Download NEO/1 (P) CARE OF NEWBORN IN SLUM AREAS OF JAMMU Ritu

NEO/1 (P) CARE OF NEWBORN IN SLUM AREAS OF JAMMU
Ritu Gupta, Ravinder K Gupta
136 Nai Basti Child Care Clinic, Jammu Cantt. J&K- 180003
Email: [email protected]
Background: Despite efforts by government and other agencies, neonatal morbidity and mortality
continues to be high in India. Among other reasons, newborn care practices are major
contributors for such high rates. AIMS: To find out the newborn care practices including
delivery practices, immediate care given after birth and breast-feeding practices in slums of
Jammu. Settings And Design: Community based, cross-sectional observational study conducted
at Child Care Clinic, Nai Basti Jammu Cantt. Study Period: March 2011 to September 2011.
Materials And Methods: About 100 mothers belonging to migrant labor population were
considered for the study. A semi-structured, pre-tested schedule was used to interview these 100
mothers of newborns in the study area. Results: About 80% newborns were born at homes ,
which were mostly conducted by local dais and relatives, while rest deliveries were conducted
at government institutions(16) and private nursing homes(4). Bathing the baby immediately after
birth was commonly practiced in 62 (77.5%) of home deliveries. The nose and oral cavity in
babies delivered at home were cleaned by finger by 54(67.4 %) while cotton swap was used in
34(42.5%) babies for cleaning. A new shaving blade in 36 (45%), knife in 28(35%), old blade in
11(13.7%) and surgical blade in rest of newborns were used to cut the umbilical cord in babies
born at home. About 63 (79.8%) of home delivered newborns were not weighed at birth.
Rooming in was practiced in majority of the cases. A few of home delivered neonates (12) were
given injection tetanus toxoid by unqualified practitioners. Injection Vitamin K was also given to
10 home delivered newborns .Use of clip, band or sterile thread to tie the cord and no application
to the cord was seen significantly higher in institutional deliveries. Honey (79%), rose water
(13%), water from sacred areas (11%), glucose water (6%), etc. were used as pre lacteal feeds by
these mothers. Breast feeding was initiated within 4 hours by about 20% mothers who had
delivered at home as compared to 75 % in institutional deliveries. Breast milk as the first feed
was significantly more in institutional deliveries. Conclusions: There is an urgent need to
reorient health care providers and to educate mothers on clean delivery practices and early
neonatal care in slum areas.
NEO/2 (P) EFFECT OF LACTATIONAL TRAINING ON THE WEIGHT PATTERN IN
THE NEONATAL PERIOD
Noella Maria Delia Pereira, Rahul Verma, Nandkishor Kabra
Torrefiel, 127, Carter road, opposite Joggers Park, Bandra -west, Mumbai - 400050
Email: [email protected]
Introduction: Successful breastfeeding during the first few hours to days after delivery is
known to be important in securing effective, long, term lactation. It has not been clearly
ascertained whether lactational training pre or post partum has any effect on the weight
pattern in the neonatal period. Materials & Methods: We assigned 357 mother – infant pairs
with gestational ages from 37 – 42 weeks and birth weights more than 2000 grams to
receive lactational counseling or no counseling after birth and till discharge from the
hospital. The weights of these babies were recorded on Day 1, 3, 7, 14, and 28 and the
weight gain from birth to Day 28 of life in both groups were compared. Results: Of the 357
mother – infant pairs, 137 were assigned to the intervention group and lactational
counseling was given to these mothers and 128 were assigned to the control group where
the usual verbal encouragement was given from the maternity staff. The average weight
gain in the neonatal period in the intervention group was 748+/- 349 grams as compared
to a weight gain of 649 +/- 398 grams in the control group which is statistically
significant (p<0.05). The weight gain per day in the neonatal period in the intervention
group was 26.7+/- 12.5 grams per day as compared to a weight gain of 23.3+/-14.2 grams
per day in the control group which is significant (p<0.05). The weight gain in grams/kg/day
was 9.25+/-4.45 in the intervention group as compared to 8.01+/-5.12 in the control
which is significant (p<0.05). Conclusions: This study demonstrates that even postnatal
lactational training helps increase the weight gain in infants in the neonatal period. It
further hurts that a combination of antenatal and postnatal interaction would bring about
a maximal weight gain.
NEO/3 (P) HEALTHY NEWBORN- ASHA WILL BE A REAL ASHA – HOPE
Amrit Lal Bairwa
Professor & Head, Ped,NMCH, Ashirwad,90-B, Bajrang Nagar,Main Road, Opposite Koushal
School, Police Line,Kota-324001 (Raj.)
Email: [email protected]
Globally, 9.7 million children dying every year, about 3.6 million of them during the neonatal
period (WHO mortality database). more than two thirds of these neonatal deaths occur in the first
week of life.India's Infant Mortality Rate (IMR) remains unbearably high at 58 per 1,000 live
births (SRS 2004)with 64%Neonatal Deaths.It is well known fact that majority of neonatal
deaths can be prevented with low-technology, low-cost but timely interventions. Lack of
specificity of the clinical manifestations of various neonatal morbidities causes difficulty in
definite diagnosis, delay in seeking care and resultant high mortality. the Integrated
Management of Neonatal and Childhood Illnesses (IMNCI) approach has attempted to provide a
standard case definition of various neonatal morbidities, IMNCI approach can be used as an
effective tool to screen the high risk and critically ill Newborn. Only Screened Newborns will be
seen by the Pediatrician and with effective and timely interventions, Neonatal Mortality can be
prevented significantly. About 279 Health Workers (ANMs-82,ASHA-194,LS-3) were evaluated
with a set of questionnaires during 11 Training Programs for IMNCI in Kota, Bundi, Jhalawar,
Baran & Tonk. All the workers did well. Untrained ASHAs performance was equivocal with the
Trained ANMs & LS etc. Surprisingly 5th standard ASHAs also did Well. Level of basic
qualification does not affect significantly, only attitude & Interest of Health Worker plays
important role. Study concludes that Interested 8th standard Untrained persons after a short (810days) training with IMNCI may be used as key person, to screen the Newborns.
NEO/4 (P) INFLUENCE OF GROWTH ON GLYCEMIC STATUS AND INSULIN
RESISTANCE AT NINE MONTHS OF AGE IN LBW AND VLBW BABIES
Rakesh Jora, Mukesh Gupta, Pramod Sharma, Pradeep Gupta
3- Shakti Nagar, 1st Lane, Paota C Road, Paota. Jodhpur (RAJASTHAN), INDIA
Email: [email protected]
Abstract-: Background-: To evaluate the influence of growth on Glycemic status and insulin
resistance up to 9 months of age in LBW & VLBW babies. We compared these parameters with
normal birth weight babies and these babies served as controls. Methods-: 100 successive low
birth weight, (birth weight between 1000-2499 gms) were successively enrolled in the study and
50 neonates with birth weight >2.5 kg included as controls. Of the150 enrolled babies only 101
babies could be followed till 9 months of age (in NBW group-36, in LBW group -35, in VLBW
group-30 were followed up to nine months of age). At the time of enrolment anthropometry and
routine blood investigation and fasting blood sugar level of neonates (after 2-4 hours fasting) was
performed. After discharge, enrolled babies were followed every 3 monthly (+10 days) up to 9
months of age on each follow up anthropometry assessment and fasting blood sugar of neonates
(after 2-4 hours fasting) was done. At the age of 9 months venous blood was taken for serum
insulin levels (after 2-4 hours fasting). Statistical analyses were performed using t-test. Results-:
Mean plasma Glucose and pondral index were at enrolment in NBW babies was higher than
LBW and VLBW babies and mean P.Glucose levels at 9 month was higher in VLBW followed
by LBW than in NBW (P value<0.01). Maximum S. Insulin level at 9 month found in VLBW
babies followed by followed by LBW and NBW but statistically significant in LBW and VLBW
in comparison to NBW. Maximum IRI at 9 month occurred in VLBW babies followed by LBW
and NBW. When we compared weight gain at 9 month of age in three group these had been
maximum weight gain in VLBW babies followed by LBW &NBW. Conclusion-: Low birth
weight is an independent risk factor for insulin resistance and this can lead to deleterious effect
in their later life in the form of development of diabetes, hypertension, coronary heart disease.
Key Words-: Insulin resistance, Plasma Glucose, LBW&VLBW babies
NEO/5 (P) TO STUDY THE EFFECT OF HUMAN MILK FORTIFIER (HMF) IN
PRETERM BABIES LESS THAN 1200GM
Ajoy Kumar Sarma
Oil India Hospital Assam
Email: [email protected]
Objective: To study the effect of human milk fortifier on growth in preterm babies less that
1200gm. Materials & methods: Neonate with birth weight <1200gm, gestation less than 30 wks
at enrolment. Eligible neonates were randomized to one of the two groups a) only EBM by
gavages or spoon feeding b) EBM along with one sachet HMF dally. Weight recorded daily,
length and head circumference was measured in the two groups at seven days interval. Outcome
variables: primary: weight gain at twenty eight days after enrolment. Result at observation: A
total of forty eight neonates were randomized to either group a (n=25) or group b(n-23) mean
(SD) weight of the babies in two group are ±266.8 grams in EBM with HMF group and
±229.9gram in only EBM group. At 28 Days weight gain in EBM with HMF group
(476.76±49.9gram) was higher compared to only EBM group (334.96±46.4gm) (p<0.05) At
seven days less weight loss (7.80±9.8gm) was observed in babies with EBM with HMF group
compared to only EBM (21, 52±19.4gm) (p=00.3) Conclusion: EBM with HMF supplementation
is a potential to improve weight gain in ELBW babies and cause less weight loss in first seven
days in ELBW neonates
NEO/6 (P) UMBILICAL CORD BLOOD TSH- A PREDICTOR OF CONGENITAL
HYPOTHYROIDISM
Joseph John
Associate Professor, Department of Pediatrics, Sree Narayana Institute of Medical Sciences,
Chalakka, North Kuthiyathodu P.O. Ernakulam District 683 594 Kerala
Email: [email protected]
Newborn screening is the most modern public health preventive screening program involving the
population at large. Congenital hypothyroidism (CH) is one of the most common causes of
preventable mental retardation in children. Incidence reports in India varies from 1:2500 - 2800
to 2.1:1000 live births. Cord TSH is used as a screening tool for patients being discharged early
from hospital after delivery. The objective of this study was to study the cord TSH values in
newborns delivered at the Sree Narayana Institute of Medical Sciences, Chalakka, Ernakulam as
an ICMR STS study. Cord blood was sent for biochemical testing for TSH during the study
period. Out of the 113 samples tested 79 (69.9%) were included and 34 (30.1%) had to be
excluded as they did not meet the inclusion criteria set. Of the 79 samples included 37 (46.8%)
were males and 42 (53.2%) were females. The mean TSH value obtained was 9.47 µU/L (SD
6.37) with a range from 2.24 to 41.32 µU/L. The mean TSH amongst males was 9.05 µU/L (SD
5.42) and that amongst females was 9.06 µU/L (SD 5.20). Of the 79 samples tested 57 (72.2%)
were in the normal range (< 10 µU/L) 21 (26.6%) were in the indeterminate range (10 - 40
µU/L) and 1 (1.2%) sample was in the hypothyroid range (>40 µU/L). Screening for CH needs to
be a national programme. The financial implications can be reduced by raising the cut off values
or at least the high risk newborns should be screened.
NEO/7 (P) ASSESSMENT OF MORTALITY IN NEONATAL SEPTICAEMIA USING
SCORE FORNEONATAL ACUTE PHYSIOLOGY-II (SNAP-II)
Vinayak Deshmukh, Shreesh V Deshmukh, Sanjay Joshi, Jagdish Pakhare
Behind Hambarde's House, Raut Wadi Akola- 444001, Maharashtra
Email: [email protected]
Introduction: -Septicaemia is a leading cause of death in India neonates. Application of severity
scores may be useful for prognostication and evaluation of the effectiveness of therapeutic
protocols in the Neonatal Intensive Care Unit. Score for Neonatal Acute Physiology-II and its
Perinatal Extension is a physiology based score that uses 6 routinely available vital signs and
laboratory tests and 3 perinatal characteristics for prediction of neonatal mortality. Aims &
Objectives: -To check the sensitivity and specificity of SNAP-II score in predicting mortality in
neonatal septicaemia. Materials and Methods: -Prospective cohort type study, undertaken in a
level-III NICU in Northern Maharashtra.Neonates with septicaemia were eligible for enrolment.
SNAP-II was applied within 24 hrs. of onset of sepsis. Neonates with major congenital
malformations and severe birth asphyxia were excluded from the study. Neonates were followed
until death or up-to 14 days from enrolment. Results: -Total 100 neonates were included in the
study of which 26 died within 14 days. The median SNAP-II and SNAPPE-II scores were
significantly higher in babies who died(50 & 56) as compared to those who survived (24 & 38)
i.e. p<0.001.A SNAP-II >40 had 93.5% specificity and 69.6% sensitivity and 76.2% positive
predictive value.The area under ROC curve was 0.895 for SNAP-II and 0.832 for SNAPPE-II in
predicting mortality. When the individual SNAP-II parameters were analysed, it was found
that parameters related to perfusion [parameter (ROC): MAP (0.677), acidosis (0.655), hypoxia
(0.653) and oliguria (0.706)] were significantly associated with death. Conclusion: -High SNAP-
II and SNAPPE-II scores (>40 and >54) has great sensitivity and specificity for predicting
mortality in neonatal septicaemia. Individual SNAP-II parameters do not contribute equally in
prediction of mortality.
NEO/8 (P) EFFECTS OF MATERNAL ANEMIA ON NEONATAL OUTCOME
Sadique MA, Venkatnarayan K, Thapar RK
Department of Pediatrics, Command Hospital (Eastern Command), Alipore Road, Kolkata-27
E mail: [email protected]
Background: Anemia is a common problem in resource poor countries. The extent to which
maternal anemia affects neonates is largely debatable, though a review of twenty randomized
control trials has found no significant association on fetal outcomes with iron supplementation in
anemic mothers. Besides, in some Indian studies, higher maternal Hb levels were correlated with
better Apgar scores and lower risk of birth asphyxia. Objective: To study the severity of anemia
in mothers admitted for delivery and correlate it with hemoglobin status, Apgar scores,
anthropometry and period of gestation of neonates born to them. Methods: Design: Prospective
Cohort study; Setting: Level-2 neonatal unit in a tertiary care hospital; Duration: Jan 2011 to
June 2012; Subjects: Mothers admitted consecutively for delivery were screened for anemia
(Hemoglobin (Hb) < 11 mg %) (n=100) or no anemia (Hb > 11mg %) (n=110).The following
were the exclusion criteria for mothers: History of any chronic systemic illness; obstetrical
complications such as pre eclampsia, eclampsia, ante partum hemorrhage, premature rupture of
membranes, diabetes; past history of any major abdominal operations, history of chronic
medications and twin pregnancies. The following babies were excluded: Gross congenital
malformations, congenital heart disease, hydrops fetalis and circulatory insufficiency. The
hemoglobin (Hb) estimations were done by cyanmeth-hemoglobin method in both the groups.
Anemia in mothers (Hb<11 mg %) were classified as mild (Hb: 9.9-10.9 mg %), moderate (Hb:
7-9.9 mg %) or severe (Hb<7mg %). For the outcome parameters in neonates, Gestational
assessment was done using Expanded New Ballard Score within 24h of delivery; Apgar scores
were assigned at 1,5 and 10 minutes of life and anthropometric evaluations were done for birth
weight, length, mid arm circumference (MAC) and occipitofrontal circumference(OFC) using
standardized tools to the nearest possible accuracy. Results: Of the 100 anemic mothers studied,
63 had mild anemia and 37 had moderate anemia. There were no mothers with severe anemia.
On comparing with the mothers with no anemia (Gp I), with those with mild (Gp II) and
moderate anemia (Gp III), there were no significant differences in cord Hb (15.2±1.71 gm% (Gp
I); 14.8±1.9 gm% (Gp II); 15.5±2 gm% (Gp III); p=0.19). Neither were there any differences in
the three respective groups in terms of period of gestations at birth (38 wks (Gp I); 37wks+5days
(Gp II); 37wks+4days (Gp III); p= 0.31) or the Apgar scores at 1,5 and 10 minutes (p=0.53,
p=0.1 and p=0.16, respectively). The anthropometric parameters were also comparable between
the three groups [(Birth weight= 2.83±0.47 Kg (Gp I); 2.89±0.53 Kg (Gp II); 2.69±0.61 Kg (Gp
III); p=0.17); (Length= 48.74±2.1 cm (Gp I); 48.79±2.72 cm (Gp II); 48.42±2.79 cm (Gp III);
p=0.74); (OFC= 33.63±1.69 cm (Gp I); 33.93±1.81 (Gp II); 33.56±2.31 cm (Gp III); P=0.52);
(MAC= 9.86±1.1 cm (Gp I); 9.93±1.26 cm (Gp II); 9.74±1.29 cm (Gp III); p=0.72)].
Conclusion: Mild and moderate anemia in mothers has no significant bearing on neonatal
outcomes in terms of cord hemoglobin, Apgar scores, period of gestation or anthropometric
parameters. Lack of severe anemia in mothers in our setting was probably due to the healthy
population encountered in our set up. The effect of severe anemia in mother on neonatal outcome
needs to be looked in further studies. Key words: Anemia, Maternal, Neonate
NEO/9 (P) NEONATAL SEPSIS: A PROFILE OF A CHANGING SPECTRUM
Bej PK, Kannan Venkatnarayan, Thapar RK
Department of Pediatrics, Command Hospital (Eastern Command), Alipore Road, Kolkata700027
E-mail: [email protected]
Abstract: Background: The clinical syndromes of sepsis in neonates are protean. Most of the
cases are identified based on the clinical manifestations presenting in early (<72h) or late (>72h)
neonatal period [Early Onset Neonatal Sepsis (EONS) and Late Onset Neonatal Sepsis (LONS),
respectively]. The bacteriological spectrum along with its relevant lab parameters have not been
extensively studied in our setting. Objective: To describe the demographical, bacteriological and
laboratory profile of neonates presenting with clinically suspected sepsis based on pre-defined
clinical criteria. Methods: Design: Cross-Sectional Study; Setting: Level-2 NICU, Tertiary Care
Hospital; Duration: Jan 2011 to Jul 2012. Subjects: 50 consecutive neonates presenting with any
of the following symptoms: Refusal to suck, Convulsions, Low/high temp, Diarrhea, vomiting,
abdominal distension, Rapid breathing, Superficial infections e.g. umbilical sepsis, pyoderma
were included for study and were also assessed for presence of maternal risk factors (PROM>18
hours, foul smelling liquor, maternal fever in 14 days, confirmed maternal urinary tract infection,
repeated PV examinations). The following were excluded: Severe Birth Asphyxia, Major
Congenital malformations, Respiratory distress caused by pneumothorax, hyaline membrane
disease. The included subjects were studied from with respect to: Gestational age, septic screen,
classification of sepsis (clinical sepsis, screen positive sepsis, culture positive sepsis); outcomes
(Response to first line antibiotic, requirement of inotropes, death); and the type and antibiotic
sensitivity of the organisms cultured. Results: Out of the fifty neonates, 38 (76%) were early
onset sepsis and of these 11 (29%) were culture positive and 10 were positive only on septic
screen (26.3%). Of the 12 (24%) babies presenting with late onset sepsis, 4 (33.3%) were culture
positive and 6 (50%) were positive on septic screen. The sepsis screen showed an overall
sensitivity of 73%, specificity of 54%; with a positive predictive value of 41% and a negative
predictive value of 83%. Of the organisms cultured, the most common organism was
Staphylococcus aureus (7 (46.6%)), followed by E Coli (3 (20%)), Pseudomonas (2(13.3%)),
Coagulase Negative Staphylococcus (2(13.3%)), Group B Streptococcus (1(6.6%)). GBS and
Pseudomonas were cultured only in EOS and the rest of the organisms were found with equal
preponderance and distribution between EOS and LOS. Amongst the Gram-positive organisms,
Ampicillin fared better than Cefotaxime for all the organisms and all of them were sensitive to
Vancomycin. Amongst the Gram-negative organisms, Amikacin fared better than Gentamicin.
All the pseudomonas cultures were sensitive to Piperacillin-Tazobactum. Our first line
antibiotics were Cefotaxime and Amikacin. In case of requirement of upgradtion, Vancomycin/
Piperacillin-Tazobactum are used. Overall, 37 (74%) responded to first line antibiotics and 11
(22%) required a change of antibiotics. 1 (2%) required addition of inotropes and 2 (4%) of the
neonates died. Conclusion: Taking blood culture as gold standard, a clinical diagnosis of sepsis
based on predefined clinical criteria along with maternal risk factors, over- treated 27 babies
(71%) with EONS and 8 babies (66.6%) with LONS. However, such a clinical diagnosis was
supported by a septic screen almost twice as frequently (50% Vs 26.3%) in LONS as compared
with EONS. Staphylococcus aureus was the most common organism isolated in both EONS and
LONS. Based on the antibiotic sensitivity pattern, it seems prudent to change the first line of
antibiotics to Ampicillin and Amikacin, in our setting.
NEO/10 (P) HOW DOES PREPREGNANCY WEIGHT OF MOTHERS AFFECT THE
BIRTH WEIGHT OF NEWBORNS–AN ANALYSIS
Devendra Sareen, Anuradha Sanadhya, Srishti Sareen, Abhishek Ojha, D.R.Dabi, Nitesh Kumar,
Ramesh Kumawat
Professor and Unit Head, Dept. of Pediatrics, 27-F, New Fatehpura, Udaipur (Raj.)
Email: [email protected]
Summary: - Introduction: Intrauterine growth retardation is multifactorial in etiology. Maternal
malnutrition is a very important cause of growth retardation in newborn babies. Amongs various
parameters of maternal nutrition, height of mothers, pre pregnancy weight of mothers, mid arm
circumference of mothers and Body mass index of mothers are important parameters. These
parameters are viewed as predictors of LBW to be used for risk detection and intervention
targeting. Aims and objectives- The present study was undertaken to study the effect of pre
pregnancy weight of mothers on birth weight of babies. Material and method- The study was a
case control study. Study group consisted of 50 mothers of TSGA neonates. Controls were
mothers of TAGA newborns. Pre pregnancy weight of mothers was noted from Antenatal record
or based on memory of patient if she is intelligent enough . Data for each variable were obtained
and compared with each other. Result- Our study revealed that 30% of women in study group
and none in control group were having pre pregnancy weight less than 40 kgs which is very low,
while weight between 40-45 kg was seen in 52%of study mothers and 48%of controls. Normal
weight (45 kg and above) was seen in18%cases and 52%controls was present in 60% of study
group and 52% of controls. Mean pre pregnancy weight was 40.94+-3.34 kgs sn46.86+-4.61 kgs
respectively, which was highly significant.(p<0.001). Conclusion- Nutritional status of mothers
is important determinant of birth weight of babies. As the pre pregnancy weight of the mother
increases, the birth weight of the newborn delivered increases correspondingly.
NEO/11 (P) CORELATION BETWEEN BIRTH WEIGHT OF THE NEWBORN AND
MID ARM CIRCUMFERENCE OF THE MOTHER : A STUDY FROM UDAIPUR
DISTRICT
Devendra Sareen, Anuradha Sanadhya, Nitin Goyal, Abhishek Ojha, D.R.Dabi, Nitesh Kumar,
Harikishan Mangal
Professor and Unit Head, Dept. of Pediatrics, 27-F, New Fatehpura, Udaipur (Raj.)
