Pub Date : 2021-01-01DOI: 10.7860/ijnmr/2021/48468.2299
Aparajita Raghav, Ajay Kumar, P. Anand, G. Yadav, R. Gera
Introduction: Neonatal meningitis in developing countries is 0.8- 6.1 per 1000 live births with mortality of 40-85% had morbidity. Since, the clinical signs and symptoms of meningitis are non- specific and like those seen in sepsis, Cerebrospinal Fluid (CSF) examination via Lumbar Puncture (LP) is essential to establish the diagnosis of meningitis. Performing a LP has its own set of complications. The need for lumbar puncture can be averted and early optimal antibiotic can be instituted if serum inflammatory markers are found to be a good predictor of meningitis in suspected neonatal sepsis. Aim: To investigate the role of serum inflammatory markers, to predict bacterial meningitis amongst neonates with sepsis and to determine the cut-off values for these markers to predict bacterial meningitis amongst neonates with sepsis. Materials and Methods:Thiswasacross-sectionalobservational study done over a period of 17 months in the paediatric wards in a tertiary care centre. All neonates presenting with clinical suspicion of sepsis were enrolled. The blood samples were collected for serum inflammatory markers and CSF examination was done as indicated (American Academy of Paediatrics, AAP guidelines). CSF examination findings and serum inflammatory markers were then statistically analysed to determine the significance in predicting bacterial meningitis in neonatal sepsis. A total of 234 neonates were selected as per laboratory investigations for enrollment in the study. Categorical variables were presented in number and percentage (%) and continuous variables were presented as mean±Standard deviation (SD) and median. Diagnostic tests were used to calculate sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV). Results: A total 234 neonates with features suggestive of sepsis and in whom C-Reactive Protein (CRP) >10 mg/L, Erythrocyte Sedimentation Rate (ESR) >15 mm, White Blood Cell (WBC) <4000 cells/mm³, Absolute Neutrophil Count (ANC) <1800/mm3 and in whom LP was recommended as per the AAP guidelines were included in the study. A 222 (94.87%) neonates were in the age group 1-10 days. A total of 134 (57.3%) study subjects were males. No significant association of ANC, WBC, ESR and CRP was seen with meningitis (p-value >0.05). Receiver Operator Curve (ROC) for all the four parameters were constructed, they showed performance was non-significant. Conclusion: Based on the current single site study results, it is implicated that diagnosis and management of neonatal meningitis should be solely based on LP since serum inflammatory markers are poor discriminators for meningitis. Future studies should evaluate the diagnostic parameters from other inflammatory markers like Immature to Total Neutrophil (IT) ratio and micro ESR, which, if proven to be of diagnostic value, can reduce the time to initiate management and avert the need for LP in neonatal meningitis.
{"title":"Significance of Serum Inflammatory Markers in Predicting Bacterial Meningitis amongst Neonates with Sepsis","authors":"Aparajita Raghav, Ajay Kumar, P. Anand, G. Yadav, R. Gera","doi":"10.7860/ijnmr/2021/48468.2299","DOIUrl":"https://doi.org/10.7860/ijnmr/2021/48468.2299","url":null,"abstract":"Introduction: Neonatal meningitis in developing countries is 0.8- 6.1 per 1000 live births with mortality of 40-85% had morbidity. Since, the clinical signs and symptoms of meningitis are non- specific and like those seen in sepsis, Cerebrospinal Fluid (CSF) examination via Lumbar Puncture (LP) is essential to establish the diagnosis of meningitis. Performing a LP has its own set of complications. The need for lumbar puncture can be averted and early optimal antibiotic can be instituted if serum inflammatory markers are found to be a good predictor of meningitis in suspected neonatal sepsis. Aim: To investigate the role of serum inflammatory markers, to predict bacterial meningitis amongst neonates with sepsis and to determine the cut-off values for these markers to predict bacterial meningitis amongst neonates with sepsis. Materials and Methods:Thiswasacross-sectionalobservational study done over a period of 17 months in the paediatric wards in a tertiary care centre. All neonates presenting with clinical suspicion of sepsis were enrolled. The blood samples were collected for serum inflammatory markers and CSF examination was done as indicated (American Academy of Paediatrics, AAP guidelines). CSF examination findings and serum inflammatory markers were then statistically analysed to determine the significance in predicting bacterial meningitis in neonatal sepsis. A total of 234 neonates were selected as per laboratory investigations for enrollment in the study. Categorical variables were presented in number and percentage (%) and continuous variables were presented as mean±Standard deviation (SD) and median. Diagnostic tests were used to calculate sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV). Results: A total 234 neonates with features suggestive of sepsis and in whom C-Reactive Protein (CRP) >10 mg/L, Erythrocyte Sedimentation Rate (ESR) >15 mm, White Blood Cell (WBC) <4000 cells/mm³, Absolute Neutrophil Count (ANC) <1800/mm3 and in whom LP was recommended as per the AAP guidelines were included in the study. A 222 (94.87%) neonates were in the age group 1-10 days. A total of 134 (57.3%) study subjects were males. No significant association of ANC, WBC, ESR and CRP was seen with meningitis (p-value >0.05). Receiver Operator Curve (ROC) for all the four parameters were constructed, they showed performance was non-significant. Conclusion: Based on the current single site study results, it is implicated that diagnosis and management of neonatal meningitis should be solely based on LP since serum inflammatory markers are poor discriminators for meningitis. Future studies should evaluate the diagnostic parameters from other inflammatory markers like Immature to Total Neutrophil (IT) ratio and micro ESR, which, if proven to be of diagnostic value, can reduce the time to initiate management and avert the need for LP in neonatal meningitis.","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":"71265163","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/2021/47177.2289
