B. Vishnu Bhat

Epidemiology of respiratory distress of newborns.

The present prospective study was conducted to find out the incidence, etiology and outcome of respiratory distress (RD) in newborns. All newborns (n=4505), delivered at this hospital over a period of 13 months, were observed for respiratory problems. Relevant antenatal, intranatal and neonatal information was noted. Cases were investigated for the cause of respiratory distress and followed up for the outcome. The overall incidence of RD was 6.7% Preterm babies had the highest incidence (30.0%) followed by post-term (20.9%) and term babies (4.2%). Transient tachypnea of newborn (TTN) was found to be the commonest (42.7%) cause of RD followed by infection (17.0%), meconium aspiration syndrome (10.7%), hyaline membrane disease (9.3%) and birth asphyxia (3.3%). TTN was found to be common among both term and preterm babies. While Hyaline membrane disease (HMD) was seen mostly among preterms, and Meconium aspiration syndrome (MAS) among term and post-term babies. Overall case fatality ration for RD was found to be 19%, being highest for HMD (57.1%), followed by MAS (21.8%) and infection (15.6%). Our results indicate that RD is a common neonatal problem. TTN accounts for a large proportion of thhese cases. MAS and infection also contribute significantly and are largely preventable. Without adequate ventilatory support HMD and MAS carry high mortality.

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.

Bone injuries during delivery

Bone injuries during the process of delivery were studied among 34, 946 live born babies over a 11 period. There were 35 cases of bone injuries giving an incidence of 1 per 1,000 live births. Clavicle was the commonest bone fractured (45.7%) followed by humerus (20%), femur (14.3%) and depressed skull fracture (11.4%) in the order of frequency. There was one case each of orbital fracture, epiphyseal separation of lower end of femur and dislocation of elbow joint. Lack of antenatal care, malpresentation often leading to obstructed labour and operative deliveries were found to be risk factors for bone injuries. Meconium stained liquor and birth asphyxia were more commonly associated with bone injuries than control cases. Cases with injuries had longer hospital stay and higher mortality. Improving the health infrastructure at the peripheral level with early identification of high risk mothers and their appropriate management can bring down the incidence of bone injuries.

Congenital malformations at birth--a prospective study from south India.

Congenital malformations were studied prospectively from September 1989 to December 1992 covering 12,797 consecutive deliveries. The overall incidence of malformations was 3.7% and it was 3.2% among live births and 15.7% among still births. Three hundred and ninety seven birth defects were observed among 308 live births and 72 among 45 still births. The incidence of malformation was significantly higher among male babies (p <0.001), still births (p < 0.001), low birth weights (p < 0.001) and preterm babies (p < 0.001). Consanguinity among parents of malformed babies was more common (p < 0.001). Musculo-skeletal malformations were the commonest (9.69 per 1000) followed by cutaneous (6.33 per 1000), genitourinary (5.47 per. 1000), gastrointestinal (5.47 per 1000), central nervous system (3.99 per 1000) and cardiac anomalies (2.03 per 1000). Musculoskeletal, cutaneous and genitourinary malformations were common among live born babies while central nervous system and gastrointestinal defects were common among still born babies. Antenatal infections and ingestion of drugs were not found to be significant factors in the causation of birth defects.

Therapeutic hypothermia using gel packs for term neonates with hypoxic ischaemic encephalopathy in resource-limited settings: a randomized controlled trial.

OBJECTIVE To evaluate the efficacy of therapeutic hypothermia (TH) using gel packs in reducing mortality and morbidity in term neonates with HIE and study the associated problems with TH. METHODS Hypoxic ischaemic encephalopathy babies were randomized into TH and control group. Babies in TH group were cooled for first 72 h of birth using cloth covered cooling gel packs to maintain target rectal temperature of 33-34°C. Infants were followed up to 6 months and were assessed using Baroda Developmental Screening Test. RESULTS There were no significant differences in baseline parameters. TH group showed significant reduction in the combined rate of death or developmental delay at 6 months of age by 21% (8.1% in the TH group vs. 29% in the control, RR 0.28, 95% CI: 0.11-0.70; p = 0.003). CONCLUSIONS TH using gel packs reduces the risk of death or developmental delay at 6 months of age in infants with HIE.

