Bhargava Sk

Oral rehydration of neonates and young infants with dehydrating diarrhea: comparison of low and standard sodium content in oral rehydration solutions.

Oral rehydration among infants aged 0–3 months has not been adequately investigated. A controlled, randomized study was thus conducted in 65 young infants hospitalized with acute noncholera dehydrating diarrhea. The study was designed to compare the efficacy and safety of the standard WHO oral glucose-electrolyte solution containing 90 mmol of sodium per liter (Group A: 22 infants) with that of an oral glucose-electrolyte solution containing 60 mmol of sodium per liter (Group B: 22 infants) and with standard intravenous therapy (Group C: 21 infants). Among the 44 infants in Groups A and B, none required intravenous therapy. Dehydration, acidosis, and initial hyponatremia or hypokalemia were corrected with equal efficacy in all the three groups. In the critical first 8 h, the mean sodium absorption was significantly higher (p < 0.01) in Group A. This resulted in hypernatremia (50%), periorbital edema (50%), mild pedal edema (27%), excessive irritability, and convulsions (4.5%). The mean serum sodium levels at 8, 24, and even 48 h were significantly higher (p < 0.05) than those in Groups B and C. It is concluded that glucose-electrolyte oral solution containing 60 mmol of sodium per liter is as safe and effective as intravenous rehydration for the treatment of noncholera neonatal and early infantile diarrhea, while the standard WHO solution carries a significant risk of hypernatremia under similar conditions.

Controlled trial of rice powder and glucose rehydration solutions as oral therapy for acute dehydrating diarrhea in infants.

Summary: A controlled, randomized trial was conducted in 50 infants (3 to 18 months old) hospitalized with acute noncholera dehydrating diarrhea to compare the safety, efficacy, and acceptability of the standard World Health Organization (WHO) recommended glucose oral rehydration solution (ORS) (Group A: 25 infants) with that of a rice powder ORS (Group B: 25 infants), containing 30 g/L of rice powder instead of glucose (20 g/L). The electrolyte composition of both solutions was identical. The proportion of successfully treated patients in each group was 92%, and the two rehydrating solutions proved comparable in correcting and maintaining the hydration status and the serum sodium and potassium levels. The mean rehydration time, stool output, stool frequency, ORS intake, weight gain, and urine output were comparable (p > 0.05) in both groups. It is concluded that rice powder ORS is safe, effective, and acceptable as the standard WHO glucose ORS for the treatment of acute noncholera dehydrating diarrhea in infants.

Current Status of Infant Growth Measurements in the Perinatal Period in India

ABSTRACT. Analysis of currently available information in the Indian literature on the present status of fetal growth measuring birthweight and gestation distribution, and the intra‐uterine growth potential of the fetus has pointed to several interesting findings. The incidence of low birthweight is 24‐39% and of preterms, 7‐22%. In general the process of labour seems to begin at an stage of earlier gestation. A significant proportion of infants that are born with birth weight between ‐1 SD and ‐2 SD show high morbidity and mortality, suggesting the need for them to be categorized as a distinct group. The early neonatal mortality varies between 1.5 and 8.4%. The results show a wide variation between hospital and community care, and between privileged and underprivileged. Logistic problems prevent the recording of birth weight at home or in the community. Recent observations reveal that mid‐arm circumference (MAC) of newborns has a strong correlation with birth weight and neonatal mortality. MAC can be reliably used to assess fetal growth and for screening hgh‐risk neonates in community care.

Outcome of Low Birth Weight Infants

Low weight at birth is a problem of considerable magnitude in India. It is believed that 7-10 million low birth weight (LBW) infants are born every year but studies from this country and other parts of the developing world are few. Even the studies which are available are not often quoted in reviews on this problem ( I ) . In several respects the results from the developing countries are at marked variance with those reported from elsewhere (2. 3). The present communication deals with our experience of this problem in the last two decades.

Perinatal mortality—report of a hospital based study

The perinatal mortality rate (PNMR) per 1000 births is reported in 27,394 consecutive births. It was 75.6, of which 40.0 were neonatal deaths and 35.6 were fetal losses. The PNMR was significantly higher at the two extremes of maternal age, in parity five and above, and with a previous history of fetal or neonatal loss. Other maternal contributing factors were antepartum haemorrhage, hydramnios and infections. One-third of the babies weighed 2500 g or less. The PNMR dropped precipitously from 340.48 in the birth weight group 1501 to 2000 g, to 46.6 in the group 2001 to 2500 g, indicating a cut-off point at 2000 g for a baby at high risk needing special care. The common necropsy causes of death were asphyxia (24.33%), pulmonary conditions (20.02%), congenital malformations (13.6%), and infections (6.19%). No cause of death could be detected at necropsy in 22.12% and no clinico-pathological cause of death could be assigned in 26.76% of deaths. A majority of deaths due to asphyxia could have been prevented by better antenatal and intranatal care. Low birth weight was an important cause of perinatal deaths, and better maternal nutrition and antenatal care could play an important role in reducing this.

