Ashok Kumar Deorari

RESEARCH, TEACHING, or OTHER INTERESTS

Multidisciplinary, Pediatrics, Perinatology and Child Health, Public Health, Environmental and Occupational Health, Health Professions

Scopus Publications

Correction to: Development of Multimodal Training Tool for Preterm Infant Care (Indian Journal of Pediatrics, (2024), 10.1007/s12098-024-05287-8)
Anu Thukral, Vaishnavi Gupta, Deepak Chawla, Praveen Kumar, Ashok K Deorari, and
Springer Science and Business Media LLC



Perceived usefulness of a blended learning approach for skills training among medical interns: a pilot study
Rashmi Ramachandran, Ravneet Kaur, Ambuj Roy, Prabudh Goel, and Ashok Kumar Deorari
Springer Science and Business Media LLC



Optimising Indian healthcare delivery with standard treatment workflows
Ashoo Grover, Jerin Jose Cherian, Saumya Srivastava Aggarwal, Deepika Pandhi, Umesh Devappa Suranagi, Anjali Bajaj, Nikhil Tandon, Sudha Chandrashekar, Roderico Ofrin, Ashok Deorari,et al.
Elsevier BV



Development of Multimodal Training Tool for Preterm Infant Care
Anu Thukral, Vaishnavi Gupta, Deepak Chawla, Praveen Kumar, Ashok K Deorari, , Kumutha Kumaraswami, Ruchi Nanavati, Jayshree Mondkar, Geeta Gathwala,et al.
Springer Science and Business Media LLC



Post-procedure pain in preterm neonates undergoing retinopathy of prematurity (ROP) screening: a prospective cohort study
Raman Singla, Ankit Verma, Vivek Kumar, Purna Chandra, Parijat Chandra, Anu Thukral, M. Jeeva Sankar, Ramesh Agarwal, and Ashok Kumar Deorari
Springer Science and Business Media LLC



Mutation spectrum and enzyme profiling of G6PD deficiency in neonates of north India: a prospective study
Upasana Bhattacharyya, Preeti Deswal, Sunil Kumar Polipalli, Diksha Sharma, Manpreet Kaur, Madhulika Kabra, Neerja Gupta, Ramesh Agarwal, A. K. Deorari, V. K. Paul,et al.
Springer Science and Business Media LLC



Vertical Transmission of COVID-19 Infection in a Tertiary Hospital in India - A Prospective Study
R. Dhinakaran, Ankit Verma, Anu Thukral, M. Jeeva Sankar, Ramesh Agarwal, Purva Mathur, Aparna K Sharma, Lalit Dar, Megha Brijwal, Aashish Choudhary,et al.
Springer Science and Business Media LLC



Feasibility, Sustainability, and Effectiveness of the Implementation of “Facility-Team-Driven” Approach for Improving the Quality of Newborn Care in South India
S. Venugopal, Ravindra B. Patil, Anu Thukral, Raja Ashok Koganti, Vasanth Kumar DL, M. Jeeva Sankar, Ramesh Agarwal, Ankit Verma, Ashok K. Deorari, ,et al.
Springer Science and Business Media LLC



Developing Standard Treatment Workflows—way to universal healthcare in India
Ashoo Grover, Balram Bhargava, Saumya Srivastava, Lokesh Kumar Sharma, Jerin Jose Cherian, Nikhil Tandon, Sudha Chandershekhar, Roderico H. Ofrin, Henk Bekedam, Deepika Pandhi,et al.
Frontiers Media SA
Primary healthcare caters to nearly 70% of the population in India and provides treatment for approximately 80–90% of common conditions. To achieve universal health coverage (UHC), the Indian healthcare system is gearing up by initiating several schemes such as National Health Protection Scheme, Ayushman Bharat, Nutrition Supplementation Schemes, and Inderdhanush Schemes. The healthcare delivery system is facing challenges such as irrational use of medicines, over- and under-diagnosis, high out-of-pocket expenditure, lack of targeted attention to preventive and promotive health services, and poor referral mechanisms. Healthcare providers are unable to keep pace with the volume of growing new scientific evidence and rising healthcare costs as the literature is not published at the same pace. In addition, there is a lack of common standard treatment guidelines, workflows, and reference manuals from the Government of India. Indian Council of Medical Research in collaboration with the National Health Authority, Govt. of India, and the WHO India country office has developed Standard Treatment Workflows (STWs) with the objective to be utilized at various levels of healthcare starting from primary to tertiary level care. A systematic approach was adopted to formulate the STWs. An advisory committee was constituted for planning and oversight of the process. Specialty experts' group for each specialty comprised of clinicians working at government and private medical colleges and hospitals. The expert groups prioritized the topics through extensive literature searches and meeting with different stakeholders. Then, the contents of each STW were finalized in the form of single-pager infographics. These STWs were further reviewed by an editorial committee before publication. Presently, 125 STWs pertaining to 23 specialties have been developed. It needs to be ensured that STWs are implemented effectively at all levels and ensure quality healthcare at an affordable cost as part of UHC.