Email: [email protected]
Summary: - Introduction: Maternal malnutrition is a very important cause of growth retardation
in newborn babies. Among various parameters of maternal nutrition, height, weight ,Body mass
index , Mid arm circumference of the mother are very important. They are viewed as predictor of
LBW newborns. Aims and objectives- The present study was undertaken to study the effect of
Mid arm circumference of mothers on birth weight of newborn delivered. Material and methodThe study was a case control study. Study group consisted of 50 mothers of TSGA newborns.
Controls were mothers of TAGA newborns. Mid arm circumference of mothers was noted by
nonstrechable tape from midway between tip of acromion process and olecranon fossa. Data for
each variable were obtained and compared with each other. Result- Our study revealed that 64%
of women in study group and 12% in control group were having mid arm circumference less than
20cms. 36%of mothers in study group and 78% in controls were having mid arm circumference
between 21 -24 cm . Mean MAC in both groups was 20.06±1.33cms and 22.34± 1.62cms
respectively, which was highly significant(p value <0.001). Conclusion- Mid arm circumference
of mothers is important determinant of birth weight of their newborn babies. Besides having
predictor of maternal undernutrition it also indicates maternal obesity which is not relevant in our
study.
NEO/12 (P) ADVERSE DRUG REACTIONS ASSOCIATED WITH CIPROFLOXACIN
IN NEONATES
Vigil James, N Thomas, Sridhar S, Binu Govind, Manish Kumar, Binu Susan, Manvizhi, Jana
AK, K. Anil Kuruvilla
Departments of Neonatology & Clinical Pharmacology, CMC, Vellore
Email: [email protected]
Introduction: Ciprofloxacin is used in many nurseries in developing countries. Data on drug
concentrations and side effects of ciprofloxacin in neonates is limited. Aims: To study adverse
drug reactions (ADR) associated with ciprofloxacin in term and preterm neonates and correlate
them with drug levels. Methods: Babies of 3 gestational age(GA) groups were enrolled: 37 (gp1),
32-36 (gp2) and 28-31(gp3) weeks. Ciprofloxacin was administered twice daily at 10mg/kg/dose
IV. Lab parameters were done at baseline, day 3 and day 7, including peak and trough drug
levels. Using Naranjo algorithm, babies who developed new symptoms after starting
ciprofloxacin were classified into definite, probable, possible or doubtful ADR. Drug levels were
correlated with ADR. Results: 165 babies receiving ciprofloxacin were enrolled. Predominant
ADR were jaundice (79%), rash(23%), hyponatremia(28%), anaemia(15%) and
hypokalemia(5%). Using Naranjo algorithm, Probable ADR were cardiac arrhythmia, mucosal
ulceration, renal failure and seizures. Possible ADR were rash, elevated liver enzymes, feed
intolerance and leucopenia. ADRs were self-limited and treatable. The mean (SD) trough and
peak values of ciprofloxacin for the entire study population was 3.57(1.88) and 11.67 (3.66),
respectively. Mean (SD) trough drug levels were gp 1 – 2.84 (1.54), gp 2 – 3.80 (1.9), gp 3 –
4.06 (1.98). GA did not seem to play a significant role in pharmacokinetics. Drug levels higher
than mean were seen in babies with rash, leucopenia and elevated LFT. Levels were adequate in
babies with HIE, high in babies with NEC and lower in those with RDS. Conclusions:
Ciprofloxacin can be considered safe for treating newborn infants.
NEO/13 (P) FAMILIAL HYPERTRIGLYCERIDEMIA IN NEONATE
Ajoy Garg, YK Kiran, Kirandeep Sodhi
Department of Pediatrics, 7Air Force Hospital, Kanpur
Email: [email protected]
Case Report: 20 days neonate a product of non-consanguineous marriage admitted with h/o
fever, not feeding well, vomiting and lethargic. On examination HR 176/min, RR 64/min, temp
100 F, SPO2 98%, CFT <3sec, wt 3.8kg, pallor +ve, abdomen was distended with
hepatosplenomegaly. On investigation Hb 8.6gm%, TLC 4000, Neutrophil 33%, lymphocyte
62%, platelet 1lac, CRP 60 and PBS S/O sepsis, CXR and Transcranial USG were WNL. Baby
was started on broad spectrum antibiotic. After 48hrs of antibiotic, child responded partially but
still fever persisting. PBS for MP was positive for plasmodium Vivax. Baby managed with
chloroquine. Incidentally the blood sample in plain sterile vacutainer found to be chylous. On
investigation cholesterol 202 mg/dl, Triglycerides 1588 mg/dl, HDL 30.46 mg/dl, LDL 97.75
mg/dl, VLDL 73.79 mg/dL, Chylomicron nil , thyroid profile , BSL , S. Amylase were wnl.
USG abdomen was s/o of hepatosplenomegaly with no feature s/o pancreatitis. There were no
eruptive xanthomas, fundus examination was normal. No family history of dyslipidaemia but
Lipid profiles of mother showed increase in triglyceride level .Child was diagnosed as a case of
familial hypertriglyceridaemia (FHTG). Baby was managed with low fat milk, Vit ADEK,
carnitine supplement and MCT oil. On follow up, baby is thriving well and lipid profiles were
within normal limit. Familial hypertriglyceridemia is an autosomal dominant condition occurring
in approximately 1% of the population .Familial hypertriglyceridaemia in a neonate is very rare
genetic dyslipidaemia .It was incidentally detected in our neonate admitted for late onset
neonatal sepsis and malaria and was treated with dietary management. Drug therapy is rarely
warranted.
NEO/14 (P) OSTEOARTICULAR INFECTIONS IN NEONATES: A CASE SERIES
Tamhankar Priti, Malik Sushma, Warke Charusheela, Saboo Ashwin, Shah Vivek
Division of Neonatology, Department of Pediatrics, T.N.Medical College & B.Y.L Nair
Hospital, Mumbai-8
Email- [email protected]
Introduction: Osteoarticular infections in neonates are relatively rare but serious infections
associated with considerable morbidity and mortality. Acute osteomyelitis (AO) and septic
arthritis (SA) in neonates differ from that in older children and often pose diagnostic and
therapeutic challenge. Early diagnosis and timely treatment are important to prevent subsequent
skeletal deformity and long term sequelae. Materials and Methods: Seven neonates with
osteoarticular infection were included in this retrospective study based on a review of cases of
osteomyelitis and septic arthritis over a period of one and a half years. Their clinical profile,
presenting symptoms, predisposing factors, radiological findings and management were
analyzed. Setting-Tertiary care neonatal unit. Results: Amongst our seven cases of AO & SA
there were five males and two females. All patients were full term babies and were symptomatic
after 1st week of life. Four neonates had antecedent risk factors like previous NICU stay,
septicaemia, birth asphyxia and prolonged mechanical ventilation. In three neonates there was
significant maternal predisposing factors like ante partum fever, urinary tract infection and one
case was a HIV seropositive mother on ART. Presenting features included fever, refusal of feeds,
paucity of movements of the involved limb and swelling. Local examination in majority revealed
swelling, redness and tenderness at involved site with decreased movement of the affected limb.
In our series 3 neonates had OM of humerus, 3 had femur and one case had tibial bone
involvement and six patients also had additionally septic arthritis. Besides complete blood
counts, blood culture and aspirate cultures, radiography of involved bone/ joint, bone scan and /
or CT scan/MRI scans in these patients helped in arriving at the diagnosis. Our subjects were all
started on broad spectrum antibiotics and two neonates required surgical intervention. All
patients recovered from the acute infection and were discharged. Conclusion: A high index of
suspicion is necessary to make an early diagnosis and prompt institution of therapy is crucial to
prevent permanent sequelae.
NEO/15 (P) VALIDATING THE AGREEMENT BETWEEN NEWER INFRARED
FOREHEAD THERMOMETRY WITH AXILLARY DIGITAL THERMOMETRY IN
NEONATES
AR Sethi, AS Nimbalkar, DV Patel, AG Phatak, SM Nimbalkar
Neonatal Unit, Pramukhswami Medical College, Karamsad-Anand-Gujarat
Email: [email protected]
Background: The traditional mercury thermometer has been replaced by the more “user friendly”
digital thermometer. As accuracy is comparable with both instruments and mercury remains an
environmental hazard they are no longer recommended. New non invasive method of measuring
temperature may reduce infection rate as well as intangible pain and suffering of neonate.
Methods: The body temperature of patients admitted in Neonatal Intensive Care Unit was
measured using axillary digital thermometer as well as a handheld infrared non touch
thermometer. Patients placed under radiant warmers were included. Temperature recordings
were taken as required routinely for clinical care. Axillary temperature was recorded within 30
seconds and the forehead temperature within 5 seconds. Results: The body temperature measured
by Axillary digital thermometer and forehead method do not agree well (95% limits of
agreement: -4.2, 2.2). A trend was observed suggesting that agreement depends on the magnitude
of the temperature. The agreement slightly improved when patients in warmer were excluded
(95% limits of agreement: -4.1, 2.1) with similar trend. The best possible agreement was
observed between warmer and axillary temperature but was not clinically acceptable (95% limits
of agreement: -0.99, 2.36). Conclusion: Forehead temperature due to the non touch may appear
less disturbing to the neonate and also time saving for the nurse but they are misleading. The
infrared technology needs further improvement before it can be used in our setting. Although
advent of technology is tempting, a scientific validation of new technology under different
settings is caveat before adapting it. Keywords: Infrared Thermometry, Digital Thermometry,
Forehead, Axillary, Neonates
NEO/16 (P) TRACHEAL AGENESIS WITH TRACHEO-ESOPHAGEAL FISTULA
SM Nimbalkar, VK Patel, DV Patel, AR Sethi
Neonatal Unit, Pramukhswami Medical College, Karamsad-Anand-Gujarat
Email: [email protected]
Background: Tracheal agenesis (TA) is a rare congenital defect that presents with respiratory
distress soon after birth. Patient: A 1500 gm preterm (32 weeks maturity) female was born by
caesarean section to 30 years old fourth gravida mother who had a pregnancy complicated by
polyhydramnios. Apgar score was 3 and 5 at 1 and 5 minutes respectively. On performing
endotracheal intubation, larynx was visualized clearly up to vocal cord but 3 mm diameter
endotracheal tube did not pass beyond the glottis on repeated attempts. PPV by bag and mask
ventilation with 100% oxygen was continued with minimum chest expansion and poor air entry
over both sides of chest. We passed feeding tube in to the stomach without encountering any
difficulty. The baby died at the age of 6 hours. Histopathologic postmortem showed obstructed
laryngeal end due to anomalous cricoids cartilage. The part of trachea was absent with short
distal trachea communicating to esophagus via tracheo-esophageal fistula. The esophagus
showed an elevated opening on the anterior wall which was communicating with the trachea. A
case of abnormal cricoids cartilage with absent upper segment of trachea (tracheal agenesis) and
a distal tracheo-esophageal fistula. Comment: Tracheal agenesis should be suspected in newborn
with history of polyhydramnios, respiratory distress, and absence of audible cry at birth and
failure to intubate beyond the vocal cord. The surgical management of neonates with tracheal
agenesis is difficult. Tracheal agenesis is a rare congenital anomaly which should be considered
when intubation of a newborn baby is difficult. Keywords: Trachea, Fistula, Esophageal
congenital anomalies
NEO/17 (P) KNOWLEDGE AND ATTITUDE REGARDING NEONATAL PAIN
AMONGST THE NURSING STAFF OF PEDIATRIC DEPARTMENT
AS Nimbalkar, AR Dongara, AG Phatak, SM Nimbalkar
Neonatal Unit, Pramukhswami Medical College, Karamsad-Anand-Gujarat
Email: [email protected]
Introduction: Neonates receiving care in intensive units are highly likely to experience pain due
to investigations or treatments carried out by the health care providers. Unaddressed and
mismanaged pain can not only affect the child’s comfort, but may also alter the development,
and cognitive abilities of the child in later part of his life. Aim: To assess and compare the
knowledge, and attitude regarding neonatal pain amongst the Nurses posted in the various units
of pediatric department. Materials and Methodology: An appropriately modified “Knowledge
and Attitudes Survey Regarding Pain” questionnaire was consensually validated, pretested and
then administered to the nursing Staff of Pediatric Department at our Hospital in Gujarat. Data
was entered in Epi-Info and analyzed using SPSS 14.0 after transferring. Result and Discussion:
The questionnaire was administered to 41 nurses of pediatric department and response rate was
97.5%. Mean age of the Nurses in the study sample was 25.75 years (SD=5.513). The mean total
score of the participants was 8.75 out of 17 (SD=2.549) which was unsatisfactory. The mean
correct answer rate was 49.67% among the staff of NICU and 48.67% among the pediatric and
PICU staff. It was concluded that the nurses lack knowledge and their attitude was also hindering
pain management. One of the barriers which were identified by the nurses was that physicians
did not prescribe analgesics. So not only the nursing staff, but all of the caregivers involved in
neonatal care, are lacking in knowledge and hold perception and attitudes which hamper neonatal
pain management. Keywords: Neonatal Pain, Nurses, Knowledge, Attitude, Perception
NEO/18 (P) CLINICAL PROFILE AND OUTCOME OF NEWBORNS WITH ACUTE
KIDNEY INJURY IN A LEVEL 3 NEONATAL UNIT IN WESTERN INDIA
A.R. Kungwani, A.S. Nimbalkar, A.R. Sethi, D.V. Patel, S.M. Nimbalkar
Neonatal Unit, Pramukhswami Medical College, Karamsad-Anand-Gujarat
Email: [email protected]
Background: Our study aims are 1) Study the clinical profile and associated conditions in
newborns with Acute Kidney Injury (AKI) in our Level 3 Neonatal ICU. 2) Evaluate the
incidence and outcome of newborns with AKI. 3) Study risk factors associated with AKI in our
newborns. Methodology: AKI was defined as Serum Creatinine> 1.5mg/dl. Data about neonates
admitted over a period of three years were studied from Level 3 Neonatal Intensive Care Unit.
Parameters associated with AKI were evaluated and descriptive analysis was done. Results: Out
of total 1745 patients, 74 (Male-61, Female-13) patients had AKI. The incidence of AKI was
4.24 % of admitted newborns, and 80% of the babies developed AKI within first week. Incidence
of AKI in outborn babies (5.83%) is higher than inborn babies (2.44%) and outborns comprised
72.97% of all AKIs (54/74). Mean Birth weight of neonates was 2.46 ± 0.55 kg with 47.30%
being LBWI. Factors associated with AKI were sepsis (91.9%), shock(64.9%), requirement of
ventilation(62.2%), Perinatal asphyxia (36.5%), resuscitation (40.5%) and requirement of
intubation at birth (23%). Mean Serum Creatinine was 2.87 ± 1.81 mg/dl(1.51 to 10.05). Mean
age at diagnosis was 5.76 ± 6.64 days(1 to 41). The mortality was 20% and 51.6% patients went
DAMA (Discharge Against Medical Advice). Conclusion: Mortality in patients with AKI is very
high. Most AKI occurs in the first week of life and factors associated with AKI are easily
recognizable and should prompt early referral of neonates. Keywords: Acute Kidney Injury,
Neonates, Clinical Profile, Mortality
NEO/19 (O) MORTALITY AND MORBIDITY OF ELBW BABIES IN TERTIARY
CARE CENTRE IN NORTHERN INDIA
Neha Thakur, ArvindSaili, Ajay Kumar, Vinay Kumar
Department of Neonatal Intensive Care Unit, Lady Hardinge Medical College and associated
Kalawati Saran Children Hospital, New Delhi, India
EMAIL ID: [email protected]
Abstract: Introduction: Perinatal care has changed dramatically over the past 20 years.
Introduction of assisted reproductive technologies has resulted in increase in the number of
preterm deliveries. New treatment strategies including antenatal steroid therapy, surfactant
administration, and newer modes of ventilation and stringent aseptic measures with better control
of nosocomial sepsis have contributed to improved survival of extremely low birth babies
(ELBW). Objective: The aim of this study was to evaluate the mortality, and morbidity of
ELBW infants delivered in our institute. Methods: The present study was a retrospective analysis
of case records of 283 ELBW babies (birth weight <1000 gms) delivered in our institute over a
period of twenty four months from April 2010 to March 2012.Gestational age was determined
from the date of the last menstrual period and was confirmed by combination of first or early
second trimester sonographic examinations and neurological examination of the newborn using
New Ballard Scoring. The baby's weight, Apgar scores and details of delivery room resuscitation
were also obtained from the delivery records .The neonatal information included duration of
hospital stay, respiratory diagnosis (including hyaline membrane disease (HMD)), duration of
oxygen therapy, neonatal jaundice, phototherapy, exchange transfusion, patent ductusarteriousus
(PDA), necrotizing enterocolitis (NEC), intraventricularhaemorrhage (IVH), culture proven
sepsis, retinopathy of prematurity (ROP), bronchopulmonary dysplasia (BPD), congenital
anomalies and final outcome (discharge or death). Feeding practices were evaluated and duration
of stay in survivors and causes of death in non-survivors were also recorded. Results: The total
neonatal mortality rate was 38.7%. The neonatal mortality in boys was 59% and in girls 41%, a
significant difference (p< 0.005). Gestational age distribution did not differ between the sexes.
None of the infants with a birth weight (BW) below 6OOg survived, Only 2 out of 16 infants
with BW 600-700g, 50% with BW 700-800g, 50% with BW 800-900g, 76% with BW 9001000g survived. Mortality was 100% below 25 weeks, 61% between 25-28 weeks, 28.6%
between 28-30 weeks, 36.4% between 30-32 weeks and 15.6% between 32-34 weeks. Of all liveborn infants, 21% were twins, triplets or quadruplets. In this group the neonatal mortality was
33.3%. RDS was the main cause of death (27%) of the deaths. Sepsis was the next most common
cause, 24% of deaths was related to IVH, either as the primary cause, or in association with other
comorbidities. Asphyxia contributed to 11% of mortality. Prenatal steroids had been given to 150
mothers. The mortality rate among the babies whose mothers have received antenatal steroids
was 26%. The mortality rate among infants born alive <28 weeks whose mothers had received
prenatal steroids was 32%, compared with 65% among infants of untreated mothers. Conclusion:
In view of high costs of NICU care in developing countries where resources are limited
continued efforts should be made to prevent preterm deliveries. 10% of our study population
comprised of IUGR babies, remaining were preterms. Babies with higher gestational age, higher
birth weight and those babies whose mothers had received antenatal steroids had better
prognosis.
NEO/20 (P) AN EVALUATION OF BUBBLE-CPAP AS A RESPIRATORY SUPPORT IN
ELBW BABIES IN A NEONATAL UNIT IN A DEVELOPING COUNTRY.
Neha Thakur, ArvindSaili, Ajay Kumar, Vinay Kumar.
Department of Neonatal Intensive Care Unit, Lady Hardinge Medical College and associated
Kalawati Saran Children Hospital, New Delhi, India
EMAIL ID: [email protected]
Abstract: Introduction: Continuous Positive Airway Pressure (CPAP) has become a common
form of support forrespiratory distress in neonatal intensive care units. Objective: To evaluate the
outcome of baby’s weighing less than 1000gm requiring respiratory assistance in the form of
Mechanical Ventilation or CPAP. Methods: Subjects included all live-born infants delivered in
our institute during April 2010 to March 2012 with birth weight <1000 gms requiring any form
of respiratory assistance.We use CPAP predominantly in preterm infants with respiratory
distress, apnea of prematurity, delayed adaptation, pneumonia and while weaning from
mechanical ventilators in ELBW infants.We studied, in detail, the records of all babies who were
initiated in any form of respiratory support (mechanical ventilation or bubble-CPAP). The
following data were extracted: birth weight, gestational age, diagnosis, presence of positive
bacterial cultures at any time during the admission, duration of hospitalstay and outcome.
Results: Of all ELBW infants 75% required some form of respiratory assistance. 47% were
mechanically ventilated and 35.6 % received CPAP treatment only Most of the latter were born
at gestational ages of ≥27 weeks. Of the live-born infants, < 27 weeks 82% were mechanically
ventilated and 88% of them died. Surfactant was given to 106 babies and of these 53 (50%) died.
Conclusion: A large percentage of ELBW babies still require some form of respiratory
assistance. CPAP alone was helpful in good percentage of these babies.Introduction of bubbleCPAP substantially reduced the need for mechanical ventilation. In models of neonatal care for
resource-limited countries, bubble-CPAP may be the first type of ventilatory support that is
recommended. Its low cost and safety makes it ideal for this purpose
NEO/21 (P) MATERNAL ANTENATAL PROFILE IN ELBW BABIES BORN IN A
TERTIARY CARE CENTRE IN NORTHERN INDIA
Neha Thakur, ArvindSaili, Ajay Kumar, Vinay Kumar.
Department of Neonatal Intensive Care Unit, Lady Hardinge Medical College and associated
Kalawati Saran Children Hospital, New Delhi, India
Email: [email protected]
Abstract: Introduction: Perinatal and neonatal mortality are importantpublic health issues in
many developing countries.Birth weightis one of the major determinantsof neonatal survival as
well as postnatal morbidity.Preterm delivery is an important cause of extremely low birth weight
babies. During the last two decades the survival for premature infants has significantly increased
due to advancement in perinatal treatment and improvement in the care of high-risk mothers.A
better understanding of maternal antenatal factors contributing to preterm birth and need for
improvement of perinatal care are necessary to increase the neonatal survival. Objective: To
evaluate the antenatal profile of the mothers and to find out the maternal risk factors for giving
rise to ELBW babies. Methods: The present study is a retrospective analysis of case records of
mothers of ELBW babies admitted in our NICU during a period of two years from April 2010 to
March 2012.Maternal information obtained from the delivery records included age, parity,
antenatal care, administration of antenatal steroids, fetal presentation, mode of delivery,
incidence of anemia, pregnancy induced hypertension (PIH), antepartum hemorrhage (APH),
previous pre-term delivery, drug intake during pregnancy. Results: During the study period 283
babies were admitted in our NICU. Retrospective analysis of their mother’s case records was
done. The overall rate of Caesarean section (CS) was 21%, whereas 79% were delivered
vaginally.More than half of the mothers (58.4%) were booked. Maternal anemia and multiple
births complicated nearly 40% of deliveries. More than 50% of mothers had received antenatal
steroids, 44% had
PROM >24 hrs. with 40% receiving antibiotics. 9.5% of deliveries were
complicated by APH. Amongst the various high risk factors for preterm labor, anemia during
pregnancy (41%), previous preterm delivery (34.2%), gestational hypertension (12.7%) and
antepartum hemorrhage (9.5%) were common associations. Conclusion: Antenatal profile of
extremely low birth weight babies delivered in our institute showed a number of high risk
factors. Identification of these risk factors along with timely intervention is important for
appropriate prenatal care and better neonatal survival rate.
NEO/22 (P) NEONATAL CHOLESTASIS
Rajesh Rai, Fehmida Najmuddin, Riya George, Keya Lahiri, Anand Sude
Department Of Paediatrics, Padmashree Dr.D.Y.Patil Medical College, Hospital And Research
Centre, Nerul, Navi Mumbai 400706
Email: [email protected]
Abstract: 2 month old female, born of non-consanguineous marriage, admitted with yellowish
discoloration of eyes, skin since day 2 and passage of acholic stools since 1 month. Mother had
fever with rashes in the last trimester of pregnancy and she was a case of hypothyroidism on lthyroxine for 2 years. Child was immunized and had attained milestones. She was exclusively
breast fed. On examination, her vital parameters were normal, icterus was seen and the anterior
fontanelle was open. Per abdomen examination showed a distended abdomen with dilated veins
with splenohepatomegaly; spleen of 8.5 cms and liver of 5.5 cms, both firm in consistency with
sharp borders; rest of the systemic examination was normal. Serum transaminases were elevated
with indirect hyperbilirubinemia. CMV IgM was positive and HIDA showed partial obstruction
of biliary tract with intraparenchymal disease of the liver. Injection Gancyclovir was initiated
and continued for 3 weeks, hemogram and renal functions were monitored weekly for
thrombocytopenia and creatinine. Child gained weight, was passing yellow stools with reduction
of jaundice. HIDA at 3 months showed preserved hepatic function and normal IgM.
