Pub Date : 2021-01-01DOI: 10.7860/ijnmr/2021/46809.2294
R. Meshram, Vishal S Gajimwar, Swapnali Bansode, H. Sonak, Kalyani Kadu, S. Dudhbhate, Ranjeet Chatnalkar
Introduction: In the last few decades, the prevalence of multiple pregnancies has increased, and it is associated with significantly higher maternal and neonatal mortality. Aim: To determine the morbidity and mortality patterns of neonates born to multiple pregnancies. Materials and Methods: Prospective observational study was undertaken on neonates who were born to a mother with multiple gestations. One hundred mother’s neonates with multiple pregnancies were consequently enrolled at a tertiary institute for six months. Morbidity and mortality patterns were analysed. The data regarding the numerical variables were summarised through percentage, average, median, and deviation patterns and comparisons of categorical data were carried out by using Pearson’s Chi-square test. Results: A total of 202 babies was delivered including two pairs of triplets. Among that two were still born and two were Intra Uterine Deaths (IUD). Most of the twin pregnancies were spontaneous and in the maternal age group of 21-25 years. The male to female ratio was almost equal and 148 (74.75 %) neonates were preterm. One hundred and seventeen (59.09%) neonates were Low Birth Weight (LBW) and 44 (22.22%) were Very Low Birth Weight (VLBW), including 85 (42.93%) Small for Gestational Age (SGA) and 43 (21.72%) were Intrauterine Growth Retardation (IUGR). Ninety-eight (49.49%) neonates’ required Neonatal Intensive Care Unit (NICU) admission with lethargy and respiratory distress being the common clinical presentation. Respiratory distress syndrome, sepsis and birth asphyxia was diagnosed in 44.9%, 24.5% and 5.1% neonates respectively while jaundice, intraventricular haemorrhage and retinopathy of prematurity were the clinical diagnosis. Perinatal mortality rate was 163.34 per 1,000 pregnancies while the neonatal mortality rate was 146.46 per 1000 live born neonates. Respiratory distress syndrome, sepsis and the intraventricular haemorrhage were the common causes of mortality. Conclusion: Prevention of prematurity and LBW neonates is the key to reduce mortality and it is the greatest challenge to paediatricians and obstetricians.
{"title":"Morbidity and Mortality Patterns of Neonates Born to Multiple Pregnancies: A Prospective Observational Study","authors":"R. Meshram, Vishal S Gajimwar, Swapnali Bansode, H. Sonak, Kalyani Kadu, S. Dudhbhate, Ranjeet Chatnalkar","doi":"10.7860/ijnmr/2021/46809.2294","DOIUrl":"https://doi.org/10.7860/ijnmr/2021/46809.2294","url":null,"abstract":"Introduction: In the last few decades, the prevalence of multiple pregnancies has increased, and it is associated with significantly higher maternal and neonatal mortality. Aim: To determine the morbidity and mortality patterns of neonates born to multiple pregnancies. Materials and Methods: Prospective observational study was undertaken on neonates who were born to a mother with multiple gestations. One hundred mother’s neonates with multiple pregnancies were consequently enrolled at a tertiary institute for six months. Morbidity and mortality patterns were analysed. The data regarding the numerical variables were summarised through percentage, average, median, and deviation patterns and comparisons of categorical data were carried out by using Pearson’s Chi-square test. Results: A total of 202 babies was delivered including two pairs of triplets. Among that two were still born and two were Intra Uterine Deaths (IUD). Most of the twin pregnancies were spontaneous and in the maternal age group of 21-25 years. The male to female ratio was almost equal and 148 (74.75 %) neonates were preterm. One hundred and seventeen (59.09%) neonates were Low Birth Weight (LBW) and 44 (22.22%) were Very Low Birth Weight (VLBW), including 85 (42.93%) Small for Gestational Age (SGA) and 43 (21.72%) were Intrauterine Growth Retardation (IUGR). Ninety-eight (49.49%) neonates’ required Neonatal Intensive Care Unit (NICU) admission with lethargy and respiratory distress being the common clinical presentation. Respiratory distress syndrome, sepsis and birth asphyxia was diagnosed in 44.9%, 24.5% and 5.1% neonates respectively while jaundice, intraventricular haemorrhage and retinopathy of prematurity were the clinical diagnosis. Perinatal mortality rate was 163.34 per 1,000 pregnancies while the neonatal mortality rate was 146.46 per 1000 live born neonates. Respiratory distress syndrome, sepsis and the intraventricular haemorrhage were the common causes of mortality. Conclusion: Prevention of prematurity and LBW neonates is the key to reduce mortality and it is the greatest challenge to paediatricians and obstetricians.","PeriodicalId":31116,"journal":{"name":"Indian Journal of Neonatal Medicine and Research","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71265144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.7860/ijnmr/2021/46844.2293
S. Patel, .. Ritupriya, P. Padhi, T. Naik, R. Nanda, E. Mohapatra, S. Agrawal