Simulation Based vs Conventional Training for Initial Steps in Delivery Room Care of Preterm Neonates: An Open Label Randomized Trial
Dilip Neupane, Akash Sharma, Anu Thukral, M. Jeeva Sankar, Ramesh Agarwal, and Ashok K. Deorari
Springer Science and Business Media LLC



Improving the Quality of Health Care in Special Neonatal Care Units of India: A Before and After Intervention Study
Ashok K. Deorari, Praveen Kumar, Deepak Chawla, Anu Thukral, Sonika Goel, Rajashree Bajaj, Manish Singh, Clare Gilbert, Rajan Shukla, and
Johns Hopkins School Bloomberg School of Public Health, Center for Communication Programs
In low- and middle-income countries, facility-based neonatal care practices can be improved using a collaborative cross-learning quality improvement approach incorporating remote mentoring, coaching, and supportive supervision. Key Findings Combining a training package to improve the knowledge and skills of health care workers in managing sick and preterm neonates with point-of-care quality improvement skills successfully reduced the unindicated use of oxygen, antibiotics, and phototherapy while increasing the use of enteral feeds. Despite a significant reduction in the use of 2 lifesaving medical interventions—oxygen and antibiotics—no increase in mortality or short-term adverse outcome was observed, indicating an overuse of these interventions in the preintervention period. Key Implication A strategy of combining professional training activities and coaching in continuous quality improvement methods can successfully improve the health care of sick and preterm neonates. With the rapid expansion of access to facility-based neonatal care, it is important to monitor for both overuse and underuse of evidence-based interventions. ABSTRACT Background: We evaluated the efficacy of training health care workers (HCWs) in point-of-care quality improvement (POCQI) and a preterm newborn health care package (PHCP), followed by remote mentoring and supportive supervision in improving health care practices, neonatal survival, and morbidities in special neonatal care units (SNCUs). Methods: This pre- and postintervention quality improvement study was conducted at 3 SNCUs in Madhya Pradesh, India from February 2017 to February 2019. Clinical care teams comprising doctors and nurses from the study sites were trained in POCQI and the PHCP. The teams identified, prioritized, and analyzed problems and designed quality improvement initiatives at their respective health facilities. Change ideas were tested by the local teams using sequential plan-do-study-act cycles. Facilitators maintained contact with the teams through quarterly review meetings, fortnightly videoconferencing, on-demand phone calls, and group chat service. State SNCU coordinators made follow-up visits to supplement coaching. Study research staff independently collected data on admissions, health care practices, and outcomes of neonates. Findings: A total of 156 HCWs were trained in the POCQI methodology and PHCP. Sixteen quality improvement projects were formulated and implemented. Among 13,821 enrolled neonates (birth weight 2275±635 g; gestation: 35.8±2.8 weeks), improvement was seen in reduction of use of oxygen (36.1% vs. 48.0%; adjusted odds ratio [aOR]=0.60, 95% confidence interval [CI]=0.55, 0.66), antibiotics (29.4% vs. 39.0%; aOR=0.76, 95% CI=0.68, 0.85), and dairy milk (33.8% vs. 49.4%; aOR=0.34, 95% CI=0.31 to 0.38). Enteral feeds were started within 24 hours of admission in a larger number of neonates, resulting in fewer days to reach full feeds. There was no effect on survival at discharge from the hospital (aOR=0.93; 95% CI=0.80, 1.09). Conclusion: A collaborative cross-learning quality improvement approach with remote mentoring, coaching, and supportive supervision was successful in improving the quality of care at SNCUs.


Secular Trends in Birthweights in Two Epochs Over 40 Years in a Tertiary Care Center
Deena Thomas, Pratima Anand, Anu Thukral, Ramesh Agarwal, Ashok Deorari, and M. Jeeva Sankar
Springer Science and Business Media LLC