Nishanth Rajan, Kalaivani Anantharaaman, P. Jose, Manikandan Mani, P. Kommu, L. Krishnan
Introduction: Nonpractice of breast feeding and noncompliance with immunisation are the two most important contributing factors of infant mortality which could be because of ignorance, illiteracy, social and cultural belief. Aim: To assess the level of knowledge, perception, and awareness among pregnant mothers after an educational intervention programme. Materials and Methods: A semi structured questionnaire was used for the pre and post-test experimental study among 145 mothers who delivered at a tertiary care center, Puducherry; during the study period of two months (November- December 2019). Those who were not willing to participate, who had postpartum complications were excluded from the study (15 mothers). Health education was imparted by one of the authors, in three stages. Stage I: Video demonstration of breast feeding for 10 minutes. Stage II: Focused group discussion for 10 minutes. Stage III: Mannequin demonstration for 10 minutes. Post-test was done on day three of life. Total of 37 questions in the form of yes/no, fill in the blanks and multiple-choice questions were used. Each question carried one mark. Wilcoxon signed rank test was used to describe the effectiveness of teaching by comparing pre-test - post-test score. The p-value of <0.05 was considered as statistically significant. Results: The median age of mothers was 26-30 years, around 62.7% were multiparous and about 50% had completed a basic undergraduate course. The post-test score of knowledge, attitude and perception were significantly higher than the pre- test scores (p-value=0.001). Conclusion: There is a significant improvement in the level of knowledge, perception and attitude regarding breast feeding after the educational intervention.
{"title":"Impact of Educational Interventional Programme Regarding Breast Feeding on the Level of Knowledge, Perception and Attitude of Post Natal Mothers","authors":"Nishanth Rajan, Kalaivani Anantharaaman, P. Jose, Manikandan Mani, P. Kommu, L. Krishnan","doi":"10.7860/ijnmr/2021/47177.2289","DOIUrl":"https://doi.org/10.7860/ijnmr/2021/47177.2289","url":null,"abstract":"Introduction: Nonpractice of breast feeding and noncompliance with immunisation are the two most important contributing factors of infant mortality which could be because of ignorance, illiteracy, social and cultural belief. Aim: To assess the level of knowledge, perception, and awareness among pregnant mothers after an educational intervention programme. Materials and Methods: A semi structured questionnaire was used for the pre and post-test experimental study among 145 mothers who delivered at a tertiary care center, Puducherry; during the study period of two months (November- December 2019). Those who were not willing to participate, who had postpartum complications were excluded from the study (15 mothers). Health education was imparted by one of the authors, in three stages. Stage I: Video demonstration of breast feeding for 10 minutes. Stage II: Focused group discussion for 10 minutes. Stage III: Mannequin demonstration for 10 minutes. Post-test was done on day three of life. Total of 37 questions in the form of yes/no, fill in the blanks and multiple-choice questions were used. Each question carried one mark. Wilcoxon signed rank test was used to describe the effectiveness of teaching by comparing pre-test - post-test score. The p-value of <0.05 was considered as statistically significant. Results: The median age of mothers was 26-30 years, around 62.7% were multiparous and about 50% had completed a basic undergraduate course. The post-test score of knowledge, attitude and perception were significantly higher than the pre- test scores (p-value=0.001). Conclusion: There is a significant improvement in the level of knowledge, perception and attitude regarding breast feeding after the educational 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":"71265325","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/2021/50408.2308
P. Vijayalakshmi, B. Chandrashekar, NP Navya, G. Manoj
Introduction: Birth Defects (BD) account for a significant proportion of neonatal mortality. BD can result in long-term disability with a significant impact on individuals, families, societies and healthcare systems. Aim: To estimate prevalence, types, clinical profile and perinatal profile of BD among neonates. Materials and Methods: This was a prospective observational study conducted in the Neonatal Intensive Care Unit (NICU), Department of Paediatrics, from November 2018 to May 2019. A total of 71 cases were admitted to NICU with total 95 BD. All the demographic details, natal, antenatal, prenatal clinical data and family histories were collected with the help of a predesigned proforma, entered in Excel sheet and analysed using Statistical Package for Social Sciences (SPSS) software; version 25.0. The p-value was calculated using Chi-square test and p-value < 0.05 was taken as significant. Results: Total number of neonates with BD was 71 (4.16% of total NICU admissions, 1.18% of total live births i.e., 6033). Neonates with single BD were 53 (74.65%) and multiple BDs were 18 (25.35%). Mean age was 3.89±5.29 days. Out of the 71 neonates, 37 (52.11%) were males while 28 (39.44%) were females, and the rest 6 (8.45%) had ambiguous genitalia. Prevalence of BD was more in Low Birth Weight (LBW) (6.27%, 34/542 cases) than normal birth weight babies (3.33%, 36/1080 babies). Prevalence of BD was highest in mothers of 26-30 years age group (28/433, 6.46%). The predominant system involved was cardiovascular system (29/95 BDs, 30.53%). The most common major BD was Ventricular Septal Defect (VSD) (13/95 BDs, 13.68%). The predominant type of BD found was malformation (83/95 BDs, 87.37%). Case fatality rate of BDs was 30.99% (22/71). Neonatal mortality rate of BDs was 0.35 per 1000 live births. Conclusion: Prevalence of birth defects was 1.18% of the total live births. Cardiovascular system was the most common system involved, VSD being the most common defect. BDs were significantly associated with late twenties parity, LBW and pre-existing medical diseases in mothers. Single and major BDs were more common than their counterparts.
