Browsing by Author "Deorari, Ashok"
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Item Alleviating Pain in Neonates – What is The Best.(2013-02) Deorari, AshokItem Continuous Positive Airway Pressure in Preterm Neonates: An Update of Current Evidence and Implications for Developing Countries.(2015-04) Gupta, Neeraj; Saini, Shiv Sajan; Murki, Srinivas; Kumar, Praveen; Deorari, AshokContext: Continuous Positive Airway Pressure (CPAP) is a cost-effective and minimal invasive respiratory support for the newborn. Objective: To review the evidence related to various aspects of CPAP usage and its applicability for developing countries. Evidence Acquisition: We conducted a literature search on PubMed, CENTRAL, and Cochrane Database of Systematic Reviews using the terms ‘CPAP’ OR ‘continuous positive airway pressure’ OR, non-invasive ventilation’ AND ‘newborn’ OR ‘neonate’ OR ‘infant’. We also searched the reference lists from the above articles and of review articles. Extracted manuscripts and reviews were analyzed and results related to various aspects of CPAP usage were summarized in narrative form. Results: Early use of CPAP with early rescue surfactant (InSurE) is the ideal approach for management of respiratory distress syndrome in preterm and extremely preterm infants. Delivery room CPAP is feasible and reduces the need for surfactant and mechanical ventilation by nearly 50%. Prophylactic surfactant for extreme preterms should be discouraged. Heated humidified high flow nasal cannula is best utilized for post-extubation respiratory support. The search for ideal interface still continues and binasal prongs or nasal masks are the good contenders. Evidence on the ideal CPAP delivery is still inconclusive. Conclusions: CPAP, if used early and judiciously, is an effective intervention and need immediate scaling-up in resource-limited settings. Future research should focus on the ideal interface and the CPAP delivery methods.Item Delivering Quality Healthcare in India: Beginning of Improvement Journey(Indian Academy of Pediatrics, 2018-09) Deorari, Ashok; Livesley, NigelItem Description and Validation of a Novel Method of Measuring Pharyngeal Pressure in New-born.(2016-04) Sampath, Nishanth; Singh, Akanksha; Gopalakrishnan, Shridhar; Thukral2, Anu; Sankar, M. Jeeva; Agarwal, Ramesh; Jaryal, Ashok Kumar; Deorari, Ashok; Paul, Vinod K.Study background: Measurement of delivered pharyngeal pressure during continuous positive airway pressure (CPAP) therapy is not in routine practice due to lack of a simple and affordable technique of intrapharyngeal pressure measurement. To overcome the lack of the gold standard solid-state catheter-tip pressure measurement technology in our set up, we improvised a novel method of pressure measurement and tested its validity in a simulated pharynx. Methods: A low-cost pressure transducer was improvised by attaching an orogastric tube to its one end. The other end of the orogastric tube was sealed into an artificial pharynx - a 20 ml syringe. The pressure transducer readings were compared with that obtained by a digital manometer attached to the tip of the syringe. Bland-Altman statistic was used to quantify the measurement reliability of the novel method against the digital manometer. Effect of tube length on the measurement agreement was also studied. The developed technique was applied in new-borns. Results & conclusion: Pressures measured by this technique were in good agreement with that obtained using a digital manometer. This technique has the potential to be used as an alternative to catheter-tip pressure transducers for bedside pharyngeal pressure measurement in new-born babies, especially in underresourced setups.Item Hypocalcemia in the Newborn.(2010-10) Jain, Ashish; Agarwal, Ramesh; Sankar, M Jeeva; Deorari, Ashok; Paul, Vinod KHypocalcemia is a frequently observed clinical and laboratory abnormality in neonates. Ionic calcium is crucial for many biochemical processes including blood coagulation, neuromuscular excitability, cell membrane integrity, and many of the cellular enzymatic activities. Healthy term infants undergo a physiological nadir in serum calcium levels by 24-48 h of age. This nadir may drop to hypocalcemic levels in high-risk neonates including infants of diabetic mothers, preterm infants and infants with perinatal asphyxia. The early onset hypocalcemia which presents within 72 h requires treatment with calcium supplementation for at least 72 h. In contrast, late onset hypocalcemia usually presents after 7 days and requires longer term therapy.Item Management of Neonatal Seizures.(2010-10) Sankar, Jeeva M; Agarwal, Ramesh; Deorari, Ashok; Paul, Vinod KSeizures in the newborn period constitute a medical emergency. Subtle seizures are the commonest type of seizures occurring in the neonatal period. Myoclonic seizures carry the worst prognosis in terms of long-term neurodevelopmental outcome. Hypoxic-ischemic encephalopathy is the most common cause of neonatal seizures. Multiple etiologies often co-exist in neonates and hence it is essential to rule out common causes such as hypoglycaemia, hypocalcemia, and meningitis before initiating specific therapy. A comprehensive evidence based approach for management of neonatal seizures has been described in this protocol.Item Management of Polycythemia in Neonates.