Editors-in-Chief
Rhishikesh
Thakre
MD DNB DCH FCPS DM (Neo) FIAP
Chairperson, IAP Neonatology Chapter Director and Neonatologist Neo Clinic and Hospital
Aurangabad,
Maharashtra,
India
Srinivas
Murki
MD DNB DM (Neo)
Chief Department of Neonatology Fernandez Hospital
Hyderabad,
Telangana,
India
Chief Academic Editor
Ranjan Kumar
Pejaver
FRCP FRCPCH (UK) FIAP FNNF
Chief of Neonatology Meenakshi Hospitals
Honorary Professor Department of Neonatology Kempegowda Institute of Medical Sciences
Bengaluru,
Karnataka,
India
Associate Editors
Sandeep
Kadam
MD DM (Neo)
Senior Neonatal Consultant KEM Hospital and Ratna Memorial Hospital
Pune,
Maharashtra,
India
Naveen
Bajaj
MD DM (Neo)
Neonatal Fellow, UWO, Canada Consultant Neonatologist, Deep Hospital
Ludhiana,
Punjab,
India
Sanjay
Wazir
DM (Neo) MD
Director, Neonatology Cloudnine Hospital
Gurgaon,
Haryana,
India
Ashish
Jain
M.D., DNB, D.M. (Neonatology)
Assistant Professor of Neonatology LNJP & Allied Hospitals, Department of Neonatology Maulana Azad Medical College,
New Delhi
Forewords
Ashok
Deorari
Pramod
Jog
6Members, Editorial Committee
7Indian Academy of Pediatrics—Neonatology Chapter
8
9Contributors
15Foreword
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Protocols in Neonatology
First Edition: 2016
9789385891731
Printed at
5Editorial Board
Editors-in-Chief
- Rhishikesh Thakre
- MD DNB DCH FCPS DM (Neo) FIAP
- Chairperson, IAP Neonatology Chapter
- Director and Neonatologist
- Neo Clinic and Hospital
- Aurangabad, Maharashtra, India
- Srinivas Murki
- MD DNB DM (Neo)
- Chief
- Department of Neonatology
- Fernandez Hospital
- Hyderabad, Telangana, India
Chief Academic Editor
- Ranjan Kumar Pejaver
- FRCP FRCPCH (UK) FIAP FNNF
- Chief of Neonatology
- Meenakshi Hospitals
- Honorary Professor
- Department of Neonatology
- Kempegowda Institute of Medical Sciences
- Bengaluru, Karnataka, India
Associate Editors
- Sandeep Kadam
- MD DM (Neonatology)
- Senior Neonatal Consultant
- KEM Hospital and Ratna Memorial Hospital
- Pune, Maharashtra, India
- Sanjay Wazir
- DM (Neonatology) MD
- Director, Neonatology
- Cloudnine Hospital
- Gurgaon, Haryana, India
- Naveen Bajaj
- MD DM (Neonatology)
- Neonatal Fellow, UWO, Canada
- Consultant Neonatologist, Deep Hospital
- Ludhiana, Punjab, India
- Ashish Jain
- M.D., DNB, D.M. (Neonatology)
- Assistant Professor of Neonatology
- LNJP & Allied Hospitals, Department of Neonatology
- Maulana Azad Medical College, New Delhi
- Binu Ninan
- MD DNB DCH
- Professor and Head
- Department of Neonatology
- Ramachandra University
- Chennai, Tamil Nadu, India
- Bishwajit Mishra
- MD
- Director
- Intensive Care
- Department of Pediatrics
- Jagannath Hospital
- Bhubaneshwar, Odisha, India
- Deepak Chawla
- DM (Neonatology) MD
- Associate Professor
- Department of Pediatrics
- Postgraduate Institute of Medical Education and Research
- Chandigarh, India
- Dinesh Chirla
- MD DM (Neonatology) MRCPCH (UK) Neonatal Fellow (Aus) Fellow in PICU (UK)
- Director
- Intensive Care Services
- Rainbow Hospital
- Hyderabad, Telangana, India
- G Pramod Reddy
- MD DCH
- Director and Head
- Department of Neonatology
- Fernandez Hospital
- Hyderabad, Telangana, India
- Nandkishor Kabra
- DM (Neonatology) MD DNB MSc (Clinical Epidemiology, Canada)
- Head
- Department of Neonatology
- Surya Mother and Child Superspeciality Hospital
- Mumbai, Maharashtra, India
- Rajesh Kumar
- DM (Neonatology) MD
- Director and Head
- Department of Neonatology
- Rani Children Hospital
- Ranchi, Jharkhand, India