{"title":"Prevalence of Birth Defects and Associated Risk Factors among Neonates in Tertiary Care Hospital, Shivamogga, Karnataka","authors":"P. Vijayalakshmi, B. Chandrashekar, NP Navya, G. Manoj","doi":"10.7860/ijnmr/2021/50408.2308","DOIUrl":"https://doi.org/10.7860/ijnmr/2021/50408.2308","url":null,"abstract":"Introduction: Birth Defects (BD) account for a significant proportion of neonatal mortality. BD can result in long-term disability with a significant impact on individuals, families, societies and healthcare systems. Aim: To estimate prevalence, types, clinical profile and perinatal profile of BD among neonates. Materials and Methods: This was a prospective observational study conducted in the Neonatal Intensive Care Unit (NICU), Department of Paediatrics, from November 2018 to May 2019. A total of 71 cases were admitted to NICU with total 95 BD. All the demographic details, natal, antenatal, prenatal clinical data and family histories were collected with the help of a predesigned proforma, entered in Excel sheet and analysed using Statistical Package for Social Sciences (SPSS) software; version 25.0. The p-value was calculated using Chi-square test and p-value < 0.05 was taken as significant. Results: Total number of neonates with BD was 71 (4.16% of total NICU admissions, 1.18% of total live births i.e., 6033). Neonates with single BD were 53 (74.65%) and multiple BDs were 18 (25.35%). Mean age was 3.89±5.29 days. Out of the 71 neonates, 37 (52.11%) were males while 28 (39.44%) were females, and the rest 6 (8.45%) had ambiguous genitalia. Prevalence of BD was more in Low Birth Weight (LBW) (6.27%, 34/542 cases) than normal birth weight babies (3.33%, 36/1080 babies). Prevalence of BD was highest in mothers of 26-30 years age group (28/433, 6.46%). The predominant system involved was cardiovascular system (29/95 BDs, 30.53%). The most common major BD was Ventricular Septal Defect (VSD) (13/95 BDs, 13.68%). The predominant type of BD found was malformation (83/95 BDs, 87.37%). Case fatality rate of BDs was 30.99% (22/71). Neonatal mortality rate of BDs was 0.35 per 1000 live births. Conclusion: Prevalence of birth defects was 1.18% of the total live births. Cardiovascular system was the most common system involved, VSD being the most common defect. BDs were significantly associated with late twenties parity, LBW and pre-existing medical diseases in mothers. Single and major BDs were more common than their counterparts.","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":"71265756","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/2021/49908.2307
Karthikeyan Kadirvel, Vinod Babu Sugumaran, S. Ramachandran, S. Palanisamy
Introduction: Newborn Screening (NBS) is an important public health measure in many developed countries. In developing countries like India, the benefits of NBS have been acknowledged and that screening is slowly gaining attention. Aim: To estimate the proportion for seven conditions screened in a tertiary care hospital in Southern India namely Congenital Hypothyroidism (CH), Congenital Adrenal Hyperplasia (CAH), Glucose-6-Phosphate Dehydrogenase (G6PD) deficiency, Biotinidase Deficiency (BD), Galactosemia, Phenylketonuria (PKU) and Cystic Fibrosis (CF). Materials and Methods: The present descriptive study was conducted at a tertiary care teaching hospital in Southern India during a three year period between January 2018 to December 2020. A retrospective analysis of the results of NBS by dried blood spots was done. There were 3152 live births during this period out of which 1649 babies were screened (52% coverage). Heel prick samples after 48 hour of life and prior to discharge were analysed by quantitative assessment. Neonates having positive screening results were recalled by telephonic call for confirmatory tests. Results: The CH, BD and G6PD deficiency were the most common disorders with a proportion of 1:824, 1:1649 and 1:1649, respectively. Galactosemia, CF and PKU were not found in study population. Conclusion: These results need to be corroborated with larger studies from the same geographical area.