Introduction: Newborn Screening (NBS) is considered the need of the hour for quality health in neonates. It is also important to understand that the rising trend of prevalence of inherited metabolic disorders and the various maternal factors that might influence genetic changes in the foetus in- utero affecting the neonatal outcome. Aim: The primary objective of the study was to determine frequency of Congenital Hypothyroidism (CH) and Glucose- 6-Phosphate Dehydrogenase (G6PD) deficiency in a most approachable tertiary care hospital. The secondary objectives were to find out impact of maternal factors on the frequency of the disease and the impact of the disorder on the neonate’s health. Materials and Methods: The cross-sectional study was conducted on 1282 neonates of 48 hours upto eight weeks of age. The Dried Blood Spot (DBS) specimens collected were analysed for Thyroid Stimulating Hormone (TSH) level and G6PD enzyme activity. Details of neonatal characteristics and antenatal history were documented. Prevalence of CH and G6PD deficiency was calculated and maternal and neonatal variables were analysed for association using Statistical Package for the Social Sciences (SPSS) version 20. Results: The prevalence of CH and G6PD were respectively 3.3/1000 and 6.6/1000 making the overall prevalence of metabolic disorders as 9.8/1000. A 27.3% had Low Birth Weight (LBW) and 62% had low Ponderal Index (PI). The odds for raised TSH was 6.62 times in sick neonates. The probability for high TSH in LBW babies was more by 94% and in female neonates by 18%. The neonates with higher TSH values depicted significant association with maternal age (p=0.016), gestational age (p=0.019) and maternal anaemia (p<0.001). Babies born by caesarean section showed twice the chances for screening positive for TSH. Conclusion: The high prevalence estimated in this study and association with maternal factors urges new queries and recommends an obligatory need for NBS program in this region.
{"title":"Newborn Screening-A Bolstering Step towards Quality Health in Neonates","authors":"S. Patel, .. Ritupriya, P. Padhi, T. Naik, R. Nanda, E. Mohapatra, S. Agrawal","doi":"10.7860/ijnmr/2021/46844.2293","DOIUrl":"https://doi.org/10.7860/ijnmr/2021/46844.2293","url":null,"abstract":"Introduction: Newborn Screening (NBS) is considered the need of the hour for quality health in neonates. It is also important to understand that the rising trend of prevalence of inherited metabolic disorders and the various maternal factors that might influence genetic changes in the foetus in- utero affecting the neonatal outcome. Aim: The primary objective of the study was to determine frequency of Congenital Hypothyroidism (CH) and Glucose- 6-Phosphate Dehydrogenase (G6PD) deficiency in a most approachable tertiary care hospital. The secondary objectives were to find out impact of maternal factors on the frequency of the disease and the impact of the disorder on the neonate’s health. Materials and Methods: The cross-sectional study was conducted on 1282 neonates of 48 hours upto eight weeks of age. The Dried Blood Spot (DBS) specimens collected were analysed for Thyroid Stimulating Hormone (TSH) level and G6PD enzyme activity. Details of neonatal characteristics and antenatal history were documented. Prevalence of CH and G6PD deficiency was calculated and maternal and neonatal variables were analysed for association using Statistical Package for the Social Sciences (SPSS) version 20. Results: The prevalence of CH and G6PD were respectively 3.3/1000 and 6.6/1000 making the overall prevalence of metabolic disorders as 9.8/1000. A 27.3% had Low Birth Weight (LBW) and 62% had low Ponderal Index (PI). The odds for raised TSH was 6.62 times in sick neonates. The probability for high TSH in LBW babies was more by 94% and in female neonates by 18%. The neonates with higher TSH values depicted significant association with maternal age (p=0.016), gestational age (p=0.019) and maternal anaemia (p<0.001). Babies born by caesarean section showed twice the chances for screening positive for TSH. Conclusion: The high prevalence estimated in this study and association with maternal factors urges new queries and recommends an obligatory need for NBS program in this region.","PeriodicalId":31116,"journal":{"name":"Indian Journal of Neonatal Medicine and Research","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71265205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.7860/ijnmr/2021/46275.2286
Bijaylaxmi Behera, B. Meena
Introduction: In developing countries, like ours, the major causes of neonatal mortality are Prematurity, Birth asphyxia and Sepsis. Although institutional delivery and in utero transport of newborn is the safest way to transport but it is difficult to anticipate preterm deliveries and perinatal illnesses. Moreover, transport with a well equipped and manned team improves neonatal outcomes than self transport. Hence, with the above hypothesis this study was conducted to analyse the profile of newborn babies transported to our unit by our team. Aim: To study the outcome of the sick neonates transported by a well equipped and manned neonatal transport to a Tertiary Care Hospital, indications of transport and also evaluate their condition at arrival. Materials and Methods: This was a retrospective longitudinal descriptive study, including 101 extramural neonates who were transported by a well equipped and manned team, to a Tertiary Care Hospital in Northern India. Transport details along with demographic parameters and clinical features prior to transport and at arrival were recorded. Follow-up was done for all neonates till discharge or death. Transport, clinical variables and Score for Neonatal Acute Physiology-Perinatal Extension ll (SNAPPE-II) were correlated with outcome using logistic regression analysis. Results: Total 101 newborn infants were transported. Fifty- eight babies were term and 43 were preterm. Birth asphyxia, Meconium Aspiration Syndrome, Hyaline Membrane Disease, Transient Tachypnea of Newborn, Congenital Cyanotic Heart Disease, Neonatal Jaundice, Pneumonia, Hypoglycaemia, Preterm, Fever, Feed intolerance were the major indications for transport. Total 16 neonates died. Out of all babies at admission, 14.8% of babies were still hypothermic, 10.8% were still hypoxic, 4.9% were still hypoglycemic and 14.8% were still in shock. SNAPPE score >40, hypoglycaemia, hypothermia, hypoxia and shock correlated with poor outcome. Distance did not correlate with the outcome. Conclusion: Stabilising newborns prior to transport is crucial and neonatal transport is not dependent on distance. Hypothermia, hypoglycaemia, hypoxia and shock should be managed in neonates before and during transport as they affect their outcomes.
