NEO/01(R).A STUDY OF RENAL INSULT IN PERINATAL ASPHYXIA
Gaurav Jain, Nagraj Singh , Dharmendra kumar , S.P.Goel
Department of paediatrics and Neonatology, LLRM. Medical College,Meerut
Objectives: To study renal insult in perinatal asphyxia and correlate the renal dysfunction with
severity of asphyxia.Design:prospective hospital based study Settings and methods: 60 term
neonates delivered in hospital and admitted in NICU of L.L.R.M.Medical college /SVBP Hospital
,Meerut were the subjects of study.They were divided into two groups.group1 (cases) comprises of
term neonates with history of perinatal asphyxia with active resuscitation,moderate to severe birth
asphyxia(apgar score=<6 at 5 min.).group2(controls)consisted of term neonates with no
asphyxia..All the neonates were examined clinically (daily wt.and input output measurement) with
detailed history, and thoroughly investigated (blood urea,serum creatinine,serum sodium,serum
potassium,urinary sodium,urine creatinine and urinary protein). Results:Out of total 60 term
neonates acute renal failure developed in 60% of asphyxiated neonates amongst which incidence of
ARF in moderately asphyxiated was 33.34% and in severely asphyxiated was 71.43%.Amongst
asphyxiated neonates 41.66% had prerenal ARF and 58.34%had intrinsic renal failure, out of which
prerenal ARF in moderate and severe asphyxia was 60% and 36.85% respectively.Incidence of
intrinsic ARF in moderate and severe asphyxia was 40%and 63.5% respectively.In asphyxiated
neonates who developed ARF ,41.66% cases had persistent proteinuria(>250 mg/m2).Amongst the
asphyxiated neonates HIE was also found and its incidence was correlated with ARF and it was
found that frequency of intrinsic ARF in HIE stageI,II and III was 40%,50% and 100% respectively
while frequency of prerenal ARF in HIE stage I,II and III was 60%,50% and 0% respectively.
Conclusion: Early recognition and effective intervention of contributing conditions of which
perinatal asphyxia being a major cause will reduce ARF incidence in neonates.
NEO/02(R).STUDY ON CLINICAL PROFILE AND OUTCOME OF RETINOPATHY OF
PREMATURITY (ROP)
Pravakar Mishra, C.R.Rath, A.G.Mohanty, .N.Gupta,.S.Mohapatra,.A.K.Mohanty
SCB Medical College and SVPPGIP , Cuttack
Introduction:ROP is a significant preventable cause of blindness in low birth weight premature
infants.early recognition and treatment result in significant decrease in incidence of retinal
detachment and blindness. Aims and Objectives:to study the clinical profile and outcome of ROP
Material & Methods:It is a prospective hospital based study in the dept. of Paediatrics,SCB Medical
College and S.V.P.P.G.I.P &Rotary Eye Hospital,Cuttack from April 2004-March 2006. Babies
included in the study are those with birth wt.<1500 gm. irrespective of gestational age;babies with
gestational age <35 weeks at birth;preterm with any of the following were in a)oxygen exposure for
30 days or more b)sepsis(clinical or culture proven) c)RDS d)apnoeic episodes e)IVH Babies who
lost to follow up/died after 1st exam/no record of birth wt. were excluded from the study . 1st
screening was done at 32 weeks post conceptional age/4 weeks after birth whichever was
earlier.Infants <1200gm/born between 24-30 weeks were screened at 2 weeks.Follow up visits
were decided based on initial findings of indirect ophthalmoscopy. Results:majority (51%)
belonged to gest. Age 30-34 weeks and birth wt. 1000-1400 gm.ROP was seen in 18%of cases of
which 76.5%had mild disease(stage 1 and 2) ELBW and gest.age upto 28 weeks were mostly prone
to ROP in 50% and 43 % cases respectively. Conclusion:babies born before 28 weeks with
wt.,1000gm with risk factors of sepsis/oxygen therapy/apnoea/RDS and boprn by C.S are at high
risk for ROP.Severity of disease is not dependant upon gest. age/birth wt. Most ROP cases regress
spontaneously.Appropriate early intervention for severe cases can improve outcome.
NEO/03(O).RIGHT DIAPHRAGMATIC HERNIA – REPORT OF A SUCCESSFUL
MANAGEMENT.
Gitanjali P.Mansukhani, Bageshree Seth, N.N.Kadam, D.B.Bhusare, A.K.Singal.
Department of Pediatrics, MGM Medical College & Hospital, Navi Mumbai
Aim: Congenital diaphragmatic hernia is rare on the right side and is considered to be a poor
prognostic factor. We present a right-sided CDH, which was managed successfully. Methods: A 3
week old neonate was admitted with respiratory distress and failure to thrive. Clinically, the baby
was tachypneic and there was decreased air entry on the right side of the chest. Chest radiograph
showed bowel loops herniating into the right thorax and this was confirmed on the USG. USG also
showed that the right kidney was also lying in the chest cavity. Results: The child was taken up for
laparotomy. Small bowel loops were reposited back into the abdomen. The defect was well
visualized after retracting the liver and raising the posterior peritoneum. Sac of the hernia was
excised and a double breasting repair of the diaphragm was done. Right kidney was placed back in
the paravertebral area. Post-operatively the child was extubated immediately and maintained
oxygen saturation well. Chest x-ray showed well-expanded lungs. Conclusions: We could achieve a
satisfactory outcome with this rare and difficult congenital defect. A proper assessment and preoperative and post-operative care is vital in achieving this.
NEO/04(P).EFFECTIVENESS OF EARLY NASAL CPAP IN PRETERMS
Mona Gajre, Priyanka Bhavsar, Archana Kher, AV Jayakar
Lecturer, Pediatrics, TNMC &BYL Nair Hospital, Mumbai
INTRODUCTION: Continuous positive airway pressure (CPAP) when applied via nasal prongs
prevents collapse of the distal bronchioles and alveoli causing decreased intrapulmonary shunting
and improved oxygenation with reduced work of breathing. AIMS & OBJECTIVES: To determine
if early N-CPAP in preterm babies with respiratory distress improves outcome MATERIALS &
METHODS: A prospective, open study in the tertiary level NICU after EC approval undertaken. 44
inborn babies (GA< 32 weeks) with early onset (within 1 hour) respiratory distress were enrolled
after parental consent. The inclusion and exclusion criteria were well defined and primary and
secondary outcomes were measured. On admission USG Brain.ABG analysis and septic screen was
done. Babies were put on Breathline CPAP machine (Meditrin) using binasal prongs. The starting
PEEP was 6cm H2O which was gradually reduced by 1cm H20 to 4 till when FiO2 <0.5 was
required (for >4 hours consecutively). The FiO2 levels were adjusted as per SpO2 (~ >92%). The
SpO2, RR, HR were monitored continuously and recorded every four hours. RESULTS: Of the 44
babies enrolled 32(72%) survived and needed no other ventilatory support, 12(27%) had CPAP
failure. Six (50%) recd IMV ventilation, 2 receiving exogenous surfactant other 6 babies died on
CPAP cause of death was sepsis. The mean GA was 28.36 weeks (24-34 weeks), birth weight was
1.3 kg (500gms-1.9kg), Fi02 needed 0.47% mean PEEP required was 5.97(7-5)..In most babies the
SA score was mild to moderate distress and were weaned off at 48-6 hrs. 22 mothers(50%) had
received antenatal steroids. 37(84%) babies had clinically suspected sepsis and of these 19 were
culture proven. Only 1 baby had recurrent apnea as a cause of failure. No other complications like
IVH, air leaks, NEC were noted. CONCLUSIONS: Early elective n-CPAP is a effective tool in
preterms with RDS and this emphasizes its use in resource limited settings. The main cause of
CPAP failure in babies were extreme prematurity (5) and sepsis with DIC (3).
NEO/05(P).COMPARISON OF DISTANCE TRAVELLED AND SAFE NEONATAL
TRANSPORT
Gupta P, Kulkarni A, Kaul S, Gupta V And Balan S.
Indraprastha Apollo Hospital, New Delhi.
Safe Neonatal Transport constitutes cornerstone of Specialized Perinatal care. Distance of transport
along with initial stabilization and ongoing care during transport are important determinants of
outcomes. Aims: To correlate distance traveled to immediate morbidity and mortality in self
transported vs retrieved neonates transported to a tertiary care center. Methods: This is a
retrospective analysis of 500 neonates transferred to NICU from August 2001 to December 2004.
Group A comprised of 157(31.4%) cases retrieved by our transport team (equipped with incubator,
ventilator, life support system) after stabilization of temperature, glucose levels, perfusion and
oxygenation. Group B comprised of 343 (68.7%) self transported babies. We studies rectal
temperature, blood sugar, capillary refill time (CFT), oxygen saturation, blood gas at arrival, and
survival at 48 hours. Neonates in Group A and B were divided according to distance traveled: < 50
Km, 50-250 Km, > 250 Km. Results: Of the Group A outborns transported <50 km, 50-250, >250
km, 8.6%, 9.5%, 18.8% had hypothermia, 11.8%, 11.9%, 22.7% had hypoglycemia, 5.3%, 4.8%,
22.7% had CFT>3 sec, 6.4%, 14.3%, 40.9% had acidosis and mortality < 48 hr was 12.9%, 7.1%
and 22.7% respectively. Of the Group B outborns transported <50 km, 50-250, >250 km, 59.6%,
70.3%, 93.2% had hypothermia, 14.2%, 70.3%, 84% had hypoglycemia, 4.5%, 40.7%, 52.3% had
cyanosis, 17.1%, 61.1%, 70.5% had CFT>3 sec, 8.6%, 72.2%, 79.5% had acidosis and mortality <
48 hr was 13.9%, 40.7% and 45.5% respectively. Conclusion: Immediate morbidity and mortality
was minimum in Group A neonates traveling < 50 km and maximum in Group B neonates
transported > 250 km. Babies transported by NICU team and those transported over lesser distance
had low incidence of hypothermia, hypoglycemia, cyanosis, poor perfusion, acidosis and lower
mortality.
NEO/06(P).TO EVALUATE THE NEONATAL OUTCOME OF RH ISOIMMUNISED
BABIES WHO RECEIVED INTRAUTERINE TRANSFUSION – CORDOCENTISIS (IUT).
Harmeet Singh Arora, Uma Raju, Sheila Mathai, Devender Arora, Kirandeep Sodhi,Vivek Bhat
Dept of Paediatrics,Command hospital, Pune
Intrauterine transfusion is perhaps the single most effective measure which has improved the
outcome of the Rh isoimmunised infant.Being a difficult procedure requiring considerable
expertise, it is being carried out at only a few centers in our country. We report our experience of
handling isoimmunised neonates who had been provided multiple IUTs. Objective: To analyse
various variables associated with intrauterine transfusion given to Rh isoimmunised babies &
evaluate their effect on perinatal & neonatal outcome & to assess the role of intravenous
immunoglobulin in reducing the incidence of hemolysis. Design:Retrospective cohort study of all
neonates who were given intrauterine transfusion through cordocentesis for Rh isoimmunisation in
our centre over a period of 20 months Results: Out of the 17 babies antenatal evidence of hydrops
fetalis was present in 4 (23%) cases & one neonate had feature of hydrops at birth. In most of the
cases average pretransfusion fetal hemoglobin was 6.8 mg/dl. Titres of indirect coomb’s test done
antenatally had no significant correlation with severity of anemia, no of transfusions required &
presence of hydrops fetalis. Average maternal age with highest middle cerebral artery peak systolic
velocity was 31.3 wks. Earliest age with highest MCA PSV was 24 wks & its average value was
63.5 . Average interval between first IUT & delivery was 6. 3 weeks. Most of the babies required
an average of four transfusions, two babies requiring one & six transfusions respectively. All the
babies were delivered at an average period of gestation of 34.5 wks. Direct coombs test was positive
in 12(70.0%) babies, mean cord hemoglobin was 10.4 gm/dl & mean cord bilirubin 8.7 mg/dl.
Three (17.6%) babies developed sepsis & none of the babies developed kernicterus or required
respiratory distress requiring ventillatory support. Severe anemia requiring top up transfusion
occurred in 3(17.6%) babies. Intravenous immunoglobulin was given randomly to 12(70.0%) babies
(group 1). There was no significant difference in neonatal outcome between groups 1 & 2 (p=0.15).
Conclusion Intrauterine transfusion is an effective intervention used for management of fetal
anemia due to Rh isoimunisation & significantly reduces the morbidity & mortality. It reduces the
requirement of exchange & top up transfusion pospostnatally. The administration of IVIG was not
found to significantly affect the neonatal outcome.
NEO/07(P).BUDESONIDE THERAPY IN MECONIUM ASPIRATION SYNDROME
J N Goswami, Uma Raju, Ashok Saxena, R K Thapar, M Kanitkar, Arvind Gupta, S K Roy
Armed Forces Medical College,Pune-411040
Objectives of the study: To evaluate the role of aerosolized racemic steroid (budesonide) therapy in
limiting the morbidity and mortality due to meconium aspiration syndrome (MAS) amongst
neonates born from a milieu of thick meconium stained liquor (MSL). Methods used: This
randomized controlled experimental prospective study was carried out in a Level II NICU of a
tertiary care hospital over two years. Subjects included neonates born from thick MSL who were
randomized into groups “A” (n=41) and “B” (n=43).Subjects in “Group A” and “Group B” were
administered three doses of nebulized budesonide (0.5mg each) and normal saline respectively at
twelve hourly intervals from the time of birth.Outcome measures included incidences of MAS,
complications and mortality; duration of NICU stay and requirement of different modes of
supplemental oxygen. Results: Incidence of MAS in Groups A and B were nine and eleven
respectively (p=0.1811).Complications included HIE, IVH, pulmonary haemorrhage, PPHN and
sepsis. Cumulative complication rate was less in Group A (p=0.00).Independently, incidence of HIE
was significantly less in Group A (p=0.0004). Groups A and B had mortality rates of six and nine
respectively (p=0.321).Logistic regression analysis showed a decreasing trend in mortality in Group
A. Differences in NICU stay in the two groups was insignificant (p=0.355).Requirement of oxygen
supplementation in Group A was less than that in Group B (p=0.042) though differences in the
requirements of CPAP (p=0.9223) and mechanical ventilation (p=0.8616) were insignificant.
Conclusions: Aerosolized budesonide reduces supplemental oxygen requirement, incidence of HIE
and overall incidence of complications including mortality among neonates born from thick MSL.
Considering the positive implications, ease of administration and practicable cost-benefit ratio,
aerosolized budesonide therapy is recommended for all neonates born through MSL.
NEO/08(O).NEONATAL VENTILATION: EXPERIENCE AT A SERVICE REFERRAL
CENTRE
Bal Mukund, Uma Raju, Sheila Mathai, Kirandeep Sodhi, R. K. Gupta, Vivek Bhat, Harmeet Singh
Dept. of Pediatrics, Armed Forces Medical College, Sholapur Road, Pune - 40
OBJECTIVE: To evaluate the indications, duration and associated complications of mechanical
ventilation in NICU at a referral tertiary care hospital in PUNE STUDY: It’s a retrospective
analysis of indications,modality,duration and complications associated with neonatal mechanical
ventilation over a period of 18 months at a service referral hospital. METHOD: 67 neonates
ventilated during Jan 2005 to Sep 2006 were included in the study. The modes of ventilation
included in our study were nasal bubble CPAP,CMV,SIMV & PSV . Information obtained from
NICU database was analysed for indication, duration and associated complications with mechanical
ventilation. RESULTS: Indications: Out of total 449 neonate admitted in NICU during above
period, 67 neonate required support of ventilation (14.92%). Out of 67 patients the various
indication for ventilation were as follows- 19 for HMD(Hyaline Membrane Disease) ,5-Pneumonia,
6-severe birth asphyxia or sepsis, 26- for MAS ( Meconium Aspiration Syndrome) or other form of
respiratory distress or recurrent apnea, 1- PPHN(Persistent Pulmonary Hypertension) and 10 postop patients.Duration of ventilation for different illnesses was as follows: 50 neonates were
ventilated for 5 days or less, 11 neonates were ventilated for 5-10 days of duration and 5 neonates
were ventilated for more than 10 days of duration. 37 neonates was put on CPAP at some time or
other, another 16 was given mix of CPAP and mechanical ventilator (CMV- continuous mandatory
ventilation or SIMV- synchronized intermittent mandatory ventilation), 30 neonates were given
various types mechanical modes of ventilation alone.25 neonates (37.31%) were given some form
of sedation/paralysis. Common drug like Midazolam, fentanyl, vecuronium were given in standard
doses. ABG monitoring was done in 19 patients (28.35%), and transcutaneous PO2/PCO2 monitor
were used in 3 patients (4.47%). Endotracheal intubation was required in 46 patients. 11times
(23.91%) 2 or more than 2 attempts were required for intubation. Chest X-ray was taken in all
patients on ventilation and 7 patients (10.44%) had more than 5 exposures during their stay.
Complication: Eight patients (11.9%) had developed pneumonia while on ventilation and had X-ray
features after 48 hours of ventilation. All such patients required IV antibiotics based on our hospital
antibiotic policy. Three out of 8 patients died of HIE stage III, Post-op NEC and DIC respectively.
Two (2.98%) patients had pneumothorax, one of them required chest tube placement. Total death
during this period among ventilated neonate was 20 (30% of ventilated babies). No report of
subglottic stenosis, vocal cord damage or palatal groove during prolong orotracheal intubation were
observed during this period. No case of aortic thrombosis, embolisation were recorded at our center.