- VC Manoj
- MD
- Unit Head
- Department of Neonatology
- Jubilee Mission Medical College and
- Research Institute
- Thrissur, Kerala, India
Office Bearers 2015-16
Chairperson | Dr Rhishikesh Thakre |
Hon. Secretary | Dr Sanjay Wazir |
Treasurer | Dr Naveen Bajaj |
Joint Secretary | Dr Nandkishor Kabra |
Imm. Past Chairperson | Dr Ranjan Kumar Pejaver |
Executive Members | |
East Zone | Dr Rajesh Kumar, Dr Bishwajeet Mishra |
West Zone | Dr Ashish Mehta, Dr Sandeep Kadam |
North Zone | Dr Deepak Chawla, Dr Pankaj Paul |
Central Zone | Dr Dinesh Chirla, Dr Pramod G |
South Zone | Dr Binu Ninan, Dr VC Manoj |
Indian Academy of Pediatrics Office Bearers 2015
President | Dr SS Kamath |
President Elect, 2016 | Dr Pramod Jog |
Vice-President | Dr Sanjay Ghorpade |
Imm. Past President | Dr Vijay Yewale |
Secretary General | Dr Pravin J Mehta |
Treasurer | Dr Bakul J Parekh |
Editor-in-Chief, IP | Dr Dheeraj Shah |
Editor-in-Chief, IJPP | Dr P Ramchandran |
Joint Secretary | Dr AS Vasudev |
- Amita Kaul
- DNB (Ped)
- Associate Chief
- Neonatal and Pediatric Intensive Care Services
- Surya Mother and Child Superspecialty Hospital
- Pune, Maharashtra, India
- Anjali Kulkarni
- MD FRCPCH Fellowship in Neonatology (Au)
- Head, Department of Pediatrics and Neonatology
- Sir HN Reliance Foundation Hospital
- Mumbai, Maharashtra, India
- Anu Thukral
- DM (Neonatology) MD DNB MNAMS
- Assistant Professor
- Department of Pediatrics
- All India Institute of Medical Sciences
- New Delhi, India
- Anuradha Bansal
- MD
- Neonatal Division
- Department of Pediatrics
- Government Medical College and Hospital
- Chandigarh, India
- Aparna C
- MD DM (Neonatology)
- Consultant Neonatologist
- Kanchi Kamakoti Child's Trust Hospital Chennai, Tamil Nadu, India
- Archana Kadam
- MD DNB (Ped)
- Developmental Pediatrician
- KEM Hospital and Jehangir Hospital
- Pune, Maharashtra, India
- Ashish Jain
- M.D., DNB, D.M. (Neonatology)
- Assistant Professor of Neonatology
- LNJP & Allied Hospitals, Department of Neonatology
- Maulana Azad Medical College, New Delhi
- Ashish Mehta
- MD Fellowship in Neonatology (Au)
- Director, Arpan Hospital
- Ahmedabad, Gujarat, India
- Ashwani Singhal
- DM (Neonatology) DNB (Neo) MD (Ped) DNB (Ped)
- Consultant Newborn and Child Specialist
- Fortis Hospital
- Ludhiana, Panjab, India
- Asim Kumar Mallick
- MD
- Professor and In-Charge
- Neonatal Unit
- Department of Pediatrics
- NRS Medical College and Hospital
- Kolkata, West Bengal, India
- Balla Kalyan Chakravarthy
- MD
- Department of Neonatology
- St. John's Medical College Hospital
- Bengaluru, Karnataka, India
- Baswaraj Tandur
- DNB (Ped)
- Senior Consultant
- Vijay Marie Hospital
- Hyderabad, Telangana, India
- MD DNB DCH
- Professor and Head
- Department of Neonatology
- Ramachandra University
- Chennai, Tamil Nadu, India
- Chetana S Naik
- MS (ENT) DORL
- Professor
- Department of Otorhinolaryngology and Head & Neck Surgery
- Smt Kashibai Navale Medical College and General Hospital
- Consultant Neurotologist
- Ghaisas ENT Hospital
- Pune, Maharashtra, India
- Deepak Chawla
- DM (Neonatology) MD
- Associate Professor, Neonatal Division
- Department of Pediatrics
- Government Medical College Hospital
- Chandigarh, India
- Deepak Pande
- MD
- Associate Professor
- Department of Pediatrics
- Government of Gujarat
- Gujarat, India
- Deepak Sharma
- MD
- Fernandez Hospital
- Hyderabad, Telangana, India
- Dinesh Chirla
- MD DM (Neonatology) MRCPCH (UK) Neonatal Fellow (Aus) Fellow in PICU (UK)
