NEO/01(P) THE KNOWLEDGE ATTITUDES AND BELIEVS REGARDING
ANTENATAL AND CARE OF SEEK NEONETS IN SCHEDULE CASTE, SCHEDULE
TRIPS AND PEOPLE LEAVING BELOW POVERTY.
Nabamita Chaudhury, Nabendu Chaudhuri
Department of Pediatrics, KPC Medical College, Jadavpur, Kolkata
nabenduchaudhuri@gmail.com
A multi centric cross sectional study was conducted in Burdwan District adjust in to Burdwan
Medical College to see the care of the antenatal mother and seek neonates. Aims & Objects: The
aim of the study to see the knowledge attitudes and believes regarding antenatal and care of seek
neonates in schedule caste, schedule trips and people leaving below poverty. Metrials &
Methods:This study was conducted in three groups and each group comprise of fifty cases. The
inclusion criteria was the subject must be SC, ST, or BPL and leading adjacent to Burdwan
Medical College. And every one had lost there children with in seven days of birth. The three
were as follows: Group I with in 15 kms, Group II >15 to 50 kms, Group III >50 kms. Results:
The socio economic status was grade 4 to 6. Literacy was <4 standard, 40 to 48% cases in
mother, 30 to 44% cases in father. Illiteracy is more common in group C in both the parents (36
to 20%). All the mothers were house wife and father’s occupation was either cultivation, daily
worker only 4 to 10% cases were service holder but in private sectors with miserable salary.
Antenatal checkup was taken from quack in 22%, 30% and 40% in group I, II, III cases. The
Antenatal checkup by specialist in this group was 40%, 30% and 24%. None of the mothers who
had received antenatal checkup by quack had not received iron and folic acid tablets, though are
available for govt. sectors. The height of the mother <145” 22% in group I, 26% in group II, and
32% in group III. The delivery was conducted at home by untrained dhai or by quack in 24% in
group I, 30% in group II, and 46% in group III. Dealing the illness of the babies they were
treated by quack or homeopath in 26% in group I, 36% in group II, and 50% in group III. Those
babies who are treated by general physician, and specialist had not received rational antibiotics.
The babies died 100% in group I, 20% in group II, and 10% in group III died in Burdwan
Medical College Conclusion: The families who are living adjacent or far away from Medical
Colleges has not the much deference in attitudes regarding the antenatal care of the mother,
conduction of delivery and treatment of the neonates. Still the people have inclination the home
delivery by the untrained dhai which is very harmful for the newborn. The attitudes of the family
remain sane in spite of having the facilities adjacent. Thus to decreases the early neonatal death
the govt. should take adequate majors to improve the knowledge the attitudes and believes but
not only providing the opportunities.
NEO/02(P) TO ASSESS THE REBOUND AFTER EXCHANGE TRANSFUSION
Ravi Bhatia, A. P. Gupta, Dipendra Garg
Dept. of pediatrics, GMCH, Udaipur
ravimonal@rediffmail.com
Objective: To assess the rebound after exchange transfusion. Material & methods: 26 babies who
had undergone exchange transfusion in our NICU were included in the study. Sex, Birth weight,
gestational age, apgar, mother blood group, baby blood group, sepsis work up, serum bilirubin
of all babies was recorded in a Performa. Exchange transfusion was done according to weight,
gestational age, day of life, risk factors etc. Out of the 26 babies, 18 were male and 8 were
females. Bilirubin level was assessed immediately after Post Exchange and 12 hrs after exchange
transfusion. Data obtained was subjected to statistical analysis. Results: In the study group 8
babies weighed >2500 grams at birth, 6 babies weighed between 2000-2500 grams, 4 babies
were between 1500-2000 grams, 6 babies were between 1000-1500 grams and 2 babies were less
than 1000 grams. The mean pre exchange serum bilirubin was 17+- 6.09 mg/dl.The mean value
of serum bilirubin immediately after exchange was 6.95+-1.87 mg/dl. The mean value of
bilirubin 12 hrs after exchange was 12.58+- 2.34mg/dl. 3 babies required a second exchange
transfusion. There was significant rise in bilirubin 12 hrs after exchange p value 0.002.
Conclusion: Rebound rise in serum bilirubin is significant 12 hrs post exchange.
