The treatment of respiratory distress in neonates ranges from non-invasive continuous positive airway pressure (CPAP) to advanced invasive mechanical ventilation. Monitoring on CPAP is often done by calculating oxygenation after blood gas analysis which is an invasive procedure. Saturation oxygen pressure index (SOPI) is a simple, non-invasive, bedside tool to monitor the severity of respiratory illness in neonates on CPAP. This study was aimed at validation of SOP index against AaDO2 and determine the cutoff values of SOPI for A-aDO2 of 70, 85 and100. This was a prospective observational study on 126 neonates with respiratory distress and treated with CPAP. The correlation between SOPI and A-aDO2 was validated using Bootstrap method. There was a significant positive correlation between SOPI and A-aDO2 with the Spearman correlation coefficient (rho) being 0.815 (p = 0). The mean coefficient of correlation after Bootstrap was 0.827 (p value < 0.0001). SOPI values of 1.52, 1.57 and 1.6 predicted A-aDO2 value of 70, 85 and 100 with a sensitivity of above 80% and specificity above 90%, respectively. Conclusion: SOPI has a significant positive correlation of 82.7% against A-aDO2 and can be a valuable tool to assess respiratory distress in neonates without arterial blood gas. Keywords SOP index. Non-invasive assessment. Respiratory distress. Neonates Abbreviations N-CPAP Nasal continuous positive airway pressure OI Oxygenation index SOPI Saturation oxygen pressure index AaDO2 Alveolar arterial oxygen difference CDP Continuous distending pressure FiO 2 Fraction of inspired oxygen NICU Neonatal intensive care unit SpO 2 Arterial oxygen saturation H 2 O Water PEEP Positive end-expiratory pressure ROC Receiver operative characteristics IQR Interquartile range SD Standard deviation What is Known: • Saturation oxygen pressure index (SOPI) is a non-invasive monitoring tool for neonates on N-CPAP. • SOPI has a good correlation with AaDO2. What is New: • Correlation of SOPI with AaDO2 is now validated. • Values between 1.52 and 1.88 indicate clinically useful range of AaDO2 for escalation of respiratory support from CPAP.

Objective To compare the variation of feeding rate and time taken for feeds between manual and automated feeding via feed rail. Methods Stable preterm babies weighing between 1 and 2 kg, on partial or full enteral feeds via gavage were randomized into gravity and feed rail feeding group, respectively. Ten nurses and 4 babies were paired to form 40 nurse-baby pairs for the study. Forty feeding events in each groups were recorded. Results The median duration of feeding in the feed rail group was 18.5 min compared to 15 min in nurse-led feeding ( p = 0.34). Feeding rate corrected for bodyweight ranged between 0.8 and 2.3 mL/kg/min in the feed rail group compared to 2.5 and 8.9 mL/kg/min in the control (manual gravity feed) group. This difference in the feed rate variation was statistically significant ( p value of <0.0001). The median feed rate with feedrail was 1.3 mL/min as compared to 4.1 mL/min with manual gravity feeds. During the feed rail feeding, nurses were hands-free for 80% of the time. Conclusion Feed rail feeding results in slow, sustained, and minimal variation in gravity feeding at a rate of 1 to 2 mL/kg/min without affecting the feeding duration compared to manual nurse-led feeding. Trial Registered Clinical Trials Registry India (CTRI/2020/06/025958). Supplementary Information The online version contains supplementary material available at 10.1007/s12098-021-03770-0.

Introduction: Vascular access especially in critically ill and preterm neonates is a major life saving procedure. There is a need for a sustained access for medications and providing the essential nutrition in sick babies. Various techniques and sites are used for IV lines in the intensive care. There are also some known and associated complications with central lines. Objectives: To describe the indications for insertion, indication for removal, type of central line and outcome of central lines placed in neonates. Methodology: This is an audit of central lines inserted in a tertiary care neonatal ICU between January 2016 to December 2016. Results: A total of 284 central lines either as umbilical, central or PICC lines were inserted. 63% of the lines were inserted through the umbilical vein and 21% through the femoral route mostly in surgical neonates. The most common central line inserted was the umbilical catheter (66%). The medical team inserted 73% of the lines while the remaining 27% was by the surgical team. Central lines in our unit were associated with minimal complications with only 3 babies posing with prolonged bleeding from insertion site. The most common indication for insertion was for infusion of multiple medications (62.7%) and inotropes (9.9)%. Majority of the lines were removed when the indication for use ceased (66.2%). Conclusion: Umbilical line is the most common central line inserted in neonates followed by surgical long lines. Indications for use can be varied and complications are minimal if proper technique and care is followed.

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Background Blue light phototherapy used extensively in the management of hyperbilirubinemia has many side effects like dry eyes, blurring, headache, and altered circadian rhythm. Healthcare providers working around the phototherapy are unduly exposed to these side effects. Altered circadian rhythm results in disruption in the sleep-wake cycle affecting healthcare providers particularly working during the night shift. The constant glare of the blue light interrupts in clinical observation of the baby on phototherapy. With the intent of providing effective phototherapy with minimal exposure of blue light to healthcare providers, a light source called the photo unit was designed and developed. The objective of this study was to estimate the intensity and spread of blue light to the surrounding in conventional phototherapy and to compare the same with newly developed converging photo unit. Results The therapeutic range of irradiance was noted up to 22 inch in diameter with conventional phototherapy compared to only 7 inch with our photo unit. The light spread with a conventional phototherapy unit was seen beyond 50 inch in all directions whereas was confined to 19-inch diameter with photo unit. Conclusion Photo unit developed by the authors has minimal divergence of light to the surrounding, thereby mitigating the side effects of blue light exposure to the people working in the vicinity. Multiple of these photo units can be used to make a phototherapy device.