NEO/10(P).NEONATAL SEIZURES-ETIOLOGY, NEUROIMAGING AND OUTCOME
Kochhar A, Kaul S, Kulkarni A, Balan S,Gupta V
Apollo Center for Advanced Pediatrics, Indraprastha Apollo Hospitals, New Delhi
Background- Seizures are more common in neonatal period than at any other time in life. Multiple
possible etiologies warrant aggressive work up. Prognosis is varied with underlying etiology being
the most important prognostic indicator. Aims and Objectives- To study the factors contributing to
neonatal seizures as well as the etiology and outcome of neonatal seizures. Materials and MethodsThis is a retrospective analysis of 100 consecutive cases of neonatal seizures in whom we looked at
sex, gestation, mode of delivery, etiology, laboratory studies, neuroimaging if done and outcome.
Results- Majority of the babies with neonatal seizures were term (77%), outborns (82%) with a M:
F of 2.7: 1. Hypoxic Ischemic Encephalopathy was the most common etiology (40%), followed by
Hypocalcemia (21%). The commonest cause of seizures in term babies was HIE (49%) and it was
intraventricular haemorrhage in preterms (34%). Neonatal seizures occurred most commonly on day
2 / day 3 of life (44%), followed by day 1 (33%). Neuroimaging was done in 66 babies and was
abnormal in 42 (64%). EEG was done in 34 babies, and was abnormal in 50%. 95% cases
responded to first and second line anticonvulsants. 52 babies were discharged, of which 25 went
home on phenobarbitone and 11 babies had abnormal neurological examination. There were 18
deaths, 16 were transferred back to the referring hospital and 14 left against medical advice.
Conclusions- Etiology was found in 95% cases. HIE remains the most common cause . The
incidence of hypocalcemia was higher than in previous studies. Only 5% babies required use of
third and fourth line anticonvulsants. 25% babies were sent home on phenobarbitone with
neurological reassessment on follow up planned.
NEO/11(P).SPECTRUM AND RISK FACTORS OF MECONIUM
SYNDROME
Manoj Nalge, Suja Moorthy, Surbhi Rathi, Mukesh Agrawal, Archana Kher
Department of Pediatrics, T.N. Medical College & B.Y.L. Nair Hospital.
ASPIRATION
Introduction- 8-20% of deliveries have meconium staining of amniotic fluid. The commonest
complication is meconium aspiration syndrome which causes respiratory morbidity and mortality
ranging from 28-40%. Aims and Objectives- To estimate the incidence of meconium aspiration
syndrome in babies born with meconium stained amniotic fluids and the associated risk factors.
Material and Methods- A prospective study was carried out over 1 year in a tertiary institute to
determine the risk factors that lead to meconium aspiration syndrome (MAS) in babies who had
meconium stained amniotic fluid (MSAF). All babies who were born with meconium stained
amniotic fluid were enrolled. Data was analysed using standard statistical test of chi-square.
Results- Out of 2299 live births, 162 (7.04%) newborns had MSAF while 35 (21%) had MAS. The
risk factors associated were sex of the baby, association with fetal distress, presence of birth
asphyxia, type of meconium whether thin or thick and mode of delivery. Of these, association of
male sex with increased incidence and fetal distress were not significant. Incidence of MAS in
newborns born through thick meconium (33.3%) was more than in those with thin meconium
(5.8%) which was very significant with p value of < 0.001. MAS was seen in 13 (81.2%) out of 16
neonates who had birth asphyxia and in 22 (15%) out of 146 who had no birth asphyxia, which was
statistically very significant with p value < 0.001. Occurrence of MAS with vaginal deliveries
(40.5%) as compared to caesarean sections (7.5%) was significant with p value of < 0.01.
Conclusion- Birth asphyxia, thick meconium stained amniotic fluid and vaginal mode of delivery
contribute to majority of cases of MAS and their appropriate management in the form of timely and
effective resuscitation will reduce the severity and incidence of MAS and improve outcome of
babies born with meconium stained amniotic fluid.
NEO/12(O).WHAT IS THE BEST TIME TO SAMPLE WHEN ORGANIZING A
UNIVERSAL NEONATAL THYROID SCREENING PROGRAM?
Virmani A, Ravishankar U, Kulkarni A, Kaul S, Balan S, Gupta V.
Apollo Center for Advanced Pediatrics, Indraprastha Apollo Hospitals, New Delhi
Aims: Congenital hypothyroidism (CH) is ideal for a screening program: condition clinically rarely
identifiable; sensitive and specific test; and irreversible damage with delayed therapy. We are a
tertiary care hospital, who decided to screen all newborns for CH from 1996. We are analyzing our
decade long experience. Methods: Data was collected from discharge summaries and thyroid reports
cross-checked against RIA lab records, for the period 1996-2006. Results: Of >3,600 newborns seen
over this period, we have T4 and TSH values for 2,327 so far. Mean TSH was 7.96 + 9.0 mIU/L
(range 0.02- 103.2), therefore Mean + 2 SD was 26 mIU/L. Mean T4 was 1.6 + 0.7 ng/dl (range
0.16- 8.6). TSH was 25.1-30 in 11 samples, with T4 < 0.65 in none; and >30 in 71 samples. T4 was
< 0.65 in 81 newborns. Only 4 had TSH values > 25 (33.3; 34.3, 41.8, 80) with low T4. Repeat
testing was advised in all 159 (7.9%) infants with high TSH OR low T4, but concern was for the 4
(0.1%) who had high TSH AND low T4. If both tests are done, we can cut down recall rates from
8% to 0.1%. Conclusions: We find that simultaneous TSH and T4 testing in cord blood can
drastically reduce the number of infants called back for re-testing. The lesser costs involved in
recalling and re-testing offsets part of the cost of 2 tests vs. one, and mean lesser parental anxiety.
Thus testing both T4 and TSH is more practical with our infrastructural constraints, at this nascent
stage of neonatal thyroid screening. A cutoff value for TSH of 25-30 mIU/L is acceptable.
NEO/13(O).OVERVIEW OF RESPIRATORY DISTRESS IN THE NEWBORN
R Bhisht, A Kulkarni, S Kaul, V Gupta, And S Balan.
Indraprastha Apollo Hospital, New Delhi.
Background: Respiratory distress is one of the commonest indications for admission to a neonatal
unit. The causes can be multiple and the outcome variable. Objective: To analyze the causes,
associated conditions, course during hospital stay and outcome of newborns with respiratory
distress. Methods: This retrospective study was conducted between January 2001 and December
2005.All newborns who developed respiratory distress within 24 hours of life were included. A total
of 346 newborns were identified (incidence 19.2%). Results: The male female ratio was 1.28 , the
ratio of outborns to inborns was 1.56. Incidence according to gestation was, < 28weeks – 13 %, 28 –
33 weeks – 30%, 34 – 36 weeks – 22.6%, > 36 weeks – 33.9%. Incidence according to birth weight
was, < 1000 gm-11%, 1000 – 1500 gm – 24.5%, 1600 – 2000gm – 13.4%, > 2000gm – 51%.
Vaginal deliveries were 39% and 61% were cesareans. Apgar score was < 4 at 1 min in 15% babies.
The ratio of ventilated to non-ventilated babies was 2.12.Ventilated babies- 25(10.5%) were
ventilated for < 24hrs, 31(13.1%) for 24 – 48 hrs and 179 (76.3% for > 48 hrs. The maximum FiO2
required was 1.0. The commonest cause for ventilation was HMD (26%) followed by PPHN (18%),
birth asphyxia (15%), pneumonia / pneumothorax (13.2%), sepsis (11%) and MAS (5.6%). Other
causes constituted 11%. All the babies with HMD were administrated surfactant. The commonest
cause of respiratory distress in the non-ventilation babies was TTNB (37%) followed by pneumonia
(22%), sepsis (27%) and others (14%). The various associated co-morbid conditions were PDA
(11%), IVH (7.8%), and ROP (12.%). Outcome: Nineteen of the 61 babies with RDS expired
(mortality-31.1%). Eight had chronic lung disease (13.1%). None of the non-ventilated babies
expired. Conclusion: HMD is the commonest cause of respiratory distress requiring ventilatory
support. Mortality and incidence of CLD is comparable to other studies.
NEO/14(R).A STUDY OF
INTRAVENTRICULAR / GERMINAL MATRIX
HEMORRHAGE IN PREMATURE NEONATES AND ITS CORRELATION WITH
DIFFERENT RISK FACTORS
Sachi Jain, Raktima Chakrabarti, Monika Agarwal, S.P. Goel.
LLRM Medical college, Meerut, UP, 250004.
Periventricular /intraventricular hemorrhage is a significant cause of both morbidity and mortality in
premature neonates. Objective: To study the incidence and risk factors of intraventricular/germinal
matrix hemorrhage in premature babies. Material and method: The study was carried out on 150
premature neonates in the NICU of the dept. of pediatrics in collaboration with the dept. of
radiology at SVBP hospital associated to LLRM Medical College , Meerut. Detailed history was
taken from mothers about antenatal period, perinatal period (antepartum hemorrhage ,premature
rupture of membrane, prolonged labour, obstructed labour, mode of delivery ). Apgar score of the
neonates (1& 5 minute) ,birth weight, obvious congenital malformations were recorded. Maturity
was assessed by new Ballard scoring, detailed neurological examination was done clinically
suspected hemorrhage was confirmed by cranial ultrasonography. Neonates were followed up
during early neonatal period for respiratory distress, septicemia, hyperbilirubinemia, seizure,
anemia, episodes of apnea, necrotizing enterocolitis). Obtained data were recorded and statistically
analysed. Result: Out of 150 neonates 30 neonates developed confirmed hemorrhage(20%), mostly
grade 1 hemorrhage( 73.32%) , maximum no. hemorrhage occurred in neonates with gestational age
< 34 weeks and birth weight <1.5 kg. Among the perinatal risk factors antepartum hemorrhage was
found significant ( 46.7% & p< 0.05). Regarding mode of delivery, caesarian section had shown a
protective role for development of IVH.( 10% of the hemorrhage occurred in caesarian section and
90% in vaginal delivery.)Low Apgar score (<5) at 5 minute, had a significant relationship with
hemorrhage(p<0.05).Among the postnatal illness respiratory distress syndrome and apnea were
significantly correlated with hemorrhage (p<0.05). Hemorrhage was clinically suspected in 46 cases
and among them 30 had radiologically confirmed hemorrhage. Conclusion: So from this study , risk
factors for IVH can be predicted and early intervention can be taken for preventable factors.
NEO/15(R).MATERNAL ANTENATAL FACTORS AND IMMEDIATE OUTCOME OF
VLBW BABIES.
Vinayak Patki, Amit Tagare, Aniket Potdar, Jeniffer Antin
Dept.of Pediatrics,Wanless hospital,Miraj(MS)
Aims/objectives- 1) To study morbidity &mortality of VLBW babies 2) To study maternal antenatal
factors associated with outcome of VLBW babies Method- Seventy babies with birth weight < 1.5
kg (VLBW) were studied prospectively over a period of one year with respect to their morbidity
,mortality and antenatal factors of mother Results- Ten babies(14.3%) had wt below 1 kg
while20(28.6%) were from 1.001 to1.119kg group and rest (57.1%)had wt between 1.2 to 1.5 kg.
Eleven babies (15.7%) had maturity below 30 wks, while 16 babies(22.8%) and 24(33.3%) were
from 31-32wks and 33-34 wks group, only 3(4.3%) babies were full term. Majority (88.5%) were
inborn. Only 8(11.4%) babies expired, out of which four because of RDS, two of IVH and one each
of sepsis and HIE. Among
morbidity 19(27.1%) babies had sepsis,18(25.7%) babies had
RDS,16(23%) had NNH, 11(15.7%) had asphyxia,7 (10%) had hypoglycemia and 5( 7%) had
hypocalcemia. Ten (58.8%) babies of RDS received surfactant and all required mechanical
ventilation , median duration on ventilation was 7 days. Among maternal obestretic factors 22
(31.4%) had PIH and / eclmpsia, 18(25.7%) had PROM more than 12 hrs,10(14.3%) had APH, 8
(11.4%) had multiple pregnancy. 13 (18.5%) mothers had anemia, 10(14.2%) had heart disease
while 23 (32.8%) mothers had no hig hrisk factor. Maternal biosocial factors like low socioeconomic class, low age, wt had not affected outcome of VLBW babies ,while primiparity, absence
of antenatal checkup, assisted delivery had significantly increased morbidity.Maternal APH,
multiple pregnancy increased risk of RDS. PROM >12 hrs, absence of antenatal care were strongly
associated with neonatal sepsis while PIH, abnormal presentation increased risk of birth asphyxia.
Conclusion- Though there is high incidence of morbidity among VLBW babies, high risk approach
about maternal antenatal factors &high quality neonatal care can reduce mortality in VLBW babies
significantly.
NEO/16(P).COMPARATIVE ANALYSIS OF EFFICACY OF IBUPROFEN AND
INDOMETHACIN FOR PRETERM PDA CLOSURE
Bhisht R, Kulkarni A, Kaul S, Gupta V Balan S.
Division of Neonatology, Apollo Centre for Advanced Pediatrics, Indraprastha Apollo Hospital,
New Delhi.
Background – PDA is a common cause of morbidity in preterm newborns. Ibuprofen and
Indomethacin are both prostaglandin synthesis inhibitors which facilitate contraction and closure of
the duct but have varying side effects. Objective- To compare the efficacy of ibuprofen and
indomethacin for preterm ductal closure. Methods- This retrospective study was conducted between
Jan 2000 to Dec 2004. A total of 55 cases of PDA were identified (incidence- 7.7%). PDA was
suspected clinically on the basis of following- systolic/ continuous murmur, bounding pulse, wide
pulse pressure and signs of heart failure. Echocardiographic confirmation was done in all cases. Of
the 55 newborns, 34 were males (61.8%) and 21 were females (38.1%). Birth weight varied from
860gm-3600gm and gestational age varied from 27wk-36wk. Birth wt break up was, <1000gm –
25.2%, 1000-1400gm - 9.2%, 1500 – 200gm – 6.3% and >2000gm – 4.2% Gestational age break up
was, <28wk – 8.5%, 29-33wk – 11.5%, 34 – 36wk- 8.4% Age at presentation varied from 1 to 6
days. Ibuprofen was administered to 25 babies (45%) of which 11 received 3 doses, 2 received 5
doses and 12 received only 1 dose. Ibuprofen was given P/R in 12 and orally in 3 babies. IV
indomethacin was administered to 13(23%) babies of which 9 received 3 doses and 4 received 6
doses. Of the remaining 17, 8 underwent PDA ligation,4 expired and 5 were taken away against
medical advice. Result – Ductal closure was 87% with ibuprofen and 63.5% with indomethacin.
Among the babies administered ibuprofen, electrolyte imbalance was noted in 1 (4%), bleeding
diathesis in 1 (4%) and NEC in 1 (4%). With indomethacin, electrolyte imbalance was noted in 2
(15.4%), thrombocytopenia in 1 (8%), worsening of renal parameters with oliguria in 4 (30.8) and
NEC in 1 (8%) Conclusion – Treatment with ibuprofen had a smaller failure rate and lesser side
effects as compared to indomethacin. Oral Bruphen is easily available, inexpensive and effective.
We feel that oral/PR ibuprofen is a useful modality of treatment for PDA closure.
NEO/17(P).NEONATAL SEIZURES-ETIOLOGY, NEUROIMAGING AND OUTCOME
Aditi Kochhar, Sushma Kaul, Anjali Kulkarni, Saroja Balan,Vidya Gupta
Institution-Department of Neonatology, Apollo Centre for Advanced Paediatrics, New Delhi
Background- Seizures are more common in neonatal period than at any other time in life. Multiple
possible etiologies warrant aggressive work up. Prognosis is varied with underlying etiology being
the most important prognostic indicator. Aims and Objectives- To study the factors contributing to
neonatal seizures as well as the etiology and outcome of neonatal seizures Materials and MethodsThis is a retrospective analysis of 100 consecutive cases of neonatal seizures in whom we looked at
sex, gestation, mode of delivery, etiology, laboratory studies, neuroimaging if done and outcome.
Results- Majority of the babies with neonatal seizures were term (77%), outborns (82%) with a M:
F of 2.7: 1. Hypoxic Ischemic Encephalopathy was the most common etiology (40%), followed by
Hypocalcemia (21%). The commonest cause of seizures in term babies was HIE (49%) and it was
intraventricular haemorrhage in preterms (34%). Neonatal seizures occurred most commonly on day
2 / day 3 of life (44%), followed by day 1 (33%). Neuroimaging was done in 66 babies and was
abnormal in 42 (64%). EEG was done in 34 babies, and was abnormal in 50%. 95% cases
responded to first and second line anticonvulsants. 52 babies were discharged, of which 25 went
home on phenobarbitone and 11 babies had abnormal neurological examination. There were 18
deaths, 16 were transferred back to the referring hospital and 14 left against medical advice.
Conclusions- Etiology was found in 95% cases. HIE remains the most common cause . The
incidence of hypocalcemia was higher than in previous studies. Only 5% babies required use of
third and fourth line anticonvulsants. 25% babies were sent home on phenobarbitone with
neurological reassessment on follow up planned.