{"title":"Newborn Screening using Dried Blood Spot for Seven Metabolic Disorders- A Retrospective Study from a Tertiary Care Hospital in Southern India","authors":"Karthikeyan Kadirvel, Vinod Babu Sugumaran, S. Ramachandran, S. Palanisamy","doi":"10.7860/ijnmr/2021/49908.2307","DOIUrl":"https://doi.org/10.7860/ijnmr/2021/49908.2307","url":null,"abstract":"Introduction: Newborn Screening (NBS) is an important public health measure in many developed countries. In developing countries like India, the benefits of NBS have been acknowledged and that screening is slowly gaining attention. Aim: To estimate the proportion for seven conditions screened in a tertiary care hospital in Southern India namely Congenital Hypothyroidism (CH), Congenital Adrenal Hyperplasia (CAH), Glucose-6-Phosphate Dehydrogenase (G6PD) deficiency, Biotinidase Deficiency (BD), Galactosemia, Phenylketonuria (PKU) and Cystic Fibrosis (CF). Materials and Methods: The present descriptive study was conducted at a tertiary care teaching hospital in Southern India during a three year period between January 2018 to December 2020. A retrospective analysis of the results of NBS by dried blood spots was done. There were 3152 live births during this period out of which 1649 babies were screened (52% coverage). Heel prick samples after 48 hour of life and prior to discharge were analysed by quantitative assessment. Neonates having positive screening results were recalled by telephonic call for confirmatory tests. Results: The CH, BD and G6PD deficiency were the most common disorders with a proportion of 1:824, 1:1649 and 1:1649, respectively. Galactosemia, CF and PKU were not found in study population. Conclusion: These results need to be corroborated with larger studies from the same geographical area.","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":"71265941","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/2021/48382.2298
S. Choudhary, D. Goyal, Dheeraj Diwaakar, Vivek Praser, D. Sareen, Hemlata Mittal
Introduction: Neonatal hypothermia is an abnormal thermal state in which body temperature drops below 36.5°C leading to adverse clinical outcomes caused due to prematurity of the neonate or severe infection. Since, the outcome of hypothermia is not immediately detected, it relatively gets neglected by the health care provider. Aim: To investigate the effect of admission hypothermia on short-term and long-term outcomes in neonates admitted at a tertiary care hospital. Materials and Methods: The descriptive study was conducted on 189 neonates with admission hypothermia which were further grouped into various grades of hypothermia and were followed-up to determine the outcome. The study population was subjected to routine investigations as per protocol. All neonates were screened by Ultrasonography (USG) cranium, 2D Echocardiogram (2D ECHO) and Retinopathy of Prematurity (ROP) screening. At each follow-up they underwent various neurological examination at 3, 6, 9 and 12 months of age, neurodevelopment assessment using DAS II at one year of age, growth assessment (detailed anthropometry) and developmental milestones, nutritional assessment (breastfeeding or weaning), retinopathy of prematurity screening at three weeks. At 12 months of age, all the babies were assessed using Developmental Assessment scale for Indian infants. The data was analysed by using Statistical Package for the Social Sciences (SPSS) Version 21.0 for data computation, p=value <0.05 was considered as statistically significant. Results: Two third (63.5%) of the neonates admitted in the NICU with admission hypothermia were males. Overall, 63% of admitted neonates with hypothermia were low-birth weight. Among the short-term outcome in neonates the most common was the Respiratory Distress Syndrome (RDS,81%). Most common combination of the short-term outcome were RDS+Patent Ductus Arteriosus (PDA)+Sepsis (n=6) and RDS+PDA+ROP Grade II (n=4), and RDS+Intraventricular Haemorrhage (IVH)+Sepsis (n=2). All the neonates 4(100%) who were extremely preterm developed RDS compared to other neonates. RDS was cause of death in 4 hypothermic neonates. The mean development age using DAS II was 11.8 months. The mean development quotient was 94. Conclusion: The present observational study demonstrates a relationship between admission hypothermia and the type of neonatal morbidity and mortality. Gestational age carried a significant relationship with the short-term outcome like RDS in terms of developing co-morbidities and their survivability but had a limited role in development of long-term outcome. Routine screening of temperature and early intervention prevents the development of hypothermia thus preventing short-term complications. There is a need to create awareness among health professionals about the dangers of hypothermia so that early intervention could be undertaken to reduce its complications.
{"title":"Effect of Admission Hypothermia on Short- term and Long-term Outcomes in Neonates Admitted at a Tertiary Care Hospital","authors":"S. Choudhary, D. Goyal, Dheeraj Diwaakar, Vivek Praser, D. Sareen, Hemlata Mittal","doi":"10.7860/ijnmr/2021/48382.2298","DOIUrl":"https://doi.org/10.7860/ijnmr/2021/48382.2298","url":null,"abstract":"Introduction: Neonatal hypothermia is an abnormal thermal state in which body temperature drops below 36.5°C leading to adverse clinical outcomes caused due to prematurity of the neonate or severe infection. Since, the outcome of hypothermia is not immediately detected, it relatively gets neglected by the health care provider. Aim: To investigate the effect of admission hypothermia on short-term and long-term outcomes in neonates admitted at a tertiary care hospital. Materials and Methods: The descriptive study was conducted on 189 neonates with admission hypothermia which were further grouped into various grades of hypothermia and were followed-up to determine the outcome. The study population was subjected to routine investigations as per protocol. All neonates were screened by Ultrasonography (USG) cranium, 2D Echocardiogram (2D ECHO) and Retinopathy of Prematurity (ROP) screening. At each follow-up they underwent various neurological examination at 3, 6, 9 and 12 months of age, neurodevelopment assessment using DAS II at one year of age, growth assessment (detailed anthropometry) and developmental milestones, nutritional assessment (breastfeeding or weaning), retinopathy of prematurity screening at three weeks. At 12 months of age, all the babies were assessed using Developmental Assessment scale for Indian infants. The data was analysed by using Statistical Package for the Social Sciences (SPSS) Version 21.0 for data computation, p=value <0.05 was considered as statistically significant. Results: Two third (63.5%) of the neonates admitted in the NICU with admission hypothermia were males. Overall, 63% of admitted neonates with hypothermia were low-birth weight. Among the short-term outcome in neonates the most common was the Respiratory Distress Syndrome (RDS,81%). Most common combination of the short-term outcome were RDS+Patent Ductus Arteriosus (PDA)+Sepsis (n=6) and RDS+PDA+ROP Grade II (n=4), and RDS+Intraventricular Haemorrhage (IVH)+Sepsis (n=2). All the neonates 4(100%) who were extremely preterm developed RDS compared to other neonates. RDS was cause of death in 4 hypothermic neonates. The mean development age using DAS II was 11.8 months. The mean development quotient was 94. Conclusion: The present observational study demonstrates a relationship between admission hypothermia and the type of neonatal morbidity and mortality. Gestational age carried a significant relationship with the short-term outcome like RDS in terms of developing co-morbidities and their survivability but had a limited role in development of long-term outcome. Routine screening of temperature and early intervention prevents the development of hypothermia thus preventing short-term complications. There is a need to create awareness among health professionals about the dangers of hypothermia so that early intervention could be undertaken to reduce its complications.","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":"71265476","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/2021/50562.2317