Strengthening emergency care systems to improve patient care for ST-elevation myocardial infarction (STEMI) at a high-volume tertiary care centre in India
Bharath Gopinath, Akshay Kumar, Rajesh Sah, Sanjeev Bhoi, Nayer Jamshed, Meera Ekka, Praveen Aggarwal, Ashok Deorari, Balram Bhargava, and Vignan Kappagantu
BMJ
BackgroundST-elevation myocardial infarction (STEMI) is a highly time-sensitive and life-threatening condition. Early recognition and timely management are challenging in a busy emergency department (ED), especially in low/middle-income countries where emergency systems are often fragmented. The aim of our quality improvement (QI) project was to increase the percentage of patients with STEMI undergoing primary percutaneous coronary intervention (PCI) with door to balloon (D2B) time of <90 min by 30% over 12 months.MethodsAs part of the first step in QI, baseline data were collected at different points in the process of care. Using process maps and fishbone analysis, delays in patient registration, ECG and communication with cardiology were identified as some bottlenecks, and change ideas were tested using plan–do–study–act cycles using point-of-care QI methodology. The majority of the change ideas focused on interventions in the ED like strengthening triage, training frontline staff, early diagnosis and quick transportation of patients.ResultsDuring the baseline phase, 22.22% of patients were found to have a D2B time of <90 min. We achieved an increase of 47.78% in patients receiving PCI within 90 min and hence increased to 70% at the end of the intervention phase. Data collected for 4 months after the intervention phase were found to have sustained the effort.ConclusionSignificant improvement in the door to reperfusion time resulted from a meticulous assessment of emergency care processes by drawing process flow chart and implementation of change ideas like introduction of fast-track policy for patients with chest pain, reducing staff turnover in the triage area, formal training of staff, continuous engagement with cardiology team and by interchanging of processes which led to a reduction in time to ECG.


Identification of Human Case of Avian Influenza A(H5N1) Infection, India
Varsha Potdar, Megha Brijwal, Rakesh Lodha, Pragya Yadav, Santosh Jadhav, Manohar Lal Choudhary, Aashish Choudhary, Veena Vipat, Nivedita Gupta, Ashok Kumar Deorari,et al.
Centers for Disease Control and Prevention (CDC)
A 11-year-old boy with acute myeloid leukemia was brought for treatment of severe acute respiratory infection in the National Capital Region, New Delhi, India. Avian influenza A(H5N1) infection was laboratory confirmed. Complete genome analysis indicated hemagglutinin gene clade 2.3.2.1a. We found the strain to be susceptible to amantadine and neuraminidase inhibitors.


Comparison of regional versus global growth charts for the classification of small-for-gestational age neonates
Pratima Anand, Deena Thomas, Ramesh Agarwal, Anu Thukral, Ashok K Deorari, Vinod Kumar Paul, and M Jeeva Sankar
BMJ
ObjectiveTo compare the performance of regional versus global charts for identifying small-for-gestational age (SGA) neonates with short-term adverse outcomes.DesignProspective cohort study.SettingLevel-3 neonatal unit in India.PatientsNeonates were categorised into SGA and appropriate-for-gestational age (AGA; 10th−90th centile) using four charts, namely, the AIIMS, Lubchenco, Fenton and Intergrowth 21st charts. They were followed up for adverse outcomes until 28 days.OutcomesWe evaluated the (1) burden of SGA, (2) sensitivity and diagnostic OR (DOR), (3) relative risk (RR) and number needed to screen (NNS) to detect adverse outcomes in SGA versus ‘optimal’ AGA (50th−90th centile) and (4) RR of morbidities in ‘additional SGA’ (ie, classified as SGA by others but not by AIIMS chart).ResultsAmong 1367 neonates, 19.6%, 4.5% and 12.5% were classified as SGA by Intergrowth 21st, AIIMS and Lubchenco charts, respectively. Intergrowth 21st had the highest sensitivity (39.1%) but the least DOR (2.6) to detect adverse outcomes; AIIMS chart had low sensitivity (19.3%) but higher DOR (4.3). RR and NNS were 3.7 and 14; 4.4 and 7; 4.0 and 8; 3.6 and 10 with Intergrowth 21st, AIIMS, Lubchenco and Fenton charts, respectively. ‘Additional SGA’ identified by Intergrowth 21st had lower risk of adverse outcomes than SGA identified by both the charts (RR 0.39; 95% CI 0.19 to 0.82).ConclusionsCompared with AIIMS and Lubchenco charts, Intergrowth 21st runs the risk of overdiagnosing SGA neonates who may not be at a higher risk of short-term morbidities.


