Leslie E Lewis

Manipal Academy of Higher Education | MAHE · Department of Paediatrics

Background: The microbiota in the intestine is made up of trillions of living bacteria that coexist with the host. Administration of antibiotics during neonatal infection causes depletion of gut flora resulting in gut dysbiosis. Over the last few decades, probiotics have been created and promoted as microbiota management agents to enrich gut flora....

The aim of the systematic review and meta-analysis is to determine the stress and stressors experienced by the parents of high-risk neonates admitted to the neonatal intensive care unit (NICU) in India. We included both quantitative and qualitative studies. The Joanna Briggs Institute Critical Appraisal Checklist and Critical Appraisal Skill Progra...

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, a...

Introduction: Neutrophil surface CD64 (Cluster of differentiation 64), the highaffinity Fc receptor, is quantitatively up-regulated during infection and sepsis. The diagnostic utility of NCD64 as a reliable marker of neonatal sepsis has not been explored so far. Hence this study has been conducted to compare NCD64 with other currently used infectio...

Background: Infants born between 28 to 32 weeks of gestation require assisted ventilation or oxygen support due to respiratory distress syndrome. Neurophysiological facilitation (NPF) is the use of selective external proprioceptive and tactile stimuli. It further normalizes the rate & depth of breathing by influencing the length-tension relationshi...

mHealth intervention can be an important tool for health education. The study aimed to determine the effectiveness of a mHealth application in improving mothers' knowledge of preterm home care. One hundred sixty mothers of preterm infants hospitalized in the Neonatal Intensive Care Unit (NICU) of a tertiary care teaching hospital in Karnataka, Indi...

Background: The microbiota in the intestine is made up of trillions of living bacteria that coexist with the host. Administration of antibiotics during neonatal infection causes depletion of gut flora resulting in gut dysbiosis. Over the last few decades, probiotics have been created and promoted as microbiota management agents to enrich gut flora....

Background: Globally, neonatal healthcare-associated infections (HAIs) are known to cause high mortality. HAIs is a preventable condition related to the healthcare environment. The current study explored the contributors to neonatal HAIs in one of the largest tertiary care referral hospitals in South India. Methods: Neonates from December 2016 to J...

Meconium aspiration syndrome (MAS) in neonates born through meconium-stained amniotic fluid (MSAF) causes significant morbidity and mortality. Early recognition of at-risk neonates could help optimize treatment. The aim was to determine predictive characteristics of cord blood pH, base deficit and lactate with subsequent MAS. Receiver operating cha...

Background: Neonatal pneumonia remains a significant contributor to infant mortality in India and responsible for increased prevalence of infant deaths globally. Objective: To identify risk factors associated with neonatal pneumonia and its mortality in India. Study design: A systematic review was conducted including both analytic study design...

Background Hospitalization of a neonate is a significant stressor for the parents as well as family members especially when a high-risk neonate is admitted to the Neonatal Intensive Care Unit (NICU) requiring continued intensive care. This prolonged physical separation from parent can have a negative psychological effect on both the neonate and the...

Purpose: To examine whether a structured neonatal physical therapy program (SNP) improves neurobehavior and general movements in moderate to late preterm (MLP) infants. Methods: Sixty MLP infants participated in this clinical trial. After baseline assessment using the Neurobehavioral Assessment of Preterm Infant (NAPI) and Prechtl General Moveme...

Introduction Offspring of diabetic mothers have five times higher risk of cardiovascular abnormalities than in normal pregnancies. These cardiac anomalies involve fetal cardiac morphological and functional changes. Here, we investigate subclinical cardiovascular abnormalities, including structural and functional changes among infants of diabetic mo...

An outborn term neonate was referred at 12 h of life with multiple congenital anomalies. A baby was born out of consanguineous marriage to a mother with 2 previous abortions. Clinical examination showed features such as bilateral cryptophthalmos, syndactyly involving all limbs, and clitoromegaly suggestive of Fraser syndrome. Ultrasound of the abdo...

Genetic disorders with predominant central nervous system white matter abnormalities (CNS WMAs), also called leukodystrophies, are heterogeneous entities. We ascertained 117 individuals with CNS WMAs from 104 unrelated families. Targeted genetic testing was carried out in 16 families and 13 of them received a diagnosis. Chromosomal microarray (CMA)...

Objective: To study the serum vitamin D levels in neonatal seizures and vitamin D status of the mothers whose babies had vitamin D deficiency. Methods: For this case-control study, vitamin D levels were studied in term and late preterm neonates admitted to NICU with seizures in a tertiary care center in South India. Controls were term and late p...