Prabhudev Basavaraj Hasbi, G. Sharma, A. L. Bairwa
Introduction: Maturation of the brain is affected by various biological and environmental factors encountered by the infant during the intensive care period in Neonatal Intensive Care Unit (NICU) due to the medical treatments, procedures, and the noisy environment that disrupts the normal brain development process. Severe neurological sequelae of preterm infants are common because of the immature central nervous system. Cerebral Function Monitor (CFM) or Amplitude integrated Electroencephalogram (a-EEG) is a device for monitoring the background neurological activity. Aim: To assess postnatal maturation of a-EEG in clinically stable and neurologically normal preterm Small for Gestational Age (SGA) and preterm Appropriate for Gestational Age (AGA) neonates from 30 weeks 0/7 days to 34 weeks 6/7 days of gestation admitted in a tertiary care NICU at J. K. Lon Mother and Child Hospital, attached to Government Medical College, Kota. Materials and Methods: This prospective observational study was conducted over a one year duration, from January 2020 to December 2020 on 60 preterm neonates that were admitted in NICU of a tertiary care hospital. The serial a-EEG recording was done on haemodynamically stable, included preterm neonates after taking consent, on 3rd, 7th, and 14th postnatal day of life during the course of admission. The postnatal maturation of amplitude integrated EEG of Preterm Small for Gestational Age (PSGA) neonates was compared with their Preterm Appropriate for Gestational Age (PAGA) neonates based on a validated a-EEG scoring. The analysis was done by using Statistical Package for Social Sciences (SPSS) version 21.0. Student t-test was applied. Results: The total a-EEG scores for 3rd, 7th, and 14th day of SGA group neonates were 7.55±1.45, 7.25±1.02 and 10.22±1.05 and were delayed from the AGA group of neonates with 7.86±1.55, 8.68±1.00 and 10.62±1.01, with mean difference (95% CI), 0.30 (-0.49 to 1.13), 1.43 (0.88 to 1.97) and 0.39 (-0.15 to 0.95) respectively. Only the total a-EEG scores for day 7 were significantly delayed in SGA group. Conclusion: All the maturation a-EEG scores of clinically stable and neurologically normal PSGA neonates was found to be significantly delayed at any point of life on postnatal day 7th of life.
{"title":"Postnatal Maturation of Amplitude Integrated Electroencephalogram in Preterm SGA and Preterm AGA Neonates: A Prospective Observational Study","authors":"Prabhudev Basavaraj Hasbi, G. Sharma, A. L. Bairwa","doi":"10.7860/ijnmr/2021/50562.2317","DOIUrl":"https://doi.org/10.7860/ijnmr/2021/50562.2317","url":null,"abstract":"Introduction: Maturation of the brain is affected by various biological and environmental factors encountered by the infant during the intensive care period in Neonatal Intensive Care Unit (NICU) due to the medical treatments, procedures, and the noisy environment that disrupts the normal brain development process. Severe neurological sequelae of preterm infants are common because of the immature central nervous system. Cerebral Function Monitor (CFM) or Amplitude integrated Electroencephalogram (a-EEG) is a device for monitoring the background neurological activity. Aim: To assess postnatal maturation of a-EEG in clinically stable and neurologically normal preterm Small for Gestational Age (SGA) and preterm Appropriate for Gestational Age (AGA) neonates from 30 weeks 0/7 days to 34 weeks 6/7 days of gestation admitted in a tertiary care NICU at J. K. Lon Mother and Child Hospital, attached to Government Medical College, Kota. Materials and Methods: This prospective observational study was conducted over a one year duration, from January 2020 to December 2020 on 60 preterm neonates that were admitted in NICU of a tertiary care hospital. The serial a-EEG recording was done on haemodynamically stable, included preterm neonates after taking consent, on 3rd, 7th, and 14th postnatal day of life during the course of admission. The postnatal maturation of amplitude integrated EEG of Preterm Small for Gestational Age (PSGA) neonates was compared with their Preterm Appropriate for Gestational Age (PAGA) neonates based on a validated a-EEG scoring. The analysis was done by using Statistical Package for Social Sciences (SPSS) version 21.0. Student t-test was applied. Results: The total a-EEG scores for 3rd, 7th, and 14th day of SGA group neonates were 7.55±1.45, 7.25±1.02 and 10.22±1.05 and were delayed from the AGA group of neonates with 7.86±1.55, 8.68±1.00 and 10.62±1.01, with mean difference (95% CI), 0.30 (-0.49 to 1.13), 1.43 (0.88 to 1.97) and 0.39 (-0.15 to 0.95) respectively. Only the total a-EEG scores for day 7 were significantly delayed in SGA group. Conclusion: All the maturation a-EEG scores of clinically stable and neurologically normal PSGA neonates was found to be significantly delayed at any point of life on postnatal day 7th of life.","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":"71265798","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/2021/49373.2305
M. Raj, K. Kadirvel, Sumathisri Ramachandran
The most common cause for neonatal persistent hypoglycemia is Congenital Hyperinsulinism (CH) which is characterised by low blood glucose with an inappropriately higher insulin level. A one-day-old male baby, third born to non consanguineous parents delivered at term, small for gestational age, detected to have hypoglycaemia at 24 hours of life. He was established on breastfeed. Glucose infusion was started initially with Glucose Infusion Rate (GIR) of 4 mg/kg/min and increased according to the blood glucose values. Euglycaemic state was achieved with GIR of 14 mg/kg/min and intravenous hydrocortisone. Critical blood samples were sent when GIR was at 8 mg/kg/min which showed detectable insulin with high ammonia and normal cortisol levels. Hence, the diagnosis of transient hyperinsulinemic hypoglycaemia of infancy with hyperammonemia was considered and treated with oral diazoxide and sodium benzoate. GIR could be tapered and was discharged on breastfeed and medications. During follow-up at three months of age, the medications were stopped under glucose monitoring. He had normal growth and development at 12 months of age. Neonatal hypoglycaemia should be aggressively managed to prevent neuroglycopenia and its resultant neurodevelopmental disability. When GIR is more than 8 mg/kg/min, hyperinsulinism should be suspected for appropriate therapy.