NEO/18(R).MAINSTREAM
ENDTIDAL
CARBONDIOXIDE
NEWBORNS
Abhishek Narayanan ,Ramesh Bhat, Nalini Bhaskaranand, Pushpa Kini
Kasturba Medical College,Manipal,Karnataka
MONITORING
IN
BACKGROUND:Critically ill neonate on ventilator needs close monitoring of CO2 to avoid
problems related to hypo and hypercarbia. Endtidal CO2 (EtCO2)measures the concentration of
carbon dioxide in exhaled gases and correlates with PaCO2.Usefulness of this noninvasive
monitoring is studied in ventilated newborns.OBJECTIVES:To determine the correlation between
the EtCO2 and PaCO2 in ventilated newborns.DESIGN:Non randomized recording of simultaneous
end tidal and arterial CO2 pairs.PATIENTS AND METHODS:Study included 107 end tidal /
arterialCO2 pairs from 23 neonates receiving mechanical ventilation between July 2005 –
06.Indications for ventilation were hyaline membrane disease(HMD) , meconium aspiration
syndrome(MAS) , birth asphyxia(BA) , sepsis , and recurrent apnoea of prematurity(AOP). Samples
were grouped based on birth weight(<1.5,1.5-2.5,>2.5kg) , gestational age (<32,32-37,>37wks) and
clinical indication for ventilation. Statistical analysis was done to see if EtCO2 correlated with its
corresponding PaCO2 value. RESULTS:The mean birth weight was 2270 (+/-830 )gm and, mean
gestational age was 34.8 (+/- 3.9 ) week There were 60pairs in HMD(56%),34 in MAS(31.7%),5 in
BA(4.6%),4 in Sepsis(3.7%),4 in AOP(3.7%).There were 40pairs in <32wks(37%) & 21pairs in
<1.5kg(19.6%).The overall paired correlation coefficient( r) was 0.76(p<0.01).There was
statistically significant correlation in babies with birth weight >1.5kg, irrespective of the gestational
age and the indication for ventilation. The r value was low(0.58)in <1.5kg group.The r value was
0.74,0.67,0.94,0.99&0.98 in HMD , MAS,BA,Sepsis and,AOP respectively. CONCLUSION:
Present study showed that EtCO2 closely correlates PaCO2 in most ventilated newborns. EtCO2 is
reliable in monitoring adequacy of ventilation in babies >1.5kg.More samples are needed to decide
Endtidal carbondioxide value in babies <1.5kg.
NEO/19(O).NEONATAL DIABETES: UNUSUAL PRESENTATION
Gurdeep Atwal, Rajiv Kumar, Nomeeta Gupta
Department of Pediatrics, Batra Hospital & Medical Research Centre, New Delhi
Neonatal diabetes is a rare disease. We report a case of neonatal diabetes in 2 months old infant
presented with fever, loose stools, difficulty in breathing for two days and one episode of abnormal
movements of the body two hours before admission. There was no history of consanguinity,
diabetes mellitus. He was born vaginally to primigravida at term with birth weight 2.8 Kg and
Apgar score 8, 9. There was no significant antenatal and postnatal history. He was exclusively
breast fed and tolerating feeds well. On examination, he was febrile with HR 160/min, RR 80/min,
BP 60/34 mm Hg with weak peripheral pulses, rapid and deep breathing, and depressed AF. Per
abdominal examination revealed hepatomegaly. CNS examination revealed irritability, increased
tone and brisk DTR. Laboratory investigations revealed hemoglobin 10.4 g/dl, total leucocyte count
20,400/cmm with 62% polymorphs, 28% lymphocytes, 10% monocytes and platelet count
412000/cmm. ABG analysis showed pH 7.10, SpO2 99.5, paCO2 13.5, paO2 252, HCO3 4.1, anion
gap 29. Random venous blood sugar was 985 mg/dl. Routine microscopic examination of urine
showed glucose 3+ and ketones 4+. BUN was 114 mg/dl, serum creatinine 1.3 mg/dl, sodium 152
meq/L, potassium 6.8 meq/L, Ca 10.1 mg/dl, Mg 2.5 mg/dl. Routine microscopic examination of
stool revealed large number of pus cells with no red blood cells. Blood and urine cultures were
sterile. Stool culture grew Enterobacter species. CSF examination revealed no cells with protein
54mg/dl, glucose 96 mg/dl with its culture sterile. CT head showed periventricular white matter
hypodensity suggestive of osmotic myelinosis. MRI brain showed periventricular hyperdensity.
EEG was normal. Serum insulin on admission was undetectable. Serum amylase was low, Serum
lipase 207 U/L and HbA1c 23%. Islet cell antibodies and anti-GAD antibodies were negative. Oral
glucose tolerance tests of both parents were normal. DKA was treated using the standard protocol.
The child showed good response to glibenclamide with serum insulin rising from 0-44µ/ml and
serum C-peptide 2.2ng/dl 4 hours after administration of glibenclamide. At 120 days of age
glibenclamide was withdrawn successfully. Genetic analysis was negative for mutations of KCNJ11
gene encoding 6.2 subunit of K-ATP channel and 6q24 defects. This disease presents as DKA but
after control of DKA is responsive to sulphonylureas.
NEO/20(P).PYRUVATE KINASE DEFICIENCY: A CASE REPORT
Rajiv Kumar, Nomeeta Gupta
Department of Pediatrics,
Batra Hospital & Medical Research Centre, New Delhi-110062.
Erythrocyte pyruvate kinase (PK) deficiency is a rare cause of neonatal hyperbilirubinemia. We
report an infant with neonatal hyperbilirubinemia due to PK deficiency. The initial approach
involved rapid evaluation, phototherapy and close monitoring of serum bilirubin levels. Case
Report: A male baby referred to our tertiary level NICU with history of meconium stained liqor and
respiratory distress at 6 hours of life. He was born to a multigravida mother at term, weighing 2.9
Kg, by normal vaginal delivery following an uneventful pregnancy and labor. There was no
significant antenatal history. There was past history of intrauterine death. On examination, he was
sick, tachypneic and had mild pallor with icterus. The heart rate was 110/minute; respiratory rate
was 64/minute with recession. Intrauterine congenital infections, G-6-PD deficiency and pyruvate
kinase deficiency were suspected. Laboratory investigations revealed Hb 8.1 gm%, TLC
24,230/cmm with 73% neutrophils, 24% lymphocytes, 2% monocytes and 1% eosinophil, ESR 58
mm, reticulocyte count 45% and platelet count 80,000/cmm. PT and PTT were normal. Malarial
thick and thin smears were negative. Total and conjugated serum bilirubin was 14.9 mg% and 4.8
mg% respectively. Liver enzymes were elevated. Serum electrolytes were normal. Serological tests
for VDRL, syphilis and HIV were negative. Hepatitis B surface antigen and hepatitis C antibody
were negative. CMV IgG and HSV IgG were positive. G-6-PD level was normal. He was evaluated
for hemolytic disease of newborn. Direct and indirect Coomb’s test was negative He developed
jaundice and double volume exchange transfusion done on first day of life. Post-exchange
laboratory investigations revealed Hb 10.4 gm%, total serum bilirubin 6.4 mg%, conjugated serum
bilirubin 2.7 mg% and serum calcium 10 mg%. He was started on intravenous fluids, IV antibiotics;
packed cells transfusion and intensive double surface phototherapy were given. He was discharged
after 7 days of admission. At the time of discharge, the infant was clinically better and there was
mild icterus. Total and conjugated serum bilirubin was 5.8 mg% and 2.1 mg% respectively; Hb 13.6
gm% and reticulocyte count 26%. He was tolerating feeds well. A quantitative pyruvate kinase
screening was done at age of 2 months, which was low. The child was diagnosed as a case of
pyruvate kinase deficiency.
NEO/21(R).IMPACT OF PREGNANCY INDUCED HYPERTENSION ON PERINATAL
OUTCOME
L. Singh, V.N. Tripathi, R.P. Singh, K Pandey,
Department of Pediatrics, GSVM Medical College, Kanpur
Introduction : Hypertensive disorders of pregnancy are diagnosed after 20 weeks of gestation with
BP >140/90 mmHg with proteinuria or oedema. It is one of the most common medical complication
of pregnancy contributing significantly to the cause of perinatal mortality and morbidity. HDP
predispose to acute or chronic uteroplacental insufficiency leading to antepartum or intrapartum
asphyxia which thereby leads to consequences like intrauterine growth retardation, prematurity,
intra uterine death.Objectives : To evaluate perinatal outcome in Pregnancy induced hypertension
and normotensive mothers and compare the results.Design and setting : A Prospective study
conducted in Upper India Sugar Exchange Maternity Hospital & Neonatal Units of Pediatrics;
GSVM Medical College, Kanpur.Method : All the booked hypertensive mothers were classified
under gestational hypertension, preeclampsia & eclampsia and their newborns underwent complete
physical examination in a predesigned proforma. Equal number of normotensive mothers and their
newborns were taken as control. HT mothers with diabetes, chronic hyertension and renal disease
were excluded from the study.Results : Among total live birth 74.29% newborns were FT while
22.86% were PT in HT mothers in comparison to 78.79% FT & 21.21% PT in normotensive
mothers. 59.37% & 12.5% of babies were LBW & VLBW respectively in HT mothers whereas
normotensive mothers the figures were 39.39% LBW & 3.03% VLBW babies. 34.38% of newborn
developed birth asphyxia in HT mothers while in normotensive mothers the figures was only
12.12%. Conclusion : Hypertensive disorder of pregnancy predispose to preterm delivery. Severity
of hypertension has bearing on birth weight leading to around 2/3rd of newborn with LBW. Birth
asphyxia is the most common complication in hypertensive mothers. On normotensive pregnancy
VLBW newborn is a very uncommon finding with respect to newborn of hypertensive mothers. Key
words : Hypertensive (HT), low birth weight (LBW), very low birth weight (VLBW), preterm (PT),
Full term FT), Hypertensive disorder of pregnancy (HDP)
NEO/22(P).INCIDENCE OF URINARY TRACT INFECTION IN ASYMPTOMATIC
UNCONJUGATED HYPERBILIRUBINEMIA IN NEONATES.
Karuna Thapar, Sandeep Aggarwal,Shailinder Jeet Singh
Department Of Paediatrics, Government Medical College & Hospital Amritsar
Urinary tract infection can present with unconjugated neonatal hyperbilirubinemia The present
study was conducted among one hundred neonates who presented with unconjugated
hyperbilirubinemia only. Urine cultures were considered the gold standard for proving the infection.
Urinary tract infection was diagnosed in fourteen neonates . The organisms were Enterobacter,
E.coli, Citrobacter and Klebsiella. Therefore evaluation of unconjugated hyperbilirubinemia in a
neonates should include urine culture examination also unconjugated hyperbilirubinemia as an ealry
marker of septicemia in neonates.Karuna Thapar, Sandeep Aggarwal,Shailinder Jeet Singh
Septicemia in a neoates can be missed due to ill defined presenting features. Indirect bilirubin can
be used as an early predictor of septicemia in a asymptomatic neonates. The present study was
conducted among one hundred neonates who presented with unconjugated hyperbilirubinemia
only. Blood cultures were considered the gold standard for proving the infection. Growth in blood
cultures was obtained in twenty three neonates. The organisms were Staph aureus, E.coli,
Pseudomonas,CONS and Enterococci.Therefore unconjugated hyperbilirubinemia can be used as
early predictor of septicemia.
NEO/23(P).ANTERIOR FONTANELLE
SIZE IN HEALTHY TERM NEWBORNS:
CORRELATION WITH ANTHROPOMETRIC PARAMETERS.
Anju Aggarwal, Mayank Singhal, M.M.A Faridi.
University College of Medical Sciences and Guru Tegh Bahadur Hospital, Delhi.
Introduction: Anterior fontanelle (AF) is physician’s window to infants developing brain and state
of health. Data on normal fontanelle size in our population is lacking. Aims- i) To measure anterior
fontanelle size and correlate it with length, weight and head circumference,ii) Compare the two
methods of measuring AF size. Methods- Subjects consisted of 300 term healthy newborns without
any congenital anomalies. Sex, birth order, type of delivery and status of posterior fontanelle was
recorded. AF size and anthropometric parameters were measured within 72 hours of birth. AF size
was measured using a vernier's caliper – METHOD I (AFsize1) - Mean of antereoposterior and
transverse diameter, METHOD 2 ( AFsize2) – Mean of both oblique diameters. Relation between
AF sizes by two methods and there relation with anthropometry was determined. P value of <0.05
was taken as significant. Results: Of the 300neonates 149 were males and 151 females. Mean AF
size was 2.63+0.55cms and AFsize2 was 2.085+0.534cms. Limits of disagreement were from –0.24
to 1.28 cms. AFsize1 was greater than AFsize2in 280( 93.3%) infants, less in 16(5.3%), same in
4(1.3%) infants. AFsize1 correlated with AFsize2 ( P<0.05). Both AFsize1 and AFsize2 correlated
with length and head circumference (P< 0.05). There was no correlation with the weight of the term
infant. Regression equation was calculated for AFsize1 and AFsize2 with length and head
circumference. Posterior fontanelle was open in 69(23%) cases. Conclusions: There was agreement
in the two methods of measurement of AFsize. AF size in term infants correlated with length and
head circumference.
NEO/24(O).FOETAL OUTCOME AND NEONATAL COMPLICATIONS OF MOTHERS
WITH PREGNANCY INDUCED HYPERTENSION IN A TERTIARY CARE MATERNITY
HOSPITAL IN MUMBAI.
Renu Bist, Tanmay Amladi, Jyothi Raghuram
Dept. of Neonatology, Nowrosjee Wadia Maternity Hospital.
Introduction: It is known that hypertensive disorders of pregnancy are responsible for significant
amount of maternal and perinatal morbidity and mortality. Objectives: To study the foetal outcome
and neonatal complications in 100 consecutive mothers with pregnancy induced hypertension (PIH)
admitted in a Mumbai maternity hospital. Method: A retrospective study about 100 cases of
pregnancy induced hypertension admitted in our hospital between Aug’ 05 to Aug’ 06 .The
pregnancies were analyzed for their foetal outcome, gestational age, birth weight and neonatal
complications. Result: Mothers’ average age 27.7 years (19-37 years). Peak systolic BP 152.7 (130180 mm Hg) and diastolic BP 99(80 to 120 mm Hg). Proteinuria trace in 50%. Hypertension
without proteinuria in 4%. Oedema in 60%. Eclampsia and HELLP syndrome 1%. Incidence
highest in primigravida(55%). The rate of Caesarean section 70%. Preterm delivery 71%. Indication
of LSCS mainly pre-maturity(52%), intra-uterine growth retardation (40%), foetal distress (33%).
Average gestation age 35.95 weeks (26-43.1) Average birth-weight 1.96 Kg (740 gms - 3.44 Kgs).
Incidence of LBW 65% and ELBW 7%. Neonates admitted in NICU mainly for pre-term
care(60%). Parenteral fluids given for an average 4.8 days. Enteral feeds started on average 2.7 day
of life. Foetal outcome 86% live, 6% mortality, 3% fresh still-birth, 5% transferred. Complications
were Meconium stained Amniotic fluid(MSAF)10%, Asphyxia 13%, Sepsis 19%, Polycythemia
6%, Hyaline Membrane disease 9%, Necrotizing enterocolitis 3%, Hypoglycemia 3%. Neonates
needing ventilator care 13%. Conclusions: Neonates had high incidence of Low Birth Weight,
Intrauterine growth retardation. Mothers had high incidence of foetal distress, caesarean section and
preterm delivery. Adverse outcome incidences i.e. Birth asphyxia, NEC, MSAF was low.
NEO/25(O).RETROSPECTIVE STUDY OF CLINICAL OUTCOME OF NATURAL
SURFACTANT IN A TERTIARY LEVEL CARE NICU IN MUMBAI CITY.
Jyothi Raghuram, Tanmay Amladi, Renu Bist,
Nowrosjee Wadia Maternity Hospital, Acharya Donde Marg, Parel, Mumbai – 12.
OBJECTIVES: This study analyses the clinical outcome of use of both porcine surfactant
(Curosurf®) and bovine surfactant (Survanta®) in 40 babies with HMD admitted in our NICU
between September 2005 – August 2006.METHODS: A retrospective analysis was done of 40
babies who were ventilated for HMD in the above mentioned period. Babies who weighed < 1.5 kgs
were given Curosurf and those who weighed >1.5 kgs were given Survanta to minimise wastage
and cost to parent. None of the babies received prophylactic or early surfactant; all received rescue
therapy. All babies were ventilated using TCPL SIMV mode with either AVEA/ INFANT STAR/
BEAR ventilator. RESULTS: There were 40 babies born to 39 mothers, 25 males and 15 females.
Group I included 22 babies who received Curosurf. Group II included 18 babies who received
Survanta. The mean gestational age in Group I was 30.06 weeks and in Group II was 32.24 weeks.
The mean birth weight in Group I was 1090 grams and in Group II was 1580 grams. In Group I,
40% required a second dose and in Group II, 22% required a second dose. The average interval
between the two doses was 23.7 hours in Group I and 31.5 hours in Group II. The average duration
of SIMV in Group I was 6.14 days and in Group II was 6.61 days. The average duration of CPAP in
Group I was 2.7 days and in Group II was 1.61 days. The complications and associated morbidity
were also analysed and are presented in detail. The average NICU stay was 40.85 days in Group I
and 22.93 days in Group II. The survival rate in Group I was 59% and in Group II was 78.5%.