NEO/03(O) NEONATAL BARTTER SYNDROME: A CASE SERIES
Subandhu Gupta, Meetu Rawat Gupta, A.S. Vasudev, R.N. Srivastava
Department of Pediatrics, Indraprastha Apollo Hospital, New Delhi.
meetur2007@yahoo.com
Introduction: Bartter syndrome is an inherited renal tubular disorder characterized by
hypokalemia, hypochloremic metabolic alkalosis, normal blood pressure(BP) with
hyperreninemia and increased urinary loss of sodium, potassium and chloride. Neonatal form
being rare, we report 2 cases, showing improvement with Indomethacin and potassium
supplements. Case1: A 15 month old boy presented with failure to thrive(FTT). He was a term
SGA(birth weight 1.8Kg), with history of maternal polyhydramnios. He showed poor acceptance
to complementary feeds but would consume large quantities of liquids and pass urine frequently.
Investigations
showed
metabolic
alkalosis(pH-7.5),
hypochloremia(98meq/l),
hypokalemia(2.4meq/l), raised serum Aldosterone(1087IU/L) and increased urinary losses of
potassium(9.9meq/l) and calcium(2.5meq/l). Ultrasound abdomen revealed bilateral medullary
nephrocalcinosis. He was managed with Indomethacin(2mg/Kg) and potassium supplementation.
On discharge, there was clinical improvement with serum potassium of 4.2 meq/l. On follow-up
visits, he showed consistent weight gain. Case 2: A 7 ½ month male infant, resident of Kabul
presented with FTT and polyuria. He was a term AGA with antenatal history of maternal
polyhydramnios. He had mild pallor, normal BP and systemic examination. Investigations
showed metabolic alkalosis, low serum potassium(3meq/l), chloride(99meq/l) and
magnesium(1.6mg/dl), high serum bicarbonate(28.17meq/l), Aldosterone, Prostaglandin and
Renin and increased urinary excretion of potassium(2meq/l) and calcium(1.8meq/l). Abdominal
Ultrasound showed hyperechogenic kidneys. He was managed and discharged on Indomethacin
and potassium supplementation. On follow up, he showed marked clinical and biochemical
improvement(K+4.1meq/l). Conclusion: Neonatal Bartter syndrome should be considered in an
infant with no obvious cause of FTT and unexplained polyuria. Early diagnosis with initiation of
Indomethacin and potassium supplements prevents complications.
NEO/04(P) NEWBORN CARE PRACTICES IN SLUM AREAS OF JAMMU
Ritu Gupta, Ravinder K. Gupta
Child Care Clinic , 136 Nai Basti Jammu Cantt., J&K 180003
riturgjammu@indiatimes.com
Background: Despite efforts by government and other agencies, neonatal morbidity and mortality
continues to be high in India. Among other reasons, newborn care practices are major
contributors for such high rates. Aims: To find out the newborn care practices including delivery
practices, immediate care given after birth and breast-feeding practices in slums of Jammu.
Settings And Design: Community based, cross-sectional observational study conducted at Child
Care Clinic, Nai Basti Jammu Cantt. Study Period : March 2009 to Feb 2010. Materials And
Methods : About 100 mothers belonging to migrant labor population were considered for the
study. A semi-structured, pre-tested schedule was used to interview these 100 mothers of
newborns in the study area .Results: About 80% newborns were born at homes , which were
mostly conducted by local dais and relatives, while rest deliveries were conducted at
government institutions(16) and private nursing homes(4). Bathing the baby immediately after
birth was commonly practiced in 62 (77.5%) of home deliveries. The nose and oral cavity in
babies delivered at home were cleaned by finger by 54(67.4 %) while cotton swap was used in
34(42.5%) babies for cleaning. A new shaving blade in 36 (45%), knife in 28(35%), old blade in
11(13.7%) and surgical blade in rest of newborns were used to cut the umbilical cord in babies
born at home. About 63 (79.8%) of home delivered newborns were not weighed at birth.
Rooming in was practiced in majority of the cases. A few of home delivered neonates (12) were
given injection tetanus toxoid by unqualified practitioners. Injection Vitamin K was also given to
10 home delivered newborns Use of clip, band or sterile thread to tie the cord and no application
to the cord was significantly higher in institutional deliveries. Honey (79%) and rose water
(13%), water from sacred areas (11%), glucose water (6%), etc.were used as prelacteal feeds by
these mothers. Breast feeding was initiated within 4 hours by about 20% mothers who had
delivered at home as compared to 75 % in institutional deliveries. Breast milk as the first feed
was significantly more in institutional deliveries. Conclusions :There is an urgent need to
reorient health care providers and to educate mothers on clean delivery practices and early
neonatal care.
