NEO/01(O) ORAL SUCROSE ANALGESIA FOR PRETERM NEONATES
Vinayak Patki, Vaibhavi Ghate
Dept. of Pediatrics, Wanless Hospital,Miraj
patkivinayak@gmail.com
Aims & objectives - To compare the pain reducing effect of orally administered glucose with that of
placebo during iv canula insertion / heel stab in normal preterm infants. Methods: A Randomized,
placebo controlled trial was carried out at the neonatal intensive care unit at wanless hospital Miraj,
Maharashtra from February 2009 to January 2010. Hundred normal preterm newborns (gestational
age < 37weeks ) undergoing iv canula insertion / heel stab for clinical purposes, were enrolled in the
study. Subjects were given either 2ml 25% sucrose or distilled water 2 minutes prior to any painful
procedure.. The behavioral pain reactions were scored with the Premature Infant Pain Profile (PIPP)
and oxygen saturation and heart rate were measured. Statistical analysis :.by student t test , chi square test and univariate analysis of variance Results The mean heart rate increase following a
painful stimuli in sucrose group (143.56 ± 5.300 ) was significantly less when compared with
placibo (161.90 ± 5.768 ) . There was no significant difference in drop of oxygen saturation. Total
pain score (PIPP) was significantly lower in sucrose group (4.32 ± 1.058 vs 10.66 ± 1.803 ) during
painful stimulus . Breast feeds as independent factor significantly reduced the total PIPP score
.Although no effect was seen on heart rate and oxygen saturation .Type of procedure had no effect
on total PIPP score , heart rate and oxygen saturation. Conclusion: Oral 25 % sucrose is useful and
safe analgesic for minor procedures in preterm newborns.
NEO/02(P) A RANDOMISED CONTROL TRIAL OF GRANULOCYTE -MACROPHAGE
–COLONY STIMULATING FACTOR (GMCSF) IN PRETERM NEONATES WITH
SEPSIS AND NEUTROPENIA IN A NICU
Chaudhuri Jasodhara , Mitra Souvik, Mukhopadhyay Debadatta ,Chakraborty Swapna, Chatterjee
Sukanta
Department of Pediatrics, Medical College, Kolkata
jasodharachaudhuri@gmail.com
Background: Bacterial sepsis in premature infants with high mortality rates. Neutropenia which is a
common association comes with increased mortality. Aims and objectives: Whether therapy with
GMCSF decreases neutropenia and mortality in neonates with sepsis compared with conventional
therapy without GMCSF in a control group. Materials and methods: Prospective RCT performed in
76(38 each arm) infants with neutropenia, signs of sepsis and positive sepsis screen. Subcutaneous
injection of GMCSF (5 mug/kg/day) administered to 38 patients 12 hourly,3days Hematological
parameters and outcome compared to 38 conventionally treated patients(control). The sample size
was calculated by statistical formula (power of the study > 80 %).Inclusion criteria: patients
weighing 1100-2500 g, vitals stable. Exclusion criteria: major congenital anomaly, stigma of
intrauterine infections. Results: 36 patients from GMCSF treated group and 37 from conventionally
treated group had early onset sepsis. There was no difference among the groups in terms of birth
weight, gestational age, maternal age or degree of neutropenia. The absolute neutrophil count
(ANC) after 72 hours was significantly increased in the GMCSF treated group compared to other
group. [5012+/-2061 compared to 2673+/-1098 respectively]. The mortality rate in the GMCSF
group was 15 % while in the other group was 28%. Mean duration of NICU stay in the GMCSF
treated group was 8+/-2.36 days compared to12+/-3.05 days in conventionally treated group.
Conclusion: GMCSF therapy is associated with increased ANC,decreased mortality and NICU stay
in neutropenic septic neonates. The results suggest that GMCSF may be effective in treatment of
neonatal sepsis though sample size is small.
NEO/03(P) A RANDOMISED TRIAL OF GRANULOCYTE -MACROPHAGE –
COLONY
STIMULATING
FACTOR IN
PRETERM NEONATES
WITH
SEPSIS AND
NEUTROPENIA IN NICU OF A TERTIARY CARE CENTRE IN EASTERN INDIA
Chaudhuri Jasodhara , Mitra Souvik, Mukhopadhyay Debadatta ,Chakraborty Swapna , Chatterjee
Sukanta
Department of Pediatrics, Medical College, Kolkata
jasodharachaudhuri@gmail.com
Background: Bacterial sepsis occurs 1 to 10 per 1,000 term infants and is three to four times more
common in premature infants. The mortality rate for neonates range from 15%-75% . Neutropenia
commonly occurs in neonates with sepsis and is associated with increased risk of death. .Various
studies done previously suggest the basis of new modes of treatment like increase in neutrophil
supply which may be beneficial for newborn infants with bacterial sepsis. Aims and objectives: To
study whether adjunctive therapy
with rhgranulocyte macrophage colony stimulating
factor(GMCSF) could reverse sepsis associated neonatal neutropenia and decrease neonatal
mortality compared with conventional therapy in a control group. Materials and methods:
Prospective randomized control trial was performed in 76 infants with neutropenia and clinical
signs of sepsis. A subcutaneous injection of rhGMCSF (5 mug/kg/day) was administered to 38
patients 12 hourly for 3days Hematological parameters and outcome was compared to 38
conventionally treated patients(control). The sample size for the randomized control trial has been
calculated by statistical formula assuming power of the study to be 80 %..Study area NICU of
Medical College and Hospitals, Kolkata. Sample size 38 in each arm .Study period 6 months
.Inclusion criteria all patients weighing between 1100 and 3500 g , had adequate renal and liver
functions and vitals stable. Exclusion criteria were presence of major congenital anomaly or
unstable vitals and stigma of intrauterine infections. Results:36 patients from the GMCSF treated
group and 37 from the conventionally treated group had early onset sepsis. There was no difference
among the groups in terms of birth weight, gestational age, gender, maternal age, severity of sepsis,
mode of delivery or degree of neutropenia. The absolute count of neutrophils after 72 hours was
significantly increased in the GMCSF treated group compared to the conventionally treated group.
[5012+/-2061 compared to 2673+/-1098 respectively]. .Mean platelet count at 72 hours in GMCSF
group was 260000+/-55120 compared to 160000+/-51034 in the conventionally treated group. The
mortality rate in the GMCSF group was 15 % while in the conventionally treated group was 28%.
Mean duration of hospital stay in the GMCSF treated group was 18+/-2.36 days compared to 22+/3.05 days in conventionally treated group. Conclusion: Treatment with GMCSF is associated with
increase in absolute neutrophil count , platelet counts and decreased mortality and reduced hospital
stay in critically ill neutropenic septic neonates. The results suggest that GMCSF may be effective
in treatment of neonatal sepsis with neutropenia and further trials are required to establish GMCSF
use as an adjunctive treatment in neutropenic neonates.
NEO/04(O)
NEONATAL
NEUROPROTECTION:
FROM
EVIDENCE
TO
IMPLEMENTATION
Sharma A, Baral V
Department of Neonatology Southampton University Hospitals Trust Southampton United
Kingdom
aloksharma@nhs.net
Introduction: Therapeutic hypothermia is a standard of carein the UK and was implemented on the
neonatal unit in Southampton (tertiary unit 24 intensive beds) in August 2009.We aim to present
how we implemented a cooling programme, and an analysis of the outcomes in 27 cases, while
discussing the ethical and risk related issues of providing such a service. Method: 27 cases that
underwent total body cooling were audited against the TOBY study cooling guidelines. Issues
looked at included meeting criteria, documentation of neurological assessment, temperature control,
and complications. We also looked at ethical issues in withdrawal of care in 3 neonates. Results: Of
27 cases cooled so far 2 cases were cooled outside trial criteria. In 3 cases care was withdrawn. In a
total of 1800 hours of cooling, temperature targets with a servo controlled machine were met 98%
of the time. Among the side effects there were 5 episodes of temperature below 33C and 1
involving arrhythmia with only minor other complications. 85% of neonates were cooled within 6
hours. Thorough introspection was made in cases with complications. Conclusions: Therapeutic
hypothermia implemented as part of a neuroprotection service needs training of staff and thorough
guidelines prior to implementation. Some cases will be cooled outside trial criteria. We present our
experience of such cases, including cases where continuing therapeutic hypothermia was not
considered to be in best interests of the baby along with neuroimaging and CFM of such babies.
NEO/05(P) UNIVERSAL SCREENING OF NEWBORNS TO DETECT HEARING
IMPAIRMENT WITH A VIEW TO EARLY INTERVENTION.
Narendra Rai, Brig Mukti sharma, Brig W.V.B.S. Ramalingum, Col R Ghuliani, V K Tiwari
Department of Pediatrics, Army Hospital(R&R), Delhi
narendrarai1976@gmail.com
Background: In contrast to the recommendations of the Joint Committee on Infant Hearing,
neonatal hearing screening programs are still not universally available. Objectives: To prospectively
evaluate the presence of hearing loss in newborn babies using the transient evoked otoactoustic
emission as the primary screening tool followed by confirmation with brainstem evoked response
audiometry before six months of age and to determine risk factors responsible for hearing loss.
Design A prospective study of nonrandomized cohort Setting: NICU of Tertiary care centre.
Participants 500 neonates (439: not at risk; 61: at risk) from a total of 610 neonates born in between
2009 to 2010 Measurements: Incidence of hearing impairment in the “at risk” and “no risk” group
was compared, using proportion test. Main Outcome Measure(s): Incidence of hearing loss in
newborns both “at risk” and in “no risk” group, risk factors responsible for hearing loss, importance
of universal newborn hearing screening. Results: The overall incidence of hearing impairment was
8 per 1000 screened. The incidence in “no risk” and “at risk” group was 2.27 per 1000 screened
and 49.18 per 1000 screened respectively. Statistically significant difference in the incidence of
hearing impairment between the two groups. (p < 0.01; Proportion Test ) was seen. Common risk
factors identified were culture positive postnatal infections, birth asphyxia, low birth weight, and
prematurity. Conclusions: A high incidence of hearing impairment warrants the implementation of
Universal newborn hearing screening. Considering the economic limitations of our country we may
employ screening of “at risk” groups initially.
NEO/06(P) BELL’S PALSY IN A NEONATE WITH RAPID RESPONSE TO ORAL
STEROIDS- A CASE REPORT
Arushi Saini, Pratibha Singhi, K S Sodhi, Ajit Gupta
Department of Pediatrics, Postgraduate Institute of Medical Education and Research PGIMER,
Chandigarh-160012
doc.arushi@gmail.com
Idiopathic facial nerve palsy, also known as Bell’s palsy is an acute, generally unilateral, peripheral
facial nerve dysfunction causing paralysis or weakness of facial musculature that is not associated
with other cranial neuropathies or brain stem dysfunction. Viral infections, vascular ischemia,
autoimmune inflammatory phenomenon and heredity have been proposed as underlying
mechanisms. Bell’s palsy is rare in the neonatal age group. Other commoner causes of facial nerve
palsy such as birth trauma, infections especially otitis media and congenital malformations need to
be excluded. We present here a 4 week-old neonate with Bell’s palsy who responded rapidly to oral
steroids and physiotherapy. Such an early presentation of idiopathic facial nerve palsy and use of
steroids in neonates is scarcely reported in literature. No standard treatment is recommended for
neonates due to the rarity of the disorder in this age-group. We have documented a rapid response to
oral steroids with significant recovery at 6 weeks of therapy, along with physiotherapy in the index
case. As recovery rates for Bell’s palsy are 80-100%, early recognition and treatment are
emphasized.
NEO/07(P) NEONATES ON MECHANICAL VENTILATION: ‘OUTCOME’
H Veerabhadrappa, Basawarajpatil, G.V.Harish
Ashirwad Maternity & Children's Hospital, Sharan Nagar, Gulbarga - 585103
dr.basavarajpatil@gmail.com
Objectives: To analyse the indications,complications and outcome of babies requiring mechanical
ventilation Study Design: Prospective study done at sangameshwar hospital attached to M.R
medical college, gulbarga. Methods: 106 Neonates ventilated in NICU from june 2010-may 2011
are included in my study. inclusion criteria:
birth asphyxia,hyaline membrane
disease,septicaemia,meconium aspiration syndrome,neonatal pneumonia results:
Among 106
ventilated neonates birth asphyxia 80(42.45%) was the commonest indication followed by hyaline
membrane disease 53(29.2%),septicaemia 28(15%),and meconium aspiration syndrome 23(11.%)
and 2 cases of neonatal pneumonia. Out of them improved and discharged were 46, deaths 60, total
survival rate is 43.4%. In the 106 ventilated neonates best outcome was seen in babies with
gestational age of 37-41 weeks, with birth weight of 2-2.5kgs, and with mean duration of ventilation
more than 120 hours. OUTCOME was good in Birth asphyxia(51%) ,followed by MAS(41.6%),
and very poor outcome in babies with septicaemia. SEPSIS was the commonest complication
followed by pulmonary haemorrhage,shock , airleaks and VAP
NEO/08(P) TO STUDY THE CORRELATION BETWEEN CRP AND BLOOD CULTURE
IN NEONATAL SEPSIS
Sharja Phuljhele, H. Santosh
Department
of
Paediatrics,
Pt.
J.N.M.
Medical
College
Raipur
492001
dr.sharjaphuljhele@gmail.com
Introdution: The diagnosis of sepsis in newborns is generally made first on clinical criteria with due
consideration to high risk factor. This is supported by necessary laboratory investigation, where
CRP and blood culture are of paramount importance. The CRP has high sensitivity and blood
culture has specificity. Aim and objectives: To evaluate the correlation between C-reactive protein
and blood culture in neonatal sepsis. Material and method: The study was conducted at Dr.B.R.
Ambedkar hospital, Raipur (CG); during November 2010 to july 2011. Total of 340 neonates were
taken into the study, considering various high risk factors. CRP and blood culture were sent on
same day and their correlation were studied. CRP values more than 10mg/L were considered
positive. Odd’s ratio was calculated and Chi-square test was applied for statistical analysis.
Observation: Out of 340 neonate 83 neonates were both CRP as well culture positive. Among this
27 patients were CRP negative but simultaneous culture were positive; whereas 86 patients were
CRP positive but blood culture was negative. Remaining were both CRP and culture negative. The
sensitivity of CRP for detection of neonatal sepsis is 75.5% and specificity 62%. The positive
predictive value is 49.1% and negative predictive value of 83.8%. Conclusion: On the basis of the
above study we conclude that, CRP has very good negative predictive value and correlates well
with blood culture.
NEO/09(P) CORD BLOOD ALBUMIN AS A PREDICTOR OF NEONATAL JAUNDICE
Suchanda Sahu, Rebecca Abraham, Joseph John, Alina Ann Mathew, Anish Sam George
C/o. Joseph John, Department of Pediatrics, Sree Narayana Institute of Medical Sciences, Chalakka,
North Kuthiyathodu P.O. Ernakulam District 683 594
drjj@rediffmail.com
Introduction: Jaundice is one of the commonest problems occuring in a newborn. Many a times it is
physiological because liver is not mature enough to handle the bilirubin and there is an increased
load of bilirubin due to a higher circulating erythrocyte volume, a shorter erythrocyte life span and a
larger early labeled bilirubin peak. Early prediction will help in early discharge and prevent
prolonged hospitalization of babies and mothers. Albumin is synthesized by liver and it helps in
transport of unconjugated bilirubin. There is paucity of reports on serum albumin or cord blood
albumin levels as a predictor of hyperbilirubinemia. Aims and objectives: We aimed to estimate
umbilical cord blood serum albumin levels and follow the babies for hyperbilirubinemia and those
requiring phototherapy (PT). Materials and methods: Forty newborns were inducted into the study
with the following inclusion criteria: sequentially born term babies (gestational age > 37 weeks)
from any mode of delivery, both genders, any birth weight, APGAR score of more than 7 at first
and fifth minutes of life, and without Rh incompatibility. Cord blood serum albumin was estimated.
Wherever necessary further laboratory tests were done for bilirubin and those children having
hyperbilirubinemia were managed as per protocol. Results and observations: Our study showed that
82 % of neonates who had albumin levels less than 2.8 gm/dl developed hyperbilirubinemia
requiring phototherapy and 12% needed exchange transfusion. At higher levels of albumin that is
2.8 - 3.3 gm/dl, 40% needed PT and those with cord blood serum albumin > 3.3 gm/dl did not need
any intervention for hyperbilirubinemia. Discussion: Albumin is the major binding protein for
bilirubin and antibiotics. Low levels will lower its bilirubin transport and binding capacity. It is the
“free” bilirubin which can cross the blood brain barrier and cause neurotoxicity. Cord blood
albumin levels more than 3.3 gm/dl is probably safe for early discharge of baby. Hence we can
conclude that umbilical cord blood albumin levels are useful in predicting the development of
jaundice in healthy term neonates.
NEO/10(P) MULTIPLE MALFORMATIONS -CASE REPORT
Neeraj Jain, Vibha Mangal Jain, Shiba Garg
Department of paediatrics, HIHT Dehradun
vibha10297@rediffmail.com
A live female baby with multiple malformations was born on 7th Sep 2011 at our hospital by LSCS.
After delivery the Apgar score was 7, 7, 7.After consent of parent we did not do any active
intervention. In this case we found multiple malformations , so that we are reporting for our
colleagues and students. Case report: On prenatal history, Maternal age was 24years, already
having 3 female normal child and there were no history of any maternal illnesses and history of
medications used during entire period of gestation except the Iron and calcium ,prescribed by
health centre doctor. Foetal movements were felt throughout pregnancy. first perceived at the age
of 21 weeks of gestation. There were no complications throughout the pregnancy except the
excessive emesis in Ist trimester. No History of infections, Teratogen exposures, such as alcohol,
tobacco, drugs and medications and peri –conceptional supplementation with folic acid.
Ultrasonogarphy done at 36th weeks revealed that baby had a large hydrocephalus. Placenta was
normal, Birth weight was 3.457 Kg, appropriate for gestational age. Length was 48 cm ,head
circumference was 54 cm .Baby was survived only for 2 hours. On Family history ,all relatives,
including parents, siblings, grandparents, uncles, aunts and cousins have no history of congenital
anomalies. No history of Consanguinity in parents. Gestational age by physical parameters was 38
weeks. Tone was poor , posture was flexed ,peripheral cyanosis present, respiratory effort were
sluggish and irregular. No any Skin pigmentation present except vesico popular erutions seen on
whole body including the face.. There were no dimples, vascular or other lesions, or excessive
peeling. Head shape was asymmetrical, fontanelles are wide open ,head size was very large . Facial
features- cleft lip and cleft palate were present. Eyes pupils, were normal, Orbits had hypertelorism
, Ears were malformed and patent, Nose appearances distorted, but nares were patent. Chest was
abnormal in shape with pericardial bulging present, nipples were widely separated.Cardiovascular
–heart was very feeble, 182/minute, no murmurs, all pulses were feeble, and blood pressure was
60/40 mm of Hg.Lungs bilaterally had poor entry air, Abdomen appearance bulged with
hepatosplenomegaly. Genitals were normal and anus is patent. Spine was normal, there were no
sinuses or hair tufts in intergluteal cleft. Extremities proportions were abnormal, both lower limbs
had the phocomalia and both upper limbs had the seven digits. Further work up and autopsy was not
due to unwillingness of parent.