{"title":"Outcomes of Sick Neonates Transported to a Tertiary Care Hospital by a Trained Team, in Northern India","authors":"Bijaylaxmi Behera, B. Meena","doi":"10.7860/ijnmr/2021/46275.2286","DOIUrl":"https://doi.org/10.7860/ijnmr/2021/46275.2286","url":null,"abstract":"Introduction: In developing countries, like ours, the major causes of neonatal mortality are Prematurity, Birth asphyxia and Sepsis. Although institutional delivery and in utero transport of newborn is the safest way to transport but it is difficult to anticipate preterm deliveries and perinatal illnesses. Moreover, transport with a well equipped and manned team improves neonatal outcomes than self transport. Hence, with the above hypothesis this study was conducted to analyse the profile of newborn babies transported to our unit by our team. Aim: To study the outcome of the sick neonates transported by a well equipped and manned neonatal transport to a Tertiary Care Hospital, indications of transport and also evaluate their condition at arrival. Materials and Methods: This was a retrospective longitudinal descriptive study, including 101 extramural neonates who were transported by a well equipped and manned team, to a Tertiary Care Hospital in Northern India. Transport details along with demographic parameters and clinical features prior to transport and at arrival were recorded. Follow-up was done for all neonates till discharge or death. Transport, clinical variables and Score for Neonatal Acute Physiology-Perinatal Extension ll (SNAPPE-II) were correlated with outcome using logistic regression analysis. Results: Total 101 newborn infants were transported. Fifty- eight babies were term and 43 were preterm. Birth asphyxia, Meconium Aspiration Syndrome, Hyaline Membrane Disease, Transient Tachypnea of Newborn, Congenital Cyanotic Heart Disease, Neonatal Jaundice, Pneumonia, Hypoglycaemia, Preterm, Fever, Feed intolerance were the major indications for transport. Total 16 neonates died. Out of all babies at admission, 14.8% of babies were still hypothermic, 10.8% were still hypoxic, 4.9% were still hypoglycemic and 14.8% were still in shock. SNAPPE score >40, hypoglycaemia, hypothermia, hypoxia and shock correlated with poor outcome. Distance did not correlate with the outcome. Conclusion: Stabilising newborns prior to transport is crucial and neonatal transport is not dependent on distance. Hypothermia, hypoglycaemia, hypoxia and shock should be managed in neonates before and during transport as they affect their outcomes.","PeriodicalId":31116,"journal":{"name":"Indian Journal of Neonatal Medicine and Research","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71265465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.7860/ijnmr/2021/47755.2290
Roshni Gurnani, Madhuri Engade, Haseeb A. Mohammed, Saranya Murlidharan Sindhu, Mahafrin Homar Goiporia, Arti Choudhary
Introduction: Cord Blood Thyroid Stimulating Hormone (CBTSH) level estimation is an accepted screening tool for Congenital Hypothyroidism (CH). CBTSH levels are affected by many perinatal factors including mode of delivery. Previous studies have shown conflicting results on effect of mode of delivery of CBTSH levels. Aim: To study CBTSH profile in neonates born at tertiary care referral centre and to analyse the influence of mode of delivery (vaginal vs caesarean) on CBTSH levels. Materials and Methods: This was a cross-sectional study conducted at Mahatma Gandhi Medical College and Hospital from February 2014 to August 2015. Study population included 856 neonates (males=437, females=419). The CBTSH levels were estimated using Electrochemiluminescence Immunoassay ‘ECLIA’ on the Elecsys 2010 analyser. CBTSH levels between vaginally delivered and caesarean section born babies were compared. The values were tabulated as mean and statistically analysed using Statistical Package for the Social Sciences (SPSS) software version 21. Results: Mean CBTSH level of vaginally born neonates were 9.59 (median 7.0) in comparison to 9.11 (median 7.15) in caesarean born babies, this difference was not statistically significant. Conclusion: As per the present study finding mode of delivery did not have any significant effect on CBTSH levels.