NEO/05(O) PREGNANCY AND EARLY NEONATAL CARE FOR UNDERSTANDING
OF COMON PEOPLE (in Hindi)
N.L. Phuljhele.
Kanchanganga, Phase2, Danganiya, PO.R.S.University, Raipur -492010
drnsph@gmail.com
Mortality under 5 is majorly contributed by neonatal deaths, which is 37% in which infection
/sepsis is the major factor counting 43% & deaths are due to preterm 26%, Birth Asphaxia 23%
and congenital anamolies 8%. Of these, nearly 70% deaths are preventable by awaring common
people in relation to causative factors of death. Therefore, I have prepared chart in Hindi with
consideration of care before, during pregnancy & delivery, for reduction of NMR, & prevention
neonatal hypothermia, sepsis .This chart shows congenital problems &critical illness.
NEO/06(O) RELATIONSHIP OF ANTEPARTUM HEMORRHAGE WITH THE FETAL
WELL BEING ,BIRTH WEIGHT AND GESTATIONAL AGE OF NEWBORN
DELIVERED.
Devendra Sareen, Ritu Chabra, Ujjwala Jain, Jyoti Jain, Jitendra Jain, Umang Upadhyay,
Virendra Patil
C/o, Dr. Devendra Sareen, 27-F, New Fatehpura, Near Big Bazar, Sukhadia Circle, Udaipur313001
drsareen@yahoo.com
Antepartum hemorrhage has adverse effect on growing fetus. The present study was conducted
to find out effect of antepartum hemorrhage on fetal well being, birth weight and gestational age
of newborn delivered. The study was conducted on 100 mothers having antepartum hemorrhage
in the Department of Obstetrics and Gynecology at Pannadhay Chikitsalya, Udaipur. In this
prospective study a detailed obstetric history was obtained and a thorough physical examination
of each patient was conducted. APGAR score at 1 minute and 5 minutes was noted and birth
weight of each newborn delivered was assessed. It was observed that 52% of the fetuses were
having normal F.H.S. while 18% had evidence of fetal distress and 30% had absent F.H.S. The
stillborn and babies with fetal distress were more in abruptio placentae group while most of the
fetus having normal F.H.S. belonged to placenta previa group. The mean weight of the newborns
being delivered was 1.90+/- 0.07 Kg in placenta previa group while it was 1.56+/-0.06 Kg in
abruptio placentae group. This was significantly low in comparison to healthy controls(2.55 +/0.08 kg ) The mean gestational age in placenta previa group being 34.20+/-0.08 weeks while in
abruptio placentae group it was low (32.09 +/-0.07 weeks) in comparison to healthy controls (
38.02 +/- .08 weeks ) . The fetal distress, low birth weight and small gestational age of these
newborns demands meticulous care for those who are delivered to mothers having ante partum
hemorrhage.
NEO/07(P) BLOOD GLUCOSE LEVEL AT 2-3 HOURS OF LIFE IN LOW BIRTH
WEIGHT NEWBORNS
Srishti Sareen, Abhishek Ojha, Jitendra Jain, PK Singhvi, Umang Upadhyaya
C/o. Dr. Devendra Sareen, 27-F,New Fatehpura, Near Big Bazar,
Sukhadia
circle, Udaipur - 313001
drsareen@yahoo.com
Low birth weight newborns form a major sector of all live births in our country.The present
study was aimed to estimate the levels of blood glucose at 2-3hours of life in low birth weight
newborns. For this study 50 low birth weight newborns weighing between 1.5 to 2 kg were
selected amongst those who were delivered in Pannadhay Mahila Chikitsalaya. 50 full term
newborns weighing >2.5 kg served as control group. The mean blood glucose level in low birth
weight newborns was 34.66 +/- 10.95 mg/dl which was significantly low as compared to age
matched control (81.33+/-8.05 mg/dl) P < 0.001. Lower blood glucose levels in low birth weight
newborns at 2hr-3hr of life warrant to start early feeding specially in low birth weight newborns.
This would safeguard these newborns to develop asymptomatic hypoglycemia and would help in
avoiding the sequelae of asymptomatic hypoglycemia.