Discussion: The worldwide incidence of congenital disorder is estimated at 3-7%, but actual
numbers vary widely between countries1 .Congenital malformations affect 2.5% of infants at birth
and are responsible for about 15% of perinatal mortality in India2,3 Early intrauterine period during
3rd – 8th weeks of gestation is the vital period of life for the normal development of organs and
organ system or organogenesis4. It was observed that better maternal care and improved standards
of living have very little effect on the overall frequency of congenital malformations 5, 6. A
congenital anomaly may be narrowly defined in terms of physical structure as a malformation, an
abnormality of physical structure or form usually found at birth or during the first few weeks of life;
or defined more widely to include functional disturbance as a defect, any irreversible condition
exiting in a child before birth in which there is sufficient deviation in the usual number, size, shape,
location or inherent character of any part, organ, cell or cell constituent to warrant its designation as
abnormal7,8 A malformation is a primary defect where there is a basic alteration of structure, usually
occurring before 10 weeks of gestation. Example cleft lip, anencephaly or radial agenesis.A
malformation could be major which requires surgical intervention e.g. spina bifida /CHD or minor
malformation that requires no treatment or can be corrected totally e.g.polydactyly.Infants with
multiple congenital anomalies (MCA) are typically infants with:• two or more major malformations
(e.g., a neural tube defect, cardiac defect, missing limb), or• three or more minor malformations
(e.g., syndactly, a club foot, abnormally formed pinnae).Common abnormalities include cardiac
defects, cleft lip/cleft palette, neural tube. A congenital anomaly is thus any alteration present at
birth of normal anatomic structure and has cosmetic, medical or surgical significance. The birth of
an infant with major malformations, whether diagnosed antenatally or not, evokes an emotional
parental response9.Congenital malformation will begin to emerge as one of the major childhood
health problems. Treatment and rehabilitation of children with congenital malformations is costly
and complete recovery is usually impossible.6 Approximately, 66% of major malformations have
no recognized etiology and most of them have multifactorial inheritance10, 11, 12 These defects can
occur for many reasons including inherited genetic conditions, poor diet, toxic exposure of the fetus
for example, to alcohol, birth injury and, in many other cases, for unknown reasons.10 Available
literature shows that congenital malformations contribute highly to prenatal mortality and postnatal
physical defects, 13,14,15A significantly higher incidence of malformation observed among the
stillbirths (13.30%) in the present study as compare to live birth (3.2%). It is consistent with earlier
reports. Aiyar and Agrawal16 observed that the highest incidence of malformations was among full
term normal weight babies. Thus, congenital malformations are emerging as important perinatal
problem contributing to the perinatal mortality and morbidity. The difference between the frequency
of types of congenital malformation in different parts of this country and reports from other
countries may be due to genetic background and geographic nutritional and socioeconomic
differences. More research is needed to determine the factors underlying the various types of
congenital malformation encountered in this area. Congenital malformations also have implication
in society as it leads to increase incidence of still birth and neonatal death. Inherited and
chromosomal anomalies are associated with loss of physical or mental and intellectual abilities.
Often emotion upset and social stigma to parents are beyond the limit of our imagination. Genetic
counseling playa vital role for the high risk parents. It provides information regarding various
procedure and diagnostic technique, the risk an consequences of some of the procedure as well as
about options available. Genetic counseling at different time period helps in reduction of congenital
anomalies, morbidity and mortality resulting from these anomalies.
NEO/11(P) ROLE OF VITAMIN K IN PREVENTING CLASSIC HEMORRHAGIC
DISEASE IN HEALTHY TERM NEWBORNS
Neha Sharma, K.K. Locham, Ish Kumar
Department of Pediatrics, Government Medical College / Rajindra Hospital, Patiala - 147001
nehanov83@gmail.com
Introduction: Hemorrhagic disease of the newborn (HDN) is a coagulation disturbance.
Vitamin K is required to form Gamma ()-carboxyglutamate which helps in synthesis of
coagulation factors II, VII, IX, X. These factors play a role in extrinsic, intrinsic and
common pathways. Vitamin K deficiency results in HDN because of non-carboxylation of
PIVKA-II. Aims & Objectives:Whether to give vitamin K or not at birth to prevent classic
hemorrhagic disease in term healthy newborns. Methods: Randomized control single blind
study conducted in tertiary care centre comprised of 50 control and study cases each. The cases
in whom vitamin K 1 was not given served as study group and cases in whom vitamin K 1 ( 1
mg I/M )was given constituted control group. Babies with underlying illness like Hepatitis,
Jaundice, Sepsis, respiratory distress syndrome, G6PD deficiency was excluded from the study
.At the end of 3 rd day of life, Prothrombin Time Index was evaluated in both groups. HDN
was diagnosed if newborn had deranged PTI (<80%) together with normal fibrinogen level and
platelet count. The data was analysed using Chi Square test. Results: 15(30%) cases of study group
had deranged PTI while no control case had deranged PTI.Of these 15 cases, 9 were males and 6
were females. The incidence of bleeding was found in 6 of these 15 cases while no bleeding
was observed in rest of study or control cases. The results on comparison were found to be
statistically significant. Conclusion: Injection vitamin K 1 at birth prevents classical hemorrhaghic
disease of the newborn.
NEO/12(P) PERINATAL TRANSMISSION OF HIV AND DBS STUDY IN THREE MAJOR
HOSPITALS OF GULBARGA- DIST. GULBARGA(KARNATAKA)
H. Veerbadhrappa, Basawaraj Pati, .Madhu. S
Professor in Paeditrics, Dept of Paediatrics, M.R. Medical College, Gulbarga
dr.basavarajpatil@gmail.com
Objective: Analysis of dried blood sample( DBS) test results in neonates born to HIV positive
mothers Study Design: Retrospective study done at Basaveshwar and sangameshwar teaching
hospital
attached to M.R
Medical college gulbarga and Govt. general hospital
Gulbarga.METHODS: Neonates born to HIV Positive mother and brought to ICTC centre for
DBS testing and there DBS test results were collected from the period of july 2010 to july 2011
from all the three major hospitals of Gulbarga.Inclusion Criteria : Neonates delivered in institutions
to HIV positive mothers reporting to the ICTC centers for DBS test at these three major
hospitalsRESULTS: From July 2010, the procedure of DBS testing was started in all 3 major
hospitals ICTC centre. Since then In GGH- out of 64 collected DBS samples result, 53 were
turned out to be negative, where as 9 were POSITIVE. All these were institutional deliveries and
both mother and the child received ART. In GGH only neveripine is administered to the neonates
by the ICTC centre.In STGH – out of 17 DBS Samples collected all were non reactive. Both mother
and child received ART . In BTGH – out of 17 DBS samples collected 3 were positive. Here also
both mother and child received ART. In these two major hospitals ( STGH and BTGH) the child
received combination of both neverepine and zidovudine. In total out of 12 DBS positive test
results ,10 babies were born by NVD. Female babies accounted for 8 in number out of 12. All the
babies were born with birth weight above 2 kgs. All the mothers were aged above 20 years.DBS
was very useful in early detection of HIV status in the newborn and early intervention
NEO/13(P) HOW DOES VIT A STATUS OF MOTHER AFFECT THE NEONATAL
OUTCOME?
Anuradha Sanadhya, Abhishek Ojha, Srishti Sareen, D.R.Dabi, Devendra Sareen
C/o. Dr Devendra Sareen, 27-F, New Fateh pura, Udaipur-313001
drsareen@yahoo.com
Introduction: Maternal malnutrition is very important cause of growth retardation in newborn
babies. Among various nutrients, proteins intake, energy consumption, various micronutrients like
iron ,zinc, Folic acid and Vitamin A are supposed to play role in birth weight of newborns. Aims
and objectives- The present study was undertaken to study the effect of Vit A status of mothers on
birth weight of newborns. 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. Vitamin A
status of mother was judged by history of night blindness, clinical assessment and biochemical
estimation. Data for each variable was obtained and compared with each other. Biochemical
assessment was done by ‘ultraviolet absorption spectrophotometry’ Result-Our study revealed that
80% of women in study group and 42% in control group were having some degree of Vitamin A
deficiency while severe Vitamin A deficiency was present in 4% of study group. Mean Vitamin A
levels in study group were very low (16.7%+-3.63 microgram/dl) in comparison to control group
(21.1+-3.69 microgram/dl ) which was highly significant (p<0.001). Signs of Vitamin A deficiency
were more prevalent in study group as compared to controls(36% versus 10%).History of night
blindness was found in 10%cases and 4% controls. Conclusion- Vitamin A is having a positive role
in the growth and development of fetus. Hence early detection of Vitamin A deficiency in
pregnancy should be made to correct it by earliest by supplementing Mega dose of Vitamin A and
improving dietary patterns of mothers.
NEO/14(P) CORRELATION OF MATERNAL ANEMIA TO BIRTH WEIGHT OF
NEWBORN
Anuradha Sanadhya, Srishti Sareen, Abhishek Ojha, NIshtha Sareen, D.R.Dabi, Devendra Sareen
C/o. Dr Devendra Sareen, 27-F, New Fateh pura, Udaipur-313001
drsareen@yahoo.com
Introduction-Maternal nutrition plays important role in development of baby . Various nutrients
like protein intake, Iron, Zinc, folic acid and vitamins are supposed to play role acid in intrauterine
growth. Aim and objective-To study the effect of Haemoglobin levels of mother on birth weight of
babies.Material and methoD-This study is having case control design. Cases were 50 mothers of
TSGA babies and controls were 50 mothers of TAGA newborns. Detail history and Hb levels of
mothers of both group were taken and data were analysed. Hb estimation was done by ‘Sahli’s
method of haemoglobin estimation’Result-28% cases and 10%controls didn’t received haematinics
at all. While 8%cases and 40%controls received iron and folic acid tablets in adequate
number.92%of mothers in study group and 34% in control group were having anemia of some
degree.6% of women in study group were having severe anemia and 72% moderate and 14%having
mild anemia. Mean Hb levels in case groups were 7.95+-1.28 and in control group were 10.3+-1.45
gm/dl respectively which was highly significant ( p<0.001) Conclusion-Thus pregnant mother’s
Hemoglobin level is having a positive role in the intrauterine growth of babies. Hence Iron and folic
acid tablets should be supplemented to pregnant women to avoid occurrence of low birth weight
newborns.
NEO/15(P) NEONATAL PROBLEM ASSESSMENT ACCORDING TO IMNCI PRACTICE
IN SLUMS OF RAIPUR C.G
N.L.Phuljhele, O.Khandwal, Deepti Singh
Kanchanganga Phase 2, P.O R.S.UNIVERSITY, Daganiya, Raipur - 492010.
drnsph@gmail.com
Background IMR in India is 50/1000 and in CG its54/1000[SRS-2008] Newborn care practices has
to be improved to achieve RCH-2 goal of35/1000 Aims : To find out defecits in newborn care
practises and care-seeking in 0-2 months age group in slums of Raipur. Method & design :
Community based observational cross sectional study of mothers of 0-2months age group subjects.
Statistical analysis : Data analysed using Epi- info version 6.04. chi square test was applied. A pvalue of < 0.05 considered significant. Result and Conclusion :.0-2 months total subjects 411,
(male 45% female 55%), maximum(63%) in grade IV socioeconomic [ Modified Prasad
Classification][p<0.05],only28 % were referred for treatment(p<0.05).,44% Hospital delivery &
56% Home delivery. All 5 cleans were used only in 45% (p<0.05). Out of all 5 cleans, clean blade
was used by maximum cases(78.8%)(p<0.005).,home deliveries(56%), in 30% cases oil & in 26%
turmeric was applied on umbilical stump(p<0.05).,93% cried immediately after birth & in rest 7%
who cried after 5minutes of birth most common practice was slapping on feet (80%)(P<0.05).,In
48% cases, some type of pre lacteal was given(p<0.05), In 41% home delivery & 7% of hospital
delivery,.59.7% breastfed within 4 hrs after birth ,57% have exclusive breast feeding(p<0.05).,47%
babies kept both head & body covered. Only 24% kept baby in contact with mother(p>0.05).,57%
bathed immediately, home delivery 52.4% & hospital delivery 4.6%(p<0.05). . 19% were reported
to have temperature below normal(p>0.05) according to coverage, BCG 46%, OPV1 52% DPT1
32.2%(p<0.05) & no immunisation in 14.1% cases.,16% were icteric ,(9.8%) after > 3 days after
birth. Among cases of icterus appearing within 3 days of birth (6.6%) only 25% were
referred(p>0.05)., (32.2%) were ‘keeping dull’ as a sign of sepsis. Out of which 24.1%(p>0.05)
referred.,(37%) subjects had 2 episodes of diarrhoea, out of which dysentery in 10.3% cases. Total
19% referred(p>0.05) & 40% given ORS.(p<0.05) There is urgent need to reorient health workers
and mothers about newborn care practices to decrease IMR.
NEO/16(P) ARE LOW BIRTH WEIGHT BABIES MORE PRONE TO INFECTIONS
DURING THE FIRST YEAR OF LIFE AS COMPARED TO NORMAL BIRTH WEIGHT
BABIES?
Daljit Singh, Saumya Joshi, KS Rana
Command Hospital (Southern Command) & Armed Forces Medical College, Pune
maapavitra@gmail.com
Introduction: Low birth weight (LBW) babies are more vulnerable to infections in first years of life.
In a study by Vik T et al, small for gestational age (SGA) infants had an increased risk (OR: 1.7, 95
% confidence interval: 1.1-2.6) of being admitted to hospital compared to non SGA infants. The
principal cause was respiratory tract infections. Data on the subject from India is scarce. Aim: To
find out whether the Low birth weight (LBW) babies are more prone to infections during the first
year of life as compared to normal birth weight babies. METHODS: Mothers of 100 LBW and 100
normal birth weight babies between the ages of 1 to 5 years visiting the pediatric O.P.D were
subjected to a comprehensible questionnaire on the medical history of their babies. Result and
analysis: The incidence of upper respiratory tract infections (URTI), diarrhea, skin and ear
infections in LBW babies during the first year of life was 90, 77, 17 and 25 percent respectively,
whereas the incidence in normal birth weight babies was 84, 48, 5 and 8 percent respectively. The
risk of hospitalization in the first year of life was 10.17 times more in a low birth weight baby
compared to a normal birth weight baby (p < 0.05). Conclusions: This study highlights the inherent
susceptibility of a LBW infant to infections and the resulting increased risk of hospitalization (OR:
10.17). URTI and diarrhea were the most common infections in LBW babies. We recommend more
OPD based surveys on infections in LBW babies in our country.
NEO/17(O) NEURODEVELOPMENTAL EVALUATION IN PRETERM NEONATE
AND ITS ASSOCIATION WITH SERIAL CRANIAL ULTRASONOGRAPHIC
FINDINGS
Somosri Ray, Asha Mukherjee
Department of Pediatrics, VIMS, Kolkata
dr.somosri@gmail.com
Introduction: Ultrasonography of brain is an integral part of neonatal care in high risk and
premature infants. Early identification has predictive values for neurodevelopmental sequelae.
Aims and objectives:To evaluate abnormal cranial ultrasound findings in preterms. To associate
clinically neurodevelopmental evaluation with abnormal cranial ultrasounds. Materials and
methods: A prospective observational study was performed on 100 preterm babies of 35 weeks or
less. Ultrasound brain was done on day 3, day7, and at term (40th wk of gestational age).All the
babies followed up till twelve month of corrected age for neurodevelopmental assessment with the
help of DDST (DENVER DEVELOPMENTAL SCREENING TEST) and AMIEL TISON
METHOD Results: 43 anomalies were detected on USG brain at day 3 . Among these 31 were
germinal matrix hemorrhage, 2 were congenital anomalies,10 were cerebral edema. Only 4 new
bleed were detected on day 7 cranial usg . USG at 40th weeks of post natal age identified 2
porencephalic cysts, 5 cystic encephalomalacia, 6 hydrocephalus . In 1 year follow up- 8 expired , 6
lost ,7 had developmental delay . But 7children out of 74 showing normal USG brain had
developmental caution.USG brain at 40th week of postnatal age showed best predictive value for
neurodevelopmental outcome .Specificity of that USG for prediction of neurodevelopmental
outcome at 1 year was 98.5%,negative predictive value was 90%.Conclusion: Though sensivity is
low,high specificity and high negative predictive value signifies that normal USG brain predicts
correctly a good neurodevelopmental outcome.
NEO/18(O) AN INTERVENTIONAL STUDY TO KNOW THE EFFECT OF
COUNCELLING ON EARLY INITIATION OF BREAST FEEDING AND AVOIDANCE
OF PRELACTEAL FEED
Parveen Mittal, Naresh Kundra, Shinu Singla
House No.37, Khalsa College Colony, Near Saket Hospital, Patiala
doc parveen@yahoo.co.in
Introduction- Early initiation of breast feeding and not giving prelacteal feeds are two useful
feeding practices which can protect the newborn from many complication. Counselling about these
two practices is required in the antenatal period since in developing countries pregnant women
usually don’t approach pediatricians and obstetricians are usually not concerned about the feeding
of the newborn, so late initiation of breast feeding (usually upto 3 days) and giving prelacteal feeds
is quite common in our setup. Present study was designed to know the effect of counselling on early
initiation of breast feeding and avoidance of prelacteal feeds. Aims and objectives- 1)To study the
effect of councelling on early initiation of breast feeding. 2)To study the effect of councelling on
avoidance of prelacteal feed. Material and methods- The current study was done in Tripuri area
having population of approximately 10,000 people under urban MCH Centre which is attached to
Department of community medicine Government Medical College , Patiala. House to house survey
was done. Two groups of pregnant women were made, with 50 women in each group. Out of these
groups,one group was kept as interventional group and councelling was done in them through one
visit during last trimester and one visit within 3 days after delivery.The other group was kept as
control group,where no councelling was done.In the councelling visits to the interventional
group,discouragement of prelacteal feeds with reasoning and encouragement for giving colostrum
and telling its beneficial effect to the baby and promotion of exclusive breast feeding upto 6 months
of age of infant was conveyed to the mother.In both the groups data was collected regarding
prelacteal feeds and time of start of breast feeding after birth.The data collected was analysed
statistically. Results- In the study group, 29 mothers (58%) started breast feeding within 1st hr,
whereas in the control group, only 3 (6 %) started breast feeding within 1st hr. the difference
between the two groups was highly significant, ( P VALUE < 0.05). In the study group all the 50
mothers (100 %) started breast feeding within 1st 12 hrs and none of the mothers( 0%) delaying after
12 hrs, whereas in the control group 17 mothers ( 34 %) started breast feeding after 12 hrs and the
difference was again significant.in the study group, 7 newborns (14 %) were given prelacteal feeds
while in the control group 36 (72 %) mothers gave prelacteal feeds to the newborns, the difference
being highly significant, ( P value < 0.05). the prelacteal feed was in the form of honey( 62%),
jaggery (23 %), sugar water (7 %), cow’s milk ( 5 %), goat’s milk( 3 %). Prelacteal feed was given
with finger, cotton wick or rarely with a spoon. Conclusion- Counselling the mothers about
beneficial effects of early initiation of breast feeding and avoiding the prelacteal feeds can help to
curb the harmful practices of delayed initiation of breats feeding and giving prelacteal feeds.
NEO/19(P) IMPORTANCE OF FETAL ECHOCARDIOGRAPHY
I B Vijayalakshmi, Chitra Narasimhan
Pediatric Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore
chitradr@gmail.com
Fetal echocardiography is a complete two dimensional and Doppler ultrasound evaluation of the
human fetal cardiovascular system. It is completely noninvasive and harmless for the fetus. Fetal
echocardiography also serves as the electrocardiogram for the foetus and helps monitoring during
foetal life. Aim : To analyse the cases of fetal echocardiography referred to a cardiac centre.
Materials and Methods: 90 cases of fetal echocardiography was done over a period of one year. The
average age of the patients was 24 years and average gestational age at referral was 25 weeks.
Referral for fetal echocardiography was done for maternal cardiac disease in 9, Diabetes mellitus in
3 and drug ingestion of antidepressant in one. History of previous sibling with heart disease was
seen in 12 cases and in 10 cases the referral was as it was a high risk pregnancy. Results: Echogenic
foci was observed in 10 patients. Abnormal fetal echocardiography was observed in 18 patients
(20%) and which was mainly complex. Fetal Arrhythmia was observed in 3 patients , of which 2
were bradycardia. One case of fetal tachyarrhythmia was treated successfully antenatally.
Conclusions: Early foetal echocardiography can effectively identify abnormal hearts. The concern
in Indian scenario is the late referrals. Fetal cardiology represents one of the most exciting and
rapidly evolving areas in the field of pediatric cardiology and with incredible advances in the
prenatal diagnosis and management of CHD there is increased ability to intervene medically,
percutaneously and perhaps surgically on the fetus. Thus this has enhanced the importance of
prenatal detection of CHD and Fetal echocardiography has opened a new horizon and is the best
tool in this direction.