CONCLUSION: Both Curosurf and Survanta were found to be equally effective in terms of
duration of ventilation. However, the morbidity and mortality were higher in Group I than in Group
II as the babies in Group I were of lower birth weights and lesser gestational age.
NEO/26(P).ORGANIZING A UNIVERSAL NEONATAL THYROID SCREENING
PROGRAM: DECIDING WHICH TEST TO DO IN INDIAN CONDITIONS
Virmani A, Ravishankar U, Gupta V, Kulkarni A, Kaul S, Balan S
Apollo Centre for Advanced Pediatrics , Indraprastha Apollo Hospitals, New Delhi
Aims: Congenital hypothyroidism (CH) is ideal for a screening program: condition clinically rarely
identifiable; sensitive and specific test; and irreversible damage with delayed therapy. We are a
tertiary care hospital, who decided to screen all newborns for CH from 1996. We are analyzing our
decade long experience. Methods: Data was collected from discharge summaries and thyroid reports
cross-checked against RIA lab records, for the period 1996-2006. Results: Of >3,600 newborns seen
over this period, we have T4 and TSH values for 2,327 so far. Mean TSH was 7.96 + 9.0 mIU/L
(range 0.02- 103.2), therefore Mean + 2 SD was 26 mIU/L. Mean T4 was 1.6 + 0.7 ng/dl (range
0.16- 8.6). TSH was 25.1-30 in 11 samples, with T4 < 0.65 in none; and >30 in 71 samples. T4 was
< 0.65 in 81 newborns. Only 4 had TSH values > 25 (33.3; 34.3, 41.8, 80) with low T4. Repeat
testing was advised in all 159 (7.9%) infants with high TSH OR low T4, but concern was for the 4
(0.1%) who had high TSH AND low T4. If both tests are done, we can cut down recall rates from
8% to 0.1%. Conclusions: We find that simultaneous TSH and T4 testing in cord blood can
drastically reduce the number of infants called back for re-testing. The lesser costs involved in
recalling and re-testing offsets part of the cost of 2 tests vs. one, and mean lesser parental anxiety.
Thus testing both T4 and TSH is more practical with our infrastructural constraints, at this nascent
stage of neonatal thyroid screening. A cutoff value for TSH of 25-30 mIU/L is acceptable.
NEO/27(P).CLINICAL PROFILE AND COURSE OF ERYTHEMA TOXICUM
Jayanthi, Ayesha Begum, P. Venugopal
Deptt. Of Pediatrics ,Andhra Medical College/King George Hospital, Visakhapatnam-530002,
Introduction : Although Erythema toxicum (ET) is a transient rash appearing in a healthy neonate,
it is of concern to parents as the rash may sometimes persist for more than a week. ET is a benign
self limiting lesion ,that usually resolves without scar.AIM : To know the clinical profile, course
and factors delaying resolution of lesions in ET in newborn period.Methods : 259 babies with ET
were selected for the study . The babies were selected from the the Pediatric ward of King George
Hospital and Victoria General Hospital between Jan 04 to Jan 06. Very low birth babies, extreme
premature babies, sick babies and babies under phototherapy were excluded from the study. All the
babies were examined by Pediatrician and followed up for two weeks Results: In our study,
majority of lesions appeared on Day 3 and resolved by first week. We also found that topical
application
of
baby
oil
and
turmeric
delays
resolution of ET. \Conclusion : ET is a benign lesion and more common in term babies and has to
be promptly diagnosed and should be differentiated from other less benign conditions. It requires no
therapy except avoiding baby oil and turmeric application.
NEO/28(R).INCIDENCE AND CLINICAL PROFILE OF NEONATAL DERMATOSES
Amit Chaudhary, P. Venugopal
Deptt. Of Pediatrics ,Andhra Medical College/King George Hospital, Visakhapatnam-530002,
INTRODUCTION : Skin lesions are very common cause of hospital visits in children.
They
cause
undue
concern
to
parents
especially
in
neonatal
period.
AIM: To study the incidence and clinical profile of neonatal dermatoses in Visakhapatnam.
Methods:
Study was conducted at King George Hospital and Victoria General Hospital,
Visakhapatnam. 539 babies weighing more than 2 kgs were examined at birth and followed up
Result :
Most common transient skin lesion found was Erythema Toxicum followed by
Mongolian Spots and Milia. Conclusion : Most of the neonatal dermatoses are transient and benign
and need only assurance.
NEO/29(P).CLINICAL PROFILE OF LOW BIRTH WEIGHT BABIES
Kumavat Vandana, Khan Maqsood Ali, Rane Vrushali, Prathima Sivaguru, Kulkarni Anay
Department Of Pediatrics, Rajiv Gandhi Medical College, Kalwa,Thane 605
LOW BIRTH WEIGHT babies contribute significantly to perinatal mortality rate in developing
countries due to multifactorial causes. A retrospective hospital based study was conducted in a
tertiary care hospital over a period of 2 years. for incidence, gestational age, weight proportion and
mortality pattern as this is a major referral centre for tribal area of Thane. All babies with birth
weight <2500gms were included in this retrospective study over a period of 2 years. Maternal and
neonatal details were retrieved from the medical record and fed into computer. Statiscal analysis
was applied whenever necessary Out of 6,520 consecutively delivered live-born babies, 2,357 were
classified as Low Birth Weight (LBW) babies, and the incidence was 36%.. Majority of babies were
Term Small for Gestational Age (SGA) and in the range of 2-2.5kg. Parity had a significant
influence on birth weight of the baby & the sex distribution was equal. Mortality rate was 72/1000
in LBWs and higher in Extreme LBW babies with Septicemia being the major killer. Birth wt of the
baby was found to be a more significant risk factor for Sepsis than gestational age. Deaths due to
Meconium aspiration and Congenital anomalies were more common in babies with birth wt more
than 1.5kgs. Late onset sepsis and mortality indicated high incidence of Nosocomial infections.
Conclusion cut off limit for definition of low birth weight babies should be decided according to
geographical area, race, community. Sepsis still remains the major killer in low birth weight babies
indicating strict asepsis and effective infection control policy. Birth weight better determinant as a
risk factor for mortality due to sepsis than gestational age
NEO/30(P).UNCONJUGATED HYPERBILIRUBINEMIA AS AN EALRY MARKER OF
SEPTICEMIA IN NEONATES.
Karuna Thapar, Sandeep Aggarwal,Shailinder Jeet Singh
Department Of Paediatrics, Government Medical College & Hospital Amritsar (Punjab)
Septicemia in a neoates can be missed due to ill defined presenting features. Indirect bilirubin can
be used as an early predictor of septicemia in a asymptomatic neonates. The present study was
conducted among one hundred neonates who presented with unconjugated hyperbilirubinemia
only. Blood cultures were considered the gold standard for proving the infection. Growth in blood
cultures was obtained in twenty three neonates. The organisms were Staph aureus, E.coli,
Pseudomonas,CONS and Enterococci.Therefore unconjugated hyperbilirubinemia can be used as
early predictor of septicemia.
NEO/31(P).IMPROVING SURVIVAL OF VERY LOW BIRTH WEIGHT BABIES IN THE
COMMUNITY
Anju Sinha, Reeta Rasaily, Shiv Kumar, Malabika Roy, N.C. Saxena
Division of Reproductive Health Nutrition, Indian Council of Medical research, Ansari Nagar, New
Delhi-110029
Introduction: Prevention of VLBW and preterm deaths is the most challenging problems of public
Health. In India more than 60% deliveries take place in homes and specialized care in NICU is not
available to majority of VLBW babies. In “Home Based Management of Young Infant project” of
The Indian Council of Medical Research we trained village level workers Shishu Rakshaks (SR)
and Anganwadi workers (AWW) in five states of the country to deliver care for LBW, VLBW and
Preterm babies during home visits. Methods: A trained Shishu Rakshaks/AWW provided care at
birth. Preterm (birth before 8 months 14 days) and LBW (B. weight <2500gms) were identified &
managed by making home visits, initiating early breastfeeding, counseling of mothers on
management of common breast feeding problems, feeding extracted breast milk with katori and
spoon. Hypothermia was management by keeping the room warm, immediately drying and covering
the baby, keeping close to mother in warm bag & blanket, not bathing for a week. Prevention of
neonatal infections by hygiene promotion & health education and management of sepsis with
injection gentamicin on refusing referral was done. Growth was monitored by weekly weight
measurements. Results: During April 05 to March 06 there were & 54 VLBW (<1500 gms) babies
born in homes. All of them received care by SR/AWW as per protocol. 85% 0f VLBW babies were
alive at the end of second month of life. Three babies were well & did not have any morbidity. Most
common morbidities detected were breastfeeding problem (29%) and hypothermia (25%), followed
by sepsis (13.7) skin infection (7.8) fever (5.8), etc. Verbal autopsies are being done to assign cause
of death. Conclusion: Early detection and management of neonatal morbidities by trained
SRs/AWWs, can improve survival of VLBW babies in the community.
NEO/32(P).COMPARISON OF THE EFFECT OF TWO DOSES OF ANTENATAL
MATERNAL VITAMIN D SUPPLEMENTATION ON NEONATAL BIOCHEMICAL AND
ANTHROPOMETRIC PARAMETERS
S Gupta, M Kumar, P Kalra, S Singh, V Das, A Agarwal, V Bhatia
Departments of Pediatrics, Sanjay Gandhi Postgraduate Institute, Lucknow.
Objectives: Maternal hypovitaminosis D, resulting in neonatal hypovitaminosis D, hypocalcemia
and poor growth, is common in India. We compared the effect of two doses of antenatal
supplementation of vitamin D on biochemical and anthropometric parameters of newborns. Material
and Methods: 299 women in second trimester of pregnancy were randomized to receive either 1
directly observed oral dose of 60,000 IU vitamin D3 in second trimester (group I) or 2 doses in
second and third trimesters (group II). 44 unsupplemented women served as controls (group III). All
were advised 1 gram elemental calcium per day. Of these, 141 women delivered in our hospital and
126 met the inclusion criteria. Cord blood serum alkaline phosphatase (SAP), neonatal calcium on
day 4-6 (NCa), weight, length, head circumference (HC) and anterior fontanelle (AF) size at birth
were measured. Results: Elevated SAP was significantly less frequent in group 2 (35%) vs group 3
(63%, p= 0.02). Mean NCa was significantly lower in group 3 (8.5 mg/dl) vs groups 1 (9.3 mg/dl,
p=0.02), and 2 (9.7 mg/dl, p =0.003). Birth weight, length and HC were significantly higher (p<
0.01) and AF significantly lower (p<0.01) in groups 1 and 2 (3.07 and 3.01 kg, 50.3 and 50.2 cm,
34.5 and 34.3 cm, 2.6 and 2.5 cm, respectively) vs group 3 (2.75 kg, 49.2 cm, 33.6 cm, 3.3 cm).
Conclusion: 2.4 lac IU of vitamin D, but not 60,000 IU, provided protection against neonatal
biochemical rickets. Both doses provided improved neonatal serum calcium and anthropometry.
Antenatal vitamin D prophylaxis is important for the neonate.
NEO/33(P).NEONATAL INTRAPERITONEAL RUPTURE OF BLADDER
Rajiv Kumar, Nomeeta Gupta, Gurdeep Atwal, Arvind Sabharwal
Department of Pediatrics, Batra Hospital & Medical Research Centre, New Delhi-110062.
INTRODUCTION: Neonatal bladder rupture is a rare cause of urinary ascites. Urinary ascites in a
newborn infant is unusual and most commonly indicates a disruption to the integrity of the urinary
tract. An early diagnosis and management lower the morbidity and mortality. We report a
successfully treated case of neonatal urinary ascites in a preterm neonate who had an intraperitoneal bladder rupture, presenting with gross abdominal distension and respiratory distress.
CASE REPORT: A 1.9 Kg preterm male baby was born to a primigravida who had a history of
chickenpox in first trimester and hepatitis E in second trimester. The baby was delivered vaginally
and had Apgar scores of 5 and 8 at one and five minutes respectively. He was transferred to our
NICU because of respiratory distress. ABG showed a case of hypoxia with severe metabolic
acidosis. There were no signs of dehydration. Laboratory investigations showed TLC 8200/cmm
with 73% neutrophils, 24% lymphocytes, 3% monocytes and platelet count 1.64 lacs. PT and PTT
were normal. He was immediately intubated and ventilated for 4 days. He was treated with oxygen,
IV antibiotics, sodium bicarbonate, dopamine, dobutamine, surfactant and phototherapy. He
developed anuria and progressive abdominal distension. No organomegaly could be appreciated and
the bladder was not palpable. Abdominal ultrasound showed free fluid in abdomen and bilateral
mild hydronephrosis with empty bladder. MCU showed extravasation of contrast media from
bladder into peritoneum suggestive of intraperitoneal rupture of bladder. Miniexploratory
laparotomy was done because of his worsening clinical status. Surgical exploration revealed 2 mm
perforation in posterior wall of urinary bladder and confirming that the peritoneal fluid was urine.
Urinary bladder repair was done and peritoneal fluid was sent for laboratory examination.
Peritoneal fluid contained high levels of potassium, urea and creatinine with a low level of
bicarbonate compared with plasma. Blood, urine and peritoneal fluid cultures were sterile. The
patient improved rapidly and discharged on 12 day of admission. This unusual presentation of
neonatal bladder rupture should become familiar to clinicians.
NEO/34(P).SOCIO-CLINICAL ANALYSIS OF SICK NEONATES IN PEDIATRICS
DEPARTMENT OF M.K.C.G. MEDICAL COLLEGE HOSPITAL, BRAHMAPUR
L. Patnaik, R.M. Tripathy, D.S. Malini, T. Sahu
Dept. of Community Medicine, M.K.C.G. Medical College, Brahmapur, Orissa
Mortality and morbidity related to neonatal period in our country are still two to three times of those
in developed countries.Objectives:1) To understand the socio-clinical factors responsible for the
causation of the health problem in neonates. 2) To study the health services offered in institution
and outcome of sick neonates. Material & methods: Study design: Cross sectional study. Setting:
Pediatrics ward in M.K.C.G. Medical College Hospital. Participants: 132 neonates admitted to
Dept. of Pediatrics. Study period: 4 months from 1.5.04 to 31.8.04 Study variables: Age, sex, SES,
Family size, Birth weight. Results: Out of 132 neonates, 19.6% were suffering from septicemia
followed by birth asphyxia (18%), prematurity and LBW (13.6%). 63.63% were male and 32.57%
were female, 50% were rural followed by urban (31.8%) and tribal (18.2%). About 44% sick
neonates were the 1st child and about 50% were having family size more than 3. Half of sick
neonates were belonging to low socio economic status. Birth weight of 63.64% neonates was <2.5
kg. 63.64% were institutional deliveries and 36.36% by home deliveries. Normal vaginal delivery
was 87.88%. Only 22.72% babies were exclusively breast fed. 56% mothers of sick neonates were
between 20-30 years of age and 30% were illiterate. 39.39% of the mothers had regular ANCs and
were immunized with TT. Only 30.3% of mothers had taken IFA tablets regularly. In the gestational
period, 33.33% mothers suffered from infections/diseases. All the sick neonates were given
supportive care including antibiotics, anticonvulsants and prompt replacement therapy when
required during the stay in the institution by the pediatrician. 64% were relieved of their symptoms
and discharged with a good health condition from the hospital. Conclusion: Since the neonatal
morbidity and mortality is very high, there is a need of strengthening the newborn care at the
primary level by inclusion of Essential Newborn Care and obstetric care.
NEO/35(P).MATERNAL AND NEONATAL PROFILE AND IMMEDIATE OUTCOME IN
ELBW BABIES
Rajiv Kumar, Nomeeta Gupta, Gurdeep Atwal, Sandeep Kumar Patel
Department of Pediatrics, Batra Hospital & Medical Research Centre, New Delhi-110062.
INTRODUCTION: Babies weighing less than 1000 grams at birth comprise a unique subclass of
the neonatal population. There has been a dramatic increase in survival rates of this population from
a dismal 10% to 50-60%. OBJECTIVES: To analyze the maternal and neonatal demographic and
clinical profiles of extremely low birth weight (ELBW) babies at NICU and assess their immediate
outcome. MATERIAL & METHODS: The present study was conducted on consecutive 52 ELBW
neonates admitted in NICU of our hospital between July 2003 and June 2005 The maternal data like
parity, antenatal care status, incidence of anemia, PIH, APH, previous preterm delivery and drug
intake during pregnancy was analyzed. The gestational age was determined by New Ballard
Scoring. Neonatal profile was assessed for various diseases typical to this population and their
respective management. RESULTS: Out of 52 ELBW babies, 28 were males and 24 females. The
overall survival rate was 57% and about half the deaths took place within 48-72 hours of birth.
