#003 - Journal Club - The latest research in neonatology (March 3rd 2025)

In this third episode of The Incubator India Podcast, hosts Dr. Anita Singh and Dr. Akanksha Verma dive into some of the latest research and break it down for our community of neonatologists in India. From hypertension in preterm neonates to the role of probiotics in NEC prevention, they break down five important studies with direct application in clinical practice. They explore the urgent need for standardized hypertension protocols, the surprising gaps in probiotic adoption, and whether blood gas analyzers can replace traditional CSF glucose testing. The discussion heats up as they examine India’s rubella vaccination campaign, uncovering both major successes and critical immunity gaps, before wrapping up with an in-depth look at vitamin K prophylaxis—does a higher dose offer real benefits?

Throughout the episode, Dr. Singh and Dr. Verma connect the dots between research and real-world practice, questioning how India can bridge the gap between data and daily neonatal care. With a sharp focus on evidence-based medicine, clinical impact, and policy evolution, this episode is a must-listen for anyone passionate about shaping the future of neonatology in India.

Tune in now for a fast-paced, insight-packed discussion that challenges the status quo!

The articles covered on today’s episode of the podcast can be found here

1. Das R, Nagpal R, Deshpande S, Kumar G, Singh A, Kallimath A and Suryawanshi P (2024) A survey on management practices of hypotension in preterm neonates: an Indian perspective.Front. Pediatr. 12:1411719.doi: 10.3389/fped.2024.1411719 

2. More K, Hanumantharaju A, Amrit A, et al. (November 18, 2024) Use of Probiotics for Preventing Necrotizing Enterocolitis in Preterm Infants: A Survey of Current Practices Among Indian Neonatologists. Cureus 16(11): e73923.DOI 10.7759/cureus.73923 

3. Jain A, Dutta S, Pal A, Kumar P. Neonatal CSF glucose measured by blood gas analyzer, glucometer, and standard laboratory methods. J Perinatol. 2024;44(12):1795-1799. doi:10.1038/s41372-024-02106-y

4. Anne RP, Kumar J, Kumar P, Meena J. Effect of oropharyngeal colostrum therapy on neonatal sepsis in preterm neonates: A systematic review and meta-analysis. J Pediatr Gastroenterol Nutr. 2024;78(3):471-487. doi:10.1002/jpn3.12085

5. Shanmugasundaram D, Viswanathan R, Winter AK, et al. Rubella immunity among pregnant women and the burden of congenital rubella syndrome (CRS) in India, 2022. Vaccine. 2024;42(24):126077.doi:10.1016/j.vaccine.2024.06.044 

6. Natarajan AS, Delhi Kumar CG, Senthil Kumar GP, et al. One milligram versus two-milligram intramuscular vitamin K to prevent late-onset hemorrhagic disease in young infants: a randomized controlled trial. Indian Pediatr. 2025;62:116-20.   doi: 10.1007/s13312-025-3374-6.

Transcript

Akanksha (00:02.417)

Hello and welcome back to Incubator India. It's truly wonderful to connect with you all again for our third episode and the very first one of 2025. I am Dr. Akanksha and I'm so thrilled to be again here with you today. We hope till now this podcast has been both informative and inspiring, helping us connect with all of you in meaningful ways. This episode is a special one- a journal club where we'll explore some of the intriguing and impactful recent research from India. It's a snapshot of the incredible work being done right here at home and we can't really wait to dive in and discuss with you.

Anita Singh (00:49.282)

Hey everyone, I am Anita and it is such a pleasure to join you for this exciting episode. Research from India is really thriving and we are here to bring you insights and highlights that matter. So stay with us as we unpack some fascinating studies and share our thoughts on their significance in neonatal care.

Akanksha (01:10.919)

Yeah, right Dr. Anita. All right then, let's get started. We're so glad you're here with us and we hope you're all ready to dive in with us into some fascinating discussions.

Anita Singh (01:23.884)

Yeah, we have got a lot of exciting studies to explore today. So settle in, make yourself comfortable and get ready for deep dive into some truly thought provoking research.