NEO/20(P) INTRAPLEURAL FIBRINOLYTIC THERAPY IN A NEONATE
AN Prasad
Pediatrician, Command Hospital Chandimandir(WC), Panchkula, Haryana-134107.
dranprasad@gmail.com
Pleural effusions are common complications of pediatric bacterial pneumonias. Failure to control
the pleural effusions may lead to progressive disease and can result in complicated parapneumonic
effusions. The natural history of a complicated parapneumonic effusion is to develop a single
loculus or multiple loculations and then progress to an empyema cavity in untreated or inadequately
treated patients. Simple chest tube drainage is often inadequate in complicated parapneumonic
effusions, due to the presence of viscous fluid with fibrinous debris clogging the tube or multiple
loculations in the pleural space. Chemical fibrinolysis, in the management of complicated
parapneumonic effusions has been employed since 1949, with the initial use of a mixture of
streptokinase and streptodornase. Although intrapleural fibrinolytic therapy has been reported for
more than 50 years, experience is limited in children. Use of intrapleural fibrinolysis with
streptokinase has never been reported in neonates. Here, we report a case of complicated
parapneumonic effusion in a neonate, which was managed effectively with intrapleural
streptokinase therapy. Case Report : A 24-days female neonate presented with clinical features
suggestive of sepsis, with onset since 15 days of life. She had respiratory distress with cyanosis. The
baby had toxic appearance with reduced sensorium, and was febrile. Clinical examination of the
chest revealed features of pleural effusion or hydropneumothorax (right), and was confirmed on CT
chest to have empyema with loculations of the right pleural space. The baby was managed with
broad spectrum antibiotics and other supportives, in form of oxygen support and maintenance
intravenous fluids. A chest tube (14 Fr) was inserted under GA, under USG guidance and fluid was
drained/ suctioned intermittently, every 24 hourly. Intrapleural Streptokinase (50,000 units) was
instilled every 24 hourly for 5 days, and chest tube was removed after 8 days. Culture of intrapleural
pus had grown staphylococcus aureus. The baby showed complete recovery, and was discharged
after 15 days.
NEO/21(P) HERPES SIMPLEX INFECTION IN A NEONATE: A CASE REPORT
Neha Singla, Karuna Thapar
Professor & HOD, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar.
dr_nehasingla02@yahoo.com
Introduction: Neonatal herpes simplex virus infections can result in serious morbidity and mortality.
The incidence of infection is approximately one per 3,000 to 20,000 live births. Most (85%)
neonatal HSV infections are acquired during delivery, although in utero (5%) and postnatal (10%)
infections do occur. The risk for transmission to the newborn is much higher in women with
primary HSV infections. Many of the infections result from asymptomatic cervical shedding of
virus after a primary episode of genital HSV in the third trimester. Neonatal herpes can be localized
to skin, eyes, and mouth (≈45% of cases), involve the central nervous system (≈30% of cases), or
can cause disseminated infection involving multiple organs such as liver, lungs, adrenal glands, and
brain (≈25% cases). We report a neonatal herpes infection localised to skin and CNS. CASE
REPORT: A preterm female baby weighing 1.5 kg was born to a 25-year-old gravida 1 woman by
normal vaginal delivery at 32 weeks of gestation. The mother had an uncomplicated pregnancy with
no history of HSV infection. There was no intrapartum fever. Rupture of membranes was
spontaneous and labor was augmented. Delivery occurred approximately 20 hours after rupture of
membranes. Baby was sent home on 2nd day of life. Baby was brought to our hospital on day 6 of
life with complaints of lethargy and refusal to feed. Baby was lethargic with mild jaundice. child
started on i/v antibiotics. Sepsis work-up was normal. On 2nd day of admission child developed
papulo vesicular rash over the chest. The rash increased despite antibiotics and involved even the
genital area. Suspicion of HSV was made & screened for that. HSV IgM and IgG titres of baby
were elevated. IgM-1.08, IgG- 3.57. Child was put on i/v acyclovir. Baby responded within 2 days,
rash started subsiding and started accepting feed.10 days of acyclovir therapy given and baby was
discharged home on breast feed. Infant was followed up in OPD and no complication was found.
This case is being reported because of its rarity.
NEO/22(P) NEONATAL AND MATERNAL OUTCOME OF DIRECT IMMEDIATE
BREAST FEEDING,Pt JNM MEDICAL COLLEGE ,RAIPUR
N.L. Phuljhele, Rachana Daddha
Pt. J.N.M. Medical College, Raipur
drnsph@gmail.com
Introduction: 1 million of neonatal deaths per year and in india 2.5 lakhs neonates can be prevented
by early initiation of breast feeding.Other mammals like animals fed their baby as soon as they are
born without pause but humans waste time.In India only 24.5 % of newborns are breastfeed within
one hour with 1 hour feeding rate being highest in Mizoram ( 66.4%) and lowest in Bihar (3.7%).
C.G. has 25% rate.Immediate and direct feeding within minutes can prevent neonatal
sepsis,diarrhea,pneumonia & maternal depriviation. Aims & objectives : To study maternal and
child effect of breastfeeding in newborns who were immediately fed and to compare it with those
who were fed late. METHODS :A Prospective comparative study on 150 term healthy newborns
who were immediately breast feed were taken from labour room in MCHR, RAIPUR as (GROUP
A) and 50 term babies from postnatal ward who were fed within hours to days (GROUP B).
Results: 100 % of GROUP A babies maintain blood sugar with 24% has bld sugar upto 110 mg %
and 16% with bld sugar b/w 80-100 mg% where as group B 22 % had 40 mg %.98.6 % of Group A
babies maintain temperature as compared to 84 % in other group B. 96% of group A had lesser
crying episodes as compared to 50 % in group B.98% of GROUP A have good reflexes and
activity, 96% have sound selep,97% had good weight gain,on follow up.98% are healthy and
require no admission in nursery and 100% have good maternal bonding as to group B,36% has
less weight gain, 10% are admitted to nursery and 22% had more crying episodes.Also in mother
early expulsion of placenta (99 %),better HB control (90%),breast problems (1%), formula feeding
(1%) were found in group A. Conclusion: Newborn if term healthy and cried immediately no time
should be wasted in suctioning ,bathing instead Baby should be directly placed on mother breast for
feeding and skin to skin contact which help in maintenance of temp,sugar level,, provide maternal
child bonding& neurodevelopment of baby.Also oxytocin release helps in uterine contraction
leading to early expulsion of placenta and prevents PPH and continuous expression of breast
milk.So by proper training of birth attendants,education of mother and family by gyanaecologist and
paediatrician can prevent neonatal mortality & morbidity.
NEO/23(P) CONGENITAL RUBELLA SYNDROME
Manish Tiwari, Khamkar Anilkumar Mohan
Department of Pediatrics, SRTR Medical College, Ambajogai, Beed – 431517
manishtiwari.peds@rediffmail.com
A 1 yr old m/ch B/B mother with c/o weakly accepting since last 3 days, c/o increased abdominal
movements since last 2 days Birth H/O-Antenatal h/o- No maternal h/o fever with rash USG done
twice-5th & 7th month -WNL Natal h/o-FTND at home, cried well after birth Postnatal h/o-not
significant Past h/o-not significant Developemental h/o-s/o global developemenatl delay O/E-mildly
febrile,HR-168/min,RR-64/min., Lt sided cataract +, microcephaly + S/E- CVS-S1 muffled, loud
P2, continuous murmur+ P/A-L3 firm in consistency S2 firm in consistency K-non ballotable RSAEBE,B/L basillar crepts+, subcostal & intercostal retractions+ Course in ward-Pt started on
antifailure treatment & antibiotics, Pt improved on Day 3 & fully recovered after 6 days.
NEO/24(P) A C/O EMPYEMA IN A 10 DAYS OLD NEONATE
Manish Tiwari, Khamkar Anilkumar Mohan
Department of Pediatrics, SRTR Medical College, Ambajogai, Beed – 431517
manishtiwari.peds@rediffmail.com
A 10 days old m/ch B/B relatives with c/o increased respiratory movement and not feeding well
since last 2 days BIRTH H/O-FTND at home, cried well after birth,was taking breast feeds till 8
days of life well without h/o s/o suck rest suck cycle. O/E-Wt-3.5 kg, cyanosis +, SpO2 without O272%, SpO2 with O2-98%, S/E-RS-AE absent in Rt middle zone & lower zone, severe respiratory
distress +, COURSE IN WARD-X-RAY chest s/o Rt sided fluid collection with blunting of CP
angle. mediastinal shift could not be appreciated, as aX-RAY was rotated. USG chest was s/o fluid
coolection on Rt side of chest.Pleural tap was done-pus & blood culture & sensitivity were sterileimmediate ICD insertion was done by Surgery people-Inj. vancomycine and Inj cefepime were
started- drain gradually became nil-ICD removed-antibiotics continued for 4 weeks.PT recoverd
completely.
NEO/25(P) CASE OF FUNGAL PNEUMONIA IN NEONATE
Manish Tiwari, Pallavi Saple, Ashwini
Department of Pediatrics, SRTR Medical College, Ambajogai, Beed – 431517
manishtiwari.peds@rediffmail.com
A preterm male neonate (32 weeks of gestation, birth weight 1700 gms) was admited to neonatal
intensive care unit. It was a preterm vaginal delivery to a primi mother. At the time of admission
baby was hypothermic, HR:140/min, RR:54/min with other general and systemic examination
findings within normal limits. Supportive treatment in the form of oxygen inhalation, IV fluids
and antibiotics was started. On day 3, patient developed sclerema, capillary refill time was
prolonged with severe respiratory distress and intermittent gasping. Patient intubated and kept on
assist control mode on ventilator. Laboratory investigations showed increased TLC with
predominance of polymorphoneuclear cells, C-reactive protein:positive, blood culture negative.
Ionotropes and broad spectrum antibiotics were added with other supportive care. Patient showed
improvement within 48 hours and was weaned off the ventilator and extubated on day 7. Further
treatment continued and patient was on continuous oxygen therapy by O2 tent. But on day 10,
patient again showed signs of respiratory distress. Chest X-ray revealed appearance of infiltrates in
right middle and lower zone. Again blood culture was sent this time it showed Candidal growth.
Intra-venous Fluconazole was added in view of patient’s general condition and prolonged aritifical
ventilation and broad spectrum antibiotics with a CULTURE diagnosis of fungal infection.
Patient’s general condition stabilized within two days of starting Flucanozole. Same treatment was
continued for further 5 days. With improvement of patient’s general condition, intra-gastric feeding
started which later on shifted to breast feeding. Patient discharged on day 25.
NEO/26(P) DEVELOPING AN EQUATION FOR GESTATIONAL AGE ESTIMATION OF
NEONATES USING ANTHROPOMETRY
Rajat Thawani, Pooja Dewan, Rajeev Kumar, MMA Faridi
Departments of Pediatrics and Biostatistics and Medical Informatics, University College of Medical
Sciences & Guru Teg Bahadur Hospital, Delhi-110095
poojadewan@hotmail.com
Introduction: Gestational age assessment of newborns is based upon Modified Ballard Scoring for
which a pediatric specialist is needed. Anthropomety of the newborn may be used to predict the
gestational age of the neonate in peripheral health facilities where often a trained paediatrician is not
available. Objective: To determine the anthropometric parameters which can reliably predict the
gestational age. Design: Cross-sectional study Setting: Tertiary hospital-based study in Delhi
Participants and Methods: Detailed anthropometric estimation (birth weight, crown heel length,
head circumference, mid-upper arm circumference, lower segment, foot length, nipple umbilical
distance, calf circumference, inter-mammary distance and hand length) of 1000 newborns was done
within 48 hours of birth using standard techniques. Gestational age was estimated using Modified
Ballard Scoring. First 800 newborns were used to devise the model and remaining 200 newborns
were used to validate the final model. Multiple linear regression analysis using stepwise selection
was used to build the predictive model. Variables that had quadratic relation with gestational age
were considered after centring to avoid collinearity. Results: Birth weight (R2= 0.521), head
circumference (R2= 0.360) and mid-upper arm circumference (R2= 0.453) were found highly
correlated, and had a quadratic relation with gestational age amongst the anthropometric variables,
when each variable was used separately. The final equationto assess gestational age was:
‘Gestational age = 5.437 BW – 0.781 BW2 + 2.815 HC – 0.041 HC2 + 0.285 MAC – 22.745’
(adjusted R2= 0.581). On validation, the predictability of this equation is 46% (±1 week), 75.5% (+2
weeks) and 91.5% (+3 weeks). Conclusion: Anthropometric assessment of newborns can be a
simple and reliable tool to assess the gestational age.
NEO/27(P) FACTORS AFFECTING OUTCOME OF NEONATAL SURGERY IN NICU AT
SGRD HOSPITAL, AMRITSAR
Manmeet Kaur Sodhi, Karuna Thapar, Manu Sharma
114-A, Guru Amar Das Avenue, Block A, Ajnala road, Amritsar, Punjab.
doctor.manmeet@yahoo.com
Introduction: In recent years, neonatal surgical mortality has steadily decreased in developed
countries due to availability of neonatal surgeons and appropriate referral of newborn surgical
emergencies. But the picture is still problematic in developing countries. Objective: To determine
the various factors that can affect the outcome of surgical conditions/disorders of the neonate in a
tertiary level NICU at SGRD medical college and hospital, Amritsar. Methods: A retrospective
study of all neonates who had surgery over a 1-year period at NICU, SGRD Institute of Medical
Sciences And Research, Sri Amritsar, India. Results: A total of 92 neonates underwent surgical
management in the last 1 year period from July 1, 2010 to June 30, 2011.There were 62 males and
30 females. The mean age at presentation was 5.6 days with a range of 2 hours to 30 days. The
weight at presentation was 1.3 to 3.9 kg (mean of 2.52kg).The most common conditions requiring
surgery in NICU were Ano-rectal anomalies (29.3%), followed by necrotizing enterocolitis (19.6%)
and trachea-esophageal fistula/esophageal atresia (18.5%).Colostomy was the most common
surgical intervention.(46%). Overall, there were 26 deaths (35.4%). Low birth weight, prematurity,
associated septicemia significantly influenced the outcome directly. Intestinal resection with
anastomosis is associated with the highest mortality (55.5%). Sepsis/septicemia was the commonest
postoperative complications accounting for 22 deaths. Conclusion: The morbidity and mortality
following surgical management of the neonate is still very high in this environment. Lower birth
weight, prematurity and sepsis are three most important factors for increased surgical mortality.
NEO/28(O) ASSESSMENT OF VITAMIN D STATUS AND SUPPLEMENTATION IN
PRETERM NEONATES AT BIRTH AND 6 WEEKS OF AGE
Niranjan Thomas, Mintoo Tergestina, Anil Kuruvilla, Sridhar S, Binu Govind, Victoria Job, Arun
Jose.
Department of Neonatology and Clinical Biochemistry, Christian Medical College, Vellore,
Tamilnadu
tergestina@gmail.com
Introduction: Current literature suggests a high level of vitamin D deficiency in mothers and
newborns even in tropical countries like India. Preterm babies are at high risk of metabolic bone
disease. There is no current literature available on prevalence of vitamin D deficiency and adequacy
of recommended supplementation in preterm infants from India Aims and objectives: To assess
Vitamin D status of preterm newborns at birth and 6 weeks and assess if the current Vitamin D
supplementation is adequate. Methods: This was an observational cohort study, set in a tertiary care
neonatal unit. The subjects were inborn preterm babies (27 to 33 weeks). A cohort of term babies
was used as controls for cord blood levels. The sample size calculated was 86 at 5% level of
significance. Results: Ninety preterm babies were followed up with cord blood and 6 week levels of
Vitamin D, calcium, phosphorus, alkaline phosphate and PTH. One hundred term babies’ cord
blood levels were also analysed. Sixty-six percentage of the preterm neonates and 28% of the term
neonates were Vitamin D deficient at birth. (p :<0.001) At 6 weeks 84% of preterm babies were
vitamin D deficient (p :< 0.001) The median Cord blood Vitamin D level was 34.71. (5-100)
Median Vitamin D level at 6 weeks was 19.34. (4-86)There was a significant fall in the Vitamin D
levels (p<0.001) as well as the levels of phosphorus. (p<0.001) There was a significant rise in
Alkaline
phosphatase
levels.
(p<0.001)
Conclusion: Preterm newborns are vitamin D deficient at birth. The deficiency significantly
increases by 6 weeks despite supplementation. Thus the current recommended supplementation
does not appear to be adequate. Further research is required to define an appropriate
recommendation that will lead to vitamin D sufficiency in the preterm neonate.
NEO/29(P) A STUDY OF VARIOUS HEMATOLOGICAL PARAMETERS IN NORMAL
TERM NEONATES
Suresh Goyal, Mohammed Asif, Sohan Lal Kumavat, Kritika Chandra.
Department of Pediatrics, R.N.T Medical College, Udaipur.
rntianasif@gmail.com; chandrakritika19@gmail.com
INTRODUCTION- Transition from foetal to neonatal life is associated with major changes in
hematological parameters due to homeostatic control. AIMS & OBJECTIVE-This study was
planned to study physiologial changes of haematological parameters in cord blood and during first
week of life. MATERIAL & METHOD:100 Normal term neonates with gestational age>37weeks
& birth weight >2100gm were included in the study. Hemaogram and PBF were studied in cord
blood, 24hrs,48hrs,7th day of life and mean, range & standard deviation were Calculated.
RESULTS:
CBC
Cord Blood at 24 Hrs Of Life
48 Hrs Of Life
7 Days Of Life
Parameter
Birth
Mean ±
(Range)
SD
Mean ±SD (Range)
Mean
±
(Range)
SD Mean
±
(Range)
SD
Hemoglobin
(Gm%)
17.6 ± 2.40 16.6
±
2.46 16.4
±
2.37 16.1
±
2.28
(12.2- 23.2)
(11.6 – 22.8)
(11.5 – 21.3)
(11.3 – 21.1)
Hematocrit (%)
51.5 ± 6.15 49.2
±
6.19 48.4 ± 6.10
(36.8 – 64.3)
(35.2 – 61.3)
– 60.6)
MCV(fl)
100.3 ± 7.20 98.5
±
7.16 98.9 ± 7.27 (82.1 99.2 ± 7.29
(82.2 – 126.5)
(82.5 – 126.1)
– 126.3)
– 126.4)
MCH(pg)
34.3 ± 2.71
(26.2 -40.9)
33.2 ± 2.70
(26.0 – 39.7)
33.5 ± 2.70
(26.0 – 40.5)
33.7 ± 2.61
(25.4 – 39.4)
MCHC
(g/dl)
34.2 ± 1.59 33.8 ± 1.57
(29.6 – 38.0)
(28.5 –37.7)
33.9 ± 1.51
(28.4 –38.6)
34.0 ± 1.52
(28.4 – 38.5)
TRBC
(Million/µl)
5.2 ± 0.72
(3.7 – 6.9)
5.0 ± 0.74
(3.3 – 6.9)
4.9 ± 0.73
(3.3 – 6.7)
4.8 ± 0.72
(3.3 – 6.3)
TLC (×103/µl)
16.8 ± 4.36
(8.4 – 29.3)
15.2 ± 3.70
(8.1 – 23.4)
14.0 ± 3.49
(7.2 – 22.8)
11.9 ± 2.91
(5.5 – 18.3)
Polymorphs
(%)
62.9 ± 7.36
(38.7 – 86.6)
68.9 ± 7.63
(49.3 – 89.5)
63.4 ± 7.15
(49.6 – 88.4)
53.4 ± 7.43
(25.3 – 73.7)
Lymphocyte
(%)
31.0 ± 7.27
(9.1 – 55.5)
24.7 ± 7.02
(8.1 – 43.2)
30.9 ± 6.80
(8.0 – 45.1)
38.2 ± 6.50
(19.3 – 62.0)
Monocytes
(%)
3.2 ± 1.00
(1.8 – 8.2)
2.5 ± 0.76
(1.0 – 7.1)
2.5 ± 0.83
(0.2 – 6.2)
4.2 ± 1.17
(0.4 – 6.3)
Eosinophils
(%)
2.4 ± 0.78
(1.0 -5.7)
3.5 ± 1.65
(0.2 – 8.8)
2.8 ± 1.15
(0.4 – 6.0)
3.5 ± 1.41
(0.5 – 9.8)
Basophils
(%)
0.5 ± 0.24
(0.0 – 1.2)
0.4 ± 0.35
(0.0 – 3.0)
0.4 ± 0.14
(0.1 – 0.9)
0.6 ± 0.19
(0.1 – 1.6)
Platelets
( ×103/µl)
249.3 ± 39.04
(123.0 – 358.0)
281.2 ± 46.91
(154.0 – 389.0)
296.1 ± 40.06
(168.0 – 410.0)
355.6 ± 41.10
(180.0 – 442.0)
(34.4 47.3
±
6.05
(32.2 – 60.1)
(80.5
SUMMARY- This study showed very wide range of haematological parameters that seems to be
abnormally high/low in healthy term neonate in cord blood and during first week of life but these
are actually normal for that neonatal period depending upon gestational and post natal age.
Conclusion: The normal values of haematological parameters in neonates are different from other
age groups and it varies with postnatal age and gestational age so same refrence range of hemogram
should not be used in all neonates instead a refrence range derived from large neonatal datasets of
varied gestational and postnatal age should be used,such as those presented here for term neonates.
