Sudarshan Kumari

Changes in anti-oxidant enzymes and lipid peroxidation in hyaline membrane disease.

This study was conducted to elucidate the changes in key antioxidant enzymes eg. Superoxide dismutase (SOD), Catalase and Glutathione peroxidase (GPx) along with lipid peroxidation (LPO) in preterm newborns having hyaline membrane disease (HMD) and thus to find out role of free radicals mediated injury in this disease.Twenty one preterm appropriate for gestational age newborns were included in the study, Eleven of them had hyaline membrane disease and ten were controls without any disease. Status of superoxide dismutase, glutathione peroxidase and catalase, the three main antioxidant enzymes and lipid peroxidation was monitored at 12–24 hours of age. SOD and catalase were found significantly elevated in cases having hyaline membrane disease along with significantly more lipid peroxidation.It is evident that free radicals result in the induction of the antioxidant enzymes; however, the elevated enzymes are unable to counteract the high concentration of the free radicals which are being produced in the diseased cases and leads to increase in lipid peroxidation in hyaline membrane disease. It is concluded that free radicals play a significant role in hyaline membrane disease and the preterm newborns have ability to induce antioxidant enzymes in response to oxidative stress.

Multi-resistant Staphylococcus haemolyticus in a neonatal unit in New Delhi

We describe a cluster of infections in a neonatal nursery due to an infrequently reported staphylococcal species, Staphylococcus haemolyticus. S. haemolyticus resistant to penicillin, methicillin, gentamicin, erythromycin, chloramphenicol and tetracycline (PMGECT) was isolated from a series of infections in neonates (conjunctivitis 6, blood 2, pustules 2) over a period of 3 weeks in a neonatal nursery. Surveillance cultures from 22 neonates, their mothers in an adjacent maternity ward and staff revealed that S. haemolyticus with three resistance patterns (PMGECT, PMG and PME) was circulating in the unit. It was isolated from two caesarian wounds, the nose/ear/umbilicus of six asymptomatic infants and from the noses of three mothers and one nurse. S. haemolyticus showed a higher frequency of resistance to antibiotics than Staphylococcus aureus and Staphylococcus epidermidis isolated from the unit at the same time. Local and asymptomatic infections were treated with local neosporin application whereas netilmicin was used to treat systemic infection. Infections were controlled by emphasising the importance of handwashing, asepsis and eye care.

Observations on coagulase-negative staphylococci in a neonatal unit in India

Fifty neonates were included in a prospective study which determined the frequency of colonization and infection with coagulase-negative staphylococci (CNS) in a neonatal unit. The isolates were characterised by species, antibiotic resistance and ability to produce slime. Twenty-four epidemiologically related isolates (including four isolates from the hands of staff) were also phage typed and had plasmid analysis performed. On the first day of birth, 18% of infants were colonized with CNS, 40% and 30% by days 3-5 and day 7 respectively, and 25% by the 14th day and beyond. Staphylococcus haemolyticus and S. epidermidis were the most frequent CNS species encountered, accounting for 36% and 35% of isolates. Resistance to four or more antibiotics was present in 37% of strains isolated on the first day and this increased to 100% of isolates from infants who stayed for more than 14 days. Forty-five percent of CNS were slime producers; no significant difference was observed in slime producing ability between the species or isolates at different days after birth. Five infants developed septicaemia due to CNS. Staphylococcus haemolyticus and S. epidermidis were recovered as the only pathogens from three and two cases respectively. Detailed typing revealed that one case of infection with S. haemolyticus was preceded by surface colonization with an identical strain. Evidence was also obtained for the transmission of CNS between babies on the hands of staff.

Trends in Neonatal Outcome with Low Apgar Scores

Trends in incidence and neonatal outcome following low Apgar scores (1 min Apgar score <6) were prospectively studied during the years (1981, 1983, 1986 and 1988. The incidence of birth asphyxia was 7.6% of live births during the study period; it was 5.8% in 1981, increased to highest of 8.9% in 1986 with slight reduction to 7.2% in 1988. Birth weight distribution of asphyxiated babies and 1 min Apgar score <3 (severe asphyxia) remained unchanged. A significant decline in neonatal mortality with asphyxia was noted from 46.0% to 28.4% during 1981 and 1988 respectively. Aetiological factors for asphyxia could be identified in nearly 90% of infants during 1988, and all but 2 of 12 factors studied registered significant differences from control non-asphyxiated group.

Asymptomatic Salmonella senftenberg carriage in a neonatal ward

During a 23-day period in April 1991, nine infants in a neonatal ward were found to be colonized with Salmonella senftenberg. All were asymptomatic on detection and all except one (who developed septic ileus) remained asymptomatic on follow-up. The affected babies were isolated and subsequently discharged from the ward as soon as possible. These measures, along with emphasis on handwashing and intensification of cleaning and disinfection, were able to prevent spread to other babies. Despite extensive sampling of the environment, mothers and staff, the source of the organism could not be identified.

Maternal attitude and practices in initiation of newborn feeding.

The present study highlights the need for due emphasis on initiation of breast feeding of newborn infants over other traditional prelacteal newborn feeds. Knowledge, attitudes and newborn feeding practices amongst 702 mothers with urban background was recorded. Though 83.5% of mothers had attended the antenatal clinics, only 13.24% had been given breast feeding advice at the antenatal clinics. It is a cause of concern that only 26.35% had initiated the feeding by breast milk and only 16% had given colostrum. A large number of newborns were fed with finger tips and other unhygienic methods. However, most (95.01%) mothers had started breast feeding their newborns before discharge from hospital.

Breast feeding: physical growth during infancy

Five hundred and seventyfour infants between 1 and 12 months of age who were exclusively breast fed after normal hospital birth, were studied for physical growth in weight, length and head circumference. The study group infants registered lower mean weight and length throughout the first year, but marked faltering in growth was observed in weight at 4 months and in length at 7 months of age. Comparison with growth of high income group infants from Delhi shows that the study infants lagged behind in weight at 3 months and in length at 6 months of age. These findings suggest inadequacy of mother’s milk beyond 4 months of age. Hence for prevention of malnutrition, introduction of weaning foods should be encouraged by 4 to 6 months of infant’s life.

Infection scoring in early neonatal infection

This study reports the usefulness of infection scoring system, comprising of maternal and neonatal high risk factors for infection. The score was applied on 947 neonates at birth who were followed up for superficial and deep infections in postnatal wards or neonatal nursery. Total score consisted of 10 points. A high association was observed between increasing score and total and deep infections. Incidence of infections was 0, 5.0, 10.5, 20.9, 61.8 and 95.4 percent respectively with infection scores of 0, 1, 2, 3, 4 and 5 and above respectively. For term infants, cut off point for infection was at score 3, while for low birth ones this was lower at 2. This study, therefore, shows the utility of this practical scoring system in prediction of early neonatal infections.

A simple method of screening for intrauterine growth retardation at birth

Midarm to head circumference ratio was evaluated in 233 term infants for identification of intrauterine growth retardation (IUGR) at birth. A ratio of 0.233±0.014 could identify all babies with severe IUGR, while all but two babies with mild I UGR had this ratio less than 0.280. The observation suggest that this method can be utilised for easy diagnosis of IUGR even by paramedical workers at community level, and is independent of ethnic groups or intrauterine growth curves.