{"title":"Congenital Hyperinsulinemic Hypoglycaemia of Infancy- A Case Report","authors":"M. Raj, K. Kadirvel, Sumathisri Ramachandran","doi":"10.7860/ijnmr/2021/49373.2305","DOIUrl":"https://doi.org/10.7860/ijnmr/2021/49373.2305","url":null,"abstract":"The most common cause for neonatal persistent hypoglycemia is Congenital Hyperinsulinism (CH) which is characterised by low blood glucose with an inappropriately higher insulin level. A one-day-old male baby, third born to non consanguineous parents delivered at term, small for gestational age, detected to have hypoglycaemia at 24 hours of life. He was established on breastfeed. Glucose infusion was started initially with Glucose Infusion Rate (GIR) of 4 mg/kg/min and increased according to the blood glucose values. Euglycaemic state was achieved with GIR of 14 mg/kg/min and intravenous hydrocortisone. Critical blood samples were sent when GIR was at 8 mg/kg/min which showed detectable insulin with high ammonia and normal cortisol levels. Hence, the diagnosis of transient hyperinsulinemic hypoglycaemia of infancy with hyperammonemia was considered and treated with oral diazoxide and sodium benzoate. GIR could be tapered and was discharged on breastfeed and medications. During follow-up at three months of age, the medications were stopped under glucose monitoring. He had normal growth and development at 12 months of age. Neonatal hypoglycaemia should be aggressively managed to prevent neuroglycopenia and its resultant neurodevelopmental disability. When GIR is more than 8 mg/kg/min, hyperinsulinism should be suspected for appropriate therapy.","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":"71265996","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/2021/51068.2312
Raman Sharma, V. Taneja, Kajal Khajuria, Rasmeen Kaur, A. Bhardwaj
Introduction: Acute Gastroenteritis (AGE) is one of the most common causes of hospitalisation in children as well as neonates. According to World Health Organisation (WHO), 80% of deaths due to diarrhoea occur in first two years of life. Acute Kidney Injury (AKI) is one of the most common complications associated with gastroenteritis and dehydration. Neonates constitute major bulk of infant mortality and morbidity. The goal of this study was to identify risk factors, feeding pattern and electrolyte abnormalities in neonates presenting with AGE. Aim: To study the clinical profile and epidemiology of neonates presenting with AGE with special emphasis on AKI. Materials and Methods: A prospective observational study was conducted in the Neonatal Intensive Care Unit (NICU) of Department of Paediatrics between December 2019 to May 2021 at MMIMS Research and Hospital, Mullana, Ambala, Haryana, India. Ethical clearance was obtained from the ethical committee prior to the study. A total of 510 neonates were admitted during this period in NICU. Out of them 151 neonates of AGE who met the inclusion criteria were enrolled in the study. Clinical Data and lab investigations i.e., serum electrolytes and Renal Function Test (RFT) were collected and entered in pretested proforma meeting the objectives of the study. Kidney Disease Improving Global Outcome (KDIGO) was used to diagnose AKI. Results: In this study, out of the 151 patients of AGE, 56 (37.09%) patients developed AKI. Hyperkalaemia in 85 (56.29%) patients was the most common electrolyte abnormality followed by hypernatremia 35 (23.18%). Hyponatraemia was present in only 15 (9.9%) patients. Acidosis was present in 41 (27.15%) patients. Exclusive formula feeding was the single most modifiable risk factor for AKI. Conclusion: It was found that feeding pattern is the most important and modifiable risk factor associated with increased incidence of AGE and AKI in neonates. Exclusive formula fed babies are more prone to AGE due to improper composition of feeds as compared to mixed feeding or exclusive breast feeding. Thus, exclusive breast feeding must be promoted. Hyperkalaemia remained the most common electrolyte abnormality in these patients.