{"title":"Effect of Mode of Delivery on Cord Blood Thyroid Stimulating Hormone Levels- A Cross-sectional Study","authors":"Roshni Gurnani, Madhuri Engade, Haseeb A. Mohammed, Saranya Murlidharan Sindhu, Mahafrin Homar Goiporia, Arti Choudhary","doi":"10.7860/ijnmr/2021/47755.2290","DOIUrl":"https://doi.org/10.7860/ijnmr/2021/47755.2290","url":null,"abstract":"Introduction: Cord Blood Thyroid Stimulating Hormone (CBTSH) level estimation is an accepted screening tool for Congenital Hypothyroidism (CH). CBTSH levels are affected by many perinatal factors including mode of delivery. Previous studies have shown conflicting results on effect of mode of delivery of CBTSH levels. Aim: To study CBTSH profile in neonates born at tertiary care referral centre and to analyse the influence of mode of delivery (vaginal vs caesarean) on CBTSH levels. Materials and Methods: This was a cross-sectional study conducted at Mahatma Gandhi Medical College and Hospital from February 2014 to August 2015. Study population included 856 neonates (males=437, females=419). The CBTSH levels were estimated using Electrochemiluminescence Immunoassay ‘ECLIA’ on the Elecsys 2010 analyser. CBTSH levels between vaginally delivered and caesarean section born babies were compared. The values were tabulated as mean and statistically analysed using Statistical Package for the Social Sciences (SPSS) software version 21. Results: Mean CBTSH level of vaginally born neonates were 9.59 (median 7.0) in comparison to 9.11 (median 7.15) in caesarean born babies, this difference was not statistically significant. Conclusion: As per the present study finding mode of delivery did not have any significant effect on CBTSH levels.","PeriodicalId":31116,"journal":{"name":"Indian Journal of Neonatal Medicine and Research","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71265370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.7860/ijnmr/2021/49117.2306
A. Rao, T. Parikh
Effect of Perinatal maternal Coronavirus Disease-2019 (COVID-19) on growing foetus is not fully understood. There are early reports of biochemical Acute Kidney Injury (AKI) in the foetus with maternal COVID-19 infection. Present case is the first clinical case of perinatal AKI in a preterm neonate associated with maternal severe COVID-19. Preterm baby (34+4 weeks) was born to mother having COVID-19 pneumonia with raised inflammatory markers. She had history of decrease foetal movements and anhydraminos a day prior to delivery. Baby showed signs of AKI in form of weight gain, oedema and hypertension with initial serum creatinine of 3.54 mg/dL and blood urea of 95.2 mg/dL at 48 hours of age. Subsequently baby showed diuresis and improving Renal Function Tests (RFT). The foetal AKI resulted in anuria followed by anhydraminos with postnatal recovering AKI; even though the baby tested negative for COVID-19 RT-PCR, The baby did not have any clinical or biochemical evidence of asphyxia or sepsis. Possible explanation could be foetal renal hyoxic ischaemic insult due to Vasomotor Nephropathy (VMNP) or AKI due to cytokine storm in mother or direct viral injury to developing kidneys without nasopharyngeal colonisation.
{"title":"Perinatal Acute Kidney Injury in a Preterm Neonate Associated with Maternal COVID-19 Infection: A Case Report","authors":"A. Rao, T. Parikh","doi":"10.7860/ijnmr/2021/49117.2306","DOIUrl":"https://doi.org/10.7860/ijnmr/2021/49117.2306","url":null,"abstract":"Effect of Perinatal maternal Coronavirus Disease-2019 (COVID-19) on growing foetus is not fully understood. There are early reports of biochemical Acute Kidney Injury (AKI) in the foetus with maternal COVID-19 infection. Present case is the first clinical case of perinatal AKI in a preterm neonate associated with maternal severe COVID-19. Preterm baby (34+4 weeks) was born to mother having COVID-19 pneumonia with raised inflammatory markers. She had history of decrease foetal movements and anhydraminos a day prior to delivery. Baby showed signs of AKI in form of weight gain, oedema and hypertension with initial serum creatinine of 3.54 mg/dL and blood urea of 95.2 mg/dL at 48 hours of age. Subsequently baby showed diuresis and improving Renal Function Tests (RFT). The foetal AKI resulted in anuria followed by anhydraminos with postnatal recovering AKI; even though the baby tested negative for COVID-19 RT-PCR, The baby did not have any clinical or biochemical evidence of asphyxia or sepsis. Possible explanation could be foetal renal hyoxic ischaemic insult due to Vasomotor Nephropathy (VMNP) or AKI due to cytokine storm in mother or direct viral injury to developing kidneys without nasopharyngeal colonisation.","PeriodicalId":31116,"journal":{"name":"Indian Journal of Neonatal Medicine and Research","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71265772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.7860/ijnmr/2021/51431.2315
S. Gopu, A. Begum