Mortality was higher in males as compared to females (58% vs 28%). Mean gestational age was
27.8 ± 3.1 weeks. Mean birth weight was 831±160 grams. 63% babies were small for gestational
age. Mortality was highest (55%) in babies less than 28 weeks gestation and those weighing less
than 800 grams. Maternal anemia and previous preterm delivery were the common predisposing
factors for preterm delivery. Exchange transfusion was done in 8 babies and one of them developed
kernicterus. Septicemia was seen in 7 babies and Klebsiella species were the commonest organisms
isolated in blood culture. Two babies had chronic lung disease. 28 babies were mechanically
ventilated out of which 20 survived. The weight in majority of the survivors at time of discharge
was between 1500 grams and 1550 grams (median 1530 grams, range 1400 - 1640 grams). The
mean duration of hospital stay was 34 days (range 25 - 43 days). The most common immediate
cause of mortality was respiratory failure. HMD (63%), sepsis (32%), IVH (20%), pulmonary
hemorrhage (18%) and NEC (9%) were the main contributors to mortality with multiple causes in
some. Neonatal hyperbilirubinemia (78%) and RDS (65%) were the commonest morbidity.
Retinopathy of prematurity screening could be done in 35 babies (68%), out of which 22 were
found to be normal. The incidence of ROP was highest in babies of less than 28 weeks gestation
(71%) and those weighing less than 800 grams at birth (62%).
NEO/36(P).MORTALITY AND MORBIDITY PATTERNS AND DETERMINATES OF
OUTCOME IN NICU
Sandeep Kumar Patel, Rajiv Kumar, Nomeeta Gupta
Department of Pediatrics, Batra Hospital & Medical Research Centre, New Delhi-110062.
Objective: To observe the patterns of morbidity and mortality in newborn as well as the
determinants of their outcome so as to be able to make practical recommendations for reduction of
neonatal mortality. Design: Prospective observational. Methods: Two seventy-nine consecutively
admitted newborns were studied. Detailed history, physical examination and investigations were
done to reach a diagnosis. The babies were followed up during the hospital stay and their immediate
outcome noted. Data thus gathered was tabulated and analyzed. Results: There appeared to be a
gender bias in seeking medical attention, as 63% of the admissions were male.87% were hospital
delivered and 62% were term. The most common cause of morbidity was low birth weight 53.8%,
respiratory distress 53%, neonatal hyperbilirubinemia 47%, sepsis 26.5%, severe birth asphyxia
17.7% and hyaline membrane disease 15.8%. The most common primary and secondary causes of
death were sepsis (65%) and shock (85%). Among the various factors, low level of maternal
education, low birth weight, prematurity, artificial feeding rural residence, poor transportation
facility, extremes of maternal age, inadequate antenatal care, maternal risk factors and home
delivery showed consistent relation with increased morbidity and mortality. Conclusions: A
decrease in neonatal mortality can be brought about by an increase in "functional health
literacy",comprising knowledge about the importance of the basics of nutrition, antenatal facilities
available, danger signs in newborn, breast feeding etc and by improving transportation. This will go
a long way in bringing down neonatal mortality rates.
NEO/37(R).STUDY THE CAUSATIVE FACTORS OF NEONATAL DEATH THROUGH
VERBAL AUTOPSY
S. P. Srivastava, Arvind Kumar Ojha
S-104, Udayagiri Bhawan, Budh Marg, Patna – 800001
Neonatal period is the most vulnerable period during life of a person and more than half of the
infact mortality occurs during this period. Such an important period in life of children has till not
not received much attention. Now that infact mortality is not decreasing at an expected pace just
because of high number of deaths during neonatal period, attention is being focused on the causes of
neonatal mortality and factors affecting them. Verbal autopsy is establishing itself as useful tool to
estimate the causes of neonatal deaths. Verbal autopsies performed on 1000 neonatal deaths
showed that 538 them were female and 462 were male. The focuse of the present study about
neonatal deaths by verbal autopsy is a relatively untouched topic and especially in Bihar this is first
study on this subject. 1000 neonatal deaths in and around Patna were subjected to verbal autopsy.
All strata of society belonging to higher, middle and low socio-economic classes were studied. An
effort was made in this study to analyse the causes of detah among neonates by putting questions to
the nearest care-giver present at the time of detah, in the form of questionnaire. The questions were
responded well and events were detailed nicely once people were convinced about the aims of the
study. We were able to come to a conclusion about the probable causes of detah in 89.5% of cases
meaning thereby that the events were recalled correctly and a recall period of 24 months allowed by
us was appropriate for the purpose. Parents had some problem with terminologies, but once they
were explained in the local language they were able to answer the questions. Mothers though
mostly illiterate (56.2%) were able to recollect the events during illness and they remembered
vividly the symptoms like convulsion, arching of back, chest indrawing, blueness (cyanosis) and
others. More number of female neonates than males reflects the neglect of girl child starting right at
birth. Prematurity appeared as the leading cause of death among neonates accounting for 25.4% of
total deaths. This is partly preventable. The number of premature deliveries could be curtailed by
providing adequate rest, nutritional supplement, avoiding smoking and encirclage operation if
required. Most of the deaths due to prematurity were found to occur during the first week of life
(248 out of total 254), emphasizing importance of this period, so for the care of the baby is
concerned. Birth injury / asphyxia, again a partly preventable cause was responsible for 23.3 of the
neonatal deaths. Out of 233 asphyxial deaths 158 occurred during 2nd to 4th week of life and 75
occurred during first seven days of life. Infections like neonatal sepsis (including septicemia and
meningitis) (20.8%) neonatal pneumonia (3.7%) diarrhoea and dysentery (1.1%) neonatal tetanus
(1.8%) accounted for 27.4% of neonatal deaths. With proper and timely treatment a large number
of these could have been survived. Respiratory distress syndrome was responsible for 4.4%,
congenital malformation for 3.3% multiple pregnancy 4% post natal aspiration for 1.5% of the total
neonatal deaths. At least some of these factors could be curtailed by taking appropriate preventie
steps at proper time. Many of the neonates with the seproblems could be saved by giving them
specialized care. As for example known teratogenic agents (drugs/toxins) could have been avoided
during pregnancy to reduce congental malformation. RDS could be prevented by giving
dexamethasone during pregnancy before delivery, 58.4% of the total neonatal deathsoccured during
the first seven days of life. Thus this period of life required special attention 82.2% of neonatal
deaths were recorded to occur, either at home or during transit reflecting poor availability of thealth
services, road and traffic facility in our area. Only 188 deaths were recorded to occur in a hospital.
Minimum number of neonatal deaths were recorded among mothers between 20-25 years of age
(13.1%) while a maximum of 41.4% of deaths were recorded amongh mothers with lower age group
(less than 20 years). Socioeconomic status of parents and maternal education ere discovered to
affect neonatal deaths to a great extent. 42.4% of total neonatal deaths were recorded in low
socioeconomic group and 26.7% in high socioeconmomic group. The difference was statistically
significant (p<.01). 56.2% of total deaths were deaths were recorded among illilerate women while
only 18.1% were found among mothers having an education up to primary or more. Mothers in
61% of neonatal deaths had not received any antenatal care. Only 25% answered that they were
cared by doctor during this pregnancy. 11% and 3% were cared by trained dais and nurses
respectively. In 64.9% of verbal autopsies performed, delivery was conducted by untrained
personnel.
Only in 35.1%, the deliveries were supervised by trained personnel
(doctor/nurses/trained dai). The difference is statistically significant (P<0.01). A high number of
deaths recorded were first order births (30.7%) Lowest number (12.2%) of deaths recorded were
second order birth. Highest number of deaths were found for birth roder four or more (41.3%).
Thus order of birthe significantly (p<0.01) affected death among neonates. The answer to the
question whether neonate was treated before death was ‘No’ in 42.8% of cases. 28.8% were treated
at hospital, 21.3% by local doctors and 7.1% by others. This reflected the lack of health care
availability / acceptability in our area. Hence on the basis of above observations it was concluded
that verbal autopsy is a useful method to diagnose cuases of death especially during neonatal period.
By this method we can find out the cause of death without going for post-mortem autopsy. We can
also find out the maternal and social factors affecting neonatal mortality. Frequency of diseases
causing death can also be deduced, so that interventional programmes could be oriented accordingly
as most of the cuases of neonatal deaths are amenable to interventional programmes.
Recommendations: (A) For the new bron care 1. Care at birth: All births should be supervised by a
skilled paediatrcian who should be well versed with neonatal resuscitation. Proper care should be
given to asepsis, particulary to the care of umbilical cord. Early identifications and referral of high
risk ceonates is must to bring down the neonatal mortality. All health staffs should be adequately
trained for this. 2. Neonatal Care: Breastfeeding should be established as early as possible
preferably as soon as the mother overcomes the exhaustion of labour. New born babies apart from
being examined at birth should be checked by a pediatrician before discharge from hospital and
should be especially looked for passage of urine / stool, signs of infection and other illness and if
present should be treated urgently. Health staff should be trained to treat illness like pneumonia
diarrhoea and other simple illnesses. They should be trained to identifiy serious illnesses and
accordingly to refer them to higher centers. (B) For the mother care: All the pregnancies must be
given proper antenatal care. Expectant mothers should be immunized with tetanus toxoid (2 doses
at one month interval) and should be provided with nutritional supplements. All deliveries must be
supervised by trained personnel (Doctor / Nurse / trained dais). Proper aseptic precautions should
be taken as for example cord should be cut with a new bladed and the thread used for tying the cord
must be sterilized. Mothers should be educated about the art of child rearing, signs of serious
illness during neonatal period, family plainning and personnel hygiene. It is further recommended
that soci-economic and environmental factors like literacy especially female literacy, economic
condition of the parents, road and transport facilities, availability of medical facilities, must be
improved through a combined effort at individual, social, political and governmental level. Legal
age for marriage should be strictly adhered to. Social myths must be removed with the help of mass
media and other forms of health education.
NEO/38(R).INCIDENCE AND CAUSATIVE ORGANISM OF SEPTICAEMIA IN VERY
LOW BIRTH WEIGHT BABIES AT BURDWAN MEDICAL COLLEGE & HOSPITAL
K.Nayek, Sabyasachi Som, K.L.Barik; T. N. Ghosh, N.Choudhuri
Department of Pediatrics, Burdwan Medical College, Burdwan; West Bengal
INTRODUCTION: In India one million VLBW Babies born each year and over all incidence of
neonatal sepsis is 3.8%. Neonatal sepsis is the most common cause of death, followed by
prematurity and birth asphyxia, in neonates. AIMS & OBJECTIVES: (i) To find out incidence ,
etiology and infection source. (ii) To help in rational drug therapy . (iii) The early intervention, to
decrease morbidity and mortality. MATERIAL AND METHOD: This is a descriptive Semi
longitudinal study , done on very low birth weight babies, (birth weight less than 1500 gms),
admitted to special care unit, baby nursery at Burdwan Medical College & hospital during one year
period, and sample size was sixty babies fulfilling the above mentioned criteria. The proforma
include detailed history taking with clinical examination & assessment of gestation and
investigations. RESULT: Neonatal sepsis observed in 32(53.3%) Babies. Sex predilection in
Septicemia 53.8% in male & 52.9% in female .VLBW babies are divided into GrI: (1000 gram; Gr
II (1000-1200 gram,) Gr III ( 1200 - !499 gram). 80% of Gr I developed sepsis and 60% in Gr II and
46.3% in Gr III .Poor feeding was universal symptom (92.8 %), Tachypnoea noted in 56.2% cases.
Leucopenia and low ANC are good markers of sepsis but not seen in this study. Mean value of band
cells in Gr I is more than that of cut off value for neonatal sepsis. Hb% level was different in
different etiological factors, High vaginal swab –There were only seven cases where same organism
was detected. Common organisms were staphylococcus aureus sensitive to Amikacin, Netilmycin
and cloxacillin, and E.Coli sensitive to Amikacin. CONCLUSION: Provisional diagnosis can be
made with the clinical picture and confirmed by sepsis screen. Birth Canal flora is one of the
common source of infection of neonatal sepsis. Blood culture is a definite diagnosis but wit a low
positivity (65.6%). Staph aureus and E.Coli are the common organisms causing neonatal sepsis.
NEO/39(P).BILI - BLANKET PHOTOTHERAPY
NEONATAL HYPERBILIRUBINEMIA
Ajoy Kumar Sarma
Oil India Hospital, Duliajan, Assam – 786602
IN
THE
MANAGEMENT
OF
Objective:- Phototherapy is the preferred method of treatment for neonatal hyperbilirubenemia by
virtue of its non invasive nature. If phototherapy fails exchange transfusion is the treatment of
choice. Currently there are two forms of phototherapy 1)conventional and 2)biliblanket
phototherapy. Thr present study was conducted with an aim to 1)compare the effectiveness of
biliblanket phototherapy over conventional phototherapy. 2) efficacy in reducing the need for
exchange transfusion Design:- Prospective control study Setting:- Oil India Hospital , Duliajan,
Assam from 1.1.05 to 31.12.05 Materials and Method:- The study included 60 babies: both preterm
and term, who required phototherapy. Neonates with even admission numbers were treated with
conventional double surface photo therapy and those with odd admission numbers were given
biliblanket phototherapy. Both groups are comparable in all clinical aspects (sex, gestational age,
birth weight and clinival condition) Serum bilirubin was estimated 6 hourly by microbilimeter.
Primary outcome variables declined in serum bilirubin after 24 hours of phototherapy and with
concomittent reduction need of exchange transfusion. Results and Observation:- The rate of fall in
serum bilirubin was 4+/- 0.7mg% after 24 hours in conventional group, compared to 3.8+/- 0.7mg%
in biliblanket group. There was less maternal anxiety and lactational failure of mother those babies
receiving biliblanket therapy in postnatal ward without separation. The incidence of exchange
transfussion is 5% in both groups. Conclusion:- We conclude both the phototherapy is effective in
neonatal hyperbilirubenemia. Added advantage of biliblanket phototherapy are 1) no need of
separation or shifting to NICO in case of stable baby 2) can be used effectively in case of VLBW
baby who requires other intervention 3) biliblanket phototherapy does not reduce the need for
exchange transfusion.
NEO/40(P).CLINICAL AND DIAGNOSTIC PROFILE OF NEONATAL SEPSIS AND ITS
CORRELATION WITH HIGH RISK FACTORS.
Gaurav Jadon, Anjoo Bhatnagar, Jatinder Sharma,
Department of Neonatology, Escorts Hospital & Research Centre Ltd., Neelam Bata Road,
Faridabad-121005.
Background - Neonatal Sepsis remains the major cause of morbidity, mortality & its high incidence
& case fatality rate are of great concern to neonatologists. Efforts are being made for early diagnosis
& institution of rational antibiotics therapy for reducing the overall mortality. Study Design :
Hospital based descriptive study. Settings: NICU, Escorts Hospital, Faridabad. Subject & Methods :
All Inborn & out born babies <28 days admitted in NICU with clinical features of sepsis with 3
or>3 high risk factors were enrolled and detailed Performa were filled & statistically analyzed with
the help of software. Univariate analysis was performed by using 2x2 table with Chi square test or
fisher exact ‘t’ test. Results : Out of 71 neonates studied, 27 babies were inborn & 44 babies were
out born, 83.1% were male & 16.9% were female, 69.1% cases had early onset sepsis & 30.9% had
late onset sepsis, 57.8% were pre- term, 42.2% were full term, 62% cases were LBW. Most
common significant maternal risk factor found was prolonged rupture of membrane, followed by
abnormal liquor, maternal fever, prolonged labor. Various neonatal & environmental factors having
significant correlation were prematurity, low birth weight, H/o fetal distress, artificial feeding,
invasive procedure & mechanical ventilation. Most common clinical features of sepsis were not
doing well 56 (78.9%), difficulty in breathing 53 (74.6%), Poor reflexes 50 (70.4%). Among
various tests for neonatal sepsis, 2nd serial CRP (+ve 91.5%), X-Ray chest (+ve 82.2%) had highest
sensitivity while high specificity observed for TLC, ANC, ESR. Blood culture was positive in
26.8% cases. K pneumoniae 41.2%, S. Aureus 21.1%, P. aeruginosa 26.7%, E.Coli 10.9%.
Commonest organism identified in early & late onset sepsis was K. pneumoniae. Organism of early
onset sepsis was sensitive to routine antibiotics but organism of late onset sepsis was only sensitive
to newer antibiotics like Imipenem, Piperacillin. Conclusion : Identification of high risk factors,
clinical features, serial CRP, chest X-Ray is useful in early identification of neonatal sepsis. Newer
antibiotics should be rationally used in resistant cases especially in late onset sepsis.Keywords:
Neonate, sepsis, risk factors.
NEO/41(R).CLINICAL PROFILE OF RESPIRATORY DISTRESS IN TERTIARY CARE
NICU OF NORTHERN INDIA
Gaurav Jadon, Monika Garg , Dr. Anjoo Bhatnagar, Jatinder Sharma, Dept. of Pediatrics, Escorts
Hospital and Research Centre, Faridabad-121005
Background: Respiratory difficulties constitute the commonest cause of morbidity, mortality in
newborns and is secondary to large number of etiological factors. Study design: Hospital based
descriptive study. Setting: NICU, Escorts Hospital, Faridabad. Subject, methods : All the babies
<20 days, admitted to NICU from April 2004 to March 2005with clinical features of respiratory
distress are included in the study. Data was collected in a pretested performa and analyzed with the
help of a software. Result: Of 94 babies studied, dischages : 54, deaths :18, LAMA : 15, Referred :
7, with Birth weight <1kg (5), 1-1.5kg (16), 1.5-2.5kg(32) & >2.5kg(41). Out of these 5 : <28, 18 :
<28-32, 29 : 32-36 and42 : >36wks gestational age. The distribution of diagnosis was found varying
from HMD 26 (27.6%), BA 17 (18%), sepsis 13 (13.8%), pneumonitis 10 (10.6%), TTN 9 (9.67%),
MAS 7 (7.4%), CHD 4 (4.2%), PPHN 3 (3.2%), ICH 2 (2.1%), severe anemia 1 (1.1%), CDH 1
(1.1%) & MOF 1 (1.1%). Totally 42 (44.68%) needed mechanical ventilation. Of which 13
(30.95%) were satisfactorily discharged & 17 (40.47%) expired, 9 (21.42%) LAMA & 3 (7.14%)
referred. 57 (60%) had NICU stay <7 days, 24 (25.5%) : 7-14 days and 13 (13.8%) > 14 days.