NEO/30(P) EVALUATION OF MULTIPLE ORGAN DYSFUNCTION AND IMMEDIATE
OUTCOME IN PERINATAL ASPHYXIA
Suresh Goyal, Mohammed Asif, Vinay Gill, Subhash Meena
Department of Pediatrics, R.N.T Medical College, Udaipur.
rntianasif@gmail.com; chandrakritika19@gmail.com
INTRODUCTION:-Perinatal asphyxia is an important cause of perinatal mortality and morbidity.
OBJECTIVES :-The present study was conducted to evaluate the frequency and spectrum of
severity of multiple organ dysfunctionin neonates with perinatal asphyxia. METHOD :- 80 neonates
with a birth weight of 1500 grams or more and gestational age of 35 weeks or more who needed
resuscitation at birth and had apgarscore of 6 or less at 1 minute were studied. Investigations were
done after 12hour ofbirth and before72hour of life. Daily follow-up and monitoring of events was
done till the discharge or death of the baby. RESULTS:-In the present study, CNS was the
commonest organ system to be involved(in 88.75% cases), followed by involvement of Hepatic,
Respiratory , Renal , Metabolic , Hematologic , CVS and GIsystem (75%, 61.25%, 56.25%,
42.5%, 36.25%, 30%and 20% respectively). Mortality rate was significantly higher when 5 or
more organ were involved (69.44%) and mortality rate was lower (13.64%) when 4 or less organ
were involved. CONCLUSION:- The present study suggest that CNS involvement is common in
perinatal asphyxia as compared to other organ systems and mortality rate increases as the number of
organ systems involvement increases.
NEO/31(P) PREDICTION OF SIGNIFICANT HYPERBILURUBINEMIA USING FIRST 24
HOUR SERUM BILURUBIN LEVELS IN TERM NEONATES.
Suresh Goyal, Mohammed Asif, Subhash Meena, Abhishek Arya
Department of Pediatrics, R.N.T Medical College, Udaipur.
rntianasif@gmail.com; chandrakritika19@gmail.com
INTRODUCTION:-The recognition, follow-up and early treatment of neonatal jaundice has
become more difficult since the early discharge from hospital has become common practice.
OBJECTIVES :-The present study was undertaken to predict the development of significant
hyperbilirubinemia by measuring first 24 hour serum bilirubin level. METHOD:-50 Healthy full
term neonates were included in the study and a total serum bilirubin level was estimated at 24±6
hour of age. Thesebabies were followed-up clinically for first 5 postnatal days for development of
significant jaundice andaTSB level was estimated again on fifth day. RESULTS :-Of the 50
neonates, 6 (12%) had significant hyperbilirubinemia. A TSB level <6 mg/dl at 24± 6 hour was
present in 32 (64%) neonates and only one (2.7%) developed hyperbilirubinemia. In remaining 18
(36%) neonates with TSB≥6 mg/dl, subsequent hyperbilirubinemia developed in 5 (27.77%). Using
serum bilirubin cut off level of≥6 mg/dl during first 24 hour of age, hyperbilirubinemia could be
predicted with sensitivity of 83.33%, specificity of 70.45%, positive predictive value of 27.77% and
negative predictive value of 96.87%. The correlation between first 24 hour bilirubin and
development of significant jaundice in the first 5days is statistically significant (p < 0.05).
CONCLUSION:-Term neonates havingbilirubin level of ≥6 mg/dl in first 24 hour of life are more
prone to develop significant hyperbilirubinemia during first five postnatal days so these babies
require close supervision and should not be discharge early from hospital.
NEO/32(P) A STUDY OF SERUM ELECTROLYTES IN NORMAL TERM NEONATES
Suresh Goyal, Mohammed Asif, Rohit Anand.
Department of Pediatrics, R.N.T Medical College, Udaipur.
rntianasif@gmail.com; chandrakritika19@gmail.com
INTRODUCTION- Transition from foetal to neonatal life is associated with major changes in water
& electrolyte homeostatic control. AIMS & OBJECTIVE-This study was planned to study
physiologial changes of serum electrolyte in cord blood and during first week of life. MATERIAL
& METHOD:100 Normal term neonates with gestational age>37weeks & birth weight >2100gm
were included in the study. Serum Sodium ,Potassium calcium were studied in cord blood,
24hrs,48hrs,7th day of life and mean, range & standard deviation were Calculated.
RESULTS:
ELECTROLYTE
CORD BLOOD
24HRS
48 HRS
7th day
S.Na+(meq/L)- Range
128-156
128-150
134-154
128-150
- Mean
(141.7)
(139.0)
(143.3)
(138.7)
S.K+(meq/l) - Range
4.2-7.2
4.0-6.6
4.0-6.5
3.8-6.2
- Mean
(6.0)
( 5.4)
(5.2)
(4.9)
S.Ca++(meq/l) Range
7.9-13.2
7.6-11.7
7.0-11.1
7.4-10.9
- Mean
(9.9)
(9.1)
(8.9)
(9.2)
SUMMARY- This study showed very wide range of electrolyte that seems to be abnormally
high/low in healthy term neonate in cord blood and during first week of life but are actually
normal for that neonatal period depending upon gestational and post natal age. Conclusion: The
normal values of serum electrolyte in neonates are different from other age groups and it varies with
postnatal age and gestational age so same refrence range of electrolytes should not be used in all
neonates instead a refrence range derived from large neonatal datasets of varied gestational and
postnatal age should be used,such as those presented here for term neonates.
NEO/33(P) POSTNATAL CHANGES OF BODY WEIGHT OF TERM NEONATES AND
CONSTRUCTION OF A PREDICTION GROWTH CURVE UPTO 28 DAYS
Bhaswati Ghoshal
Assistant Professor, Department of Pediatric Medicine, Calcutta National Medical College,
Kolkata-700 014
bhaswatighoshalmailme@yahoo.com
INTRODUCTION- A norm of postnatal growth of neonates would be a very useful tool to assess
growth locally. AIMS AND OBJECTIVES- To produce a postnatal prediction curve for term
neonates to judge the adequacy of growth during that period. MATERIALS AND METHODS460 hospital born stable term AGA, as per Lubchenco, neonates were studied. 245 of them were
male (53.2%) and 215 (46.8%) were female. The gestation was calculated by New Ballard Scoring.
31.8% of neonates were born by normal delivery, 54.7% by cesarean section 13% by forceps and
0.5% by breech delivery. They were breastfed and received care as per unit policy in postnatal ward
of a referral teaching hospital. Their birthweights were recorded and followed by subsequent record
of body weight every 12 hours till discharge by triple beam balance with least count of 1gm.
Multiple regression equation was calculated to detect the relationship among birthweight
,subsequent bodyweight, age in days using SPSS version 16 software and prediction curves were
constructed for different birth weights for ages upto 28 postnatal days using Microsoft Excel.
RESULTS- Mean birth weight was 2749.6±425.93 gm, mean gestational age was 38.605 ± 1.338
wks. There was initial fall from birth weight by 112±10.058 gm on 4.5±2.02 postnatal days. Birth
weight was regained on 8.5±2.11 postnatal days. No statistical difference was found among male
and female neonates growth pattern. CONCLUSION- Prediction curves of postnatal changes of
body weight of neonates would be a ready to use local norm for term neonates.
NEO/34(O) DO LATE PRETERMS HAVE INCREASED MORBIDITY AND MORTALITY
COMPARED TO TERMS?
Reeta Bora, Uttam Mondal
Department Of Paediatrics, Assam Medical College, Dibrugarh
mondaluttam9@gmail.com
Background: Elective caesarean section(CS) at 35-36 wks of gestational age(GA) has become
common practice. Objective: To compare morbidities in late preterm with term infants. To estimate
impact of CS delivery on incidence of respiratory morbidity. Study design: Prospective cohort
study Setting: Tertiary care neonatal unit in North East India Subjects: 3166 live newborns
delivered in AMC(217 late preterm & 2949 term) within six months. Methods: Babies (GA of 35
wks and above) were divided into late preterm(35-36 wks) (group1)and term (groupII), followed for
morbidities and mortality. Results: There were 6.8%preterms and 93%term infants. Gr1 constituted
6.6% of all births & 65.2% of all preterms. In NICU 43% grI vs19.9% grII infants were admitted(p
<.005 ). Incidence of morbidities in gr1 vs gr2 infants were neonatal jaundice (NNJ)
31.8%vs14.9%(p<.005), Sepsis 11.98%vs3.5% (p<.005), birth asphyxia 7.8%vs2.2%,(P<.005),
respiratory distress 11.52%vs4.7% (p<.005).Mean days of phototherapy was 70.49hrs in gr1 vs
55.6hrs
in grII(P<.005).Mean hospital stay was 12.75days in gr1 vs 5.86days in
grII(p<.005).Mortality among gr1 was 4.6% vs 0.8%in grII. Infants delivered by CS had RD in
6.2%vs 4.2% by spontaneous vaginal delivery(p<.005). Conclusion: Late preterm babies have
increased risk of Respiratory distress ,NNJ , birth asphyxia, sepsis and babies born by CS are more
likely to develop RD.
NEO/35(O) STUDY TO ASSESS THE ROLE OF PENTOXIFYLLINE IN NEONATAL
SEPSIS
Gaurav Monga, Ram Dinesh Singh, Rajeev Krishak
Pushpanjali Hospital & Research Centre, Delhi Gate, Agra.
gauravmonga79@gmail.com
Introduction: with global emergence of antibiotic resistance there has been need to search for new
modalities to enhance neonatal host defence mechanisms, which could be used as adjuncts to
antibiotics in treating neonatal sepsis. Aims and Objective: To assess the effect of intravenous
pentoxifylline as an adjunct to antibiotic therapy on the mortality, length of hospital stay in neonates
with suspected/confirmed sepsis and to determine safety and adverse effects attributable to
pentoxifylline. Methods: total of 70 neonates admitted with suspected sepsis were divided into
study and control group with 35 in each group. All neonates were subjected to detailed history and
clinical examination and there results recorded and analyzed statistically using 2 and ‘t’ test.
Results: Mortality in newborns with sepsis was found to be 13.33% in study group and 25% in
control group. The observed difference between two groups was statistically insignificant
(p=0.245). Mean duration of hospital stay among survivors in study group was 11.35±2.46 days and
in control was 13.62±3.48 days. The difference was statistically significant (p=0.01). Mean
duration of hospital stay of preterm survivors in study group was 12.23±2.62 days and in control
group was 14.62±3.62 days and difference was statistically significant (p=0.03). Need for
ventilation in study group was recorded to be 20% where as in the control group it was 34.38%.
There was no adverse effect attributable to pentoxifylline in study group, Conclusion: The effect of
intravenous pentoxifylline as an adjunct to the standard antibiotic therapy in neonates with sepsis is
beneficial. There are no significant adverse effects of pentoxifylline therapy when used for the
management of neonatal sepsis.
NEO/36(P) CARDIAC TROPONIN I AS AN EARLY PREDICTOR OF HYPOXIC
ISCHEMIC ENCEPHALOPATHY
Geeta Gathwala, Sonal singal, Poonam Dalal, Jagjit Singh Dalal, Veena Singh
8/6J, Medical Enclave, Pt.B.D.Sharma PGIMS Rohtak, Haryana 124001
geetagathwala09@gmail.com
Introduction: As the therapeutic window for neuronal protection in newborns with hypoxic ischemic
encephalopathy (HIE) is very brief, there is need for a simple, rapid, early and reliable test for
identification of neonates who are at high risk for developing HIE. Objective: To evaluate cord
blood cardiac troponin I (cTnI) as an early predictor of hypoxic ischemic encephalopathy (HIE).
Patients and Methods: This prospective observational study was conducted in 100 newborns over a
period of 20 months. A total of 50 full term (≥37 weeks) inborn neonates with an Apgar score of
less than 6 at 5 minutes formed the study group (asphyxia group) and 50 consecutive asymptomatic
full term(≥37 weeks) inborn neonates with a 5 minute Apgar score of more than 7 formed the
control group. Infants with gross congenital malformation,mothers who received magnesium
sulphate or beta-sympathomimetics or with evidence of infection were excluded. Cord blood venous
samples were collected at delivery. Blood gas analysis was performed and cord blood cardiac
troponin I levels were estimated using the ADVIA Centaur CP system using direct
chemiluminescent technology. Results: Infants with asphyxia (0.590.41) had significantly higher
cord blood cardiac troponin I levels than controls (0.040.03, p< 0.001). Cord blood cardiac
troponin I levels positively correlated with the occurrence of HIE (Pearson’s correlation coefficient
r=0.746) and the severity of HIE in the asphyxia group(r=0.915).There was significant negative
correlation with 5 minute and 10 minute Apgar scores and cord pH and Cord blood base
deficit.Eighteen neonates in the asphyxia group (n=50) expired of which Tn I levels in those who
expired (1.04±0.19ng/ml) were significantly higher than those who survived. (0.33±0.25ng/ml,
p<0.001). Conclusion: Cord blood cardiac troponin I (cTnI) levels can be reliably used as an early
predictor of the occurrence of HIE in asphyxiated term neonates and the levels correlate
significantly with the severity and mortality in HIE.
NEO/37(P) ATYPICAL ERYTHEMA TOIXICUM NEONATORUM IN A TERM INFANT
Pranav Gupta, Payal Mittal, Vandana Sharma, Veena Devgan
Department of Pediatrics and Dermatology, Hindu Rao Hospital, New Delhi
pranavgupta@hotmail.com
Introduction Erythema toxicum neonatorum (ETN) is the most common neonatal pustular eruption
of unknown aetiology. In this report we describe an atypical case of ETN. Case Report: Forty week
male infant with birth weight 2900 gms was born by normal vaginal delivery to a 22-year-old
primigravida following a uneventful prenatal course. Apgar scores were 9, 9 and 9 at 1, 5, and 10
minutes respectively. The infant was healthy and had no skin eruptions at birth. The exclusively
breast fed, otherwise asymptomatic infant had sudden appearance of a rash at around 12 hours of
life. Physical examination revealed an afebrile, alert and healthy infant with numerous firm and
discrete pustules, ranging from 1 to 2 mm in diameter, localised to bilateral upper eye-lids and
bilateral pinna, with a normal background skin. No rash was observed elsewhere. Mucous
membranes were not involved. Smears from the pustular content showed eosinophilic
predominance (70%) with a significant number of neutrophils. Gram’s stain and KOH preparation
of pustules failed to reveal any microorganisms. The rash resolved overnight after three days
without any residual signs. No squeale were observed at 1 month follow-up. Discussion: Transient
Neonatal Pustular Melanosis (TNPM) presents with fragile, superficial, vesiculo-pustules appearing
at birth or within the first day of life, which rupture leaving pigmented macules surrounded by
collarette of scales. There is absence of peri-pustular edema. Smear from the lesion demonstrates
neutrophils or occasional eosinophil. In our patient, the rash appeared on the first day and there was
absence of typical background erythema, however, eosinophilic predominance in firm pustules and
the lack of collarettes of scale or residual hyperpigmentation contradict this diagnosis. Eosinophilic
pustular folliculitis, infantile acropustolosis, miliaria and bacterial pyoderma are important
differentials. Features suggestive of any of the above were not detectable in our case. Infectious
agents such as Varicella, Herpes Simplex, Cytomegalovirus and Candida and impetigo should be
ruled out using appropriate methods.
NEO/38(P) ASSESMENT OF ERYTHROCYTE INDICES, SERUM IRON AND FERRITIN
IN NEONATES AT BIRTH
Patidar S, Shrivastava J, Dwivedi R.
Department of Pediatrics, Gandhi Medical College, Bhopal
shailendra8430@yahoo.in
Introduction: At birth, hematological values are higher as compared to older children. This is in
response to increased erythropoiesis caused by intrauterine hypoxia. In addition, hematological
values and iron reserve in newborns vary according to fetal growth. Aims and objective: This
descriptive, cross-sectional study was design to describe hematological profile and iron reserve in
newborns at birth. Material and method: 90 healthy term Newborns (40 small for gestational age
and 5o appropriate for gestational age) delivered either vaginally or by cesarean section with
gestational age of ≥37 weeks and birth weight of at least 1.5 kg were enrolled. Newborns venous
blood samples were obtained with in 24 hrs of birth for measurement of hematological profile
(hemoglobin, RBC count, hematocrit, MCV, MCH, MCHC, RDW), serum iron, and serum ferritin.
Results: Mean values of Hb (16.4g/dl±2.8 vs. 15.0g/dl±2.09; P<0.01), RBC count (4.3×108/µl±0.7
vs. 4.0×108/µl±0.5; P<0.01), and Hematocrit (43.12%±8.4 vs. 38.75%±7/.6; P<0.01) were observed
significantly higher in SGA newborns. Serum ferritin levels were significantly low in SGA group
[mean 103µg/dl vs. 158µg/dl; P<0.01; 95% CI=85.5 to121.7 in SGA and 130.9 to 185.3 in AGA]
than in AGA newborns. In SGA group serum iron, MCH, MCV were low and MCHC and RDW
were
high
but
the
difference
was
not
statistically
significant
(P>0.05).
Conclusion: Term SGA newborns have low iron stores despite high hemoglobin,hematocrit,and
RBC count as compared to term AGA neonates at birth (both statistically significant).
NEO/39(P) COMPARISON OF SERUM APOLIPOPROTEIN B (APO-B) AND
APOLIPROTIEN A-1 (APO-A-1) AND THEIR RATIO IN HEALTHY FULLTERM SMALL
FOR GESTATIONAL AGE (SGA) AND APPROPRIATE FOR GESTATIONAL AGE
(AGA) NEWBORNS.
Siddiqui M.H., Shrivastava J, Dwivedi R.
Department of Paediatrics, GMC, Bhopal.
aradhanamishra81@gmail.com
Introduction: David Barker pioneered the “foetal origin of adult disease hypothesis” which states
that intrauterine growth restriction is associated with an increased propensity to develop adult-onset
diseases. Elevated apolipoprotein B levels and apolipoprotein B to A-1 ratio are considered to be
the most sensitive predictors of atherogenesis in adults. This study was designed to compare
apolioprotiens
in
fullterm
SGA
and
AGA
newborns.
Aims and Objective: 1. To determine the concentrations of serum lipids and apo-B and apo-A-1
and their ratio in a population of healthy fullterm SGA and AGA newborns. 2. To assess the impact
of
birth
weight
on
these
values.
Material and Method: Among 100 healthy newborns enrolled, 50 full term SGA comprised the
cases and 50 terms AGA were taken as controls. Their venous samples were collected within 24
hours of birth and assays of apolipoprotiens are performed via nephelometry.
Results: Among 50 SGA and 50AGA newborns, the difference between mean values of apoB/apoA-1 ratio [O.87vs0.55; p <.01; 95% CI=0.80 to 0.94 in SGA and .495 to .605 in AGA) was
significantly high and apo-A1 [87.59vs118.87; p <.01] was significantly low in SGA newborns.
Serum apo-B did not show any significant difference. There was large negative correlation between
birth weight and apo-B/apo-A1 (r = -0.596 at 0.01 level). Conclusion: The study reinforces the
Barker’s hypothesis, showing altered apolipoprotiens in SGA newborns thus predicting the future
risk of athterogenesis in adult life.
NEO/40(P) DELAYED PRESENTING CONGENITAL DIAPHRAGMATIC HERNIA: A
NEONATAL SURGICAL EMERGENCY
Bhawna Malik, P.D.Sharma, Anand Bhardwaj
Department of Pediatrics, MMIMSR, Mullana, Ambala, Haryana
dr_bhawnamalik@yahoo.co.in
Background: Congenital Diaphragmatic hernia(CDH) is defined as a communication between the
abdominal and thoracic cavities with or without abdominal contents in the thoracic cavity. Posterolateral (Bochdalek) hernia of left diaphragm is the commonest. The incidence of CDH is estimated
to be 1 per 5000 live births, delayed presentation being still rarer. The symptoms and prognosis
depend on the location of defect and associated anomalies like short abdominal cavity. In such
patients primary closure of abdomen may have to be defered after surgery. A 13 day neonate with
an uneventful early neonatal period presented to us with complaints of hurried breathing, chest
indrawing and episodes of vomiting virtually after every feed for few days. He was diagnosed and
successfully operated on same day in emergency but due to short peritoneal cavity the abdominal
contents were covered with sialo bag instead of primary closure of abdomen. Conclusion; The case
is being presented for its rarity and unusual delayed presentation. A high index of clinical suspicion,
good clinical examination corroborated by chest x-ray can easily diagnose this rare but definitely
correctable pathology. This exhibit also highlights the need for combined efforts by pediatric and
surgical team to improve the survival of such patients even in setup where the specialized pediatric
surgical care is unavailable.