NEO/08(O) RISK SCORE FOR PREDICTION OF NEURODEVELOPMENTAL
OUTCOME OF VERY PRETERM INDIAN BABIES
Radhika S, Abey Mathew, Prameela Joji, Naveen Jain
Department of Neonatology, Kerala Institute of Medical Sciences, Anayara, PB
No.1,Thiruvananthapuram, Kerala-695029.
radhika_ajith@yahoo.co.in
Objectives: To evolve a risk score to predict the neurodevelopmental outcome of very preterm
Indian babies (≤ 33 weeks). Methods: Descriptive analytic study. Setting: Referral NICU with a
developmental follow up clinic Study period: January 2005 to July 2009 Materials and methods:
All Very Preterm babies (≤ 33 weeks gestation) discharged from the NICU were followed up for
a period of one year of age or more, corrected for prematurity. The perinatal and neonatal risk
factors known to affect neurodevelopmental outcome were recorded prospectively, in a
structured form. Outcome measures: Major Neurodevelopmental Disability (NDD) was defined
as Cerebral Palsy or DASII Motor /Mental score <70 or Blindness in one or both eyes or Hearing
impairment needing hearing aids. Results : The incidence of Major NDD among the 225 babies
with follow up for more than one year was 6.2%. A simple clinical score, to predict risk of major
NDD, was evolved by combining 5 risk factors of greater significance in our study, gestation ≤
28 weeks, need for extensive resuscitation at birth, symptomatic hypoglycemia, ventilation for >
7 days and abnormal neurosonogram findings. Scores of 1- 5 were associated with 4, 6, 10, 25,
100% risk of major NDD respectively (p=0.00). Conclusion: We could stratify 87.5% of the
babies, based on the risk score, into low risk and 12.4% into high risk for major NDD. Infants in
the low risk category could be placed on a less frequent follow up schedule. Hence, this would
serve the purpose of optimal utilization of limited follow-up services.
NEO/09(P) THE BEHAVIOUR OF THE SERUM BILIRUBIN UNDER STANDARD
PHOTOTHERAPY IN NEONATAL JAUNDICE
K. K. Locham, Jaswir Singh, Maninder Kaur, Manpreet Sodhi, Deepak Sharma, Ashwani Kumar
Deptt. Of Pediatrics & Biochemistry, Govt. Medical College/ Rajindra Hospital,Patiala-147001
kklocham@hotmail.com
Aims & Objectives:To evaluate the behaviour of serum bilirubin under phototherapy. Material
and Methods:The study was conducted on 100 jaundiced newborns.The phototherapy unit was
comprised of 4 special blue and 2 day light fluorescent tubes (20 watt each). Total, direct and
indirect bilirubin in serum was estimated before starting and after stopping phototherapy by
Malloy and Evelyn method. Results:The mean rise in total serum bilirubin(TSB) in 1st 24, 24-48
& 48-72 hrs of phototherapy in mg/dl was 1.60±1.26(38 cases), 1.32±0.95(5 cases), 1.72±0.51(4
cases).The mean fall observed in 0-24, 24-48, 48-72, 72-96, 96-120, 120-144&144-168 hours
was 2.25±1.41 (61 cases), 2.41±1.23(60 cases), 2.12 ± 0.95(44 cases), 1.89 ± 0.99(19 cases),
1.75 ± 1.03 (11 cases) and 1.72 ± 0.94 (6 cases) and 1.4 ± 0.5 in 3 cases. The rise and fall
between different hours was not significant.The mean rise in TSB in mg/dl/day was 1.50±1.03,
1.84±1.67 and 1.85±1.51 in >2000g, 1501-2000g and 1001-1500g babies. The mean fall was
2.31±1.24, 1.79±1.10, 1.92±0.70 in >2000g, 1501-2000g and 1001-1500g weight babies
respectively. Conclusion: There was rise as well as fall in TSB during 1st 72 hours of
photothrapy.There was only fall beyond 72 hrs of phototherapy.The mean rise in TSB was
1.59±1.18 mg/dl/day and mean fall was 2.18±1.20 mg/dl/day.
NEO/10(P) ABDOMINAL DISTENSION IN NEWBORNS - AN EVALUATION
K.K.Locham, Manpreet Sodhi, Neeraj Arora.
Deptt. Of Pediatrics & Biochemistry, Govt. Medical College/ Rajindra Hospital,Patiala-147001
kklocham@hotmail.com
Aims and Objectives: To evaluate the causes of abdominal distension in newborns. Material and
Methods: 17 newborns with abdominal distension admitted to Neonatology Section of
Department of Pediatrics, Government Medical College, Patiala were the subjects of the study.