NEO/23 (P) AN UNUSUAL CASE OF ANTENATAL PUERPERAL BREAST ABSCESS
Patil Varsha, Jobanputra Neha, Malik Sushma, Warke Charusheela, Shah Dipti
Division of Neonatology, Department of Pediatrics, T.N.Medical College & B.Y.L Nair
Hospital, Mumbai-8
Email: [email protected]
Introduction: Puerperal or lactational mastitis occurs in approximately 2-3% of lactating women.
Breast abscess may develop in 5-11% of women with mastitis. We present an uncommon case of
multiple puerperal breast abscesses developed during the antenatal period. Case History: A 24
year old gravida two mother presented in 8th month of gestation with fever, pain and palpable
lump in left breast. Local ultrasound revealed abscess in left breast (lower medial quadrant)
which was surgically drained by private practitioner and treated with antibiotics and pyridoxine
for 7 days. Two weeks later, she developed another abscess in upper medial quadrant of the same
breast in addition to persistence of previous abscess. At this time (36 weeks), she was admitted at
our hospital where she delivered a 2.6 kg female baby. She had history of copious milk discharge
during pregnancy which predominantly occurred from right breast. Her first conception occurred
after treatment for primary infertility which terminated as intrauterine fetal demise. There was
similar history of copious milk production during previous pregnancy too. There was no history
of trauma, wearing tight undergarments, cracked nipple, diabetes mellitus, any drug intake,
tobacco chewing or smoking. General examination was normal without any focus of infection.
Investigations revealed high leucocyte counts. Both the abscesses in left breast were confirmed
by ultrasound and surgically drained twice. The pus grew Staphylococcus aureus. She was
treated with injectable antibiotics for 14 days. Her HIV ELISA was negative. X-ray skull, serum
prolactin and TSH levels done twice 3 years apart were normal and helped to rule out
prolactinoma. Analysis of breast milk from both breasts revealed elevated sodium levels. Baby
was breast fed only from right breast due to active pus drainage from left side. Baby had no
clinical or laboratory evidence of sepsis, dehydration or hypernatremia. The mother was
discharged on oral antibiotics after the breast abscesses reduced. Discussion: Puerperal mastitis
and breast abscess occurs most commonly in first 6 weeks of breastfeeding. The breasts are
however capable of full lactation from 16 weeks of pregnancy. Abrupt withdrawal of
progesterone in presence of high prolactin levels stimulates copious milk production at birth.
Antenatal breast abscess is uncommon. Milk stasis is a major predisposing factor for mastitis and
breast abscess, which is exemplified in present case. Conclusion: Puerperal breast abscess is
uncommon during antenatal period. The goal of treatment for mastitis and breast abscess is to
provide prompt and appropriate management to prevent further lactation issues.
NEO/24 (P) REFRACTORY SUPRA VENTRICULAR TACHYCARDIA IN A
NEONATE: A TREATMENT CHALLENGE.
Ravindra Sharma, Sushma Malik, Bhavesh Rathod, Charusheela Warke, Ashwin Saboo, Sandeep
Patil.
Division of Neonatology, Dept. of Pediatrics, BYL Nair Ch. Hospital and TN Medical College,
Mumbai-8
Email: [email protected]
Introduction- Supraventricular tachycardia (SVT) is the most common sustained arrhythmia to
present in the neonatal and infancy age group. Acute management of the neonate / infants who
presents in SVT can be a challenge. The treatment strategy depends upon the clinical
presentation and hemodynamic status. Here we present a neonate who had refractory SVT. Case
Report- 28 days old, 3 kg FTND male child, with an uneventful antenatal and postnatal history
was admitted at peripheral hospital with complaints of respiratory distress, tachycardia
(220/min), cardiac failure, normal 2D ECHO and the ECG suggestive of SVT. Patient responded
to adenosine and oral propranolol. The neonate was then referred to our NICU for further
workup. However, subsequently, baby developed recurrent episodes of SVT, which were
refractory to adenosine, amiodarone drip and multiple DC cardioversions. Digoxin was withheld
in view of doubt of WPW syndrome. Patient ultimately responded to oral flecainide and
amiodarone drip. Discussion- SVT is the most common pathological tachycardia in a neonate
that can be a recurrent and persistent condition. Three major subcategories of SVT are reenterant tachycardia using an accessory pathway, re-enterant tachycardia without using an
accessory pathway, and ectopic or automatic tachycardia. Predisposing factors (congenital heart,
drug, fever and illness) occur in only 15% of infants. Congestive cardiac failure is more common
in infants under 4 months of age (35% incidence). Chronic therapy with beta blocker, flecanide,
sotalol and amiodarone has proved effective in controlling recurrent episodes of SVT.
Radiofrequency ablation (RFA) is the definitive treatment of refractory SVT, however,
interventional therapy poses a high risk of morbidity and mortality in neonatal and infant age
group. Conclusion- SVT is successfully terminated in 80 to 90% by adenosine. In refractory
SVT, combination of Flecainide & Sotolol effectively controls refractory SVT. Radiofrequency
ablation is reserved for drug resistant or life threatening arrhythmias.
NEO/25 (P) CRANIOFACIAL MICROSOMIA - THE NEED FOR EARLY
INTERVENTION
Neha Jobanputra, Bhavesh Rathod, Sushma Malik, Charusheela Warke.
Division of Neonatology, Department of Pediatrics, T.N.Medical College & B.Y.L Nair
Hospital, Mumbai-8
Email: [email protected]
Introduction:- Craniofacial microsomia (CFM) includes a spectrum of malformations primarily
involving structures derived from the first and second branchial arches. CFM encompasses facial
asymmetry, preauricular or facial tags; ear malformations like microtia, anotia or aural atresia,
hearing loss, cleft lip / palate and microphthalmia. Non-craniofacial malformations especially
vertebral, cardiac or renal can be involved. Here we report a rare case of CFM in our neonate
who had anotia, microtia and facial nerve palsy. Case history: - A gravida two mother delivered a
full term normal 2.6 kg female baby, who was brought on day 3, for assessment of dysmorphic
features and ear anomalies. Antenatally the mother had no fever, rash or diabetes and had not
recieved any drugs including retinoic acid or teratogens. An antenatal USG done at 32 weeks
was normal. Examination of the neonate showed left anotia, right microtia, facial asymmetry and
unilateral left sided LMN facial nerve palsy. X-Ray chest and spine were normal. ECHO
revealed small ASD with VSD. Hearing evaluation posed difficulty due to the left anotia and
extreme microtia on other side and patient advised for reassessment at 4 weeks for BERA/BOA.
USG abdomen showed absence of left kidney with hypertrophied right kidney. Thus the baby
was diagnosed as a case of CFM and was discharged with advice of regular follow up especially
for hearing and renal assessment and early rehabilitation. Discussion:- Prevalence of CFM has
been estimated between 1: 5600 to 1: 26,550 live births. Spectrum of CFM, includes microtia,
anotia, sensorineural hearing loss, cleft lip and/or palate, preauricular skin tags, vertebral
anomalies, facial nerve palsy, congenital heart defects and renal anomalies. A systematic
approach in these cases including hearing, speech, ophthalmologic evaluation and genetic testing
will help in appropriate management to maximize hearing and communication, improve facial
symmetry, and optimize cardiac and renal functioning. Conclusion: - Early management is
required in cases of CFM, as treatment and interventions are age-dependent and time-sensitive
which are done at appropriate stages of craniofacial growth and development.
NEO/26 (P) ROLE OF SILDENAFIL IN PERSISTENT PULMONARY
HYPERTENSION IN NEWBORN
Asha Mukherjee, Nandita Chatterjee, Somosri Ray, Monomit Halder, Arghya Kusum Pal, Pallavi
31 Lake Temple Road, Kolkata- 700029
Email: [email protected]
Abstract: Introduction: We share our experience with 10 newborns, diagnosed to have PPHN in
last
two
years
in
our
hospital
RAMAKRISHNA
MISSION
SEVA
PRATISTHAN,KOLKATA.Sildenafil (phosphodiesterase-5 inhibitor )is a unique drug in PPHN
which reduces the need of mechanical ventilatior,inhaled nitric oxide and ECMO.We
experienced dramatic improvement with this drug. Aims And Objectives: 1) To evaluate the
success rate of sildenafil in PPHN. Material And Methods: 10 cases of PPHN were included in
the study.Tools used –pulse oximetry,multi channel monitor,serial echocardiography.Response
to sildenafil was assessed in terms of decrease in oxygen requirement,respiratory rate,echo
criteria-decrease in peak pulmonary pressure and tricuspid regurgitation gradient.
Echocardography were performed –one before and another after 5 days of sildenafil. Results:
Age of presentation of 10 term babies was between day-1 to day 3 of life.3(30%) out of them
were infant of diabetic mother.2(20%) had birth asphyxia ,3 (30%)had sepsis, 2(20%) had
meconium aspiration syndrome.All these cases had respiratory distress and diference of oxygen
saturation >5% between upper right arm and left lower limb.Echo was done before and ater 5
days of oral sildenafil (2mg/kg/dose four times a day).1 case expired on 3rd day of life,one
needed ventilator.8 out of 10 showed 90% decrease in TR gradient,near normalization of peak
pulmonary pressure.All 8 cases showed decrease in oxygen requirement from mean 7 litre/min to
1.5 litre/min.Decrease of mean respiratory rate was from 76 to 40/min. Conclusion: Sildenafil is
a useful drug in PPHN and its use may avoid mechanical ventilator ,NO and ECMO.
NEO/27 (P) APGAR SCORE: DO WE NEED TWO (HR & RR) OR ALL FIVE
COMPONENTS
Nirmal Kumar, .Sunaina Arora, V. Sreenivas
St. Stephens Hospital, Dept. Of Neonatology, Tis-Hazari, Delhi-110054
E-mail: [email protected]
Abstract: The Apgar scoring system has been conceptualized as a cycle, linked to cardio
respiratory reflexes and metabolically supported by oxygenation .Neonatal resuscitation based
mainly on heart rate and respiratory rate. Resuscitative measures directly linked with severity of
birth asphyxia. Aim: To see if resuscitative measures are same for two components and all five
components of Apgar score. Methods: Data was collected prospectively from the routine Apgar
scoring system and resuscitative measures that were done in the delivery room were recorded.
Two components of Apgar scores, heart rate and breathing were assigned as Apgar scores (
heart rate 0 , 1, 2 and breathing 0, 1, 2 ). Total score for two component ranges from 0-4. Use of
PPV, chest compression and drug were recorded at 1 and 5 minutes. Results: 1999 babies were
studied.Mean weight and gestational age was 2.8 kg and 38 weeks respectively. Apgar score ( 2
component ) was 1 in 9 babies, 2 in 17 babies, 3 in 33 babies and 4 in 1940 babies. Almost all
babies with Apgar score ≤ 6 and Apgar score ( 2 component ) of ≤ 3 received bag and mask
ventilation at 1 minute . Only Apgar score ≤3 and Apgar score ( 2 component ) of 1 received
endotracheal intubation, chest compression and epinephrine. For bag & mask vantilation,
sensitivity (82.3% vs. 91.90%), specificity (99.9% vs. 99.9%), positive predictive value (96.2%
vs. 96.6%) and negative predictive value (99.4% vs. 99.7%) of Apgar score and two component
Apgar were comparable . For chest compression, Apgar score ≤ 3 and two component Apgar
score of 1 had sensitivity and specificity of 99%, PPV ( 30.7 Vs 44.4% ) and NPV of 100%
were observed. For the use of medication ( Epinephrin ) too the sensitivity and specificity were
greater than 99% and PPV ( 22.2% Vs 15.38% ) and NPV 100% were observed. Conclusion
:Apgar score ≤ 3 and two component Apgar score of 1 are almost parallel to each other in terms
of resuscitative measures that is positive pressure ventilation, chest compression, and
epinephrine. Only two components ( HR & RR ) are required for Apgar score.
NEO/28 (P) CONGENITAL SURFACTANT DEFFICIENCY
Manish K Arya, Payal Shah, A.D. Rathod, S.K. Valinjkar, Kiran M
201, Darshan Apt, Opp Sonivadi, Chikan Villa Road, Borivali (W) , Mumbai 92
Email: [email protected]
Introduction: Respiratory Distress Syndrome (RDS) is due to deficiency of surfactant and
commonly occurs in preterm babies. We report the case of congenital surfactant deficiency
which is a rare but important cause of RDS in term babies. Case report: A 37 week gestation boy
with birth weight 3 kg born to registered immunised primi mother developed respiratory distress
at four hours of age. baby was shifted on o2 by hood to NICU ,however as baby was not
maintaining saturation on the same was put on nasal CPAP. CXR was done which was s/o
WHITE OUT LUNG. Subsequently baby was intubated and put on CMV mode. 2 d echo was
done to rule out congenital heart disease. Pt was administered surfactant following which pt
showed improvement on CXR and ABG and required lesser pressure settings. After 12-16 hour
child was requiring higher pressure settings and there was deterioration on CXR and ABG.
During 16 days of his life child was given repeated surfactant and each time improvement was
seen on CXR, ABG and clinical settings. CBC and septic profile was normal. Renal and liver
parameter were within normal limit. Lung biopsy was sent which was s/o surfactant deficiency.
Bronchoalveolar lavage was s/o surfactant protein B deficiency. Based on clinical picture and
biopsy report case of congenital surfactant deficiency was considered.
NEO/29 (P) ASSOCIATION OF SIGNIFICANT HYPERBILIRUBINEMIA AND TOTAL
SERUM BILIRUBIN TSB MEASUREMENT AT 24±6 HOUR OF LIFE LEVEL IN
HEALTHY TERM NEONATES
Subhash chand Meena, Gaurav Ameta, Suresh Goyal
Department of Pediatrics, RNT Medical College, Udaipur
Email: [email protected]
Abstract: Back ground: Significant hyperbilirubinemia occurs in 5–10% of healthy term and
is most common reason for readmission after early hospital discharge. Aims and Objectives:
To evaluate whether the first 24 ± 6 hours TSB value can predict development of significant
hyperbilirubinemia; Design: prospective study; Participants and interventions: Intramural
healthy neonates with birth weight ≥2500 gm, and gestational age ≥37 weeks born from Dec
2009 to Oct 2011 were included; Exclusion criteria: Rh incompatibility, hydropes fetalis,
maternal diabetes, any congenital malformation, any illness requiring NICU admission, Apgar
score <5 at 5 min, known viral infection in mother; Intervention: 100 healthy full term
neonates participients were subjected TSB estimation at first 24±6 hrs of age and followed
clinically (using Kramer’s rule) for the appearance jaundice and total seum Bilirubin
estimation was done on fifth day of life or early (if clinical assessment of jaundice
>10mg/dl before discharge of baby). Babies were classified into four groups depending on the
serum bilirubin levels at first 24 ± 6 hours of life i.e. <4 mg/dl (group-I), 4.0-5.99 mg/dl (groupII), 6.0-7.99 mg/dl (group-III), = 8 mg/dl (group- IV). Results: (mean±SD)TSB beyond 24
hour of life was highest i.e. 15.73±1.44 in group IV and lowest i.e. 10.66±1.43 in group I.
Mean TSB level after 24 hour of life increased as the first 24±6 hour TSB level
increased from group I to group IV which was highly significant (P<0.001). Conclusions: TSB
measurement at 24±6 hour of life predicts significant hyperbilirubinemia during first 5 days of
life.
NEO/30 (P) EFFICACY AND SAFETY OF TOTAL PARENTERAL NUTRITION (TPN)
IN INFANTS WEIGHING LESS THAN 1250 GRAMS – A CASE CONTROL STUDY
Soundaram V, Jayashree P, Ramesh Bhat Y, Leslie E Lewis
Department of Paediatrics, Kasturba Medical College, Manipal University, Manipal-576104,
Udupi District, Karnataka, India
Email: [email protected]
Introduction: VLBW infants are born at a time of rapid intra-uterine growth. Neonates receiving
only glucose were found to experience protein loss of 0.5-1g/kg/d. These deficits are difficult to
recoup and lead to significant growth and neurodevelopmental delay. Aim: To compare the
growth of infants<1250g who received TPN with those not received and assess TPN
complications. Materials And Methods: Neonates weighing <1250 g, hemodynamically stable
and survived till 7th postnatal day were studied. Cases received TPN and controls did not. Amino
acids and lipids were started at 1 g/kg/day on Day 1 and graded up by 1 g/kg/day till 4 g/kg/d of
AA and 3 g/kg/d of lipids. Enteral feeds were started within Day2 of life and graded up as per
standard protocol. Results: 20 cases and 20 controls were studied. Time to regain birth weight
(9.85+/- 3.7 days vs 20.06+/- 7.28 days) and cumulative weight loss (78.75+/- 48.26 vs
130.79+/-54.91grams) were lesser for cases than controls. Cumulative energy intake in 1st week
had significant positive correlation with growth velocity (81.35vs37.66 Kcals, p-0.043). Four
neonates among cases and two among controls had culture proven sepsis. Asymptomatic
hyponatremia(55%) , hypokalemia(45%) ,hyperglycemia(75%), elevated ALP(60%), and
elevated urea with normal creatinine(20%) were observed in cases. Duration of hospital stay
after controlling for gestational age and discharge weight was shorter for cases(42.68vs54.01
days). Conclusion: Infants who received TPN showed better growth than controls. Careful
attention regarding transient metabolic complications and sepsis is required while administering
TPN.
NEO/31 (P) STUDY OF THE ROLE OF ZINC IN THE TREATMENT OF NEONATAL
SEPSIS
Kayur Mehta
45 Flat S1 Chilume Apartment, West Park Road Malleshwaram, Bangalore - 560003
Email: [email protected]
Abstract: Objective: To study the role of Zinc in the treatment of neonatal sepsis. Design: Double
blinded, randomized, placebo controlled trial. Setting: B.P. Koirala Institute of Health Sciences,
Dharan, Nepal. (Tertiary Care Hospital) Participants: 614 neonates with Probable Neonatal
Sepsis, randomized to receive Zinc (Drug group, n = 307) or Placebo (Placebo group, n =307), in
addition to standard antibiotic therapy and supportive care. Intervention: The drug group (n=307)
received 1mg/kg/day of elemental zinc, and placebo group (n=307) received the placebo, in
addition to antibiotic therapy and supportive care, till the final outcome (discharge/death).
Outcome Measures: Decrease in mortality rates (primary outcome), duration of hospital stay and
need of higher lines of antibiotic therapy (secondary outcomes) were tested. Results: Baseline
characteristics of the two groups were similar. No statistically significant differences in mortality
rate (drug group–9.77% vs. placebo group–7.81%; p=0.393), mean duration of hospital stay
(drug group-142.85±69.41 hrs, vs. placebo group-147.99±73.13 hrs; p=0.841), and requirement
of higher lines of antibiotic therapy (drug group–13.35% vs. placebo group–12.05%, p=0.628)
were found after supplementation. Conclusions: This study does not report decrease in mortality
rates, duration of hospital stay and requirement of higher lines of antibiotic therapy following
zinc supplementation in neonatal sepsis. More trials and subsequently meta-analyses are required
to clarify the role of zinc in the treatment of neonatal sepsis.
NEO/32 (P) CORRELATION OF PULSE OXIMETRY AND APGAR SCORING IN
THE DELIVERY ROOM
Sandhya Chauhan, Prashant Kumar.
69 Silver Estate, Post Rohilkhand University, Pilibhit Bypass Road, Bareilly, 243006, Uttar
Pradesh
Email: [email protected]
Introduction: Newborn assessment immediately after birth is routinely done by the Apgar
score. Newborns are normally desaturated at birth. Pulse oximetry is a non invasive tool
which can easily detect this desaturation and help in deciding further intervention. Aim: To
detect whether Apgar Score is a sensitive indicator of hypoxemia in normal vigorous
babies in the delivery room and to evaluate which component of Apgar Score correlates
with the SpO2 levels. Methods: In this prospective cross-sectional observational study
,Apgar Scoring was done in normal vigorous babies at 1 and 5 minutes of birth along with
simultaneous recording of the preductal SpO2 values with the help of pulse oximeter.
Results: Apgar score at 1 and 5 minutes failed to correlate with the level of hypoxemia
at 1 and 5 minutes. Also AS did not show any effect on the time taken to achieve
normoxia. Out of the 5 components of Apgar Score , respiratory effort at 1 minute and
muscle tone had significant correlation with the level of arterial desaturation persisting in
the newborns at 5 minutes. Heart rate, color and reflex activity did not have any
significant association with the SpO2 values. Conclusion: Apgar Score is a misleading tool
for neonatal evaluation in the delivery room . Respiratory efforts and pulse oximetry
readings are the most important factors which determine the level of neonatal hypoxia in
the first few minutes of life and the required management .
NEO/33 (P) SLEEP CYCLE IN NEWBORNS
Jaswir Singh, Manpreet Sodhi, Anil Kumar Poonia, Jaspreet Kaur
Deptt. Of Pediatrics, Govt. medical college / Rajindra Hospital, Patiala (Punjab)-147001
Email: [email protected]
Introduction: Rapid Eye Movement (REM) sleep patterns first appear between 28 and 30 weeks
gestation. Most of the sleep cycle is REM sleep, with little Non Rapid Eye Movement (NREM)
sleep. By term at 40 weeks, the sleep cycles are about equal REM and NREM. Aims &
objectives: To study pattern of sleep cycle in newborns. Material and methods: The study
included 20 healthy, AGA Newborns (10 male & 10 females) admitted to Neonatology section
of Level- teaching hospital. All babies were breastfeed. Study was done on 48th-72th hour of
life. There was no antenatal risk factor in these babies. Behaviour variables for this study were
body activity, rapid eye movement & respiratory pattern. All variables were studied clinically.
Study conducted in a silent and warm room. All babies were taken to study room after adequate
breastfeed (average 1 hour 40 min). Results: Babies fell into REM (active) sleep first followed
by NREM (quiet) sleep.
Sleep
Active
Quiet
Active
Quiet
Active
Quiet
Mean
18
duration(min)
Range
6-26
10.4
23
12
28.45
11.6
6-14
14-34
8-17
16-40
8-18
For active sleep, mean duration was 67.15 ± 19.30 minute and for quiet sleep it was 33.2 ± 6.44
minute (p value = 0.0001; statistically significant). While comparing male & female babies, p
value for active & quiet sleep was 0.7637 & 0.6398 respectively (not significant). Conclusion:
Active sleep is the major part of sleep cycle in newborn.
NEO/34 (P) CLINICAL STUDY OF HYPOXIC ISCHEMIC ENCEPHALOPATHY
WITH ECHOCARDIOGRAPHY AND LABORATORY CO-RELATION
Mamata.S.Kori, M.M.Karva, L.H.Bidari
Dr.Bidari’s Ashwini Institute Of Child Health And Research, Bijapur, Karnataka.