Introduction: Antenatal Hydronephrosis (ANH) is one of the most commonly detected congenital anomaly by antenatal sonogram. It requires periodic follow-up and in selected cases, early interventions are required in postnatal period. Aim: To study the relationship between Anteroposterior Diameter (APD) of foetal renal pelvis and postnatal outcome of hydronephrosis in neonates and to study the relation between APD of foetal renal pelvis and structural abnormalities of kidney. Materials and Methods: This prospective study included neonates whose antenatal scan showed hydronephrosis. The study was conducted during the period of November 2018 to November 2020, in Niloufer Hospital (Osmania Medical College), Hyderabad, Telangana, India. A total of 50 neonates were included. For all neonates postnatal monitoring with ultrasonography was done to detect structural anomalies and resolution of hydronephrosis. Micturating cystourethrogram was done in selected cases. The cases which needed surgery were treated accordingly. The Statistical Package for the Social Sciences (SPSS) version 24.0 was used for data analysis. Kruskal-Wallis Chi-square test was used to test the significance of difference between quantitative variables. The p-value less than 0.05 was taken as statistically significant. Results: Among 50 neonates enrolled in the study, 27 (54%) had transient hydronephrosis and 23 (46%) had urogenital structural abnormalities. Twenty-two cases (44%) required micturating cystourethrogram. Antenatal APD of 9.5 mm predicted the development of significant postnatal uropathy with a sensitivity of 74% and specificity of 89%. Antenatal APD of 9.5 mm had 100% sensitivity and 67% specificity in predicting the need for surgical intervention. Only 3 (6%) cases needed surgical intervention in neonatal period and all cases were kept under follow-up. Conclusion: All cases of ANH need postnatal evaluation and pertinent follow-up to detect significant uropathy for their proper management to prevent renal damage. Antenatal renal pelvic diameter has significant role in predicting the significant uropathy and surgical intervention.
{"title":"Neonatal Outcome of Antenatally Diagnosed Hydronephrosis at a Tertiary Care Centre, Telangana, India: A Prospective Study","authors":"S. Gopu, A. Begum","doi":"10.7860/ijnmr/2021/51431.2315","DOIUrl":"https://doi.org/10.7860/ijnmr/2021/51431.2315","url":null,"abstract":"Introduction: Antenatal Hydronephrosis (ANH) is one of the most commonly detected congenital anomaly by antenatal sonogram. It requires periodic follow-up and in selected cases, early interventions are required in postnatal period. Aim: To study the relationship between Anteroposterior Diameter (APD) of foetal renal pelvis and postnatal outcome of hydronephrosis in neonates and to study the relation between APD of foetal renal pelvis and structural abnormalities of kidney. Materials and Methods: This prospective study included neonates whose antenatal scan showed hydronephrosis. The study was conducted during the period of November 2018 to November 2020, in Niloufer Hospital (Osmania Medical College), Hyderabad, Telangana, India. A total of 50 neonates were included. For all neonates postnatal monitoring with ultrasonography was done to detect structural anomalies and resolution of hydronephrosis. Micturating cystourethrogram was done in selected cases. The cases which needed surgery were treated accordingly. The Statistical Package for the Social Sciences (SPSS) version 24.0 was used for data analysis. Kruskal-Wallis Chi-square test was used to test the significance of difference between quantitative variables. The p-value less than 0.05 was taken as statistically significant. Results: Among 50 neonates enrolled in the study, 27 (54%) had transient hydronephrosis and 23 (46%) had urogenital structural abnormalities. Twenty-two cases (44%) required micturating cystourethrogram. Antenatal APD of 9.5 mm predicted the development of significant postnatal uropathy with a sensitivity of 74% and specificity of 89%. Antenatal APD of 9.5 mm had 100% sensitivity and 67% specificity in predicting the need for surgical intervention. Only 3 (6%) cases needed surgical intervention in neonatal period and all cases were kept under follow-up. Conclusion: All cases of ANH need postnatal evaluation and pertinent follow-up to detect significant uropathy for their proper management to prevent renal damage. Antenatal renal pelvic diameter has significant role in predicting the significant uropathy and surgical intervention.","PeriodicalId":31116,"journal":{"name":"Indian Journal of Neonatal Medicine and Research","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71265959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.7860/ijnmr/2021/52782.2313
T. Rehna, K. Shiyas
Introduction: Hyperbilirubinemia is a commonly encountered medical condition in neonates. It becomes problematic when the levels of bilirubin raises to abnormally high values leading on to neurological problems. Bilirubin Albumin Ratio (BAR) can be used as a prediction tool for subsequent hyperbilirubinemia in neonates thereby helping in early institution of therapy. Aim: To compare Umbilical Cord blood Bilirubin (UCB) and the BAR in predicting neonatal hyperbilirubinemia. Materials and Methods: This prospective observational study was conducted in the neonates born at Al-Azhar Medical College, Thodupuzha, Kerala, India, from April 2020 to February 2021. After obtaining clearance from Institute Research Committee and Institute Ethical Committee, 1025 healthy term babies were included in the study. After an informed consent from either of the parent, cord blood was sent for bilirubin, albumin and the blood group estimation. Babies were examined daily for any development of jaundice for five days or till discharge. Venous blood was sent for bilirubin estimation if clinical icterus was noted by Kramer’s rule any time after birth or at 72 hours. If hyperbilirubinemia was detected, treatment was instituted. Two cut-offs for UCB-2 and 2.5 mg/dL and two cut-offs for BAR 0.59 and 0.69 were correlated with the neonatal hyperbilirubinemia using Pearson correlation and Chi-square test. The p-value <0.05 was taken as statistically significant. The cut-off values for cord bilirubin and BAR that could predict hyperbilirubinemia was also obtained from Receiver Operating Curve (ROC). Results: Of the 1025 babies