Background: Ventilator induced lung injury prevention may begin from birth, and respiratory support without endotracheal intubation is an attractive option in preterm baby with Respiratory distress syndrome (RDS). The objective of the study was to evaluate the clinical course and respiratory outcomes in preterm infants with moderate RDS assigned from birth to Nasal Continuous Positive Airway Pressure (NCPAP) or Bi-level Nasal Continuous Positive Airway Pressure (Bi-level NCPAP).Methods: 60 infants of 28-34 weeks GA (<35 wks GA), affected by moderate RDS, were considered eligible and were randomized to NCPAP (CPAP level=6cm H2O, Group A n=30) or to Bi-level NCPAP (lower CPAP level=4.5 cmH2O; higher CPAP level=8 cmH2O, Group B n=30), provided with the variable flow devices (Infant Flow CPAP vs Infant Flow SiPAP™, Viasys Healthcare, Yorba Linda, CA).Results: Length of ventilation, oxygen dependency, need for intubation and occurrence of air leaks were considered as outcomes. Infants showed similar characteristics at birth (Group A versus Group B: GA 30.4±2 wks versus 30.3±2wks, BW 1433±545g versus 1415±560g. Group A underwent longer respiratory support (6,2±2 days versus 3,8±1 days, p=0.025), longer O2 dependency (13,8±8 days versus 6,5±4 days, p=0.027) and was discharged later (GA at discharge 36,7±2,5 weeks versus 35,6±1,2 weeks, p=0.02). All infants survived. No BPD or neurological disorders occurred.Conclusions: Bi-level NCPAP was associated with better respiratory outcomes versus NCPAP, and allowed earlier discharge, inducing the same changes in the cytokine levels. In our population, it was well tolerated and safe

Background: Respiratory distress syndrome (RDS) contributes significantly to mortality and morbidity. Continuous positive airway pressure (CPAP), when applied to premature infants with RDS, re-expands collapsed alveoli, splints the airway, reduces work of breathing and improves the respiration. Objectives: To ascertain the immediate outcome of preterm infants with RDS on Bubble CPAP and identify risk factors associated with its failure.Methods: This was a prospective analytical study and inborn preterm infants (gestation 28 to 34 weeks) admitted to the NICU with RDS were included in the study. All the spontaneously breathing infants were stared on bubble CPAP and different variables were recorded. Those in whom CPAP failed were given surfactant and mechanical ventilation.Results: 170 neonates were enrolled in the study. 52 (30.5%) babies failed CPAP. The predictors of failure were; partial or no response to Antenatal Steroids (ANS), white-out on the chest X-ray, Silverman Anderson scoring >6 or FiO2 > 0.4 after 15-20 minutes of CPAP, extreme prematurity. Other maternal and neonatal variables did not influence the need for ventilation. Rates of mortality and duration of oxygen requirement was significantly higher in babies who failed CPAP. No baby had chronic lung disease.Conclusions: Infants with no or partial exposure to antenatal steroids, white-out chest X-ray and those with higher FiO2 requirement after initial stabilization on CPAP are at high risk of CPAP failure (needing mechanical ventilation). Bubble CPAP is safe for preterm infants with RDS; it decreases need of surfactant and mechanical ventilation.

Background: Enlarged mesenteric lymph nodes (MLN) are frequently seen in children with abdominal pain and in the absence of other disorders, have been attributed to primary mesenteric lymphadenitis. Mesenteric lymphadenitis is commonly reported in children with acute, chronic or recurrent abdominal pain and no evidence of other pathologies. The purpose of this study was to find out the association of USG finding of enlarged mesenteric lymph nodes with causation of recurrent abdominal pain and outcome of these patients on follow up.Methods: This hospital based prospective study was done on 82 patients aged 5 to 15 years, attending Bal Chikitsalaya, RNT Medical college, Udaipur, fulfilling Apley’s criteria of RAP. Detailed history, physical examination, relevant investigations and USG abdomen was done in all patients.Results: Eighty-two children were enrolled; out of which majority (62.19%) were in age group 5-8 years with mean age 7.9±2.69 years. Mesenteric lymphadenopathy was found in 14 (17.07%) cases. All patients with mesenteric lymphadenopathy 14 (100%) had periumbilical pain and diurnal variation of pain. Follow up of 14 patients who had mesenteric lymphadenopathy showed that in 12 (85.71%) patients, the mesenteric lymphadenopathy resolved on USG despite that pain abdomen persisted in 7 (58.33%).Conclusions: The presence of mesenteric lymphadenopathy can’t be attributed to recurrent abdominal pain.

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Background: To assess the complimentary feeding practice in Severe Acute Malnutrition (SAM) children aged between 6months to 5years.Methods: 110 SAM children admitted in Malnutrition Treatment Centre (MTC) of MBGH Hospital, Udaipur over a period of 3 months were taken in the study. Structured questionnaire including child’s personal data, socioeconomic status of the family, breast feeding and complementary feeding status were used. Clinical and anthropometric assessment of children was done.Results: Out of the 110 children included in the study, 58 (52.7%) were males and 52 (47.2%) were females. Mean age of children included was 16.8 ± 10.73 months. Maximum children were in the age group of 6-12months 60 (54.5%), followed by 13-24 months of age 38 (34.5%), followed by >2-5years of age 12 (10.9%). Thirty-four (30.9%) children were on exclusive breast feeding, with 30 (27.3%) in age group of 6-12 months and 4 (3.6%) in 12- 24 months. Breast feeding with complimentary feeding was practiced in 30 (27.3%) children of 6-12 months of age and 22 (20%) children of 13-24 months. Out of the 76 children on additional feed with or without breast feeds, 70 (92.1%) consumed milk- either goat milk, cow milk or buffalo milk.Conclusions: Anthropometric assessment revealed that maximum number of SAM children also had chronic malnutrition. Diet of SAM children mainly included milk and cereals. They did not obtain a balanced diet to meet their nutritional requirement.