Indian Journal of Neonatal Medicine & Research

Umbilical Coiling Index and Its Relationship with Perinatal Outcomes

Saswati Tripathy

Aim: To evaluate any adverse perinatal outcomes associated with abnormal coiling of umbilical cord. Materials & Methods: One hundred two (102) umbilical cords of babies delivered either by vaginally or by lower segment caesarian section were examined. The umbilical coiling index was calculated by dividing the total number of coils by the length of the cord. Subjects with umbilical coiling index below 10th percentile, between 10th and 90th percentile and above 90th percentile were defined as hypocoiled, normocoiled and hypercoiled respectively. Various outcome measures like gestational age at birth, intrauterine growth retardation, birth weight, meconium staining, APGAR scores at 1 and 5 mins were observed. Statistical analysis was done and p < 0.05 was considered as significant. Results:The mean Umbilical coiling index was 0.20 ± 0.08. A significant relationship was found between hypocoiled cords and pregnancy-induced-hypertension (PIH) in mother and meconium staining (p< 0.05). Hypercoiled cords were associated with PIH in mother, preterm delivery and low birth weight (p< 0.05). APGAR score at 5min ≤ 6 was seen in hypocoiled cords (p<0.05). Conclusion:Abnormal coiling index is associated with adverse perinatal outcomes.

New Born Care: Our Perspective

Benjamin M Sagayaraj, Nidhi Sharma, Lal D. V.

A low birth weight baby is a clinical and diagnostic challenge. The neonatologists are faced with numerous neonatal intensive care unit protocols. This study was designed to review the literature of past twenty five years regarding management of neonatal jaundice, sepsis, anaemia, hypoglycaemia, jaundice and hypoxic encephalopathy in a low birth weight newborn. The low birth weight newborn baby should be intubated electively if signs of respiratory distress appear. There should be an early Doppler of cerebral arteries to predict the ischemic changes in neonatal brain. Probiotic therapy with Bifidobacterium bifidus and Streptococcus thermophillus protects against necrotizing enterocollitis and results in incresed weight gain. Newborn intravenous lines should not be flushed with normal saline ampoules containing benzyl alcohol as preservative, as this increases the fluidity of neonatal blood brain barrier and predisposes to neonatal jaundice. Erythropoietin subcutaneous injections are most rewarding in low birth weight babies with neonatal anaemia. There is also increase in weight. Kangaroo care is useful in management of neonatal hypothermia and is also an immunological boast as the baby gets colonized with favorable microorganisms of maternal skin.

Outcome of Newborns Born to Mothers with Heart Disease by Operative Mode of Delivery – A Study from South India

Kalpana RY, Patil SJ

Context: Heart disease complicates approximately 1% of all pregnancies. Maternal cardiac disease in pregnancy has a bearing on pregnancy course and neonatal outcomes. Indian studies in this regard are sparse and moreover were undertaken mostly by obstetricians. Aims: The present study was planned looking from a paediatrician’s perspective in order to study all possible neonatal outcomes born to mothers with heart disease delivered by operative mode. Settings & Design: The data consisted of retrospective (old patient records with obstetric and cardiac details including echocardiography reports) and prospective data (monitored from the first antenatal visit to the delivery regularly by obstetricians and cardiologists) conducted in a multispeciality hospital including a tertiary care cardiac centre. Materials and Methods: Pregnant women with Congenital Heart Disease and Rheumatic Heart Disease and their newborns born by caesarean section were enrolled from 2006 – 2010. These women were treated according to their New York Heart Association (NYHA) class to improve their cardiac status. The neonatal group was followed for certain events (outcome) from delivery till discharge. These outcomes were compared between the test group (mothers with cardiac risk factors, unoperated mothers and those without drugs) and the control groups (mothers with no cardiac risk factors, operated mothers and those on drugs). Statistical Analysis used: SPSS v 17 software was used for statistical analysis. Descriptive analysis, Chi Square test and multiple logistic regression were used. Statistical level of significance was fixed at p < 0.05. Results: 55 pregnant women with heart disease and their 55 newborns were seen. Neonatal outcome was adverse in 58% babies; 47% were born to mothers with cardiac risk factors. 25 newborns (45%) had low birth weight, 15 (27%) were preterm, 20 (36%) had jaundice. 18 (33%) were small for gestational age, 8 babies (15%) had congenital anomalies (cardiac - 7; non cardiac – 3). 21% of babies with CHD were born to mothers with CHD. There were 2 neonatal deaths (4%). Statistically significant outcome was found with respect to prematurity only. 33% mothers had one or more of the 5 cardiac risk factors. There was no difference in neonatal outcomes between mothers with RHD or CHD. Conclusion: The outcome of newborns is influenced by maternal cardiac risk factors. There were no differences in neonatal outcomes born to mothers with RHD and CHD & mothers with operated and unoperated heart disease.