studied, hyperbilirubinemia was detected in 246 babies (24%). Babies with higher UCB and BAR had statistically significant risk of neonatal hyperbilirubinemia. UCB >2 mg/dL and 2.5 mg/dL and BAR 0.59 and 0.69 were found to strongly correlate with the risk of hyperbilirubinemia. Higher the UCB and BAR, higher the risk. On ROC analysis, cut-off points for UCB and BAR were 2 mg/dL and BAR >0.59 respectively. A highly significant correlation was found between UCB and hyperbilirubinemia as well as between BAR and hyperbilirubinemia with a p-value <0.001. Among UCB and BAR, UCB is found to have better sensitivity and specificity than BAR with cut-off 2 mg/dL with better sensitivity of 75.2% and cut-off 2.5 mg/dL with a better specificity of 89.6%. Conclusion: UCB and BAR are strong predictors of neonatal hyperbilirubinemia with UCB a better predictor than BAR.
{"title":"Comparison of Umbilical Cord blood Bilirubin (UCB) and Bilirubin Albumin Ratio (BAR) in Predicting Neonatal Hyperbilirubinemia: A Prospective Observational Study","authors":"T. Rehna, K. Shiyas","doi":"10.7860/ijnmr/2021/52782.2313","DOIUrl":"https://doi.org/10.7860/ijnmr/2021/52782.2313","url":null,"abstract":"Introduction: Hyperbilirubinemia is a commonly encountered medical condition in neonates. It becomes problematic when the levels of bilirubin raises to abnormally high values leading on to neurological problems. Bilirubin Albumin Ratio (BAR) can be used as a prediction tool for subsequent hyperbilirubinemia in neonates thereby helping in early institution of therapy. Aim: To compare Umbilical Cord blood Bilirubin (UCB) and the BAR in predicting neonatal hyperbilirubinemia. Materials and Methods: This prospective observational study was conducted in the neonates born at Al-Azhar Medical College, Thodupuzha, Kerala, India, from April 2020 to February 2021. After obtaining clearance from Institute Research Committee and Institute Ethical Committee, 1025 healthy term babies were included in the study. After an informed consent from either of the parent, cord blood was sent for bilirubin, albumin and the blood group estimation. Babies were examined daily for any development of jaundice for five days or till discharge. Venous blood was sent for bilirubin estimation if clinical icterus was noted by Kramer’s rule any time after birth or at 72 hours. If hyperbilirubinemia was detected, treatment was instituted. Two cut-offs for UCB-2 and 2.5 mg/dL and two cut-offs for BAR 0.59 and 0.69 were correlated with the neonatal hyperbilirubinemia using Pearson correlation and Chi-square test. The p-value <0.05 was taken as statistically significant. The cut-off values for cord bilirubin and BAR that could predict hyperbilirubinemia was also obtained from Receiver Operating Curve (ROC). Results: Of the 1025 babies studied, hyperbilirubinemia was detected in 246 babies (24%). Babies with higher UCB and BAR had statistically significant risk of neonatal hyperbilirubinemia. UCB >2 mg/dL and 2.5 mg/dL and BAR 0.59 and 0.69 were found to strongly correlate with the risk of hyperbilirubinemia. Higher the UCB and BAR, higher the risk. On ROC analysis, cut-off points for UCB and BAR were 2 mg/dL and BAR >0.59 respectively. A highly significant correlation was found between UCB and hyperbilirubinemia as well as between BAR and hyperbilirubinemia with a p-value <0.001. Among UCB and BAR, UCB is found to have better sensitivity and specificity than BAR with cut-off 2 mg/dL with better sensitivity of 75.2% and cut-off 2.5 mg/dL with a better specificity of 89.6%. Conclusion: UCB and BAR are strong predictors of neonatal hyperbilirubinemia with UCB a better predictor than BAR.","PeriodicalId":31116,"journal":{"name":"Indian Journal of Neonatal Medicine and Research","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71265653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.7860/ijnmr/2021/46426.2296
Rutvik H. Parikh, Y. Dattani, Rohan M. Modi, Bhanu Desai, T. Ninama, Amay Himanshu Khara, K. Patel
Introduction: Cord blood would be a feasible and simple method for detecting cholesterol level at birth. Neonatal lipids level could serve as a guide to know the physiological levels of lipids required for maintaining the normal bodily mechanisms. Aim: To compare the cord blood lipid profile of 300 newborn babies born to hypertensive and normotensive mothers. Materials and Methods: The case-control study was done in the Department of Paediatrics, GCS Medical College, Hospital and Research Centre, Ahmedabad, Gujarat, India, for the period of one year from Jan 2019 to Jan 2020. A total of 300 pregnant ladies were included in the study. They were divided in two groups: group A consisted of 150 newborns who were born to 150 hypertensive mothers and group B consisted of 150 newborns who were born to 150 non hypertensive mothers. Five millilitres of cord blood were collected from the placental end of the umbilical vein, and then the serum was separated by centrifugation. Data was collected and mean±SD were calculated. Chi-square test and Mann Whitney test were done for statistical analysis. Results: When the cord blood was evaluated for the cholesterol, Triglyceride (TG) (p-value 0.001), High Density Lipoprotein (HDL) (p-value 0.001) and Low Density Lipoprotein (LDL) (p-value 0.001) level; it was found that in group A the levels were more in mean value as compared to the non hypertensive group, where the level was found to be lower than the mean value. The difference was found to be statistically significant. Conclusion: Hypertensive status of mother could impact neonatal lipid profile; however, larger prospective studies are required to validate these results.