Periodic change of body position under phototherapy in term and preterm neonates with hyperbilirubinaemia
Anu Thukral, Ashok Deorari, and Deepak Chawla
Wiley
BACKGROUND Phototherapy is the mainstay of treatment of neonatal hyperbilirubinaemia. Periodic change in position of the neonate under phototherapy (from supine to prone or lateral positions) may improve the efficiency of phototherapy by hastening the access of phototherapy light to bilirubin deposited in different parts of the skin and subcutaneous tissue. OBJECTIVES To evaluate the effects of periodic change of body position during phototherapy as compared to no prescribed change in body position, on serum total bilirubin level and duration of treatment in neonates with unconjugated hyperbilirubinaemia during the first 28 days of life. Secondary objectives of the review included evaluation of the efficacy of periodic change of body position on the need for or number of exchange transfusions, incidence of bilirubin-induced neurological damage (BIND), side effects of phototherapy, and sudden infant death syndrome (SIDS). SEARCH METHODS We used the standard search strategy of Cochrane Neonatal to run comprehensive searches in the Cochrane Central Register of Controlled Trials (CENTRAL; 2021, Issue 3) in the Cochrane Library and Ovid MEDLINE and Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Daily and Versions on 5 March 2021. We also searched clinical trials databases and the reference lists of included studies and relevant reviews for randomised controlled trials (RCTs) and quasi-RCTs. SELECTION CRITERIA We included RCTs and quasi-RCTs if they enrolled neonates (term and preterm) of either gender with unconjugated hyperbilirubinaemia requiring phototherapy and compared periodic change of the body position of the infant under phototherapy with no prescribed change in body position. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality and extracted data, consulting with a third review author in the case of disagreement. We used standard Cochrane methodological procedures, including assessing the risk of bias of included studies. We used the GRADE approach to assess the certainty of evidence. Primary outcomes were the duration of phototherapy and rate of fall of serum bilirubin at 24 hours. Secondary outcomes included the need for exchange transfusion, number of exchange transfusions, incidence of BIND, and SIDS. MAIN RESULTS We included five studies (343 neonates) with an overall high risk of bias in the review. The body position under phototherapy was changed every two hours or every two-and-a-half hours in two studies each, and every three hours in one study. Three of the five studies included healthy term neonates, whilst the other two studies also included preterm neonates (≥ 33 weeks' gestation); however, separate data about review outcomes in preterm neonates were not available. Periodic change in body position may lead to little or no difference in the duration of phototherapy (mean difference (MD) 1.71 hours, 95% confidence interval (CI) -3.17 to 6.59 hours; I² = 58%; 4 studies, 231 participants; low certainty evidence). Only one study reported the rate of fall of serum total bilirubin at 24 hours of starting the phototherapy. Periodic change in body position may lead to little or no difference in the rate of fall of serum total bilirubin at 24 hours (MD 0.02 mg/dL/h, 95% CI -0.02 to 0.06 mg/dL/h; 1 study, 100 participants; low certainty evidence). We downgraded the certainty of evidence to low due to risk of bias and imprecision. None of the included studies reported the need for or number of exchange transfusions, incidence of BIND, or SIDS. Lack of separate data precluded subgroup analysis. AUTHORS' CONCLUSIONS The available evidence is insufficient to determine the effects of periodic change of body position compared with no prescribed change of body position under phototherapy. There is low certainty evidence that there may be little or no difference in the duration of phototherapy and rate of fall in bilirubin at 24 hours of starting phototherapy between periodic change in body position and no prescribed change of body position under phototherapy in term and preterm neonates. None of the included studies reported the effect of change of position on the need for or number of exchange transfusions, incidence of BIND, or SIDS. One study is awaiting classification and could not be included in the review. Further studies are needed to evaluate the effect of periodic change in body position under phototherapy, especially in neonates with haemolytic hyperbilirubinaemia and in very preterm neonates. The results of this systematic review apply mainly to neonates born at late-preterm or term gestation receiving phototherapy for non-haemolytic hyperbilirubinaemia.


A Rapid Transformation of an Existing Testing Facility Area for COVID-19 into a Fully Functional Pediatric Emergency in 72 Hours’ Time—An Experience from a Tertiary Care Teaching Hospital
Jitender Sodhi, Prakash Swaminathan, Hamad Bin Khalid, Angel Rajan Singh, Rakesh Lodha, and A. K. Deorari
Springer Science and Business Media LLC