{"title":"Clinical Profile and Epidemiology of Neonates Presenting with Acute Gastroenteritis with Special Emphasis on Acute Kidney Injury","authors":"Raman Sharma, V. Taneja, Kajal Khajuria, Rasmeen Kaur, A. Bhardwaj","doi":"10.7860/ijnmr/2021/51068.2312","DOIUrl":"https://doi.org/10.7860/ijnmr/2021/51068.2312","url":null,"abstract":"Introduction: Acute Gastroenteritis (AGE) is one of the most common causes of hospitalisation in children as well as neonates. According to World Health Organisation (WHO), 80% of deaths due to diarrhoea occur in first two years of life. Acute Kidney Injury (AKI) is one of the most common complications associated with gastroenteritis and dehydration. Neonates constitute major bulk of infant mortality and morbidity. The goal of this study was to identify risk factors, feeding pattern and electrolyte abnormalities in neonates presenting with AGE. Aim: To study the clinical profile and epidemiology of neonates presenting with AGE with special emphasis on AKI. Materials and Methods: A prospective observational study was conducted in the Neonatal Intensive Care Unit (NICU) of Department of Paediatrics between December 2019 to May 2021 at MMIMS Research and Hospital, Mullana, Ambala, Haryana, India. Ethical clearance was obtained from the ethical committee prior to the study. A total of 510 neonates were admitted during this period in NICU. Out of them 151 neonates of AGE who met the inclusion criteria were enrolled in the study. Clinical Data and lab investigations i.e., serum electrolytes and Renal Function Test (RFT) were collected and entered in pretested proforma meeting the objectives of the study. Kidney Disease Improving Global Outcome (KDIGO) was used to diagnose AKI. Results: In this study, out of the 151 patients of AGE, 56 (37.09%) patients developed AKI. Hyperkalaemia in 85 (56.29%) patients was the most common electrolyte abnormality followed by hypernatremia 35 (23.18%). Hyponatraemia was present in only 15 (9.9%) patients. Acidosis was present in 41 (27.15%) patients. Exclusive formula feeding was the single most modifiable risk factor for AKI. Conclusion: It was found that feeding pattern is the most important and modifiable risk factor associated with increased incidence of AGE and AKI in neonates. Exclusive formula fed babies are more prone to AGE due to improper composition of feeds as compared to mixed feeding or exclusive breast feeding. Thus, exclusive breast feeding must be promoted. Hyperkalaemia remained the most common electrolyte abnormality in these patients.","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":"71266010","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/2021/48393.2301
R. Sehra, Mahendra Kumar Palsania, Chandani R. Verma, S. Verma
Introduction: Thymic size is measured as Cardiothymic: Thoracic ratio (CT/T ratio) in chest X-ray. In a state of stress, the thymus tissue rapidly involutes, owing principally to the thymocytolytic effect of glucocorticosteroids. Different pre and postnatal factors affect thymic size in neonates. Aim: To determine the thymic size in preterm neonates with Respiratory Distress Syndrome (RDF), its relation to survival to determine which antenatal and postnatal factors influence thymic size. Materials and Methods: This prospective observational study was carried out in neonatal units of tertiary care hospital in North India from May 2018 to September 2019. Premature (<37 weeks gestation) neonates admitted in NICU with clinical and radiological evidence of RDS were included in the study. CT/T ratio was measured in chest X-ray. The quantitative data was presented as mean and standard deviation (SD) and were compared using student t-test, one-way ANOVA test and continuous non parametric data were compared using Pearson correlation coefficient test. Results: Mean age of 110 studied neonates was 32.07±1.76 weeks. The mean±SD CT/T in the study was 0.361±0.043. Mean CT/T ratio (0.372±0.043) of non survivor (44) was higher (0.356±0.043) than survivor neonates (66). This difference was statistically not significant (p-value=0.058). Mean CT/T ratio >0.361 has sensitivity 59.09% and specificity 68.18% for non survivor group. Logical regression analysis for probability of survival showed that as CT/T ratio increases probability of survival decreases. Mean CT/T ratio was not affected by gestational age, sex, mode of delivery, use of antenatal steroid, pre-eclampsia, mother’s parity, perinatal asphyxia and sepsis. Conclusion: The mean CT/T ratio was higher in non surviving neonates with RDS as compared to those who survived. Mean CT/T ratio is a poor predictor for mortality in premature neonates with RDS.
