Publications by authors named "Nishad Plakkal"

Background: Neonatal sepsis epidemiology has been adequately reported in tertiary-care hospitals. However, such data are scarce from district hospitals in low-income and middle-income countries. This study aimed to evaluate the incidence of sepsis, pathogen profile, and antimicrobial resistance among neonates admitted to the special newborn care units in district hospitals in India.

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The objective of this study was to determine the risk factors associated with Elizabethkingia anophelis infection in neonates admitted to a tertiary care neonatal intensive care unit (NICU). A case-control study was undertaken as part of the outbreak investigation for E. anophelis sepsis in a tertiary care NICU in South India.

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Introduction: It is unclear if serum procalcitonin (PCT) estimated at sepsis suspicion can help detect culture-positive sepsis in neonates. We evaluated the diagnostic performance of PCT in culture-positive sepsis in neonates.

Methods: This was a prospective study (February 2016 to September 2020) conducted in four level-3 units in India.

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Article Synopsis
  • Vertical transmission of infections, including scrub typhus, is documented but rare, especially in neonates.
  • A notable resurgence of scrub typhus, a tick-borne zoonotic disease, has been observed in tropical regions.
  • A specific case is reported where a newborn showed symptoms of scrub typhus within 72 hours of birth, with the causative organism confirmed in both the mother and infant.
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Background: There is limited data on antibiotic treatment in hospitalized neonates in low- and middle-income countries (LMICs). We aimed to describe patterns of antibiotic use, pathogens, and clinical outcomes, and to develop a severity score predicting mortality in neonatal sepsis to inform future clinical trial design.

Methods And Findings: Hospitalized infants <60 days with clinical sepsis were enrolled during 2018 to 2020 by 19 sites in 11 countries (mainly Asia and Africa).

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Neonatal sepsis is a significant cause of mortality and morbidity in low- and middle-income countries. To deliver high-quality data studies and inform future trials, it is crucial to understand the challenges encountered when managing global multi-centre research studies and to identify solutions that can feasibly be implemented in these settings. This paper provides an overview of the complexities faced by diverse research teams in different countries and regions, together with actions implemented to achieve pragmatic study management of a large multi-centre observational study of neonatal sepsis.

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Context: Despite advances in neonatal intensive care, surgical methods, and anesthesia, congenital diaphragmatic hernia (CDH) is still associated with significant mortality. Predicting which babies will have poorer outcomes is essential to identify the high-risk babies and to give targeted care and accurate prognosis to the parents, especially in a resource crunch set-up.

Aims: The aim of this study is to evaluate the antenatal and postnatal prognostic factors in neonatal CDH that can be used to predict the outcome.

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Neonates and children are physically as well as physiologically different from adults. They are immunologically vulnerable, and the effects of transfusion can be longstanding, including with respect to their development. The transfusion reactions in children differ from those in adults in the type of reactions, incidence, and severity.

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Article Synopsis
  • Hypoxic ischemic encephalopathy (HIE) is a major concern for term and late preterm infants, being a leading cause of death and neurological issues in survivors.
  • The study aimed to assess the survival rates of these infants with moderate or severe HIE, alongside exploring management variations and factors affecting survival.
  • Results revealed an 82% survival rate to discharge, with severe HIE, need for epinephrine during resuscitation, and persistent pulmonary hypertension significantly lowering survival chances.*
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Pineoblastoma is an extremely rare intracranial neoplasm, with increased risk of craniospinal metastasis. There is only one case reported in the literature who presented during pregnancy. Described here is a woman who presented at five months of gestation with recurrence of pineoblastoma, who had previously defaulted adjuvant therapy following surgical decompression.

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Objective: To assess the utilization of SCC implemented in southern India and the effect on SCC utilization of face-to-face verbal education versus video-based content delivery.

Methods: The study included newborns with postnatal age of less than 2 wk at discharge. Mothers were administered SCCs and provided standardized verbal or video health education based on the time-period of enrollment.

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Pregnancy complicated with uncorrected Ebstein's anomaly is uncommon and may pose a serious threat to maternal and foetal life in the clinical setting of altered hemodynamics of pregnancy. Data of eight pregnancies in four women with Ebstein's anomaly who delivered in a tertiary care institute was analysed. Among the four women, one had associated atrial septal defect, one had pulmonary hypertension and three had right bundle branch block.

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Background: Spinal dysraphism occurs due to incomplete fusion of the midline mesenchymal, bony, or neural elements of the spine. The defects in the spinal cord can be associated with skin lesion since both have same embryonic origin.

Aims And Objectives: This study was conducted to determine the association of midline and paramedian cutaneous lesions with spinal dysraphism by using spinal ultrasonography.

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Aim: To evaluate whether a strategy of oropharyngeal administration of colostrum reduces morbidity and mortality in very preterm infants.

Methods: A total of 260 neonates with gestational age 26-31 weeks at birth were randomised between August 2017 and August 2018 to receive 0.2 mL of human milk or placebo respectively via the oropharyngeal route, beginning within 24 h after birth, and continued every 3 h until oral feeds were initiated.

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Background: Women with an uncorrected single ventricle heart are at increased risk of adverse maternal and perinatal outcomes.

Methods: We report our experience of managing pregnant women with uncorrected single ventricles, during the time period 2011 to 2017, in a low-resource setting and compare pregnancy outcome with healthy concurrent controls. Outcomes assessed include the mode of delivery, maternal complications, neonatal death and birth weight.

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Background: Women with tetralogy of Fallot especially uncorrected are at increased risk of adverse maternal and perinatal outcomes.

Method: We reviewed the maternal complications and pregnancy outcomes of women with tetralogy of Fallot (ToF), having corrected or uncorrected lesion during the period from 2011 to 2019 attending a south-Indian tertiary care center. Data regarding demographics, clinical course, and medications received and echocardiographic diagnosis regarding ToF, labor and delivery details, and postpartum follow-up was collected from the records.

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Objective: To assess the short term outcome and predictors of mortality among very low birth weight (VLBW) neonates.

Methods: This descriptive study from a tertiary care teaching institute in south India included 239 VLBW neonates who were uniformly managed as per unit's protocol and followed up till discharge or death, whichever was earlier. Univariate analysis and logistic regression analysis were done to determine the predictors of mortality.

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Article Synopsis
  • - The study aims to identify factors affecting the length of stay (LOS) for preterm infants (25-33 weeks gestation) in Indian NICUs, which is crucial for healthcare planning and family counseling.
  • - Data from 3,095 infants showed that as gestational age decreases, the LOS increases significantly, with a weekly decrease in gestation correlating to an additional 9 days in hospital.
  • - Key influences on LOS included conditions like abnormal antenatal umbilical artery Doppler, severe small for gestational age, and various health complications, with the study noting that LOS in India was lower compared to similar cases in developed countries.
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