Neural Tube Defects in Pondicherry

Objective: This study was carried out to identify the trend and the frequency of neural tube defects from July 1998 to June 2004.Methods; A total of 310 babies were born with neural tube defects with the overall frequency of 5.7/1000 births compared to 2.3/1000 births observed earlier in our hospital.Results : The most common defect was spina bifida (54.8%) followed by anencephaly (31.6%), and encephalocele (11.6%). More neural tube defects were observed in female and low birth weight babies, still births and unbooked mothers. Neural tube defect was significantly higher among babies born to parents of consanguineous marriage (p<0.01). Associated congenital defects were observed in thirty nine (12.6%) cases.Conclusion: The rise in the frequency of NTDS may indicate the current trend of NTDs in Southern India. A further prospective study is desired to measure the effectiveness of regular folic acid supplementation in bringing down this frequency

Cardiac enzyme levels in myocardial dysfunction in newborns with perinatal asphyxia

ObjectiveTo study the usefulness of cardiac enzymes in evaluating myocardial damage in perinatal asphyxia.MethodsThirty term babies with perinatal asphyxia and without any congenital malformations were selected as cases. They were compared with thirty healthy term babies without asphyxia. Myocardial dysfunction was evaluated using clinical, electrocardiography, echocardiography and cardiac enzymes i.e, troponin-T and CK-MB levels.ResultsAmong the 30 cases 23 had evidence of myocardial involvement while one baby in the control group had ECG evidence compatible with cardiac involvement. Cardiac enzymes were significantly increased in babies with perinatal asphyxia. The mean level of C-troponin-T among cases and controls were 0.22±0.28 and 0.003±0.018 while CK-MB levels were 121±77.4 IU/L and 28.8 ± 20.2 IU/L respectively. C-troponin-T had higher sensitivity and specificity compared to CK-MB levels. Moreover, C troponin-T levels correlated well with severity and outcome in babies with perinatal asphyxia.ConclusionC-Tropopnin assay is useful in evaluating the severity of myocardial damage and outcome in perinatal asphyxia.

Genital standards for South Indian male newborns

One hundred and thirty-five male newborns in JIPMER hospital were studied. The penile length (stretched and unstretched), width as well as testicular length and breadth were measured. The influence of the gestational age and intrauterine growth on these measurements were studied. The mean stretched penile length for term babies was 3.57 cms (±0.46), the unstretched length 3.26 cms (±0.41), and the width was 1.04 cms (±0.15). There was a linear increase in the above measurements with increasing gestational age. The right testicular length was 1.39 cms (±0.28) and breadth was 0.98 cm (±0.15) while the length and breadth for left testis were 1.32 cms (±0.24) and 0.95 cm (±0.14) respectively for term babies. The prepucial type was tubular in 103 (76.3%) babies and of ring type in 32 (23.7%). In 72 (53.3%) babies the prepuce could be retracted enough to visualise external urinary meatus.

Perinatal risk factors in neonatal infections.

Perinatal risk factors were studied among 50 cases of neonatal septicemia and 200 matched normal neonates during one year period. The consanguinity among parents, birth order and sex of the baby did not increase the risk for developing septicemia. There was significant increase in the risk for septicemia when the duration of labour was more than 24 hours (P<0.01), time interval between rupture of membrane and delivery of baby was more than 12 hours (P < 0.001), liquor was meconium stained or foul smelling (P<0.001) and delivery was operative (P<0.01), The neonatal factors identified with risk for septicemia were preterm delivery (P<0.01), low birth weight (P<0.01), birth asphyxia (P < 0.001) assisted ventilation (P < 0.001) and intravenous alimentation (P<0.02). Identification of high risk pregnancies and appropriate management can minimize many of the above risk factors which in turn will reduce the occurrence of neonatal sepsis.

Neonatal septicaemia among inborn and outborn babies in a referral hospital

Neonatal sepsis was studied among one hundred neonates (50 hospital born and 50 outborn babies) over one year period. The incidence of neontal septicaemia was 15.5 per 1000 live births in the hospital. Among outborn babies it accounted for 6.1% of total pediatric admissions and 43.7% of sick neonates referred from outside. Low birth weight and prematurity were important predisposing factors in both the groups. Blood culture was positive among 32% of outborn and 34% of inborn babies. Coagulase-negative Staphylococcus, Klebsiella and Acinetobacter were the common causative organisms. All isolated organisms were sensitive to Gentamicin whereas 75% of them were resistant to Ampicillin. Mortality among outborn neonates (32%) was much higher in comparison to (10%) hospital born babies. Early identification of high risk antenatal cases and neonates and appropriate referral can bring down mortality and morbidity from neonatal sepsis.