{"title":"Comparison of Lipid Profile in the Cord Blood in the Hypertensive and Non hypertensive Mothers: A Case-control Study","authors":"Rutvik H. Parikh, Y. Dattani, Rohan M. Modi, Bhanu Desai, T. Ninama, Amay Himanshu Khara, K. Patel","doi":"10.7860/ijnmr/2021/46426.2296","DOIUrl":"https://doi.org/10.7860/ijnmr/2021/46426.2296","url":null,"abstract":"Introduction: Cord blood would be a feasible and simple method for detecting cholesterol level at birth. Neonatal lipids level could serve as a guide to know the physiological levels of lipids required for maintaining the normal bodily mechanisms. Aim: To compare the cord blood lipid profile of 300 newborn babies born to hypertensive and normotensive mothers. Materials and Methods: The case-control study was done in the Department of Paediatrics, GCS Medical College, Hospital and Research Centre, Ahmedabad, Gujarat, India, for the period of one year from Jan 2019 to Jan 2020. A total of 300 pregnant ladies were included in the study. They were divided in two groups: group A consisted of 150 newborns who were born to 150 hypertensive mothers and group B consisted of 150 newborns who were born to 150 non hypertensive mothers. Five millilitres of cord blood were collected from the placental end of the umbilical vein, and then the serum was separated by centrifugation. Data was collected and mean±SD were calculated. Chi-square test and Mann Whitney test were done for statistical analysis. Results: When the cord blood was evaluated for the cholesterol, Triglyceride (TG) (p-value 0.001), High Density Lipoprotein (HDL) (p-value 0.001) and Low Density Lipoprotein (LDL) (p-value 0.001) level; it was found that in group A the levels were more in mean value as compared to the non hypertensive group, where the level was found to be lower than the mean value. The difference was found to be statistically significant. Conclusion: Hypertensive status of mother could impact neonatal lipid profile; however, larger prospective studies are required to validate these results.","PeriodicalId":31116,"journal":{"name":"Indian Journal of Neonatal Medicine and Research","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71265081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.7860/ijnmr/2021/44056.2288
SP Pargaonkar, SS Poyekar, L. Gaur
Introduction: Preterm Birth (PTB) is a major problem associated with neonatal morbidity and mortality globally. In developing countries magnitude of the problem is much more. Aim: The present study was undertaken to find out the incidence of preterm labour/births, to evaluate different related risk factors and to assess the neonatal mortality in PTBs. Materials and Methods: This cross-sectional study was conducted in a Maternal and Neonatal Units of Rural Teaching Hospital among all cases who delivered during study period of two months from mid-February 2019 to mid-April 2019. Probable maternal risk factors for preterm labour, neonatal clinical profile and risk factors for neonatal mortality were recorded. Frequencies and proportion of variables were computed. Results: The incidence of PTB/labour was 8.5%. Pregnancy duration of less than 34 weeks was observed in 35.6% mothers. It was observed that major factors contributing to PTBs were hypertensive disorders of pregnancy, maternal medical illness/severe anaemia, Bad Obstetric History (BOH)/ previous preterm labour and Ante-Partum Haemorrhage (APH). Survival rate amongst preterm babies was 90.5%. Conclusion: The morbidity amongst newborns is mainly caused by PTB. The study found lower incidence of PTB as compared to previous studies conducted in this region. Many of the risk factors evaluated are modifiable. Risk factor modifications and timely interventions will help in the reduction of PTBs and associated mortality.
