Rojo Joy

Early versus late enteral prophylactic iron supplementation in preterm very low birth weight infants: a randomised controlled trial

Objectives To evaluate whether preterm very low birth weight (VLBW) infants receiving early iron (EI) supplementation (2 mg/kg/day elemental iron) at 2 weeks postnatal age have improved serum ferritin levels compared with late iron (LI) supplementation at 6 weeks postnatal age. Design Single-blinded parallel-group interventional randomised controlled trial. Setting Tertiary care centre in southern India. Interventions Randomised at 2 weeks postnatal age to EI and LI groups and evaluated at 2, 6 and 12 weeks postnatal age. Outcome The primary outcome was serum ferritin level at 12 weeks, and the secondary outcomes were the incidence of neonatal morbidities, haemoglobin level, anthropometric parameters and blood transfusion requirements. Results Of the 104 babies randomised, outcomes were analysed in 46 and 47 babies in EI and LI groups, respectively. Serum ferritin level was significantly higher (p<0.001) at 12 weeks (82±5 vs 63±3 ng/mL) in the EI group. Haemoglobin (10.1±0.4 vs 9.2±0.4 g/dL) and mean corpuscular haemoglobin concentration (31±0.5 vs 29.4±0.5 g/dL) were also significantly (p<0.001) higher at 12 weeks in the EI group. There was a significant decrease of ferritin in the LI group and significant increase in ferritin in the EI group at 6 weeks compared with 2 weeks. There were no significant differences in the incidences of neonatal morbidities (necrotising enterocolitis, periventricular leukomalacia, retinopathy of prematurity), anthropometric parameters and blood transfusion requirements between the two groups. Conclusions EI supplementation in preterm VLBW infants improves serum ferritin and haemoglobin levels. Trial registration: CTRI/2013/01/003277.

Effect of therapeutic hypothermia on oxidative stress and outcome in term neonates with perinatal asphyxia: a randomized controlled trial.

OBJECTIVES To evaluate in term babies with perinatal asphyxia, the effect of therapeutic hypothermia (TH) on oxidative stress and neurological outcome at discharge. METHODS Babies who satisfied inclusion criteria were randomized to TH, with cooling gel packs to a target temperature of 33-34°C for 72 h or normothermia. Blood sample was collected before and after TH for oxidative stress assessment: total antioxidant status (TAS) and malondialdehyde (MDA). RESULTS Of 116 babies randomized, there was no statistically significant difference in the baseline TAS and MDA. After 72 h of TH, TAS was significantly higher (p = <0.001) (761.69 ± 114.01 vs. 684.16 ± 88.86) and MDA was significantly lower (p = <0.001) in TH group (1.73 ± 0.66 vs. 5.2 ± 1.06). Risk of developing deficit was lower (p < 0.001) in TH group with relative risk of 0.49 and 95 % confidence interval: 0.29-0.68. CONCLUSION TH reduces oxidative stress and improves neurological outcome in perinatal asphyxia. TRIAL REGISTRATION NUMBER CTRI/2011/12/002196.

Frank -Ter Haar Syndrome in a Newborn

Frank-Ter Haar syndrome is an unusual type of skeletal dysplasia with megalocornea and developmental delay. It is usually transmitted as autosomal recessive disorder. Only a few cases have been reported in the literature and none from India. The authors report a case with other unusual features and a short review of the condition.

Postnatal counseling on exclusive breastfeeding using video – experience from a tertiary care teaching hospital, south India

Abstract Introduction: Adequate antenatal counseling combined with postnatal lactation support is likely to improve exclusive breastfeeding rates. Objective: To assess the impact of a postnatal video based health education program in promoting exclusive breastfeeding among primiparous mothers. Methods: This interventional study was done in a tertiary care teaching hospital, south India. Primiparous mothers in one postnatal ward (group A) received routine lactation counseling. A similar group of primiparous mothers in another postnatal ward (group B) were administered a video based health education program on exclusive breastfeeding in the local language Tamil in addition to the routine lactation counseling. The exclusive breastfeeding rates of these two groups of mothers were compared. Their knowledge and perceptions after intervention were also compared using a pretested questionnaire. Results: Among 878 primiparous mothers, 94% fed colostrum and 43% initiated breastfeeding within one hour of delivery. Correct attachment was noted with 96% and 13% had lactation issues. Group B had marginally better exclusive breastfeeding rate at six months but not statistically significant. Mothers in group B had a statistically significant better knowledge score post-intervention compared to those in Group A. Use of gripe water was more in group A compared to group B. Conclusion: The video based health education program when combined with routine lactation counseling improved the knowledge regarding exclusive breastfeeding among postnatal primiparous mothers better than with routine lactation counseling alone. However, both interventions had similar effect on exclusive breastfeeding rate at six months.

Silencing a noisy goitre sans scalpel

A term male baby weighing 2.6 kg born by spontaneous vaginal delivery was noted to have a large neck swelling and respiratory distress. Antenatal ultrasonography had revealed a large thyroid swelling encasing the trachea but not extending into the mediastinum or causing obstruction. The mother was clinically euthyroid and was not on any drugs. On examination, he had severe stridor and tachypnoea and required oxygen by nasal prongs. His neck was hyperextended …

Atrial flutter in a newborn

Abstract Fetal and neonatal arrhythmias present as diagnostic and therapeutic challenges to obstetricians and neonatologists. We present a case of antenatally detected atrial flutter in which the infant presented with congestive cardiac failure at birth and a short review of tachyarrhythmias in the perinatal period.