Validation of visual estimation of neonatal jaundice in low-income and middle-income countries: A multicentre observational cohort study
Gary L Darmstadt, Davidson H Hamer, John B Carlin, Prakash M Jeena, Eduardo Mazzi, Anil Narang, A K Deorari, Emmanuel Addo-Yobo, MAK Azad Chowdhury, Praveen Kumar,et al.
BMJ
ObjectiveDetermine the sensitivity and specificity of neonatal jaundice visual estimation by primary healthcare workers (PHWs) and physicians as predictors of hyperbilirubinaemia.DesignMulticentre observational cohort study.SettingHospitals in Chandigarh and Delhi, India; Dhaka, Bangladesh; Durban, South Africa; Kumasi, Ghana; La Paz, Bolivia.ParticipantsNeonates aged 1–20 days (n=2642) who presented to hospitals for evaluation of acute illness. Infants referred for any reason from another health facility or those needing immediate cardiopulmonary resuscitation were excluded.Outcome measuresInfants were evaluated for distribution (head, trunk, distal extremities) and degree (mild, moderate, severe) of jaundice by PHWs and physicians. Serum bilirubin level was determined for infants with jaundice, and analyses of sensitivity and specificity of visual estimations of jaundice used bilirubin thresholds of >260 µmol/L (need for phototherapy) and >340 µmol/L (need for emergency intervention in at-risk and preterm babies).Results1241 (47.0%) neonates had jaundice. High sensitivity for detecting neonates with serum bilirubin >340 µmol/L was found for ‘any jaundice of the distal extremities (palms or soles) OR deep jaundice of the trunk or head’ for both PHWs (89%–100%) and physicians (81%–100%) across study sites; specificity was more variable. ‘Any jaundice of the distal extremities’ identified by PHWs and physicians had sensitivity of 71%–100% and specificity of 55%–95%, excluding La Paz. For the bilirubin threshold >260 µmol/L, ‘any jaundice of the distal extremities OR deep jaundice of the trunk or head’ had the highest sensitivity across sites (PHWs: 58%–93%, physicians: 55%–98%).ConclusionsIn settings where serum bilirubin cannot be measured, neonates with any jaundice on the distal extremities should be referred to a hospital for evaluation and management, where delays in serum bilirubin measurement and appropriate treatment are anticipated following referral, the higher sensitivity sign, any jaundice on the distal extremities or deep jaundice of the trunk or head, may be preferred.


Correction: Stepwise interventions for improving hand hygiene compliance in a level 3 academic neonatal intensive care unit in north India (Journal of Perinatology, (2021), 41, 12, (2834-2839), 10.1038/s41372-021-01141-3)
Shridhar Gopalakrishnan, Suman Chaurasia, M. J. Sankar, V. K. Paul, A. K. Deorari, M. Joshi, and R. Agarwal
Springer Science and Business Media LLC



Stepwise interventions for improving hand hygiene compliance in a level 3 academic neonatal intensive care unit in north India
Shridhar Gopalakrishnan, Suman Chaurasia, M. J. Sankar, V. K. Paul, A. K. Deorari, M. Joshi, and R. Agarwal
Springer Science and Business Media LLC



Aqueous chlorhexidine 1% versus 2% for neonatal skin antisepsis: A randomised non-inferiority trial
Akash Sharma, Srikant Kulkarni, Anu Thukral, M Jeeva Sankar, Ramesh Agarwal, A K Deorari, Sarita Mohapatra, Thirumurthy Velpandian, and Minu Bajpai
BMJ
ObjectiveTo evaluate whether 1% aqueous chlorhexidine gluconate (CHG) when compared with 2% aqueous chlorhexidine gluconate is non-inferior for neonatal skin antisepsis.DesignParallel, blinded, non-inferiority randomised trial.SettingLevel III, academic, neonatal intensive care unit.PatientsInfants born at 260/7to 426/7weeks of gestation from June 2019 to December 2019.InterventionsParticipants were randomised to skin antisepsis by either 1% aqueous CHG or 2% aqueous CHG.Main outcome measuresThe primary outcome was the proportion of negative skin swab cultures after skin antisepsis. Secondary outcomes were local skin reactions at 0, 6, 12 and 24 hours and plasma chlorhexidine levels in a subset of the study population.ResultsA total of 308 neonates with a median gestation age of 34 (31–37) weeks and mean birth weight of 2029 g were randomised on 685 occasions (1% CHG: n=341; 2% CHG: n=344). 93.0% of the post-antisepsis skin swabs were sterile in 1% CHG group compared with 95.6% of the swabs in the 2% CHG group (risk difference −2.7%, 95% CI −6.2% to +0.8%). The lower bound of 95% CI crossed the pre-specified absolute non-inferiority limit of 5%. Neonates developed mild dermatitis on 16 (2.3%) occasions. There was no significant difference in median plasma CHG levels in the two groups, 19.6 (12.5–36.4) and 12.6 (8.7–26.6) ng/mL, respectively.ConclusionsApplication of 1% aqueous CHG was not shown to be non-inferior to 2% chlorhexidine aqueous for skin antisepsis in neonates. There were no severe skin-related adverse events in either of the two groups.Trial registration numberCTRI/2019/06/019822; (http://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=33453&EncHid=&userName=CTRI/2019/06/019822)