Akanksha (01:35.837)

Yeah, so let's begin our journal club with an article published in Frontiers and Pediatrics in October 2024. It was titled, A Survey on Management Practices of Hypotension in Preterm Neonates from an Indian Perspective. So this original research explores the diagnostic and the management approaches for hypotension in the Indian NICUs.

So, and I must say that with Dr. Anita herself as one of the co-authors of this study, it makes it even more special for our discussion today. So, I would ask none other than Dr. Anita herself, so please briefly share the motivation behind this study and what it aims to achieve.

Anita Singh (02:26.286)

Thanks Akansha, this study aimed to identify variation in diagnostic criteria and treatment strategies for hypotension in preterm neonates across Indian NICUs. It involved a cross-sectional survey of over 320 neonatal physicians. Those were predominantly from Level 3 NICUs and they focused on their practices regarding diagnosis, use of echocardiography and treatment modalities like volume expansion, inotropes and steroids.

Akanksha (02:54.557)

Wow, that's such an important topic. The methodology was solid with a 29 question online survey gathering insights from across 23 states, ensuring diverse representation. And here's what stood out from the study. 

So talking first of the diagnostic variations, only 44 % of the respondents actually had a written protocol for diagnosing, for management of hypotension in their NICUs. And the  most common diagnostic criteria which was being used was that the mean BP, if found less than gestational age, that was used to define hypotension. And it was like almost 52 % of the respondents are using this criteria. And regarding the use of echocardiography bedside,

only 85 % reported that echocardiography was available in their NICU bedside and but out of these also only 73 % used it for assessing hypertension and if you talk of structured training that was just limited to 29 % of the respondents. Now moving on next to treatment practices, volume expansion was the first line treatment

for 85 % of participants and dopamine as the preferred first line inotrope. Steroid was mostly reserved for refractory cases only. So we realized that there were significant variations that existed in the diagnostic and treatment approaches and only of minor of them were actually utilizing advanced tools like if we talk of near infrared spectroscopy. Any comments from you Dr. Anita?

Anita Singh (04:52.046)

Yeah, Aakansha, as you summarized, but let's not forget to highlight the positive finding that came out from this survey was high adoption of delayed court clamping with about 78 % of respondents reporting its practice in their units. So that's a remarkable progress and aligns well with evidence supporting its benefits in improving unit outcomes such as better blood pressure regulation in the first few hours of life.

Akanksha (05:20.765)

Yeah, yeah, yeah, can't agree more and that's encouraging as well. I mean it reflects growing awareness and implementation of this critical practice across NICUs in India. But definitely on the flip side, there's still room for improvement in the diagnostic approaches because we saw that almost half of the respondents are still using the criteria of blood pressure being equivalent to their gestational age.

and with very few of them relying on actually reference tools like Zubrow's curves or other centile-based charts. So if they use this, they certainly provide a more standardized and evidence-based approach for diagnosing hypertension. I think then adopting these widely could reduce the inter physician variability which has been well highlighted in this survey. What do you say?

Anita Singh (06:14.594)

Yeah, absolutely. standardized diagnostic criteria not only improve consistency but also guide targeted interventions. It forms the more streamlined approach and uniformity amongst the various units. And additionally, the limited use of invasive blood pressure monitoring despite such accuracy in critically ill units remains an area of concern in our country. In many centers, resource constraints and procedural challenges might limit its use, but it is essential to address this for better hemodynamic monitoring.

Akanksha (06:48.093)

Absolutely. actually speaking of monitoring, I think increasing training opportunities for bedside echo could also empower the neonatologists to make more accurate pathophysiology driven decisions. So what do you think Dr. Anita, how feasible it is to scale up such training programs in India?

Anita Singh (07:11.598)

Yeah, it's really feasible, though it's challenge, but definitely doable. And I would say that institutional can collaborate organizations like the National Neonatology Forum to facilitate hands-on training. it's becoming a trend in the last two to three years. Our national body has come up with a structured echocardiographic training program for over six months with physical hands-on training.

So both virtual platforms along with the hands-on training can improve the role of echocardiography and its widespread use across the country. So in that way, it would provide a better opportunity to reach towards the more practice.