Sex, gestation, antenatal risk factors, apgar score, disease pattern, day of appearance of
abdominal distension and its duration were noted on the pretested proforma. Septic Screen in the
form of CRP and I/T ratio was done. Blood Culture and sensitivity, blood urea and random blood
sugar were evaluated in every case. Plane X- ray abdomen was done in 9 cases.
Results: 7 babies were preterm and 10 were term. Birth asphyxia was present in 3 cases and only
2 of these had mild and one had moderate asphyxia. In maximum number of cases (7) abdominal
distension was observed on 2nd day of life. 4 babies each had abdominal distension on 1st and 3rd
day of life respectively. One each had distension on 4th and beyond 4th day of life. No baby had
delayed passage of meconium. Distension persisted for only 1 day in majority of babies (59%). It
persisted for 2 days in 29 % of babies and only 1 day in rest. Mean duration of abdominal
distension was 38 hours and 20 minutes. In 41% of cases, distension was idiopathic followed by
feeding intolerance in 23.5%, birth asphyxia in 17.6%, and septicemia in 11.8% and
hypoglycemia in 6%. Conclusion: Abdominal distension was idiopathic in 41% of babies.
NEO/11(P) THE OUTCOME OF MECONIUM ASPIRATION SYNDROME
G. Sarat Chandra, B.Sandeep, T.A. Veena
saratgullapalli@gmail.com
Objective: To Study The Outcome of Meconium Aspiration Syndrome. Study design: This is a
prospective study to know the outcome of Meconium Aspiration Syndrome in both the inborn &
outborn admissions to RLJH attached to Sri Devaraj Urs Medical College during the study
period from December 2007 to November 2008. Method : 60 babies of the inborn & outborn
admissions with Meconium Aspiration Syndrome were taken into the study who fulfilled the
inclusion criteria . Needed investigations were done & treatment was followed up for a period of
six months to see for the outcome and development of morbidities. Results: Of the 60 babies
taken into the study, 45 were in born & 15 were out born. There was one mortality and remaining
59 babies were followed up subsequently and it was found that 7 babies had developmental
delays, 12 developed bronchopneumonia , 4 developed bronchiolitis and in 1 baby a
coincidental finding of Atrial septal defect was found. Conclusion: Meconium aspiration
syndrome is responsible for a large number of morbidities in the new born period . Early and
timely interventions can prevent the immediate mortality as well as long term morbidities.
NEO/12(P) AMNIOTIC BAND SEQUENCE
Uma Raju, Ajoy Garg, Monisha Biswas
Department of Pediatrics, 7Air Force Hospital, Kanpur
rakhee.garg@yahoo.com
Amniotic band sequences are generally a sporadic condition. Its incidence is one in 10 000 - 45
000 births. The cause of amniotic band sequence is not known. The most widely accepted
explanation is that amnion rupture occurs in the first trimester of pregnancy, and fetal parts
become entangled in bands which form between a torn amnion and chorionic mesenchyme. Case
Report: A boy baby was delivered by Caesarian section at term to 35 yrs old G2P1L1 lady with
fibroid uterus. Mother was booked and immunized and not on any medication. VDRL was
negative. Antenatal & natal periods was uneventful. At birth the neonate was observed to have
multiple grooves over ring & middle index finger of left hand & hypoplasia of left little finger.
Distal & middle phalanx of Left Middle finger was gangrenous with amniotic bands at the base.
Both Great toes were amputated. Right hand was normal. Birth weight of baby was 3.8kg
.Routine screening for other anomalies were normal. Pedigree analysis was not found to be
contributory. In view of symmetrical involvement, presence of amniotic band, no other organ
involvement and sporadic case, it was diagnosed as a case of amniotic band sequence.
Congenital amputations should be distinguished from congenital hypoplasia and/or aplasia. The
latter are due to transverse defects and hypoplasias are usually caused by monogenic mutations,
are severely damaging to the fetus, with a high risk of recurrence (often 25%).Risk of
reoccurrence of amniotic band sequence is rare. Ultrasound plays a leading role in prenatal
diagnosis of both transverse defects and amniotic bands and their complications. Differentiation
is important in genetic counseling and evaluating the risk of recurrence.
