Indian Journal of Neonatal Medicine & Research

Surrogate Anthropometric Parameters for Assessment of Low Birth Weight Babies

Rupesh Srivastava, Shishir Chandrakar

Introduction: Low Birth Weight (LBW) accounts for significant proportion of infants and under five mortality. Screening of LBW babies in peripheral areas with poor facilities, with surrogate anthropometric parameters is necessary to prevent morbidity. Aim: To evaluate calf circumference and other anthropometric parameters as a measure of LBW. Materials and Methods: A prospective observational study including consecutive live newborn admitted to tertiary hospital, Mumbai, from June 2014 to June 2015. All anthropometric measurements were carried out within 24 hours of birth. Birth weight was measured using digital weighing scale and calf circumference, thigh circumference, Head Circumference (HC), Chest Circumference (CC) and Mid Arm Circumference (MAC) measured according to standard guidelines. Results: Overall prevalence of LBW was 6.8%. All anthropometric indicators had a statistically significant sensitivity, specificity and predictive value (p<0.001) for LBW babies. However, predictive accuracy of calf circumference was found to be the highest. Conclusion: Calf circumference and other surrogate parameters can be employed as standard anthropometric parameter for identification of LBW babies especially in the peripheral health centers.

Pre Feed Aspirates vs Abdominal Girth Monitoring for Detection of Feed Intolerance in VLBW Babies

Shiv Prasad Dubey, Ashish Jain, Nisha Kumari, Anjoo Bhatnagar, Veena Devgan

Introduction: Feed intolerance is well known in Neonatal Intensive Care Unit (NICU) and is linked to morbidity and mortality in Very Low Birth Weight (VLBW) babies. Most definitions of feed intolerance include one or more of clinical criteria’s viz. pre feed Gastric Residual Volumes (GRVs), colour of gastric aspirates, abdominal distension, emesis, bloody stools and clinical deterioration (increase in apnoea and/or bradycardia) resulting in discontinuation of feeding. But clinical significance of each of these criteria has not been studied systematically. Aim: To compare the role of abdominal girth monitoring vs pre feed residuals in prediction of feed intolerance, fasting hours, time to reach full feeds, incidence of Necrotizing Enterocolitis (NEC) II, and weight gain in VLBW babies. Materials and Methods: This prospective, two centre trial was conducted in the NICUs of two Tertiary Care Hospitals. Total 60 VLBW babies (30 from each hospital) on gavage feeding were enrolled. VLBW babies on gavage feeds at Faridabad Escort Hospital (FEH)-Pre feed Aspiration group (PA) and Hindu Rao Hospital (HRH)-Abdominal Girth monitoring group (AG) were studied. The outcome variables were vomiting, apnoea, bradycardia, fasting hours, days to reach full feeds, NEC-II and weight gain. Results: Lesser feed were found in AG group and fasting hours (p=0.015), days to reach full feeds (p=0.001) were significantly less and weight gain (p=0.02) was significantly more in AG group as compared to PA group. Conclusion: Monitoring feed intolerance by pre feed abdominal girth had advantage of better weight gain and fewer fasting hours and days to reach full feeds compared to pre feed aspiration in VLBW babies. Abdominal girth monitoring is less invasive and equally effective as pre feed aspiration.

Effect of Phototherapy on Various Biochemical Parameters in Neonatal Hyperbilirubinaemia: A Clinical Insight

Shilpa Suneja, Rajani Kumawat, Rahul Saxena

Introduction: Neonatal Hyperbilirubinaemia (NH) is a very common complication in newborns. It occurs due to excessive formation of unconjugated (indirect) bilirubin and inability of neonatal liver to rapidly clear it from blood. Phototherapy is the first and most common treatment for jaundice in newborns and in most cases is the only treatment required. Aim: To assess the changes in various other biochemical parameters including proteins, enzymes, lipids, urea, creatinine and uric acid levels in plasma/serum of pre and post phototherapy treated in full term jaundiced neonates. Materials and Methods: This prospective hospital based comparative study was conducted in the Department of Biochemistry and Paediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India, from November 2016 to March 2017, after obtaining ethical clearance from institutional ethical committee and informed consent from parents or guardians of neonates. The study included 119 neonates (64 males and 55 females) who were receiving phototherapy and their data was recorded on a predesigned proforma. Biochemical assay was measured using commercially available system pack kits on Fully Automated Clinical Chemistry Analyser, ADVIA -2400 for the biochemical parameters. The significance of the difference between the groups was assessed by student’s ‘t’-test for pair matched samples. The p-value of <0.05 were considered statistically significant. Results: Levels of bilirubin profile were elevated significantly in patients prior to phototherapy and returned to normal generally after 48 hours to 96 hours of phototherapy. Levels of hepatic enzyme markers namely AST, ALP and LDH were also elevated significantly in the pre phototherapy group which declined significantly after phototherapy (p<0.05). Levels of total cholesterol, triglycerides and VLDL showed significant decline in our study (p<0.05, <0.005 and <0.001 respectively), however no significant changes were observed in LDL and HDL levels in the patients treated for phototherapy. Our study also observed significant decline in uric acid (p<0.001), creatinine (p<0.005), total serum proteins (p<0.001) and albumin levels (p<0.001). There was also significant decline in the levels of electrolytes including sodium, potassium, chloride and calcium (p<0.001 in each case). Conclusion: Though, it is well known that phototherapy has a beneficial effect in treatment of NH but its effect on other biochemical parameters is also noteworthy and therefore the neonate should be assessed accordingly while on treatment with phototherapy.