Akanksha (07:59.064)

Well said, Dr. Anita. I mean, this survey really gives us both a sense of how far we've come and where we actually need to go. So bridging gaps in training, standardizing diagnostic criteria, and optimizing monitoring practices are the vital steps towards improving the outcomes for preterm neonates. So.

Akanksha (08:24.143)

A big congratulations to the authors for conducting such a comprehensive and impactful study.

Anita Singh (08:30.85)

Yeah, indeed Akansha. So shall we move ahead for the next study?

Akanksha (08:36.615)

For sure. next up, we explore again another fascinating survey. And this one's titled Use of Probiotics for Preventing Necrotizing Enterocolitis in Preterm Infants. So it was a survey of current practices among the Indian urologists published in Curious in November 2024.

It comes from the vibrant academic ecosystem of aamchi Mumbai and it includes contributions from Dr. Sanjay Patole, which we all know is a stalwart in this field. So it's an honor to discuss his work, which sheds light on the critical topic of routine probiotic supplementation in preterm infants. So Dr. Anita, I mean, this is such a clinically impactful topic.

Could you please share the studies, aims and methodology with our listeners?

Anita Singh (09:34.752)

Yeah, Akansha, sure. So, the survey aimed to assess the current practice of routine robotic use in Indian NICUs, particularly in the prevention of necrotizing enterocolitis in preterm babies. The study employed a web-based questionnaire distributed to neonatologists across the country, collecting responses from 615 centers. So, this included level 1, 2, and predominantly level 3 NICUs, reflecting a comprehensive snapshot of current practices.

Akanksha (09:57.565)

Wow.

Akanksha (10:08.061)

Thank you Dr. Anita for letting us know the methodology. So let's talk about the results now. Results are eye-opening I would say. Only 39 % of the 615 NICUs that responded said that they are actually using routine probiotic supplementation and that is also mostly for preterm infants under 32 weeks or those who are weighing less than 1500 grams.

Akanksha (10:38.009)

Nearly half of the non-adopting centers cited that inadequate evidence as the main reason. Again, was followed by concerns about the safety of the products that are available, difficulties in sourcing the effective probiotics. And also what this survey highlighted that among the centers who are using probiotics,there were significant variations in the choice of the strains, dose, duration and the starting criteria. So we saw that the most common strains included were lactobacillus acidophilus, bifidobacterium brevi and saccharomyces boulardi. Adverse events are in according to this survey were rarely reported, but many centers lacked the capability to monitor for probiotic related sepsis

Anita Singh (11:38.986)

Yeah, exactly. This variability underscores the need for standardized guidelines and reliable probiotic products. The study also highlights that a significant number of centers that up to a tune of 43 % plan to implement routine probiotic supplementation soon, which is a really positive trend.

Akanksha (11:59.383)

Yeah, I mean, it is encouraging definitely, but then it's also a call to action. Given the compelling evidence that we now have from systematic reviews and meta-analysis supporting probiotics in reducing the neck and late onset sepsis, actually, we really need to address these barriers swiftly. And what stood out to me was the strong emphasis on clinical judgment due to the lack of uniform protocols. 

So what do you think Dr. Anita like in your view what steps could accelerate the adoption of this routine probiotic supplementation in India?

Anita Singh (12:43.926)

Yeah, to tackle this we really need to have a concerted efforts on multiple fronts, increasing awareness of existing evidence, ensuring the availability of high quality robotic products and developing a new level policy supported by national guidelines. So collaboration between academic bodies and regulatory authorities will be a key to driving this change.

Akanksha (13:05.967)

Absolutely, I mean, regulatory authorities do have a key role to play in this. And this survey with its rich data and practical insights actually serves as both a mirror and a guide for our neonatal community. I must say it's a brilliant effort by the authors and like we really hope that it sparks some meaningful action across the board.

Anita Singh (13:32.076)

Yes, additionally based on the NNF guidelines on the feeding of low birth weight units, multistrain probiotic supplements can be started as early as within 24 hours after birth for stable newborns once central feed has been initiated. The supplement can be continued until 36 to 36 weeks of gestation or until discharge if earlier. Having a structured guideline like this can provide much needed clarity on duration and timing ensuring uniformity in practice across NICUs

Akanksha (14:03.271)

Certainly, I mean I agree to it to the fullest Dr. Anita. Thank you. So shall we now move on to our next study?

