M. M. A. Faridi

Predictors of mortality among the neonates transported to referral centre in Delhi, India.

A descriptive study was conducted with an objective to determine the predictors of mortality among referred neonates and to ascertain their transport characteristics. A total of 300 consecutive neonates who were transferred to the centre were enrolled in the study. Following information were recorded: maternal details, birth details, interventions before transportation, details of transportation and neonatal condition at arrival. Detailed clinical assessment and management was done as per standard neonatal protocols. Birth weight <1 kg (OR 0.04; 95% CI: 0.006-0.295, P<0.01) and transportation time >1 hour (OR 5.58; 95% CI: 1.41-22.01, P=0.01) were found to be significant predictors for mortality among the transported neonate. Transport characteristics reflect road transport with limited utility of ambulances and lack of trained health personal. Hence to conclude, extreme low birth weight and prolonged transportation time were found to be significant predictors of neonatal mortality among the transported neonate.

Maintenance tocolysis with oral micronized progesterone for prevention of preterm birth after arrested preterm labor.

To evaluate the efficacy of maintenance therapy with oral micronized progesterone (OMP) for prolongation of pregnancy in cases of arrested preterm labor.

Prevalence and outcome of hepatobiliary dysfunction in neonatal septicaemia.

Background: Cholestatic jaundice and liver enzyme abnormalities have been reported in neonatal septicaemia; the course, pattern, and outcome of such hepatobiliary dysfunction have not been described. Methods: One hundred fifty-three neonates with blood culture–positive sepsis were recruited from the neonatal intensive care unit of an urban hospital. Liver function tests were done on day 3 and day 10 in all of the cases. In babies with abnormal results (direct bilirubin >20% of total with a minimum level of 2 mg/dL or alanine aminotransferase [ALT] >50 U/L), tests were repeated weekly for 1 month and then fortnightly for 3 months or until normalization of values. Anthropometry was recorded at all of these visits. Results: Klebsiella pneumoniae was the commonest organism, isolated in 95.4% of subjects. Eighty-three (54.2%) subjects had hepatobiliary dysfunction in the form of either cholestatic jaundice (n = 65 [42.5%]) or derangement in ALT (n = 57 [37.3%]). The onset of cholestasis was seen by day 3 of sepsis in 80% (n = 52), with maximum value of direct bilirubin seen by the 10th day in 90% (n = 58). Only 15% (n = 10) continued to have cholestatic jaundice beyond 30 days of onset of sepsis, and it resolved by 60 days. Hepatic enzyme abnormalities followed a more protracted course: onset by day 10 in 95%, peak value by day 38 in 90%, and normalisation by 60 days in 82% of subjects. The prevalence of any hepatobiliary dysfunction was found less frequently in babies who died as compared with survivors (43.4% vs 56.7%; P < 0.01). The weight, length, and head circumference during follow-up visits were comparable between neonates with or without hepatobiliary dysfunction. Conclusions: Hepatobiliary dysfunction is common in Gram-negative neonatal septicaemia. The onset of abnormalities is early in most cases but ultimately resolve within 2 to 3 months after sepsis. The presence of conjugated hyperbilirubinemia in neonatal sepsis may carry a better prognosis in terms of survival and has no significant effect on growth during early infancy.

Transabdominal amnioinfusion in preterm premature rupture of membranes.

To evaluate the effect of transabdominal amnioinfusion on prolongation of pregnancy, and maternal and neonatal outcomes in preterm premature rupture of membranes (pPROM).

Gender Differences in Outcomes of Low Birth Weight and Preterm Neonates: the Male Disadvantage

Various studies conducted worldwide have shown that male neonates have higher rates of mortality and morbidity in the perinatal period compared with females. However, there has been only one study from India on this subject. Therefore, this study was conducted to establish the difference in mortality between males and females among neonates born with two established risk factors of septicaemia--low birth weight (<2.5 kg) and preterm birth (<37 weeks). One hundred and fifty consecutive neonates which were either preterm or had low birth weight were recruited after obtaining informed consent from the parents. Blood culture was done, and the bacterial isolates were identified by standard protocol. Statistically significant association was found between male gender and mortality among culture-positive neonates. Therefore, results of the present study indicate that preterm or low birth weight male neonates have higher likelihood of mortality compared with their female counterparts in the Indian scenario.

Effect of carbamazepine therapy on homocysteine, vitamin B12 and folic acid levels in children with epilepsy

ObjectivesTo compare the levels of homocysteine, vitamin B12 and folic acid before and after 6 months of carbamazepine therapy and to correlate them with carbamazepine level at 6 months.DesignProspective comparative study.SettingTertiary care centre in North India.Participants51 children (2–12 years of age) presenting with motor partial seizures.InterventionCarbamazepine (10–20 mg/μ/day) for 6 months.Main outcome measureChange in serum homocysteine, B12, folic acid level.MethodsFasting venous samples were collected before carbamazepine therapy and after six months. Homocysteine was analyzed using homocysteine enzyme immunoassay. Vitamin B12 and folic acid were estimated using electrochemiluminesence technique. Carbamazepine levels were measured at 6 months.ResultsOf the 51 children, 36 (males-21), were followed up and their data analyzed. Mean homocysteine level was 11.51±3.95 μmol/L at recruitment and 11.77±6.65 μmol/L at six months (P=0.785). At recruitment 6(16%) children had homocysteine level above 15 μmol/L which increased to 10(27%) at 6 months. Mean vitamin B12 at recruitment was 292.1±111.2 pg/mL and 297.8±82.9 pg/mL at 6 months (P=0.764). Mean folic acid at recruitment was 9.98±3.45 ng/mL and 10.66±3.97 ng/mL at 6 months (P=0.358). There was no correlation between carbamazepine levels with homocysteine, vitamin B12 and folic acid (P>0.05). There was no effect of age, sex or dietary pattern on homocysteine levels.ConclusionHence 6 months of carbamazepine therapy did not cause significant change in serum levels of homocysteine, vitamin B12 and folic acid.