{"title":"Risk Factor Evaluation of Preterm Labour/ Births in Rural Medical College Hospital","authors":"SP Pargaonkar, SS Poyekar, L. Gaur","doi":"10.7860/ijnmr/2021/44056.2288","DOIUrl":"https://doi.org/10.7860/ijnmr/2021/44056.2288","url":null,"abstract":"Introduction: Preterm Birth (PTB) is a major problem associated with neonatal morbidity and mortality globally. In developing countries magnitude of the problem is much more. Aim: The present study was undertaken to find out the incidence of preterm labour/births, to evaluate different related risk factors and to assess the neonatal mortality in PTBs. Materials and Methods: This cross-sectional study was conducted in a Maternal and Neonatal Units of Rural Teaching Hospital among all cases who delivered during study period of two months from mid-February 2019 to mid-April 2019. Probable maternal risk factors for preterm labour, neonatal clinical profile and risk factors for neonatal mortality were recorded. Frequencies and proportion of variables were computed. Results: The incidence of PTB/labour was 8.5%. Pregnancy duration of less than 34 weeks was observed in 35.6% mothers. It was observed that major factors contributing to PTBs were hypertensive disorders of pregnancy, maternal medical illness/severe anaemia, Bad Obstetric History (BOH)/ previous preterm labour and Ante-Partum Haemorrhage (APH). Survival rate amongst preterm babies was 90.5%. Conclusion: The morbidity amongst newborns is mainly caused by PTB. The study found lower incidence of PTB as compared to previous studies conducted in this region. Many of the risk factors evaluated are modifiable. Risk factor modifications and timely interventions will help in the reduction of PTBs and associated mortality.","PeriodicalId":31116,"journal":{"name":"Indian Journal of Neonatal Medicine and Research","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71265253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.7860/ijnmr/2021/46949.2285
Sukhdeep Kaur, Kunwar Pal Singh
Introduction: Neonatal septicaemia is a significant cause of morbidity and mortality in newborn infants. It often presents a diagnostic challenge in the resource poor setting of most developing countries. Aim: To determine the efficacy of C-Reactive Protein (CRP) and Immature Neutrophil Count (INC) to Total Neutrophil Count (TNC) ratio (I/T ratio) in the early diagnosis of neonatal sepsis. Materials and Methods: This prospective observational study included all term and preterm babies inborn and out born referred cases. The babies less than seven days of age with clinical symptoms and signs of suspected neonatal sepsis were included. Significant values for screening tests were taken as Total Leucocyte Count (TLC) of >25,000/<5000, I/T ratio >0.2 and CRP positive (>0.6 mg/dL). Sepsis screen was considered positive for two or more positive tests. Blood culture was used as gold standard. The statistical analysis was done by Chi-square, Fisher’s exact and ANOVA tests using SPSS 20.0 version. Results: A total number of 60 subjects were included in the study with 45 (75%) as outborn neonates. Most of the neonates presented with tachypnea 27 (45%), 11 (18.3%) with difficulty in feeding and 10 (16.7 %) with lethargy. Significant p-values were observed using CRP and ITR as independent sepsis screening markers. The combination of CRP with I/T ratio showed positive correlation with blood culture (p-value 0.016). Conclusion: Sepsis screen in neonates is required for detection of infection as blood culture may be negative and even positive result takes few hours. C-reactive protein showed high sensitivity while I/T ratio was found to be highly specific.
{"title":"Role of C-Reactive Protein and Immature to Total Neutrophil Ratio in Early Onset Neonatal Sepsis","authors":"Sukhdeep Kaur, Kunwar Pal Singh","doi":"10.7860/ijnmr/2021/46949.2285","DOIUrl":"https://doi.org/10.7860/ijnmr/2021/46949.2285","url":null,"abstract":"Introduction: Neonatal septicaemia is a significant cause of morbidity and mortality in newborn infants. It often presents a diagnostic challenge in the resource poor setting of most developing countries. Aim: To determine the efficacy of C-Reactive Protein (CRP) and Immature Neutrophil Count (INC) to Total Neutrophil Count (TNC) ratio (I/T ratio) in the early diagnosis of neonatal sepsis. Materials and Methods: This prospective observational study included all term and preterm babies inborn and out born referred cases. The babies less than seven days of age with clinical symptoms and signs of suspected neonatal sepsis were included. Significant values for screening tests were taken as Total Leucocyte Count (TLC) of >25,000/<5000, I/T ratio >0.2 and CRP positive (>0.6 mg/dL). Sepsis screen was considered positive for two or more positive tests. Blood culture was used as gold standard. The statistical analysis was done by Chi-square, Fisher’s exact and ANOVA tests using SPSS 20.0 version. Results: A total number of 60 subjects were included in the study with 45 (75%) as outborn neonates. Most of the neonates presented with tachypnea 27 (45%), 11 (18.3%) with difficulty in feeding and 10 (16.7 %) with lethargy. Significant p-values were observed using CRP and ITR as independent sepsis screening markers. The combination of CRP with I/T ratio showed positive correlation with blood culture (p-value 0.016). Conclusion: Sepsis screen in neonates is required for detection of infection as blood culture may be negative and even positive result takes few hours. C-reactive protein showed high sensitivity while I/T ratio was found to be highly specific.","PeriodicalId":31116,"journal":{"name":"Indian Journal of Neonatal Medicine and Research","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71265278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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