B. D. Bhatia

Role of antibiotics in meconium aspiration syndrome

Abstract Background: Meconium aspiration syndrome (MAS) is a major cause of severe respiratory distress in newborns and the role of antibiotics in its management is not well defined. Objective: To determine the role of routine antibiotic therapy in the management of MAS. Methods: After excluding the possibility of sepsis, 144 patients with MAS were randomised into two groups. Group A (study group) received ampicillin and gentamicin for 7 days, commencing between 24 and 36 hours of life, and group B, the controls, received no antibiotics. Both groups received similar supportive management. The primary outcome measure was the development of infection. Details of clinical progress during hospitalisation were recorded. All were followed up for a minimum of 3 months. Results: The patient profiles were similar in both groups. Five patients (three in the study group, two controls) developed culture-positive sepsis during their hospital stay. No significant difference was detected between the groups regarding period of oxygen dependency (5.8 vs 5.9 days), day of starting feeds (4.0 vs 4.2), day of achievement of full feeds (9.4 vs 9.3), clearance of chest radiograph (11.7 vs 12.9 days) or duration of hospital stay (13.7 vs 13.5 days). The most common radiological features were parenchymal infiltrates followed by hyperinflation. The incidence of complications was similar in both groups. Conclusion: Routine antibiotic therapy is not necessary for managing MAS.

A study of bone marrow failure syndrome in children.

BACKGROUND Bone marrow failure syndrome (BMFS), or aplastic anemia, includes peripheral blood single cytopenias, as well as pancytopenia due to inability of the marrow to effectively produce blood cells. AIM To study the clinico-hematological profile and etiological factors of bone marrow failure syndrome in children. SETTING AND DESIGN This prospective study was carried out in the Department of Pediatrics of a university teaching hospital over 36 months. MATERIALS AND METHODS Children with pancytopenia (Hb 9 /L, platelet count<100x10(9)/L) and bone marrow cellularity<25% were included in the study. History of exposure to drugs, socioeconomic status, ethnicity and occupation of father were noted. Bone marrow aspiration; trephine biopsy; Ham test; viral studies for hepatitis A, B and C; and cytogenetic investigations were carried out. STATISTICAL ANALYSIS Relative risk was estimated by odds ratio (OR) with 95% confidence interval (CI) in matched cases and controls. RESULTS Of the 53 children studied, 6 (11.3%) were diagnosed as Fanconi anemia. Two cases had features of myelodysplastic syndrome. Forty-five children were labeled as acquired aplastic anemia, of whom one had evidence of hepatitis B infection and two patients (5.8%) had paroxysmal nocturnal hemoglobinuria. Aplastic anemia was more common in children from family with lower socioeconomic status; in Muslims; and where the fathers occupation was weaving, dyeing and painting. However, the number was small to make statistically significant conclusions. No correlation could be established with exposure to drugs. CONCLUSION Fanconi anemia was responsible for approximately one-tenth of the cases of bone marrow failure syndrome. Majority of the patients had acquired aplastic anemia. Hepatitis B infection was an uncommon cause of acquired aplastic anemia.

Autoimmune hemolytic anemia

ObjectiveTo study the clinico -hematological profile and treatment outcome in children suffering from auto immune hemolytic anemia (AIHA).MethodsTwelve children were diagnosed with auto immune hemolytic anemia over a period of four years. Direct antiglobulin test was positive in all the cases. Other causes of hemolytic anemia like thalassemia syndromes, hereditary spherocytosis, G6PD deficiency were excluded by appropriate tests. The children were followed up for 6 months to 4 years.ResultsThe age ranged from 7 mth to 9 yr with a mean age of 4.51 yr. All patients had pallor as the presenting complaint followed by splenomegaly (83.3%), jaundice (66.7%), fever (50%) and bleeding manifestations (16.7%). 9 patients had primary disease and 3 had secondary disease. Tubercular infection was seen in 2 patients with secondary disease. Jaundice was seen equally in both the groups. Oral prednisolone produced remission in 83.3% cases. 4 patients (3 in primary and one in secondary group) had relapse after initial response. All responded to a second course of steroids but had subsequent relapses and developed a chronic course.ConclusionAutoimmune hemolytic anemia is an uncommon cause of hemolytic anemia in children. Tubercular infection is an underlying pathology in cases of secondary autoimmune hemolytic anemia. Although oral steroids induce remission in most of the cases, relapses are common.