NEO/13(O) NEONATAL TRANSPORT – A RIDE TO BETTER CARE OR A
NIGHTMARE
Isha Chaudhari, Rajni Sharma, Vikram Datta
Dept. of Pediatrics, Kalawati Saran Children’s Hospital, New Delhi
drrajnisharma@yahoo.com
Introduction: Transportation of sick neonates whether from home to the nearest hospital or
interhospital transfer is a neglected area in India and there are not many studies addressing this
issue. Objective: We did this prospective study to evaluate the transport of sick neonates to a
tertiary care centre in the metropolis city of Delhi. Materials and Methods: The study was done
in the emergency department of Kalawati Saran Children Hospital, New Delhi over a 2 month
period. A structured questionnaire was administered to the accompanying care givers containing
pretransport, transport and post-transport details and patient review at admission included the
temperature, vitals, capillary refill time, oxygen saturation and blood glucose level. Results: 150
neonates were enrolled; 66% neonates were male and 26.6% were preterm. The major reasons
for admission were sepsis (22.6%), birth asphyxia(17.3) and jaundice(17.3). Majority of
neonates were transported from home followed by private hospitals. 27.3% of the babies were
brought to the hospital in ambulances, the rest were brought by public or private transport. 52%
of the children were brought from distance more than 25 km . In 60% babies the travel time was
more than 1 hour. 61.3% of the babies were brought in serious life threatening condition. At
admission, 44% of neonates brought by ambulance had hypothermia including 4.9% with severe
hypothermia, 29.3% had poor perfusion. No heating devices were used. Only one ambulance
out of a total of 41 had an incubator and 17.0% cases was the baby accompanied by trained
personnel. 54% of the parents who brought their referred critically sick children by public
transport due to unavailability of ambulances, 6.6% due to economic reasons, and 2.6% due to
lack of knowledge. We found an increased risk of hypothermia, poor perfusion and apnea of
neonates at arrival if the travel was more than 25 Km or greater than one hour duration but this
was not clinically significant. Conclusion: Transport of sick neonates is suboptimal in the
metropolis of Delhi. Ambulance facilities are not adequate, and the ones available are ill
equipped Outreach education programmes for pediatricians and healthcare workers and training
in neonatal transport are vital as a part of essential newborn care.
NEO/14(P) VLBW & ELBW- MATERNAL PROFILE, COMPLICATIONS AND
OUTCOME: A COMPARATIVE STUDY
Ajit Singh, Anupam Chaturvedi, Rajiv Kumar Bansal
dr.ajitsingh2503@yahoo.in
Objective: To compare the antenatal profile of the mother and immediate neonatal morbidity and
mortality of VLBW and ELBW neonates over 3 years, delivered at SDMH. Methods:
Comparative analysis of 82 pre-terms weighing <1500 gm in year 2009 with 95 pre-terms in year
2006. The antenatal maternal profile, causes of preterm labour, immediate postnatal
complications and complications during the hospital stay were analysed. Results: A total of 76
mothers in preterm labour, delivered 61 VLBW and 21 ELBW babies, including 6 pairs of twins
and 1 triplet between 2009, as compared to 91 mothers with four set of twin delivery in 2006.
Amongst the various high risk factors for preterm labour, gestational hypertension was seen in
both the groups 37.8% in 2009 and 41% in 2006. Neonatal complications in both VLBW and
ELBW babies were RDS, neonatal jaundice and sepsis in both the year groups. Antenatal steroid
was administered in 69 (84%) cases in 2009 as compared to 35 (39%) cases in 2006,due to which
surfactant requirement significantly decreased in year 2009. Features of IUGR was seen in both
the groups. Incidence of neonatal mortality was 19.4% in 2009 to 29.5% in 2006. The mortality
rate was high in ELBW babies. Conclusion: The comparative study shows increase in number of
multiple pregnancy with time, increase in antenatal steroid administration in premature births
and decreased mortality rates.
NEO/15(P) CLINICAL SPECTRUM OF NEONATAL SEPSIS PATIENTS ADMITTED
IN A MEDICAL COLLEGE HOSPITAL NEONATOLOGY
Agarwal Vishnu, Verma C.R., Gupta Ashok, Sharma R.B.
Department of Paediatrics, SPMCHI, Jaipur
vishnu.agarawal@yahoo.in
Introduction: Neonatal sepsis is commonest diagnosis among admitted newborns in neonatal
ICU and is responsible for increasing morbidity, mortality and cost of treatment. Setting &
Design : Retrospective, hospital based, descriptive, case study. Aims and Objective : This
study was (total 60 neonates with proven diagnosis of neonatal septicemia was included)
undertaken to study the clinical spectrum, diagnostic profile, risk factor, neonatal mortality and
culture sensitivity of neonatal septicemia patients admitted in paediatric medicine wards of
S.P.M.C.H.I., Jaipur. Following diagnostic investigations were done for all patients like TLC,
DLC, PBF for toxic granules and band cells, CRP, Chest x-ray (PA view) and blood culture.
