Indian Journal of Neonatal Medicine & Research

Role of Hypothermia Detecting Device during Transitional Adaptation of Healthy Full Term Infant: A Pilot Studyduring

Manisha Bhandankar, Bhadresh Patel

Introduction: Maintenance of warm chain and prevention of hypothermia to ensure smooth transitional adaptation of a newborn during early postnatal period is an important component of essential newborn care. Early detection of hypothermia in term normal weight newborns, kept in busy postnatal wards is essential, but is a challenge for healthcare personnels. Empowering the mothers with a simple tool to recognise hypothermia can decrease the burden on the healthcare personnels and also increase awareness among the mother and family members. Aim: The present study aimed at detecting hypothermia in healthy term newborns in the postnatal ward using a hypothermia alert (BEMPU TempWatch) device while simultaneously recording the abdominal skin temperature. Materials and Methods: The pilot study conducted from June 2018 to September 2018, recruited 51 full-term healthy infants in the postnatal ward and monitored them for hypothermia using BEMPU TempWatch on the wrist for 6 hours. Simultaneously, abdominal skin temperature was also recorded for these babies using a portable monitor. The number of hypothermia episodes detected using Bempu TempWatch and simultaneous abdominal skin temperature were recorded and analysed using R i386.3.5.1 and Microsoft Excel ver. 2010. Results: The device beeped when the temperature was <36.5°C; 68 episodes of hypothermia using TempWatch were recorded in 51 infants within 6 hours of transfer to the postnatal ward. The hypothermic incidence was significantly more (p-value 0.006) during the day shift (70%) than during the night shift (30%). Conclusion: The hypothermia alert BEMPU TempWatch was useful to detect hypothermia in healthy term neonates.

Role of C-Reactive Protein and Immature to Total Neutrophil Ratio in Early Onset Neonatal Sepsis

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.

Outcomes of Sick Neonates Transported to a Tertiary Care Hospital by a Trained Team, in Northern India

Bijaylaxmi Behera, Babu Lal 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.

Evaluation of Hyponatraemia among Paediatric Patients having Lower Respiratory Tract Infections Visiting a Tertiary Care Centre

SP Akshatha

Introduction: Serious health risks arise from Lower Respiratory Tract Infections (LRTI). In particular, this infection is very evident in children among less than 5 years of age group, who require hospital admission and sadly contributes to the thirty percent of annual deaths worldwide. Aim: To evaluate the incidence of Hyponatremia in Lower Respiratory Tract Infections among paediatric patients less than five years. Materials and Methods: The prospective study was conducted from January 2019 To February 2020. All patients having quantifiable indications evocative of heightened lower respiratory tract infectivity were assessed in detail at hospital, on Inpatient Department (IPD) basis. Patients having serum sodium value <135 mEq/L were assessed for Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) with the refrigerated sample of urine and the second serum sample. Estimation of the following parameters was done in these patients-blood urea, blood glucose, urinary sodium, serum creatinine, serum osmolality, urinary creatinine, urinary urea, and urine osmolality. Results: Fifty eight of the total numbers had hyponatremia that ranges to the 38.66% of the total count. Out of these cases, forty nine, comprising a total percentage of 84.4% were due to SIADH. Out of the total 59 hyponatremic cases, four were suggested to have difficulty in the form of seizures followed by altered sensorium that comprise 12.12% of the total figures. Conclusion: Existence of hyponatraemia in LRTIs further increases the morbidity in the affected children in the form of extended hospital stay and incidence of seizure attacks, followed by deranged sensorium, in a number of cases. Hence, children admitted for LRTIs should be assessed not just clinically, but also for their serum levels sodium at the time of hospital admission.

Risk Factor Evaluation of Preterm Labour/Births in Rural Medical College Hospital

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.

Impact of Educational Interventional Programme Regarding Breast Feeding on the Level of Knowledge, Perception and Attitude of Post Natal Mothers

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.

Effect of Mode of Delivery on Cord Blood Thyroid Stimulating Hormone Levels- A Cross-sectional Study

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.

Study of Severe Adverse Events Following Immunisation in Children of Jamnagar District with Follow-up at Tertiary Care Hospitalbe

Sonal Shah, Triya Malde, Maulik Shah, Parth Kalyani, Bhadresh Vyas

Introduction: The World Health Organisation (WHO) defines Adverse Effects Following Immunisation (AEFI) as a medical incident that takes place after an immunisation, causes concern, and believed to be caused by immunisation. Aim: To study the patterns of serious adverse events following immunisation among children in Jamnagar district in tertiary care centre. Materials and Methods: The study was conducted at Paediatrics Department at Shree M. P. Shah Medical College, Jamnagar, Gujarat, India along with two primary health centers, one community health centre and four private clinics of Jamnagar district. There were 26 children included in the study that lasted for one year, from April 2013 to April 2014.The numbers of adverse event reports were calculated in five age groups: 0-1 month (neonates), 1-12 months (infants), 1-3 years (toddler), 3-6 year (preschool) and 6-14 years (school going). Vaccination details had been taken from place of immunisation. The variables were assessed for normality using the Kolmogorov-Smirnov test. Descriptive statistics were calculated. Results: From the one year of events reported of AEFI, most commonly AEFI noted was due to immunisation of Pentavalent vaccine. Most serious adverse events found were swelling, pain and tenderness, redness and persistent crying. Remaining were local requiring primary support in the hospital. Conclusion: The most common age group affected was infants. Regular follow-up should be done for all participants, so that focus should be done in this population for reducing AEFI.

A Study on Seroprevalence of Hepatotropic Viruses in Neonatal Cholestasis Patients at a Tertiary Care Hospital of Central India

Nagaraj Perumal, Deepti Chaurasia, Rajeev Kumar Jain, Jyostna Srivastava

Introduction: Neonatal Cholestasis (NC) is defined as conjugated hyperbilirubinaemia in infancy, Diverse aetiologies and several disorders are responsible for this hepatobiliary dysfunction. Hepatotropic viral infection may have an important role in the pathogenesis of NC and related clinical outcomes. Aim: This study was aimed to estimate the seroprevalence of the hepatotropic viruses and their possible role in neonates presenting with cholestatic jaundice. Materials and Methods: This retrospective study included 51 infants who presented with cholestatic jaundice. Serum samples were collected and screened for the hepatotropic viruses. The presence of serological markers to Cytomegalovirus (CMV), Epstein-Barr Virus (EBV), Hepatitis C (HCV), Hepatitis E (HEV), Herpes Simplex Virus (HSV) and Rubella were tested using enzyme-linked immunosorbent assays. Hepatitis B Virus (HBV) serostatus was determined by using rapid card tests. Results: Of the 51 cases, 4 (7.6%) patients presented with biliary atresia. Seroprevalence of CMV (23.5%) was found to be more predominant followed by EBV (13.7%), HCV (5.8%), HEV (5.8%), HSV (1.9%) and Rubella (1.9%). Co-infections were found in 7 (13.7%) cases and CMV-EBV co-infection being the most common. Conclusion: The presence of specific serological markers to hepatotropic viruses in the NC cases strongly suggests their aetiological role in this disorder. To the best of the knowledge, this is the first report documenting the seroprevalence of hepatotropic viruses in NC patients from Central India.

Newborn Screening-A Bolstering Step towards Quality Health in Neonates

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.

Morbidity and Mortality Patterns of Neonates Born to Multiple Pregnancies: A Prospective Observational Study

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.