Background Neonatal pneumonia is one of the leading factors contributing to neonatal mortality. The objective of this review was to identify the barriers associated with case management of neonatal pneumonia in India by conducting a scoping review. Methods Nine databases (PubMed, ProQuest, Ovid Medline, CINAHL, Web of Science, EMBASE, IndMED, SCOP...

Objective To explore stressors and support system for families with a neonate admitted with a systemic infection. Design Qualitative study using in-depth interviews (IDIs), based on principles of grounded theory. Setting A busy level III neonatal unit of a tertiary care teaching hospital in coastal Karnataka, India, between May 2018 and January 2...

There is sparse Indian data on whether fetal echocardiography among pregnant diabetics would be useful to predict adverse perinatal/neonatal outcome. Objectives To study fetal cardiac changes in diabetic mothers and non-diabetic controls from 24 weeks gestation until the neonatal period; correlate them with maternal glycemic control; study their i...

Looking at the neonatal mortality due to infectious diseases like sepsis and healthcare-associated infections (HAIs) in India. It is necessary to collate the evidence that is feasible to practice in the Indian healthcare system to prevent further morbidity or related mortality. This review focuses on the levels of evidences and the practices follow...

Aim: Certain rare inborn errors of metabolism clinically present with intractable seizures that readily respond to vitamin therapy. If identified early, brain damage due to seizures can be prevented. Methodology: A LC–MS method was developed and validated for the simultaneous quantification of the biomarkers in selected vitamin responsive pediatric...

Objective To gain an understanding of the variation in available resources and clinical practices between neonatal units (NNUs) in the low-income and middle-income country (LMIC) setting to inform the design of an observational study on the burden of unit-level antimicrobial resistance (AMR). Design A web-based survey using a REDCap database was c...

Objective: The neonatal period of a child is considered the most crucial phase of its physical development and future health. As per the World Health Organization, India has the highest number of pre-term births [1], with over 3.5 million babies born prematurely, and up to 40% of them are babies with low birth weights, highly prone to a multitude...

Thiamine deficiency, if detected early in infancy, can be treated with thiamine supplementation and can prevent seizures, other disabilities and death. The dried blood spot sampling technique is an attractive sample collection technique for infants. The present study reports the development and validation of a highly sensitive and precise method fo...

Methyl malonic acid and branched-chain keto acids are important biomarkers for the diagnosis of cobalamin deficiencies and maple syrup urine disease. We report the development and validation of a HILIC-ESI-MS2 method for the quantification of these organic acids from neonatal urine. The samples were 100 times diluted and analyzed on a ZIC-HILIC col...

Background Current dosage regimen of aminophylline is similar in both Appropriate for Gestational Age (AGA) and Small for Gestational Age (SGA) preterm neonates. ¹ In contrast with AGA babies, SGA babies handle drugs in different way. However, developing countries like India has significant proportion of Growth Restricted/SGA babies. Hence, there i...

Background: Carbon dioxide (CO2) is a by-product of cellular metabolism, which could be considered as a reflection of metabolism, circulation, and ventilation. Arterial blood gas analysis (ABG) is the gold standard of monitoring for CO2. However, is an expensive method leading to blood loss and iatrogenic anemia. In addition, each sample is only a...

Background: The incidence of neonatal sepsis in India is the highest in the world. Evidence regarding its risk factors can guide clinical practice and prevention strategies. Objective: To review, assess and synthesize the available literature from India on the risk factors of sepsis among neonates. Methodology: A systematic review was conducte...

Completed PRISMA checklist for the study. (DOC)

Sensitivity analysis. (DOCX)

Protocol of the systematic review. (DOCX)

Results from studies not included in meta-analysis. (DOCX)

Definitions and diagnostic criteria in included studies. (DOCX)

Risk factor profile of the included studies. (DOCX)

Quality assessment of included studies. (DOCX)

Forest plots illustrating subgroup analysis. (DOCX)

Funnel plots illustrating publication bias assessment. (DOCX)

25-Hydroxyvitamin D (25-(OH)D) deficiency is recently been described as one of the multiple factors responsible for pediatric seizures. 25-Hydroxyvitamin D3 and 25-Hydroxyvitamin D2 are the well-known markers to determine Vitamin D status. In this work we report the development of a sensitive and cost effective HPLC technique for the quantification...