‘Negotiating the tensions of having to attach and detach concurrently’: A qualitative study on combining breastfeeding and employment in public education and health sectors in New Delhi, India

OBJECTIVE the aim of this study was to explore the factors involved in combining breastfeeding and employment in the context of six months of maternity leave in India. DESIGN qualitative semi-structured interviews were conducted and analysed using a Grounded Theory approach. SETTING Health and Education sectors in New Delhi, India. PARTICIPANTS 20 first-time mothers with one 8-12 month-old infant and who had returned to work after six months׳ maternity leave. MEASUREMENTS AND FINDINGS the interviews followed a pre-tested guide with a vignette, one key question and six thematic areas; intentions, strategies, barriers, facilitators, actual experiences and appraisal of combining breastfeeding and employment. Probing covered pre-pregnancy, pregnancy, maternity leave, the transition and return to work. This study revealed a model of how employed women negotiate the tensions of concurrently having to attach and detach from their infant, work, and family. Women managed competing interests to ensure trusted care and nutrition at home; facing workplace conditions; and meeting roles and responsibilities in the family. In order to navigate these tensions, they used various satisficing actions of both an anticipatory and troubleshooting nature. KEY CONCLUSION in spite of a relatively generous maternity leave of six months available to these women, several individual, familial and workplace factors interacted to both hinder and facilitate the process of combining breastfeeding and employment. Tension, negotiation and compromise are inherent to the process. IMPLICATIONS FOR PRACTICE antenatal and postnatal interventions providing information and support for working mothers need to address factors at the individual, family and workplace levels in addition to the provision of paid maternity leave to enable the successful combination of breastfeeding and employment.

Physiological skin manifestations in twins: association with maternal and neonatal factors.

Abstract:  There is paucity of literature on the incidence and clinical associations of transient benign dermatological conditions in twin neonates. This prospective study evaluated 253 live‐born twin babies (≥23 wks) at a tertiary care hospital in Delhi, India. All study subjects were observed for the first 7 days of life, and regular dermatological examination was performed. The primary focus was on palatine Epstein pearls (PEP), milia, erythema toxicum neonatorum (ETN), and physiological skin desquamation (PDS). Zygosity was determined with the help of sex combination of the pairs, chorionicity of the placentae, and seven blood group phenotypes. Chi‐square test, Cohen’s kappa test, and logistic regression analysis were done. PEP, milia, ETN, and PDS were seen in 88.1%, 83.4%, 2.4%, and 4.3% twin babies, respectively. Preputial Epstein pearls were not seen. Birth order, maternal anemia, route of delivery, meconium staining of amniotic fluid, gestational maturity, birth weight, and presence of intrauterine growth restriction were found to be associated with one or more of the studied skin conditions (p < 0.05), but maternal age, pregnancy‐induced hypertension, and sex of the baby did not affect incidence of any (p > 0.05). The intrapair concordance was highly significant (p < 0.001) in mono‐ and dizygotic twins. PEP and milia were equally common in the evaluated twins as compared to reports in singletons, while ETN and PDS were less common in this twin cohort. Environmental and genetic factors may regulate physiological skin manifestations in newborns.

Effect of sequencing of complementary feeding in relation to breast-feeding on total intake in infants.

Objective: The aim of the present study was to evaluate whether the order of complementary feeding in relation to breast-feeding affects breast milk, semisolid, or total energy intake in infants. Methods: The present study was designed as a randomized crossover trial. The study was conducted in a tertiary care hospital. The study participants were 25 healthy infants between the ages of 7 and 11 months who were exclusively breast-fed for at least 6 months and were now receiving complementary foods for at least 1 month in addition to breast-feeding. Infants were randomized to follow a sequence of either complementary feeding before breast-feeding (sequence A) or complementary feeding after breast-feeding (sequence B) for the first day (24 hours) of the study period using simple randomization. For the next day, the sequence was reversed for each child. All babies received 3 actively fed complementary food meals per day (morning, afternoon, and evening). A semisolid study diet was prepared in the hospital by cooking rice and pulse with oil using a standard method, ensuring the energy density of at least 0.6 kcal/g. The infants were allowed ad libitum breast-feeding during the observation period. Semisolid intake was directly measured and breast milk intake was quantified by test weighing method. Energy intake from complementary foods was calculated from the product of energy density of the diet served on that day and the total amount consumed. The total energy intake and energy intake from breast milk and complementary foods between the 2 sequences were compared. Results: The mean (standard deviation) energy intake from breast milk during 12 hours of daytime by following sequence A (complementary feeding before breast-feeding) was 132.0 (67.4) kcal in comparison with 135.9 (56.2) kcal in sequence B, which was not statistically different (P = 0.83). The mean (standard deviation) energy consumed from semisolids in sequences A and B was also comparable (88.6 [75.5] kcal vs 85.5 [89.7] kcal; P = 0.58). The total energy intake during daytime in sequence A was 220.6 (96.2) kcal in comparison with 221.5 (94.0) kcal in sequence B, which was also comparable (P = 0.97). The results related to energy intake through breast milk and total energy intake were not different when insensible losses during feeding were adjusted in both groups. Conclusions: Altering the sequence of complementary feeding in relation to breast-feeding does not affect total energy intake.

Seven versus 10 days antibiotic therapy for culture-proven neonatal sepsis: A randomised controlled trial

Optimal duration of parenteral antibiotics for treating neonatal sepsis ranges from 7–14 days. We compared the efficacy of 7 versus 10 days duration of intravenous antibiotics for neonatal septicaemia.