Oral therapy of neonates and young infants with World Health Organization rehydration packets: a controlled trial of two sets of instructions.

Summary: The World Health Organization (WHO) recommends an oral rehydration solution (ORS) that has been linked with a risk of hypernatremia in young infants when extra water or dilute milk is withheld. A controlled, randomized study was therefore undertaken in 50 male infants aged 0–3 months to evaluate the relative safety, efficacy, and practicability of two methods of obviating this risk without negating the concept of a universal rehydrating packet. Twenty-five infants in Group A were re- hydrated with a 2:1 regimen (two parts, i.e., 60 ml, WHO-ORS followed by one part, i.e., 30 ml, plain water in an alternating manner) whereas 25 infants in Group B received diluted WHO-ORS (1.5 L water instead of 1 L). In two patients, one in each group, oral therapy failed and they were excluded from analysis. Sub-Group Ac was comprised of 15 cases in Group A in whom the rehydrating instructions were followed correctly. Diluted WHO-ORS provided as safe and effective rehydration as the 2:1 regimen administered properly (sub-Group Ac). Both methods adequately corrected and maintained the hydration status and serum sodium levels, but a few infants in each group had subnormal serum K+/HCO3- levels during therapy. Rehydrating instructions in Group A were misinterpreted in nine (37.5%) cases. Excessive ORS intake in five infants resulted in hypernatremia (three cases, 12.5%), periorbital edema (three cases, 12.5%), excessive irritability (two cases, 8.3%), and mild pedal edema (one case, 4.2%). Excessive water intake in comparison to ORS in four infants was responsible for delayed rehydration (three cases, 12.5%) and asymptomatic hyponatremia and hypokalemia (two cases, 8.3%). It is concluded that diluted WHO-ORS is as efficient as the 2:1 regimen for correcting and maintaining the serum sodium and hydration status. However, complications can arise from improper administration of the latter by illiterate users; and both methods are deficient with respect to K+ and HOC3- requirements.

A longitudinal study of physical growth of small for date infants from birth to six years

Abstract In a longitudinal study 62 term small for date (SFD) and 63 term appropriate for gestational age (AGA) control children were followed from birth to six years of age. Weight, height and head circuference were recorded at the specified ages of 3, 6, 9 and 12 months ± 1 week in the first year and every 6 mean weight, height and head circumferece of SFD group was dignificantly lower than the control group. However, the differences in mean weight, height and head circumference decreased from 41.4%, 10.4% and 7.3% at birth to 11.0%, 2.3% and 3.2% at 6 years respectively. The mean growth velocity of the SFD group was similar to the control group with the maximum velocity occuring in the first 3 months of life.

Maternal Nutrition and Fetal Growth Retardation

This paper reports on the association of maternal nutrition and other factors with the length of gestation and the intrauterine growth of the offspring. 122 mothers with almost similar poor socioeconomic background reliable menstrual history and with newborns of clinically consistant gestational age were investigated to determine the influence of maternal nutrition on fetal growth retardation. The maternal height weight and hemoglobin did not show any significant differences in mothers of the 3 groups of preterm term small for date and term normal infants. The maternal serum albumin levels were low in preterm and small for date as compared to normal infants but the differences were statistically significant only between small for date and normal infants. The results suggest the possible role of poor maternal nutrition in causation of fetal growth retardation. (authors modified)

Non invasive continuous anterior fontanel tension monitoring in neonates

Anterior fontanel tension (AFT) has been shown to reflect the intracranical pressure (ICP). A new transducer was designed for AFT measurement which overcomes the problems of replacement in subsequent use. Using the transducer AFT was monitored noninvasively over extended periods in about 200 normal and sick neonates. The results indicate that the technique can be used to identify elevated pressure due to different disease conditions and it has a potential to help in understanding physiological and pathological mechanisms causing alterations in the normal cerebrospinal dynamics. Further studies are underway to establish the full potentials of the technique.

Double outflow right ventricle with pulmonary stenosis in a neonate

SummaryA newborn infant with double outflow right ventricle and pulmonic stenosis is described.Electrocardiographic evidence of adult R/S progression over left precordial leads in a cyanotic neonate should make one suspect the diagnosis. The clinical profile may closely simulate tetralogy of Fallot with severe obstruction to pulmonary blood flow. Selective angiocardiographic studies provide the only means of a definite diagnosis.