Email: [email protected]
Introduction:-Hypoxic ischemic encephalopathy(HIE) remains a serious condition in spite of
major advances in technology causing significant mortality and long term morbidity. Aims and
Objectives: 1. To study clinical profile of neonates with HIE. 2. To study biochemical
hematological Echocardiographic and radiological profile of neonates with HIE. 3. To study
their outcome and correlate it with relevant clinical and laboratory findings. Materials and
Methods: The present study is prospective study carried out on 78 neonates admitted in the
NICU Dr BIDARI’S ASHWINI HOSPITAL, BIJAPUR, KARNATAKA from April 2010 to
April 2012. All asphyxiated babies with history of fetal distress, state of neurological depression
at birth, need for resuscitation efforts and neurological depression afterwards were included.
Those with major systemic malformation, <1500g and <32 weeks gestation were
excluded.Investigations were done after 12 hours of birth and before 78 hours of life. The data
was collected through interviewing,physical examination and investigation techniques.
Echocardiography done on all neonates with birth asphyxia by trained ECHO technician with
tele – echocardiographic support of cardiologist from “NARAYANA HRUDAYALAYA”
Bangalore. Results: There is multiorgan dysfunction in HIE,with CNS most commonly
affected,overall mortality 8.97%,HIE III major cause of mortality,metabolic derangements in
HIE metabolic acidosis,hypocalcemia,hypoglycemia, and hyponatremia.Tricuspid regurgitation
most common finding on echocardiography,symmetrical diffuse periventricular white matter
echogenecity most common finding on cranial USG. Conclusion: The results of this study
highlights the varied clinical picture of multisystem involvement with special reference to
cardiac involvement and importance of bed side echocardiography in predicting the outcome in
asphyxiated newborn infant and indicate the need for global management of these infants.
Keywords:Birth asphyxia, multiorgan dysfunction, metabolic derangements, Echocardiography,
Cranial USG.
NEO/35
(P)
EVALUATION
OF
MYOCARDIAL
DYSFUNCTION
AND
ECHOCARDIOGRAPHIC PROFILE IN NEONATES WITH HYPOXIC ISCHEMIC
ENCEPHALOPATHY IN A TERTIARY CARE HOSPITAL
Mamata.S.Kori, M.M.Karva, L.H.Bidari
Dr.Bidari’s Ashwini Institute Of Child Health And Research, Bijapur, Karnataka.
Email: [email protected]
Introduction: Perinatal asphyxia leads to multi-organ dysfunction. Virtually any organ system
can be affected. Cardiac abnormalities in asphyxiated neonates are often under diagnosed and
require a high index of suspicion. Aims and objectives: 1.Assesment of myocardial dysfunction
and Echocardiographic profile of neonates with hypoxic ischemic encephalopathy. Materials and
methods: The present study is a prospective study carried out on neonates admitted in the NICU
of Dr BIDARI’S ASHWINI HOSPITAL, BIJAPUR, KARNATAKA from April 2010 onwards
to April 2012. All asphyxiated babies with history of fetal distress, state of neurological
depression at birth, need for resuscitation efforts and neurological depression afterwards were
included. Those with major systemic malformation, <1500g and <32 weeks gestation were
excluded. The data was collected through interviewing,physical examination and investigation
techniques. Echocardiography done on all neonates with birth asphyxia by trained ECHO
technician with tele – echocardiographic support of cardiologist from “NARAYANA
HRUDAYALAYA” Bangalore. Results:Out of 78 neonates 17(21.79%) neonates had normal
study on Echocardiography,28(35.89%) neonates had tricuspid regurgitation(TR),30(38.46%)
had Tricuspid Regurgitation with Pulmonary Arterial Hypertension (PAH),03(3.85%) had TR
plus PAH plus Left Ventricular Ejection Fraction ( LVEF)<60%. Conclusion: Cardiac
abnormalities in birth asphyxia are often underdiagnosed. This study highlights the cardiac
involvement in birth asphyxia and importance of bedside Echocardiography in predicting the
outcome in asphyxiated newborn babies. Keysword: Birth Asphyxia, Myocardial Dysfunction,
Echo-cardiography .
NEO/36 (P) HAIR DISTRIBUTION IN NEWBORNS IN RELATION
GESTATIONAL AGE
Jaswir Singh, Manpreet Sodhi, Anil Kumar Poonia, Jaspreet Kaur
Deptt. Of Pediatrics, Govt. medical college/ Rajindra Hospital, Patiala (Punjab)-147001
Email: [email protected]
TO
Aims & objectives: To study hair distribution in relation to gestation. Material and Methods: The
study included 50 neonates. Five groups were formed by gestational age as 28-29 wk 1st group;
30-31 wk 2nd ; 32-33 wk 3rd ; 34-35 wk 4th ;36- 41 wk as 5th group. 10 newborns were in each
group. Newborns included were either AGA or SGA. LGA, infants of diabetic mother,
newborns with congenital malformation & chromosomal diseases were excluded. All were
examined at birth for growth of hair on different body areas, which are- ear pinna; scalp; trunk
both side; arm & forearm; dorsum of hand, visually and by magnifying lens. Results:
Week
Scalp
Ear pinna
Trunk
Arm & forearm
Dorsum of hand
28-29
P
P
P=7
P =8
A
A=3
A =2
30-31
P
P
P
P
A
32-33
P
P
P
P
A
34-35
P
P
P
P
A =9
P =1
36-41
P
P
P
P
P =8
A =2
P = present; A = absent.
For 28-29 wk gestation, absence of hair on trunk (p = 0.2104) and arm & forearm (p = 0.4561)
was statistically insignificant in comparison to later gestation. For hair at dorsum of hand, p
value for 36-41 wk in comparison to 34-35 wk was 0.0055 and to rest of other groups was
0.0007(statistically significant). Conclusion: As gestation proceeds, hair growth proceeds from
scalp, ear pinna to trunk, arm & forearm. Dorsum of hand is last to show growth.
NEO/37 (P) RETINOPATHY OF PREMATURITY IN PRETERM LOW BIRTH
WEIGHT NEONATE AND ITS ASSOCIATION WITH OXYGEN THERAPY
Atul K.Gupta, Asha Mukherjee, Arghya K.Pal. Somen Sur
Dept. of Pediatrics Ramakrishna Mission Seva Pratisthan Kolkata
Email: [email protected]
Objective: To determine the incidence of Retinopathy of Prematurity (ROP) in preterm low birth
weight babies admitted to the neonatal unit and to study association with oxygen therapy for its
development. Design: Prospective observational study. Setting: Level 2 Neonatal Intensive Care
Unit. Subjects: 50 babies admitted to the neonatal unit during a 1½year period who were ≤1500 g
or whose gestation was ≤ 34 weeks. Methods: Examination of the eye was done in the neonatal
unit or in the neonatal follow up clinic by an Ophthalmologist by indirect Ophthalmoscopy at 4-6
weeks postnatal age. Results: The incidence of ROP was 24%. Of the 50 babies screened, 3 had
stage 1, 5 had stage II, 4 had stage III. The incidence of ROP was 83.3% among < 1000 g babies
and 18.9% among 1000 - 1500 g babies. The incidence of ROP 75% among < 28 weeks, 37.5%
among 29 – 30 weeks and 16.6% among 31 - 32 weeks babies. The maximum stage of ROP
developed between 37-42 weeks post conceptional age in 69% subjects. On univariate analysis,
gestation < 32 weeks, anemia, blood transfusions, apnea and 7 of the 12 ROP babies received
laser photocoagulation. Among ventilated babies 91.6% developed ROP against 8% of CPAP.
Conclusion: The incidence of ROP among high risk babies is significant and duration and typeof
oxygen therapy predicting the development of ROP. All high risk babies should be screened for
ROP. Key words: Retinopathy of prematurity, Prematurity, Low birth weight, Cryotherapy.
NEO/38 (P) MAGNESIUM SULPHATE AS A NEUROPROTECTIVE AGENT FOR
PERINATAL ASPHYXIA IN TERM NEONATES
Raj Prakash, M.R. Savitha
Department of Pediatrics, Mysore Medical College and Research Institute, Mysore, Karnataka
Email: [email protected]
Introduction:Magnesium antagonizes glutamate excitotoxicity and neuronal injury in perinatal
asphyxia and is a promising neuroprotective agent. Aims and objectives:To determine whether
magnesium therapy causes early recovery and favorable neurological outcome at discharge for
asphyxiated term neonates. Materials and methods: This randomized case control study was done
from November 2011 to February 2012 in 120 asphyxiated term neonates (60 cases and 60
controls). Cases received 3 doses of 250 mg/kg magnesium sulphate infusion and controls
received 3 doses of 0.5ml/kg normal saline 24 hours apart. Both groups received supportive care
according to the NICU protocol. Statistical analysis was done through SPSS for
windows(version 16.0).P value < 0.05 was taken as statistically significant. Results:Mild,
moderate and severe hypoxic-ischemic encephalopathy were present in 40%, 56.7% and 3.3%
cases and 45%, 53.3% and 1.7% controls respectively. Post-intervention mean serum magnesium
level of cases was in neuroprotective range of more than 1.2mmol/L. During hospital stay,cases
achieved seizure control earlier than controls(36.5 hours vs 55 hours-p=0.026).More cases
achieved seizure control in less than 2 days(92% vs 70%-p=0.048) and with single antiepileptic
drug(96% vs 74%-p=0.029).Cases recovered early from abnormal neurological findings(3.36 vs
4.96 days-p=0.0001) and more cases recovered within 4 days(84% vs 53%- p=0.0006).Cases
recovered from acute kidney injury early(3.16 vs 4.27 days-p=0.046).At discharge,fewer cases
with moderate and severe encephalopathy had abnormal neuroimaging(20% vs 37.5%p=0.112).Fewer cases had neurological abnormalities(8.6% vs 31.25%-p=0.019) and more cases
established breast feeding(91.4% vs 65.6% p=0.009). Conclusions:Magnesium therapy causes
early recovery and favorable neurological outcome at discharge for asphyxiated term neonates.
NEO/39 (P) ACQUIRED REVERSIBLE DILATED CARDIOMYOPATHY DUE TO
PSEUDOMONAS SEPSIS IN A NEONATE
Kailash Chandra Patra, Sharik Navrungabade, Vaishali Ghane, Sameer Wankhade,
Anjalikalbhande
Department of Paediatrics, ESI PGIMSR, Andheri Mumbai 400093
Email id: [email protected]; [email protected]
Introdcution: Neonatal sepsis remains a cause of significant neonatal morbidity and mortality.
Impairment of the heart in systemic sepsis is called septic cardiomyopathy. Dilated
cardiomyopathy is commonly encountered secondary to viral myocarditis and bacterial
infections with diptheria, mycoplasma, listeriosis and streptococci etc. We present a case of
Reversible Dilated Cardiomyopathy in a neonate with pseudomonas sepsis. Case history: A
preterm SGA, male neonate of 34 weeks of gestation, weighing 1500 grams born by emergency
LSCS i/v/o severe maternal PIH. Baby cried immediately but had respiratory distress at birth
hence required NICU care. Day three of life baby had gastric aspirates, eye discharge, delayed
capillary refill time, poor peripheral pulses indicating sepsis. Baby received oxygen, IV fluids,
and emperical antibiotics for the same. Blood culture collected on day three of life isolated
pseudomonas aeruginosa sensitive to piperacillin, tazobactum and received the same. Baby
clinically responded to the therapy and was feeding well with satisfactory weight gain. On day
30th baby was asymptomatic but had tachycardia, short systolic murmur in 2nd and 3rd left ICS
and enlarged liver measuring 2cms. Family history of congenital heart disease or sudden deaths
was absent. 2D ECHO detected Dilated cardiomyopathy with left ventricular dilatation and
moderately impaired left ventricular function with LVEF of 0.35 to 0.40. A small ASD with left
to right shunt was also noted. Baby received Digoxin, Furosemide, Enalapril, Carvedilol for
three months. Throughout baby remained asymptomatic, had adequate weight gain. Murmur
gradually disappeared and palpable liver regressed by 1cm. 2D ECHO at the end of three months
of antifailure therapy showed normal ventricular wall thickness and contractility, with LVEF of
0.6 and intact IAS. Baby is presently continued on Enalapril and Carvedilol, is on regular follow
up visits and is clinically doing well. Discussion: Septic cardiomyopathy is impairment of heart
in systemic sepsis. Myocardial depression is the most prominent feature of septic
cardiomyopathy, resulting in right and left ventricular pump failure and is potentially reversible.
Septic cardiomyopathy occurs more often than presently diagnosed. In recent years, the concept
of septic cardiomyopathy was proposed, which emphasized alterations of cardiac cellular
phenotype as a basis of cardiomyopathy in response to a variety of agents acting on heart cells.
In systemic sepsis the detrimental action of endogenous mediators, such as tumour necrosis
factor-alpha (TNF-α) , a direct toxicity of the bacterial toxins such as endotoxin ,
Pseudomonas exotoxin A and lipoteichoic acid are potentially found to cause malfunctioning of
various organs, including the heart. Conclusion:Although septic cardiomyopathy is potentially
completely reversible also described as myocardial hibernation, still is a condition of high
prognostic importance as it accounts for approximately 10% of the fatalities observed in sepsis
and septic shock . In at least approximately 50% of all sepsis patients, a systolic pump failure can
be documented by echocardiography.
NEO/40 (P) ‘STUDY OF CORRELATION BETWEEN OAE(OTOACOUSTIC
EMISSION) AND ABR(AUDITORY BRAINSTEM RESPONSE) TEST RESULTS FOR
ASSESSMENT OF HEARING LOSS IN TERM & PRETERM NEWBORNS IN NICU’
Asha Mukherjee, ManomitHaldar, SomosriRay.
31 Lake Temple Road, Kolkata- 700029, West Bengal
Email: [email protected]; [email protected]
Introduction: Universal newborn hearing screening with OAE test is now recommended to detect
hearing impairment. Sensory-neural hearing loss is detected by ABR test.Any correlation
between these 2 tests is very significant,as early detection of hearing impairment helps proper
language acquisition. Aims &Objectives: 1. To find out the incidence of hearing impairment in
both NICU admitted &normal babies. 2. Any correlation between OAE and ABR tests. Materials
& Methods: A prospective observational study was performed on both NICU-admitted (case)
and normal post-natal ward (control) babies. Screening OAE was done on day-3 of life,for all
babies. 2nd OAE was repeated at 6wks. ABR test was done at 3 months of age for all of them.
Results: In the NICU, 17 out of 100 babies had ‘REFER’ result in their screening OAE, out of
which 14 had persistent ‘REFER’ in repeat OAE. On ABR testing at 3 months, 5 showed
abnormal ABR with deafness. In control group, 10 out of 100 had ‘REFER’ result,6 of them had
persistent ‘REFER’ in 2nd OAE; only 1 detected as deaf. Prematurity,Mechanical ventilation,
Sepsis , Jaundice& Drugs were significantly associated with abnormal OAE & ABR test.
Conclusion: 1.Risks of sensory-neural hearing loss is more in NICU admitted babies. 2.
Bothabnormal OAE & ABR test results were having good correlation with deafness. Therefore, a
combination of these 2 tests is well suited for use in hearing assessment in newborn & older.
NEO/41 (P) ASSESSMENT OF HEARING LOSS IN NORMAL NEWBORNS&
CORRELATION BETWEEN OAE & ABR TEST RESULTS’
Asha Mukherjee, ManomitHaldar, SomosriRay.
31 Lake Temple Road, Kolkata- 700029, West Bengal
Email: [email protected]; [email protected]
Introduction: Hearing impairment is the most common congenital abnormality in
newborns.OAE& ABR are 2 different tests for hearing assessment. OAE detects hearing
impairment upto outer hair-cell of cochlea. Sensory-neural hearing loss due to neural
dysfunction or auditory brain-stem affection is detected by ABR test. Because of this high
incidence of hearing-loss in normal babies, universal newborn hearing screening with OAE &
ABR tests should be mandatory. Aims &Objectives: 1. To find out the incidence of hearing
impairment in normal newborns. 2. Any correlation between OAE and ABR tests. Materials &
Methods: A prospective observational study was performed on normal post-natal ward
babies.100 normal newborns above 37wks without any risk-factors were taken as subjects.
Screening OAE was done on day-3 of life,for all babies. 2nd OAE was repeated at 6wks. ABR
test was done at 3 months of age for all of them. Results: 10 out of 100 normal babies had
‘REFER’ result during screening OAE.6 of the initial 10 abnormal subjects had persistent
‘REFER’ on repeat OAE. 1 baby had abnormal ABR & diagnosed as deaf. Conclusion:
1.Incidence of hearing loss is quite high, even in normal newborns. 2.Both abnormal OAE &
ABR test results were having good correlation with deafness.
NEO/42 (P) STUDY ON NEONATAL JAUNDICE WITH SPECIAL REFERENCE TO
GLUCOSE 6 PHOSPHATE DEHYDROGENASE (G6PD) DEFICIENCY
Sabyasachi Das.
Junior Resident. R.G.Kar Medical College and Hospital. Kolkata-700001, West Bengal
Email: [email protected]
Introduction: Jaundice is the most common condition that requires medical attention in
newborns. G6PD has been reported as an important cause of pathological jaundice. Data on
prevalence of G6PD deficiency among jaundiced neonates is lacking from West Bengal. Aims
and Objectives: a) Frequency of different causes of pathological jaundice and prevalence of
G6Pd deficiency among jaundiced neonates. b) Finding any correlation between the frequency of
G6PD deficiency and sex, religion, gestational age, birth weight, peak total serum bilirubin
(TSB), significant hyperbilirubinemia, requirement of phototherapy and exchange transfusion of
neonates. Materials and method: A cross-sectional study was done for a duration of 4 months
among all jaundiced neonates admitted in baby nursery, RGKarMCH. Complete hemogram,
CRP, liver function test, direct coombs test, blood grouping of mother and baby and quantitive
assay of G6PD was done. The data obtained was analysed by SPSS 17 to find any correlation
between them. Results: ● ABO incompatibility (30.99%) was the leading cause followed by
G6PD deficiency (6.61%). ● TSB, duration of phototherapy, frequency of exchange transfusion,
significant hyperbilirubinemia ( bilirubin > 20mg/dl) was found to be significantly higher in
G6PD deficient group than G6PD normal group. No significant difference was found in regards
to sex, religion, gestational maturity, birth weight or haemoglobin level. ● The G6PD level of
neonates with gestational age 30-32 weeks were significantly higher than neonates of 3840weeks and 40-42weeks. Conclusion: Newborn screening for G6PD deficiency is a necessity in
West Bengal.
NEO/43 (P) SPECTRUM OF RESPIRATORY DISTRESS IN NEWBORN: A STUDY
FROM A TERTIARY CARE HOSPITAL IN KOLKATA.
Abhijit Dutta, Sibnath Gayen, Sabyasachi Ghosh, Pradip Pakira, M.Basu, S.Ghosh
Asst. professor, Dept. of Pediatrics, R.G.Kar Medical collage, 1.No.Khudiram Bose Sarani,
Kolkata -700004
Email: [email protected]
Abstract: Introduction: Respiratory distress is a common problem in neonatal problem. It is an
important cause of of neonatal mortality. The etiology of respiratory distress in newborn is large,
include, transient tachypnea of the newborn, respiratory distress syndrome, meconium aspiration
syndrome and other miscellaneous causes. Aims & Objective: To find out the incidence and
aetiology of respiratory distress among admitted newborn babies. Materials and Methods: This
prospective study was conducted among 2382 inborn newborns admitted in neonatal care unit of
R.G. Kar Medical Collage & Hospital between June 2010 to march 2011.The cases were
analysed for incidence and aetiology of respiratory distress. Results: In the study population,
respiratory distress was detected in 152 newborns, comprising 6.4% of all newborn admission
and 14.5% of sick newborns. Transient tachypnea of the newborn was the commonest cause
(32.23%) of respiratory distress followed by pneumonia (24.35%), meconium aspiration
syndrome (13.15%), perinatal asphyxia (12.5%), RDS (7.9%), cardiovascular (3.3%) and
surgical cause (2.63%). Conclusion: The incidence and etiology of respiratory distress is
comparable to other studies except, relative high incidence of MAS and birth asphyxia. The
incidence of RDS among ELBW was quite high (41.6%). Besides early onset tachypnea with
grunting and subcostal suction along with increasing oxygen demand, frothing from mouth was
an important early finding of RDS.
NEO/44 (P) A CASE OF MISOPROSTOL EMBRYOPATHY
M.Sabarinath, M. Balasubramaniam, E. Sivakumar, P. Ramasubramaniam, S. Balasankar, M.
Nagendran, G.Mathevan
Room No-609, Pg Hostel Oasis, Madurai Medical College, Panagal Road, Shenoy Nagar,
Madurai-625020.
[email protected]
Abstract: Misoprostol is a synthetic prostaglandin E1 analogue that has been used as an
abortifacient. If abortion doesn’t occur and the conception continues, the baby delivered may
have wide range of defects depending on the time of exposure to misoprostol. Central nervous
system and limb defects are the most commonly reported anomalies. Here we report a case of
newborn with limb defects with history of prenatal exposure to misoprostol. A female baby was
born on 03-03-2012 to a non -consanguineous 33year old father and a 23year old mother. The
mother has taken by herself one tablet (200mcg) of misoprostol orally during the first trimester
of pregnancy with the intention of aborting the fetus. Mother didn’t seek any medical help,
though it didn’t result in abortion and she continued with the pregnancy. Antenatal period was
otherwise uneventful. The baby was delivered at term by caesarean section and the birth weight
was 2.7 kg. On physical examination, the baby showed absence of all four fingers of right hand
and rudimentary thumb. The rest of the physical and neurological examination was normal and
there was no other congenital anomaly. The limb defect the child had is most probably due to
misoprostol ingestion during the first trimester. A plausible teratogenic mechanism involves
uterine contractions induced by misoprostol. Such contractions could potentially create a
vascular disruption of the fetal–placental unit, resulting in a range of defects. Hence prenatal
exposure of misoprostol should be considered in the setting of congenital anomalies
phenotypically similar to amniotic band sequence.
NEO/45 (P) TO STUDY THE INCIDENCE AND OUTCOME OF NEONATE WITH
HYPERBILLIRUBINEMIA IN PT.J.N.M.M.C. RAIPUR (CG)
Sharja Phuljhele, Akash, Kanak
Dept. of Pediatrics, Administrative Block, Dr.B.R.A.M.Hospital and, Pt.J.N.M.Medical College,
Raipur, C.G
Email- [email protected]
Introduction. Neonatal jaundice is the most common reason for readmission to hospital in the
first week of life. About 60% of term and 80% of preterm babies develop jaundice in the first
week of life. Objective. Study was done to evaluate the incidence and outcome of Neonatal
Hyperbilirubenemia. Material and Method:- All the neonates admitted in NICU during OCT
2011 to 27th SEP 2012 with hyperbilirubinemia were included and were classified as term or
preterm according to the day of presentation and the treatment modalities and outcome. Result.
Out of 1466 cases 353 had NNHB.Of these, 38 were Preterm admissions , of which 11 were
Inborn and 27 were Outborn.315 term admissions of which 65 were Outborn and 250 were
Inborn. 14 preterm and 89 term were ABO incompatible while 2 preterm and 10 term were Rhincompatable. Total 12 exchange transfusions were done during this period of which 7 were
done for incompatibility, of which 5 for ABO and 2 for Rh incompatibility. No death was
reported. Conclusion. My study showed that one fourth of all NICU admission were NNHB,
most of them were Term, out of which ABO-incompatible were one third and 3% were Rhincompitable. With interventions (Phototherapy and Exchange transfusion) outcome was
excellent and no death was reported.