Comparing the Results of Chest X-ray with Chest Ultrasound in Neonates Admitted in Neonatal Intensive Care Unit

Elham Zarei, Vahid Alizadeh

Introduction: Chest X-ray (CXR) is the potential method for the diagnosis of pulmonary disorders. It has been using in respiratory distress syndrome detection in neonates. Aim: To compare the diagnostic accuracy of lung sonography against the CXR in Acute Respiratory Distress Syndrome (ARDS) in newborn babies admitted in Neonatal Intensive Care Unit (NICU). Materials and Methods: This cross-sectional study was conducted on newborns admitted in NICU ward during July 2016 to April 2017. The recorded data includes gender, gestational age at birth and bedside trans-thoracic chest ultrasonography from the neonates, which were undergone anterior-posterior CXR by the clinical physician. The chest sonography was accomplished longitudinally from anterior and lateral chest. Two different expert radiologists performed the interpretation of CXR and sonography without knowledge about the results of other test. Results: Total 134 newborns were enrolled in this study containing 75 males (55.9%). Seven cases had congenital abnormality including diaphragmatic hernia and situs inversus. Pneumothorax and pleural effusion were detected in eight and four cases, respectively. All these diagnoses were confirmed by both CXR and chest sonography. The most prevalent findings in CXR were haziness and consolidation. Chest sonography showed abnormal pleural line in 55 newborns (41%), more than three B-lines in 44 cases (32.8%), white lung in 31 newborns (23.1%) and consolidation in 38 patients (8.4%). Chest ultrasonography had 89.09% (95% CI, 81.72%-94.23%) sensitivity and 95% (95% CI, 75.13%- 99.87%) specificity for diagnosis of chest abnormalities in NICU-admitted neonates. Conclusion: Although, sonography has good potential for diagnosis of chest pathologies in newborns, it seems it is not the first step for assessing the newborns’ chest, instead of CXR. However, chest sonography is so valuable for serial follow-ups and as a supplementary technique in suspicious CXRs

Neonatal Outcome of Rh-D Alloimmunisation in Antenatal Women Attending a Tertiary Care Hospital

Shaiji Panthiyil Shahulhameed, Sobha Kumar, Meena Dharmadas

Introduction: Haemolytic disease of foetus and newborn due to Rh-D alloimmunisation was one of the grave complications of pregnancy years back, which contributed for a number of perinatal deaths and disabilities. Yet, advancement in technologies used for early detection and treatment of haemolytic disease of newborn as well as better neonatal care has further contributed to bring down the magnitude. Our study attempts to follow-up Rh-D alloimmunised pregnancies and collect data regarding the perinatal and postnatal plight of affected neonates. Aim: To follow-up Rh-D alloimmunised pregnancies and describe the perinatal and postnatal characteristics of affected neonates. Materials and Methods: This two year prospective study was done on Rh-D alloimmmunised women. Diagnosis of haemolytic disease of newborn due to Rh-D alloimmunisation was confirmed if a positive Direct Coomb’s Test (DCT) was found in an Rh-D positive baby. Severity of disease in terms of haemoglobin and bilirubin levels and presence of hydrops were assessed. Newborns were followed-up till discharge. Results: Out of 2496 Rh-D alloimmunised women, 78 antenatal cases were found positive for anti D-antibodies. Frequency of haemolytic disease of foetus and newborn was 57 out of 64 cases which were followed, four newborns were DCT negative although, Rh-D positive and three newborns were Rh-D negative. Mean cord Hb in unaffected newborns were significantly higher. Twenty nine out of 58 live born newborns needed no treatment. Four cases (6.25%) needed exchange transfusion. Out of 60 live born infants, 59 survived. Overall survival rate of newborns in 64 alloimmunised pregnancies was 92.18%. The survival rate in live borns was 98.33%. Conclusion: Severe cases of haemolytic disease of newborn in Rh-D alloimmunisation is limited to <10 % and after the advent of better neonatal care and monitoring services survival rates of affected newborns are much higher.