Conclusion: Most common causes of respiratory distress in a neonate are Hyaline membrane
disease, Birth asphyxia and Sepsis which were preventable to some extent, accounted for mortality
in majority of the patients.
NEO/42(P).SURFACTANT REPLACEMENT THERAPY IN HYALINE MEMBRANE
DISEASE IN TERTIARY CARE HOSPITAL OF NORTHERN INDIA
Gaurav Jadon, Anjoo Bhatnagar, Jatinder Sharma
Fortis Escorts Hospital And Research Centre, Neelam Bata Road, Faridabad, Haryana-121005
Background: Surfactant replacement therapy has been shown in numerous clinical trials to be
successful in ameliorating Respiratory distress syndrome. However, there are only few studies
reported from India.Aims and Objectives: To study the efficacy of surfactant therapy in decreasing
the Fio2requirement, ventilator days and decreasing the overall mortality in HMD babies.Material
and Methods: This study is a retrospective analysis of outcome of administration of surfactant as
rescue therapy in all premature babies with HMD needing ventilator, admitted in NICU from March
2004 to August 2006. The study included 51 babies with HMD. Eligibility criteria – Premature
babies with suggestive clinical finding of HMD, Fio2 more than 0.4, suggestive arterial blood gases
and radiological features. Babies with congenital anomalies were excluded from the study. Babies
were given Survanta (Natural Bovine type surfactant) in doses of 4 ml/kg/dose through ET tube
with extra port in 4 aliquots in neutral position along with ongoing ventilations. Repeat doses at 6
hours, 12 hours were given if persisting Fio2 requirement > 40%.Results: Out of total 51 babies
studied, 32 (62.7%) were male babies and 19 (37.3%) were female babies. Gestation wise
distribution: < 28 weeks – 15 (30.2%), 28 – 32 weeks – 25 (48.2%), > 32 weeks – 11(21.6%). Birth
weight wise distribution: < 1 kg – 16(31.4%), 1 – 1.5 kg – 24 (47%), > 1.5 – 11 (21.6%). 71% of
babies were intramural. 66 % were born by LSCS section. 82% of intramural babies received
antenatal steroids while only 18% of extramural babies received steroids. 65.4% babies required 1
dose of surfactant, 28.6% required 2 doses, 4% required 3 doses and 2% required 4 doses. Mean age
at 1st dose was 4.5 hour. Mean duration of ventilation was 4.7 days. Change in Fio2 > 20% with in
6 hour was seen in 88% of babies after surfactant administration. There was no significant adverse
effect seen during surfactant administration except 1case of pulmonary hemorrhage. Overall
mortality rate was 31.2%. On analysis gestation wise mortality was < 28 weeks (83.4%), 28- 32 wks
(15.6%), > 32 wks 1%.Sepsis with multi organ failure was seen in 71% of babies and was the
commonest cause of mortality, other associated complications were intra ventricular hemorrhage
13%, patent ductus arteriosus 10%, chronic lung disease 9%, Necrotizing Enterocolitis 8%,
Pnumothorax 4%, ROP in 2%. Survival was better in >28 wks of gestation and birth weight > 1000
grams.
Conclusion: Administration of exogenous natural surfactant can greatly reduce the Fio2
requirement, ventilatory days and overall mortality and morbidity in preterm babies with HMD.
Issue of giving antenatal Steroids to all the pregnant women in preterm labour still needs to be
emphasized to prevent HMD.Key words: HMD - Hyaline Membrane Disease
NEO/43(P).ROLE OF CULTURAL PRACTICES IN NEONATAL SEPTICEMIA
Navdeep Dhaliwal, Ashu Rastogi, A. Agarwal
Resident doctor, Department of Pediatrics, N.S.C.B Medical College, JABALPUR (M.P)
Introduction: Neonatal mortality accounts for nearly 5 million deaths across the globe, and 98% of
these deaths take place in the developing countries. Nearly 2 million neonates die in the South-East
Asia region, and 60 % of these deaths occur in India alone. Neonatal septicemia is one of the
important cause of neonatal mortality and nearly one third of these neonates die after one week of
age. Aims and objectives: To identify the role of various sociocultural practices prevalent in the
community contributing to neonatal septicemia. Material and methods: The present study was
conducted in the Department of Pediatrics, NSCB Medical College, Jabalpur from October 2004 to
April 2005. Hundred consecutive admitted newborn up to 4 weeks of age with birth weight greater
than 1500 grams and suspected sepsis were studied. Results: In our study of 100 newborns, we
found that in a large number of these late onset septicemia cases (stastically significant), some form
of the cultural practices was present. Special mention to prelacteal feed and head shaving, which
were present in maximum number of the cases. Conclusion: The intricate interplay of socio cultural
and neonatal care in the community, which is often ignored, thus seems to be an important risk
factor leading to neonatal infection and septicemia. An understanding of these issues and adequate
counseling of parents can protect the neonate from easily avoidable sources of infection and
decrease the incidence of late onset neonatal sepsis.
NEO/44(O).FETAL ORIGINS OF OSTEOPOROSIS
L.G.Ramavat
Ahmadi Hospital, Kuwait. P. O. Box 132, Curepipe, Mauritius
Fifty six newborns with low 25hydroxycholecalciferol out of seventy five
were born with
rickety rosary are susceptible to
osteoporosis.
These
newborns
with
low
25hydroxycholecalciferol were treated with
Alfacalcidol and
followed for a period of one year. Author examined 858 newborns within 24 hrs of their birth in
the neonatology unit of the pediatric department of Ahmadi Hospital, Kuwait, over a period of two
years. Apart from the routine examination these newborns were specifically examined for rachitic
rosary, widened anterior/posterior fontanelle, sagittal suture and hypotonia. Gestational age and
maturity was assessed by Dubowitz method. Venous blood was obtained and three to five ml of
serum was sent on the same day by air to J.S. pathology PLc, London for the estimation of 25hydroxycholecalciferol and 1,25–dihydroxycholecalciferol by Radio Immuno Assay. X-ray of the
wrist, calcium, phosphorus and alkaline phosphates were done in our hospital’s laboratory. 75
newborns out of 858 fullterm, normal delivery and weighing more than 2.5 kg were born with
rachitic rosary. 25-hydroxycholecalciferol was lower than normal in 56 newborns
(mean:12.5;range:3-22nmol/L) and normal (>25nmol/L). Calcium concentration was within the
normal range in all 56 newborns (2.2-2.62-mmol/L). Plasma phosphate concentration was
significantly higher in all the newborns (mean:1.7;range:1.6-1.8mmol/L) and normal
(mean:1.5;range:0.81-1.58mmol/L). Plasma alkaline phosphates was higher than normal in twenty
six newborns (mean195; range: 170-220u/L) and normal (mean195; range: 170-220u/L) for our
laboratory. Fourteen newborns had the radiological changes, early flaring, widening and cupping
seen in their wrist x-ray. These newborns, born with vitamin D deficiency rickets will grow to
suffer from osteoporosis (silent killer disease) later in life unless they are diagnosed at birth by
25(OH) D. Screening test 25(OH) D needs to be done routinely on all newborns at birth.
NEO/45(P).TO STUDY THE INFLUENCE OF PERINATAL VARIABLES LIKE
GESTATIONAL AGE AND BIRTH WEIGHT ON NEONATAL BLOOD PRESSURE.
Mranal Joshi,D.K.Pathak,D.P.Pande
Deptt of Pediatrics, Northern Railway Central Hospital, NewDelhi 400001
Introduction: Factors directly associated with increase in blood pressure of newborns include
maternal smoking, gestational and post natal age, stress, agitation, crying, upright position and
abdominal compression. Study Design: Prospective study, Study period October 2004 to July 2005.
Setting: Obstetric and neonatal unit, Northern Railway Central Hospital, New Delhi, Zonal referral
Hospital of Northern Railway. Material and Methods: 201 newborns delivered during the study
period were included irrespective of gestational age or birth weight. The neonates with gross
congenital malformations (including renal or cardiac defects), hemodynamically unstable or sick
babies were excluded from the study. Two blood pressure readings, first at 18-24 hours of age and
second at more than 72 hours of age were taken using an automatic non invasive Oscillometric
monitor, while the new born were in quiet awake state. All data were collected and analyzed by
appropriate statistical tests.Results:1) Mean Systolic blood pressure of newborns who were less than
37 weeks gestational age (n = 30) was 65.07 ± 5.17(± SD) mm Hg at 18-24 hours of age and there
was a statistically significant (p = 0.003) higher blood pressure recorded in ≥ 37 weeks gestational
age new born (n = 171) at same age.2)There was a positive correlation between mean blood
pressures of newborns whose birth weight was less than 2.5Kg (n = 47) (Mean BP Systolic 67.4±8.09, Diastolic BP - 44.13 +-7.08) compared with those whose birth weight was ≥2.5Kg (n =
154)(Mean BP Systolic – 68.34±8.13, Diastolic BP - 44.36 ± 6.61) which remained even after
controlling for gestational age but was not statistically significant(p = 0.488(sys), p =
0.831(diastolic)).3)41 newborns were small for gestational age, 158 were appropriate for gestational
age(AGA) while 2 were small for gestational age (SGA). No significant correlation was found
between blood pressures of SGA and AGA babies. Conclusion: There was a statistically significant
rise in blood pressure with increase in gestational age, but there was no difference in blood pressure
between small and appropriate for gestational age groups, pointing that the blood pressure in our
study showed stronger relation with gestational age rather than birth weight. Although a positive
correlation was noted between birth weight and blood pressure even after controlling gestational age
but this was not statistically significant
NEO/46(R).CONTROLLED FiO2 THERAPY TO NEONATES BY OXYGENHOOD IN THE
ABSENCE OF OXYGEN ANALYSER
S K Jatana, S Dhingra, M N G Nair
151 Army Base Hospital, Pin 903151, C/o 99 APO
Objectives of the study: A study was conducted to evolve a system of standardizing the oxygen
concentration inside the oxygen hood and to develop guidelines for controlled FiO2 administration
without oxygen analyzer. Also to study the effect of low flow rates on carbon dioxide retention
inside the hood. Methods used: A dummy patient and thirty neonates, requiring oxygen to be
delivered through head box, constituted the material for the study group. Oxygen content in the
head box was measured using a standard oxygen analyzer while the size of head box; flow rate and
lid position were changed independently and in combination. The head boxes were tested on a
dummy patient. These results were analyzed, a general guideline derived, and were applied to thirty
neonates requiring oxygen therapy using head box. Multiple readings were taken. Data thus
collected was tabulated, statistically analyzed, and appropriate conclusions drawn. Results: Volume
of headbox had an inverse relation with the oxygen concentration inside the headbox. A smaller
sized headbox achieved better & more predictable oxygen concentration at all flow rates. Maximum
difference in oxygen concentration by varying the lid position was observed in the large headbox.
Keeping the variables constant, oxygen concentration was lower in babies as compared to dummy,
which is statistically significant. No significant CO2 retention was found at flow rate of 4 lpm in a
small & 3 lpm in a medium & large head box respectively. Flow rates below this were associated
with significant CO2 retention. Conclusion: It is possible to predict the oxygen concentration inside
the head box depending upon various variables without the use of oxygen analyzer. Larger the size
of the head box and higher the lid position, lesser the oxygen concentration achieved at a given
oxygen flow rate. Flow rates of less than 4 lpm in small & 3 lpm in medium & large sized head
boxes are associated with CO2 retention.
NEO/47(R).SEASONAL VARIATION IN NEONATAL JAUNDICE
Lt Col Amarendra N Prasad, Col (Mrs) Mukti Sharma
Deptt. of Pediatrics, Military Hospital, MHOW, Indore - 453441
Objective: It is important to consider additional factors known to affect serum bilirubin levels in the
newborn, and that might yield new criteria for the diagnosis of physiological and non-physiological
(or pathological) jaundice. The aim of this study was to analyse the seasonal differences of
pathologic hyperbilirubinemia during the neonatal period. Methods: One hundred and twenty-one
consecutive newborn infants with pathologic hyperbilirubinemia who were admitted to our
Neonatal Care Unit during three years were studied prospectively. Jaundice (and
hyperbilirubinemia) was considered pathological if the time of appearance, duration or pattern of
serially determined serum bilirubin concentrations varied significantly from that of physiological
jaundice. Complete obstetric histories were obtained and examinations were performed at the time
of admission. Seasonal differences in this population were studied. Results: We found more
pathologic hyperbilirubinemia during the summer months (April to September) and less in winter
months (October to March), and these differences between seasons were statistically significant. An
association between weight loss of the newborn and the level of hyperbilirubinemia was also noted.
Conclusions: The higher temperature during the summer could contribute to the qualitative and
quantitative differences in hyperbilirubinemia, found in this season. In general, investigation of the
cause of hyperbilirubinemia in healthy breastfed newborn infants is not indicated unless the serum
bilirubin level exceeds 15 mg/dl, but this value could be higher in the summer.
NEO/48(P).CAN NURSERY ADMISSION CUT OFF BE LOWERED DOWN TO 1500g
BABIES? A RETROSPECTIVE ANALYSIS
Ipsita Roy Goswami, Jayant K Ghosh, Malay Kr. Sinha, H Begum, Sukanta Chatterjee
Department of Pediatrics, Neonatology Unit, Department of Pediatrics, Medical College Kolkata
BACKGROUND: According to the recommended guidelines of National Neonatology Forum, all
low birth weight babies below 1800g birth weight should be given institutional care, irrespective of
other indications. But due to limitations the rate of neonatal admission outnumbers the available
resources. Thus the guidelines cannot be strictly followed. OBJECTIVE: The study was conducted
to find out whether there is any significant difference in outcome if low birth weight babies
weighing between 1500g and 1800g are managed by keeping them with their mothers, i.e. without
nursery admission. METHODS: It was a retrospective study for which data was collected from past
medical records of 6 months duration from 1.1.06 to 30.6.06.The subjects of the study were babies
born between 1500g and 2000g, divided into 2 groups. Group A representing babies born between
1500g and 1800g, group B representing babies born between 1801g and 2000g.The groups were
compared with regard to four variables namely average maternal age ,sex of the babies, singleton or
twin pregnancy and mode of delivery. Chi square test was used for statistical analysis of outcome.
RESULTS: Total number of live born babies in group A were 198 and in group B were 223.Two
groups were comparable with respect to average maternal age (23.7years),sex distribution ,singleton
or twin pregnancy and number of caesarian section or vaginal delivery. In both groups 13 babies
required nursery admission after being given to their mothers in the perinatal ward. No significant
difference in outcome was observed between the groups. CONCLUSION: We suggest that the
recommended guidelines for giving institutional care to babies below 1800g may be lowered down
to 1500g.However; more babies should be evaluated prospectively, over a longer duration of time,
before changing the standard guidelines.
NEO/49(P).ESTABLISHMENT OF NEONATAL COLONIZATION
REFERENCE TO GROUP B STREPTOCOCCUS
Palak Hapani, J R Gohil, Dilip Vaghera
Resident in Pediatrics, B J Medical College & Civil Hospital, Ahmedabad
RATE
WITH
Introduction: Group B streptococci are the best known cause of post partum infection and most
common cause of neonatal sepsis. Colonization of GBS means isolation of organism from
individual without clinical evidence of invasive or disseminated disease, which may predispose to
infection and development of sepsis. Aims and Objectives: To study- Establishment of frequency of
colonization of organisms in new-borns Incidence of isolation of group B streptococci and coorganism Incidence specific to age, sex, weight and gestation of newborns Incidence of site of
inoculation Incidence of influences of maternal status with isolation Sensitivity of organisms to
antibiotics Material and method: Prospective study from Sept 2003 – Oct 2004. 70 neonates within
24 hr after birth included. Samples collected from umbilicus & nasopharynx and sent for culture.
GBS identified by typical colony morphology and Gram stain. Observations: Total newborns – 70.
Grp B beta hemolytic streptococci – 2(2.86%), Streptococci viridans – 2(2.86%), Pseudomonas –
1(1.43%), Staph coagulase negative – 2(2.86%), Staph aureus – 3, Klebsiella – 9, E. coli – 3. For
GBS, umbilical colonization – 1, throat colonization – 1; both male sex, both vaginally delivered,
both full term & sensitive to ampicillin, penicillin, ciprofloxacin, levofloxacin, ceftriaxone (both) by
disc method. 1 was resistant to tetracyclin and 1 to cloxacillin. Total culture positive – 22, of which
17 were vaginally delivered, 3 by forceps & 2 by LSCS; 14 were full term, 8 preterm. Conclusions:
Of 70 studied newborns, 2 were found colonized with GBS, both male and full term sensitive to
routinely used antibiotics. Rate of non GBS colonization was much higher(20 as against 2 GBS,
total 22). GBS detection is advisable only for high risk group.
