Context: Recent advances in neonatology have influenced the incidence and severity of ROP in a dichotomous fashion. Aims: To determine the incidence of ROP and to analyse its risk factors. Settings and Design: Prospective clinical case series. Materials and Methods: 282 preterm infants with birthweight < 1500g and/or gestational age ≤ 32 weeks and also those with gestational age > 32 weeks, with birthweight between 1500-2000 g, who were at risk for ROP were selected. Weight gain proportion was measured as weight at 6 weeks minus birthweight divided by birthweight. Statistical Analysis: Univariate and multivariate logistic regression. Results: Incidence of any ROP was 21.6% while severe ROP was 6.7%. Prenatal factors like multiple gestation (P = 0.510) and antenatal steroids (P = 0.104) were not significantly associated with ROP. On multivariate analysis, postnatal factors like weight at birth < 1250 g (P = 0.01) and gestational age between 31-32 weeks (P = 0.02) were independent risk factors for any ROP, while intraventricular hemorrhage (P = 0.03) was the only independent risk factor for severe ROP. Mean birthweight of infants with severe ROP was 1056 μ 207 g (P = 0.004), which was significantly low. After logistic regression, the mean weight gain proportion at 6 weeks, of those neonates with severe ROP was 30%. Conclusions: Low birthweight and prematurity were the most important risk factors for developing any ROP, while intraventricular hemorrhage was the independent risk factor for developing severe ROP. The mean postnatal weight gain at 6 weeks was not statistically significant in neonates with severe ROP.

Introduction: Given the significant role of the gut microbiota in early immune and metabolic development, the impact of perinatal antibiotic administration on the neonatal gut microbiome remains a crucial area of investigation. This study examines how maternal and neonatal antibiotic exposure affects the composition of the gut microbiome in preterm infants. Methodology: A prospective controlled cohort study was conducted in the neonatal intensive care unit of a tertiary care hospital from January 2021 to September 2023. The study enrolled neonates with a gestational age of less than 37 weeks. Preterm infants were categorized into four groups based on exposure to maternal or neonatal antibiotics: the NE group (no exposure), IE group (infant exposure only), ME group (maternal exposure only), and IME group (both infant and maternal exposure). In the NE group, “No exposure” refers to participants whose mothers did not receive intrapartum antibiotics or whose neonates were not administered postnatal antibiotics prior to sample collection. Data on antibiotic use and microbiota composition from stool samples were collected and analyzed via the convection culture method. Results: This study included 182 preterm infants, yielding 364 stool samples. By day 4, the prevalence of Klebsiella pneumoniae increased significantly, reaching 70% in the IE group compared with 42.6% in the NE group (p < 0.001). Bifidobacterium spp. was more prevalent in the NE group than in the other groups on day 4 (57.4%, p = 0.019). The antibiotic-exposed groups (IE, ME, and IME groups) presented greater abundances of potentially pathogenic bacteria, such as Klebsiella pneumoniae and Escherichia coli, whereas beneficial bacteria, such as Bifidobacterium spp., were more abundant in the NE group. Conclusion: These findings suggest that perinatal antibiotic exposure is associated with significant changes in the neonatal gut microbiota, potentially increasing the pathogenic microbiota. Trial registration: The study was registered with the Clinical Trials Registry-India (CTRI) under the number CTRI/2020/11/029375 |http://ctri.nic.in/ on November 19, 2020.

OBJECTIVE: Methylxanthines are the most commonly prescribed drug in neonatal setups. However, Clinicians show indecision in choosing the right agent for Apnea of Prematurity in most of the developing countries. Present study aimed to compare rate of mortality and survival with normal neurodevelopment outcome at 18 to 24 months of corrected age, between Caffeine- and Aminophylline-treated infants for apnea of prematurity. METHODS: 240 infants were randomly allocated to caffeine and aminophylline for apnea of prematurity during February 2012 to January 2015. Long-term neurodevelopmental assessment was done only from children who had attained corrected age of 18 to 24 months during April 2014 to February 2016. Cognitive, language and motor deficits were assessed by Bayley Scale of infant and toddler development (BSID – III). Postnatal characteristics such as hearing and visual impairments during NICU stay were noted and same were followed up. RESULTS: Infants allocated to caffeine group showed 83% less risk of getting cognitive impairment (RR 0.16; CI 95% range 0.02 to 1.36), 50% less risk of developing motor deficits (RR 0.50; CI 95% range 0.12 to 1.95) and 24% less risk of developing language problems (RR 0.76; CI 95% range 0.36 to 1.58). However in all the neurodevelopment domains the difference between groups was not statistically significant. Risk of mortality in caffeine group was 9% less over aminophylline group which was statistically non-significant (RR – 0.92; CI 95% range – 0.45 to 1.84; p = 0.81). Physical growth parameters were found to be similar in both the groups. Risk of developing visual abnormality and hearing impairments was also statistically non-significant between the groups. CONCLUSION: Caffeine and aminophylline showed similar effects in reducing the rate of mortality and improving the survival without neurodevelopment delays; though the clinical significance of caffeine over aminophylline cannot be undermined.

Introduction Billions of microorganisms reside in gut altering its homeostasis and leading to various diseases. The initial days of life are crucial for developing gut flora that helps in gut maturation and neonatal health. This review summarizes the evidence on seeding of neonatal gut microbiota, modulation of gut microbiota in neonatal sepsis, antimicrobial resistance, and role of probiotics or other therapies to re-establish altered microbiota. Conclusion Gut microbiota regulates host physiological homeostasis mediators, including the gut barrier function, and disease susceptibility pathways. Maintenance or restoration of microbiota and metabolite composition may be a therapeutic or preventative target against critical illness.