 Namaste Viewers and welcome to the episode 6 of NICU Diaries and to answer your queries I have Dr. Ravi Swami and Dr. Sanjeeva Reddy joining in today. How do you handle ethical considerations and decision making in NICU such as end-of-life care? Can you just throw some light on that? So in an ICU environment unfortunately there will be times when we have to talk about the outcome. So most babies that come through to NICU they have a very favorable outcome. So they recover and go home but there are times when the condition that we are treating for is such that the outcome is futile. So these are the times when we have to have some difficult conversations. So we sit down with parents, so try and gather as much information as possible about the baby and also try and speak to the parents in a manner they understand about all the things that is happening with a particular baby. So once we have decided on what is the condition and what are the likely outcomes, we have a set process in place so where we explain the likely outcomes and then get the parents consent and get them to sign the appropriate paperwork so that we can do it in an acceptable and legal way. What would be the long-term developmental and health outcomes for infants who spent more time in an ICU? It is not generalizable so basically the developmental outcomes depend on what the baby is admitted for. So for example if you have a baby who is extremely premature so they have set complications that is expected to happen in an ICU so the outcome and the eventual development, neurodevelopmental outcome will depend on what exactly will happen. So the key principle is that if earlier the baby is born the more likely the chance of the neurodevelopmental outcome is and the complication rate also increases. Can you just provide some insights about what are the recent advancements and breakthroughs in neonatal medicine per se that have improved the outcomes for the infants who are there in an ICU? So there are multiple beehive research going on but if you say name two or three which really had a major breakthrough would be revolutionized how we look after the pre-term babies that has improved their breathing outcome. The second thing would be the therapeutic hypothermia which is also for babies who have got lack of oxygen that has come as a very significant treatment. The third thing would be medicines like antenatal steroids previously most of the medicines which we are focusing on the babies but giving the steroids to the mother that has made a huge difference in our outcomes as well. So these are sort of the three main papers I would probably say that has revolutionized the neuro-treatment. What would be the key research areas that you think in neonatalgy and ICU that we as a hospital are focusing currently on? So currently most of us have our own interest in what we would like so predominantly my research focuses on the brain so I am looking at term babies who have got lack of oxygen and that is where my predominantly research has been going on. So the last ten years I have spent in how best we can work on this so we have just completed one multi-country act to be honest a randomized controlled trial a couple of years back in Lancet we are doing one more study now a lot of things to understand so it is still exciting to look forward actually. That ends our episode 6 thank you so much viewers for watching us.