Cloudnine Group of Hospitals is a chain of maternity, childcare, and fertility hospitals headquartered in Bengaluru, India. It was founded by neonatologist Dr. R. Kishore Kumar with his team of three co-founders in 2007. Cloudnine Group of Hospitals is a joint venture of the Kids Clinic India Private Limited, owned by Dr. R. Kishore Kumar, and Scrips N Scrolls India, a company into property development and investments. Cloudnine has 19 hospitals and clinics in Bengaluru, Chennai, Gurugram, Pune, Mumbai and Chandigarh. In addition to maternal care, Cloudnine also provides Gynecology, Pediatrics, Intensive Care, Fertility and Neonatal Care services.
Neonatal home phototherapy is novel approach to de-institutionalize and demystify newborn healthcare through early and careful identification of newborns who are at risk for severe hyperbilirubinemia but are at low risk for acute bilirubin encephalopathy (kernicterus) such that bilirubin reducing intervention may be administered in a safe, remotely medical-supervised setting such as the family home. Advent of affordable light-emitting-diode (LED) lamps configured to a specific narrow blue-green wavelength with the clinical capacity to provide remotely but intensely supervised medical care in a low-risk setting as well as the ability to track bilirubin values with point-of-care settings has allowed several global communities to structure curricula and standard-operating-procedures to practice neonatal home phototherapy. Thus far, the literature review has demonstrated no adverse outcomes for kernicterus, exchange transfusion, any complications attributed to phototherapy or rising bilirubin levels. These practices have been implemented in diverse cultural and geographic communities. More extensive and evidence-based experiences would enhance both clinical and societal roles of this intervention. However, this approach is not an alternative for those needing in-hospital treatment, such as preterm neonates, those with proven hemolytic disorders, sepsis or other neonatal illnesses that require intensive cardio-pulmonary care. Most importantly, active parent-partnership, education, support and collaboration is the primary key to success. Neonatal home phototherapy is feasible; it is safe, and it is a valid alternative to in-hospital phototherapy if candidate neonates are selected carefully to exclude unexpected experiences. Clinicians need to selectively identify the most suitable candidates (babies and their families), provide thorough and understandable parent education, and carefully guide equipment use and maintenance as well as vigilantly track serial TSB levels of infants> Neonates treated at home should have similar care as during in-patient practice. Costs of home phototherapy appear to be considerably less than those for rehospitalization. Advantages of breast-feeding at home are beneficial such that both clinician and family satisfaction is incurred while minimizing any adverse consequences.
BACKGROUND:Bronchopulmonary dysplasia (BPD) is the most common complication of preterm birth and may lead to difficulties with oxygen control even at home. How oxygenation is managed outside the hospital and in high and low resourced settings is unclear. AIMS:To determine clinician perspectives for managing oxygenation after hospital discharge in infants with BPD. METHODS:An opportunistic, anonymous, online survey was developed in English and translated into Mandarin, Vietnamese and Korean. The survey was disseminated three times to neonatal clinicians between December 2022 and August 2023. Responses were classified using the World Bank Income Classification. RESULTS:Overall, 610 clinicians from 44 countries responded, with 453 (74%, 453/610) from high- and upper-middle-income countries (HMIC) and 153 (25%, 153/610) from low- and lower-middle-income countries (LMIC). Most clinicians (84%, 510/610) would advocate discharge on home oxygen therapy (HOT), but this was less possible in LMIC (65% vs. 91%, p < 0.001). Most clinicians perceived HOT to improve growth (73%, 370/510) and neurodevelopment (72%, 366/510). HMIC respondents were more likely to use home oximetry (78% vs. LMIC 67%, p = 0.012). There were wide variations in oxygen saturation targets, pre-discharge oximetry use, and parameters for weaning. Most clinicians perceived novel technologies such as wearable oximetry with parent-led oxygen control as important (77%, 460/596) and useful (84%, 499/595) for improving oxygen management at home. CONCLUSION:Most neonatal clinicians would prescribe HOT for infants with BPD but are limited by barriers to sufficient resourcing, especially in LMIC. Evaluation of cost-effective novel monitoring techniques may improve accessibility and control of HOT.