Dissemination of Best Practices in Preterm Care Through a Novel Mobile Phone-Based Interactive e-Learning Platform
Pratima Anand, Anu Thukral, AK Deorari, , Amanpreet Sethi, Amit Kumar, Anita Yadav, Anitha Balachandran, Ankita Raj, Ashutosh Kumar,et al.
Springer Science and Business Media LLC



Preterm White Matter Injury: A Prospective Cohort Study
Mohsin Raj Mantoo, Ashok K. Deorari, Manisha Jana, Ramesh Agarwal, M. Jeeva Sankar, and Anu Thukral
Springer Science and Business Media LLC



Diagnostic Accuracy of WINROP, CHOP-ROP and ROPScore in Detecting Type 1 Retinopathy of Prematurity
Deena Thomas, Shamnad Madathil, Anu Thukral, M. Jeeva Sankar, Parijat Chandra, Ramesh Agarwal, and Ashok Deorari
Springer Science and Business Media LLC



'NOPAIN-ROP' trial: Intravenous fentanyl and intravenous ketamine for pain relief during laser photocoagulation for retinopathy of prematurity (ROP) in preterm infants: A randomised trial
Shamnad Madathil, Deena Thomas, Parijat Chandra, Ramesh Agarwal, M Jeeva Sankar, Anu Thukral, and Ashok Deorari
BMJ
ObjectivesTo investigate if intravenous fentanyl or intravenous ketamine can provide adequate analgesia in preterm infants undergoing laser photocoagulation for retinopathy of prematurity (ROP).DesignOpen-label randomised trial.SettingTertiary care institution.ParticipantsPreterm infants who underwent laser photocoagulation for ROP.InterventionsInfants were randomised to receive fentanyl as intravenous bolus dose of 2 µg/kg, followed by an intravenous infusion of 1 µg/kg/hour increased to a maximum of 3 µg/kg/hour or intravenous ketamine as bolus dose of 0.5 mg/kg, followed by further intermittent intravenous bolus doses of 0.5 mg/kg to a maximum of 2 mg/kg in the initial phase and intravenous fentanyl (bolus of 2 µg/kg followed by infusion of 2 µg/kg/hour to a maximum of 5 µg/kg/hour) or intravenous ketamine (bolus dose of 1 mg/kg followed by intermittent bolus doses of 0.5 mg/kg to a maximum of 4 mg/kg) in the revised regimen phase.Main outcome measuresProportion of infants with adequate analgesia defined as the presence of both: (1) all the Premature Infant Pain Profile-Revised scores measured every 15 min less than seven and (2) proportion of the procedure time the infant spent crying less than 5%.Secondary outcomes included apnoea, cardiorespiratory or haemodynamic instability, feed intolerance and urinary retention requiring catheterisation during and within 24 hours following the procedure.ResultsA total of 97 infants were randomised (fentanyl=51, ketamine=46). The proportions of infants with adequate analgesia were 16.3% (95% CI 8.5% to 29%) with fentanyl and 4.5% (95% CI 1.3% to 15.1%) with ketamine. Ten infants (19.6%) in the fentanyl group and seven infants (15.2%) in the ketamine group had one or more side effects. In view of inadequate analgesia with both the regimens, the study steering committee recommended using a higher dose of intravenous fentanyl and intravenous ketamine. Consequently, we enrolled 27 infants (fentanyl=13, ketamine=14). With revised regimens, the proportions of infants with adequate analgesia were higher: 23.1% (95% CI 8.2% to 50.2%) with fentanyl and 7.1% (95% CI 1.3% to 31.5%) with ketamine. However, higher proportions of infants developed apnoea (n=4; 30.7%), need for supplemental oxygen (n=5, 38.4%) and change in cardiorespiratory scores (n=7; 53.8%) with fentanyl but none with ketamine.ConclusionsFentanyl-based and ketamine-based drug regimens provided adequate analgesia only in a minority of infants undergoing laser photocoagulation for ROP. More research is needed to find safe and effective regimens that can be employed in resource constrained settings.Trial registration numberCTRI/2018/03/012878.

RECENT SCHOLAR PUBLICATIONS

Correction to: Development of Multimodal Training Tool for Preterm Infant Care
A Thukral, V Gupta, D Chawla, P Kumar, AK Deorari
Indian Journal of Pediatrics, 1-1 2025



Development of Multimodal Training Tool for Preterm Infant Care
A Thukral, V Gupta, D Chawla, P Kumar, AK Deorari
Indian Journal of Pediatrics, 1-7 2024



Perceived usefulness of a blended learning approach for skills training among medical interns: a pilot study
R Ramachandran, R Kaur, A Roy, P Goel, AK Deorari
BMC Medical Education 24 (1), 1357 2024