Physical stress, including high temperatures, may damage the central metabolic nicotinamide nucleotide cofactors [NAD(P)H], generating toxic derivatives [NAD(P)HX]. The highly conserved enzyme NAD(P)HX dehydratase (NAXD) is essential for intracellular repair of NAD(P)HX. Here we present a series of infants and children who suffered episodes of febr...

Introduction: Congenital anomalies of the kidneys and urinary tract (CAKUT) comprise various structural malformations that result from defects in morphogenesis of the kidney and/or urinary tract. In most cases, CAKUT are associated with infant mortality and morbidity in older children and adults. Hence this study was undertaken to follow up antenat...

Aim To describe a randomized controlled trial protocol designed to evaluate the effectiveness of mobile health based Preterm Home Care Program (mHealthPHCP) known as ‘NeoRaksha’ mobile health application in improving parent‐infant‐interaction, growth and development of preterms. Design A prospective, randomized controlled clinical trial. The proto...

Waardenburg syndrome (WS) is a disorder of neural crest cell migration characterized by auditory and pigmentary abnormalities. We investigated a cohort of 14 families (16 subjects) either by targeted sequencing or whole exome sequencing. Thirteen of these families were clinically diagnosed with WS and one family with isolated non‐syndromic hearing...

This work was aimed at developing an analytical tool for the simultaneous quantification of methylmalonic acid, glutaric acid, succinyl acetone, homogentisic acid, and pipecolic acid in pediatric urine samples. Organic acids were isolated from urine by liquid-liquid extraction. The extracted samples were then derivatized by using BSTFA + 1% TMCS so...

Pyridoxine dependent epilepsy is a condition where the affected infant or child has prolonged seizures (status epilepticus), which are nonresponsive to anticonvulsant therapy but can be treated with pharmacological doses of pyridoxine. If identified earlier and treated prophylactically with pyridoxine, severe brain damage due to seizures can be pre...

Background: Methylxanthines have cardiac stimulant effects. The current study aimed to compare acute hemodynamic changes between caffeine and aminophylline in ≤34 weeks' preterm neonates. Methods: The study was performed using information on echocardiography measurements from preterm neonates recruited for apnea of prematurity (75 of 240) and pr...

The aim of the study was to determine the mortality and morbidity among preterm neonates admitted to Neonatal Intensive Care Unit (NICU) of a tertiary care hospital of Udupi District, Karnataka, South India. Material and methods: A cross sectional study was carried out among preterm neonates born with gestational age less than 37 weeks. A total of...

Background: Heated humidified high-flow nasal cannula (HHHFNC) is gaining popularity as an alternative to nasal continuous positive airway pressure (nCPAP) therapy in the management of preterm neonates with respiratory distress due to ease of administration and patient comfort. However, limited evidence is available addressing its risks and benefit...

The study was carried out at twenty-four bedded NICU associated with 2034 bedded tertiary care teaching private hospital at south canara district of Karnataka, India. Active surveillance, observations, interview of healthcare workers and exploration of determinants for HAIs through root cause analysis was done for a period of one year. CDC definit...

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the efficacy and safety of pertussis vaccination in pregnancy for preventing whooping cough in early infancy.

Background: The reported prevalence and pattern of thrombocytopenia in neonatal sepsis vary widely. Objectives: We aimed to determine the prevalence and severity of thrombocytopenia in blood culture proven neonatal sepsis. Methods: The study was conducted in a University hospital by recruiting neonates with sepsis in whom blood culture had grown...

Asparagine synthetase deficiency (ASNSD, MIM 615574) is a recently delineated rare neurometabolic disorder caused by mutations in ASNS (MIM 108370) (Ruzzo et al., 2013). It is characterized by congenital and/or postnatal progressive microcephaly, global developmental delay, seizures, growth retardation, cerebral atrophy and simplified gyral pattern...

Introduction India accounts for more neonatal deaths than any other country. There is a lack of consolidated evidence from India regarding the determining factors of pneumonia in neonates. This systematic review is aimed to consolidate and appraise the evidence on risk factors and determinants of pneumonia among neonates in India. Methods and anal...

With the increase of data in the medical domain over the years, it is extremely crucial that we analyze useful information and recognize patterns that can be used by the clinicians for better diagnosis of diseases. Clustering is a Machine Learning technique that can be used to categorize data into compact and dissimilar clusters to gain some meanin...

Objective: The aim of this study was to evaluate the effect of nurse-led early initiation of breastfeeding on LATCH breastfeeding assessment. Materials and Method: An evaluative quasi-experimental study was conducted after ethical approval. The setting of the study was the Labor Theatre (LT) of a tertiary referral hospital of Udupi district in sout...

