Publications by authors named "Preetham Poddutoor"

5 Publications

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The spectrum of acute leukoencephalopathy with restricted diffusion (ALERD): A case series and review of literature.

Eur J Paediatr Neurol 2021 Jun 6;33:86-93. Epub 2021 Jun 6.

Department of Pediatric Neurology, Rainbow Children's Hospital, Hyderabad, Telangana, India. Electronic address:

Introduction: The clinico-etiological spectrum of Acute leukoencephalopathy with restricted diffusion (ALERD) is not well known in Indian population. This is likely to vary between populations and ethnicities.

Methods: We retrospectively reviewed the clinicoetiological spectrum of ALERD at a tertiary care pediatric center, and described the clinical, imaging, etiological spectrum and short-term outcomes.

Results: Eleven out of 78 children with non-traumatic encephalopathy presenting to our center had a final diagnosis of ALERD. The mean age at presentation was 34.9 months (6-80 months) and 63.6% were males. The monophasic course (72.7%) and the diffuse pattern (63.6%) on neuroimaging were predominant in these children. Dengue haemorrhagic fever was the commonest underlying/triggering infection (5 of 11 children). Ten children required mechanical ventilation in view of neurogenic respiratory failure, with mean duration of ventilation of 6.4 days (Range 2-10 days). The duration of hospital stay varied from 11 to 25 days (Mean - 15.3 days). One child (9 %) died, 6 children (54.5 %) had varying degrees of cognitive impairment and 4 (36.3 %) children had a normal outcome. Children with a shorter duration of ventilation seemed to have a better outcome.

Conclusion: Dengue haemorrhagic fever was the commonest cause, and diffuse imaging pattern with monophasic course was the commonest presentation in Indian children with ALERD. The clinical presentation and factors influencing outcome are possibly different from previously described literature.
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June 2021

A quality initiative to improve exclusive breast milk feeding in preterm neonates.

Int J Pediatr Adolesc Med 2018 Dec 13;5(4):131-134. Epub 2018 Dec 13.

Neonatalogy, Rainbow Children's Hospital, Hyderabad, India.

Background And Objective: Preterm babies thrive well on exclusive breastfeeding with fewer complications. In a retrospective analysis, challenges were noticed in the form of delayed first milk expression and frequency of expression, which was limited to 2-3 times a day. A quality improvement initiative was designed to increase the exclusive breast milk feeding rates in admitted preterm babies. The purpose of the present study is to evaluate the proportion of preterm neonates receiving mother's own milk by day 7 of life after such an initiative.

Methods: The quality improvement initiative was conducted at a level 3 neonatal intensive care unit from May 10, 2018, to August 10, 2018. Inborn preterm neonates <34 weeks with a minimum hospital stay of 7 days were included. Neonates of critically sick mothers and neonates having major congenital malformations were excluded. Mothers were given structured antenatal counseling regarding expressing breast milk (EBM). Postnatal visits were conducted to provide information through a video and a leaflet and formation of breastfeeding support group.

Results: A total of 30 babies were recruited during a period of 3 months and compared to historical controls. The median age of the first EBM improved from 2.5 days to 1.16 days, and the amount of EBM on the first day improved from 0.24 ml to 2.6 ml ( = .002). The proportion of babies receiving EBM on the first day improved from 24% to 80% ( = .0001), and at the end of 7 days, it increased to 73% from 46% ( = .02). The factors time to reach full enteral feeds, time to regain birth weight, rate of necrotizing enterocolitis, rate of sepsis, and proportion of babies on exclusive mother's milk during discharge appear comparable in both the groups.

Conclusions: A simple quality improvement approach through the formation of breastfeeding support group, antenatal counseling, and postnatal support for breast milk expression has made a significant improvement in milk expression from mothers delivered prematurely. It reflects on a team approach using the available resources.
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December 2018

Antimicrobial Justification form for Restricting Antibiotic Use in a Pediatric Intensive Care Unit.

Indian Pediatr 2016 Apr;53(4):304-6

Department of Pediatrics, Rainbow Childrens Hospital, Banjara Hills, Hyderabad, Andhra Pradesh, India. Correspondence to: Dr Preetham Kumar Poddutoor, Consultant Pediatrician, Rainbow Childrens Hospital, Vikrampuri Colony, Secunderabad 500 034, Hyderabad, Andhra Pradesh, India.

Objective: To study whether introduction of an antimicrobial justification form deters clinicians from prescribing restricted antimicrobials and results in de-escalation of these antimicrobials.

Methods: Clinicians were asked to fill a justification form if prescribing an antimicrobial from the pre-identified restricted group. Antimicrobial usage pattern over next year was compared with that in the one year preceding the introduction of justification form.

Results: Significant overall decrease in antimicrobial usage (40.5% vs 34.6%) was noted in the post-intervention group along with a significant increase in the de-escalation of antibiotics.

Conclusion: Introduction of a justification form before prescribing antimicrobials or at the time of deferring de-escalation can be useful in restricting usage of antimicrobials.
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April 2016

ATP-binding cassette transporter A3 (ABCA3) mutation in a late preterm with respiratory distress syndrome.

Indian Pediatr 2014 Jul;51(7):579-80

Department of Neonatology, Rainbow Childrens Hospital and Perinatal Center, Hyderabad, Andhra Pradesh, India. Correspondence to: Dr Preetham Kumar Poddutoor, Department of Neonatology, Rainbow Childrens Hospital and Perinatal Center, Hyderabad, Andhra Pradesh, India.

Background: Surfactant protein abnormalities are rare causes of respiratory distress syndrome.

Case Characteristics: A late preterm (36 wks) who presented with respiratory distress syndrome.

Observation: He was found to be a homozygous for a G to T transversion at the first base in intron 24, of ABCA3 gene which is necessary for lamellar body formation and surfactant production.

Outcome: He died of severe respiratory failure even after multiple doses of surfactants and ventilation.

Message: Surfactant deficiency with ABCA3 gene mutation needs to be suspected in late preterms who present with respiratory distress syndrome.
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July 2014

Rescue high frequency oscillation in neonates with acute respiratory failure.

Indian Pediatr 2011 Jun 28;48(6):467-70. Epub 2011 Feb 28.

Rainbow Childrens Hospital and Perinatal Centre, Banjara Hills, Hyderabad, India.

The aim was to study the efficacy of rescue High Frequency Oscillatory Ventilation (HFOV) in improving the oxygenation and ventilation in neonates with acute respiratory failure after failing Conventional Mechanical Ventilation (CMV). Primary outcome was short term oxygenation, lung recruitment, and ventilation and secondary outcome studied was survival. 675 babies were ventilated and 97 of them received HFOV. HFOV significantly improved oxygenation index, alveolar-arterial oxygen gradient, pH, PCO2, PO2 and caused better lung recruitment within 2 hours. Fifty seven babies (58.77%) survived and the mortality was more in <28 weeks, babies with pulmonary hemorrhage, sepsis and CDH.
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June 2011