(2010-10) Sankar, M Jeeva; Agarwal, Ramesh; Deorari, Ashok; Paul, Vinod KPolycythemia is defined as a venous hematocrit above 65%. The hematocrit in a newborn peaks at 2 h of age and decreases gradually after that. The relationship between hematocrit and viscosity is almost linear till 65% and exponential thereafter. Increased viscosity of blood is associated with symptoms of hypo-perfusion. Clinical features related to hyperviscosity may affect all organ systems. Neonates born small for gestational age (SGA), infants of diabetic mothers (IDM), and multiple births are at risk for polycythemia. They should therefore undergo screening at 2, 12, and 24 h of age. Polycythemia may be symptomatic or asymptomatic and guidelines for the management of both types based on the current evidence are provided in the protocol.Item A Micro-costing Model of Neonatal Intensive Care from a Tertiary Indian Unit: Feasibility and Implications for Insurance.(2014-03) Venkatnarayan, Kannan; Sankar, Jeeva; Deorari, Ashok; Krishnan, Anand; Paul, Vinod KObjective: To calculate and compare costs of neonatal intensive care by micro-costing and gross-costing methods. Methods: The costs of resources of a tertiary care neonatal intensive care unit were estimated by the two methods to arrive at specific costs per diagnosis related categories for 33 neonates followed-up prospectively. Results: Grosscosting as compared to micro-costing resulted in higher cost per bed (Rs 6315 vs. Rs 4969) and wide variations of costs (-34.8% to +13.4%). Intensity of interventions, relative stay in neonatal intensive care unit compared to the step-down nursery, and total length of hospital admission accounted for these variations. Conclusions: Estimates based on micro-costing arrived in this study may be used as a starting point in developing assumptions for insurance models covering neonatal intensive care.Item Online learning in newborn health: A distance learning model.(2012-01) Deorari, Ashok; Thukral, Anu; Aruna, VItem Patent Ductus Arteriosus in Preterm Infants.(2011-04) Sasi, Arun; Deorari, AshokPatent ductus arteriosus (PDA) is a major morbidity in preterm infants, especially in extremely premature infants less than 28 weeks. The clinical signs and symptoms of PDA in preterm infants are non specific and insensitive for making an early diagnosis of significant ductal shunting. Functional echocardiography is emerging as a new valuable bedside tool for early diagnosis of hemodynamically significant ductus, even though there are no universally accepted criteria for grading the hemodynamic significance. Echocardiography has also been used for early targeted treatment of ductus arteriosus, though the long term benefits of such strategy are debatable. The biomarkers like BNP and N- terminal pro–BNP are currently under research as diagnostic marker of PDA. The primary mode of treatment for PDA is pharmacological closure using cyclo-oxygenase inhibitors with closure rate of 70-80%. Oral ibuprofen is emerging as a better alternative especially in Indian scenario where parenteral preparations of indomethacin are unavailable and side effects are comparatively lesser. Though pharmacological closure of PDA is an established treatment modality, there is still lack of evidence for long term benefits of such therapy as well as there is some evidence for the possible adverse effects like increased ROP and BPD rates, especially if treated prophylactically. Hence, it is prudent to reserve treatment of PDA to infants with clinically significant ductus on the basis of gestation, birth weight, serial echocardiography and clinical status to individualize the decision to treat.Item Secular Trends in Birthweights in Two Epochs Over 40 Years in a Tertiary Care Center(Indian Academy of Pediatrics, 2022-08) Thomas, Deena; Anand, Pratima; Thukral, Anu; Agarwal, Ramesh; Deorari, Ashok; Sankar, M JeevaObjective: To compare the average birthweights and the weight centiles of the ‘new’ growth charts with the ‘old’ (1974) charts developed in the same unit four decades ago. Methods: Birthweight and gestation data of the eligible 12,355 singleton neonates born between 2009 and 2016 at a level-3 neonatal unit at a public sector hospital were used to develop the new growth chart. We then compared the prevalence of small for gestational age (SGA) and large for gestational age (LGA) classified by the new charts and the old charts, the incidence of short-term adverse outcomes among them, and the diagnostic performance of both the charts to identify the adverse outcomes in a separate validation cohort. Results: The mean birthweights of boys and girls across all gestations were higher by 150-200 g and 100-150 g, respectively, in the new chart. The prevalence of SGA doubled (9.8% vs 4.7%), but LGA decreased by one-third (17.5% vs 25.9%) with the new chart. However, the proportion of SGA and LGA having one or more short-term adverse outcomes, and the diagnostic performance of both the charts to identify neonates with shortterm adverse outcomes, were comparable. Conclusion: There was an upward shift in the birthweights by about 150 g across all gestations in the new chart compared to the old chart developed 40 years ago. The findings imply the need to consider using updated growth charts to ensure accurate classification of size at birth of neonates.Item Single versus multiple courses of antenatal corticosteroids.(2008-08-30) Deorari, Ashok