B. Adhisivam

Endotracheal Suction for Nonvigorous Neonates Born through Meconium Stained Amniotic Fluid: A Randomized Controlled Trial

OBJECTIVE To assess whether endotracheal suctioning of nonvigorous infants born through meconium stained amniotic fluid (MSAF) reduces the risk and complications of meconium aspiration syndrome (MAS). STUDY DESIGN Term, nonvigorous babies born through MSAF were randomized to endotracheal suction and no-suction groups (n=61 in each). Risk of MAS, complications of MAS and endotracheal suction, mortality, duration of neonatal intensive care unit stay, and neurodevelopmental outcome at 9 months were assessed. RESULTS Maternal age, consistency of meconium, mode of delivery, birth weight, sex, and Apgar scores were similar in the groups. In total, 39 (32%) neonates developed MAS and 18 (14.8%) of them died. There were no significant differences in MAS, its severity and complications, mortality, and neurodevelopmental outcome for the 2 groups. One infant had a complication of endotracheal suctioning, which was mild and transient. CONCLUSIONS The current practice of routine endotracheal suctioning for nonvigorous neonates born through MSAF should be further evaluated. TRIAL REGISTRATION Clinical Trial Registry of India: CTRI/2013/03/003469.

Effect of Kangaroo mother care in reducing pain due to heel prick among preterm neonates: a crossover trial

Abstract Background: Preterm neonates undergo several painful procedures in NICU including heel prick for blood sugar monitoring. Nonpharmacological interventions have been tried to decrease this procedural pain. There are only few studies on Kangaroo mother care (KMC) in reducing pain among preterm neonates. Method: This crossover trial was conducted at a tertiary care teaching hospital in south India. Premature Infant Pain Profile (PIPP) related to heel prick was assessed in 50 preterm neonates undergoing KMC and compared with 50 preterm babies without KMC. Results: PIPP scores at 15 minutes and 30 minutes after heel prick were significantly less in KMC group compared to control group. Mean PIPP difference between baseline and 30 minutes after heel prick was also significantly low in KMC group compared to control group. Conclusion: KMC is effective in reducing pain due to heel prick among preterm babies.

Persistent Diarrhea: Risk Factors and Outcome

ObjectiveTo identify risk factors associated with Persistent diarrhea (PD) and deaths due to PD.MethodsThis prospective case control study included 60 children with PD (cases) and 60 children (controls) with acute diarrhoea (AD). Detailed history, examination and appropriate investigations were done for all children. Crude Odds ratio was calculated for each risk factor by univariate analysis and adjusted odds ratio was calculated by multivariate logistic regression.ResultsPrior antibiotic use, steroid use, anemia, vitamin A deficiency, malnutrition, LRI, UTI, oral candidiasis, and hyponatremia, were statistically significant risk factors by univariate analysis. Prior antibiotic use, vitamin A deficiency, malnutrition and LRI were independently associated with PD by multivariate logistic regression analysis. The risk factors for mortality were stool frequency more than 10 times per day, severe malnutrition, oral candidiasis, hypoalbuminemia and HIV positivity.ConclusionsThe presence of these risk factors should alert the clinician to take appropriate measures, to decrease the mortality.

Oxidative stress and antioxidant status among neonates born to mothers with pre-eclampsia and their early outcome.

Abstract Objective: To study the oxidative stress and antioxidant status among neonates born to pre-eclamptic mothers and their role in the early outcome of these babies. Study design: This case control study was conducted at a tertiary care teaching hospital in South India. We included 75 neonates born to mothers with pre-eclampsia matched against 75 neonates born to mothers with normal blood pressure. Relevant antenatal and neonatal clinical data were collected for all babies. Levels of malondialdehyde (MDA) and total antioxidant status (TAS) were estimated in cord blood and oxidative stress was correlated with early neonatal outcome. Results: Oxidative stress was increased among cases compared to controls as evidenced by increased mean MDA levels (7.43 ± 1.21 versus 3.06 ± 0.69 µmol/L) and decreased mean TAS (742.15 ± 27.30 versus 829.26 ± 23.16 mmol/L). Level of oxidative stress correlated with poor neonatal outcome including sepsis, NEC and respiratory distress among cases. An MDA value of 8.68 µmol/L can be used as a cut-off, with sensitivity of 60% and specificity of 89.2%, to predict neonatal death among babies born to pre-eclamptic mothers. Conclusion: Oxidative stress is increased in neonates born to mothers with pre-eclampsia and useful in predicting outcome.