NEO/50(P).APPROACH TO A CASE OF BLEEDING NEONATES
S.A. Krishna, A.K. Jaiswal, Anil kumar
3 Mitan Ghat, Patna – 800008
Bleeding neonates results due to variety of reasons like physiological deficiencies of coagulation
factors, antenatal factors like maternal disease or intake of drugs, immaturity of blood vessels,
vulnerability to birth trauma, sepsis and asphyxia. Local or diffuse hemorrhage and thrombosis are
common causes of morbidity and mortality during the newborn period. A pediatrician should be
conversant with these to ensure early detection, management and prevention, where possible
specific clinical approach and laboratory tests are available to confirm the differential diagnosis of
bleeding neonates. PT, PTT and Platelet count can serve much of our purpose. Definite therapeutic
options like prevention by administration of Vitamin K can prevent this disease. Severe hemorrhage
in the newborn is uncommon but it is a life threatening emergency which demands urgent fresh
blood transfusion. Newborn body is predisposed to develop Vitamin K deficiency. Vitamin K is
required for the synthesis of coagulation factors II, VII, IX, & X. Vitamin K deficiency may cause
Vitamin K dependent Bleeding. HEMORHAGIC DISEASE OF NEWBORN (HDN): Occurrence –
One in every 200-400 neonates not given vitamin-K prophylaxis. There are three types of HDN
based on the age at onset.Early HDN – Seen in utero or within 24 hours of life. Bleeding is
concealed inside the body cavity like cranium, thorax and abdomen.Classical HDN- Due to
Physiological Vitamin-K deficiency. Manifest during 2nd & 3rd day of life (up to 7 days). Late
HDN- Manifest after first week of life in specially chronic disease like chronic diarrhoea &
jaundice. APPROACH TO THE DIAGNOSIS: History – History can be more valuable than any
laboratory test. Family history of excessive bleeding and history of familial bleeding disorder like
hemophilia, Von Willebrand disease in a previous sibling. Birth history including asphyxia and
trauma. History of maternal drug intake like aspirin, phenytoin etc. History of maternal infections.
Does the mother have lupus erythematous, ITP, nose bleeding, excessive bruising etc. Physical
Examination- Sick Newborn- Indicates sepsis, DIC, asphyxia & Liver disorder hypothermia,
hypovolemia, hypoglycemia, seizure, prematurity with severe RDS and perinatal infections.
Bleeding is likely secondary due to DIC, platelet destruction. Well Newborn- Suggests Vitamin Kdeficiency, Inherited coagulation factor deficiency, immune thrombocytopenia. Congenital
anomalies with thrombocytopenia- TAR syndrome, Fanconi- Pancytopenia, Chediak- Higashi
syndrome, Wiskot-Aldrich and Other syndromes. Petechiae, purpura, Small ecchymosis suggest
platelet linked bleeding. Large hematomas suggest, DIC, Vitamin –K deficiency, inherited clotting
factor deficiency. Jaundice indicates liver disease, sepsis, Torch infections. Splenomegaly suggests
Torch infection, septicemia etc. LABORATORY TESTS –. Simple diagnostic approach in a
bleeding neonate
Platelets
PT
PTT
Diagnostic Possibilities
“SICK” NEONATE
Decreased
Increased
Increased
Dissiminated intravascular coagulation
Decreased
Normal
Normal
Normal
Increased
Increased
Platelet Consumption (infection, necrotizing
enterocolitis, renal vein thrombosis)
Liver disease, heparinization
Normal
Normal
Normal
Altered Vascular integrity (e.g., extreme
prematurity, severe hypoxia and acidosis,
hyperosmolality.)
Normal
Increased
Immune thrombocytopenia
Hemorrhagic disease newborn
“WELL” NEONATE
Decreased
Normal
Normal
Increased
Normal
Normal
Normal
Normal
Increased
Normal
Hereditary clotting factor deficiencies
Bleeding due to local factors (trauma,
anatomic
abnormalities),
qualitative
platelet, abnormalities (rare), disrupted
vessel from anatomical lesion(e.g. Ulcer,
Hemangioma, swallowed blood.)
It is difficult to measure the serum Vitamin-K. Level of protein induced Vitamin-K absence
(PIVKA-II) is specific and provide sensitive index of Vitamin-K deficiency. APT Test –
Differentiate between swallowed maternal blood and neonatal gastrointestinal bleeding. Steps- One
part of blood vomitus or stool is mixed with five parts of water. Mixture is centrifuged for one
minute. Four ml. of supernatant is mixed with one ml of 1% Sodium Hydroxide. Colour of adult Hb
will change into yellow brown but Fetal Hb. will remain same. Blood Smear exam – fragmented
RBC’s are seen in DIC. Neutrophilia, shift to left, increased band cell counts are found in
septicemia. Fibrinogen level- Decrease in liver disorder or DIC. Fibrin split product and d-dimer
assay- indicate hepatic disease and DIC. TREATMENT: Classical HDN- It can be prevented by
administration of Vitamin-K 0.5 to 1.0 mg 1M to all new born babies at birth. Vitamin-K1
(phylloquinone) & K2 (Menaquinone) are naturally occuring lipid soluble Vitamin K. Theses
Vitamins are non-toxic. Synthetic preparation of Vitamin K (Menadione Sodium bi sulphite) can
cause hemolysis and severe Jaundice. Therapeutic dose- 1 to 2 mg IV or SC. Infants predisposed to
develop early HDN- Vitamin K1 2mg IV at birth. High risk infant to develop late HDN- Monthly
IM injection of 1.0 mg of Vitamin-K till underlying disorder controlled. Life- Threatening
Hemorrhage- Administration of Vitamin K followed by 10 to 20 ml. per Kg of frozen plasma. Fresh
Whole Blood. If patient is in Shock. Factor Concentrate- Clotting factor level should be raised to
minimal adult level. Specific therapy- Aim of management should be proper diagnosis and
treatment of underlying causes like DIC, Infection, NEC etc. Reference: Pramanik AK- Bleeding
disorder in neonates. Pediatr REv 1992; 13:163-173 Christensen RD Newborn hematology in
hematological problems of the neonate Saunder 2000; 114-157.Buchanam GR coagulation disorder
in the neonate.peditrclin north Amer 1986; 33:203-220. Lane PA and hathway WE – Vitamin K in
infancy. J Pediatr 1985; 106:351-354. Choulika S, Grabowski E, Holmus LB. is antenatal Vitamin
K prophylaxis needed for pregnant women taking anticonvulsant AMJ Obstel Gynecol
2004;190:882-883. Goorin AM, newfeld E, Bleeding in Cloherty JP Eichenwald EC, Stark AR –
manual of neonatal case-medn philadelphia ;lippincott Williams and Wilkins 2004;465474.D’Souze IE, Rao SD, late hemorrhagic disease of newborn Indian pediatr 2003; 90:226-229.
Singh M,Vitamin –K during infancy : Current status and recommendation. Indian pediatr 1997;
34:708-712.Pooni PA, singh D,Singh H, jain B.K.. intracranial hemorrhage in late hemorrhagic
disease of the newborn. indian pediatr 2003;40:243-248. MC Ninch AW, tripp JH, hemorrhagic
disease o1 of the newborn in the british Isles : Two year prospective study BMJ 1991;303:1105.
NEO/51(P).IS AWAKE INTUBATION IN NEONATES JUSTIFIED?
Mudit Kumar
Neonatal Intensive Care Unit, Kings College Hospital, Denmark Hill, London, SE5 9RS
Objectives: Endotracheal Intubation is one of the most common procedures in NICU. Only 10% of
intubations in NICU are emergency intubations. Neonates have no ability to verbally express pain
therefore physiological responses are used as surrogate markers for pain and these physiological
responses are positively influenced by the use of premedication Various surveys have shown that
the use of premedication for intubation in neonates is still limited Methods and Results: Drugs used
in neonates Analgesics – Morphine, Fentanyl Sedatives- Midazolam-significantly decreases
cerebral blood flow in preterms Etomidate- extremely short onset/duration, very hemodynamically
stable, cerebroprotective. Propofol- rapid recovery period Ketamine- effective analgesic and
amnesic agent, useful in hypotension Neuromuscular Blocking Agents Succinylcholine- majority of
contraindications not relevant to neonates Atracurium - causes histamine release – bronchospasm
and drop in MBP Cisatracurium- no histamine release Anticholinergic Atropine- minimum dose
100 mcg, should always be given before neuromuscular paralysis Rapid Sequence Induction – RSI
Preoxygenation – 100% O2 to produce a nitrogen washout. Pretreatment and induction pretreatment medications to counteract potential adverse effects of intubation. Followed by an
induction agent to provide sedation Pretreatment – Atropine Induction- Morphine/
Diamorphine/Fentanyl/Etomide Paralysis - to provide muscle relaxation.
Suxamethonium
Conclusion: All elective and semi-elective intubations should be preceded by pre-medication where
possible. Vital parameters (saturation, HR and RR) should be monitored before, during and after
pre-medication. Newborn infants demonstrate physiologic, behaviour and hormonal responses to
painful interventions, similar to those seen in older children and adults. Pre-medication reduces
some of the adverse physiological reactions associated with intubation and decreases the time
necessary to accomplish intubation. The primary goal during an intubation procedure is to achieve
safe and rapid stabilisation of the airways with the minimum of adverse effects
NEO/52(P).CLOSURE OF PATENT DUCTUS ARTERIOSUS WITH ORAL IBUPROFEN
SUSPENSION IN NEWBORNS : A PILOT STUDY
AnuradhaV, Vasanthakumari M.L, KannanP, Murugan S,KrishnanG, PalanisamyS, AmuthanV,
BalasubramanianS, Naina MohamedS, JeyakumarG, MarimuthuG, SabapathyK
Dept. of Paediatrics, Dept. of Cardiology, Madurai Medical College and Govt Rajaji Hospital,
Madurai, Tamilnadu
ABJECTIVE: Patent ductus arteriosus(PDA) closure is tried with ORAL Ibuprofen (alternative to
I.V Ibuprofen) in premature infants with respiratory distress syndrome and normal full term infants.
METHODS: 126 newborn were studied from July05 to June06. Inclusion criteria 1 Preterm infants
(gestational age<32 weeks & <1500g) 2 Full term infants with low birth weight(LBW) 3 Full term
infants with normal body weight(NBW) 4 echo evidence of hemodynamically significant PDA (left
atrium/aortic root diameter ratio >1.4 or ductal size >1.5 mm). Exclusion criteria: major congenital
anomalies,
Intraventricular
Hemorrhage,
serum
creatinine>1.5mg%,BUN>50mg%,
platelets<60000/mL3, hyperbilirubinemia necessitating exchange transfusion. 126 patients received
oral ibuprofen suspension 10 mg/kg as first dose followed at 12 hour interval by 2 additional doses
of 5mg/kg each, if needed second repeat dose continued. RESULTS: Echo was done before
treatment and after 24 hrs. Out of 126 patients, 80 were preterm, 20 were fullterm with LBW and 26
were fullterm with NBW. Ductal closure was achieved 93.7% in preterm, 80% in fullterm with
LBW, 61.5% in fullterm new born with NBW. Among them responding to first dose of oral
ibubrufen therapy was 75% in preterm, 60% in fullterm with LBW, 38.4% in fullterm with NBW.
2nd dose response was achieved 18.8% in preterm, 20% in fullterm with LBW and 23.07% in
fullterm with NBW. No serum creatinine changes before and after treatment with oral ibuprofen.
CONCLUSION:ORAL ibuprofen may be an effective and safe alternative to iv ibuprofen for PDA
closure in premature infants. Further studies needed to validate these findings.
NEO/53(P).CARDIAC AND LIVER DULLNESS IN NORMAL NEONATES
KK Locham, Manpreet Sodhi, Kamaljeet Kaur, Prasad AP
Deptt. Of Pediatrics, Govt. Medical College / Rajindra Hospital. Patiala.147001
Objectives: To determine cardiac and liver dullness in normal neonates. Setting and methods: 117
normal babies admitted to Neonatology section of Deptt. of Pediatrics, Govt. Medical College,
Patiala were the subjects of study. Sex, gestation and birthweight, were recorded on a predesigned
proforma. Cardiac and liver dullness was assessed by percussion. Liver span was also measured by
palpating lower border of liver. Results: Out of 117 newborns, 90 babies were term, 25 were
preterm and 2 babies were postterm. In preterm group, 24 babies were AGA and only one was
SGA. 73 babies were AGA and 17 were SGA in term group. Both the babies in postterm were
AGA. Cardiac dullness could be appreciated in 99 babies only. In preterm group, 10(52.64%) had
cardiac dullness in 2nd intercostal space (ICS) and 9 (47.36%) had in 3rd ICS whereas in term group
70 (89.75%) babies had cardiac dullness in 3rd ICS and 8 (10.25%) had it in 2nd ICS. Both postterm
babies had cardiac dullness in 3rd ICS. In preterm group, maximum 14 (56%) no. of babies had
liver dullness starting from 4th ICS. 9(36%) had liver dullness in 5th and 2(8%) had liver dullness in
3rd ICS. Maximum no. of babies 68 (75.56%) in term group had liver dullness in 4th ICS followed
by 14(15.55%) in 5th and 8(8.9%) in 3rd ICS. One postterm baby had liver dullness in 4th and
second had dullness in 5th ICS. Mean liver span in preterm and term babies was 4.31+0.31 cm and
4.90+ 0.73 cm respectively whereas it was 6.25+ 0.35 cm in post term group. Conclusions: Majority
of preterm (52.64%) had cardiac dullness in 2nd ICS and maximum no of term (89.75%) had
cardiac dullness in 3rd ICS. Majority of preterm (56%) and term (75.56%) had liver dullness in 4th
ICS.
NEO/54(P).LIPID PROFILE IN SMALL AND APPROPRIATE FOR GESTATIONAL AGE
NEWBORNS V/S STANDARD NORMS
KK Locham, Kiranjeet Kaur, Jaswir Singh,Manpreet Sodhi, Shalini Soi
Deptt. Of Pediatrics, Govt. Medical College / Rajindra Hospital. Patiala.147001
Objective : To compare the lipid profile {triglyceride (TG), cholesterol, low density lipoprotein
(LDL) and high density lipoprotein (HDL)} in SGA and AGA newborns with standard norms.
Setting and Methods : 100 SGA babies who were otherwise normal admitted to Neonatology
section of Department of Pediatrics, Govt. Medical College, Patiala were the subjects of the study.
30 AGA newborns served as the control. Lipid profile was done on the cord blood. TG was assessed
by Buceole and David method. Cholesterol was determined by enzymatic calorimeter method. HDL
was assessed by method described by Burnstein et al. LDL was determined by formula devised by
Friedwald et al. LDL = Total cholesterol – (TG/5 + HDL). 5th – 95th percentile value for cord serum
TG and cholesterol was taken as 14-84 mg/dl and 42-103mg/dl respectively. These values for LDL
and HDL were taken as 13-60mg/dl and 17-50mg/dl respectively. Results : 70% preterm and
58.75% term SGA babies had elevated TG. The elevation was statisticaly significant as compared to
rest of the babies in SGA group. 55% preterm SGA, 38.75% term SGA and 26.67% term AGA
babies had elevated cholesterol which was statistically significant as compared to rest of babies in
their respective groups. 25% preterm SGA, 45% term SGA and 13.33% term AGA babies had
significant elevation in LDL levels as compared to remaining babies in their respective groups. 10%
preterm and 5% term SGA babies had significantly elevated HDL levels as compared to rest of the
babies in their respective groups. Conclusion : TG was raised in majority of preterm and term SGA.
Cholesterol was raised in majority of preterm SGA. LDL and HDL were normal in majority of SGA
newborns. Cholesterol, LDL and HDL were also affected in AGA babies though to a lesser extent.
NEO/55(P).PERINATAL OUTCOME IN HIGH RISK PREGNANCY
Prof. N.L.Phuljhele, Astha Tripathi
Kanchanganga –II, Behind Ayurvedic College, P.O. Pt. R.S. University Danganiya, Raipur
INTRODUCTION: Study of varies high risk pregnancy & follow up of case during intranatal &
postnatal period to evaluate the fetal outcome . AIM: To know the Perinatal outcome of high risk
pregnancy in form of mortality ,still birth ,birth asphyxia, low birth weight , prematurity ,IUGR &
other congenital abnormalities. MATERIAL & METHOD :Standered research & statistical method.
RESULT: maternal anemia68%,hypertension disorder in pregnancy- 29%,Maternal age < 20yr 16%,Premature onset of labor-13%,Metarnal infection -10%,Bad obstratics H/O-16%, Incidence of
sickle cell anemia -7%,Maternal Diabeties -%,Antipartam Hemorrhage-5.7% Heart disease -.4%
Perinatal Outcome: Perinatal Mortality 15%,Still Birth15%,Low Birth Weight 35%, Prematurity
28%, Birth Asphyxia9% IUGR15%, Full Term30% Previous High Risk Studies: By Rechard
ABURY—Shows LBW -31% & Prematurity 20% Comparison of hypertensive studies : by J
Nandkarini etal & Present Study. Still born-15.9%(Previous study),10%( Present study ), LBW51.7%(Previous study)50%( Present study ), Preterm- 23%(
Previous study)45%( Present study
), IUGR-21.3%(Previous study)30% ( Present study ) Mortality during Perinatal period is highest in
unbooked handled cases in the present study. CONCLUSION: In present study we are found the
higher incidence of preterm(45%) & IUGR(30%) and nearly equal incidence of LBW.
