TY  - GEN
AU  - Shah, Arvind.
TI  - Gastric aspirates shake test for prediction of hyaline membrane disease in preterm babies
PY  - 2011///
KW  - Gastric Aspirate
KW  - Prediction
KW  - Hyaline Membrane
KW  - Preterm babies
N1  - Thesis Report; SUMMARY:  The Gastric Aspirate Shake Test for prediction of Hyaline Membrane disease was evaluated in 81 newborns with respiratory distress at NICU and Nursery, Patan Hospital.   1. Objective: Negative shake test signifies the risk of HMD with adequate sensitivity and specificity in a wide range of preterm infants. To evaluate whether shake test done with gastric aspirate in the preterm babies can predict the likelihood of HMD.   2. Study Design: This is descriptive, Cross Sectional study   3. Methodology: This study was conducted in the neonatal intensive care unit and nursery in Department of Paediatrics at Patan Hospital. All babies greater than or equal to 28 weeks and less than 37 weeks (36+6) with or without respiratory distress after birth who met the inclusion criteria were included in the study. Infants born greater than or equal to 28 weeks to 37(36+6) weeks gestation admitted to the Neonatal unit at participating centres within 1 hour of life were included in the study. The gestational age was estimated according to criteria of New Ballard scoring. Neonate more than 1 hour, who received  breast feed or any other feeds, neonates with severe congenital anomalies or incompatible with life, neonates whose gastric aspirates obtained through NG tube <0.5 ml or samples mixed with meconium or blood were excluded from the study. Neonates were defined with Hyaline Membrane Disease if respiratory rate >60/ min, expiratory grunting, suprasternal, intercostals, subcostal retraction or cyanosis occurred within 6 hours of life and persisted for >24 hours, and if chest x-ray showed hypoaeration, diffuse reticulogranular pattern with airbronchogram. Over 0.5 ml of gastric aspirate was obtained within 1 hour of birth and mixed with an equal amount of normal saline for 15 seconds; 1 ml of 95% alcohol was then added and the mixture agitated for next 15 second. Then after 15 minute, the air-liquid interface was examined for bubbles.    4. Result : A total of 7678 live birth were delivered in Patan Hospital during the study period from August 2009 to July 2010. Out of that 659 were preterm births. Among the preterm neonates, 104 were enrolled in the study. Out of that 81 preterm neonates who met the inclusion criteria were enrolled in the study. All the newborn babies had shake tests performed within 1 hours of life. 56.8% (26/46) of neonates with negative shake test developed HMD which was statistically significant(p<0.05).The sensitivity, specificity, positive predictive value and the negative predictive value were 96.29%, 76.47%, 86.6% and 92.8% respectively. The sensitivity (100% vs. 91.6%), specificity (92.85 vs. 94.4%) and the positive predictive value (100% vs. 96.3%) for the fetal lung maturity by gastric aspirate shake test was better for those 36-37 weeks of gestation when compared with those below 35 weeks of gestation. However 37 babies had an intermediate shake test this was 45.7% of total enrolled population. Out of that 19/37(23.45%) developed HMD and 18/37(22.2%) did not develop HMD.     5. Conclusion: Shake test on gastric aspirate is a rapid, simple and inexpensive procedure for the prediction of HMD in premature infants, and might be of particular value in developing countries. It is of high utility in a country like ours where advanced facilities are not available everywhere so early transfer to specialized hospital can be expedited.      6. Recommendations: It is recommended that this test be included as routine in preterm newborns in all facilities where births take place. Shake test on gastric aspirate is found to be very useful in predicting HMD and thus in early transfer of such high risk babies to appropriate facilities.
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