Anita Singh (14:13.122)

Yeah, sure.

Akanksha (14:15.229)

Okay, so next now we from the surveys we now delve into another practical study. This one's titled as neonatal CSF glucose measured by blood gas analyzer, glucometer and standard laboratory methods. So published in the Journal of Perinatology in September 2024, this study addresses a pressing question faced in neonatal care.

How reliable are point of care methods like blood gas analyzers and glucometers compared to standard laboratory methods for measuring CSF glucose? And I actually found this study particularly relevant given the logistical challenges that we often face with lab CSF glucose measurement. So Dr. Anita, would you mind walking us through the study's aims and methodology?

Anita Singh (15:13.454)

Certainly Akansha, you very well highlighted the pertinent issue which the various centers of this country face with respect to the laboratory delays. So this prospective observational study was conducted in level 3 NICU on 97 units undergoing lumbar puncture. It aimed to evaluate the agreement between CSF glucose levels measured using a standard laboratory method, a blood gas analyzer, and a glucometer.

The researcher used Lin’s coefficient of concordance and Bland Alktan plot to assess agreement and even developed regression equation to predict laboratory glucose values from blood glucose analyzer and glucometer readings. Importantly, one of the key author of this study is Dr. Sourabh Dutta, a respected senior distinguished neonatologist and researcher from PGIMER Chandigarh, who contributed in neonatal research in India, especially in the field of Neonatal sepsis and meningitis have been remarkable and this study is yet another significant addition to our understanding of neonatal diagnostics.

Akanksha (16:17.661)

So, thank you, Dr Anita, let's get into the findings of the study that are actually incredibly insightful. Firstly, let's talk about the agreement between the methods. So, as you mentioned about the Lin’s coefficient of concordance. So, I would just briefly like to say that it quantifies how closely the measurements from two methods align with the

perfect 45 degree line on a scatter plot. So in this study, the coefficient was higher for the blood gas analyzers versus the laboratory methods, which was 0.973 precisely, which indicated an excellent agreement and slightly lower for glucometers at 0.873. And talking next about the bland Altman plots.

these plots again compare the difference between the methods against their mean values. So this again showed that blood gas analyzers had a smaller bias compared to glucometers. So the narrower limits of agreement for blood gas analyzer further supports its reliability. if we talk about the turnaround time.

So we all know that for lab methods, it can be up to 34 minutes or maybe sometimes if the lab is closed. So it may be even longer, two hours, three hours, four hours. We really don't know. But it is significantly longer any time for blood gas analyzers, which the turnaround time is usually around 10 to 15 minutes, and just two to three minutes for glucometers.

So again this highlights the efficiency of point of care methods, especially in emergencies or in settings where the lab methods may not be available round the clock. And they also saw that blood gas analyzer values, they closely matched the lab values. Even the glucometers sometimes tended to overestimate glucose levels.

Akanksha (18:33.169)

So overall they found a better reliability in agreement with the blood gas analyzers.

Anita Singh (18:41.122)

Yes, exactly. This study makes a stronger case for using blood gas analyzers for rapid glucose estimation, especially in resource-limited settings or emergencies where lab delays are common.

Akanksha (18:53.201)

Hmm, yeah, yeah. And I think their use of agreement methods like the Linz coefficient and the bland Altman plots that this study has used, it provides a well-rounded analysis. So it definitely adds confidence in the blood gas analyzers potential as a reliable alternative to lab methods.

Anita Singh (19:13.614)

Again, let me add to another strength of the study is to acknowledge its limitations like a small sample size for newborns with hypoglycorrachia and the inability to assess the impact of red blood cell contamination in traumatic samples. While Blood Gas Analyzer shows promise, further research is needed before its widespread adoption.

Akanksha (19:37.277)

Absolutely. So this study certainly answers a very important clinical question and again it opens door for innovation in neonatal care. Hopefully it will inspire some more research to make rapid CSF glucose estimation more accessible and more reliable for all of us.