NEO/46 (P) PATTERN OF DISTRIBUTION OF CONGENITAL ANOMALIES IN THE
NEWBORNS IN A TERTIARY CARE HOSPITAL IN EASTERN INDIA
Abhijit Dutta, Chaitali Patra, Shatanik Sarkar, Prativa Biswas, Shaon Mitra, S.Ghosh
Dept. of Pediatrics., R.G.Kar Medical collage, 1.No.Khudiram Bose Sarani, Kolkata—700004
E.Mail: [email protected]
Abstract: Introduction: Congenital anomalies are important cause of neonatal mortality both in
developed and developing countries. It is not only a leading cause of fetal loss, but also
contributes significantly to preterm birth, childhood and adult morbidity along with considerable
repercussion on the mothers and the families. Aims & Objectives: To determine the incidence
and distribution pattern of congenital anomalies in newborns and associated maternal risk
factors. Materials And Methods: This prospective study was carried out in the obstetrics and
gynaecology department and neonatal care unit of R. G. Kar Medical College and Hospital
during the period of August 2011 to July 2012. The newborns were examined and assessed
systematically for the presence of congenital anomalies. System wise distribution of anomalies
and risk factors were analysed. Results: During the study period,17896 newborns were delivered,
of which 286 had congenital malformation, making the incidence of 1.59%. Congenital
anomalies were more commonly (66%) seen in the multiparas. Most of the women (57%)
belonged to the age group between 21 to 30 years. Prematurity and low birth weight was found
to have a higher risk of congenital anomalies. The predominant system involved was musculoskeletal system followed by central nervous system. Talipes was the commonest one in
musculoskeletal group and likewise meningomyelocele in CNS. Conclusion: The commonest
associated risk factor was low birth weight, prematurity and multiparity, the frequency of which
may be reduced by creating awareness regarding regular antenatal visit and early prenatal
diagnosis.
NEO/47 (P) EARLY RECOGNITION AND IMMEDIATE OUTCOME OF NEONATAL
SEIZURES
Satish Ashtekar, Uday Rajput, S.S.Wagh, Nikhil Kadam
Government Medical College, Miraj, Sangli- 416410, Maharashtra
Email: [email protected]
Introduction- Recognition of neonatal seizures is difficult because subtle seizure is the most
common type of neonatal seizure. Unrecognised seizure of prolonged duration is associated with
poor neurological outcome in future.Hence early recognition of various presentation of neonatal
seizure is useful to reduce the morbidity and mortality associated with it. Aims And Objectives:
● To find out clinical manifestation and various presentation of neonatal seizures. Materials and
methods- The present study was conducted at tertiary care NICU at government medical college
and hospital, during the period of 2 years. Those babies who have presented with seizures in
NICU(witnessed seizures) are included Those who are referred from outside or with history of
convulsions are excluded. Study Design: a hospital based prospective observational study.
Methodology:neonates presented with seizures are recognized by medical or paramedical staff
which are readily acted upon by anticonvulsants and supportive measures.The anticonvulsants
used are lorazepam,phenobarbitone,phenytoin,midazolam.neurological outcome in each patient
ie evaluated over a period of time. Statistical methods-observations drawn. ● Results- Baseline
characteristics- Incidence of Neonatal Seizures is higher in preterm babies(22.98%) than
term(6.18%) babies ,There is higher preponderance of male infants(5.72%) in the seizure
population. Seizure rate is least found in babies between 30 to < 37 completed weeks of
gestation(4.42%) ● Primary outcome measure are; overall Subtle seizures are commonest (48%)
seizure type.subtle seizures are commonest (61.9%) in preterm babies. Multi-focal Clonic type
of seizures common in term babies. Secondary outcome measured are mortality due to seizures is
22% of neonates. Out of 29 patients died, in 16 pts(55%) died even if using 3
anticonvulsants(loraz+phenobarb+phenytoin/midaz) Conclusions : ● Subtle seizures are
commonest seizure type seen.mortality and neurological outcome is poor when more number of
anticonvulsant used. ● Early recognition is the key to good outcome in neonatal seizures.
NEO/48 (P) PREDICTING OUTCOME IN TERM NEONATES WITH HYPOXIC
ISCHEMIC ENCEPHALOPATHY USING ELECTROENCEPHALOGRAPHY AND
MAGNETIC RESONANCE IMAGING
Chetan. M, G.S. Sengar, Anil Lahoti, C.K. Chahar
Department of Pediatrics, S.P Medical College, Bikaner, Rajasthan
Email ID: [email protected]
Abstract: Introduction: Magnetic Resonance Imaging of the neonatal brain and
Electroencephalography have been used either independently or together to assess the prognosis
of HIE. Objectives: To evaluate the clinical spectrum, MRI and Electroencephalography profile
of neonatal HIE and to correlate these findings with neurodevelopmental outcome. Methods: In
all the neonates enrolled in the study, detailed history regarding antenatal events, Apgar scores,
resuscitation notes were recorded. The severity of HIE was assessed using Sarnat & Sarnat
staging system. All infants had a MRI between 2nd to 8th postnatal days. An EEG was recorded
once the baby became stable using the standard 10-20 International system. Neurological
examination, anthropometry were performed during admission in the unit. All neonates were
followed up at monthly intervals and a neurodevelopmental outcome was assessed at 6 months
using Denver Developmental Screening Test II. Results: In a total of 70 term neonates with HIE,
16 neonates had mild HIE (22%), 45 had moderate HIE (65%) and 9 neonates were grouped into
severe HIE (13%). Both MRI and EEG were predictive of outcome. A normal MRI was always
associated with normal EEG and normal neurodevelopment. Severe changes on MRI (i.e. severe
Basal ganglia and thalamus with white matter lesions) were associated with stage 4 EEG changes
(abnormal background and presence of epileptiform discharges) and were also associated with
poor neurodevelopmental outcome. Conclusion: Both Electroencephalography and MRI are
valuable tools that predict the prognosis of infants with HIE thus helping in choosing the best
possible preventive measure and also in counselling parents regarding further development of the
infant.
NEO/49 (P) INDICATORS OF MECONIUM STAINED AMNIOTIC FLUID AND
NEONATAL OUTCOME IN RELATION TO MATERNAL FACTORS
Uday Rajput, Nikhil kadam, S.S Wagh
Government Medical College, Miraj, Sangli- 416410, Maharashtra
Email: [email protected]
Introduction-Meconium Aspiration Syndrome (MAS)continues to be threat to many newborns
throughout world with a case fatality rate of 5%(as much as 40%),in addition to short and long
term pulmonary and neurodevelopmental sequale. In resource poor developing countries like
India where modern electronic gadgets for foetal monitoring like NST,FETAL DOPLER are not
available at every situation, it is difficult to predict the foetal outcome. Therefore, this study is
planned to highlight the antenatal,intranatal factors responsible for MSL and markers for
prevention of early neonatal mortality and morbidity. With this knowledge,we provide approach
to enhance health outcomes among neonates by early enactment. Materials- Setting-Tertiary care
NICU. Subjects- Study was conducted on 200 babies born with meconium stained amniotic
fluid who are admitted in NICU , born in ANC ward and outborn babies referred for meconium
stained liquor. Inclusion criteria-all babies born to mothers who had meconium stained amniotic
fluid inclusive of their birth weight and gestational age. Exclusion criteria-Babies with
congenital abnormalities were excluded from the study. Methodology. Detail history of babies
and
mother
with
MSAF
noted
with
emphasis
on
antepartum(PIH,Oligohydramnios,anaemia,antepartum haemorrhage) and intrapartum risk
factors and factors like need of resuscitation ,need for NICU admission, consistency of
meconium(thick,thin and moderate)etc.were taken. Results- During study period of 2 months,
there were 1513 livebirths, out of which 200 babies born with MSAF. Thus, making incidence
of MSAF to 13.21%.. Primary outcome- Common maternal and fetal risk factors were foetal
distress(30%)followed by Oligohydramnios(30%),Pregnancy induced hypertension(24%),
anemia(14%),severe
anemia(5%),
Antepartum
hemorrhage(4%)
and
Antepartum
eclampsia(4%).Out of 200,48 babies were admitted to NICU and mean duration of NICU stay
was 4 days. Most common indication for NICU admission were birth asphyxia (16%) and MAS
(6%) .Total number of deaths were 18 and all these babies had thick meconium with severe birth
asphyxia. Secondary outcome-out of 200,78 mothers are between 20-25 yrs of age,122 were >25
years of age.out of 200,136 mother has wt 40-50 kg,54 has 50-60 kg. out of 200,86(43%) were
primigravida,114(57%) were multigravida. Out of 200,159(72.5%) were >37 weeks of
gestation(post dated),33(16.5%),were 35-36 weeks of gestation,8(4%) were <34 weeks of
gestation. There were 110 male babies and 90 females babies . 104(54%) had BW < 2.5
Kg,96(43%) had BW>2.5 kg,. Majority of babies were delivered through thin MSL(44%)
followed by thick (35%) and moderate (21%). Out of these 18 babies,4 had septicaemia with
DIC and 2 had NIH. 38 babies were non vigorous requiring tracheal suctioning and positive
pressure ventilation at birth. Common mode of delivery was emergency Cesarean in 83%
patients. Conclusions-Oligohydramnios,PIH,anemia and fetal distress were common antenatal
and intranatal factors associated with MSAF. Major morbidity and indication for NICU
admission was Birth asphyxia and non vigorous babies.Mortality rate was 9% which is
commonly associated with thick meconium and severe birth asphyxia.
NEO/50 (P) ADRENALINE IN REFRACTORY SHOCK IN NEWBORNS WITH BIRTH
ASPHYXIA
Sharath Chandra N, Usha B K,Sudha Rudrappa
Department of Pediatrics, Mysore medical College & Research Institute.
Email: [email protected]
Introduction: Shock is an important cause of morbidity and mortality in new born.Shock in
babies with birth asphyxia is cardiogenic. Ionotropes are used in the management of shock.
Adrenaline with its actions on both α and β receptors is used as ionotropes when shock is
resistant to dopamine and dobutamine. Aims And Objectives: To evaluate adrenaline as
ionotropes in refractory shock in newborn with birth asphyxia. Materials And Methods: Study
was conducted from June to Aug 2011.Newborn with Apgar score < 5 at 10 min were admitted.
NIBP mean arterial pressure was used as reference to start ionotropes and during treatment.
Fluidchallenge 20ml/kg given.Inotropes started in order dobutamine,dopamine and
adrenaline.Baby was evaluated for sepsis and for bleeding.When MAP was stable for 24
hrs,ionotropes was tapered and stopped. Results: There were 15 cases with male:female - 2.75:1.
11(73.37%) delivered vaginally.10(66.6%) were term.
Total 15
N
%
MSAF
6
40
Wt < 2499
6
40
>2500
9
60
Resp distress
11
73
Resp failure
7
46
HIE I
6
40
II
7
46
III
1
6.6
G I hage
5
33
Blood culture
4
26.6
Duration of adrenaline <24 hrs
Death 6
40
Survived 2
13.3
>24 hrs
Survived 7
46.6
Dose of adrenaline(µg/kg/min) 0.1
Survived 7
46.6
Death 0
0
0.2
Death 5
33.3
Survived 2
13.3
0.3
Death 1
6.6
Recovered from shock
9
60
Death
6
40
Conclusions: 1. Adrenaline is an effective adjunct to ionotopes in refractory shock. Adrenaline
when started early even in small doses improves survival of babies
NEO/51 (O) PROBIOTICS HAVE A ROLE IN LATE-ONSET SEPSIS BY CANDIDA
SPECIES IN PRETERM NEONATES
Amrita Roy, Swapna Chakraborty,
Department of Paediatric Medicine, Medical College, Kolkata
Email: [email protected]
Introduction: Candidemia in the neonatal intensive care unit (NICU) is steadily increasing, with
an incidence of 1.6 to 9% in very-low-birth-weight neonates. The gastrointestinal tract is most
frequently implicated site in candida septicaemia. Aims & Objectives: Probiotics may reduce the
colonization of fungal colonies in the gastrointestinal tract, and reduce the risk of bacterial and/or
fungal nosocomial infections. Materials & Methods: From May 2009 to July 2010, a prospective
randomized trial was conducted in 166 preterms with a birth weight <2500 g and a gestational
age <37 weeks consecutively admitted at the NICU & Nursery of Medical College & Hospitals,
Kolkata. Inclusion criteria were stable oral feeding within 72 h of birth and an informed parental
consent; exclusion criteria were the presence of major congenital malformation or antenatal and
perinatal risk factors for sepsis. The newborns were randomized into 2 groups by simple random
sampling: group I (n=83) received supplementation with Enterogermina 5 drops daily from the
first 72 h after hospitalization for 6 weeks or until they were discharged; group II(control) (n=83)
received with no probiotics. Stool samples were cultured for Candida detection & CFU (Colony
forming Units) at birth and after 7, 14, 21 and 28 days or till discharge. Statistics: χ2 test and
Fisher's exact test was used when applicable. Results: No significant differences at baseline
between the 2 groups. The probiotic group presented a significant reduction in gastrointestinal
symptoms than the control group. Candida stool colonization was significantly higher (P<0.01)
in the control group. The number of invasive Candida infections between 2 groups was not
statistically different. All the infants with invasive fungal infection had a gestational age <32
weeks and a birth weight <1500 g. No statistical difference was observed in the duration of
antifungal treatment however, neonates with probiotic supplementation resulted in a fast clinical
improvement. Conclusion: The use of both probiotics seems to be effective in the prevention of
gastrointestinal colonization by Candida, faster clinical improvement in candida septicaemia.
However, it could not decrease the incidence of late onset sepsis.
NEO/52 (P) ROP SCREENING BY RET CAM
M K Behera, A Parekh, S Kulkarni, P Soni
Dept of Paediatrics S K N Medical College & Hospital Pune , 411041
Email: [email protected]; [email protected]
Introduction: ROP is a fibro vascular proliferative disorder, affect the developing retina of
preterm infants and it is an important avoidable cause of blindness in children. RETCAM for
ROP screening is very sensitive for early diagnosis and follow up. Aim & Objective: A
prospective follow up study was conducted to determine the incidence of ROP and to analyze the
associated risk factor. Material & Method: All babies < 34 wks and weight < 1750 gram as
well as 34 -37 wks & weight 1750-2000 grm with risk factors were screened for ROP from
April 2009 to March 2012 in NICU and High risk follow up clinics in S.K.N. Medical
College & Hospital Pune in collaboration with S. V. Desai Eye Hospital Pune by using
RETCAM . Expired babies & lost to follow up were excluded from the study. Result: Total
Babies screened 83, ROP detected in 21 and incidence of ROP is 25.30 %. Incidences of ROP
in babies < 1000 gm - 62% , in < 1200 gm – 48% ,in > 1200 gm 14%, 5 ( 25% )ROP babies
are <1000 gm, 13 ( 62% ) are < 1200 gm and 8( 38% ) are > 1200 gm . Male: female ratio of
ROP babies 10:11 , Mean wt of ROP babies - 1.19 kg ± 0. 25. Mean age of of ROP babies
29.81 ± 2.13. . ROP Stage I in 3 (14%), stage 2 & stage 3 each in 8 (38%), Plus disease 2
(9.52%) , 5 babies (24%) were treated with laser therapy . Lower birth weight was significantly
associated with increased incidences and seventy of ROP. On variant analysis risk factors like
oxygen administration, RDS, blood transfusion, apneas, ventilation, and de saturation were
significant (p < 0001). Conclusion: ROP screening with RETCAM is an easy procedure avoid
stress and expertise of indirect opthalmoscopy, it eliminate inter observer variability. It is very
useful for early diagnosis, follow up, documentation and helps in referring the images for
opinion of
NEO/53 (P) STUDY OF RETINOPATHY OF PREMATURITY IN A TERTIARY CARE
NEONATAL UNIT
Ranjit Kumar Joshi, Anjali Kulkarni
Dept. of Pediatrics, Apollo Hospital, Unit-15, Sainik School Road, Bhubaneswar-751005,
Odisha
E-mail: [email protected]
Objective: To study the incidence, risk factors, early diagnosis and treatment of retinopathy of
prematurity. Design: Both Retrospective and Prospective study comprises of 145 babies.
Settings: Infants admitted to tertiary care neonatal intensive care unit between Apr-2008 to Apr2012. Methods: Both inborn and outborn with birth weight <1500kgs and gestation<32 weeks
and selected infants with birth weight between 1500 to 2000 grams and more than 32 weeks with
unstable clinical course were screened for ROP at 6 weeks post-gestational age(for<26 weeks
gestation); at 5 weeks(27 to 28 weeks); at 4 weeks (29 to 30 weeks) and at 3 weeks for >30
weeks babies. Infant found to have threshold ROP had laser photocoagulation. Results: The
incidence of ROP was 30% and highest in <1000 grams (58%) and <28 weeks(75%).Comorbidities such as packed red blood cell transfusion (p<0.0001), sepsis (p<0.0001) and
prolonged ventilation(p<0.0001) were associated with majority of ROP cases. Duration of
ventilation and labile oxygen requirement for prolonged period was also associated with higher
stage of ROP and requirement of LASER. Out of 44 infants who had ROP, 20(45%) needed laser
photocoagulation. Conclusion: Incidence of ROP is increasing due to increased survival of low
birth weight babies. So early diagnosis with reduction of risk factors can prevent serious
morbidities.
NEO/54 (P) PROFILE OF NEONATAL MENINGITIS CASES IN A TERTIARY LEVEL
HOSPITAL
Kanta Boro, Reeta Bora, Diganta Barman, Ajay kumar
Department of Paediatrics,Assam Medical College,Dibrugarh
Email: [email protected]
Introduction: Studies done in late 90s have found neonatal meningitis to be associated with
neurological sequele in almost 50%.Neonatal care has improved in recent years. No study is
available in our state to find out profile and sequele of neonatal meningitis. Setting: Neonatal
unit,AMCH. Objectives: To find 1. Incidence of neonatal meningitis 2. neonatal outcome after
meningitis.
Materials
And
Methods:
Neonates
born
in
AMCH
between
September,2011&February,2012 with clinical or culture proven sepsis with meningitis were
included. Neonates with CMF & needing surgery were excluded. Enrolment was done if septic
neonates had CSF suggestive of meningitis biochemically/cytologically. Neurological
examination& USG cranium was done at discharge. Follow up was at 1,3,6 months . Results:
After applying exclusion & inclusion criteria 47 babies were included. 545preterm&3668term
were born during study period .Meningitis was present in 17 preterm & 30 term
babies.(p<0.01)&in 38/102 culture positive sepsis(37.25%)&9/54 clinical sepsis(16.67%).91.4%
had EOS. Respiratory distress was the commonest symptom(53%) followed by
HYPOGLYCEMIA(23%) followed by convulsion(14.9%).Predominant organism was GRAM
NEGATIVE BACILLI(36.17%). In Csf average value of protein(mg%) was 194(50400),sugar(mg%) 32(0.5-60)&cells(/cm3)165(5-4500).Csf culture was positive in 2.1%.USG
cranium at discharge was abnormal in 21% cases.Neurological examination was abnormal in
15% cases at discharge&in 19.4% cases at 6 month(p<0.01).7.7% babies died during follow up
period. Conclusion: Neonatal meningitis was more common in preterms. Neurological sequele
with present management is 19%.Longterm neurological follow up is essential.
NEO/55 (O) SEVEN DAYS VERSUS 14-DAYS OF INTRAVENOUS ANTIBIOTICS FOR
NEONATAL SEPTICEMIA – A RANDOMIZED TRIAL
Saurabh Kataria, Reeta Bora
Department of Paediatrics, Assam Medical College (AMC), Dibrugarh
Email: [email protected]
Setting: Neonatal unit AMC, Dibrugarh. Introduction: Studies done to find out ideal duration of
antibiotics for neonatal sepsis (NNS), a major cause of neonatal death are few with no acceptable
conclusion. A short course of antibiotic for culture proven NNS if proven efficacious, will reduce
complications like NEC, microbial resistance etc. Objectives: To find if 1. 7-day antibiotic
course is comparable to 14-day course in NNS. 2. Relapse rate varies with causative organism.
Materials And Methods: Inborn neonates >30wks gestational age (GA) & birth weight (BW)
>1000grams born during study period with blood culture-positive sepsis were included.
Neonates with major CMF, deep seated infection, meningitis or needing major surgical treatment
were excluded. Enrolment and randomization was done if neonates had culture- positive sepsis
&asymptomatic after 5 days of antibiotics. Reappearance of signs of sepsis within15 days of
stopping antibiotics with same growth in blood culture was relapse. Neonates were followed for
15 days after stopping antibiotics. For statistical analysis, chi-square was applied for categorical
variates. For statistical calculations, SPSS software was used. Results: After applying exclusion
& inclusion criteria 39 babies were randomized to 7 days &40 babies to 14 days AB course
(n=79). In 7-days group EOS: LOS was 97.5%:2.5% & in 14-days group 90%:10% (P=0.3).In 7days group symptomatic: asymptomatic was 80:20 and in 14-days gr 85:15(p=0.7). Sepsis screen
was positive in 76.92% in 7-day group &in 62.5% in14-days group (P= 0.25). Staphylococcus
aureus was predominant organism in both groups (58.97%in 7-days& 50%in 14-days group). No
relapse was seen in both groups. Conclusion: 7-days antibiotic course is equally effective as 14days course for blood culture-positive sepsis.
NEO/56 (P) STUDY TO IDENTIFY NEWBORN AT RISK OF DEVELOPMENT OF
HYPERBILIRUBINEMA USING FIRST DAY TOTAL SERUM BILIRUBIN (TSB)
Chandan CK, Mounesh P,Chinmay B,N Tago,N Mohanty
S/O Ca Kumar, Mig-I Door # 30, Housing Board , Kr Nagar, Mysore – 571602, Karnataka
Email: [email protected]
Introduction: Jaundice is commonly encountered clinical condition and constitutes major
morbidity 50-60% in term and >80% preterm baby within early neonatal period.Neonatal
hyperbilirubinemia is considered to be significant when Total Serum Bilirubin (TSB)
≥17mg/dl.Trend of early discharge of newborn has led to significant re-admission for
jaundice.Hence there is need for to predict development of jaundice to prevent possible re
admission. Aims And Objectives: To evaluate co-relation of first day TSB with occurrence of
jaundice in early neonatal period. Materials And Methods: Prospective study was conducted in
SNCU of SCB Medical College.250 Healthy term neonates ≥37 weeks with no risk factors were
enrolled in study. TSB was measured on D1, D3, D5 of life by modified jendrassik-grof
method.TSB ≥6mg/dl on D1 of life was taken as cut off value for risk assessment. Result: With
ROC analysis mean TSB of ≥6mg/dl on D1 of life was found to have sensitivity of 94% to
predict new born who would have significant jaundice. With this critical mean
TSB≥6mg/dl,negative predictive value was very high 98.4% and positive predictive value was
22.3%.Of the 134 newborn who had TSB≥6mg/dl, 35% and 51% developed significant jaundice
on D3& D5 of life respectively and only 6% and 10%of newborn with TSB<6mg/dl developed
significant jaundice on D1&D5. Conclusion: Mean TSB ≥6mg/dl on D1 of life as cut off can be
useful to predict significant hyperbilirubinemia in early neonatal period, but study need to be
conducted in large scale and can be established as tool to predict N hyperbilirubinemia.