NEO/41(P) RELIABILITY OF VISUAL ASSESSMENT OF JAUNDICE IN NEONATES
WITH DIFFERENT SKIN TONES.
Piyush Jaiswal, V. Dandge, N. Mujawar, Meenakshi Girish, G. Nanoti
bhupendra_121@yahoo.co.in
Introduction: Neonatal Jaundice is one of the commonest finding, it could range to be a normal
physiologic finding to being pathologic enough to cause significant brain damage. Investigations for
bilirubin estimations are usually done on recommendations when one notices yellow discolouration
of skin.Aims & Objectives: Correlations of visual assessment of Jaundice in fair skin and dark skin
neonates with laboratories values. Materials & Methods: All new-borns of post natal wards and
those admitted in Lata Mangeshkar Hospital who appeared jaundice were classified according to
their skin tones and were visually assessed for appearance of jaundice and blood sample was drawn
on the same day for laboratory assessment. Study Design: Cross –Sectional Analysis: it will be
done by using Epi info software - chi square test Results: To be computed
NEO/42(P) CONGENITAL TUBERCULOSIS – CASE REPORTS
Bipsa Singh , Snehamayee Nayak , Pravakar Mishra,
P.G. Department of Pediatrics, SCB Medical College, Cuttack
bipsasingh@gmail.com
INTRODUCTION :- Congenital tuberculosis is rare in spite of tuberculosis being so
common . Now in the decade spanning from 1995 to 2005 there have been a number of case reports
with rare manifestations of this rare disease. We present three cases of congenital tuberculosis. Case
Report: - 1 A 2 months old Indian female infant presented with respiratory distress since birth,
fever, abdominal distension since 1 month, swelling of right inguinal region since 1 month,
vomiting, poor feeding, failure to gain weight inspite of adequate feeding since birth,Antenatally
infant mother was having continuous low grade fever,productive cough with leaking membrane
since 4 months of gestation with chest x ray showing milliary mottled opacities. On investigations
the chest X-ray showed bilateral lung infiltrates. Biopsy of the right inguinal lymphnode revealed
caseating granuloma suggestive of tubercular lymphadenitis. The tuberculin test in the infant is
15mm .So the infant was diagnosed to be Congenital Tuberculosis & responded to treatment with
antitubercular drug. Case Report: - 2. A 2 months old Indian female infant presented with
respiratory distress since birth,failure to thrive, fever, since 1 month, The baby didn’t respond to IV
antibiotics. After 1 month of hospital stay the mother disclosed and showed RNTCP card with
sputum positive Pulmonary-TB on DOTS(CAT II) just before the birth of the baby.Then the baby
was started with ATT.But we couldn’t save the baby due to delayed treatment. Case Report :-3 A
two days old new born admitted to new born ward since the mother was admitted to hospital with
tubo-ovarian mass,the biopsy of which confirmed to be tubercular origin. But the baby was stable
and on artificial feeding since birth.The gastric lavage samples of baby was found to be AFB
positive.The baby was started immediately with ATT.Hence the baby was survived. Outcome:- The
case 1 & 2 couldnot be survived due to delay in diagnosis and treatment. The Case 3 was survived
due to early diagnosis and treatment. Conclusion :- Congenital tuberculosis is rare ; Due to some
non-specific symptoms and signs , sometimes the early diagnosis is difficult and treatment is
delayed for which outcome may be fatal. Hence any case with congenital tuberculosis should be
diagnosed immediately and treated with ATT immediately, so that infant mortality
can be reduced.
NEO/43(P) OUTCOME OF SCLEREMA NEONATORUM IN A RURAL MEDICAL
COLLEGE HOSPITAL
D.Y. Shrikhande, P.V. Nigwekar, Abhijeet Singla, Neeraj Shaha
Department of Pediatrics, Rural Medical College, PIMS, Loni, Maharashtra
abhijeet.singla@gmail.com
Introduction: Sclerema Neonatorum is a harbinger of death in majority of neonates. It is associated
with many underlying disorders with sepsis being the commonest. It is a disease of subcutaneous
adipose tissue characterized by hardening of the skin that gets bound to the underlying muscle &
bone, giving waxy appearance & feel, hindering respiration & feeding & is associated with
respiratory illnesses & sepsis. The virtual irreversibility and eventual fatality which was the norm
earlier, can be reversed and neonate given a fresh life & future by appropriate & energetic specific
& supportive management. Aims & Objectives: To find out etiology of the underlying disorder &
institute appropriate management. To find out whether significant number of sclerema cases can be
reversed and survival made possible. Material & Methods: All neonates inborn and outborn with
developing sclerema were included All neonates without Sclerema & neonates with congenital
malformations were excluded. Results: 62 cases of sclerema neonatorum were observed during a
period of 12 months, of these 29 survived. Mean birth weight was 1768.17 gms. 36 were males &
26 were females. Among survivors, 20 were males, 9 were females. All 62 cases of sclerema had
clinical, hematological & microbiological evidence of sepsis. In addition, 14 presented with
respiratory distress syndrome, 9 with apnea, 8 with thrombocytopenia, 9 with meningitis, 10 with
shock, 5 with asphyxia, 8 required ventilation. There was no case of pulmonary hemorrhage.
Conclusions: Early detection of septicemia & prevention of hypothermia as well as hypoglycemia
along with prompt institution of appropriate antibiotics and good supportive management proved to
be more effective in this study.
NEO/44(P) CLINICO- LABORATORY PROFILE OF CULTURE POSITIVE NEONATAL
SEPSIS IN A TERITIARY CARE HOSPITAL
N.Kamalakar Rao, Abani kanta Sahu, Laxmi Aparna,K.Umamaheswar Rao,P.Sudarsini
Department of Pediatrics, Alluri Sitarama Raju Academy of Medical Sciences, Eluru, A.P
dr_abani@rediffmail.com
INTRODUCTION : Neonatal sepsis is the commonest diagnosis among admitted newborns in
neonatal ICU. Culture positive neonatal sepsis is a special entity in view of increased mortality and
morbidity associated with it. SETTING & DESIGN : A prospective hospital based study during
Feb’2010 – Aug’2011 at ASRAMS, Eluru, Andhra Pradesh. METHODS : This study included
prospective cases (n=50) of clinically suspected neonatal sepsis admitted in NICU of ASRAMS
hospital. Sepsis screen and blood culture was sent for all cases and CSF analysis done when needed.
AIMS & OBJECTIVES : To evaluate the sensitivity of presenting clinical symptoms in predicting
culture positive neonatal sepsis. To find out the role of laboratory parameters as early predictor of
culture positive neonatal sepsis. RESULTS : Among the study cases, Males :26(5 2%) > female :
24(48%), LBW : 28(56%) > normal wt : 22 (44%), EONS : 26(52%) >LONS : 24(48%), EONS :
15(75%) > LONS : 5 in preterms(20), LONS : 19 (79%) > EONS : 11 in terms (30%) Blood
culture was positive in 26 cases , Pathogenes grown were coagulase +ve staph – 12 (46%),
Coagulase –ve staph – 5 (19%), Pseudomonas – 4 (16%), Klebsiella – 4 (15%) ,Enterococci -1 (4%)
Clinical
symptoms
Jaundice
Refusal of feeds
Temp. instability
Lethargy
Resp.Distress
LABORATORY
PARAMETERS
CRP > 12 µg/ml
TWBC <5000)
Micro ESR >10mm
Ban cell count>20%
Present in
sensitivity
% of cases
specificity
PPV
Accuracy
74 %
72 %
50 %
32 %
36 %
29.2 %
17 %
54.2 %
62.5 %
62.5 %
54 %
50 %
56 %
43.8 %
50 %
54 %
48 %
54 %
44 %
48 %
76.9 %
69.2 %
36.4 %
26.9 %
34.6 %
Present in
sensitivity
% of cases
specificity
PPV
Accuracy
90 %
44 %
20 %
10 %
12.5 %
52 %
60.5 %
83 %
53.8 %
58 %
42 %
52 %
54%
46 %
40 %
52 %
92.3 %
46.2 %
18.8 %
20.4 %
CONCLUSION: Despite of their low specificity Jaundice and refusal of feeds shown good
sensitivity in predicting culture positive neonatal sepsis. Among Lab parameters CRP > 12 µg/ml
was the best predictor with a sensitivity of 92.3% of a severe condition like neonatal sepsis.
Though widely advised other screen parameters performed poorly in predicting the same.
NEO/45(P) CLINCO-BACTERILOGICAL PROFILE OF CULTURE PROVEN
NEONATAL SEPTICEMIA & ANTIBIOTIC SENSITIVITY PATTERN OF ISOLATED
ORGANISM IN A TERTIARY CARE HOSPITAL IN JAIPUR
Anand Jain, Kailash Meena
Department of Pediatrics, SMS medical college, Jaipur
dranandjain76@gmail.com,
OBJECTIVE: To determine bacterial isolates & its antimicrobial senstivity pattern. MATERIAL &
METHOD: Retrospective hospital based study in inborn babies of Zenana hospital, attached to SMS
medical college, Jaipur. The data was collected from their case records from Jan 2010 to Dec 2010.
All the babies with maternal risk factors and all symptomatic babies in whom sepsis was considered
were subjected to blood culture( BACTEC). Organisms causing sepsis and their sensitivity pattern
were analysed in the study. RESULTS: 241 neonates with suspected sepsis were sent, out of which
85(35.5%) were culture positive, presented as early ( 77.6%) & late ( 22.5%) onset sepsis. The
most common symptom was respiratory distress, refusal to feed, abdominal distension and fever.
Majority (41%) isolated gram negative bacilli, most commonly Enterobacter(21.1%), E.coli(15.2%)
& Klebsiella(4.7%). Also Non Albicans Candida were 37.6% among the isolates. CONS ( 30.5%)
being the most common among Gram positive bacilli. Gram negative bacilli were sensitive to
Amikacin, Ciprofloxacin, Meropenem but resistance is increasing with Gentamycin ,Cefotaxim,
Ampilcillin-Sulbactam. The sensitivity for cephalosporins & aminoglycosides has declined
significantly. Vancomycin resistance is also increasing among gram positive bacilli most common
isolates being Staphylococcus aureus. 31 out of 85( 36.4%) culture positive cases died.
CONCLUSION: Resistance to commonly used antibiotics is increasing. Emergence of Non
Albicans Candida even in 1st week of life in LBW babies. Establishment of proper antibiotic policy
is essential to control resistance.
NEO/46(P) AETIOLOGICAL PROFILE OF NEONATAL SEIZURES IN A TERTIARY
CARE NURSERY
Devika M, Warrier A, Jana AK, Kuruvilla KA
Neonatology Department, CMC Hospital, Vellore 632004, Tamil Nadu.
anilkdj@hotmail.com
Seizures are more common in the neonatal period than at any other time throughout life.
Investigation leading to prompt diagnosis of the underlying condition is important because many of
the aetiologies have specific treatments which, when used early, may improve the prognosis. The
aetiological profile of neonatal seizures was studied over 1 year in CMC Hospital, Vellore and the
role of neuroimaging in these babies was also investigated. Methods: All newborn babies admitted
with seizures in the nursery were enrolled, excluding major congenital anomalies. Baseline
information was collected, including the clinical profile, relevant perinatal history, and essential
investigations were done in all subjects. Ultrasound head and other neuroimaging was done when
feasible. Results: 175 babies had seizures during the study period: 65 inborn (among 9441
livebirths) and 110 outborn babies. 155 babies were term, 39 were low birth weight. Multifocal
clonic (40%) and subtle (22%) seizures were the most common types. The most common aetiology
was HIE (50%), sepsis and metabolic causes (hypocalcemia, hypoglycemia, IEM). There was no
obvious cause for seizures in 32 babies. Infarcts were found in 28%, structural anomalies and IVH
in 6% each. However, no cause could be detected in 53% despite ultrasound and CT scan.
Conclusions: Incidence of neonatal seizures was 7/1000 livebirths. Majority of babies with seizures
were term; commonest cause for seizures was perinatal asphyxia. The aetiology of seizure could not
be determined in 9.7% of babies even after neuroimaging.
NEO/47(P) EFFECTIVENESS OF PROPHYLACTIC PHOTOTHERAPY IN PRETERM
LOW BIRTH WEIGHT NEONATE FOR PREVENTION OF UNCONJUGATED
HYPERBILIRUBINEMIA: A RANDOMIZED CONTROLLED TRIAL.
Samrat Ganguly
Kolkata Medical College, Kolkata
samratganguly@gmail.com
Background: Preterm low birth weight neonates are at greater risk of complications of
hyperbilirubinemia due to immaturity of hepatic enzyme system and blood-brain barrier. Objective:
To evaluate the role of prophylactic phototherapy from birth in preterm low birth weight neonates in
preventing high rise of serum unconjugated bilirubin (UCB) and associated complications.
Methods: In this prospective, randomized, controlled trial 50 low birth weight (weighing <
1500gms. in birth weight, gestational age < 37 weeks) neonates were randomly allocated into
intervention and control groups. Intervention group received phototherapy following initial
stabilization after birth and control group received phototherapy after serum UCB level reached 7
mg/dl. The peak serum bilirubin level were compared among the two groups along with time to
reach the peak UCB level, no. of exchange transfusions and incidence of kernicterus. Results: The
intervention group (n=25) with mean birth weight 1232.6±167.1 g, gestational age 32.16±1.8 weeks
was demographically comparable with the control group (n=25) (1230±194.1 g, 31.8±1.7 weeks
respectively). The peak UCB level and average rate of rise of bilirubin was significantly lower in
the intervention group compared to the control group (9.048±2.05mg/dl and 0.076±0.02 mg/dl/hr in
intervention group vs. 12.16±2.38mg/dl and 0.11±0.03 mg/dl/hr in control group, respectively)
(p<0.0001). There is no significant difference in time to reach peak bilirubin level between
prophylactic group (120.48±18.8 hr) and control group (110.6±19.6 hr)(p=0.07). Neonates in
intervention group required significantly less exchange transfusions(1 vs 5, p<0.05). No neonate
was diagnosed with kernicterus among intervention group against two cases among control group.
NEO/48(P) ERYTHROCYTE INDICES, SERUM IRON AND FERRITIN IN NEONATES,
AT BIRTH.
Patidar S, Shrivastava J, Dwivedi R.
Department of Pediatrics, Gandhi Medical College, Bhopal (M.P.)
shailendra8430@yahoo.in
Introduction: At birth, hematological values are higher as compared to older children. This is in
response to increased erythropoiesis caused by intrauterine hypoxia. In addition, hematological
values and iron reserve in newborns vary according to fetal growth. Aims and objective: This
descriptive, cross-sectional study was design to describe hematological profile and iron reserve in
newborns at birth. Material and method: 90 healthy term Newborns (40 small for gestational age
and 5o appropriate for gestational age) delivered either vaginally or by cesarean section with
gestational age of ≥37 weeks and birth weight of at least 1.5 kg were enrolled. Newborns venous
blood samples were obtained with in 24 hrs of birth for measurement of hematological profile
(hemoglobin, RBC count, hematocrit, MCV, MCH, MCHC, RDW), serum iron, and serum ferritin.
Results: Mean values of Hb (16.4g/dl±2.8 vs. 15.0g/dl±2.09; P<0.01), RBC count (4.3×108/µl±0.7
vs. 4.0×108/µl±0.5; P<0.01), and Hematocrit (43.12%±8.4 vs. 38.75%±7/.6; P<0.01) were observed
significantly higher in SGA newborns. Serum ferritin levels were significantly low in SGA group
[mean 103µg/dl vs. 158µg/dl; P<0.01; 95% CI=85.5 to121.7 in SGA and 130.9 to 185.3 in AGA]
than in AGA newborns. In SGA group serum iron, MCH, MCV were low and MCHC and RDW
were
high
but
the
difference
was
not
statistically
significant
(P>0.05).
Conclusion: Term SGA newborns have low iron stores despite high hemoglobin,hematocrit,and
RBC count as compared to term AGA neonates at birth (both statistically significant).
NEO/49(P) CLINICO ETIOLOGICAL PROFILE OF NEONATAL SEIZURES
Ali Mehdi Johar, S. P. Verma, Nilesh Jain
alimehdi.27@gmail.com
INTRODUCTION : Neonates are at particular risk for development of seizures because of
immature brain. The increased susceptibility of neonates to convulsion made us to identify the
etiological profile in this age group of patient along with associated clinical presentation. AIMS &
OBJECTIVES : To study the incidence, clinical presentation, and etiological factors of seizure
disorder among 0-1 month age group in hospitalized patient. To compare the characteristics of
neonatal seizures between preterm and full-term infants. Material and Methods : Prospective study
conducted in deptt. of Pediatrics, CNBC & MYH, Indore. 100 consecutive cases of seizure admitted
in our NICU were included in the study and cases were studied from clinical & biochemical aspects.
Data was analyzed using Chi-square test. Results : Out of 100 cases HIE (47%) was the most
common cause followed by meningitis (20%), hypocalcaemia (15%), hypoglycemia (14%).
Commonest age of presentation of babies with HIE and seizures was the first 24 hours. Tonic
seizures (43%) were most common type of seizure followed by subtle (38%) seizures. In preterm
most common were subtle seizures (42%) while in term most common were tonic seizures (50%).
Conclusions : The commonest cause of seizure in term babies was birth asphyxia with majority
presenting to us within the first 48hrs. Sepsis contribute maximum to seizure in preterms.
NEO/50(P)
ETIOLOGICAL SPECTRUM OF NEONATAL SEIZURES AND
CORRELATION WITH EEG AND SHORT TERM OUTCOME-A STUDY FROM SOUTH
INDIAN TERTIARY CARE CENTRE
Lokesh Lingappa, Swapna Neharika , Dinesh Kumar Chirla, Venkatalaksmi Alla, Preetham Kumar
Department of Pediatric Neurology, Rainbow Children’s Hospital and Perinatal Centre, Hyderabad
siriloki@gmail.com
Aims- To study etiological spectrum of neonatal seizures, correlate with EEG findings and short
term outcome Methods- Prospective Observational Study, Consecutive Neonates with seizures
admitted included, data, investigations and management done according to protocol. July 2009 to
dec 2010. Follow up data using DDST II at 6 months. Results -103 were enrolled, 95% out born,
87% term, 18% SGA. 33% had HIE, 26% Sepsis, intracranial bleed 6.5%, Hypoglycemia- 9.7%,
hypocalcemia 8.7%. Neurometabolic disorders in 4.8%, Vascular and structural abnormality in
2.7%each and 6% unknown etiology. EEG performed 89 babies, normal in 47 and abnormal 42. 23
had diffuse cerebral dysfunction, 14 had epileptiform discharges, 4 –burst suppression, one excess
of beta. Of 12 with HIE and cerebral dysfunction 4 died, 5 had developmental delay on FU. HIE
with epileptiform discharges 3 died, 3 developed infantile spasms and one normal. HIE with normal
EEG in 12, six were normal at 6 months, five had developmental delay. Neonates with sepsis and
normal EEG 12/13 had normal development, with abnormal EEG 3/5 died and two were normal.
Hypoglycemia with normal EEG 3/4 were normal, 2/3 with abnormal EEG had delay and one died.
Two with Nonketotic hyperglycinemia with burst suppression died. In 10 Levetriacetam used as
third line medication without any adverse effects Midazolam infusion use reduced by 75%. Three
on levetriacetram died of unrelated severe illness. MRI in 10/27 normal, 10 had HIE changes, 3
stroke, 2 structural malformation. Conclusion- Neonatal EEG is useful tool in prognostication,
Levetriacetam reduced Midazolam usage
NEO/51(P)
AN UNUSUAL PRESENTATION OF NEONATAL ADRENAL
HAEMORRHAGE
Anup Joshi, Sushma Malik, Charusheeela Warke, Shweta Shirke, Varun Bansal
Division of Neonatology, Dept. of Pediatrics, BYL Nair Ch. Hospital and TN Medical College,
Mumbai-8
dranupjoshi@hotmail.com
Introduction: The incidence of neonatal adrenal haemorrhage (NAH) ranges from 1.9 to 5.5 per
1000 live births, with male preponderance. NAH is frequently associated with large fetal size, birth
trauma, fetal or perinatal asphyxia, shock and septicaemia. Incidence of neonatal hypertension
ranges from 0.7 to 3.2%. Here we report an unusual case of unilateral adrenal haemorrhage
presenting as neonatal hypertension. Case History: A G2P1 mother delivered a male child (3.5Kg)
vaginally with an antenatal scan showing bilateral hydrocoele. At birth patient was asymptomatic
and a USG scrotum and abdomen revealed moderate hydrocoele and large echogenic areas within
the right suprarenal region (3.7×3.2 cm) suggesting an adrenal hemorrhage. This was confirmed
with a CT scan, and malignancy and renal vein thrombosis was ruled out. On day 3 patient was
observed to have hypertension (average- 100/70 mmHg) and mild jaundice. Patient had no
hypoglycemia or electrolyte imbalance and renal function was normal. Baby was started on
enalapril and was extensively worked up for hypertension and adrenal hemorrhage. Renal Doppler,
urinary VMA levels, serum cortisol, beta HCG, alpha fetoprotein were all normal. Repeat USG
done weekly showed resolution of the hemorrhage (2.5 cm), however the hypertension continued
even
till
followup
at
6months.