Anita Singh (19:56.704)

Yeah, so let's wrap this one and jump for our next fourth study. So the next topic for the study is beautifully marries the simplicity with impact that is application of oropharyngeal cholesterol therapy. So this was a systematic review and meta-analysis published in the Journal of Pediatric Gastroenterology and Nutrition in late 2023. It evaluates whether applying colostrum to the oropharynx of preterm neonates reduces the risk of neonatal sepsis and other morbidities. With contributions from esteemed researchers across India, this study is a prime example of how basic intervention can hold transformative potential.

Akanksha (20:40.879)

Okay, wow. So this review represents an outstanding contribution as you said from the Indian researchers and it shows actually how they worked in affiliation with the esteemed institutions from the country. Their meticulous work has consolidated evidence supporting the oropharyngeal colostrum application in reducing the culture proven sepsis, mortality and necrotizing enterocolitis.

So all important outcomes in preterm neonates.

Anita Singh (21:12.75)

Yeah, that's just fascinating that how a small volume just 0.2 ml of colostrum can have such an important impact. in this study, the 0.2 ml of colostrum was applied to oropharynx and the study aggregated data from 21 RCTs involved over 2300 preterm babies and that finds a truly compelling study to discuss.

Akanksha (21:40.453)

So, I will just break down the findings for all of you. Talking of reduction in the neonatal sepsis, this colostrum application significantly reduced the incidence of culture proven positive sepsis with a risk ratio of almost 0.78 and a high certainty evidence. Again, there was 27 percent reduction in the mortality among neonates who received oropharyngeal colostrum application.

Akanksha (22:10.205)

a whooping 41 % reduction in necrotizing enterocolitis stage 2 or more was observed and it also shortened the time to full enteral feeding by approximately two days and I think that's really great.

Anita Singh (22:29.452)

Yeah, well summarized Akanksha and what stands out to me is the safety of this intervention. There was no significant adverse effect making oropharyngeal colostrum an easily implementable and risk free addition to the newborn practices.

Akanksha (22:46.873)

Exactly and as you said in the beginning that the beauty of this colostrum application lies in its simplicity and accessibility. I mean everyone has an access to colostrum which is like rich in immunoglobulins, antimicrobial factors, cytokines and what not and it definitely acts as a natural booster for the neonates underdeveloped immune system. So by applying it to the oropharynx we are what we are actually trying is we are stimulating the

oral mucosa associated lymphoid tissue which helps modulate inflammation and enhance the gut immunity.

Anita Singh (23:27.308)

Yeah, but it is worth noting some of the limitation. The data was predominantly from low and middle income countries where new and adult subsist rates are higher. In high income countries where donor milk and advance care protocols are more common, the benefits were not as pronounced. Also, there is limited evidence for extremely preterm and extremely low birth weight babies.

Akanksha (23:51.481)

Yeah, that's true. I mean, but somehow this study paves the way for future research, surely. Larger trials focusing on more like extremely preterm babies and their long term neurodevelopmental outcomes could help this practice as a standard of care worldwide. So Dr. Anita, before we wrap up, what's your take on integrating oropharyngeal colostrum application into the routine practice, especially for talking of the LMICs?

Anita Singh (24:23.118)

Yeah, answer is quite evident and it's no-brainer that the low cost is this is the low cost intervention and the ease of administration with significant impact on critical outcome make it a highly feasible intervention. So it is important that we should train more and more lactation counselors and having more of their involvement in the NICUs along with the nurses to facilitate the smooth implementation of this intervention. I believe it is a step

forward to bridging the gap in the medical care outcomes between LMICs and high-income countries.

Akanksha (25:00.413)

Absolutely and actually this review not only highlights the power of colostrum but it also underscores the need for equitable healthcare solutions. Undoubtedly it is a significant contribution to the neonatal care practices globally. 