Effect of Therapeutic Hypothermia on DNA Damage and Neurodevelopmental Outcome among Term Neonates with Perinatal Asphyxia: A Randomized Controlled Trial

OBJECTIVE To study the effect of therapeutic hypothermia (TH) on deoxyribonucleic acid (DNA) damage and the neurodevelopmental outcome in term babies with perinatal asphyxia. METHODS Babies in the hypothermia group were cooled for the first 72 h, using gel packs. Rectal temperature of 33-34°C was maintained. Blood sample was collected before, at 36 h and after completion of TH for assessment of comet assay and 8-hydroxy2-deoxyguanosine (8-OHdG). Infants were followed up till 12 months. RESULTS Baseline parameters were similar. After 72 h, the hypothermia group showed lower olive tail moment (12.88 ± 2.14) than the control group (22.16 ± 5.26) (p < 0.001). 8-HDG levels increased significantly in the control group (1252.87 ± 357.07) as compared to the hypothermia group (757.03 ± 198.49) (p < 0.001). Neurodevelopmental assessment at 12 months showed significantly low motor and mental developmental quotient in the control than hypothermia group. CONCLUSIONS TH reduces oxidative stress-induced DNA damage and improves neurodevelopmental outcome.

Synbiotics for decreasing incidence of necrotizing enterocolitis among preterm neonates – a randomized controlled trial

Abstract Objective: To study the effect of synbiotics in reducing incidence and severity of necrotizing enterocolitis (NEC) among preterm neonates. Methods: This randomized controlled trial conducted in a tertiary care teaching hospital, south India, included 220 enterally fed preterm neonates who were randomized to receive either synbiotics or no intervention. The synbiotic contained Lactobacillus, Bifidobacterium and fructo-oligosaccharide. The demographic parameters, risk factors for NEC and outcome including incidence of NEC, its severity, sepsis and mortality were evaluated. Results: Multiple pregnancies, preeclampsia and prolonged rupture of membranes were important maternal characteristics. The average birth weight and gestational age of the preterm neonates was 1.4 kg and 31 weeks, respectively. There was a 50% reduction in the incidence of NEC of all stages in preterm infants who received synbiotics compared to the non-intervention group (7.4% versus 14.5%). Administration of synbiotics did not reduce the severity of NEC, sepsis or mortality. Conclusion: Enteral supplementation of synbiotics along with breastmilk results in a tendancy to decrease the incidence of NEC among preterm neonates.

Tumoral calcinosis with hyperphosphatemia

Tumoral calcinosis is a rare disorder of mineral metabolism among adolescents and young adults characterized by deposition of calcific masses around large joints. It is less commonly reported in pediatric population and commonly mistaken for bone tumors. Typical lab parameters include hyperphosphatemia with normal levels of serum calcium, parathyroid hormone (PTH) and alkaline phosphatase. A ten-year-old boy with typical features of tumoral calcinosis is presented.

Therapeutic Cooling for Perinatal Asphyxia-Indian Experience

Therapeutic hypothermia (TH) has been established as standard of care for term babies with perinatal asphyxia in developed countries. However, it is yet to gain momentum in India. This review summarizes some of the TH trials conducted in India and the various related issues in adapting the same for the Indian context.

Oxidative stress in preeclamptic mother – newborn dyads and its correlation with early neonatal outcome – a case control study

Abstract Background: Preeclamptic mothers are likely to have increased oxidative stress during pregnancy which can adversely affect the outcome in their neonates. Objectives: To measure the oxidative stress in preeclamptic mother- newborn dyads and correlate it with the immediate neonatal outcome. Methods: This case control study conducted in a tertiary care teaching hospital, South India included 71 preeclamptic mothers – newborn dyads (cases) and 72 normal mothers – newborn dyads (controls). Biochemical parameters including total antioxidant status (TAS), protein carbonyls and malondialdehyde levels (MDA) were measured in both maternal and cord blood. Association between these oxidative stress parameters and early neonatal outcome was studied. Results: All oxidative stress markers were higher in the preeclampsia group compared to the controls. Cord blood protein carbonyl levels had significant correlation with maternal levels. Prematurity, low-birth weight, respiratory distress syndrome (RDS), early onset sepsis (EOS) and intra-uterine growth restriction (IUGR) were more among cases. Early neonatal outcomes like death, IUGR, EOS, and RDS had significant correlation with protein carbonyl levels among the cases. Conclusions: Oxidative stress is increased in preeclamptic mother – newborn dyads. Increased protein carbonyl levels in preeclampsia correlate with adverse early neonatal outcome.

Arrhythmogenic Dilated Cardiomyopathy Due to a Novel Mutation in the Desmoplakin Gene

The authors describe an 11-year-old girl who presented with congestive heart failure due to arrhythmogenic dilated cardiomyopathy. She had curly, woolly hair since birth and palmoplantar keratoderma. Molecular genetic analysis of the desmoplakin gene revealed that she was homozygous for the c.3901C>T (p.Gln1301X) change in exon 23 of the desmoplakin (DSP) gene, confirming the diagnosis of Carvajal disease. As per the Arrhythmogenic Right Ventricular Dysplasia/ Cardiomyopathy Genetic Variants Database, this is a novel mutation. She was managed with diuretics, enalapril, carvedilol and amiodarone, is presently stable, and on regular follow-up. Carvajal disease is a rare cardiocutaneous disorder and few cases have been reported in the literature. The authors review the published cases of the Naxos-Carvajal phenotype from India. Pediatricians need to be aware of this clinical entity whenever arrhythmogenic dilated cardiomyopathy is associated with woolly hair and/or palmoplantar keratoderma.