- Director
- Intensive Care Services
- Rainbow Hospital
- Hyderabad, Telangana, India
- Femitha P
- DM (Neonatology) MD
- Consultant
- Kerala Institute of Medical Sciences
- Thiruvananthapuram, Kerala, India
- Giridhar Sethuraman
- MD DM (Neonatology)
- Associate Professor
- Department of Neonatology
- Chettinad Hospital and
- Research Institute
- Chennai, Tamil Nadu, India
- Gp Capt SS Dalal
- DM (Neonatology) MD
- Professor
- Department of Pediatrics
- Armed Forces Medical College
- Pune, Maharashtra, India
- Harish Kashyap
- MD (Ped)
- Department of Neonatology
- Fernandez Hospital
- Hyderabad, Telangana, India
- Hemasree Kandraju
- Consultant Neonatologist
- Fernandez Hospital
- Hyderabad, Telangana, India
- Jaikrishan Mittal
- DM (Neonatology)
- Consultant Neonatologist
- Neo Clinic Jaipur, Rajasthan, India
- K Shankaranarayanan
- CCT (Neo) CCT (Ped) MRCPCH DM (Neo) MD (Ped) DNB (Ped) DCH
- Senior Consultant Neonatologist
- Kanchi Kamakoti
- Childs' Trust Hospital
- Chennai, Tamil Nadu, India
- Kiran Sathe
- DNB (Ped) DCH
- Clinical Research Fellowship (Ped)
- Fellow, Pediatric Nephrology
- (Mumbai, Singapore; IPNA, ISPN)
- Associate Consultant
- Pediatrics and Pediatric Nephrology
- Sir HN Reliance Foundation Hospital
- Mumbai, Maharashtra, India
- MD DCH
- Professor
- Department of Pediatrics
- Kasturba Medical College
- Manipal, Karnataka, India
- LS Deshmukh
- DM (Neonatology) MD
- Professor and Head
- Department of Neonatology
- Government Medical College and Hospital
- Aurangabad, Maharashtra, India
- Manish Mittal
- MD
- Consultant Neonatologist
- Cocoon Neo Clinic
- Jaipur, Rajasthan, India
- Monika Kaushal
- DM (Neonatology) MD
- Visiting Fellowship RCPCH
- Head, Department of Pediatric and Neonatology
- Zulekha Hospital
- Dubai, UAE
- N Chandra Kumar
- MD (JIPMER) DNB MNAMS DM (Neonatology) DNB (Neonatology)
- Cloudnine Hospital
- Chennai, Tamil Nadu, India
- Nandkishor Kabra
- DM (Neonatology) MD DNB MSc
- Fellowship in Perinatal Medicine (Canada)
- Surya Mother and Child Care
- Mumbai, Maharashtra, India
- Naveen Bajaj
- DM (Neonatology) MD
- Neonatal Perinatal Medicine Fellowship (Canada)
- Consultant Neonatologist
- Deep Hospital
- Ludhiana, Panjab, India
- Naveen Jain
- DM (Neonatology) MD DNB
- Associate Professor
- Department of Neonatology
- Kerala Institute of Medical Sciences
- Thiruvananthapuram, Kerala, India
- Nishad Plakkal
- MD Fellowship in Neonatal-Perinatal Medicine
- Assistant Professor
- Department of Neonatology
- Jawaharlal Institute of Postgraduate Medical Education and Research
- Puducherry, India
- Pradeep Suryawanshi
- MD DCH Fellowship in Neonatal Perinatal Medicine (Au)
- Professor and Head
- Department of Neonatology
- Bharati Vidyapeeth Deemed University
- Consultant Neonatologist
- Sahyadri Hospital
- Pune, Maharashtra, India
- Pramod G
- MD
- Director
- Department of Neonatology
- Fernandez Hospital
- Hyderabad, Telangana, India
- Preetha Joshi
- MD
- Fellowship in NICU & PICU
- Critical Care Transport and Cardiac Intensive Care Unit
- Department of Pediatric and Neonatal Critical Care
- KD Ambani Hospital
- Mumbai, Maharashtra, India
- Sanjay Wazir
- DM (Neonatology) MD
- Director
- Department of Neonatology
- Cloudnine Hospital
- Gurgaon, Haryana, India
- MD DM (Neonatology)
- Director and Chief Neonatologist
- Rani Children Hospital
- Ranchi, Jharkhand, India
- Rajiv Sharan
- DNB MNAMS
- Consultant Pediatrician
- Tata Motors Hospital
- Jamshedpur, Jharkhand, India
