Rewat Meshram

Oxygen Saturation in Neonates After Birth in Rural Hospital

Background: Pulse oximetry is a noninvasive test for quantification of hypoxemia. It is a simple bedside test to determine the amount of oxygen in a babys blood and use for early detection of critical congenital heart disease (CCHD). Aim: To analyze the influence of birth weight, gestational age, mode of delivery and gender, on levels of SpO2 in healthy newborns. Methods: Within first 6 hours of life, pulse oximetry was performed on clinically normal newborns. Echocardiography was performed, if oxygen saturation (SpO2) was below 90%. Inclusion criteria: Newborns who were admitted in postnatal ward & NICU. Exclusion criteria: Out born babies and babies with a prenatal diagnosis of duct dependent circulation. SpO2 were performed using a Massimo Single Extraction Technology (SET) handheld pulse oximeter with a neonatal reusable Nellcor SpO2 sensor OXI-A/N probe. For each newborn, SpO2 was measured by trained social worker of the newborn within the first 6 hours of life. The probe was held manually to the sole of the foot. Results: A total of 6101 neonates were born at the hospital during the period of January 2013 to December 2014 and registered in the CCHD screening project. For 68 neonates (1.1%), the first SpO2 was 0.01). No statistical significant difference in SpO2 was found in children born by caesarean section (98.62±1.20) than in those delivered vaginally (98.62±1.17). Conclusions: In healthy newborns, level of SpO2 measures within 6 hours of life is negatively correlated with birth weight but not statistically significant. Also, no correlation was found in neonate born by caesarean section than in neonate delivered vaginally.

Resolution of isolated large fetal pericardial effusion after delivery

Pericardial effusion (PE) is detectable during routine obstetric ultrasonography. PE is the result of the same mechanism that produces fetal hydrops. Structural cardiac malformations and fetal cardiac arrhythmias are the most common cause of nonimmune hydrops. A male infant weighing 2300 g was born by through elective cesarean section. Isolated large PE was detected in a fetus at 34 weeks of gestation. The women delivered a male neonate at 37 weeks period of gestation through elective cesarean section. Baby cried immediately after birth with APGAR score 7, 9, 10 at 1, 5, and 10 min, respectively. Though the mother condition was stable. The baby was shifted to special care neonatal unit in view of for respiratory distress and severe grunt. Neonatal echocardiography showed trivial tricuspid regurgitation with no PE. Most fetal PEs resolve and fetuses with isolated PEs have a good prognosis.

New guidance is needed on diagnosing microcephaly in severely malnourished children

The American Academy of Pediatrics recommends that all children have a head circumference measurement at each well-child visit until 2 years of age. Low head circumference is associated with preterm birth and very low birthweight as well as a variety of genetic, nutritional and health factors (1). Microcephaly is an important neurological sign, but there is no uniformity in its definition and no standardisation. It is important to measure head circumference in infants, because this correlates with brain size and growth. Deviations from normal head growth may be the first indication of an underlying congenital, genetic or acquired problem. Microcephaly is usually defined as a head circumference of two or more standard deviations below the mean or less than the second percentile for age and sex. Severe microcephaly is defined as a head circumference that is three or more standard deviations below the mean for age and sex. If the brain is not growing, the skull will not grow and, therefore, a small head reflects microcephaly. Microcephaly combined with delay and regression might be an indication of Rett syndrome or infantile neuronal lipofuscinoses (2). An infants head circumference depends upon the nutritional and socio-economic status of the child, and its mother and genetic factors play a role in head circumference (3). Mental retardation is likely if the head circumference is less than the third percentile. In chronic malnutrition, weight for age, height for age and weight for height are less than normal. Traditionally, it has been stated that the brain sparing effect is present in malnutrition on the basis of an increased brain weight to body weight ratio. Naturally, the head circumference for age is reduced in malnourished children by up to three standard deviations. So in chronic malnutrition, the effect on the length and height should correlate with the head circumference. No standards are currently available for older children. The head size is small or microcephaly is present if it is less than the third percentile of the World Health Organization charts, but this does not consider the stature of older children. Most of these children do not have mental retardation, delayed gross motor development or adaptive development. Can we label the severely malnourished child as having microcephaly if their weight and height are affected by up to three standard deviations? It is clear that new methods or charts are needed to enable us to detect microcephaly in malnourished children.