Discussion: The clinical presentation of NAH is variable, ranging from asymptomatic (unilateral
incidentally diagnosed cases) to severe (bilateral massive affection) leading to adrenal insufficiency
or shock; common manifestations being poor feeding, vomiting, hypotension, persistent jaundice,
anemia and abdominal mass, however, our case had persistent hypertension. The common causes of
neonatal hypertension are renal artery thrombosis, bronchopulmonary dysplasia, and co-arctation of
aorta and rarer causes include hypocalcemia, total parental nutrition and idiopathic arterial
calcification. Symptomatic treatment and follow up serial USGs are necessary for documenting
resolution of the adrenal lesion and also for hypertension to subside. Conclusion: Unilateral NAH
must be differentiated from other cystic lesions like adrenal cyst, abscess and
tumors like
neuroblastoma. These cases can be asymptomatic and incidentally detected and can rarely present
as neonatal hypertension.
NEO/52(O) A STUDY OF PROFILE OF NEONATES BORN TO RH ISOIMMUNISED
MOTHERS
Aradhana Dwivedi, Suprita Kalra, Daljit Singh
Institute: Command Hospital (Southern Command), Pune 411040
aradhanakd@gmail.com
Background & Objectives: Rh isoimmunisation has continued to remain a common cause of
hydrops fetalis in our country due to relative lack of antenatal care and non provision of Anti-D.
Due to timely provision of Anti-D it has become rare in developed countries. Methods: In our
centre we had 24 newborns with h/o Rh isoimmunisation from the period of May 2007-July 2009.
The mothers of these babies underwent antenatal evaluation including ICT titres & serial USGs as
indicated. These babies were given intrauterine transfusions as per protocol using middle cerebral
artery velocities. At delivery the babies were started immediately on intensive double surface
photototherapy & given prophylactic intravenous immunoglobulin (IVIg) 1gm/kg. Samples for
serum billirubin, hemoglobin & reticulocyte count were monitored at birth, at 6 hrs, 12hrs & 12 hrly
thereafter till indicated. IVIg 1gm/kg was repeated for neonates when their serum billirubin was
found to be approaching exchange transfusion levels for gestational age as per AAP charts. Results:
Of the total 24, three babies had severe hydrops fetalis at birth. A total of 12 mothers’ had received
intrauterine transfusions & 9 babies were given a second dose of IVIg . Maximum serum billirubin
levels were 22 gm/dl at day 3 & average days of phototherapy were 6. 4days.No babies required
exchange transfusion & none had any sequelae of kernicterus on follow-up visits.All babies
underwent OAE to screen for hearing which was normal in all babies. Interpretation & Conclusion:
With intensive double surface phototherapy & prophylactic dose of IVIg the morbidity & mortality
in neonates born to Rh isoimmunised mothers is brought down. It also reduces the number of babies
requiring exchange transfusion.
NEO/53(P) RENAL SODIUM HANDLING IN PERINATAL ASPHYXIA
Jyoti Bagla, Roli Srivastav
Deptt. Of pediatrics, ESI PGIMSR Basaidarapur, New Delhi.
jyotibagla@yahoo.co.in
Background : Kidneys are one of the target organs for hypoxic ischemic damage. Hyponatremia is
one of the consequences of hypoxic injury to the kidneys. Study design : Prospective case control
study. Methods : Severely asphyxiated 70 babies (APGAR 7 or less at 5 min) were enrolled and
compared against 28 matched controls. Renal function parameters like blood urea, serum
electrolytes, serum creatinine, urinary sodium and creatinine were monitored and Fractional
excretion of sodium (FENA) calculated within 24 hrs and thereafter until recovery. Results :
Incidence of Hyponatremia ( sodium <135mEq/l) in asphyxiated neonates was 74.28%(52 /70) with
mean sodium 129.8mEq/l in cases Vs 135.8mEq/l in controls (p<0.001). Majority 62.8% (44/70)
were having mild hyponatremia ( Serum sodium 135 to 126mEq/l), 8(11.43%) subjects were having
moderate to severe hyponatremia (sodium 107- 125mEq/l). 18/52(34.6%) asphyxiated neonates
with hyponatremia had no signs of HIE, 7/52(13.46%) were having HIE I, 18/52(34.6%) were
having HIE II and 9/52(17.3%) were having HIE III. Overall mortality was 6 / 70 (8.57%) and all of
them were having hyponatremia (mean sodium 128mEq/l). Mean FENA in asphyxiated neonates
(0.6±0.56%) was significantly higher than in controls (0.29±0.27%) (p<0.05) . 40/70(57.14%)
neonates were having FENA more than 1 including 3 babies with FENA>2.5, out of them 25
(62.5%) were having HIE. Serum sodium normalized in majority of cases with in 72 hrs but in 11
of them (15.7%) hyponatremia persisted for more than 72 hrs with mean sodium being 127.7mEq/l
that again normalized later on. Conclusion : Hyponatremia is a significant problem in babies with
perinatal asphyxia. Severity of hyponatremia correlates with the severity of HIE. Hyponatremia is a
predictor of mortality in asphyxiated newborns in the current study. Thus, meticulous sodium
monitoring is required in babies born asphyxiated.
NEO/54(P) EFFECT OF BIRTH ASPHYXIA ON THYROID PROFILE OF TERM
NEWBORN
Somnath Pal , Debadatta Mukhopadhyay, Sukanta Chatterjee
Junior Resident, Medical College, Kolkata
somnathpal1983@gmail.com
BACKGROUND : Birth asphyxia causes alteration in the level of several hormones. Thyroid
hormone levels are also altered though some studies produce conflicting results. OBJECTIVE : To
compare the thyroid hormone levels in term , asphyxiated newborn with term non asphyxiated
newborn in cord blood & venous blood collected on day 1 & day 7 respectively.
MATERIALS AND METHODS: STUDY DESIGN : case- control study STUDY POPULATION :
25 term newborn ( apgar score =>8 & =>9 at 1st min & 5th min ) as control and 25 term, asphyxiated
newborn( apgar score ≤3 and ≤5 at 1st min & 5th min)as case. Both groups were matched with
respect to possible confounding factors. EXCLUSION CRITERIA : congenital malformations
Newborns whose mother used steroids, thyroxine , antithyroid medications during pregnancy
RESULTS: COMPARISON OF THYROID HORMONES
IN CORD BLOOD OF
ASPHYXIATED & NON-ASPHYXIATED TERM NEWBORN :- revealed no significant
difference ; p value ( student t test ) for T3, T4 and TSH were – 0.227, 0.347 and 0.079
respectively ). COMPARISON OF THYROID HORMONES IN VENOUS BLOOD OF DAY 1
:Asphyxiated newborns showed significant fall of TSH, T3 , T4 from cord blood value. (p value for
T3 -0.029, T4 -0.006, and TSH – 0.015). Control newborns had significant rise of T3,T4,TSH from
cord blood value (p value for T3 – 0.001, T4 –0.001 and TSH -<0.001 ) COMPARISON OF
THYROID HORMONES IN VENOUS BLOOD OF DAY 7 No significant difference for T3 (
p=0.324 ), T4 ( p=0.093 ) and TSH ( p=0.077 ) COMPARISON OF T3,T4,TSH and SEVERITY
OF ASPHYXIA
T3,T4,TSH levels were significantly lower in HIE2/HIE3 than HIE or no
encephalopathy group; p< 0.001( ANOVA ) CONCLUSION : 1. Birth asphyxia causes reversal of
TSH surge in asphyxiated newborn 2. Change in thyroid hormone levels are temporary 3. There is
greater reduction of thyroid hormone level in severely asphyxiated newborn
NEO/55(P) CONGENITAL MALARIA IN A TWO DAY OLD NEWBORN-A CASE
REPORT
Shivani Deswal,Akhilesh kumar,Pratima Anand,Harish Chellani
Department of Pediatrics, Safdarjung hospital & V.M.M.C, New Delhi
shivanipaeds@gmail.com
Malaria is considered to be congenital in the neonate when asexual parasites are detected in the
peripheral blood within the first week of life. However, the disease can be seen in a day old baby or
be delayed for weeks or months{commonly 10 to 30 days}.Congenital malaria is a rare
disease.Only 300 cases are reported in a literature. We report a case of Preterm girl Baby {34-36
weeks} large for gestational age {Wt-3.75kg} born to 35yrs old booked immunized G8 P4 L2 A3
with 8 months of gestation with uncontrolled diabetes on regular insulin 8/8/8 units with Bad
Obstetric History (3 abortions and 2 still births) ,delivered by Emergency LSCS in view of breech
with fetal distress. Mother had fever for 20 days with jaundice 1 year prior to pregnancy which was
diagnosed as malaria and treated. Mother also had history of fever 2 months before pregnancy for 4
days for which she took some over the counter medication. Baby Cried immediately after birth with
Apgar score- 8 and 9 at 1 and 5 minutes respectively. Baby was put on breast feed and maintaining
blood sugar. Baby developed fast breathing at 48 hrs of life .On examination-H.R- 174/min; regular,
peripheral pulses palpable.Resp. rate- 84/min with mild subcostal and intercostal retractions present
.Temp.- 102.5°F (axillary), Blood Pressure 60/34 mm of Hg in right arm.SpO2 in all 4 limbs (off
O2)- 93%.Per abdomen-Liver 4 cm below costal margin, span8cm and spleen 3cm,firm.Baby was
Investigated for fever and hepatosplenomegaly . Hb-18.9 g%,TLC-12100cc/m3 ,Platelet count165000cc/m3 ,PCV-58.8 % ABG - pH-7.29,PO2-65.8,PCO2-46.0,HCO3s-21.6 ,SBE- -4.2, PS Normocytic Normochromic with ring and ameboid schizont forms, suggestive of P.Vivax .
RMAT and P/S for Malaria parasite of mother were negative.TORCH Profile of baby and mother –
negative.X ray chest was normal.CRP – negative .Blood and CSF culture/sensitivity -no growth
after 7 days.KFT &LFT-normal. Syp chloroquine given for 3 days.After 3 days baby was afebrile
and spleen was just palpable .Repeat PS at day 8 and 1 month for both baby and mother was
negative.Mother received primaquine for 14 days. Transmission of congenital malaria can occur in
antenatal or perinatal period. Parasites hide in placenta and interferes with transfer of oxygen and
nutrients to the baby, increasing risk of: Spontaneous abortion, Preterm birth, Low birth weight,
Stillbirth and Neonatal deaths. Fever, anemia, and splenomegaly are seen in 80 % cases while
hepatomegaly, jaundice, regurgitation, loose stools, and poor feeding, drowsiness, restlessness, and
cyanosis are other manifestations. Congenital infection has been described after uncomplicated
asymptomatic pregnancies also.
NEO/56(P) NEONATAL OUTCOME OF DELIVERIES WITH MECONIUM STAINED
LIQUOR
Garima Gautam, Amit Gupta, Sanjeev Dutta, Anjoo Bhatnagar, Hitesh Pant
Department of Paediatrics, Fortis Escorts Hospital and Research Centre, Neelam Bata Road, NIT,
Faridabad-121001.
dr.garimagautam.7@gmail.com
Introduction: Babies born through meconium stained liquor (MSL) may aspirate meconium which
may occur in-utero, during delivery or immediately after birth, blocking air passages and causing
atelectasis and air leak, constituting Meconium Aspiration Syndrome(MAS) which is a significant
cause of neonatal morbidity and mortality. Aim: To find the incidence of MSL amongst all the
deliveries, and analysing outcome of the same in a tertiary care multispeciality hospital. Method:
Observational study, done at FEHRC, Faridabad, carried out from January 2010-September2011.
All newborns born with MSL were analysed on parameters as follows: a) Requirement of
resuscitation (endotracheal intubation and suctioning with/without positive pressure ventilation), b)
Requirement of respiratory support (oxygen by hood/ mechanical ventilation/ CPAP) and, c)
Incidence of MAS. Result: A total of 90 newborns with MSL were identified in 21 months.
Incidence of MSL amongst total deliveries (n=1079) was found to be 8.3 %( n=90). 11 newborns
(12.2% of MSL) required endotracheal suctioning, and 8 (8.8% of MSL) required resuscitation with
positive pressure ventilation. Later 7.7% (n=7) developed MAS. Among neonates who underwent
tracheal suctioning 27.2% (n=3) developed MAS as compared to 5% (n=4) who had MSL, but did
not undergo tracheal suctioning. Respiratory support in the form of oxygen by hood was required in
17.7% (n=16), mechanical ventilation and CPAP in 2.2% (n=2) each, with no mortality.
Conclusion: Proportion of births complicated with MSL was comparable with that of National
Neonatal Perinatal Database 2002-2003, suggesting that there is still need for improvement in
antenatal survelliance and intrapartum fetal monitoring as incidence of MSL remains the same in
last 9 years. However, proportion of MSL complicated births developing MAS is much lower (7.7%
versus 15.6%) attributable to widespread use of NALS guidelines.
NEO/57(P) THROMBOCYTOPENIA AS A MARKER OF SEPSIS AND ITS RELATION
TO ORGANISM SPECIFICITY
Shivprasad Dubey, Amit Gupta, Anjoo Bhatnagar, Hitesh Pant, Sanjeev Dutta
Department Of Pediatrics and Neonatology, Fortis Escorts Hospital and Research Centre, Neelam
Bata Road, N.I.T, Faridabad-121001,
dubindoc@yahoo.com
Introduction: Sepsis is a common complication in the neonatal intensive care unit and it remains a
diagnostic challenge due to its non-specific symptoms. The sensitivity and specificity of leukocyte
count changes (leucopenia/leucocytosis) ranges from 17-90% and 31-100% respectively.
Thrombocytopenia is also a frequent hematological change seen in neonatal sepsis. It is not yet
clear whether thrombocytopenia can be used as a diagnostic marker of sepsis. Also it is
controversial whether thrombocytopenia is an organism specific response. Aim: To evaluate the
utility of thrombocytopenia as a marker of neonatal sepsis and its relation to organism specificity.
Methods: An observational cohort study carried out at Level III NICU on 210 neonates admitted
from August 2010 to August 2011 with suspected sepsis or with risk factors for sepsis. Through
database search, data on platelet counts, sepsis, clinical course, and microbiological culture were
collected and analyzed. Results: Sepsis was diagnosed as per microbiological criteria (Blood
Culture) in 35 patients (16.6%) and thrombocytopenia was detected in 29 patients (13.8%).
Thrombocytopenia occurred in 19 of 35 blood culture positive patients (54.2%), P value <0.001.The
sensitivity,
specificity,
positive predictive value
and negative predictive value of
thrombocytopenia were 54.2% and 94.2%, 65.5% , 91.1% respectively. There were 57.1% cases of
Gram-ve, 25.7% cases of Gram+ve and17.2% cases of fungal sepsis. Thrombocytopenia occurred in
55% of Gram-ve, 44% of Gram+ve and 67% of fungal sepsis cases with no statistically significant
difference between these groups. (P value=0.898) Conclusion: Thrombocytopenia is a good sepsis
marker with its sensitivity and specificity comparable to leukocyte count changes, and thus may be
used as a sepsis marker in conjunction with/ or in place of leukocyte count changes. In contrast to
previous reports, thrombocytopenia might not be an organism-specific marker of sepsis.
NEO/58(P) NEONATAL SCREENING FOR G6PD DEFICIENCY IN OUR HOSPITAL
SETUP- A PROSPECTIVE PRELIMINARY STUDY
K.L. Srivastava, Shitanshu Srivastava, Shivam Shingla.
Department of Pediatrics, ERA Medical College and Hospital, Lucknow-226003.
drklskgmc@yahoo.com
Objective: 1.To perform preliminary screening of Glucose-6-Phosphate Dehydrogenase G6PD
deficiency in AGA newborns. 2. To evaluate the onset of bilirubin rise in G6PD deficient
newborns. Methods: Cord blood samples from 196 AGA newborns during 8-month period were
examined for G6PD activity using quantitative test. G-SIX (kinetic method) estimation was used for
quantitative assessment to know the level in normal subjects. The relation between G6PD
deficiency and the variables of gestational age, sex, jaundice, haemolysis and anaemia was
examined and their statistical correlations were done. Results: Six neonates (4 males and 2 females)
were found to be G6PD deficient. The incidence of G6PD deficiency was 3.0% (2 % for boys and
1% for girls), this is in accordance with the international and national figures (1). Two male subjects
had low WBC with normal haemoglobin level and normal packed cell volume (PCV), but none of
them had high reticulocyte counts. There was no correlation between G6PD deficiency and the
gestational age, haematocrit and reticulocyte counts of the cord blood. The mean cord bilirubin
levels in G6PD deficient group and normal newborns were comparable (1.27±.08mg/dl vs
1.39±0.52 respectively, P=0.54). Cord haematocrit was also similar in both the groups (50.4±3 vs
49.0±4 respectively, P=0.40). Conclusions: G6PD deficiency in newborns in this preliminary study
was 3.0%. In utero rise of serum bilirubin in patients with G6PD deficiency was not observed in
Indian population studied by us. Universal newborns screening for enzyme deficiency by examining
the cord blood is recommended (2).
NEO/59(P) PROFILE OF NEONATAL TETANUS: A HOSPITAL BASED STUDY IN
NORTH INDIA
Kirtisudha Mishra, Srikanta Basu, Dipti Kumar, Ashok Kumar Dutta, Bimbadhar Rath Kalawati
Saran Childrens’ Hospital, Lady Hardinge Medical College, New Delhi
kirtisen@gmail.com
Introduction: Neonatal tetanus (NT), an important preventable cause of neonatal mortality,
accounts for nearly 1% of the total number of deaths in children below 5 years of age in India. Aims
and objectives: To study the epidemiological and clinical profile, the outcome and the factors
affecting the outcome of neonatal tetanus cases admitted in our hospital.Material and methods: A
retrospective observational study was conducted in Kalawati Saran Children’s Hospital, New Delhi,
to review the records of all cases of NT between January 2009 and December 2010. Possible factors
affecting mortality were compared between survivors and non-survivors for statistical significance.
Results: A total of 55 cases with NT were admitted in the hospital during the study period with a
mean age of presentation 9.4 ± 1.2 days. Three mothers had received single dose of tetanus toxoid,
rest being unimmunised. Only 8.8% neonates were born out of institutional deliveries, while 91.1%
were born at home. 77.8% of the home deliveries were attended by untrained birth attendants. 33%
cases gave history of application over umbilicus. Case fatality rate was 60%. Mortality was
significantly higher in newborns with low birth weight (p=0.05), duration of spasms lasting more
than 3 days (p=0.008), those delivered by untrained birth attendants (p=0.029) and those with
aspiration pneumonia (p=0.002). Conclusion: The current admission rate of cases shows that the
elimination of NT remains a major challenge. Improving maternal immunization, increasing
deliveries by skilled birth attendants, prevention of low birth weight babies, prompt and careful
management of cases should be the main areas of focus to reduce the case fatality rate.