Results : Male to female ratio was 2 : 1. 18 patients were of L.B.W., 10 were of E.L.B.W. and
16 were of V.L.B.W. Rest 16 patients were of normal birth weight. 20 patients had early onset
sepsis and 40 patients had late onset sepsis. Main risk factor associated was prematurity (44/60).
20 patients were culture positive. Pathogen grown were coagulate negative staphylococcus (6),
followed by E. coli (4), enterococcus (3), klebsiella (3), streptococci (2) and pseudomonas (2).
Mortality among proven cases of neonatal sepsis was 40%, out of which 10 were of E.L.B.W.,
12 were of V.L.B.W. and 2 were of normal birth weight. Conclusion : Sepsis remains the most
important cause of mortality and mortality in NICU. The most significant risk factor associated
with Neonatal sepsis was prematurity.
NEO/16(P) NURSING CARE OF A NEONATE WITH OSTEOGENESIS IMPERFECTA
Ramaa Vijaykumar, Charusheela Warke, Nisha Iyer, Shruti Hule, Sushma Malik.
Pediatric Resident, Department of Pediatrics, 1st Floor, College Building, TNMC & BYL Nair
Hospital, Mumbai Central, Mumbai-400008
ramaa5885@gmail.com
Introduction: Osteogenesis imperfecta (OI) is a spectrum of connective tissue disorder
characterized by multiple fractures, osteopenia, blue sclera, bone deformities and hearing loss.
Incidence is 1 in 20,000 and there is no age, sex or race predisposition. Due to increased
susceptibility to fractures such cases need dedicated, timely and appropriate nursing care to
decrease the morbidity and mortality. Here we report a case of OI where nursing care played a
substantial role in the care of a neonate. Case study: A one day old child born to primigravida
mother with birth wt of 2.5 kg presented with multiple fractures (ribs, upper and lower limbs).
Antenatal USG was suggestive of short limb length and no fractures were detected. Examination
at birth, revealed wide open fontanelle, bowing of extremities with short limbs, blue sclera,
triangular facies and frog leg posture. X-ray showed multiple fractures, beading of ribs, and
narrow thoracic cage with generalized osteopenia. Child was clinically diagnosed as type 2/type
3 OI and was conservatively managed. Discussion: The spectrum of presentation of OI ranges
from lethal disease in perinatal period to milder forms. The SILLENCE classification divides OI
into four types based on clinical and radiographic data. Diagnosis is supported by collagen
synthesis analysis of dermal fibroblast, DNA mutation analysis by chorionic villous sampling
and antenatal USG. Nursing care plays a pivotal role in the management of a baby with OI which
includes gentle handling, provision of standard crib mattress, frequent repositioning with support
to the skull. Diapering done by lifting the buttocks and not the ankles, dressing with clothes
having wide openings for free movement of limbs. Adequate immobilization of fractures with
splints. Education of parents regarding daily care, measures to be undertaken during fractures
and reference to an appropriate OI support group are important components of management.
Conclusion: Good neonatal and nursing care helps in improving the quality of life of children
with OI and decreases the morbidity and mortality.
NEO/17(P) CAUSES OF NEONATAL DEATHS WITH SPECIAL REFERENCE TO
DERMATOLOGICAL NEONATAL EMERGENCIES IN A TERTIARY CARE
HOSPITAL IN DELHI.
Rohit Kapoor
Vardhman Mahavir Medical College & Safdarjang Hospital, New Delhi-110029
rohitvmmc@gmail.com; rkkapoor57@yahoo.co.in
Introduction: Neonates contribute to majority of deaths in children under 5 years of age.