Post-procedure pain in preterm neonates undergoing retinopathy of prematurity (ROP) screening: a prospective cohort study
R Singla, A Verma, V Kumar, P Chandra, P Chandra, A Thukral, ...
Journal of Perinatology, 1-6 2024



Sustaining Current Policies and Introducing New Initiatives: Strategic Five-year Plan for the Government of India
S Bhattacharya, KM Gopal, S Garg
Journal of the Epidemiology Foundation of India 2 (3), 134-143 2024



Optimising Indian healthcare delivery with standard treatment workflows
A Grover, JJ Cherian, SS Aggarwal, D Pandhi, UD Suranagi, A Bajaj, ...
Clinical Epidemiology and Global Health, 101732 2024



Neonatal Seizures
AK Deorari, P Kumar, B Adhisivam, A Sachdeva, A Jain, A Mehta, ...
Journal of the Epidemiology Foundation of India 2 (01Supp), S19-S20 2024



Post Asphyxial Management of Neonates
AK Deorari, P Kumar, B Adhisivam, A Sachdeva, A Jain, A Mehta, ...
Journal of the Epidemiology Foundation of India 2 (01Supp), S31-S32 2024



Sepsis in Neonates
AK Deorari, P Kumar, B Adhisivam, A Sachdeva, A Jain, A Mehta, ...
Journal of the Epidemiology Foundation of India 2 (01Supp), S33-S34 2024



Feeds & Fluids in Neonates
AK Deorari, P Kumar, B Adhisivam, A Sachdeva, A Jain, A Mehta, ...
Journal of the Epidemiology Foundation of India 2 (01Supp), S27-S28 2024



Neonatal Hypoglycemia
AK Deorari, P Kumar, B Adhisivam, A Sachdeva, A Jain, A Mehta, ...
Journal of the Epidemiology Foundation of India 2 (01Supp), S25-S26 2024



Respiratory Distress in Neonates
AK Deorari, P Kumar, B Adhisivam, A Sachdeva, A Jain, A Mehta, ...
Journal of the Epidemiology Foundation of India 2 (01Supp), S21-S22 2024



A Quality Improvement Initiative to Reduce Prescription Error in a Pediatrics Outpatient Department at a Secondary-Level Community Hospital
A Gupta, S Malhotra, S Mandal, A Ahmad, V Polisetty, DN Shaik, ...
Cureus 16 (3) 2024



Post-procedure pain in preterm neonates undergoing retinopathy of prematurity (ROP) screening: A prospective cohort study
A Verma, R Singla, V Kumar, P Chandra, P Chandra, A Thukral, ...
2024



Vertical Transmission of COVID-19 Infection in a Tertiary Hospital in India-A Prospective Study
R Dhinakaran, A Verma, A Thukral, MJ Sankar, R Agarwal, P Mathur, ...
Indian Journal of Pediatrics 90 (10), 1045-1045 2023



Feasibility, Sustainability, and Effectiveness of the Implementation of “Facility-Team-Driven” Approach for Improving the Quality of Newborn Care in South India
S Venugopal, RB Patil, A Thukral, RA Koganti, V Kumar Dl, MJ Sankar, ...
Indian Journal of Pediatrics 90 (10), 974-981 2023



Developing Standard Treatment Workflows—way to universal healthcare in India
A Grover, B Bhargava, S Srivastava, LK Sharma, JJ Cherian, N Tandon, ...
Frontiers in Public Health 11, 1178160 2023



Comparison of regional versus global growth charts for the classification of small-for-gestational age neonates
P Anand, D Thomas, R Agarwal, A Thukral, AK Deorari, VK Paul, ...
Archives of Disease in Childhood-Fetal and Neonatal Edition 108 (1), 15-19 2023



Simulation Based vs Conventional Training for Initial Steps in Delivery Room Care of Preterm Neonates: An Open Label Randomized Trial
D Neupane, A Sharma, A Thukral, MJ Sankar, R Agarwal, AK Deorari
Indian Pediatrics 59 (11), 847-851 2022



Improving the quality of health care in special neonatal care units of India: a before and after intervention study
AK Deorari, P Kumar, D Chawla, A Thukral, S Goel, R Bajaj, M Singh, ...
Global Health: Science and Practice 10 (5) 2022

MOST CITED SCHOLAR PUBLICATIONS

Sepsis in the newborn
MJ Sankar, R Agarwal, AK Deorari, VK Paul
The Indian Journal of Pediatrics 75, 261-266 2008
Citations: 407



Inpatient care of small and sick newborns: a multi-country analysis of health system bottlenecks and potential solutions
SG Moxon, JE Lawn, KE Dickson, A Simen-Kapeu, G Gupta, A Deorari, ...
BMC pregnancy and childbirth 15, 1-19 2015
Citations: 264