NEO/60(P) CHOANAL ATRESIA – UNCOMMON CAUSE OF CARDIOVASCULAR
COLLAPSE IN A PRETERM NEWBORN BABY
SK Roy, KD Sodhi, S Mehrotra,
Sr. adv. & HOD, Department of Paediatrics Command Hospital Lucknow -226002
sodhikirandeep@gmail.com
This preterm (period of gestation 34 weeks), very low birth weight (1.4 kg), female newborn baby
born by LSCS, cried at OT table subsequently developed apnea followed by cyanosis and cardiac
arrest, requiring intubation, chest compression and inj adrenaline in OT and shifted to NICU with
bag and tube ventilation. As baby was maintaining spO2 with FiO2 of 40 – 50% with minimal
ventilator support, baby was extubated. Within few minutes of extubation, baby developed severe
sub-costal and supra-sternal retraction, so was placed on mechanical ventilation. During weaning
when placed on nasal CPAP, baby again developed severe supra-sternal retraction. At that time,
nasogastric tube could not be passed bilaterally more than 03- 04 cm. So diagnosis of bilateral
choanal atresia was suspected which was corroborated by CT nasopharynx as bilateral 05 mm bony
septum. Following endoscopic guided Diode Laser perforation of B/L choanal atresia, 2.5 mm ETT
was placed in both nosopharynx with stay at collumella, which was replaced one by over 10 – 12
weeks. Screening for CHARGE association revealed bilateral sensory neural hearing loss as well as
low set ears clinically. Subsequent follow up revealed global developmental delay.
NEO/61(P)
SUCCESSFUL
TREATMENT
OF
MULTIDRUG
RESISTANT
ACINETOBACTER BAUMANNII IN A NEONATE
Soume Bhattacharya, Pooja Dewan, MMA Faridi, Prerna Batra
Division of Neonatology, Department of Pediatrics, University College of Medical Sciences, Delhi
drsoume@gmail.com
Ventriculitis is a known complication of neonatal meningitis associated with a high mortality of
upto 70%. While, gram negative organisms like E.coli are common etiological agents, over the last
decade Acinetobacter baumannii is an emerging pathogen in the neonatal intensive care setting with
a still higher fatality rate. Herein we report a neonate successfully treated for Acinetobacter
ventriculitis. A female neonate, delivered at 31-weeks’ gestation to a primigravida mother weighed
1.315 kg at birth, was admitted for respiratory distress to the intensive care unit. The neonate was
started on parenteral antibiotics as the mother had a history of prolonged rupture of membranes
associated with foul smelling liquor. On day 7, the baby developed seizures. CSF examination
revealed: 120 polymorphs/mm3, protein: 320 mg/dl, sugar: 10 mg/dl, venous sugar: 125 mg/dl.
Blood culture and CSF culture revealed Multidrug resistent Acinetobacter baumanni (MDRAB)
sensitive to Polymixin B and resistant to gentamycin/ciprofloxacin/cefotaxime/meropenem. CECT
revealed communicating hydrocephalous with ventriculitis. USG cranium revealed ventricular
debris. Treatment started with intravenous polymixin B (40,000 units/kg/d divided q6hr) on day 10
of life; in view of persistent seizures and non-improvement intraventricular polymixin B (20,000
units/day) was started on day 17 of life. After seven days of intraventricular therapy, the CSF was
normal and intraventricular polymixin B was discontinued. Intravenous polymixin B was continued
till three sterile CSF and blood cultures, completing about 6 weeks of therapy. The baby was
discharged successfully on day 52 of life. Our case illustrates that aggressive intraventricular
therapy may facilitate successful treatment of MDR Acinetobacter baumanniii ventriculitis in
neonates. Polymixin B is a useful drug for MDRAB in neonates.
NEO/62(P) PFEIFFER SYNDROME TYPE 1: A RARE CASE
Soume Bhattacharya, Ruchita Negi, Pooja Dewan
Department of Pediatrics, University College of Medical Sciences, Delhi
drsoume@gmail.com
Pfeiffer syndrome is a rare craniofacial anomaly with an incidence of 1 in 100,000 births
worldwide. It is rare in the Asian population, with only a few cases reported. Inherited in an
autosomal dominant manner, this syndrome is characterized by craniosynostosis, mid face
abnormalities, broad and deviated thumbs and big toes, and partial syndactyly on hands and feet.
Some children with Pfeiffer Syndrome may have only one or both mid-face problems and
craniosynostosis. Here we report a case of Pfeiffer syndrome type 1 with only midface problems.
The male baby was delivered at 39 weeks of gestation, to a second gravida mother. He weighed 2.5
kg, with a length of 52 cm, head circumference of 35 cm, and an upper segment : lower segment
ratio of 1.7:1. The baby had high forehead, underdeveloped mid face, flat nasal bridge, widely
spaced eyes, broad thumbs & toes, syndactyly of 2nd and 3rd toes bilaterally. Anterior fontanelle
was palpable (1 × 1 cm) while the posterior fontanelle was closed. Digital X-ray of bilateral hands
& feet showed bulbous terminal phalanges of hands, without bony fusion. CT scan revealed
maxillary hypoplasia without any evidence of craniosynostosis. At follow up, the child was
developmentally and neurologically normal. Our case had only mid facial and digital anomalies.
This case illustrates that mere absence of craniosynostosis at birth does not rule out Pfeiffer
syndrome type 1.
NEO/63(P)
NONPROGRESSIVE
CONGENITAL
UNILATERAL
VENTRICULOMEGALY.
Sujay Kumar E, Sushma Malik, Charusheela Warke, Manju Kumari, Anender Dhariwal
Division of Neonatology, Dept. of Pediatrics, BYL Nair Ch. Hospital and TN Medical College,
Mumbai-8
dr.sujay253@gmail.com
Introduction: Unilateral ventriculomegaly is a rare medical condition. It usually occurs due to the
obstruction of the foramen of Monro from a neoplasm like thalamic tumor, choroid plexus cyst,
abscess, vascular anomaly, gliomatosis, TORCH infections and in many it is idiopathic. Here we
report a case of unilateral dilatation of the lateral ventricle in a neonate. Case history: A 2.45 kg
baby delivered after a 36 week of gestation had been diagnosed by ultrasound examination as
having a unilateral ventriculomegaly at 33 weeks of gestation. The head circumference at birth was
35 cm. The child was active, neurologically normal, without any signs of raised intracranial tension.
The MRI brain demonstrated a moderately dilated left lateral ventricle with no apparent space
occupying lesion or vascular malformations. Further, investigations done for this unilateral
hydrocephalus of the child revealed that the mother’s and infant’s toxoplasma IgG titres were
positive. Therefore this unilateral dilation was probably due to congenital toxoplasmosis or was an
incidental finding. Confirmation with further IgG or IgM titres were not done as patient took
discharge against medical advice. Discussion:- Unilateral hydrocephalus is an uncommon disorder
of the newborn. Overall, congenital hydrocephalus occurs between 1.8 and 3 per 1000 live births;
however, vast majority of these cases are bilateral, symmetric hydrocephalus. The etiology is
usually due to obstruction of the foramen of Monro, which may be atretic, stenotic or occluded by a
membrane. Acquired etiologies include thalamic and intraventricular neoplasms, colloid cysts,
tuberculous masses, ventriculitis, vascular malformations, infections and inflammatory conditions.
If ventriculomegaly is an isolated finding, then emergent surgical intervention may not be required.
However if there is progressive ventricular dilatation, cortical thinning, or abnormal rapid
intracranial growth, then surgical intervention is warranted. Ventriculoperitoneal shunting in the
first month of life is critical in order to prevent thinning of the cortical matter and poor neurological
outcome. Conclusion:- Unilateral hydrocephalus is a rare anomaly that can be recognized by
prenatal sonography. Even though unilateral ventriculomegaly may be marked, early diagnosis and
treatment may result in a favorable outcome.
NEO/64(P) HEALTH SUPERVISION OF NEONATES WITH NEUROFIBROMATOSIS-1
Sandip P. Bandewar , Sushma Malik, Charusheela Warke, Umakant Marde, Rameshwar Gore
Pediatric Resident, Department of Pediatrics, 1st Floor, College Building, TNMC & BYL Nair
Hospital, Mumbai Central, Mumbai-400008
sbandewar@yahoo.com
Introduction:-Neurofibromatosis-1 (NF1) is a multisystem disorder that primarily involve skin and
nervous system, in which some features may be present at birth and others are age related. Health
supervision of affected neonates involves early detection of symptoms, complications and their
management. Case history:- At our tertiary care hospital form Jan2009 to June 2011, amongst 7425
deliveries we had seven neonates with neurofibromatosis-1 (as per the diagnostic criteria), which
were diagnosed at birth, giving a high prevalence of nearly 1 in 1000 births . Amongst these cases
the predominant presenting feature was multiple café-au-lait spots. Four neonates had a parent who
was also having NF-1 and in three cases there was no family history. All parents on discharge were
asked to follow up regularly and to note any further skin changes. Discussion :-.NF1 is often
asymptomatic at birth and most commonly presents with Café au lait spots. Other rare findings in
neonates includes tibial dysplasia (bowing of leg), plexiform neurofibroma and MRI Brain may
reveal unidentified bright objects in brain ( in 60%) which may suggest optic glioma or may predict
propensity for learning and cognitive disabilities. Management of neonatal NF1 includes thorough
screening of first degree relatives, advise to parents to report any unusual or new findings. Emphasis
should be made for regular followup visits, careful cutaneous, skeletal, ophthalmologic and
neurological examination and neurodevelopmental progress. Conclusion :- Neonatal NF1 can be
detected by simple skin examination and family history. Parental Education and counseling
regarding regular scheduled visits for detecting complications will improve quality of life and
decrease morbidity.
NEO/65(P) A STUDY OF CERTAIN FACTORS RELATED TO THROMBOGENIC
STATES IN NEWBORNS WITH HYPOXIC ISCHEMIC ENCEPHALOPATHY IN
RELATION TO NEURO-IMAGING FINDINGS
P. K. Rajeev
House # 24-88/48/1C, East Anandbagh, Post Malkajgiri, Hyderabad – 400047
rajeevpk9@gmail.com
BACKGROUND: There are very few studies on factors related to thrombogenic states in relation to
Hypoxic Ischemic Encephalopathy and Neuro-imaging studies. Aims and Objectives: To study the
relationship between blood levels of certain factors related to thrombogenic states in neonates with
Hypoxic Ischemic Encephalopathy. To study the role of the above factors in the causation of neuroimaging findings if any in Hypoxic Ischemic Encephalopathy in newborns. Materials & Methods of
Study: 34 neonates inborn and outborns, admitted in NICU, Gandhi Hospital with features of
Hypoxic Ischemic Encephalopathy according to Sarnat & Sarnat staging clinically were subjected
to cross sectional study. All cases were subjected to Neurosonogram,MRI. .EEG could be done in
30 cases.ProteinC,ProteinS, Antithrombin-lll, Antiphospholipid antibody and Homocysteine were
sent. Inclusion Criteria: Neonates admitted in Gandhi Hospital NICU with clinical features of
Hypoxic Ischemic Encephalopathy, whether inborn or referred from other govt. or private hospital.
Exclusion Criteria: The neonates were excluded if they had sepsis or meningitis at the time of
admission, inborn errors of metabolism or had dysmorphic features or syndromic malformations.
Results: (Regression Analysis of various factors related to thrombosis: with MRI brain & EEG) By
regression analysis), protein C levels were statistically related with EEG abnormalities (P = 0.045);
greater EEG abnormalities are associated with greater mean protein C levels. Protein S levels were
statistically related with both EEG and MRI brain abnormalities (P = 0.039, 0.036 respectively).
There is an observed higher mean level of Protein S in relation to EEG abnormality and decreased
levels of Protein S in relation to MRI brain abnormality. Antithrombin III is statistically related with
MRI brain abnormalities (P = 0.032). Lesser mean levels of Antithrombin III were associated with
greater MRI abnormalities. Homocysteine levels are statistically related to MRI brain abnormalities
(P = 0.004), greater levels of Homocysteine are associated with greater MRI brain abnormalities.
CONCLUSIONS: Sarnat & Sarnat staging05 remains to be a useful modality in classifying the
stages of HIE as often APGAR scores and arterial blood gases are not available. Sequential neuro
imaging may be more helpful. Neonatal stroke is probably under-recognized, and may be better
picked up by neuro-imaging especially MRI of the brain. Levels of factors related to thrombosis
have no association to the stages of HIE in this study, but are associated with abnormalities on MRI.
Assessing factors related to thrombosis in those with MRI brain abnormalities
NEO/66(P) PROPHYLACTIC INSTILLATION OF SURFACTANT IN HIGH RISK
INFANTS – A CLINICAL OBSERVATION
S. Radha madhavi, S.Uday Shankar, P. Yashodhara, Pasha
Department Of Paediatrics, Guntur Medical College, Guntur
radhamadhavi76@yahoo.co.nz
Background
: RDS [HMD], a major problem of premature births is due to the deficiency of
surfactant in the lung. Added to the prematurity of birth, the issue of a diabetic mother, elderly
primi, multiple gestation etc also add a risk factor. In our centre,a study was carried out to see the
prophylactic surfactant in preventing neonatal morbidity and progression to mechanical ventilation.
All cases were given prophylactic surfactant instillation. No rescue surfactant were given.
Methods : A scoring system was deviced as follows
Scoring factor
score
1) Maternal age > 35
1
2) Maternal diabetes, PROM
1 each
3) Maternal sepsis, multiple gestation
2 each
4) Male
1
5) Female
0
6) Term
0
7) Preterm
>32 wks
1
<32wks
2
8) Weight
Normal
0
LBW
1
VLBW
2
ELBW
3
9) RR
<60 / min
0
60-80/min
1
>80/min
2
Results
: 65 infants were identified as high risk infants and prophylactic surfactant was
administered. Excepting for two mortalities all others did well. 63 were shifted to the mother side
within a duration of 1 hr to 5 days. The NICU stay in this study was comparatively less compared
to the previous trials of rescue surfactant instillation. Conclusion: Prophylactic surfactant
instillation in our study identified by our score positively helped reduction in
the development or
progression of RDS. We believe prophylactic surfactant prevented the
progression of many of
the babies who normally would have needed ventilator support. Most babies were healthy and
feeding well by the 2nd day.
NEO/67(P) CASE REPORT – CONGENITAL SYPHILIS
Rashmi D, Gangadhar Belavadi, Sarala
Bangalore Medical College & Research Institute, Bangalore
rashmi.d326@gmail.com
We report a case of early congenital syphilis in a day 1 old male, second born to a non
consanguineously married couple who presented with history of abnormal shape of both lower
limbs, swelling of right thigh, abnormal mobility of right thigh and crying on handling right thigh.
The antenatal history of mother was uneventful (VDRL – negative) . The obstetric scan done at 32
weeks revealed ?short femur (4.81cm) ,? Skeletal dysplasia . The neonate was of low birth weight
of 2. 25 kg and No h/o difficult / prolonged labour . There were no skin lesions, no microcephaly or
snuffles. X ray showed fracture of right femur and hyperosteosis. The mother and the neonate’s
TPHA was positive and the neonate’s CSF VDRL was reactive. The mother and child were both
treated for syphilis. The father was tested negative .The neonate was discharged after 21 days. The
unusual features of this case was that mother’s VDRL was negative, the neonate presented with a
fracture and had no skin lesions. This emphasizes that the diagnosis of congenital syphilis remains
complicated and requires high index of suspicion. Because of the high morbidity associated with
congenital syphilis , screening of all pregnant women should be done at the first prenatal visit, in the
third trimester and at delivery is important. An additional screening of infants born to high- risk
mothers may be appropriate at 4 to 8 weeks of age.
NEO/68(P) CASE REPORT – HARLEQUIN ICTHYOSIS
Rashmi D, Gangadhar Belavadi, Sarala
2nd Year PG Pediatrics, Bangalore Medical College & Research Institute, Bangalore
rashmi.d326@gmail.com
We report a case of Harlequin ichthyosis in a male newborn , first born to a non consanguineously
married couple with an uneventful antenatal and birth history and with no significant family history.
The prenatal ultrasound was normal.The neonate had parchment like skin, ectropion, eclabium, and
low set dysplastic ears and linear scars on the scalp and upturned nostrils. The neonate had no
respiratory distress but had feeding difficulties and was given intravenous fluids and nasogastric
feeds. The neonate was discharged against medical advice and the prognosis was explained to the
relatives. Harlequin ichthyosis is a rare and extremely severe form of congenital ich-thyosis, with
an incidence of about 1 in 300 000 births . Prenatal diagnosis is usually difficult because of nonspecific signs in the ultrasonographic examination and rareness of the disorder. Delivery of a child
with congenital ichthyosis identifies a family at risk, and for subsequent pregnancies prenatal
diagnosis can be offered. ABCA12 gene (on chromosome 2q35) product is a protein that functions
in the intracellular lipid keratinocytes and is involved in transport of substrates across both plasma
membrane and intracellular membranes . Defective gene causes excessive transcutaneous loss of
water and electrolytes which contributes to the development of polyhydramnios and also causes
significant morbidity and mortality after delivery. Neonates usually die within the first days of life
from infections and dehydration-related complications. Prenatal diagnosis remains difficult but may
be possible in high risk pregnancies by performing a fetal skin biopsy or by three-dimensional
ultrasonograhy.
NEO/69(P) A RARE CASE OF ACUTE GASTRIC DILATATION SECONDARY TO
SEPTICAEMIA IN NEWBORN
Rajiv Singh, Vineeta Pande, S.R. Agarkhedkar
Department of Pediatrics. Dr. D Y Patil Hospital, SantTukaram Nagar, Pimpri Pune Maharashtra 411018
doc.rajivs@yahoo.co.in
Acute gastric dilatation in a newborn is a rare clinical entity. Such dilatation without any
obstruction is furthermore rare. We hereby present a rare case of acute gastric dilatation that
developed in a three days old baby who was born premature and was suffering from septicaemia
and respiratory distress. A 33-weeks baby was born by emergency lower segment Caesarian section
in view of fetal distress. There was a history of meconium stained liquor . The newborn cried
immediately after birth. Antenatal ultrasound done wasnormal and did not reveal any congenital
malformation including gastrointestinal obstruction. The child was admitted in NICU. Clinical
examination revealed hypothermia,respiratorydistressThere was no cyanosis. Auscultation revealed
decreased air entry on both sides with presence of few crepts. Abdomen was soft with bowel sounds
on
auscultation.
Rest
of
the
clinical
examination
was
unremarkable.
Onthird day baby started abdominal distension and started deteriorating. .She passed stool and
bowel sounds were sluggish. Investigations revealed high titres of CRP , thrombocytopenia , and
deranged renal functions. X ray abdomen revealed distension of stomach .Ultrasonography did not
show any evidence of obstructive lesion. Blood culture revealed Pseudomonas aeruginosa.
Antibiotics were upgraded to MeropenumThe baby was administered IVIg, FFP and blood
alongwith antibiotics and vasopressors were added. On 10th day the baby started showing
improvement in the form of reduction of abd girth, reduced bloody aspirate and better general
condition cry. Antibiotics were continued for 3 wks and the baby was discharged on breastfeeds
Acute gastric distension in a newborn is a rare entity but can occur secondary to sepsis and
dyselectrolytemia. Early recognition of condition and its underlying treatable cause is mandatory to
reduce the morbidity and mortality associated with this condition.
NEO/70(P) NEONATAL INCONTINENTIA PIGMENTI – RARE INHERITED
ECTODERMAL DISORDER
Rameshwar Gore, Charusheela Warke, Sushma Malik, Samruddhi Khopkar, Chitra Nayak.
Pediatric Resident, Department of Pediatrics, 1st Floor, College Building, TNMC & BYL Nair
Hospital, Mumbai Central, Mumbai-400008
drrameshwargore@gmail.com
Introduction:- Incontentia pigmenti (IP) is a rare (incidence is 1:40000) sporadic or ‘X’linked
dominant disorder of ectoderm, characterized by four distinctive, transient stages of cutaneous
lesions with variable systemic involvement. Case history:- .FTND female born to primi mother
presented on day of life 3 with complains of multiple vesiculobullous lesion over both upper limb
and lower limb, trunk and face. On day one the lesions resembled neonatal pustulosis but the rash
gradually became extensive and was characterized by linear vesicular, pustular and bullous lesions
with surrounding erythema. Baby was accepting feeds well with no signs of sepsis. Neurological,
ophthalmological and other systemic examination were normal. There was a history of similar
lesions were also present in the mother in her childhood. Skin biopsy done in the neonate was
classical of incontinentia pigmenti. On follow up after 21 days, the vesicles had subsided leaving a
dry scaly skin. Discussion: IP is an uncommon X-linked dominant multisystem disorder, caused by
random inactivation of ‘X’gene, lethal in the majority of affected males and has variably expression
in females. Cutaneous manifestations of IP are benign, classically occurring in four stages:
vesicular, verrucous, hyperpigmented, and hypopigmented (atrophic) which can overlap with each
other. They are usually present at birth and typically spread along the lines of Blaschko. Skin biopsy
during the bullous phase shows characteristic intraepidermal vesicles filled with eosinophils. It may
be variably accompanied by dental 90%, ocular 35%, neurologic 40%, bones 40% and joints, and
development anomalies. Morbidity and mortality primarily result from neurologic and ophthalmic
complications including visual loss, seizures, mental retardation. Regular follow up with
neurologist, ophthalmologist and dentist are required. Conclusion: Genetic counseling may be
helpful for those with a family history of IP who are considering having children. Early diagnosis,
regular monitoring and therapy can prevent or slow down the systemic complications of IP.