- Raktima Chakrabarti
- MD Fellowship in Neonatology (Germany)
- Senior Consultant and Head
- Department of Neonatology and Pediatrics
- W Pratiksha Hospital
- Gurgaon, Haryana, India
- Ranjan Kumar Pejaver
- FRCP FRCPCH (UK) FIAP FNNF
- Chief of Neonatology
- Meenakshi Hospitals
- Honorary Professor Department of Neonatology
- Kempegowda Institute of Medical Sciences
- Bengaluru, Karnataka, India
- Rhishikesh Thakre
- MD DNB DCH FCPS DM (Neo) FIAP
- Chairperson, IAP Neonatology Chapter
- Director and Neonatologist
- Neo Clinic and Hospital
- Aurangabad, Maharashtra, India
- Rohit Arora
- MD
- Head
- Department of Neonatology
- Apollo Cradle
- Gurgaon, Haryana, India
- Sachin Shah
- MD DM (Neonatology)
- Fellowship in Neonatology (Aus) Fellowship in Pediatric Critical Care (Canada)
- Director
- Neonatal and Pediatric
- Intensive Care Services
- Surya Mother and Child Superspecialty Hospital
- Pune, Maharashtra, India
- Sandeep Kadam
- DM (Neonatology) MD
- Consultant Neonatologist
- KEM Hospital and Ratna Memorial Hospital
- Pune, Maharashtra, India
- Sanjay Aher
- DM (Neonatology) MD
- Director
- Neocare Hospital
- Nashik, Maharashtra, India
- Snehal Thakre
- MS DNB (Opth)
- Professor
- Department of Ophthalmology
- MGM Medical College and Hospital
- Aurangabad, Maharashtra, India
- Somashekhar Nimbalkar
- MD
- Head
- Neonatal Intensive Care Unit
- Shree Krishna Hospital and Pramukhswami Medical College
- Anand, Gujarat, India
- Sreeram Subramanian
- MD (Ped) DM (Neonatology)
- Consultant Neonatologist
- BBC Children's Hospital
- Paramitha Children's Hospital
- Hyderabad, Telangana, India
- Srinivas Murki
- MD DNB DM (Neo)
- Chief, Department of Neonatology Fernandez Hospital Hyderabad, Telangana, India
- Suman Rao PN
- MD DM (Neonatology)
- Professor and Head
- Department of Neonatology
- St. John's Medical College Hospital
- Bengaluru, Karnataka, India
- Surg Cmde Sheila Mathai
- VSM MD DNB DM (Neonatology)
- Professor and Head
- Department of Pediatrics
- Armed Forces Medical College
- Pune, Maharashtra, India
- MD
- Consultant Neonatologist
- Department of Pediatric and Neonatal Critical Care
- KD Ambani Hospital
- Mumbai, Maharashtra, India
- Tejo Pratap Oleti
- DM (Neonatology) MD
- Consultant Neonatology
- Fernandez Hospital
- Hyderabad, Telangana, India
- Tushar B Parikh
- DNB DM (Neonatology)
- Fellowship in Neonatal Perinatal Medicine (Aus)
- Consultant Neonatologist
- KEM Hospital and Columbia Asia Hospital
- Pune, Maharashtra, India
- VC Manoj
- MD
- Associate Professor and Head
- Department of Neonatology
- Jubilee Mission Medical College
- Thrissur, Kerala, India
- Vinay Joshi
- MD (Ped) DM (Neonatology)
- Fellowship, PICU & PCICU
- (University of Toronto, Canada)
- Fellowship, Neonatal and Perinatal Medicine
- (University of New South Wales, Australia)
- KD Ambani Hospital
- Mumbai, Maharashtra, India
- Vinay Kumar Rai
- MD
- Department of Neonatology
- Cloudnine Hospital
- Gurgaon, Haryana, India
- Vinay Mishra
- MD
- Department of Pediatric and Neonatal Critical Care
- KD Ambani Hospital
Ensuring healthy survival of all neonates is among the highest priorities of our times. The global community has committed itself to attain an under-five child mortality rate of less than 20 per 1,000 live births in all countries by 2,035. This would only be achieved if the neonatal mortality rate declines to less than 10 per 1,000 live births. For India, this would be a two-thirds reduction from the prevailing level of 29 per 1,000 live births.