Abdominal tuberculosis with autoimmune hemolytic anemia

An eight-year-old male child presented with progressive distension of abdomen, fever, pallor and jaundice with a history of tubercular contact. Investigations were suggestive of abdominal tuberculosis with autoimmune hemolytic anemia. The child responded well to a course of oral steroids with antitubercular treatment. A literature search did not reveal any previous case report of an association between tuberculosis and autoimmune hemolytic anemia.

Benign Recurrent Intrahepatic Cholestasis

Benign recurrent intrahepatic cholestasis (BRIC) is a rare cause of cholestasis in children. The disease may start in infancy or early childhood. Jaundice persists or recurs throughout life but does not lead to chronic liver disease or cirrhosis. Treatment is mostly symptomatic. The condition has not been reported in Indian children. We report an interesting case of BRIC in a 9-year-old boy who had recurrent episodes of jaundice since when he was 1 yr old.

Perceptual development in relation to nutritional status

The present study was conducted on 180 children in the age group 5–10 years. These children were divided accordingly their ages into 3 sub-groups i.e. 5–6, 7–8 and 9–10 years respectively. In each group 60 children were studied. For the assessment of perceptual skills each child was tested with the help of Picture Ambiguity Test. Responses to the ambiguous cards were scored with respect to time taken to react in each card and ability of the child to perceive figure and ground relationship i.e. centration and decentration. The observations showed that with increase in age, centration effect reduces and majority of the children start decentring their perception by middle childhood. Further, children in higher age group took lesser time to respond on different ambiguous cards. When the responses of well-nourished and undernourished children were compared for perceptual flexibility in terms of part-whole perception i.e. centration and decentration; no difference was observed between the two groups. There was a significant difference in the performance of well-nourished and undernourished children when time to respond on ambiguous card was compared. Well-nourished children took lesser time to respond on different ambiguous cards. These observations in general suggest that poor nutrition may result in impaired perceptual abilities in children.

Determinants of Capillary Refill Time in Healthy Neonates.

OBJECTIVES Traditionally Capillary refilling time (CRT) has been used as a widely accepted method to assess cardiac output and peripheral circulation in neonates. There are only few studies describing normal values and the correct method of recording CRT. The value of CRT is affected by various factors like ambient or skin temperature, age, site of measurement, duration as well as amount of pressure and inter observer variation. However, none of these have been standardized. Hence, we conducted this study to establish the normal value and factors affecting Capillary Refilling Time (CRT) in healthy neonates in Varanasi. DESIGN Prospective observational study done over a period of 2 years. SETTING Maternity wards and Neonatal intensive care unit of Sir Sunderlal Hospital, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India. PARTICIPANTS Healthy neonates between 35-42 weeks of gestation staying with their mothers and admitted in neonatal intensive care unit. MATERIALS AND METHODS CRT was measured by standard technique four times during first week of life on day 1, 3, 5 and 7. STATISTICS ANALYSIS Student t-test was used for analysis. A p-value less than 0.05 was taken as statistically significant. RESULTS The mean capillary refilling time (CRT) was 2.23 ± 0.37 seconds in healthy neonates during first week of life. We studied each neonate four times in first week of life. Significantly lower values of CRT were noted in low birth weight babies throughout first week in healthy neonates. Babies under phototherapy and radiant warmer had also shorter CRT values. Values were not affected by age, sex and gestation. CONCLUSION The normal value of capillary refilling time (CRT) in healthy neonate is less than three seconds. The major determinants of CRT in healthy neonate are birth weight, radiant warmer and phototherapy. CRT alone in neonatal age is less informative haemodynamic parameter; it should be evaluated along with either blood pressure or oxygen saturation with pulse oxymeter. Further studies are needed to assess the reliability and validity of CRT as a clinical tool to measure perfusion in neonates.

Aplasia cutis congenita

Two cases of aplasia cutis congenita are reported here. One of the cases also had pre- and postaxial polydactyly and other digital anomalies.