NEO/56(P).ARE WE BEING BLIND TO ROP: INITIAL EXPERIENCES FROM A NICU.
Peeyush Jain, Anuradha Govil, Ajay Kapoor, D N Virmani
Kasturba Hospital, Darya Ganj, New Delhi-2
Retinopathy of Prematurity (ROP) is the second most common cause of childhood blindness. With
an increase in survival rate of premature babies, the incidence of ROP is on the increase. However
most of ROP patients are not being picked-up in time. Design: Initial data from an on-going
prospective hospital based study is being presented. Settings & Methods: Susceptible Nursery
admissions of Kasturba Hospital, New Delhi, fulfilling standard ROP screening criterion (Birth
wt.<1500 gms &/or Gest.Age<34 wks, &/or other high risk factors) were included. Examination by
Indirect Opthalmoscopy and subsequent follow-ups were conducted in Nursery by trained viteroretinal opthalmologists. Screening was considered complete once the retina reached maturity or
threshold disease. Results: Thirty Four neonates with mean(+sd) birth weight of 1442(218)gms
ranging from 1000 to 1800gms with mean(+sd) gestational age at birth being 31.8(2.0)wks ranging
from 28 to 36wks were initially examined at a mean(+sd) post-conceptional age of 34.5(2.4)wks.
Thirteen (38.2%) of the babies came for follow up examination. Six(17.6%) of the neonates were
detected to have ROP: 3(8.8%) were diagnosed as ROP at the first screening and 3(23%) on
subsequent follow-up. Two(5.8%) neonates were also detected to have non-ROP probable causes of
blindness. One(16.6%) baby of ROP has already been subjected to Laser treatment. Conclusions:
Mandatory and timely screening of susceptible neonates, in perspective of high incidence of ROP
with easily available diagnostic and management techniques, is need of the hour. It would go a long
way in preventing blindness in children.
NEO/57(P).NEONATAL RESUSCITATION WITH ROOM AIR Vs 100% OXYGEN
Shreepal M. Shah, B.B. Javadekar
Depatment of Pediatrics, M.P. Shah Medical College, Irwin Hospital, Jamnagar
Growing evidences from both animal & human studies showing that room air is as effective as
100% oxygen & oxygen may have adverse effects on breathing physiology & cerebral circulation.
To determine the concentration of oxygen that maximize the efficacy is an important task to
improve outcome of neonatal resuscitation. Objectives: Study carried out with aims & objectives of
comparing short term outcome of newborns with birth asphyxia resuscitated with either 100%
oxygen or room air. The comparison was carried out with help of following parameters: Heart rate
& oxygen saturation at 1.5, 3, 5 and 10 minutes; incidence & severity of Hypoxic ischemic
encephalopathy (Sarnat & Sanat method); Neurological examination at the time of discharge.
Design: Prospective study; Setting & Methods: 105 newborns termed as asphyxiated according to
defination were resuscitated with either room air or 100% oxygen. Inclusion criteria: Babies of 37
weeks completed gestation age with apnea or gasping respiration at birth &/or heart rates less than
100 beats/minute were defined as Asphyxiated babies. Randomization of babies was done according
to their date of birth. Parameters recorded continueously till oxygen saturation reached 90% or for
atleast 10 minutes & heart rate, HIE staging, neurological status at time of discharge. Results: Heart
rates in oxygen group (100% oxygen) at 1.5,3,5 & 10 minutes respectively were 113.54 ± 8.53,
139.18 ± 13.41, 164.63 ± 12.88, 183.70 ± 12.29 where in room air group (21% oxygen) they were
114.56 ± 10.01, 146.90 ± 45.19, 165.90 ± 13.74 & 181.76 ± 21.90 (P > .05). Oxygen saturation at
1.5,3,5 & 10 minutes respectively in oxygen group were 34.89 ± 7.39, 58.52 ± 8.91, 75.78 ± 7.9 &
81.10 ± 12.41 in comparision to room air group 33.6 ± 7.50, 59.1 ± 8.44, 76.14 ± 8.67 & 87.82 ±
5.5 respectively (P >.05). Diagnosis of HIE stage-1 was made in 16.36% babies in oxygen group
whilst it was made 16% in room air group (P >.05). HIE stage-2 & 3 diagnosed patients were
21.81% in formal group & 20% in later group (P >.05). Neurological abnormal newborns at the
time of discharge in both the groups were found nonsignificant statistically (P > .05). Conclusion: In
the present study the room air resuscitated newborns recovered as quickly as the 100% oxygen
resuscitated newborns when tested by parameters such as heart rate, oxygen saturation at 1.5, 3, 5 &
10 minutes, occurrence of Hypoxic ischemic encephalopathy & short term neurological outcome.
NEO/58(P).NEONATAL SEPSIS, CLINICAL CORRELATION
Satyapal P. Rathod, Rekha Bhavsar, Rajal Prajapati, Ashish Mehta, Satyapal Rathod
Room No. D-24, Doctor Quarters, V.S. General Hospital, Ellisbridge, Ahmedabad – 380006.
Introduction : Neonatal sepsis ranks amongst the three commonest illnesses : affecting babies and
ranks as topmost illnesses responsible for neonatal mortality. Early diagnosis and intervention is
key in good outcome of sepsis. Aims : To study clinical risk factors and reliability of laboratory
parameters for neonatal sepsis. Materials & Methods : Total 63 newborns studied prospectively,
admitted in NICU (January 06 to August 06). Inclusion and exclusion criteria for study followed.
Detail history, examination and routine investigations done as per protocol and babies followed.
Observation & Discussion : (1) First day blood culture positive were 18/63 (28%) treated as EOS
and remaining 45/63 (72%) blood culture negative were observed & followed. (2) 8/45 (17%)
premature babies became symptomatic for sepsis. Birth weight didn’t play major roll in
development of sepsis. (2) 7/45 (16%) AGA, 2/45 (4%) babies became symptomatic for sepsis. (4)
Maternal risk factors : fever in last trimester(3/63 4%), PROM (6/63, 9.5%), inadequate ANC (9/63,
14%) had significant correlation with sepsis (5) Neonatal risk factors : birth asphyxia12/45 (23%),
active resusqitation16/45(35%), instrumental deliveries3/45(6%), showed significant correlation
sepsis. (6) Clinical Parameters : colour changes(16/63, 25%) apnea(7/63, 11%), hypothermia(7/63,
11%), prolong CRT(25/63,39%) and sclerema(11/63, 17%) showed high correlation with sepsis. (7)
Laboratory parameters : CRP had 80% specificity and 50% sensitivity, APC(75% specificity, 50%
sensitivity), ANC(55% specificity, 100% sensitivity), micro ESR(66% specificity, and 100%
sensitivity), I:T ratio 34% specificity 100 sensitivity. Summary : Prematurity(17%), SGA(16%),
AGA(4%),
Birth
asphyxia(26%),
RDS(26%),
Instrumental
delivery(6%),
Active
resusqitation(35%), Maternal pyrexia(4%), PROM(9.5%), inadequate ANC(14%), Symptomatic
babies with positive laboratory findings are the high risk for development of sepsis.
NEO/59(P).STUDY OF NEWBORNS OF MOTHERS HAVING HISTORY OF MECONIUM
STAINED LIQUOR
Pankti V. Modi, Rekha Bhavsar, Archana Shah, Pankti Modi
15, Blue Moon Appartment, 35, Mahalaxmi Society, Paldi, Ahmedabad – 380007.
Introduction : Meconuim is the greenish material passed as the first stool by newborn or
occasionally the fetus. when passed in utero, it spills in amniotic fluid causing Meconium Stained
Amniotic fluid (MSAF), MSAF is regarded as a sign of fetal distress. Meconium Aspiration (MA) –
defined as presence of Meconium below the vocal cords and (MAS) Meconium Aspiration
Syndrome (MA with respiratory distress) are associated with MSAF. This study was undertaken as
MAS is an important cause of parinatal morbidity and mortality. Aims : To study incidence and
factors affecting morbidity and mortality in babies with MSAF and MAS. Materials and Methods :
90 Newborns delivered through MSAF between January 2004 to June 2005 were enrolled in this
prospective study. All babies were observed for 6 hours, only depressed babies were admitted to
NICU. Vigorous babies kept with mothers were followed and admitted if signs of respiratory
distress or asphyxia developed. Direct laryngoscopy for evaluating MA and endotrachal suction
there after was done for MA and for all depressed babies. Data was recorded in proforma and
standard management protocols were used. Babies were followed till discharge. Data was analysed.
Observation & Discussion : 75/90(83%) cases were post term and term babies, 33/90(36.6%) were
depressed at birth, M/F ratio was 1.7: 1; 49/90 (55%) were >2.5 kg at birth. 68/90(75%) were
delivered vaginally. 34/90(37.7%) had history of antenatal fetal distress and 26/34(79%) were born
depress, 38/90(42.2%) babies developed MA. 32/33(96.7%) babies born depressed had MA.
36/90(40%) developed MAS. 31/33 (93.4%) of depressed babies had MAS. Mortality in MSAF was
11/90(12.2%) all with MAS and in MAS was 11/36 (30.5%) Summary : Incidence of MAS in
MSAF was 40% MSAF mortality was 12.2% while MAS mortality was 30.5%. Full term and post
term (83%) weight >2.5 kg (55%), antenatal fetal distress (37.7%) and vaginal delivery (75%) are
associated with MSAF. Babies born depressed, having prolonged contact with MSAF and thick
meconium had poor outcome in the form of MAS and increased morbidity and mortality.
NEO/60(P).PAIN ASSESMENT IN THE PRETERM NEWBORNS AFTER HEEL PRICK
WITH PHARMACOLOGICAL(EMLA) AND NONPHARMACOLOGICAL (BREAST
FEED) ANALGESIA.
S Manazir Ali, Mohd. Ziaul Haque, Shajahan Bano, Seema Alam, Musharraf Shamim
Department of Pediatrics and Anesthesiology, JNMCH, AMU, Aligarh -202002
Newborns especially preterm babies are more sensitive to pain due to free nerve endings. However
it is often neglected during routine procedures like heel prick and other invasive intervention. Hence
this cross sectional study was carried out in the Neonatal Section of the Department of Pediatrics in
collaboration with the Department of Anesthesiology with effect from October 2005 to August 2006
in order to assess the pain in the form of physiological and behavior changes in the preterm
newborns. Out of 75preterm babies 25 babies have not received any analgesia before heel prick
while 50preterm babies have received analgesia (25 have received Breast feed and in the remaining
25 babies EMLA was applied at the heel site prior to 30 minutes prick) The preterm babies who
have not received any analgesia served as control while babies who have received analgesia
constituted study group. The physiological parameters included in this study were heart rate,
respiratory rate, systolic and diastolic B.P, spo2. while behavioral parameters were observed in the
form of changes in muscle tone, flushing, finger clinching, limb thrashing, writhing, arching of
back, head banging, grimacing, eye screwing, nasal flaring, tongue curving, nasolabial folds, chin
quivering. Pain assessments in the preterm babies were done using the PIPP (Premature Infant Pain
Profile) score and the duration of the first cry noted. The mean gestational age was 33±1.44 wks.
Significant changes in the HR & RR was observed at 30 seconds after heel prick while significant
HR & RR persisted till 1 minute which normalized at 5 minutes. However no significant changes
were observed in temperature, spo2 and systolic & diastolic B.P. in the control group. The PIPP
score of breast feed group(5.93±1.72) is lower than EMLA(11.5±2.31)and control
group(10.72±2.76) which suggest that breast feeding acts as good analgesic agent than EMLA .
Hence in conclusion breast feed and skin contact act as better non pharmacological analgesia than
EMLA for acute, short painful intervention. So breast feed which is cheap, easily available can be
used as better alternative to pharmacological analgesia i.e. EMLA (Eutectic Mixture of Local
Anaesthetic).
NEO/61(P).DISCORDANT TWINS WITH THE SMALLER BABY APPROPRIATE FOR
GESTATIONAL AGE – UNUSUAL MANIFESTATION OF SUPERFETATION
Tanmay Toteja, Noopur Baijal, Mohit Sahni,Neeraj Verma,Amit Kumar,Jacob M. Puliyel
Department of Pediatrics and Neonatology,St Stephens Hospital,Tis Hazari,Delhi 110054
Introduction: Superfetation is fertilization and subsequent development of an ovum when a foetus is
already present in the uterus. We report a case where smaller of the twin was of appropriate
maturity, weight and length for gestational age - circumstances that argued against intrauterine
growth retardation in the smaller twin. Case Report: A 21-year-old had an antenatal ultrasound
examination done at 26 weeks. This showed twins, one who was of appropriate size for duration of
amenorrhoea and the other who was approximately four weeks too large. Six weeks later, after 32
weeks of amenorrhoea, live twins were delivered. The first of twins weighed 980 grams and the
next baby weighed 2160 grams. The evidence of disparity in the gestational ages of the 'twins', was
corroborated by the estimation of age based on anthropometric measures, weight, length and head
circumference, ophthalmic examination, bone age and dental age estimates. These evidence taken
together, suggest that there was a real difference of approximately 4 weeks in the gestational ages of
the twins and this was in keeping with the findings of the ante-natal ultrasound examination.
Discussion: Intra uterine growth retardation is the usual cause of discordance in multiple
pregnancies. A search of Pubmed has shown that there are 17 cases of superfetation reported in
literature. In all previous reports the larger twin is of appropriate gestational age and the smaller
twin was small for the gestation calculated from the date of the last menstrual period. In our case the
smaller twin was of appropriate size and maturity for the gestation assessed from the mother's report
of LMP and the second twin was approximately a month too large and mature.
NEO/62(P).REFRACTIVE ERROR AT BIRTH: IT'S RELATION TO NEWBORN
PHYSICAL PARAMETERS AT BIRTH AND GESTATIONAL AGE
Pallav Rastogi, Varghese RM., Sreenivas V., Puliyel JM., Varughese S.
Department of Neonatology and Department of Ophthalmology, St Stephens Hospital, Delhi
Background :Refractive error at birth is related to gestational age. Preterm babies have myopia
which decreases as gestational age increases. This study looked at the correlation between refractive
error and birth weight, and other physical indicators of growth such as head circumference and
length of the baby at birth. Methods : Data from 1118 eyes at birth is analyzed. Growth parameters
were measured soon after birth. Refraction was performed within the first week of life. Simple
linear regression analysis was performed to see the association of refractive error, (mean spherical
equivalent, astigmatism and anisometropia) with each of the study variables, namely gestation,
length, weight and head circumference. Subsequently multiple linear regression was carried out to
identify the independent predictors for each of the outcome parameters. Results : Simple linear
regression showed a significant relation between all 4 study variables and refractive error but in
multiple regression only gestational age and weight were related to refractive error. We found that
refractive error correlated better with birth weight than it did to gestational age. Conclusions: It
would appear from this study that birth weight rather than gestation should be used as criteria for
screening for refractive error especially in the context of developing countries where the incidence
of intra uterine malnutrition is common.
NEO/63(R).NEONATAL MORTALITY IN RURAL INDIA- A CROSS SECTIONAL
STUDY
Reeta Rasaily
Indian Council of Medical Research rasailyr@icmr.org.in
Introduction: The Indian Council of Medical Research is carrying out a community based
effectiveness study of providing home based newborn care by appropriately trained village health
worker at five rural sites of India for reducing morbidity and mortality in neonates and young
infants. Objective: Baseline mortality survey was carried out for identifying PHCs with similar
neonatal mortality rates for selecting intervention and control areas. Observation from baseline
mortality survey is being reported. Methodology: A house to house survey was carried out during
the period of January to July 2003 in 9 PHC areas (selected by convenience selection process) of
five districts namely Patna, Yeotmal, Cuttack, Rajsamand and Barabanki in the state of Bihar,
Maharashtra, Orissa, Rajasthan and Uttar Pradesh respectively. Information was collected
retrospectively on births and infant deaths, age at death and details of delivery during the reference
period of one year (i.e. 2002 January to March 2003 by using local calendars to ascertain dates.
Survival analysis was done to determine time of death. Results: In the five districts 2,53,903
household covering a population of 1,316,681 were surveyed. More than half (54.5 %) mothers
were illiterate, most (70.8%) deliveries took place at home and 66.1% deliveries were conducted by
dais or family members. There were 29,850 live births, 623 still births, 1,521 neonatal deaths and
2,218 infant deaths in five sites. The IMR, NNMR and ENMR were 74.3/1000 LB (range
52.2/1000 -112.6/1000 LB), 50.9/1000 LB (range 36.6/1000 LB-77.6/1000LB) and 37.7/ 1000 LB
respectively. Still birth rate and perinatal mortality rates were 20.9/1000 LB and 58.6/1000LB
respectively. 74.1% of neonatal deaths and half (50.8%) of infant deaths took place in the early
neonatal period. Of all neonatal deaths, 39.3% occurred on the first day of life and 56.8 % during
the first three days. Mortality during first three days ranged from 51.1% to 65.3% across the centers.
Further, the proportion of infant deaths on the first day was 27.0 % and 38.9% in the first three
days. Conclusion: Early neonatal mortality especially during first three days of life appears to be
the major contributor to neonatal and infant mortality. Interventions targeting the perinatal and early
neonatal period must be put in place urgently for further reduction of infant mortality.