India's success in reducing neonatal mortality, in particular, since the launch of the National Rural Health Mission has been modest. Nonetheless, the country mounted a spectacular effort in establishing newborn care corners and the special newborn care units, thus creating an impressive neonatal care infrastructure in the public sector. There has also been a concomitant expansion of neonatal care services in the private sector.
This massive expansion of neonatal care services has also brought to the fore an extraordinary need for skilled nurses and doctors. IAP Neonatology Chapter envisioned the need of trained neonatal fellows to manage these facilities in the country. They have also recognized a felt need to have uniform standardized protocols for managing normal, at-risk and sick neonates. This compilation of protocols in neonatology is a timely step towards filling the gap for education translation for quality of care. These protocols are tailored to needs of neonatology fellow, resident doctors and practicing pediatricians.
I would like to congratulate the contributors, reviewers and the editorial team for an outstanding product. The credit goes to a very large team of neonatologists trained in India and abroad who have contributed in this endeavor. I am glad to see many young neonatologists contributing to this book. I know them for more than a decade. They are exceptional up-to-date educators with hands-on experience in managing sick neonates. They have created simple protocols applicable in Indian context. It is heartening that these evidence-based protocols have been reviewed and critiqued by the most respected expert from all over the country. My special congratulations to Dr Rishikesh Thakre and Dr Srinivas Murki for a job well done.
I am sure these protocols will help in providing safe care with focus on quality, so that healthcare is affordable and cost effective in the country.
Ashok Deorari
MD FAMS FNNF
Professor
Department of Pediatrics
WHO Collaborating Centre for Education and Research in Newborn Care
All India Institute of Medical Sciences
17Foreword
Publication of any book is a process as laborious as the process of delivering a baby. Maturity (contents and the quality), weight gain (number of pages) and intact survival (final copy) all have to be carefully looked after.
Protocols in Neonatology has gone through all these laborious processes and has come out as an exclusive book for newborn healthcare providers giving instant guidelines for treatment, bringing uniformity in management and training minds for protocolized thinking. With each protocol, the book provides concise, precise and up-to-date information, which shall help standardize care in neonatal practice.
Textbooks published from the medically advanced countries do not focus enough attention on the prevailing problems and circumstances in the developing countries, such as India. When a practitioner is confronted with a clinical problem, he can rarely turn to a textbook for help. What he needs at that time is not a recounting of a long list of differential diagnosis, but practical guidelines as to how to arrive at a particular diagnosis and how to proceed further.
With the help of history, focused examination and minimum investigations, one can reach a working diagnosis and lay down immediate priorities in management.
The goal behind publication of this book is to facilitate a logical and efficient stepwise approach to reasonable differential diagnoses for the common problems in a neonate. Moreover it would train the brain to approach a problem.
To put it in the words of Henry David Thoreau…our lives are frittered away by detail; simplify, simplify.
I am sure that the protocols will enhance the capabilities of students, house officers and clinicians guiding them towards optimal utilization of available investigative and therapeutic resources.
The explosion of knowledge in neonatology is phenomenal and fast. If the medical advances and good clinical practice get coupled with effective advocacy, our increasing knowledge will benefit newborn care in our country.
Pramod Jog
19Preface
We take great pleasure and pride in offering the Protocols in Neonatology to the learned reader. It is said that there are many ways to boil an egg. So also when it comes to managing newborn's, no two neonatal intensive care units (NICUs) are the same, so also the management by consultants within a NICU. It has been our endeavor to appraise and sensitize the reader to management of common disorders by providing precise, concise and relevant information, which should streamline the care of the sick newborn. Divided into theme-based sections, several topics of practical relevance are being covered under the headings—Clinical Approach to Sick Newborn; Care of Well Newborn; Care of Preterm/Low-birth Weight/High-risk Newborn; Neonatal Dilemmas; Specific Therapies, and Miscellaneous Topics. We hope this book serves as a ready-reference tool in a busy NICU.
A standardized approach and management enables the competent residents, fellows and pediatricians to quickly evaluate, identify and intervene before complications set it. We are confident that the protocols will be a step in this direction.
We are grateful to all our authors for their valuable contributions without which this book would not have seen the light of the day. We would appreciate and look forward to your feedback and comments.
We thank the office bearers of IAP Neonatology Chapter for having the faith in us. We appreciate all the support of Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Group President) and Mr Tarun Duneja (Director–Publishing) of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India.
Rhishikesh Thakre