Introduction INtubate‐SURfactant‐Extubate (InSurE) approach is traditional method of surfactant delivery in preterm neonates with respiratory distress syndrome (RDS). Newer, less invasive surfactant administration (LISA) techniques lessen the need for mechanical ventilation and its adverse consequences. Evidence on the favorable effects of LISA can't be extrapolated from developed to developing countries. Aim of study is to compare the effectiveness of InSurE and LISA. Objectives Primary outcome was to find need of intubation and mechanical ventilation within 72 h of birth. Neonates were followed until discharge/death for adverse events and complications. Materials and Methods Open‐label randomized controlled trial (RCT) was conducted at tertiary neonatal intensive care unit. Preterm neonates with diagnosis of RDS were randomized in two groups (InSurE or LISA) to receive surfactant soon after birth. Nasal intermittent positive pressure ventilation (NIPPV) was used as primary mode of respiratory support. Results A total of 150 neonates were analyzed (75 in each group). Insignificant statistical difference was seen in the need for intubation and mechanical ventilation within 72 h of birth between the two groups (InSurE, 30 [40%] and LISA, 30 [40%], relative risk 1.0, 95% confidence interval 0.68–1.48). Twelve percent (n = 9, LISA group) and 14.6% (n = 11 InSurE group) had adverse events during the procedure. Also, we observed insignificant statistical difference in the rates of major complications or duration of respiratory support, hospital stay, and mortality. Conclusion LISA and InSurE are equally effectiSpontaneously breathing pretermve for surfactant administration in the treatment of RDS, when NIPPV is the primary mode of respiratory support. More RCTs are required to compare the efficacy and long‐term outcomes of LISA with InSurE.

BackgroundKangaroo Mother Care (KMC) is a low-resource, evidence-based, high-impact intervention for low-birth weight (LBW) care. Quality improvement in KMC requires meso-level, macro-level and micro-level interventions. Our institution, a public teaching hospital, hosts a level-II/III neonatal intensive care unit (NICU). The average demand for beds typically exceeds available capacity, with 60% occupancy attributed to LBW patients. There was low uptake of KMC practice at our unit.Aim statementIn the initial phase, we aimed to improve the coverage of KMC in admitted eligible neonates from a baseline of 20%–80% within 15 days. After a period of complacency, we revised the aim statement with a target of improving the percentage of babies receiving 6-hour KMC from 30% to 80% in 12 weeks.MethodsWe report this quasi-experimental time-series study. With the Point of Care Quality Improvement methodology, we performed Plan-Do-Study-Act (PDSA) cycles to improve KMC practice. We involved all the healthcare workers, mothers and caregivers to customise various KMC tools (KMC book format, KMC bag, mother’s gown) and minimise interruptions. Feedback from all levels guided our PDSA cycles.ResultsThe percentage of babies receiving at least 1-hour KMC increased from 20% to 100% within 15 days of August 2017. In the improvement phase, baseline 6-hour KMC coverage of 30% increased to 80% within 12 weeks (October–December 2017). It sustained for more than 2 years (January 2018 till February-2020) at 76.5%±2.49%.ConclusionsQuality improvement methods helped increase the coverage and percentage of babies receiving 6-hour KMC per day in our NICU. The duration specified KMC coverage should be adopted as the quality indicator of KMC. The training of healthcare workers and KMC provider should include hands-on sessions involving the mother and the baby. Maintaining data and providing suitable KMC tools are necessary elements for improving KMC. Minimising interruption is possible with family support and appropriate scheduling of activities. Having a designated KMC block helps in peer motivation.

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Background: Idiopathic nephrotic syndrome (INS) is a common childhood renal disease characterized by a remitting and relapsing course, associated with different histopathological subtypes. The true incidence of various histopathological subtypes of NS remains under estimated owing to the diversity in indication criteria for performing renal biopsies in pediatric population.Methods: This was a cross-sectional observational study in children with nephrotic syndrome at a tertiary health care centre. Total 22 children, with nephrotic syndrome, who underwent renal biopsy procedure during a period of one year, were enrolled for the study. Indications of renal biopsy were noted, and the histopathology reports were studied in detail.Results: In this study group, the most common indication for renal biopsy was “Atypical age (> 8years) of diagnosis in 45.5% (10/22) patients, followed by 22.7% (5/22) in “Children presenting with hypertension and hematuria”.The most common histopathological finding in these children was mesangial proliferative glomerulonephritis in 45.5% (10/22) patients followed by IgA nephropathy with mesangial proliferation in 22.72% (5/22) and minimal change disease in only 13.6% (3/22).Conclusions: This study highlights the occurrence of non-MCD as the common cause of INS in the children and denotes the significance of performing renal biopsies in children with INS for better prognostication.