Background Neonates managed in neonatal intensive care units undergo several invasive procedures. However, neonatal procedural pain is not well recognized and managed in most neonatal units. Aims To decrease the severity of procedural pain in preterm neonates (<37 weeks gestational age at birth), as measured by Premature Infant Pain Profile , by 50% by April 2020. Methods A quality improvement initiative was conducted in a level 3 neonatal intensive care unit in South India. The pain was assessed independently by 2 interns not involved in clinical care using Premature Infant Pain Profile. After a baseline data recording and questionnaire assessing knowledge of healthcare personnel regarding neonatal pain, the interventions were planned. These were conducted as plan‐do‐study‐act cycles—(i) Educational sessions, (ii) Introduction of bedside visual aids, (iii) Simulation sessions demonstrating the use of nonpharmacological measures and introduction of procedure surveillance chart in daily rounds, and (iv) Video feedback‐based sessions. In the maintenance phase, the observations were continued. Results The healthcare personnel under recognized pain related to heel pricks and endotracheal intubation. They also had poor awareness of signs and symptoms of neonatal pain. A total of 202 procedures were observed during the study period. The mean pain score decreased significantly from 12.8 ± 4.5 in baseline period to 6.2 ± 1.8 in the maintenance phase. The use of analgesic measures increased from 13% in the baseline period to 73% in the maintenance phase. The use of automated lancet for heel prick increased from 0% to 94% in maintenance phase. More and more procedures were done with appropriate environment and baby state. The mean number of procedures per day decreased from 6.5 ± 1.8 in baseline period to 2.7 ± 0.9 in the maintenance phase. Conclusions Targeted interventions can improve neonatal procedural pain management by improving use of analgesic measures, decreasing the number of procedures, and educating and training healthcare personnel.

Background: Lack of knowledge about the preventive and therapeutic measures pose a barrier in the management of diarrhoea in children.Methods: This study was conducted to assess awareness and attitude among mothers of children <5 years, towards diarrhea, feeding practices during diarrhoea, awareness and use of oral rehydration therapy (ORT). A standard questionnaire including handwashing practice, sanitation, personal hygiene, feeding practice, knowledge about disease was the assessmetn tool.Results: Of 300 mothers, 190 (62.60%) were in 20-30 years age group. Mean±SD age was 24.5±2.47 years. Literates were 78.67%; majority belonged to class III (37.69%) and IV (23.32%) socioeconomic class. Disease awareness was low (71.86%) and 68.03% were unaware of complications. Teething (32.64%), contaminated food and water (29.32%) were the main causes. Rice based food considered best (45.96%) followed by fruit juices (21.98%), boiled saboo daana (20.65%). Breast feed continued in 73.93%, solid food in 27.30%. Bottle feeding (92%) was preferred for top feeding and cleaning the bottle with boiling water was the most practiced (68.0%) method. Knowledge on oral rehydrating fluids was adequate (Home made salt and sugar solution (66.0%) and oral hydration solution (80.0%)); knowledge on correct preparation was inadequate. Not practicing proper hand wash (50.55%), wrong dilution (69.50%) and use of unsafe water (29.49%) were correctable factors. There was insufficient knowledge (89.50%) about quantity of fluid to be restored.Conclusions: There is an urgent need to educate mothers on initial fluid replacement and hygienic practices to be followed during diarrhoea apart from improving handwashing practice, sanitation, feeding practice, knowledge about disease.