assess image quality of chest CT examinations acquired at 70 kVp in comparison with standard scanning at 80 kVp.

Materials and methods

We prospectively evaluated 129 children with a 70-kVp scanning protocol (group 1). All scanning parameters were kept similar to those usually selected for pediatric standard 80-kVp protocols, except the milliamperage increased by a factor of 1.6 to maintain comparable radiation dose. Image quality of group 1 examinations was compared to that of a paired population scanned at 80 kVp (group 2). The noninferiority hypothesis was fixed at 10% of the mean level of image noise.

Results

There was no significant difference in the mean dose length product (DLP) and the volume computed tomography dose index (CTDI_vol) between the groups (DLP: 20.5?±?5.8 mGy.cm [group 1] vs. 19.7?±?7.6 mGy.cm [group 2]; P?=?0.06) (CTDI_vol: 0.8?±?0.1 mGy [group 1] vs. 0.8?±?0.18 mGy [group 2]; P?=?0.94). The mean of differences in image noise between group 1 and group 2 examinations was ?1.38 (?2.59; ?0.18), verifying the noninferiority hypothesis. Subjective image quality did not significantly differ between group 1 and group 2 examinations (P?=?0.18).

Conclusion

At equivalent radiation dose levels, 70-kVp protocols provide similar image quality to that achievable at 80 kVp.     

First Hour Initiation of Breastfeeding and Exclusive Breastfeeding at Six Weeks: Prevalence and Predictors in a Tertiary Care Setting

Objective

To assess the prevalence of first hour breastfeeding initiation and exclusive breastfeeding at 6 wk and identify its barriers in healthy term babies born in a tertiary hospital setting.

Methods

A prospective observational cohort study was carried out in consecutively selected 400 mothers who delivered (normal, instrumental or cesarean) term healthy babies in a tertiary care hospital setting. All mother-infant dyads were enroled within 48 h of delivery.

Results

Breastfeeding was initiated within first hour in 255 out of 400, i.e., 64 % of babies. Cesarean delivery and male gender were strongest risk factors for delayed initiation of breastfeeding [OR (95 % CI)?=?1.99 (1.14–3.48) and 34.17 (17.10–70.40) respectively]. Among the babies followed up till 6–8 wk, 83 % were exclusively breastfed. Breast milk substitutes were given in 172/400 (43 %) babies on day one, which emerged as an independent predictor of failure to continue exclusive breastfeeding at 6 wk (OR 2.96; 95 % CI 1.09–8.06). Odds of exclusive breastfeeding were two times higher in babies breastfed within first hour (n?=?255/400, 64 %) when compared to babies initiated breastfeeds beyond first hour (n?=?145/400, 36 %) (OR 2.01;05 % CI 1.12–3.61).

Conclusions

Cesarean section and male gender emerged as significant risk factors for delayed initiation (beyond first hour) of breastfeeding in the index study cohort. In addition, use of breast milk substitute emerged as the only predictor for failure to continue exclusive breastfeeding at six weeks in a tertiary care hospital.