NEO/57 (P) A PROSPECTIVE STUDY ON IMPACT OF KANGAROO MOTHER CARE
IN REDUCING MORBIDITY AND MORTALITY AMONG LOW BIRTH WEIGHT
BABIES IN A TERTIARY CARE HOSPITAL
Nandini Naskar, Leena Das, Pravakar Mishra, Niranjan Mohanty
Department of Pediatrics, SCB Medical College & Hospital, Cuttack-753007, Odisha
Email: [email protected]
Introduction: Worldwide more than 20 million babies are born each year with low birth weight
either because of preterm birth or impaired prenatal growth.These babies require intensive
neonatal nursing & care from often limited resources at a vast expence.Kangaroo mother care (
KMC) is defined as skin to skin contact between mother and baby,early initiation of frequent and
exclusive breast feeding and early discharge from hospital so as to continue such care at home.
Aims & Objectives: To determine whether there is evidence to support the use of KMC in low
birth weight infants as an alternative to conventional neonatal care. Materials & Methods: Place
of study: Newborn ward of SCB Medical College & Hospital and SVP PGIP,Cuttack. Study
design: Prospective Cohort study. Duration of study: 1 year study from October 2011 to
September 2012. Study subjects: 240 low birth weight newborns (<1800g) with mothers
complying with our study, started KMC after stabilisation of the newborn for at least 6 hr/day.
Study instrument: Pre designed proforma, electronic weight machine and measuring tape. Data
thus obtained was tabulated and analysed using percentage, relative risk (RR), mean difference
and chi square test. Results: At discharge or 40 week post menstrual age KMC was found to be
associated with a significant reduction in the risk of mortality(RR 0.7), nosocomial sepsis(RR
0.55), hypothermia(RR 0.32)length of hospital stay ( mean difference 3 .1 days). KMC has
significant positive impact on initiation and sustaining breast feeding, growth parameters and
mother infant bonding. Conclusion: This study supports the use of KMC in low birth weight
babies as an alternative to conventional neonatal care mainly in resource limited settings.
NEO/58 (P) NEWBORN SCREENING FOR CONGENITAL HYPOTHYROIDISM (CH)
IN UTTAR PRADESH UP)
Bhatia V, Joshi K, Gopalakrishnan V, Dabadghao P, Phadke SR, Das V, Agarwal M.
Additional Professor, Department Of Endocrinology, Sgpgims, Post Box- 375, Lucknow 226001, Uttar Pradesh
Email: [email protected]
Introduction – Newborn screening (NBS) in India is still in its nascent stages due to poor
infrastructure and economic constraints. Aims and Objectives- To evaluate feasibility and recall
rates in a thyroidNBS program in underprivileged population in UP.Methods- Post natal heel
prick samples were collected on Whatman 903 filter papers at 24 to 96 hours of life for TSH
assayby immunofluorescence. Babies with screen TSH20 - 40miu/L were recalled for repeat
filter paper sample at10 days.Those with screen TSH>40miu/L were immediately recalled for
serum TSH and T4. After the first 5000 babies,in view of high recall rates, age related cut offs
were used:TSH >34miu/l during 24-48 hours of life and >20miu/L after 48 hours. Results11,700 newborns were screened. 5% mothers refused screening and 11% of those recalled
refused to come for confirmatory sample. Using 20miu/l cutoff,recall rate was 1.47%.With age
related cutoffs,recall was lowered to 0.88%, though still high.Nine babies with CH were
identified. Three (screen TSH 96 to 331miu/L)have transient CHand are off therapy. Three have
permanent CH (imaging and follow up findings).Three are possibly transient, on tapering doses
of levothyroxine at 4 to 6 months of age. Conclusions - NBS can be successfully implemented in
underprivileged regions of India. Age related cutoffs may be necessary to deal with the high
recall rate resulting from early discharge and neonatal TSH surge. Follow up is important to
distinguish transient and permanent CH.
NEO/59 (P) EVALUATION OF NEONATAL JAUNDICE BY TRANSCUTANEOUS
BILIRUBIN MEASUREMENT DEVICE (BILICHECK)
Devdeep Mukherjee, Rafiqul Hassan,.Apurba Ghosh
Institute Of Child Health, Kolkata 17
Email – [email protected].
Introduction: Levels of transcutaneous bilirubin (TcB) can be determined with a device that non
invasively estimates total serum bilirubin levels by measuring light transmission through the skin
of neonates. Materials And Methods: 120 neonates were studied during September 2011 to
August 2012 at NICU of ICH, Kolkata. All neonates having clinical jaundice, requiring
estimation of serum bilirubin were included in the study. Babies who had received phototherapy
or had an exchange transfusion were excluded. BILICHECK (transcutaneous bilirubinometer)
and Laboratory method (Diazo Reaction) were used for the study. Neonates were investigated for
total serum bilirubin by a single standard laboratory method and simultaneously with
transcutaneous measurement of bilirubin by BILICHECK. Results: 60 neonates were male. The
study group was divided into term (83 neonates) and preterm (37 neonates).Mean gestational age
was 37.9 weeks and mean birth weight was 2583.3 grams. Mean age when measurements were
taken was 74.3 hours. The overall correlation of TcB and TSB for the whole population is linear
and statistically significant. Pearson”s correlation co-efficient: r=0-79, P = <0.001 and r2 =
0.61.Similar correlation existed between TcB and TSB in term population as was in whole
population. Pearson”s correlation co-efficient r= 0.79, P= <0.001 and r2= 0.62.Corelation
between TcB and TSB was linear and statistically significant for pre-term population. Pearson”s
correlation co-efficient r=0.78, r2 =.602, P<0.001.The average error in evaluating
hyperbilirubinemia with TcB compared with evaluation with TSB was 0.3mg/dl (95% CI = -5.9
to 6.4). This finding means that TcB measurement slightly underestimated in comparison with
TSB. The agreement between TcB and TSB was poor with increasing bilirubin level. Only 6 data
point (5%) fall outside 2SD of the difference, indicating that the difference were normally
distributed. Conclusion: According to our results,TcB level was correlated well with the
laboratory measurement of TSB. It also demonstrated that using TcB level of above the 75th
percentile for age was 100% sensitive in identifying infants who may be at risk for clinically
significant hyperbilirubinemia.
NEO/60 (P) COMPARATIVE ANALYSIS OF EFFICACY OF IBUPROFEN AND
INDOMETHACIN FOR PDA CLOSURE
R. Kishore Kumar, Abhay B Mahindre, Mir Dilshad Ali, Ashwini Kawale, Nandini Nagar, S.V.
Girish.
Neonatal Department, Cloudnine Hospital, 1533, 9th Main, 3rd Block Jayanagar, Bangalore –
560011, INDIA
Email: [email protected]
Background: PDA is a common cause of morbidity in preterm newborn. Ibuprofen &
indomethacin are both prostaglandin synthesis inhibitors that facilitate contraction & closure of
the duct but has varying side effects. Objective: To compare the efficacy of ibuprofen &
indomethacin for preterm ductal closure. Methods: This retrospective study was conducted from
August 2007 to July 2012. A total 35 cases of PDA were identified. PDA was suspected
clinically based on signs & symptoms. Echocardigraphic confirmation was done in all cases. Of
35 newborn newborns 19 (54.28%) were male and 16 (45.72%) were female. Birth weight varied
from 710 gm -3860 gm (mean 2000 gm) & gestation age varied from 27 wks - 36 wks. Age at
presentation varied from 1 to 6 days. Ibuprofen was administered to 22 (62.85%) babies IV
Indomethacin was administered to 13 (37.14%) babies of which 8 (61.58%) received at the rate
of 0.2 mg/kg/dose for 3 days & remaining 5 ( 38.46%) received at the rate of 0.1 mg/kg/dose for
6 days. Results: Ductal closure was observed in 21 (95.45%) with ibuprofen and 12 (92.30%)
with indomethacin. Babies who failed to respond to one mode of medical treatment was switched
to other modality but no closure occurred & failure babies required surgical ligation. Side effect
profile was comparable in both the groups. Conclusion: Treatment with ibuprofen &
indomethacin is equally effective and the babies do not respond to one mode is unlikely to
respond to other & requires surgical ligation. Key words: PDA; Ibuprofen; indomethacin;
efficacy.
NEO/61 (P) OSTEOPENIA OF PREMATURITY: EXPERIENCE OF TERTIARY
LEVEL NICU OF SOUTH INDIA
Abhay B Mahindre, R. Kishore Kumar, Mir Dilshad Ali, S.V. Girish, Nandini Nagar, Syed
Tejamul.
Neonatal Department, Cloudnine Hospital, 1533, 9th Main, 3rd Block Jayanagar, Bangalore –
560011, INDIA.
Email: [email protected]
Background: Osteopenia of prematurity (OPP) is a metabolic bone disease referred to as
hypomineralized skeleton of the premature infants due to decreased amount of bone matrix
(scarcity of bone) & can be caused by either insufficient synthesis &/or increased resorption of
organic bone matrix. In growing VLBW infants(Birth weight < 1500 grams; GA < 32 weeks)
OPP is very common. Serum alkaline phosphate is often correlated with disease severity.
Objective: To see the incidence & prevalence of osteopenia of prematurity in VLBW newborns
admittied at tertiary level NICU of Cloudnine hospital Bangalore. Methods: This retrospective
study was conducted between August 2007 to July 2012. All VLBW newborns admitted in
NICU over the study period were subjected to screening for ostepenia based on standard
protocol. Results: During the study period there were 158 VLBW babies admitted in NICU. Out
of these 13 babies had serum alkaline phosphate value > 500 IU/L with the incidence of 8.2%
among VLBW newborns. Mean gestational age of these newborn is 28.6 weeks & mean birth
weight is 1140 grams, mean age of diagnosis is 20.8 days. Two babies had alkaline phosphate
value > 1000IU/L with radiological evidence of rickets. Conclusion: Incidence of osteopenia of
prematurity is significantly lower in our NICU compared to present available data. This low
incidence can be correlated with antenatal screening of mothers for calcium & vitamin D
deficiency with adequate supplementation and early enteral feeding. Key words: Osteopenia,
alkaline phosphate, VLBW
NEO/62 (P) NON HEREDITARY SPHEROCYTOSIS IN NEWBORN - A RARE CASE
REPORT
Abhay B Mahindre, R. Kishore Kumar, Syed Tajamul, Ravi Sahota
Neonatal Department, Cloudnine Hospital, 1533, 9th Main, 3rd Block Jayanagar, Bangalore –
560011, INDIA
Email: [email protected]
Introduction: Hereditary spherocytosis is a common hemolytic anemia. But non hereditary
spherocytosis is rare in newborn population. Case report: 3 day old male baby first born to non
consanguinous married couple, delivered by LSCS presented with yellowish discoloration of
skin. There was no other risk factor; breast-feeding well, no significant weight loss & no family
H/O neonatal jaundice Examination: had pallor, deep icterus, no hepatospenomegaly. Other
systems were normal. With a provisional diagnosis of Neonatal hyperbilirubinemia started on
phototherapy and investigated. Initial Investigations: i) Hemoglobin 16.3g/dl. ii) Peripheral
smear- Marked anisopoikilocytosis, spherocytes, polychromasia, 2 nucleated RBCs/100 WBCs.
WBCs and platelets were normal. iii) MCHC- 39.3 % MCV -75.3 fl. iv) Reticulocyte count –
8% v) Osmotic fragility – Markedly increased vi) Hemoglobin Electrophoresis (SDS PAGE) normal Spectrin & Ankyrin vii) Direct coomb’s test- negative viii) Liver function tests- S.
bilirubin- total 15.3 mg/dl and indirect 0.5 mg/dl. Diagnosis and further course of management.
Diagnosis of non hereditary spherocytosis was confirmed. Baby readmitted on day 8 of life with
severe unconjugated hyperbilirubinemia requiring exchange transfusion. At 6 weeks check baby
was found to have severe pallor with mild icterus. Investigation reveled severe anemia, mild
jaundice with high retic count & peripheral smear showing few spherocytes, mild polychromasia.
USG abdomen reveled moderate splenomegaly, parents were evaluated for hereditary
sphereocytosis, were normal. As child had severe anemia, he was given one unit of blood
transfusion. He was put on folic acid supplement 1 mg daily. Key words: Non hereditary
spherocytosis, Osmotic fragility, Gall stones, Splenectomy.
NEO/63 (O) ROUTINE NEWBORN SCREENING PROGRAMME – WHAT ARE WE
WAITING FOR? AND WHAT ARE THE IMPLICATIONS FOR THE REST OF THE
WORLD?
R. Kishore Kumar, Nandini Nagar, Arvind Shenoi, Girish.S.V., Suma, Prince Dinakar, Abhay
Mahindre
Neonatal Department, Cloudnine Hospital, 1533, 9th Main, 3rd Block Jayanagar, Bangalore –
560011, INDIA.
Email: [email protected]
Objectives: Routine newborn screening programme – is it worth the effort and money? Subjects
and interventions: Newborn screening (NS) was performed on samples between 26.01.2007 and
31.08.2012. Dried blood samples from either heel prick or vene-puncture were collected from
babies at 36 hours of age, on special filter papers, dried & sent in for analysis. Results: A total of
10,651 samples were tested. Abnormal results were detected in 453 (4.21%). One hundred
twenty nine needed to be repeated – majority because of abnormal results (79) -) - galactosaemia
(1), congenital hypothyroidism (CHT)(11), Congenital adrenal hyperplasia (CAH) (5), transient
tyrosinaemia (8), abnormal acylcarnitine profile (10), hyper-phenylalaninaemia (8) and glucose 6
phosphate dehydrogenase deficiency [G6PD] (319) - and rest were for poor sampling (40) &
prior transfusion (10The baby with galactosaemia had a variant type as the Galactose-1phosphate uridyl transferase enzyme activity was measured at 25 % of normal. G6PD ranged
from 0 to 20 % of normal activity. 80 cases of “pseudo-methylmalonic acidaemia (MMA)” were
detected due to maternal vitamin B12 deficiency. Conclusions: 1) The incidence of
hypothyroidism – in our study was less than 1:1000. 2) G6PD - The results of the ongoing
programme clearly indicate that it is beneficial as we would have missed these cases, which
could have caused significant morbidity. 3) We have enough data that India needs to screen for
CHT, CAH, G6PD and MMA. Commercialisation and poor reporting can destroy the
programme. We give a cautious welcome to this programme, with proper analysis and reporting
being in place. Keywords: Newborn screening, inborn errors of metabolism
NEO/64 CASE PROFILE IN HIGH RISK CLINIC (HRC) IN A TERTIARY CARE
HOSPITAL
Pravakar Mishra, N. Gupta, Sandeep Ku Tripathy, Dolamani Tandi
SVP PG Institute of Pediatrics & SCB Medical College, Cuttack – 753002, Odisha, India
Email- [email protected]
Introduction:- As a large number of ELBW & VLBW babies are surviving by improved neonatal
care including NICU, they are followed up in HRC for better outcome. Our Institute started HRC
from February 2012. Babies surviving from NICU and Newborn wards satisfying criteria for
High Risk babies are included in this study. They are followed up on Wed and Monday 9AM to
12 Noon at specified intervals as per NNF guidelines. We followed up 192 babies. Results:- 1)
Hie- 45.8%. 2) Neonatal sepsis-20.8%. 3) Preterm- 28 to 35 wks- 22.6%. 4) -<28 wks- 2.2%. 5)
LBW- 12.5% VLBW- 16.6%
ELBW- 6.8%. 6) Neonatal seizure- 9.4%. 7) Neonatal
meningitis- 4.6%. 8) Congenital malformations- 16.6%. 9 Nicu(ventilated)- 3.4%. 10) TTT-
1.04%. 11) Neonatal bilirubinimia encephalopathy- 9.4%. 12) Abnormal neurological exam4.7%.
Interventions in HRC:-1) Feeding councelling- 87%. 2) Immunisation-87%. 3)
Physiotherapy-32.4%. 4) Speech therapy-7.3%. 5) EEG - 34.6%. 6) AED- 13.8%. 7) BERA18.6%. 8) CT/MRI brain-9.3% abnormal in- 7.3%. 9) Echo study with cardiology consultation10.1%. 10) Malformation with surgical consultation- 4.1%. Conclusion:- High Risk babies have
significant single or multiple morbidities, which need timely intervention and longterm follow
up for better outcome.
NEO/65 (P) NEONATAL MORTALITY – RETROSPECTIVE ANALYSIS
Jhancy.M, Madhavi.N, A.Satyavani,.Giridhar, D.Manikyamba
Rangaraya Medical College, Kakinada, A.P.
Email:[email protected]
Introduction: The Neonatal period is a highly vulnerable time for an infant. The Neonatal
Mortality is highest during first 24 hours and accounts for about 65% of all infant deaths.The
leading causes of Neonatal deaths in India are infection (sepsis), birth anoxia and prematurity.
India, with about 1.2 million deaths of neonates each year, accounts for over one quarter of all
neonatal deaths in the world. Aims & Objectives: To study major causes of inborn neonatal
mortality in single teaching hospital. Materials And Methods: Retrospective analysis of causes of
inborn newborn mortality. The data collected every month from the neonatal case sheets from
NICU, GGH, Kakinada during January 2012 to June 2012. Results: Total institutional deliveries
were 5472, Inborn admissions 562 (10.27%). The total number of deaths were 131 with neonatal
mortality of 23.31%. 63(48.10%) neonatal deaths were due to birth asphyxia including MAS
with more incidence around May , June. 34 ( 25.95%) were due to sepsis. The parturient to
Obstetrician ratio is 10:1. Newborn to paediatrician ratio 25:1 Nurse to newborn ratio 10:1.
Conclusions: Our analysis showed major neonatal deaths were due to birth asphyxia. Few other
contributing factors are delayed Referrals from outside. Lack of newborn care corners in delivery
rooms, trained staff who continuously changes to various other departments. Lack of qualified
lab technicians with 24 hrs laboratory facilities, sufficient disposables and quality equipment
with annual maintenance. Preventable deaths from our analysis were 97 out of 131 with NMR
6.05% provided many practical difficulties are rectified.
NEO/66 (P) SHORT RIB POLYDACTYLY SYNDROME: REPORT OF TWO CASES
OF TWO DIFFERENT SUB-TYPES
Kausik Mandal, Swarupananda Maiti
Department Of Neonatology; IPGME&R and SSKM Hospital; Kolkata; India.
E mail: [email protected]
Introduction: Short rib polydactyly syndrome (SRPS) is a group of rare lethal skeletal dysplasia
manifested with short limb, short ribs and polydactyly. There are four major sub-types. Here we
report 2 cases of SRPS. Case 1: A macerated still born was born vaginally at term to a 20 year
old gravid2 para1 woman. The couple was nonconsanguinous. 1st pregnancy resulted in a
spontaneous abortion at 4months. Antenatal USG at around 30 weeks revealed fetal ascites,
shortened limbs and macrocephaly with mega cysterna magna. External examination showed a
hydropic and dysmorphic fetus weighing 3000grams. The thorax was short and narrow. External
genitalia was ambiguous; phallus was small with penoscrotal hypospadias; small gonads in
genital folds were noted. All four limbs were short and revealed postaxial polydactyly on both
hands with overlapping of 4th toe over 3rd toe on both feet. Postmortem radiograph showed short
horizontal ribs (there were 11 pair of ribs;12th rib was absent), small scapula, high positioned
clavicles, relatively normal tibia and smooth pointed femoral ends with no spur. Radiograph was
suggestive of SRPS Type I. Autopsy examination revealed dysplastic left kidney. Case 2: A 2125
gram female baby was delivered vaginally at 34weeks. She expired within 30 minutes of birth
due to pulmonary hypoplasia. The parents were nonconsanguinous. Mother was a 3rd gravida.
Prior to this pregnancy, a term male baby died similarly within 1hour of birth. Exact details of
that baby were not available. There was no history of infection or drug intake or radiation
exposure during current pregnancy. Antenatal USG at 28 weeks revealed mild ascites, small ribs,
pulmonary hypoplasia, large echogenic kidneys, small limbs and polydactyly. There was central
cleft lip, natal teeth and bifurcated tongue. The thorax was short and narrow. External genitalia
was normal female. All four limbs were short and revealed postaxial polydactyly along with
bilateral bifid thumbs and toes. Postmortem radiograph showed narrow long thorax with short
horizontal ribs with bilateral short ovoid tibia suggestive of SRPS Type II. Discussion: Short rib
polydactyly syndrome is a heterogenous group of skeletal dysplasia presenting with hypoplastic
thorax, short horizontal ribs, polydactyly and a variety of nonskeletal defects. According to the
international osteochondrodysplasia classification, there are at least four types of SRPS: Type I
(Saldino-Noonan), Type II (Majewski), Type III (Verma-Naumoff) and Type IV (BeemerLanger). All the types are inherited as autosomal recessive trait and all are lethal in the newborn
period. The molecular basis of different varieties of SRPS has not been very clearly elucidated
and subtyping of SRPS is often difficult because of considerable overlap of the characteristic
features. Our first case has most features of type I and the second that of type II.
NEO/67 (P) NEONATAL AIRWAY COMPROMISE BY AN EXTENSIVE VENOUS
HEMANGIOMA –SURGICALLY MANAGED
Shenoy J, Coutinho A, Kamath Sowmini P, Pai S, Anchuri Swapna, Malayil Shareef
Kasturba Medical College, Mangalore, Manipal University
Email: [email protected]
Abstract: Background: Hemangiomas may appear at birth as cutaneous (surface) or subcutaneous
(deep) lesions affecting any part of the body. Diagnosis may be missed, if it is deeply situated.
Case report: Third trimester antenatal scan revealed cystic lesion (63 X 55 mm) with multiple
septations - ? Cystic hygroma neck. Outborn 34-36 wks preterm female AGA (Birth Wt - 2.54
Kg) delivered by caesarean section. Resuscitation and immediate ventillatory support required
due to mass obstructing the airway.Clinical examination revealed an ill defined lobulated, non
pulsatile, compressible, nonreducible mass (6x5 cm) over the anterior aspect of neck extending
between the bilateral anterior borders of sternocleidomastoid muscles with the lower border
inappreciable along with absence of bruit. Systemic examination was unremarkable. USG neck
revealed large mutli septated cystic lesion with vascularity noted and extending into the
retrosternal area, features suggestive of vascular malformation. CECT NECK was conclusive of
vascular malformation extending inferiorly till the superior mediastinum. As there was no
clinical response with inj dexamethasone and propranolol, the mass was surgically removed on
day 25 of life. Histopathology of the lesion was suggestive of venous hemangioma. Baby is off
ventilator and is maintaining saturations on tracheostomy with T piece. She is tolerating feeds
well.Thyroid and parathyroid hormone assays were done to rule out deficiency states. She is on
oral thyroxine for the associated hypothyroidism. Conclusions: Extensive and deeply situated
hemangiomas can be life threatening and requires early identification and intervention.
NEO/68 (P) OUTCOME OF VLBW BABIES AT 1 YEAR OF AGE IN A TERTIARY
CARE CENTRE
Jeena Annie Philip, Soumya S.P, Shanavas.A, Sobha Kumar.S
Neonatology Unit, Dept of Pediatrics, SAT Hospital, Trivandrum
Email: [email protected]
Abstract: Objectives: To study the growth and neuro-developmental outcome of VLBW babies
(<1500g) in the 1st year of life. Design: Hospital based prospective descriptive study. Study
setting: Neonatal ICU and Outpatient clinic of newborn division of a tertiary level teaching
centre at Trivandrum. Study Period: 1 Year. Participants: 50 consecutive Very Low Birth Weight
newborn babies discharged during the study period. Exclusion criteria: Babies with major
congenital anomalies, evidence of Intrauterine infections and hypoplastic babies. Methods:
Gestational age was determined by NBS score, LMP and 1st trimester antenatal USG. Babies
discharged From NICU were asked to attend the follow up clinic. ROP screening was started at 1
month of age. Assessment of growth was done by 3 monthly measurements and interpreted using
IAP growth charts. Developmental evaluation was done by DDST II. Hearing was evaluated
using OAE/BERA. Assessment for intermittent illnesses/ rehospitalisation were also done.
