Background: In India, there is high burden of prematurity in newborns due to high birth rate and lack of good antenatal care. The objective of this study was to compare the outcome (efficacy and safety) of Bubble Continuous Positive Airway Pressure (B-CPAP) machine and Indigenous Bubble Continuous Positive Airway Pressure (I-CPAP) as a primary mode of respiratory support in preterm new-borns with respiratory distress syndrome (RDS). It was a prospective observational comparative study conducted at NICU of a tertiary care teaching hospital of western Gujarat, India, from December 2016 to July 2017.Methods: Eighty-one preterm babies <36 weeks of gestation age with respiratory distress (Silverman Anderson scoring >4) within 6 hours of birth were included (out of 182 preterm newborns with respiratory distress syndrome) and put on respiratory support either with B-CPAP machine (n = 48) or with I-CPAP (n = 33). Outcome was compared in the form of CPAP failure, survival and complication rates.Results: There was no significant difference in the demographic profile of patients in both groups except number of neonates between 1.5-2.5 kg birth weight were significantly high in B-CPAP (45.8%) compared to I-CPAP (33.3%) (p = 0.00074). There were no significant differences in CPAP failure rates in B-CPAP (27%) versus I-CPAP (24.2%). The survival rate (72.9% in B-CPAP) versus (75.7% in I-CPAP) in both groups was also similar (CI 95%, p = 0.774). The complications, such as moderate to severe nasal septal damage, occurred significantly more frequent with B-CPAP machine (47.9%) than on I-CPAP (6%) (CI 95%, p = 0.000062).Conclusions: Efficacy of I-CPAP as a primary mode of respiratory support for preterm new-born with respiratory distress was comparable to B-CPAP. The ease with which it can be assembled makes it a suitable alternative to B-CPAP.

Introduction: Despite the availability of cheap, safe and effective vaccine, tetanus is still a serious health problem worldwide and rural India, and a common cause of death in the new born. Community surveys have shown that only a small proportion of neonatal tetanus (NT) cases are routinely reported and under-reporting is often highest in areas at highest risk of NT. So, the objective of the study was to find out the epidemiological factors, clinical profile and outcome of childhood tetanus. Also to find out the preventable factors and prognostic factors in childhood tetanus. Methods: It was a prospective observational study. Legal guardians of all children less than 12 years old including neonates with diagnosis of tetanus admitted in pediatric department were inquired for detailed history regarding the present complaint, history of sources of infection, history of antenatal care, immunization status and detailed labor history. Grading of tetanus was done after detailed general and systemic examination. Result: Total 35 cases were included in the study with Male: Female ratio of 1.7:1. Among them 28.57% were neonatal tetanus and 28.57% were traumatic case. Among 10 neonatal tetanus cases 9 mothers were not immunized and among 25 non-neonatal cases 19 were unimmunized. Mortality was 90% in NT cases and 36% in Non-Neonatal Tetanus (NNT) cases. Common complication were septicemia [9 (25.71%)], Disseminated Intravascular Coagulation (DIC) [8 (22.85%)], Hyperpyrexia [7 (17.14%)], Pneumonia [5 (14.28%)], Bed sore [3 (8.5%)], and thrombo phlebitis [1(2.8%)] of cases. Conclusion: Although incidence of childhood tetanus has been reduced over the years, but still tetanus is more common in rural population due to illiteracy, poor socioeconomic status, poor vaccination and superstitions. The mortality by tetanus can be reduced by improving routine immunization specifically in rural and low socioeconomic population, by recognition of disease severity and providing proper management with intensive care as early as possible.