Background: The preterm infants admitted to a high-tech Neonatal Intensive Care Unit (NICU) are defenseless to the adverse effects of the NICU, especially the noise present in the environment of the NICU. Aim of the Study: To determine the behavioral responses of preterm infants exposed to noise in the NICU. Materials and Method: Noise levels in th...

Objective: To assess the level of depressive symptoms and mother-infant-attachment among mothers of preterms admitted in Neonatal Intensive Care Unit (NICU) and find the relationship between of depressive symptoms and mother-infant-attachment. Materials and Methods: A cross sectional survey was conducted among 100 mothers whose preterm babies were...

The decision-making process for estimating the optimal dosage is critical in clinical settings. In the neonatal intensive care unit (NICU), preterm neonates suffering from apnea of prematurity, optimum drug dosage can make a difference between life and death. To improve clinical decision making in the NICU, we have developed prediction models using...

Neonates who are critically ill are cared for in a neonatal intensive care unit (NICU) for continuous monitoring of their conditions. Physiological parameters such as heart rate, respiratory wave form, blood oxygen saturation, and body temperature are constantly monitored in the NICU. However, NICUs are not always equipped with a computer system fo...

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, be...

Objective: To assess the feasibility and safety of cooling asphyxiated neonates using phase changing material based device across different neonatal intensive care units in India. Design: Multi-centric uncontrolled clinical trial. Setting: 11 level 3 neonatal units in India from November 2014 to December 2015. Participants: 103 newborn infan...

To assess the feasibility and safety of cooling asphyxiated neonates using phase changing material based device across different neonatal intensive care units in India. Multi-centric uncontrolled clinical trial. 11 level 3 neonatal units in India from November 2014 to December 2015. 103 newborn infants with perinatal asphyxia, satisfying pre-define...

Background: The highly sophisticated Neonatal Intensive Care Unit (NICU) exposes preterm infants to constant unexpected stimuli especially noise, impacting their growth and development. Modifying the environment of the NICU by provision of patterned stimuli like music is essential. There is a paucity of data from large and well-conducted trials on...

Background and objectives: Multidisciplinary team approach can act as the major facilitator for the successful implementation of newborn hearing screening. Nurses can act as a good educator for the parents due to their close association. Therefore, the need was felt to explore the knowledge, attitudes and existing practices towards newborn hearing...

Background: Advances in neonatal care have resulted in improved survival of neonates admitted to the intensive care of the Neonatal Intensive Care Unit (NICU). However, the NCU may be an inappropriate milieu, with presence of overwhelming stimuli, most potent being the continuous presence of noise in the ambience of the NICU. Aim and Objectives: To...

In Table II, P value in first row (against ‘continuing apnea’ at 1–3 d of therapy) should be 0.05 in place of 0.03; and in second row (against ‘continuing apnea’ at 4–7 d of therapy), P value should be 0.03 in place of 0.05. In Fig. 1, the number in the frame “Neonates completed treatment and follow-up” in the Caffeine group should be read as 77 in...

Introduction: Heparinized saline is usually used as a regular flush solution to prevent occlusion of peripheral intravenous locks in neonates but the risks associated with the use of heparin cannot be ignored in these patients. Aim: To assess and compare the efficacy and safety of Heparinized Saline (HS) and Normal Saline (NS) flush solution in neo...

Objective: The aim of this study was to determine the perceptions of health care personnel regarding noise present in the ambience of the Neonatal Intensive Care Unit (NICU) as well as the attitudes of health care personnel regarding implementation of music in the NICU. Materials and Method: A cross-sectional descriptive survey using interview tech...

Background: Preterm infants spend a considerable amount of time in the Neonatal Intensive Care Unit (NICU)braving the overwhelming stimuli. The sick preterm infants are usually put on ventilator support for their respiratory problems. Ventilation is usually invasive and extremely stressful for these infants. Preterm infants, on ventilation especial...

Introduction India contributes to the highest number of neonatal deaths globally. It also has the greatest number of pneumonia-related neonatal deaths in the developing world. We aim to systematically review the evidence for the factors associated with mortality due to neonatal pneumonia in the Indian context, to address the lack of consolidated ev...

Introduction India contributes to the highest neonatal deaths globally. Case management is said to be the cornerstone of pneumonia control. Much of the published evidence focuses on children aged 1 to 59 months. This scoping review, thus, aims to identify the treatment options for and barriers to case management of neonatal pneumonia in India. Met...