Kangaroo mother care in very low birth weight infants
K Ramanathan, VK Paul, AK Deorari, U Taneja, G George
The Indian Journal of Pediatrics 68, 1019-1023 2001
Citations: 248



Characterisation and antimicrobial resistance of sepsis pathogens in neonates born in tertiary care centres in Delhi, India: a cohort study
S Chaurasia, M Jeeva Sankar, R Agarwal, CP Yadav, S Arya, A Kapil, ...
Lancet 4 (10), e752-e760 2016
Citations: 237



Sepsis in the newborn
R Aggarwal, N Sarkar, AK Deorari, VK Paul
The Indian Journal of Pediatrics 68, 1143-1147 2001
Citations: 216



Count every newborn; a measurement improvement roadmap for coverage data
SG Moxon, H Ruysen, KJ Kerber, A Amouzou, S Fournier, J Grove, ...
BMC pregnancy and childbirth 15, 1-23 2015
Citations: 179



Hypocalcemia in the newborn
A Jain, R Agarwal, MJ Sankar, A Deorari, VK Paul
The Indian Journal of Pediatrics 77, 1123-1128 2010
Citations: 166



Incidence and risk factors of retinopathy of prematurity in a tertiary care newborn unit in New Delhi.
R Maheshwari, H Kumar, VK Paul, M Singh, AK Deorari, HK Tiwari
The National medical journal of India 9 (5), 211-214 1996
Citations: 164



Light‐emitting diode phototherapy for unconjugated hyperbilirubinaemia in neonates
P Kumar, D Chawla, A Deorari
Cochrane Database of Systematic Reviews 2011
Citations: 161



Effects of oral Lactobacillus GG on enteric microflora in low-birth-weight neonates
R Agarwal, N Sharma, R Chaudhry, A Deorari, VK Paul, IH Gewolb, ...
Journal of pediatric gastroenterology and nutrition 36 (3), 397-402 2003
Citations: 160



Jaundice in the newborns
S Mishra, R Agarwal, AK Deorari, VK Paul
The Indian Journal of Pediatrics 75, 157-163 2008
Citations: 156



Perinatal-neonatal management of COVID-19 infection—guidelines of the Federation of Obstetric and Gynaecological Societies of India (FOGSI), National Neonatology Forum of
D Chawla, D Chirla, S Dalwai, AK Deorari, A Ganatra, A Gandhi, ...
Indian pediatrics 57, 536-548 2020
Citations: 149



Analgesic effect of expressed breast milk in procedural pain in term neonates: a randomized, placebo‐controlled, double‐blind trial
A Upadhyay, R Aggarwal, S Narayan, M Joshi, VK Paul, AK Deorari
Acta Paediatrica 93 (4), 518-522 2004
Citations: 145



Risk factors for severe retinopathy of prematurity in preterm low birth weight neonates
P Kumar, MJ Sankar, A Deorari, R Azad, P Chandra, R Agarwal, V Paul
The Indian Journal of Pediatrics 78, 812-816 2011
Citations: 136



Impact of education and training on neonatal resuscitation practices in 14 teaching hospitals in India
AK Deorari, VK Paul, M Singh, D Vidyasagar, Medical Colleges Network
Annals of tropical paediatrics 21 (1), 29-33 2001
Citations: 132



Etiology of bacteremia in young infants in six countries
DH Hamer, GL Darmstadt, JB Carlin, AKM Zaidi, K Yeboah-Antwi, ...
The Pediatric Infectious Disease Journal 34 (1), e1-e8 2015
Citations: 130



Setting research priorities to improve global newborn health and prevent stillbirths by 2025
S Yoshida, J Martines, JE Lawn, S Wall, JP Souza, I Rudan, S Cousens, ...
Journal of global health 6 (1), 010508 2015
Citations: 118



Trial of daily vitamin D supplementation in preterm infants
CK Natarajan, MJ Sankar, R Agarwal, OT Pratap, V Jain, N Gupta, ...
Pediatrics 133 (3), e628-e634 2014
Citations: 114



Helping babies breathe: a model for strengthening educational programs to increase global newborn survival
BD Kamath-Rayne, A Thukral, MK Visick, E Schoen, E Amick, A Deorari, ...
Global Health: Science and Practice 6 (3), 538-551 2018
Citations: 107



Light-emitting diodes versus compact fluorescent tubes for phototherapy in neonatal jaundice: A multi-center randomized controlled trial
P Kumar, S Murki, GK Malik, D Chawla, AK Deorari, N Karthi, ...
Indian pediatrics 47, 131-137 2010
Citations: 104