Results: Mean Gestational age of study group was 31.1 weeks and mean birth weight was
1.297kg. On follow up at 1 year, 59.6% of babies had weight less than 3 rd centile, 38.2% had
length less than 3rd centile and 6.3% had head circumference less than 3rd centile. 16% developed
ROP of which 14% underwent laser therapy. Of them 62.5% had myopia and 58% had
strabismus at 1 year follow up. 18% had developmental delay at 1 year of age , of which 4% had
spastic diplegia. On Neurosonogram, 4% babies had evidence of periventricular leucomalacia.
No babies with hearing impairment were identified. Rate of hospital readmissions was 19%.
Bronchiolitis was the major morbidity. Conclusions: VLBW babies are at a high risk for
postnatal growth retardation. Follow up for visual morbidities is necessary for all VLBW babies.
NEO/69 (P) TO STUDY THE PATTERN OF MORBIDITY AND MORTALITY IN
NEONATES ADMITTED TO TERTIARY CARE NEONATAL UNIT IN CENTRAL
INDIA
Khan I.A., Dwivedi R.,Malik S., Bhargava S.,Tiwari A.
D3, Bda Colony, Kohe Fiza ,Bhopal
Email: [email protected]
Introduction: To achieve millennium developmental goals, specific focus on neonatal mortality
and morbidity is required. Knowledge about spectrum of neonatal diseases and proper
management of common neonatal problems will lead to better outcome and improved quality of
life among survivors. Aims And Objectives: to study the pattern of morbidity and mortality in
neonates in tertiary care neonatal unit in Central India. Material And Methods: A hospital based
prospective study was conducted during period between October 2010 to September 2011. All
neonates admitted at age of less than 24 hours were included in the study. Data was
prospectively recorded on pre-tested proforma developed with references of standard definitions
developed by National Neonatal Forum, India. Results : out of 1388 patients, most of patients
were males(63.5%).Nearly two-third were low birth weight (63.5%) and nearly half were
preterm(44.5%). Highest mortality rate was for septicaemia (47.57%) followed by perinatal
asphyxia (25.95%), extremely low birth weight (21.08%), pneumonia (13.24%), hyaline
membrane disease (12.97%), congenital malformation(6.21%), intraventricular haemorrhage
(5.40%).Systemic infections ( 45.1%), birth asphyxia (43.94%), neonatal seizures in (22.48%),
hyperbilirubinemia ( 14.9%), meconium aspiration ( 12.54%), congenital pneumonia (11.31%),
hyaline membrane disease (5.12%) were common morbidities involved. Conclusion: the study
helps in developing appropriate facilities and management protocol to improve neonatal survival.
Pattern of mortality and morbidity is different as compared to National Perinatal Neonatal
Database so there is compelling need to obtain and analyse reliable data on uniform format from
all regions of the country. Keywords: neonates, mortality, morbidity
NEO/70 (P) TO STUDY THE CORRELATION OF C REACTIVE PROTEIN AND LOW
TOTAL LEUCOCYTE COUNTS TO CULTURE POSITIVE SEPSIS IN NICU.
S.Phuljhele, K.Ramnani, Sanjeev, V.Kurrey
Administrative block department of pediatrics, Dr B R Ambedkar Memorial Hospital, Pt JNM
Medical College, Raipur
Email:[email protected]
Introduction: NICU neonates are very prone to sepsis which is a major cause of mortality.
Cultures requires 72 hrs, till then CRP and low TLC can be used as indicators. Objectives – To
study the efficacy of CRP, leucocytopenia and thrombocytopenia as predictors in neonatal sepsis.
Materials And Mathod: total 580 neonates included in study admitted in the NICU of
PT.J.N.M.M.C from September 2011 to august 2012 with propable sepsis. Their CRP, CBC and
blood culture were sent from same sample. Results were collected and positive and negative
predictive value calculated. Result: Of 580 patient studied,360 had positive CRP, of these, 195
had culture positive sepsis and 165 culture negative sepsis. So the positive predictability value of
CRP is 54% whereas in the CRP negative group only one neonate had culture positive sepsis so
the negative predictability value of CRP is 99%. Of 195 neonates with CRP and bood culture
positive sepsis, 64( 32.8%) had leucopenia and thrombocytopenia, 70(36%) had only
thrombocytopenia and 53(27% )had normal leucocyte and platelet counts.In the CRP positive,
culture negative group 54 (33%) had leucopenia and thrombocytopenia; 37(22.5%) had only
thrombocytopenia. 1 neonate who presented with CRP negative, culture positive sepsis had both
leucopenia and thrombocytopenia. Conclusion: CRP is a good indicator of sepsis in NICU. Its
specificity is 99% , hence a negative CRP level is a good predictor to rule out sepsis in a neonate.
Similarly a patient with thrombocytopenia with or without leucopenia should be worked up for
sepsis.
NEO/71 (P) NEONATAL SPONTANEOUS PLEURAL EFFUSION - A RARE CASE
REPORT
P. Nagasree, Manas Ranjan Sahoo,P.Sudarsini,G.Chaitanya
Department of Pediatrics , Alluri Sitarama Raju Academy of Medical Sciences, Eluru, AP
Email: [email protected]; Pydinagasree @hotmail.com
Introduction: Congenital isolated pleural effusion is a rare condition with an incidence of about 1
in 12,000 to 1 in 15,000 pregnancies. It is usually chylous. Herein, we report a rare case of
nonchylous congenital pleural effusion managed successfully. Case report: A baby boy weighing
2520 grams was delivered by LSCS to an unbooked, immunized, full-term, primigravida
mother,aged 20 with breech presentation with polyhydramnios. The baby had no h/o birth
asphyxia & developed respiratory distress since birth & shifted to our NICU at 4hrs of life. There
were signs of severe respiratory distress and the breath sounds were poorly audible in the both
hemithorax. Baby was neither dysmorphic nor hydropic. Rest of the systemic examination was
normal. ABG revealed respiratory alkalosis. A chest radiograph obtained at 4 hours of birth,
revealed bilateral hydrothorax (figure 1).Intercostal needle drainage revealed straw coloured
fluid which was sent for analysis.USG chest & abdomen revealed bilateral pleural effusion & b/l
hydronephrosis..2-D echo was normal.. Following pleural fluid drainage also respiratory distress
continued so was put on CPAP for36 hrs. Two 10 Fr size intercostal tube were put in left &
right hemithorax which drained straw coloured fluid & drained clear fluid later(figure 2).Then
he developed distress and hypoxia ,so ventilated at 36 hrs of life with assist control mode On day
3 child developed left hydropneumothorax and another 10 Fr catheter was inserted in left 2nd
intercostal space .The baby passed urine and meconium within 24 hrs of life. A total 150ml of
clear fluid was over the next 7 days .Chest tubes were removed after chest xray showing
significant resolution of hydrothorax & hydropneumothorax.(Figure 3)Then he was extubated on
day 9 ,followed by on oxygen for 4 days. Baby was started on tube feeding on day 10 of life and
over 7 days full feed established. The pleural aspirate was found to be a transudate , with
proteins 2.3 g /dl and normal sugars, triglycerides, cholesterol, lactate dehydrogenase and
culture. The,karyotype ,TORCH, LFT, RFT,Haemogram sepsis screen were normal. No Rh
incompatibility noted .The baby was finally discharged on day 40, with a weight of 2.745
kilograms and the mother was advised breast feeding -
Figure 1: bilateral pleural
effusion at 4 hrs of life
Figure 2: left & right ICDs
Figure 3: Resolution
NEO/72 (P) UMBILICAL CORD BLOOD GLYCOSYLATED HEMOGLOBINAND
C-PEPTIDE IN INFANTS OF DIABETIC MOTHERS AND ITS CORRELATION
WITH NEONATAL HYPOGLYCEMIA
Girish M, Dandge V, Mujawar N, Punia S, Bhattad S.
C/o Dr Vithalrao P Dandge Asha' Plot # V-42, Narendranagar, Ring Road, Nagpur- 440015,
Maharashtra
Email:[email protected];[email protected];vithalrao.dandge.dahigaon@gmail.
com
We hypothesise that cord blood HbA1c would be a good marker to determine the risk of
neonatal hypoglycemia in IDM. If this is confirmed we can very easily identify the group
which needs close monitoring and probably early supplemental feeding to decrease the risk of
hypoglycemia. Such a prediction would not only help avoid the short and long term
consequences of neonatal hypoglycemia but also obviate the need to start artificial feeds in all
babies. Objectives- 1. To study the relationship between maternal glycated hemoglobin and
cord blood HbA1c in Infants of Diabetic mothers (IDMs). 2. To evaluate whether there is an
association between maternal glycated haemoglobin, cord blood insulin,C-peptide. 3. To
study the relationship of cord blood insulin,with birth weight in offspring of diabetic mothers.
4. To test the hypothesis that cord blood glycosylated hemoglobin can predict occurrence of
postnatal hypoglycemia in IDMs. 5. To investigate long-term effects of maternal glcemia on
their offsprings. Methodology – All mothers with diabetes mellitus and their newly born
delivered in any hospital in Nagpur in a period of one year, between the period of July 2011
and July 2012 will be recruited for the study. Babies with sepsis or birth asphyxia, meconium
aspiration, respiratory distress syndrome etc. and babies with major congenital anomalies not
attributed to maternal diabetes were excluded. Cord blood was collected for analysis of
HbA1C, C-peptide, maternal blood for HbA1c and postnatal blodd sugars done as per current
consensus protocol. Study Design- Observational Longitudinal Study. Statistical AnalysisChi square and t test by NCSS and EPI info.
NEO/73 (O) TO ASSESS AND COMPARE THE NEONATAL MORTALITY AND
MORBIDITY IN LATE – PRETERMS AND TERM NEONATES
Parveen Mittal, Ravneet Kaur
House no. 37, Khalsa college colony, Near saket hospital, Patiala
Email: [email protected]
Introduction: Pre term birth rate has been on a rise throughout the world mainly at the
expense of late – preterm births (defined as births between 34 weeks and 36 weeks 6 days
gestation). Late – preterm newborns often termed as “near – terms” have been historically
managed as terms because of their relatively large size and seemingly larger appearance,
these late – preterms are considered to have significantly more mortalities and morbidities
because of less physiological maturity and limited compensatory responses compared to term
neonates. Late – preterm newborns are the fastest growing subgroup of neonates and
constitute approximately 70 % of preterm births. In recent years, the absolute number of late
– preterms being admitted to NICUs has been rising, only few studies have been conducted
regarding their morbidities and mortalities. The present study was an attempt to obtain data
regarding the morbities and mortalities in late – preterms as compared to their term
counterparts. Aims And Objectives: To assess the mortality and morbidity in late – preterm
newborns and to compare it with term newborns born in Rajindra Hospital, Patiala. Materials
And Methods: The study was conducted on 200 newborns born in Rajindra Hospital, Patiala,
comprising of 100 late – preterms and 100 term neonates. Their mortality rates were assessed
and compared in terms of total deaths in neonatal periodin late – preterms and terms. Their
morbidities were assessed and compared in terms of incidence of hypoglycaemia (that was
managed by i/v infusions), respiratory distress syndrome (neonates who were given oxygen
in 1st 24 hrs of life), hyperbilirubinemia (requiring phototherapy) and septicaemia (requiring
antibiotic therapy). The data obtained was statistically analysed. Results: following results
were obtained:
No. Of Late preterms No. Of Terms (out or P value (significance
(out of 100)
100)
value)
Mortality in neonatal 5
2
P=0.4448(fischers
period
exact test,two tailed p
value)
hypoglycemia
22
6
P=0.0018
fischers
exact test,two tailed p
value
hyperbilirubinemia
68
46
P=0.0026( fischers
exact test, two tailed
p value)
septicemia
56
21
P < 0.001
RDS
72
23
P < 0.001
Conclusions: Our study showed a significantly higher risk of overall morbidity but not
mortality in late – preterms as compared to terms. As the late preterm subgroup comprises
approximately 10 % of all the births, even a modest increase in the morbidity may have a
profound impact on health care resources, thus explaining the need to consider these
seemingly mature late preterm newborns as physiologically immature and to be carefully
evaluated, monitored and followed up.
NEO/74 (P) RETINOPATHY OF PREMATURITY IN INFANTS WITH BIRTH
WEIGHT BETWEEN 1501-1800 GRAMS
Rohit Kapoor, Harish Chellani, B.P.Guliani, Sugandha Arya, Rakesh Yadav.
Institute-Vardhman Mahavir Medical College & Safdarjang Hospital New Delhi-110029
Email [email protected],[email protected]
Introduction:According to American academy of pediatrics screening criteria adopted for
Indian infants may miss Retinopathy of premaurity in infants with larger weight
Abstract:Aims and objectives: To determine the incidence and associated risk factors of ROP
among new born infants between 1501-1800 grams in a tertiary care hospital. To compare the
possible risk factors associated with Retinopathy of Prematurity in infants with birth weight
between 1501-1800 grams and with birth weight <1500 grams.To suggest recommendations
for ROP screening of infants with birth weight between 1501-1800 gram babies in
developing countries if any. Materials and Methods:278 infants with birth weight <1800
grams were longitudinally followed in uptil complete vascularization of Retina the surviving
neonates born were divided in 3 sets depending on the birth weight viz.less than 1800 grams
and between 1501 to 1800 grams and <1500 grams , the comparision of the incidence and
associated risk factors for ROP in both of these groups was done .Qualitative data was
analysed using Pearson’s Chi Square test with Yates correction of Ficher’s exact test
,Multiple logistic regression analysis was performed to determine independent risk factors for
the Disease in each of the 3 groups.Results:Out of 278 babies 203 completed the follow
up,and data was analysed from the 1st contact of the infant with the ROP team.The incidence
of ROP was found to be 13.67% of which 11.87% had stage I ,Stage II was present in 1.44%
and Stage III 0.36%,Risk Factors which came out to be significant on univariate analysis
were low birth weight,Low gestational age,Respiratory distress syndrome, prolonged oxygen
exposure,
acidosis,
mechanical
ventilation,
blood
transfusions,
exchange
transfusions,anemia,Intraventricular
hemorrhage,Sepsis,NNH,Multiple
Gestation,
Resuscitation, Low APGAR score, vasopressor use, pneumothorax ,IUGR,PIH, APH, Patent
ductus arteriosus. Risk factors which independently came out to be significant were Multiple
Gestation ,mechanical ventilation ,low APGAR score at 1 min,blood transfusions Pregnancy
induced hypertension and antepartum hemorrhage. Incidence of ROP in Babies weighting
greater than 1501 grams ,Stage I was found to be 10.27%,Stage II to be 1.37% and no cases
of stage III,IV and V were found , Univariate analysis showed low birth weight, Low
gestational age ,respiratory distress syndrome, prolonged oxygen exposure ,
acidosis,mechanical ventilation,blood transfusions,exchange transfusions, anemia,
Intraventricular hemorrhage, Sepsis,Resuscitation,Low APGAR score, vasopressor
use,pneumothorax,PIH,APH,Patent ductus arteriosus came out to be significant. Independent
risk factors were Blood transfusion and anemia. Incidence In infants weighing less than 1500
grams incidence was 15.9% ,The univariate analysis revealed were low birth weight,
Respiratory distress syndrome, prolonged oxygen exposure, acidosis, mechanical ventilation,
blood transfusions, exchange transfusions, anemia, Intraventricular hemorrhage, Sepsis,
Multiple Gestation, Resuscitation, Low APGAR score, vasopressor use, pneumothorax,
IUGR, Patent ductus arteriosus. independent risk factors for ROP in this set was found to be
Mechanical ventilation, APGAR score <3 at 5 min. Conclusion: Thus ROP in larger babies as
seen greater in developing countries may be a upcoming problem in coming years.
NEO/75 (P) SUBCUTANEOUS FAT NECROSIS OF THE NEWBORN AND
HYPERCALCEMIC ENCEPHALOPATHY
SK Patnaik, SS Dalal, Arvind, V Venkateshwar
Dept of Pediatrics, Command Hospital Air Force, Bangalore 560007
Email: [email protected]
Introduction Subcutaneous fat necrosis of the newborn (ScFN) is an uncommon condition
caused by hypoperfusion associated with perinatal asphyxia, shock and hypothermia. Only 3
cases have been reported from India till date. Aims & Objectives To present our experience
with ScFN at a tertiary care level Armed Forces hospital Materials & Methods Retrospective
case review amongst 234 infants who received neonatal intensive care during Oct 2010 to
Sep 2012 Results ScFN was noted in 2 male term neonates with history of perinatal asphyxia
leading to a prevalence of 4.2 per 1000. Subcutaneous panniculitis was notable by first 2
weeks in both cases. While one baby remained asymptomatic with regression of lesions over
08 weeks without any metabolic complications, PTH independent hypercalcemic
encephalopathy (Serum calcium 14.2 mg/dl phosphate 4.1 mg/dl creatinine 0.6 mg/dl 25OH
Vit D 20.9 ng/ml 1,25 (OH)2 Vit D 131.5 pmol/l PTH 1.54 pg/ml) occurred in the other baby
by 6 weeks age. Hepatosplenomegaly. hypertriglyceridemia, hyperferritinemia, subcutaneous
fat granulomas with cholesterol crystals, periventricular calcification on CT head and
nephrocalcinosis were also observed. Bone marrow examination ruled out hemophagocytosis.
Liver biopsy showed intracellular cholestasis. Infant was managed with steroids and
alendronate with normalization of calcium levels within 2 weeks. Hypertriglyceridemia
persisted till 3 months age. At 09 months followup, child has mild developmental delay and
normocalcemia but has persistent firm hepatosplenomegaly, nephrocalcinosis and sporadic
calcinosis cutis. Conclusions ScFN is an underrecognized entity. Longterm surveillance must
be in place to detect late onset life-threatening hypercalcemia. Oral alendronate is an effective
therapy.
NEO/76 (P) AUDIT OF NEONATAL ADMISSIONS AND DEATHS AT A
TEACHING HOSPITAL IN
Parihar Mahendrasingh Y, More P W, Savaskar S V
Department of Pediatrics, Government Medical College, Latur, Maharashtra
Email: [email protected]
Objective: - To know the disease pattern and causes of deaths among newborns admitted to
the neonatal intensive care unit of tertiary care teaching hospital, Latur, Maharashtra.
Methods:- It was descriptive study conducted from 1st March 2011 to 29th February 2012.
Data of all the babies admitted to the NICU was recorded in prefixed format. The records
were studied statistically for sex, weight, age, gestational age, place of delivery and mode of
delivery. The causes of admissions and deaths were determined on the basis prefixed working
definition. The reasons for referral were also recorded and studied. Results:- A total 929
neonates were admitted during the study period. Among them 536 (57.69 %) were male and
393(42.30 %) were female. Majority of babies i.e. 625 (67.72%) were admitted in first 24
hours of life. Low birth weight (< 2.5 kg) admitted were 585(62.97%). The inborn delivered
babies were 559(60.17%) and outborn were 370(39.83%). 833(89.66%) were delivered at
hospital and 91 (9.75%) were home delivered. Birth asphyxia (29.58%), sepsis (25.72%) and
preterm with low birth weight (13.82%) were the main causes for referral to the hospital.
Among the 403(43.38%) preterm babies, preterm with LBW were 279(69.23%), preterm with
sepsis were 106(26.30%), only preterm were 60 (14.88%), preterm with RDS were 44
(10.91%) and other were 5(1.24%). Among 526(56.62%) full term babies diagnoses were
birth asphyxia (29.65%), sepsis including meningitis and pneumonia (23.57%) and
meconium aspiration syndrome (13.68%), neonatal jaundice (7.6%), congenital heart disease
(6.27%), intrauterine growth retardation (8.74%), transient tachypnea of newborn (3.04%),
surgical conditions(8.93%), antibiotics prophylaxis(11.78%) and other(2.85%). 552(59.41%)
were completely cured and discharged, 238(25.61 %) died, 29(3.12%) were referred out,
63(6.78%) left against medical advice and 47(5.05%) were discharged on request.
Prematurity (72.26%), hypoxic ischemic encephalopathy (15.81%) sepses (14.43%) were the
main causes of the deaths in neonatal intensive care unit. Conclusions:- Prematurity, low
birth weight, birth asphyxia and sepsis are main causes of admission to the neonatal intensive
care unit. The main causes of deaths are prematurity, hypoxic ischemic encephalopathy and
sepsis. There increased need for awareness for in time referral to the tertiary level hospital is
mandatory to increase the neonatal survival. Mortality in NICU in high and suggests need to
identify and reduced the risk factors with emphasis on prematurity, low birth weight, birth
asphyxia and sepsis.
NEO/77 (P) IS KANGAROO MOTHER CARE (KMC) INCREASES BONDING
WITH MOTHER
S. Nath, Arya suchismita, R.Sharan
Department Of Paediatrics, Tata Motors Hospital, Jamshedpur
Email- [email protected]
Introduction- Kangaroo mother care (KMC) is a cost effective method to promote health &
wellbeing of preterm low birth weight (LBW) babies. In our NICU acceptability of KMC by
mother was a great concern. Although benefits of KMC are well established but there is
insufficient data in our country regarding its acceptability by mothers. Aim & Objective- To
determine the effectiveness of KMC in LBW babies and to analyse the bonding effect of
KMC. Material & Method- prospective comparative study. Setting- Level II NICU in Tata
Motors Hospital Jamshedpur. Period- Nov 2010-Feb 2012. Study group- Neonate weighing
<2kg admitted in NICU were initiated KMC as soon as they were stable. Intervention KMC
was conducted and bonding was assessed by infant maternal attachment scale and weight was
recorded daily. Result – The KMC babies documented a significantly better average wt gain
22.6+ 9.4 gm/day vs 13.9+3.2 gm/day in conventional method of care (CMC) gr p value <
.01. The confidence level of mother increasing for their LBW infant was significantly higher
in KMC group (P<0.0001). Bonding between mother and baby was more in the KMC group
when compared to CMC group. Conclusion: KMC has immense benefits on growth &
reduction of morbidities in LBW babies. It also increases bonding between mother & babies.
NEO/78 (P) TO EVALUATE THE TOLERANCE OF RAPID ADVANCEMENT OF
ENTERAL FEED IN LBW BABIES
Anand Jain, Kailash Meena, Prashant Agrawal, Shiv Kumar Vishnoi, Pankaj Jain
798 Ram Nagar Colony, Shastri Nagar, Jaipur
E-mail- [email protected]
Abstract: Introduction: Paediatricians are very much concerned about GI intolerance & risk
of NEC in LBW babies and hesitates in rapid advancement of feeding so enteral nutrition has
generally been slowly advanced at most of centres. Recent studies have shown that rapid
advancement of feed is well tolerated in LBW babies without any risk of gut intolerance,
NEC & shown faster weight gain. Aims & Objective: To evaluate the tolerance of rapid
advancement of enteral feed in lbw babies (1000-1800gms). Method: Stable newborns
weighing between 1000-1800 gms randomized in two groups, Group A- slow advancement
group-feed increased by 20 ml/kg/day & Group B-rapid advancement group-feed increased
by 40 ml/kg/day till maximum 180 ml/kg day in both groups. Outcome measured were rate
of weight gain/day, regaining of birth weight, time achieving full feed, hospital stay,
incidence of NEC, & other feeding related complications. Results: In slow advancement of
feed (group-A) time of attainment of full feed was mean 9.4 days & in rapid advancement
(group-B) was 6.6 days(p<0.001), mean time of regaining birth weight was 10.32 days in
group-A & 9.13 days in group-B (p<0.001),Feeding was interrupted in 8(13.33%) cases in
group-A & 12(20.34%) cases in group B(P>0.05), Gastric residue found in 5(8.33%) cases in
group-A & 8(13.56%) cases in group-B(P>0.05),abdominal distension found in 7(11.67%)
cases in group-A & 11(18.64%) cases in group-B(P>0.05). Conclusion: The adverse events
related to rapid advancement of feed as gastric residuals, abdominal distension, and feeding
interruption were found equal in both groups with benefits of rapid advancement of feed were
early regaining of birth weight, less hospital stay, & early achievement of full feed. So it can
be concluded that in LBW babies rapid advancement of feeding up to 40 ml/kg/day is a safe
& well tolerated& reduces nosocomial infections, parental stress and extra work load on
hospitals.