{"title":"Can Cardiothymic Thoracic Ratio be a Marker of Mortality in Preterm Neonates with Respiratory Distress Syndrome?","authors":"R. Sehra, Mahendra Kumar Palsania, Chandani R. Verma, S. Verma","doi":"10.7860/ijnmr/2021/48393.2301","DOIUrl":"https://doi.org/10.7860/ijnmr/2021/48393.2301","url":null,"abstract":"Introduction: Thymic size is measured as Cardiothymic: Thoracic ratio (CT/T ratio) in chest X-ray. In a state of stress, the thymus tissue rapidly involutes, owing principally to the thymocytolytic effect of glucocorticosteroids. Different pre and postnatal factors affect thymic size in neonates. Aim: To determine the thymic size in preterm neonates with Respiratory Distress Syndrome (RDF), its relation to survival to determine which antenatal and postnatal factors influence thymic size. Materials and Methods: This prospective observational study was carried out in neonatal units of tertiary care hospital in North India from May 2018 to September 2019. Premature (<37 weeks gestation) neonates admitted in NICU with clinical and radiological evidence of RDS were included in the study. CT/T ratio was measured in chest X-ray. The quantitative data was presented as mean and standard deviation (SD) and were compared using student t-test, one-way ANOVA test and continuous non parametric data were compared using Pearson correlation coefficient test. Results: Mean age of 110 studied neonates was 32.07±1.76 weeks. The mean±SD CT/T in the study was 0.361±0.043. Mean CT/T ratio (0.372±0.043) of non survivor (44) was higher (0.356±0.043) than survivor neonates (66). This difference was statistically not significant (p-value=0.058). Mean CT/T ratio >0.361 has sensitivity 59.09% and specificity 68.18% for non survivor group. Logical regression analysis for probability of survival showed that as CT/T ratio increases probability of survival decreases. Mean CT/T ratio was not affected by gestational age, sex, mode of delivery, use of antenatal steroid, pre-eclampsia, mother’s parity, perinatal asphyxia and sepsis. Conclusion: The mean CT/T ratio was higher in non surviving neonates with RDS as compared to those who survived. Mean CT/T ratio is a poor predictor for mortality in premature neonates with RDS.","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":"71265094","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}
Introduction: Worldwide major proportion of preterm births is late preterm infants. Preterm infants are deprived of optimal in-utero nutrition leading to immediate consequences of growth failure and long-term complications like adverse neurodevelopment outcomes whereas preterm infants with fast catch up growth after birth have health consequences like obesity and hypertension in adulthood. Aim: To assess growth of late preterm infants at their term equivalent Gestational Age (GA) and compare their growth and body composition with term infants. Materials and Methods: This was a cohort study of late preterm (34 0/7 to 36 6/7 weeks) infants that were Appropriate for Gestational Age (AGA) and controls that were AGA term infants (39 0/7 to 40 6/7 weeks). All enrolled late preterm infants were followed-up at term equivalent (39 0/7 to 40 6/7 weeks). Growth plotted on Fenton’s chart and body composition were calculated using pre-defined formula for total mid-upper arm area (cm2), mid-upper arm muscle area (cm2), mid-upper arm fat area (cm2), and the Arm Fat Index (AFI) (%). The data was analysed using Epi info (version 7.2) with student t-test for continuous variables and chi-square test for dichotomous variables. A p-value of <0.05 was considered statistically significant. Results: Out of the 135 infants enrolled, 45 were late preterm and 90 were term born infants. Median GA of the case cohort was 35 (IQR 35-36) weeks and in the control cohort it was 39 (IQR 39-40) weeks. Total 45.7% (N=35) of the late preterm infants (after excluding loss to follow-up) were below 10th percentile (EUGR) at term GA. At term follow-up, mean weight and length of late preterm infants compared to term born infants was less and statistically significant. The mean Skin Fold Thickness (SKT) (cm) at triceps level 0.55 (SD 0.07) vs. 0.49 (SD 0.06), mean of calculated AFI (%) 31.25 (SD 3.08) vs. 28.19 (SD 2.5) and among late preterm infants at follow-up was more than in term infants and was statistically significant. Conclusion: Failure to thrive is common among the late preterm infants at term equivalent GA. Late preterm infants show postnatal growth characterised by predominant fat mass accretion and less lean mass.
{"title":"Late Preterm Infant Growth and Body Composition at Corrected Term Gestation: A Cohort Study","authors":"Saikiran Deshabhotla, Snehal Pallod, Baswaraj Tandur","doi":"10.7860/ijnmr/2021/45525.2297","DOIUrl":"https://doi.org/10.7860/ijnmr/2021/45525.2297","url":null,"abstract":"Introduction: Worldwide major proportion of preterm births is late preterm infants. Preterm infants are deprived of optimal in-utero nutrition leading to immediate consequences of growth failure and long-term complications like adverse neurodevelopment outcomes whereas preterm infants with fast catch up growth after birth have health consequences like obesity and hypertension in adulthood. Aim: To assess growth of late preterm infants at their term equivalent Gestational Age (GA) and compare their growth and body composition with term infants. Materials and Methods: This was a cohort study of late preterm (34 0/7 to 36 6/7 weeks) infants that were Appropriate for Gestational Age (AGA) and controls that were AGA term infants (39 0/7 to 40 6/7 weeks). All enrolled late preterm infants were followed-up at term equivalent (39 0/7 to 40 6/7 weeks). Growth plotted on Fenton’s chart and body composition were calculated using pre-defined formula for total mid-upper arm area (cm2), mid-upper arm muscle area (cm2), mid-upper arm fat area (cm2), and the Arm Fat Index (AFI) (%). The data was analysed using Epi info (version 7.2) with student t-test for continuous variables and chi-square test for dichotomous variables. A p-value of <0.05 was considered statistically significant. Results: Out of the 135 infants enrolled, 45 were late preterm and 90 were term born infants. Median GA of the case cohort was 35 (IQR 35-36) weeks and in the control cohort it was 39 (IQR 39-40) weeks. Total 45.7% (N=35) of the late preterm infants (after excluding loss to follow-up) were below 10th percentile (EUGR) at term GA. At term follow-up, mean weight and length of late preterm infants compared to term born infants was less and statistically significant. The mean Skin Fold Thickness (SKT) (cm) at triceps level 0.55 (SD 0.07) vs. 0.49 (SD 0.06), mean of calculated AFI (%) 31.25 (SD 3.08) vs. 28.19 (SD 2.5) and among late preterm infants at follow-up was more than in term infants and was statistically significant. Conclusion: Failure to thrive is common among the late preterm infants at term equivalent GA. Late preterm infants show postnatal growth characterised by predominant fat mass accretion and less lean mass.","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":"71265344","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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