Myocardial ischemia in neonate with perinatal asphyxia: Electrocardiographic, echocardiographic and enzymatic correlation

Objective: The objective of this study is to evaluate the presence and severity of cardiac involvement in asphyxiated neonates and toestablished which clinical and laboratory parameters (electrocardiogram [ECG], echocardiography [ECHO], and cardiac enzyme)are reliable predictors of myocardial ischemia. Design: Nested case–control study. Setting: Neonatology unit of tertiary careinstitute. Materials and Methods: The study group consist of 90 term neonates who had APGAR score <7 at 5 min as cases and90 term neonate who had APGAR score >9 at 5 min as controls. On the 2nd day of life (between 24 and 36 h), all neonate underwentECG, ECHO, and enzyme estimation (CK-MB). Result: The cases were divided into three groups according to SARNAT scale andGroup I consist 25, Group II - 54, and Group - III, 11 neonates. The mean gestational age was 36.97±0.35 and 37.12±0.46 week forcases and controls respectively while mean birth weight was 2.79±0.36 kg and 2.68±0.76 kg for cases and controls, respectively.ECG changes were present in 70 (77.7%) of cases. ECG changes of Grade 3 and 4 were present in only Group III neonates andall neonates with Grade 4 changes were died in 1st week of life. Fractional shortening (FS) decreased progressively from Group Ito Group III (p<0.001) and showed a significant difference between cases and controls as well as in different groups except incontrols versus Group I. Peak aortic velocity behaved similarly. Concerning mean acceleration, the significant difference wasobserved between control and cases (all 3 groups). CK-MB activity increased from Group I to Group III and statistically significantdifference was seen in controls and different Groups as well as in between different groups except in Controls versus Group I.Conclusion: Severe ECG changes (Grades 3 and 4), CK-MB elevation and reduced FS can be considered as reliable marker ofmyocardial ischemia in perinatal asphyxia

Role of ultrasound in characterization of ovarian masses

Background: Ovarian cancer is the second most common malignancy in Pakistani women, accounting for 4% of all cancers in the female population. The aim of this study was to determine sensitivity, specificity, positive and negative predictive values and 95% confidence intervals for ultrasound in characterization of ovarian masses in patients presenting at public and private tertiary care hospitals in Karachi, Pakistan.MATERIALS AND Methods: We adopted a cross-sectional analytical study design to retrospectively collect data from January 2009-11 from medical records of two tertiary care hospitals. Using a non-probability purposive sampling technique, we recruited a sample of 86 women aged between 15 and 85 years fulfilling inclusion criteria with histopathologically proven ovarian masses presenting for an ultrasound examination in our radiology departments.Results: Our retrospective data depicted sensitivity and specificity of ultrasound to be 90.7%, 95%CI (0.77, 0.97) and 91.4%, 95%CI (0.76, 0.98) respectively. Positive predictive value was 93%, 95%CI (0.79, 0.98) and negative predictive value was 89%, 95%CI (0.73, 0.96). A total of 78 ovarian masses were detected, out of which 42 were malignant and 36 were benign.CONCLUSIONS: Results of our study further reinforce the conclusion that ultrasound should be used as an initial modality of choice in the workup of every woman suspected of having an ovarian mass. It not only results in decreasing the mortality but also avoids unnecessary surgical interventions

Neonatal Risk Factor for Seizures in Term Neonate: A Hospital - Based Case Control Study

Objective: Assessing the neonatal risk factors for seizure in first 72 hours of life in term neonate.Design: Case control study.Setting: Department of Paediatrics, Neonatology unit tertiary care centre Govt. Medical College, Nagpur.Method: A 210 cases i.e. term neonate with seizure within first 72 hours of life and 210 controls i.e. term neonate without seizure in first 72 hours of life were randomly selected as study subject over a period of two year. Seizures were defined as per standard definition. Data were collected regarding age of onset of seizure, birth weight, Apgar score at 1 minute and 5 minute, type of delivery. Appropriate investigation was done and neonates were followed up till discharge or deathResults: In73% neonate’s subtle seizure was most common and occurs within 48-72 hours of life. Neonates with low birth weight had 0.22 times more risk of seizure than normal weight. Birth asphyxia was most significant risk factor for seizure and had 4.66 times more risk of seizure (P<0.001). Presence of low Apgar score at 1 minute and 5 minute are found to be significant in univariate analysis but in multiple logistic regression analysis it is found that 5 minute Apgar score is more significant than 1 minute. Low Apgar score at 5 minute had 1.29 times more risk of seizure. In study population 7.1% neonates died in case group compared to 1.4% in control group which was statistically highly significant (OR 3.98, 95% CI 1.23-16.7, P<0.0095) and most common cause of death was severe birth asphyxia and sepsis.Conclusion: Early identification and timely intervention of neonatal risk factor may reduces the seizure in term neonate