So moving on next to our next topic for today and I must say that our next study addresses a matter of immense public health importance. and that is rubella immunity and the burden of congenital rubella syndrome in India. This multi-centric research published in vaccine in 2024 evaluates the impact of the nationwide measles and rubella vaccination campaign and it offers critical insights into the burden of congenital rubella syndrome or CRS in the country. Dr. Anita, I would...say that methodology is remarkable. Please walk us through it.

Anita Singh (26:04.792)

Certainly, Akansha, the study involved sero surveys conducted at 13 sentinel sites across the country between August and October 2022. It involved 3,900 pregnant women visiting antenatal clinics to estimate rubella IgG seroprevalence. The participants' blood samples were tested for IgG antibodies with concentration more than or equal to 10 IU per ml, indicating immunity.

Additionally, the study used catalytic modelling to estimate the force of infection and calculated the CRS incidence before and after the MR vaccination campaign.

Akanksha (26:44.879)

Okay, wow. talking of the findings, I mean, they're both sobering and encouraging. So, in 2022, 85 % of the women were found to be immune, but still it leaves approximately 15 % of the women susceptible to rubella. And there was a disparity between the urban and rural areas as well. The immunity was found to be higher in urban areas. I think, because of more accessibility and awareness regarding the vaccinations there compared to the urban areas. And there were some significant gaps in regions like Trivandrum and Sevagram. 

Again, they looked at this burden of the congenital rubella syndrome before and after the campaign. So the annual incidence of CRS before the campaign was actually 200 plus.

per 1 lakh live births and that almost equated to approximately 50,000 cases annually. But post campaign, my God, the incidents dropped to just five per 1 lakh live births. I mean, that's really commendable. And it estimated to around 1000 cases in 2022. And some sites like this predominantly mentioned like Bengaluru and Chandigarh.

It was found in the geographic variation, these areas exhibited rubella transmission even after the campaign. So it may indicate some localized gaps in the vaccination coverage at those locations.

What do you say, Dr. Anita?

Anita Singh (28:29.518)

Yeah, really, the results really show the success of MR campaign and its role in reducing the incidence of congenital rubella syndrome. However, the 15 % susceptibility among women of childbearing age remains a concern as there are no routine vaccination opportunities for this age group under our National Immunization Schedule or Universal Immunization Program.

So maybe the adolescent chapter of our Indian Academy of Pediatrics could step in to bridge the gap through school health initiatives or targeted vaccination drives.

Akanksha (29:10.521)

Yeah, I mean, that's a critical point I think that you have made. While vaccinating children is obviously essential, addressing the immunity gaps in women of reproductive age is equally vital. So although supplementary vaccination campaigns for this group may seem to be logistically challenging, but they could significantly reduce the exposure, rubella exposure and the risk of CRS.

Anita Singh (29:39.79)

Yeah, absolutely. The most sustainable approach would be to maintain a high vaccination rates among children up to the tune of over 90 % in high transmission regions to prevent Rubella virus circulation. Additionally, the targeted intervention in low immunity pockets could bridge existing gaps.

Akanksha (29:58.077)

I mean, this study is a testament to the strides India has actually made in Rubella elimination. But it again serves as a reminder of the work that remains. So ensuring equitable vaccination coverage and some robust surveillance. But definitely a well-deserved appreciation to the researchers for this impactful contribution to public health. Any final thoughts, Dr. Anita?

Anita Singh (30:24.438)

Yeah, I would conclude this study with that. This research exemplifies how data driven strategies can shape policy and save lives. I hope it inspires for more such initiatives as we march towards eliminating CRS altogether. Along with that, it is more imperative so these days that the government take up the mumps along with the MR campaign. So it becomes MMR campaign and we can hope for tackling another important infectious disease.

Akanksha (31:00.455)

Certainly, I mean, I can't agree more with you on this. So let's just finally move up to wrap up this episode with our last study for today's episode. And that's a very important one again. Vitamin K prophylaxis for preventing late onset hemorrhagic disease of newborn. Published in Indian Pediatrics this month, this randomized control trial from JIPMER Puducherry.

evaluates whether a higher 2 mg intramuscular dose of vitamin K provides better protection compared to the standard 1 mg dose. We all know that vitamin K deficiency bleeding is rare and it can be devastating but like I mean it can lead to serious intracranial bleeds. Particularly this deficiency remains more so common in exclusively breastfed infants.