NEO/79 (O) STUDY OF TOTAL SERUM CALCIUM LEVEL IN ICTERIC
NEWBORN RECEIVING PHOTOTHERAPY
Anand Jain, Kailash Meena, Surendra Meenal, Nishant dangi, Pankaj Jain, Prashant agarwal
798 Ram Nagar Colony, Shastri Nagar, Jaipur
E-mail- [email protected]
Abstract: Introduction- Jaundice is the most common abnormal physical finding during early
days of life in newborn Presently phototherapy is the most effective and widely accepted
method for management of neonatal jaundice but phototherapy is not free from its side effects
i.e. hyperthermia, diarrhoea, dehydration, rashes and hypocalcemia etc. Among these
hypocalcemia is one of the potential side effect but commonly neglected and lesser studied
earlier. So we have conducted this study to determine the effect of phototherapy on total
serum calcium level with comparison between full-term and pre term icteric neonates. Aim &
Objective- Effect of phototherapy on total serum calcium level in preterm (≥32 to <37wks)
and full term (≥37wks) newborn receiving phototherapy. Methods- This comparative study
was carried out in NICU, Zenana Hospital, Jaipur. A total number of 120 icteric neonates
were enrolled for the study on consecutive basis and divided in two group, group A included
full term babies and group B included pre-term babies each group consisting of 60 neonates
including 20 neonates as control. All neonates of study group were fulfilling the criteria for
indication of phototherapy and neonates in control group were icteric but not in phototherapy
range. Measurement of total serum calcium level was done before and after 48 hr of
institution of phototherapy. Result- In group A 15% of study group showing hypocalcemia
after phototherapy with mean fall in total serum calcium level of 0.99mg/dl which was
statistically significant (p<0.001). In group B 32.5% of study group showing hypocalcemia
after phototherapy with mean fall in total serum calcium level 1.057mg/dl which was
statistically significant (p<0.001).While fall in serum calcium level of control in both group
was statistically insignificant. Conclusion- This study concluded that hypocalcemia is benign
but a significant adverse effect of phototherapy in newborn particularly in preterm neonates
therefore during the period of phototherapy serum calcium level should be monitored.
NEO/80 (O) OVER-HYDRATION IN LABOUR CAN BE DANGEROUS FOR
MOTHER AND BABY
Siba Prosad Paul, Alexander
Department of Paediatrics, Yeovil District Hospital, Yeovil BA21 4AT (UK);
Email: [email protected]
Introduction: Women in labour are encouraged to drink plenty of fluids. Some may receive
intravenous fluids. While intravenous fluids are documented, oral fluids may be administered
without being recorded leading to dilutional hyponatraemia both in the mother and newborn
baby. Case studies: The first case was a neonate born by C-section following a prolonged
rupture-of-membrane of 20hours. He underwent blood investigations and antibiotics were
started. Serum sodium was 126mmol/L. Review of documented records and speaking to the
mother, it was found that a total of 3litres of oral fluids and 1litre of intravenous fluids were
received. The infant was managed with fluid restriction and observation. The second case
was of a septic lady in labour where intravenous fluid was administered before C-section. She
was transferred to NNU, suffered convulsions secondary to hyponatraemia. Managed by fluid
restriction and administration of 3%NaCl bolus. Discussion: 1) Dilutional hyponatraemia
remains undetected in most cases. 2) Oral fluids remain underestimated and often not
documented. 3) Moen et al. (BJOG, 2009) highlighted total volume of >2.5litre in labour is
associated with increased risk of hyponatraemia. 4) Eclampsia-like presentation can occur in
expectant mothers who received plenty of hypotic fluids e.g. water. 5) Neonates may suffer
from irritability, poor feeding and rarely convulsions secondary to dilutional hyponatraemia.
Conclusion: Dilutional hyponatraemia is avoidable in most cases by careful monitoring and
clear documentation of fluid received in labour. Unexpectedly low sodium in neonate (after
birth) should raise suspicion of dilutional hyponatraemia secondary to over-hydration in
labour.
NEO/81 (P) PROFILE OF TWIN BIRTH BABIES IN OUR SET UP
Jaswir Singh, Baljinder kaur, Jaspreet, Anil
197 Sewak Colony, Patiala, Punjab
Email: [email protected]
Aims & Objectives: To study profile of twin babies in our set up. Design:A Prospective
study. Material&Methods: 54 babies born as Twin & Triplet deliveries in Department of
obstetrics & gynaecology Government Medical college& Rajindra Hospital were the subjects
of study.Study was conducted for a period of one year.Name &Address of Parents,Antenatal
Record,Mode of delivery,APGAR,Complete examination of Newborn,Postnatal events were
recorded on Pretested,Predesigned Proforma & data so obtained was analysed. Results:
Incidence of Twin deliveries were found to be 2.7%.Out of 54 multiple births 48 were found
to be Twins 2 were Triplets.90% were born by caesarian section while10% were born by
vaginal deliveries.6[12%] babies were born between 25 to 30weeks while26[50%]were born
between 30to35 weeks while 20 were born between35 to 37 weeks; None of the Pregnancy
was carried to Full Term.Respiratory distress developed in 18 [21%]Twin one babies
24[48%] Twin two babies.Birth Asphyxia was observed in 8[15%] babies 4 each in 1st & 2nd
Twin.Neonatal hyperbilirubinemia was observed in 44[81%] babies;20Twin one
babies,22Twin two babies & 2 Twin three babies.Polycythemia developed in 3 babies. 3
babies were weighing less than 1000 grams,11 babies weighed between1001to1500
grams;29 weighed between1501 to 2500 grams .9 babies were born with weight more than
2500 grams
NEO/82 (P) IV FLUIDS SURVEY ACROSS NEONATAL UNITS IN UK
Kishore Yerur Vrajananda, Pravin Desai
Consultant Neonatologist and Paediatrician, Cloudnine Hospital, Bangalore, India
Email: [email protected]
Introduction: Newborn babies vary in the requirement of IV fluids and serious morbidity can
result from fluid imbalance. Aims & Objectives: To survey practices of IV fluid
administration in term and preterm neonates across the neonatal units in the UK. Material &
Methods: We emailed questionnaires to neonatologists working at the neonatal units across
the UK. Results: Response was obtained from 120 neonatal units in the UK
IV fluids
in
term in
DAY 1
DAY 2
DAY 3
DAY 4
DAY 5
babies
ml/kg/day
(mean)
Level
1
Term
neonatal
59
85
110
137
146
babies
units
Preterm
65
94
121
144
152
babies
Term
Level 2
58
85
112
139
148
babies
Preterm
68
95
122
145
152
babies
Term
Level 3
62
86
110
134
146
babies
Preterm
76
101
121
143
150
babies
Number of units Extra fluids for Extra fluids
(%)
babies less than babies
for Restricting fluids
on for babies at risk of
1kg
phototherapy
HIE
Level 1 neonatal
6/18 (33.3%)
11/18 (61.1%)
16/18 (88.9%)
units
Level 2 neonatal
28/62 (44.2%)
27/62 (43.5%)
58/62 (93.5%)
units
Level 3 neonatal
17/40 (42.5%)
8/40 (40%)
33/40 (82.5%)
units
Conclusions: The practice of fluid administration varies across the UK. The level 3 units are
more liberal with their fluids. Most units restrict IVfluids for babies at risk of HIE. There is a
variation in practice in terms of liberalizing fluids for extreme preterm babies and babies on
phototherapy. This study highlights the dilemma faced by neonatologists in the fluid
management, mainly due to multiple variables influencing fluid balance in the newborn. We
are not aware of similar studies in India, which will be helpful in managing preterm babies in
NICU.
NEO/83 (P) PRETERM INFANT WITH SEMILOBAR HOLOPROSENCEPHALY
AND HYDROCEPHALUS (A CASE- REPORT)
Namita Agrawal, J.P.Singh, Sunil Gupta
Department Of Pediatrics, Tirath Ram Shah Hospital, Delhi
Email: [email protected]
Holoprosencephaly (HPE) is the most common structural anomaly of developing forebrain,
and affects 1 in 8-16,000 live births. It refers to incomplete cleavage of pros encephalon into
two halves and is associated with facial dysmorphism and neurological impairment. We
present A preterm infant with gestational age of 35 weeks 3 days delivered to a primi 29 yr
old Bengali mother who presented to the emergency in active labor, an urgent USG done at
that time was s/o hydrocephalus with H.C of 443.6 mm and bpd of 138.9 mm, since the head
was very large ante natal decompression was done and 550 ml of CSF drained out. After birth
baby cried immediately APGAR of 8, 9 at 1 and 5 minutes, was moving all the four limbs
and had no obvious congenital anomaly. Baby was shifted to NICU and started on antibiotics
i/v/o CSF leak. Ballard’s scoring was consistent with maturity of 35 weeks, vital signs were
within normal limits, physical examination revealed widely separated sutures, evidence of
CSF leak, H.C of 33 cm and neurologically baby was normal. The maternal history was
unremarkable for prenatal infections, trauma, drug abuse and chronic disease. No significant
obstetric or family history could be elicited. Iron and folic acid was taken regularly, AN –
USG done in first trimester was normal and further USG was done in our hospital only when
patient went into labor at 8 mo. Daily monitoring of H.C showed gradual increase in head
size and CT scan was planned –that was s/o semilobar type of HPE with intra parenchymal
bleed (due to needle trauma), there was no associated congenital malformation, karyotype
and USG abdomen were normal. MRI was not done as it would not have changed the
diagnosis and management. At discharge the H.C was 41 cm which was increasing on follow
up, so V-P shunt placed at 3 mo of age. On f/u child was developmentally delayed and was
having seizures requiring two anti-convulsant for control. Discussion –HPE is the insult to
developing forebrain and by rule presents with microcephaly, if the H.C at birth is normal or
increased it is s/o hydrocephalus (an atypical feature in our case). It is classified into four
types depending on degree of non- separation of fore-brain and has varied prognosis. Also it
is important to diagnose and classify HPE as it has prognostic implications for future
pregnancies.
NEO/84 (P) NEONATAL REFERRAL PATTERNS IN DAKSHINA KANNADA
DISTRICT- A PROSPECTIVE OBSERVATIONAL STUDY
K. Dileep Kumar, Suchetha Rao, B. Shantaram Baliga
C/o Dr B. Shantaram Baliga Kshitij, Blue Berry Hills, Yeyyadi, Mangalore, Dakshina,
Kannada-575008, Karnataka
Email: [email protected]
Introduction: A referral can be defined as a process in which health worker at one level of the
health system, having insufficient resources (drugs, equipment, skills) to manage a clinical
condition, seeks the assistance of a better or differently resourced facility at the same or
higher level to assist in, or take over the management of the clients case. Aim: To study
referral patterns to neonatal intensive care unit in Dakshina Kannada district of Karnataka
state. Objectives: 1. To study referral patterns 2. To study outcome measures. Study design:
prospective observational study. Inclusion criteria: all neonates referred to neonatal intensive
care unit of: 1. RAPCC 2. Lady Goschen hospital. Study design: prospective observational
study. Statistical analysis: proportions. Results: Out of 267 patients referred, 158 are males
and 109 are females. Majority of patients are of term babies. Most of the referrals are for
medical causes. Out of 267 patients, 45 cases expired.
NEO/85 (P) INCIDENCE OF RETINOPATHY OF PREMATURITY (ROP) IN
PRETERM VERY LOW BIRTH WEIGHT BABIES AND ITS CORRELATION
WITH NEONATAL AND MATERNAL RISK FACTORS.
Jyoti Bagla, Sonia Baidya, Anita Arora, M C Agarwal
Department of pediatrics, ESI PGIMSR Basaidarapur, New Delhi, India
Email: [email protected]
Objective:– Incidence of ROP in preterm, VLBW babies and its correlation with maternal
and neonatal risk factors. Design: Prospective Observational Cohort Study. Setting: NICU of
a tertiary care hospital. Participants: 100 preterm < 32 wks and < 1500 gm babies. Methods:
100 Intramural premmies enrolled after consent and managed with standard NICU protocol.
Gestation assigned by LMP/New Ballards Score. First screening done at 4 weeks postnatal
age by Retina specialist with expertisation in neonatal ROP screening. Detected ROP were
further followed up weekly till threshold ROP or regression of the disease. For threshold
ROP laser therapy was done and and followed up till regression of the disease. Babies with
no ROP on first screening followed up every 2 week for partially vascularised retina and no
follow up for fully vascularised retina. Data analysed by SPSS. Result: Overall Incidence of
ROP was 30% with more in 1001 – 1250 gm weight (58%) and 28-30 wks gestation (47%).
20% had stage 1, 6% stage 2, 4% stage 3 and none had stage 4 and 5 disease. All the 4
infants with stage 3 ROP underwent successful laser surgery. On univariate analysis birth
weight, gestation, oxygen and total days on oxygen & blood transfusion were found to be
significant risk factors while gender, multiple births, sepsis, ventilation, shock, IVH, NNH,
exchange transfusion, acidosis & NEC were not. Maternal risk factors- Leaking PV,
Pregnancy Induced Hypertension (PIH), Antepartum hemorrhage (APH), Diabetes &
Maternal fever were not correlating for development of ROP. Conclusion: Screening of
babies below 31 wks gestation or 1300 gms with risk factors will save valuable resources
and not miss any baby who required therapy for ROP.
NEO/86 (O) A STUDY OF HYPOXIC ISCHEMIC ENCEPHALOPATHY IN
NEWBORNS WITH ITS RELATION WITH LEVELS OF SUPEROXIDE
DISMUTASE AND REDUCED GLUTATHIONE IN CEREBROSPINAL FLUID
Arvind Kumar Singh, Taraknath Ghos, Snehansu Chakraborti, Kanailal Barik.
Senior Resident, Kalawati Saran Children Hospital, Lady Hardinge Medical College, New
Delhi
Email: [email protected]
Abstract: Objective: To find out the relationship between severity of hypoxic ischemic
encephalopathy and levels of superoxide dismutase and reduced glutathione in cerebrospinal
fluid (CSF). Design: Cross sectional hospital based study. Setting: Burdwan medical college
and hospital. Subjects: Intramural newborns suffering from birth asphyxia and admitted in
Department of Pediatrics of Burdwan medical college and hospital. Result: The values of
superoxide dismutase (SOD) were found to be 84.45±11.56, 54.32±19.02, 32.53±13.82 SOD
U/ml of CSF respectively in 3 stages of HIE (P<0.001, r=-0.8) and significantly low in
newborns who expired when compared to survived newborns, the values being 62.26±23.14
and 23.42±7.94 U/ml respectively (P<0.001).The obtained values of reduced
glutathione(GSH) for 3 stages of HIE being 1361.54±272.84, 1045.56±289.78,
693.68±187.49 ng/ml of CSF respectively(P<0.001,r=-0.722) and were found to be
significantly low in newborns who expired when compared to survived newborns, the values
being 1107.58±336.86 and 585.32±116.62 ng/ml of CSF respectively (P<0.001). Conclusion:
Oxidative stress is an important factor in deciding the extent of damage due to hypoxic
ischemic injury. Biochemical parameters like superoxide dismutase and reduced glutathione
levels in cerebrospinal fluid not only get altered significantly but also the levels may suggest
the extent of free radical injury during the process.
NEO/87 (P) TO STUDY THE EFFECT OF MATERNAL NUTRITIONAL STATUS
ON THE BIRTH WEIGHT OF THE NEW BORN
Khushbu Verma, Veenu Aggarwal
C/O Dr Veenu Agarwal, W/O Dr Amit Kumar, R-2/156 Raj Nagar, Ghaziabad, Uttar Pradesh
Email: [email protected]
Objective: 1. To study the proportion of low birth weight babies in our setup. 2. To study and
prioritize the effect of various maternal dietary and anthropometric parameters on the birth
weight of the new born. Study design: A hospital based retrospective study. Material and
methods: A total of 365 mothers were enrolled. Mothers with significant illness, pregnancy
related complication, multiple pregnancy were excluded. Newborns with any chromosomal
anomaly, syndrome or pre term gestation were excluded. Outcome variable was birth weight
of the baby. Predictor variables were diet , anthropometry and haemoglobin of the mother.
Dietary data was collected by recall method. Bivariate analysis followed by multivariate
analysis was done. Results ●Incidence of LBW was more in females as compared to males. ●
LBW was more common in mothers with BMI <19 kg/m2. ● 53% of all the LBW
occurrences were found in mothers having a caloric intake of less than 1500 kcal. ● 58% of
the mothers having a daily protein intake of less than 40 gm delivered LBW babies. ●
Consumption of milk and egg during pregnancy resulted in better birth weight. Conclusions:
It was concluded that maternal anthropometry and dietary intake have a significant role to
play in determining the birth weight of the new born and are important predictors of low birth
weight. It is therefore necessary to take care of the health of the females as it is closely linked
to the health of the progeny as well.
NEO/88 (P) CEREBRAL BLOOD FLOW VELOCITY
HYPERBILIRUBINEMIA
Sriparna Basu, Dibyajyoti De, RC Shukla, Ashok Kumar
IN
NEONATAL
Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi
Email: [email protected]
Abstract: Introduction: Neonatal hyperbilirubinemia (NNH) with high bilirubin load is well
known for its potential neurotoxicity. Till date several studies have documented increased
cerebral blood flow velocity (CBFV) after phototherapy in NNH, but no study has ever
assessed CBFV in NNH before phototherapy. Objective: To assess CBFV changes in NNH.
Methods: In this prospective observational study, 60 healthy newborns with NNH requiring
phototherapy (AAP guidelines) were compared with 60 age-and weight-matched neonates
without NNH. Neonates with perinatal asphyxia, systemic or metabolic disorders, shock, and
hypoalbuminemia were excluded. Resistance index (RI), pulsatility index (PI), peak systolic
velocity (PSV) and vascular diameter were measured in internal carotid, vertebral and middle
cerebral arteries by transcranial color-doppler at the beginning of phototherapy, after 48
hours of starting phototherapy and again at 48 hours after stoppage of phototherapy. In
controls CBFV was assessed once at inclusion. Data were analyzed by SPSS 16.0 Results:
Decreased RI, PI with increased PSV and diameter of cerebral arteries were observed in
NNH even before starting phototherapy compared to controls. After 48 hours of
phototherapy, CBFV increased further. After 48 hours of stoppage of phototherapy, CBFV
came down to baseline and became comparable to controls. There was linear correlation
between total serum bilirubin (TSB) concentrations and CBFV. ROC curve analysis showed
high predictive accuracy of CBFV parameters in moderate-to-severe hyperbilirubinemia with
TSB above 16 mg/dL. Conclusions: CBFV is increased in NNH, which has further been
potentiated by phototherapy. Increased CBFV is directly correlated with TSB with high
predictive accuracy. Key words: Cerebral blood flow velocity, phototherapy, neonatal
hyperbilirubinemia
NEO/89 (P) TO STUDY THE EFFECT OF EARLY NASAL CPAP FOR
PREVENTING MORBIDITY AND MORTALITY IN VLBW BABIES
S. Nath, Debjani Bose
Department Of Paediatrics, Tata Motors Hospital, Jamshedpur
Email- [email protected]
Introduction: CPAP is a non-invasive method that prevents collapse of lung alveoli and
provides respiratory support to immature lungs of preterm babies. Aims And Objectives:To
determine if ENCPAP in preterm VLBW babies reduces the need for mechanical ventilation
and its associated morbidities. Material And Methods: Design – Randomized Control Trial
●SETTING – Level II NICU, Tata Motors Hospital, Jamshedpur. ● PERIOD – Sep 2011 to
Aug 2012 ● INCLUSION CRITERIA –spontaneously breathing neonates with birth weight
<1.5 kg & gestational age < 34 week ● EXCLUSION CRITERIA: i. No spontaneous
breathing ii. Congenital anomaly iii. Complete dose of antenatal steroids received ●
METHOD- Neonates were randomized into 2 groups. GROUP 1- Early nasal CPAP within
10-15 min after birth. GROUP 2- Conventional method of care. Neonates followed for 30
days and intubated if required, at specified conditions. ● OUTCOME – 1) Percentage
developing RDS requiring rescue surfactant& ventilator 2) Percentage developing adverse
effects - air leaks, sepsis, ROP. 3) Mortality 4) Results. 40 neonates were randomized into 2
groups. In Group 2, 55% developed RDS, required intubation & rescue surfactant, compared
to 20% in Group1. which is significant( p value=.02). Difference of incidence of sepsis in gr2
was significant as compared to Gr1( P VALUE=.04). The incidence of air leaks, sepsis,
ROP, mortality & Mean duration on ventilator were not significant ( P >.05) . Conclusion:
There is less incidence of RDS, requirement of intubation and associated morbidities in
neonates who received ENCPAP.
NEO/90 (P) PRUNE BELLY SYNDROME(EAGLE-BARRETT SYNDROME)
Ashok Rathod, Spoorthi Jagadish, Chetan Patil
Prof Of Pediatrics, Bldg # 1, Flat # 15, Sir JJ Hospital Campus, Byculla Mumbai-400008,
Maharashtra
Email: [email protected]
Prune Belly Syndrome affects 1/40,000 live births. It is characterised by deficient abdominal
muscles,undescended testes, urinary tract abnormalities resulting from severe urethral
obstruction in foetal life. Other features are oligohydramnios, pulmonary hypoplasia,
dysplastic kidneys, malrotation of bowel, musculoskeletal system-limb abnormalities and
scoliosis. It overlaps closely with type 4 subtype of Potter’s syndrome. Prognosis depends on
degree of pulmonary hypoplasia and renal dysplasia. 1/3 are stillborn or die within first few
months of life. 30% survivors develop end stage kidney disease requiring renal transplant.
Our patient was a full term, male child of birth weight 2.4 kg born to a primi by vaginal
delivery with breech presentation, baby did not cry after birth and had severe bradycardia and
was resuscitated and shifted to NICU. Antenatal USG in late 2nd trimester showed single live
fetus with gestational age 25 weeks with breech presentation along with grossly distended
bladder with dilated proximal urethra with backpressure hydroureters bilaterally causing
intra-abdominal mass effect with anhydramnios likely suggestive of posterior urethral valve.
Patient had syndromic facies with low set ears,depressed nasal bridge, receding chin,
hypertelorism,external abdominal wall laxity,epispadias, bilateral undescended testis,right
CTEV.Chest X ray showed left pneumothorax,right lung hypoplasia,liver on left, stomach
bubble on right(malrotation of gut),floating ribs and scoliosis.Cardia was normal. Patient was
managed with Ventilatory support,fluids, IV antibiotics, IV adrenaline and dopamine
infusion, but succumbed to death after 5 hours of birth due to lethal anomalies incompatible
with life.