Studying the common causes of neonatal deaths is important to plan policy measures for
reduction of the same. Objective: To assess the distribution and determinants of neonatal
mortality in a tertiary care hospital.Material and methods : a)Setting: A hospital in Delhi.
b)Study Design: A retrospective analysis of case sheets of neonates who died in an interval of
one year in the hospital. c)Sample size: 527 neonatal deaths. Results: It was found out that male
deaths (314; 60.62%) outnumbered the female deaths (204; 39.38%). The majority of deaths
occur <48hrs (368; 69.53%) than >48hrs (147; 27.81%). The three major causes of neonatal
death were birth asphyxia 195 (37%), septicemia 121 (22.96%) and Respiratory Distress
syndrome 73 (13.86%). The other minor causes of death among neonates were low birth weight
36 (6.83%), congenital anomalies 35 (6.64%), preterm 16 (3.04%), HIE 4 (0.79%), DIC 3
(0.59%) and other causes 44 (8.34%) including dermatological emergencies 16 (3.03%). The
dermatological emergencies (16) included collodian baby and epidermolysis bullosa 6(37.5%)
which was the major cause followed by staphylococcal scalded skin syndrome (SSSS) 5(31.3%),
chemical burns due to antiseptics and phototherapy induced erythema 3(18.75%), infantile
seborrheic dermatitis 2 (12.0%). Conclusion: The dermatological emergencies were an important
cause of neonatal deaths. Neonatal skin is more susceptible to several infections and close liaison
between the pediatrician and the dermatologist can allow early prevention and treatment and thus
can prevent significant mortality among these patients.
NEO/18(O) RANDOM SAFETY AUDITS – IMPROVING HEALTH CARE IN
NEONATAL UNITS
Rao B V, Gilmour J, Bali S
Antrim Hospital, 45 Bush Road, Antrim, Northern Ireland, United Kingdom BT412RL
sanjeev.bali@northerntrust.hscni.net
Introduction: Random safety audits are a new clinical governance concept for improving health
care using regular audit of standards of healthcare delivery, with rapid feedback to staff within
that clinical speciality. Internationally, random safety audits are becoming a user-friendly tool in
neonatal units.Aims and objectives: (1) To audit ongoing neonatal clinical practice against
national and local standards of care. (2) To feedback results on a regular basis to all staff
involved. (3) To suggest changes in practice. (4) To re-audit performance regularly Materials and
methods: 8 audit standards were chosen from the National Patient Safety Agency (UK)
document - ‘Neonatal care, improving safety’. 6 Unit specific standards were added to these.
These created 14 standards – 7 based on infection control, 7 based on routine neonatal care. An
initial pilot audit was performed to obtain the baseline and raise awareness within staff. Each
standard was then audited twice on clinical ward rounds over 6 months. Results were fed back to
staff present after the ward round and subsequently presented on a regular basis to all staff.
Results: Thepilot audit showed a range of compliance with standards 44%-100%. Subsequently,
there was significant improvement in all 14 standards audited over the 6 months period February
– July 2010. 100% compliance with all the standards is now being obtained consistently.
Conclusions: This program has shown a very rapid, significant and sustained improvement in
compliance with these crucially important standards. Staff feedback is positive and staff
members are involved with formulation of new standards.
NEO/19(P) REAPPRAISAL OF GASTRIC ASPIRATE CYTOLOGY AS A SCREENING
TOOL FOR NEONATAL SEPSIS IN VERY LOW BIRTH WEIGHT BABIES.
A Roy, T N Ghosh, S Chakraborty, T K Chatterjee, N Chaudhuri.
Department of Paediatrics, Burdwan Medical College, Burdwan, West Bengal
atanuroy76@gmail.com
Aims and objectives: To assess the role of Gastric aspirate cytology as marker for Neonatal
sepsis in Very low birth weight babies. We compared gastric aspirate cytology and blood culture
of the babies and high vaginal swab of the respective mothers, in a group of VLBW babies.
Settings: Special care nursery of a multi speciality teaching and regional referral
hospital in West Bengal. Study Design : Case Control study. Participants: 150 VLBW babies
were selected randomly. Out of them 55 babies were suffering from neonatal sepsis (cases) and
remaining 95 were clinically normal (Controls). Interventions: Gastric aspirate cytology done
for the babies (n = 150) Blood culture done for the babies (n = 150) High vaginal Swab for
culture of the mothers of the above mentioned babies (n = 150). Sepsis screen done for the babies
(n=150). Main outcome measures: Association between the incidence of sepsis, gastric aspirate
cytology and high vaginal swab results. Results were tested against controls with Chi-square test.
Results: It is seen there is strong association between neonatal sepsis, especially early onset
sepsis, positivity of maternal high vaginal swab and positive gastric aspirate cytology in VLBW
babies.. Gastric Aspirate Cytology has been found to have an odds ratio of 3.9 and a positive
predictive value of 65 % . Conclusion : Gastric aspirate cytology is an inexpensive and specific
marker for early determination of risk of neonatal sepsis in VLBW babies. It can be an
indispensable part of any sepsis screen.