So Dr. Anita, could you please walk us through the study design and methodology?

Anita Singh (32:03.446)

Yeah, why not? This open-label RCT-enrolled 82-term neonates, delivered vaginally, that were randomly assigned to receive either 1 mg or 2 mg of intramuscular vitamin K at birth. Infants of mothers on anti-epileptic, antitubercular drug or with a family history of bleeding disorders were excluded. The researchers based protein induced by vitamin K absence that is PIVKA 2, a very sensitive marker of subclinical VKDB, at birth, 30 days and 72 days.

A PIVKA 2 level of above 100 nanograms per ml was considered indicative of vitamin K deficiency. The aim was to determine whether a higher 2 mg dose provided better and longer lasting protection against VKDB compared to standard 1 mg dose.

Akanksha (32:50.961)

Yeah, mean a very clear aim and the findings are also intriguing. So as you said about the PIVKA 2 levels at birth almost all of the infants had elevated levels of PIVKA. So that confirms universal vitamin K deficiency. At 30 days they found that the PIVKA 2 levels remained high in both groups. So but there was no significant difference between the 1 mg and the 2 mg groups.

Akanksha (33:21.147)

By 72 days, I mean that's where the interesting part gets in, the PIVKA 2 levels had dropped significantly only in the 1 milligram group, but they remain almost relatively unchanged in the 2 milligram group. I mean that is a paradoxical effect. Now talking of clinical implications, no cases of clinical vitamin K deficiency bleeding were reported in either group.

that again reinforces the efficacy of vitamin K prophylaxis. Higher dose of 2 mg did not confer any additional benefits and there were no adverse effects like hemolysis or hyperbil with either of the doses.

Anita Singh (34:07.438)

That's really fascinating. It challenges the assumption that more is better. While 2 mg of vitamin K didn't work in all terms, also didn't improve. Protection against late onset VKDB. This suggests that 1 mg remains the optimal dose balancing efficacy and safety.

Akanksha (34:13.821)

Mm-hmm.

Akanksha (34:26.031)

Exactly and this aligns well with the American Academy of Pediatrics and the ESPGHAN guidelines as well which recommends 1 mg intramuscular vitamin K at birth for all neonates. However, in settings where oral vitamin K is used, multiple doses may be needed to achieve comparable protection.

Anita Singh (34:28.542)

Yeah,

Akanksha (34:45.851)

So just Dr. Anita, I would just like to ask that what do you think should be the next steps in research on this very important practice of prophylactic vitamin K at birth?

Anita Singh (34:58.638)

Akansha, would say that further studies in this area should focus on longer follow-up periods to assess vitamin K levels and neurodevelopmental outcome impacts, evaluating optimal vitamin K dosing in preterm babies with the risk of VKDB higher, invesstigating alternative routes like weekly oral vitamin K regimens for new units who miss IM prophylaxis, the study from JIPMER is a valuable addition to neonatal medicine.

reinforcing the continued importance of universal vitamin K prophylaxis at birth.

Akanksha (35:32.973)

Certainly, I mean this research reminds us that sometimes less is actually more in neonatal care. So all points to the authors for shedding light on this important topic. And let us just keep advocating for some evidence-based newborn care to prevent avoidable morbidity. And as we wrap up this episode, we hope these discussions have sparked curiosity.

.

Akanksha (35:59.865)

and provided insights into the latest neonatal research from India. So we talk of hypertension management to probiotics, CSF glucose estimation, impact of rubella vaccination on CRS and vitamin K prophylaxis. These studies undoubtedly showcase the incredible contributions of the Indian researchers.

Anita Singh (36:23.182)

Thanks. Thank you all for joining us today. We will be back with more thought provoking discussion in our next episode of Incubator India. Until then keep learning, keep questioning and keep pushing the boundaries of neonatal Care. See you next time.

Akanksha (36:39.343)

Absolutely. Stay engaged, informed, and let's continue making neonatalcare better, one study at a time. So goodbye, everyone.

Anita Singh (36:40.958)

as we continue to support the project.