Introduction: Bilirubin is a frequently ordered investigation in neonatal intensive care units and out-patient practice during follow- up. The gold standard for its estimation is serum bilirubin which is invasive resulting in parenteral apprehension, pain, discomfort and iatrogenic anaemia in a neonate, while the non-invasive measurement by transcutaneous bilirubinometer is not available in all the centres because of its cost. Biliscan is a smartphone application that uses a phone’s inbuilt camera and a colour calibration card to detect neonatal jaundice. We compared bilirubin measured by Biliscan with reference to serum bilirubin among neonates admitted to a tertiary care centre. Methods: We conducted an observational study from June-2019 to September-2019 at a tertiary care centre in Hyderabad, India. Inborn neonates (greater than > 35 weeks gestational age at birth, and less than a week old) who required bilirubin estimation, underwent both invasive serum sampling and non-invasive estimation by Biliscan. Photograph of the baby’s chest was captured using the colour calibration card of the Biliscan application. Bilirubin values derived from the Biliscan application were compared to those derived from blood samples. Results: A total of 143 neonates were enrolled. The mean bilirubin value estimated by serum sampling was 11.9 g/dl against 13.1 g/dl of that derived from smartphone application. Biliscan and serum bilirubin showed moderate agreement with a correlation coefficient of 0.6. Bland- Altman plot constructed showed bias of 1.1 with the limits of agreement ranging from -3 to +5.3. Biliscan had a good sensitivity of 90% in identifying high levels of serum bilirubin (> 95th percentile on Bhutani nomogram). Conclusion: Biliscan application is a non-invasive, real-time, inexpensive and an easily available method that cannot replace serum bilirubin, however can complement and has the potential to help in screening neonates thus facilitating recognition of jaundice early and minimising the number of invasive pricks.

Clinical and microbiological profile of 9 neonates with meningitis by Elizabethkingia meningosepticum identified by 16S ribosomal gene sequencing was studied. All the clinical isolates were resistant to cephalosporins, aminoglycosides, trimethoprim-sulfamethoxazole, β-lactam combinations, carbapenems and only one isolate was susceptible to ciprofloxacin. All the isolates were susceptible to vancomycin. Six of nine neonates died even after using vancomycin, based on susceptibility results. E. meningosepticum meningitis in neonates results in high mortality rate. Though the organism is susceptible to vancomycin in vitro, its efficacy in vivo is questionable and it is difficult to determine the most appropriate antibiotic for treating E. meningosepticum meningitis in neonates.

Introduction: COVID-19 pandemic has affected the KMC practices in our SNCU. Lack of clear guidelines and training about continuing KMC in COVID-19 times has further lead to decrease in KMC practices. Methods: This is a prospective single centered quality improvement study conducted in the inborn unit of a tertiary care hospital. Intervention phase was done in August and September 2020. Preterm mother-infant dyads who were admitted in the inborn Level 2 Neonatal care unit with birth weight less than 2000 grams were enrolled in this study. A QI team comprising of resident doctors, nurses and supporting staff and a lactation counsellor was formed. The potential barriers for prolonged KMC were evaluated using fish bone analysis. A variety of measures were introduced and subsequently tested by seven plan-dostudy-act (PDSA) cycles. Data on percentage of initiation of KMC was measured by bedside nurses on daily basis and the data was plotted on run chart every week during implementation phase. Results: 116 eligible mother-infant dyads were studied during implementation period (50 days). We achieved our goal by step-wise implementation of changes through multiple PDSA cycles. The percentage of initiation of KMC among eligible preterm infants has increased from baseline of 43.4% to 83.3% and duration of KMC from 1.5 mean hours to 4.5 hours over a period of eight weeks. Conclusions: Ongoing quality improvement measures increased the percentage of initiation and duration of KMC among eligible preterm infants without addition of extra man power.

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