Study of fetal malnutrition in full-term small for gestational age babies

Introduction: Fetal malnutrition (FM) is a risk factor for increased neonatal morbidities and mortalities worldwide. Clinician’s comes across the challenge to identify small for gestational age (SGA) babies whose health is endangered in utero due to a hostile intrauterine environment and to monitor and intervene appropriately. Objectives: This prospective observational study aimed to know the prevalence of FM and to study the occurrence of adverse perinatal events in term SGA babies. Materials and Methods: The studyenrolled 903 term SGA neonates. Clinical assessment of nutrition (CAN) score was applied and anthropometric evaluation was carried out between 24 and 48 h of birth. Babies with adverse perinatal events were treated according to standard hospital protocol. Results: The prevalence of FM in the present study was 34.21% in term SGA babies. All anthropometric parameters such as birth weight, length, head circumference (HC), and ponderal index (PI) were significantly lower in SGA babies with FM as compared to those without FM. There was significantly higher occurrence of FM in SGA babies. Risk of FM was 3.17 times higher in SGA babies with length <3rd centile and risk 2.07 times higher when HC was <3rd centile. The risk of FM was 4.27 times higher when PI <2.2. When PI was compared to CAN score for FM, it had low sensitivity and specificity. Conclusion: CAN score is the better index for the detection of FM and for predicting high risk of perinatal morbidity in term SGA babies. Our study demonstrates that predicting malnutrition is more meaningful than birth weight alone

Isolated congenital factor VII deficiency

Congenital factor VII (FVII) (proconvertin) is a rare autosomal recessive bleeding disorder. Bleeding manifestations and clinical findings vary widely, ranging from being asymptomatic to life-threatening bleeding. Intracranial bleeding is relatively less common with inherited FVII deficiency than with other coagulation disorders. We report a rare case of congenital FVII deficiency in an 11-year-old male child. The patient had recurrent subdural hemorrhages. The prothrombin time was markedly prolonged with a normal bleeding time, normal partial thromboplastin time and normal platelet count. Treatment consists of replacement therapy with fresh frozen plasma, prothrombin complex concentrates or plasma-derived FVII concentrates, and/or recombinant factor VIIa. Clinical heterogeneity is the hallmark of this disorder

Short-term safety and beneficial effects of hydroxyurea therapy in children with sickle cell disease

Introduction: Worldwide, sickle cell disease (SCD) is the most common hemoglobinopathy among which SS pattern is more common. Although hydroxyurea (HU) is approved by the Food and Drug Administration for the treatment of recurrent moderate-to-severe painful crises in pediatric sickle cell anemia, there is a fear of toxicities. Objectives: The objectives of the study were to evaluate the short-term safety and beneficial effects of low-dose HU therapy in SCD (SS pattern) children. Materials and Methods: This prospective cohort study enrolled 40 cases of severe SCD and started HU in a fixed dose of 10 mg/kg/day. During follow-up, cases were evaluated for compliance of HU, its toxic effects and adverse events from their histories, clinical examinations, and laboratory parameters. Furthermore, beneficial effects of HU therapy were evaluated by assessing blood transfusion rate, frequency of painful events, strokes, acute chest syndrome, avascular necrosis of femur, and estimation of hemoglobin F (HbF) level after 2 years of therapy. HU was discontinued temporarily if any toxicity or minor adverse drug events occurred during therapy and was restarted at the same dose after normalization of deranged laboratory parameters. Results: The clinical adverse drug events seen were nausea (8.33%), diarrhea (2.78%), and hematuria (2.78%). The most common hematological toxicity was anemia and thrombocytopenia. Renal and hepatic toxicities were transient in nature. The mean acute painful events and blood transfusion rate reduced significantly on HU therapy. It increased Hb and HbF level significantly in SCD children. Conclusion: HU is a safe drug without significant toxicity or adverse events in a dose of 10 mg/kg/day for short duration and it is beneficial in SCD (SS pattern) children in reducing acute painful events and decrease blood transfusion rate

Utility of the Modified Sick Neonatal Score to Predict the Mortality in Outborn Neonates: A Cohort Study

Introduction: Illness severity scoring systems are essential tools for reducing mortality by identifying disease severity and providing early intervention. The application of the Modified Sick Neonatal Score (MSNS) in resource-limited settings has been studied in inborn neonates, but there is a lack of data regarding outborn neonates. Aim: To predict mortality in outborn transported neonates by applying the MSNS score. Materials and Methods: This cohort study was conducted from June 2020 to November 2021 in the Department of Paediatrics at Government Medical College, Nagpur, Maharashtra, India. Parameters of the MSNS scoring system (respiratory effort, heart rate, axillary temperature, capillary refilling time, random blood sugar, oxygen saturation, gestational age, and birth weight) were evaluated in all admitted outborn neonates upon admission, and outcomes (discharge or death) were noted. The score and individual parameters were correlated with the outcome. Chi-square test, Fischer's-exact test, and Mann-Whitney U test were applied to statistically analyse the data. A receiver operating curve was plotted to determine the cut-off value for the score to predict mortality. Results: In the present study, 866 (58.2%) neonates were male, while 622 (41.8%) were female, and the mean age at admission was 43.3±58.9 hours. Nearly two-thirds of the neonates were born at term, and the mean birth weight was 2191.62±595.47 gm. A total of 91.7% of the neonates were referred by government facilities, and 82.8% of the neonates were transported by ambulance, but only one-third of the ambulance-transported neonates were accompanied by a health assistant. The mean traveling distance was 83.57±72.79 km, and the mean transport duration was 2.14±1.07 hours. The common clinical diagnosis were sepsis (42.68%), respiratory distress (19.89%), and birth asphyxia (14.78%). The neonatal mortality rate was 29.3%. The total MSNS score for neonates who survived was 11.26±2.34, compared to 8.52±2.23 for the neonates who died (p-value <0.0001). The sensitivity was 80.5%, with a specificity of 63.1% and an area under the curve of 0.79 (OR-24.72, 95% CI 0.77-0.81, p-value <0.001) when using the optimal cut-off score of ≤10. Conclusion: The MSNS score of ≤10 has better sensitivity and specificity in predicting neonatal mortality in outborn transported neonates