NEO/71(P) PANNICULITIS OR SUBCUTANEOUS FAT NECROSIS IN A NEONATE
Sushma Malik, Charusheela Warke, Nisha Iyer, Ashwin Saboo, Rachita Dhurat
Block No 3, Flat No 7, Brady’s Flats, Sorab Bharucha Road, Colaba, Mumbai-400005
sushmamalik@hotmail.com
Introduction: Subcutaneous fat necrosis (SCFN) or Panniculitis is a rare, self-limited pathology
affecting adipose tissue of full term or post term neonates associated with cold exposure, obstetrical
trauma, asphyxia etc. Here we report a neonate admitted to our NICU with SCFN. Case History: A
Full term 2.9 kg female born to G2P1L1 mother with meconium stained amniotic fluid requiring
under cord suction and apgar score - 3,5,8. After the initial resuscitation, baby active, good cry,
suck, tone and there was no respiratory distress. On day 5 of life neonate developed two 5 x 6 cms
irregular, erythematous, tender indurations were noted bilaterally over lateral aspect of thighs.
Gradually similar lesions appeared over the deltoid region, back and gluteal region. Septic screen
and CRP were positive. The serum calcium levels were normal. A punch biopsy from the thigh
lesion was done and it revealed fat necrosis with needle shaped crystals and inflammation with
multinucleate giant cells which was consistent with SCFN. The lesions resolved over a few months
and no fresh indurations appeared and also calcium levels regularly done were normal. Discussion:
SCFN / panniculitis is an uncommon, benign, temporary process characterised by necrosis of the
subcutaneous fat with needle shaped crystal formation within the fat cells which initiates a localised
inflammatory process with foreign body giant cell formation. It occurs in the first few weeks of life
and presents clinically as multiple subcutaneous, indurated, erythematous plaques and nodules with
or without pain in a neonate with history of birth asphyxia, hypothermia, traumatic birth etc. Exact
pathogenesis remains unknown and a hypothesis is crystallisation of the saturated subcutaneous fat
leading to necrosis. It may be associated with hypercalcemia due to increased non-renal absorption
of calcium secondary to increased level of 25 dihydroxy Vitamin D3 alpha hydroxylase within the
granulomatous infiltrate. Hypercalcemia must be looked for as it can lead to lethargy, seizures,
blindness, poor weight gain, cardiac rhythm disturbances and can be treated with fluids, calcium
losing diuretics like furosemide, low calcium and Vitamin D in diet. Diagnosis is confirmed by
punch biopsy from the lesion and differential diagnosis includes sclerema neonatarum, plexiform
neurofibromas and skin tumours. SCFN is generally self resolving but one needs to watch for
hypercalcemia for at least 6 months after the skin lesions resolve. Conclusion: SCFN is a benign
condition that resolves spontaneously and requires parental counselling and follow up especially for
appearance of new lesions and hypercalcemia.
NEO/72(P) STUDY ON END OF LIFE CARE SUPPORT AND PARENTAL DECISION
MAKING IN NICU OF SVPPGIP.
Nayak Snehamayee, Priyadarshini Lipsa, Meher B K, Satpathy S K,Mohanty N
Dept Of Paediatrics ,SCBMCH & SVPPGIP, Cuttack
Snehamayee.nayak@gmail.com.
INTRODUCTION:-survival rates of VLBW,ELBW & critically ill infants are increasing raising
complex ethical issues for health care providers and parents who face the challenge of making
end of life decision for newborns.The purpose of this study was to evaluate parental involvement
and the underlying causes in end of life care of babies in NICU. MATERIALS AND
METHODS:-This is a cross-sectional observational study conducted in NICU of SVPPGIP from
mar2011-aug2011 on newborns admitted to NICU in whom life sustaining medical management
methods were discontinued.Information regarding all of them were gathered and analysed.
RESULTS:-Life sustaining measures were withdrawn with consent from 54 patients during study
period.85%(46) of babies were from BPL card holder families.Females dominated by 55%(30 in
number).92%(50) babies were on ventilator.Total duration of ICU stay categorised as upto
3days,3-7 days,>7days were 50%,22%,28% respectively.Duration of ventilator requirement
3days(52%),3-7days(24%),>7days(24%).HIE was the most common diagnosis(44%) followed by
prematurity with complications.In 72% cases(39) treating physician had positive opinion
regarding good outcome of treatment. CONCLUSION:-Parents should be given clear,accurate
and timely information regarding diagnosis management plan along with the anticipated costs
for further management.There should be a hospital policy and separate counsellor for
counselling of parents regarding termination of life sustaining medical treatment.
NEO/73(P) WARFARIN EMBRYOPATHY: A CASE REPORT
Mehndiratta S, Suneja A, Gupta B, Bhatt S
Junior Specialist, Department of Pediatrics, Lok Nayak Hospital, New Delhi
drsmehndiratta@gmail.com
Introduction: Warfarin embryopathy (WE) is a consequence of maternal intake of warfarin during
the antenatal period. The manifestations are varied, ranging from still births and abortions to
varying degrees of dysmorphology and malformations that may involve different organ systems.
We present a case of a neonate with WE whose mother was on unsupervised warfarin prophylaxis
throughout pregnancy. Case report: A male baby was delivered by a 25-year-old woman. The baby
was born at term with a birth weight of 2 kg (SGA). The medical history revealed that the mother
had rheumatic heart disease and left-sided hemiparesis. She had been started on warfarin
prophylaxis by a cardiologist. It was found that the neonate had a depressed nasal bridge. The
systemic examination was essentially normal and there were no hemorrhagic manifestations.
Radiology of the skull revealed thinning of the bones of the skull and that the nasal bone was
absent. An infantogram revealed the presence of stippled epiphyses of the femoral head along with
stippling of the calcaneum bones (chondrodysplasia punctata) on both sides. Discussion: Warfarin
is a potent anticoagulant. It readily crosses the placenta because of its low-molecular weight and can
achieve significant levels in the fetus. The consequences of maternal ingestion of warfarin are a
specific pattern of anomalies known as WE. Nasal hypoplasia and epiphyseal and vertebral
stippling (chondrodysplasia punctata) are the two most consistent and classical features of WE. The
reported incidence of WE ranges from 0% to almost 30%. The severity and range of manifestations
are variable. The management is entirely supportive depending on the presentation. Conclusion:
The choice of appropriate anticoagulation in pregnancy is still debatable in women that require
anticoagulation. The risk to benefit ratio needs to be explained to parents.
NEO/74(P) CORRELATION BETWEEN TRANSCUTANEOUS BILIRUBIN AND SERUM
BILIRUBIN IN NEONATES WITH HYPERBILIRUBINEMIA ON PHOTOTHERAPY.
M.R.Savitha, Ajay M, Kumar G.M, Venugopal B.L
Department of Pediatrics, Mysore medical college and research institute, Mysore
drsavithamr@yahoo.com
Introduction: There are conflicting reports on efficacy of Transcutaneous bilirubin(TCB)
measurement during phototherapy. Aims and objectives:To study correlation between TCB and
serum bilirubin(SBR) in jaundiced neonates during phototherapy Materials and Methods:Present
crossectional study included jaundiced neonates requiring phototherapy. SBR and TCB on patched
and unpatched skin over forehead were simultaneously measured at the start of phototherapy and at
the end of 24, 48 and 72 hrs. Results:Of 72 neonates studied there were 52 term, 20 preterm
neonates. Mean age was 4.63 days. At the end of 24hrs of phototherapy there was a significant
correlation between TCB at the unpatched skin and SBR with correlation coefficient of
0.718(p=0.000). At the end of 48 hrs of phototherapy the correlation coefficient was still significant,
with correlation coefficient of 0.674(p=0.008). At the end of 72 hrs of phototherapy there was no
significant correlation between TCB at unpatched skin and SBR(p=0.207) When separately studied
for preterms, there was a significant correlation between TCB at unpatched skin and SBR at the end
of 24hrs with correlation coefficient of 0.783(p=0.000) but the correlation was lost after 48hrs of
phototherapy(p=0.375). There was statistically significant correlation between TCB at patched and
unpatched skin during first 72hrs of phototherapy(p<0.05) Conclusions:1) Transcutaneous
bilirubin measurement shows a significant correlation with SBR during first 72hrs of phototherapy.
However, correlation was lost at the end of 48hrs of phototherapy in preterm neonates. 2) There is
no added advantage of transcutaneous bilirubin measurement on patched skin during phototherapy
in the first 72hrs of phototherapy.
NEO/75(P) THE ROLE OF EARLY VS LATE ENTERAL NUTRITION IN PRETERM
NEONATES WITH RESPIRATORY DISTRESS SYNDROME
Rahul Sinha
167 Military Hospital, Pathankot, Punjab
drrahul_2000@yahoo.com
INTRODUCTION: The respiratory distress syndrome in preterm neonate is mostly due to
surfactant deficiency. The early nutritional support not only decreases the need for prolonged
ventilation but also maintains positive nitrogen balance in the body. AIMS/OBJECTIVE: To
compare early(first 24 hr) vs late(after 24 hrs) enteral nutrition in preterm neonates suffering from
respiratory distress syndrome METHODS: Retrospective study, data collected from medical case
sheet of NICU born in between 1st June 2010 to 1st May 2011 in 167 Military hospital Pathankot
Punjab. 30 preterm neonate were given expressed breast milk(10-15 ml/kg/day) using feeding tube
within 24 hrs of birth (early group) which was gradually increased and 30 other preterm neonate
was given enteral nutrition after 24 hrs of birth ( late group). The two group were similar in terms of
birth weight, APGAR score, gestational age, mode of delivery and diagnosis of respiratory distress
syndrome. RESULTS: In comparison to neonates in late nutrition group, the early nutrition group
required less days of mechanical ventilation, fewer days of aminophylline, less days of intravenous
fluids, early weight gain and less chances of neonatal sepsis. CONCLUSION: So early nutrition in
preterm neonates with respiratory distress syndrome is beneficial on many parameters.
NEO/76(P) A STUDY OF COMPARISON OF APOLIPOPROTEIN B (APO-B) AND
APOLIPROTIEN A-1 (APO-A-1) AND THEIR RATIO IN HEALTHY FULLTERM
SMALL FOR GESTATIONAL AGE (SGA) AND APPROPRIATE FOR GESTATIONAL
AGE(AGA) NEWBORNS.
Mohsin Hasan, Siddiqui M.H., Shrivastav J, Dwivedi R.
Department of Paediatrics, GMC, Bhopal
dr.mohsinhasan@gmail.com
Apolipoprotein B is elevated in small for gestational age (SGA) newborns compared with normally
grown appropriate for gestational age(AGA) newborns , demonstrating a link between low birth
weight and risk of subsequent atherosclerosis. Increased apolipoprotein B levels and an elevated
apolipoprotein B to A-I ratio are predictors of atherogenesis. Elevated apolipoprotein B levels in
young adults have been linked to atherosclerosis in later life, whereas impaired fetal growth has
been linked to higher than normal apolipoproteinB levels in adulthood.We conducted this research
to test the hypothesis that circulating apolipoprotein A-I and B concentrations and their ratio differ
in SGA compare to AGA newborns. Venous samples of newborns were collected within 24 hours
of delivery under all aseptic precautions and assays of Apoliprotiens were performed by
nephelometry with a nephelometre 100 analyzer
NEO/77(P) A STUDY ON ETIOLOGY AND
OUTCOME OF NEONATAL
HYPERBILIRUBINEMIA REQUIRING EXCHANGE TRANSFUSION
Nayak Snehamayee, Priyadarshini L, Mohanty A K, Beriha S S
Dept. of Pediatrics, SCBMCH & SVPPGIP, Cuttack
lplpriyadarshini@gmail.com
INTRODUCTION: Jaundice is a common physical finding in newborn. Over 2/3rd of newborn
babies develop clinical jaundice out of which very few require invasive procedures like exchange
transfusion . AIMS AND OBJECTIVES: To study the incidence of neonatal hyperbilirubinemia
requiring exchange transfusion and their underlying etiologies and complication during procedure.
MATERIALS AND METHODS: We have conducted a hospital based cross sectional observational
study at SCBMCH&SVPPGIP during a period of June 2011 to Aug 2011 on newborns presenting
with jaundice at the time of admission or during hospital stay. Exchange transfusion was done on
newborns with bilirubin level above the cutoff range as per Bhutani chart and according to weight
in preterm babies in NICU and they were observed till discharge. RESULTS: Out of total 195
patients admitted with neonatal hyperbilirubinemia 14(7%) required exchange transfusion .3(21%)
required transfusion within 48 hrs of life, 5 (36%) within 48-120 hrs of life and 6(43%) beyond 120
hrs. 3(22%) babies were preterm and 11(78%) were term .Most common underlying etiology was
ABO incompatibility 6(43%). Incidence of Rh incompatibility was 2(14%). 65% of babies had
associated risk factors like sepsis , birth asphyxia ,iso immune hemolytic disease and 35% had no
risk factors .Complications during the procedure were rare like 2(16%)developed hypoglycemia
and 4(32%) had seizure due to hypocalcemia .4(28%) of patient had features of bilirubin
encephalopathy prior to exchange. Only 2 patients required repeat transfusion. CONCLUSION: If
performed appropriately it can prevent mortality and neurological damage. It is quiet safe in
experienced hands.
NEO/78(P) OUTCOME OF SEPSIS IN VERY LOWBIRTH WEIGHT BABIES
Sharath Chandra N, Usha B K, Sudha Rudrappa
Department of Pediatrics, Mysore Medical College and Research Institute, Mysore.
drnsharathchandra@gmail.com
INTRODUCTION: Very low birth weight (VLBW) babies constitute approximately 4%–7% of all
live births but need a major share of effort, time and resources for their care. AIMS AND
OBJECTIVES: To study the outcome of early onset sepsis(EOS) in very low birth weight.
MATERIALS AND METHODS: This study was conducted from Jan to July 2011. Neonates who
were born with weight less than 1500 gms were included in the study. The babies were evaluated
for sepsis with sepsis screen and blood culture. Babies below 1000 gms, with congential
malformation and who died within 12 hrs of birth are excluded in study. RESULTS: There were 64
neonates studied with male: female (1.13:1) .There were 27 (42.12%) inborn, 37(57.72%) out born
babies, 60(93.6%) born vaginally, 7(10.92%) cases with prolonged rupture of membrane,
10(15.6%) were twins. 57(88.92 %) appropriate for gestational age.
N
%
Preterm 28±2 wks
9
14.04
30± 2wks
23
35.88
32± 2wks
21
32.76
34± 2wks
11
17.16
Blood Culture positive
22
34.32
Acinetobacter
8
12.88
MR CONS
6
9.36
Pseudomonas
2
3.12
Klebsiella
2
3.12
Citrobacter
1
1.56
MRSA
2
3.12
Shock
11
17.16
RDS
10
15.6
Neonatal Hyperbilirubinemia
30
46.8
Discharge
42
65.52
Death
8
12.48
CONCLUSIONS: Early onset sepsis is one of the factors which influence survival of VLBW
babies. Other comborbid conditions like RDS,NNH & shock play a role in morbidity and mortality.
If managed with nutritive, supportive care, thermo neutral environment and appropriate antibiotics
survival of VLBW babies can be improved.
NEO/79(P) MECONIUM ASPIRATION SYNDROME
AMNIOTIC FLUID
Bhawna Malik, P. D. Sharma, Anand Bhardwaj
Department of Pediatrics, MMIMSR, Mullana, Ambala
dr_bhawnamalik@yahoo.com
IN
MECONIUM
STAINED
Introduction: Passage of meconium in-utero is a serious neonatal disorder carrying high morbidity
and mortality. Meconium passage may be a physiological response of increasing level of motilin or
parasympathetic(vagal) stimuli. Aims & Objectives: This study was done to determine the
incidence of meconium aspiration syndrome in babies born with meconium stained amniotic fluid.
Materials and Methods: The study was conducted in the Neonatology section of the Department of
Pediatrics of MMIMSR, Mullana, Ambala in 75 neonates born to mothers having meconium stained
amniotic fluid. The study period was from Oct. 2009 to July 2011. Meconium aspiration
syndrome(MAS) was labeled on the basis of development of respiratory distress along with
radiological evidence in babies born to mothers with meconium stained amniotic fluid(MSAF). The
babies were observed for a period of 72 hours after birth. Cases with septicemia were excluded from
the study. Assessment of gestation age was done by Ballard scoring and babies classified as
preterm, term and post term. Birth weight was recorded immediately after birth. The results were
subject to statistical analysis. Results: 8 out of 75 babies(10.7%) with MSAF developed MAS.
Majority of the babies with MSAF(56.7%) and MAS(62.5%) were from rural areas. Babies born to
Para1 mothers were highest(46.3% for MSAF & 37.5% for MAS). Anaemia(45%) and PIH(28%)
were the commonest risk factors for both MSAF and MAS(68.75% and 31.25% respectively).
Majority of the babies with MSAF(82.1%) and MAS(62.5%) were term. Majority of the babies with
MSAF had no asphyxia(70.1%).In babies with MAS, 37.5% had severe asphyxia and no asphyxia
each. In babies with MAS, tachypnoea, expiratory grunt and chest indrawing were present in
majority and commonest radiological changes observed on the right side alone (50%) followed by
bilateral changes. Conclusions: The incidence of MAS in present study was 10.7 % in babies born
with MSAF.
NEO/80(P)
FOLLOW
UP
STUDY
NEURODEVELOPMENTAL OUTCOME
Rajendra Shinde, Madhavi Shelke, L.S. Deshmukh
drrajendra.shinde2@gmail.com
OF
PRETERM
NEONATES
–
Introduction: Prematurity (born≤ 37 weeks of gestation) is commonly associated with high rates of
medical and developmental sequelae like Respiratory issues, Immunisation, Growth: Anemia,
Rickets, Feeding problems. Aim: To study the neurodevelopmental outcome of preterm neonates
admitted in NICU. Methods: Retrospective analysis type of study. Preterm infants admitted in
NICU of GMCH, Aurangabad were followed up in high risk OPD of GMCH. The
neurodevelopmental assessment was done with Amiel Tison angles and Denver Developmental
screening test II. The correlation with various risk factors was done with respect to presence of
sepsis, RDS, Multiple gestation, neonatal seizures, etc. Results: Total 43 preterm newborns were
followed up in high risk OPD at 3 months, 6 months, one year period. preterm with gestation age ≤
32 weeks were 8/43 (23%) preterm with gestation age ≥ 32 weeks were 35/43 (87%) Total % of
developmental delay notice on follow up was 10/43(23%). The commonest risk factor associate
with neurodevelopmental delay was meningitis & sepsis.followed by presence of respiratory
distress syndrome. Conclusion: The risk factor associated with adverse neurodevelopmental delay
of preterm newborn were presence of sepsis and meningitis and respiratory distress syndrome.
Gestation age did not correlate with adverse outcome.
NEO/81(P) CLINICAL AND ETIOLOGICAL PROFILE OF NEONATAL SEIZURES
Balwant Ramteke, Madhavi Shelke, L.S. Deshmukh, P. Pardeshi
drrajendra.shinde2@gmail.com
Introduction: Neonatal seizures have different clinical manifestations and etiology as compare to
childhood seizures. Future neurological outcome depends on the cause of neonatal seizure. Aim:
The study the clinical profile, etiology of neonatal seizures. Methods:Retrospective analysis type of
study. Newborns admitted in NICU, having seizures in neonatal period were enrolled. They were
analyzed with respect to etiological factors like perinatal asphyxia, meningitis, sepsis, intracranial
bleed, metabolic derangement like hypoglycemia, hypocalcaemia, etc.Results: The total 31
newborns with neonatal seizures were analyzed. Age group ranged from 1 day to 14 days, M:F ratio
1.2:1. The commonest etiology was perinatal asphyxia. 12/31 (38%) followed by infections like
meningitis & sepsis 7/31 (22%) and metabolic seizures like hypoglycemia, hypocalcaemia 6/31
(19%) and other etiology were intracranial hemorrhage 2/31 (6%), hypoxia with meconium
aspiration, etc. Conclusion: The most common etiology of the neonatal seizures in our NICU was
perinatal asphyxia followed by infections like meningitis and sepsis.