ROLE OF TRANSCRANIAL ULTRASOUND IN HOSPITALISED HIGH-RISK NEWBORNS : A PROSPECTIVE OBSERVATIONAL STUDY

Introduction: High-risk neonates are always an increased risk of morbidity and mortality. They contribute to as high as 15% of all morbidities and mortalities in newborns independently. Hence identifying them early and appropriate management of these high-risk newborns is important. Cranial ultrasonography (CUS) is a reliable tool for detecting congenital and acquired abnormalities of the perinatal brain and the most frequent patterns of brain injury in preterm and full-term neonate. Aim& Objective: To study cranial ultrasound findings in high-risk neonates and to correlate the clinical manifestations with cranial ultrasonogram findings. Material& Method: This study was a prospective observational study carried out at Department of Paediatrics, SVPPGIP & SCBMCH between October 2019 to October 2021. Observation: The incidence of CUS abnormalities in high-risk neonates in the present study was 54.5%.  There was a statistically significant correlation between birth asphyxia and abnormal CUSfindings(p<0.001), birth trauma and abnormal CUS findings(p<0.001), hypoglycemia and abnormal CUS findings(p=0.004), and abnormal Central Nervous System examination and abnormal CUS findings(p=0.008). Conclusion: Cranial ultrasound is important and critical as an investigation modality and effectively documents morphology of brain damage. Recommendation : The concept of ‘survival’ of the newborn has given way to the importance of ‘intact survival’ of the high-risk infant, prompting the initiation of strategies to identify neurological sub-normality at the earliest. CUS is an ideal tool for the primary screening of the neonatal brain, it must be done in all high-risk neonates for prognosticate and guide to outcome

STUDY OF CO-MORBIDITIES AND OUTCOME IN HOSPITALISED CHILDREN WITH PRIMARY SEVERE ACUTE MALNUTRITION

Introduction:  Aim & Objectives: To determine the different co-morbidities associated in children aged 6 - 59 months with primary severe acute malnutrition and the outcome of primary severe acute malnutrition in children. Material & Method:  This study was conducted over 2 years (From November 2019 to October 2021) at the Department of Pediatrics, S.C.B. Medical College & Hospital, S.V.P. Postgraduate Institute of Pediatrics, and Nutritional Rehabilitation Centre (NRC), Cuttack. This is a hospital-based descriptive survey study. The children aged 6 – 59 months, meeting the WHO definition of Severe Acute Malnutrition were included in the study. Results  The most common presenting complaint seen in our study population was fever, present in 60 of cases. The 2nd most common presenting complaint was cough and cold in 51 (%) of subjects, followed by loose stool, seen in 34 cases; and not gaining weight in 31 (%) cases. Acute respiratory tract infections were found to be the most common infectious co-morbidity, present in 43 children. Diarrhea was the second most common infectious co-morbidity which was seen in 34 children. Conclusion: SAM is more seen in low socio-economic groups; and in families with lower rates of access to and utilization of safe water and sanitation facilities. Lower rate of complete immunization, as compared to national and state level statistics; and inadequate exclusive breastfeeding and delayed weaning are common findings in SAM children.  Recommendation  Exclusive breastfeeding for the first 6 months of life, followed by the introduction of complementary feeds at 6 months; continued breastfeeding till 2 years. Immunization as per schedule, as several cases were partially immunized. Socioeconomic status has to be improved including parental education regarding following hygienic practices, usage of safe water, and sanitatio

A clinical study on retinopathy of prematurity in a tertiary care centre

Background: Retinopathy of prematurity (ROP) is a multifactorial vasoproliferative retinal disorder that increases in incidence with decreasing gestational age. India shares 20% of the world childhood blindness. Besides congenital cataract, congenital glaucoma and ocular injuries, ROP is emerging as one of the important causes of childhood blindness in India.Methods: This hospital based prospective study was undertaken during October 2016 to September 2018 in the Department of Ophthalmology, SCB Medical College. Authors included (a) all preterm infants weighing less than 1750gm or gestational age less than 34 weeks at birth, (b) infants with birth weight between 1750gm to 2000gm and gestational age more than 34 weeks (late preterm and term infants) those were considered as high risk.Results: Among the 328 babies included in our study, the incidence of ROP was 29.57%. Bilateral ROP was found in 76.29% with nearly equal stages in both eyes and only 23 neonates showed unilateral involvement.Conclusions: Low birth weight, lower gestational age, blood transfusion, Respiratory Distress Syndrome (RDS), apnoea, supplemental oxygen therapy, maternal anaemia and gestational diabetes mellitus (GDM) were strongly associated with development of ROP

TO STUDY THE EFFECT OF ANTIEPILEPTIC DRUGS ON THYROID FUNCTION AND THYROID VOLUME IN CHILDREN 1-14 YEARS WITH SEIZURE DISORDER: A PROSPECTIVE STUDY

Background:  The incidence of epilepsy (recurrent unprovoked seizures) in children and adolescents seems relatively constant across different populations studied, ranging from 50 to 100/l00,000 person-years. The prevalence of epilepsy as a major public health problem worldwide is estimated to be 0.5- 1% of the population in industrialized countries. Anti-epileptic drugs (AEDs) can impair thyroid hormone homeostasis by changing its biosynthesis, secretion, transport, metabolism, and excretion, which may cause growth and developmental disorders in children.    Materials and methods:  This prospective study included children of 1 to 14 years with seizure disorder on AEDs over two years. Clinical and laboratory details were recorded in pre-designed proforma. Thyroid hormone levels were measured by ECLIA (Electro Chemiluminescent Immuno Assay). Ultrasound of the thyroid gland was performed for size measurement.   Results:  A total of 50 children were included. The majority of the children were in the 7 to 10 years age group (48%). The mean (±SD) age was 7.36(±2.59) years, and there were 72% males. Forty-six (92%) children had TSH levels within the normal range, and 4(8%) had increased levels. The TSH level was progressively increasing while on monotherapy with all AEDs except levetiracetam. A significant increase in TSH level was found with valproic acid. There was no clinical hypothyroidism, and no significant change in thyroid gland size was noted. USG of the thyroid gland shows mild hypoechogenicity and increased vascularity in children with altered TSH levels.    Conclusion:  Subclinical hypothyroidism with elevated TSH levels without any signs and symptoms of hypothyroidism was noted in children on all AEDs except levetiracetam, which had no effects on thyroid function.  Recommendations:  Subclinical hypothyroidism has been found to affect cognition of the growing brains in children. Thus, periodic monitoring of Thyroid function and volume may be needed in children on anticonvulsants

Epidemiology of oral poisoning in paediatrics age group

Introduction: Poisoning in children is a common and preventable cause of morbidity and mortality. Our environment is still not child-safe and the medications are not dispensed in a child-safe manner. The incidence of childhood poisoning in India varies from 0.3 to 7.6 percent. Poisoning accounts for 0.03% of mortality in infants, 0.16% in preschool age group and 0.37% of in five to fourteen year’s age group as per the statistics projected by Government of India. The poisoning in paediatric age group includes obsolescent traditional poisons, the in fashion intoxications with recreational drugs as well as chronic exposure to industrial chemicals. The peak incidence of accidental overdoses is in the second year of life and 85% of accidental poisoning affect children under five years of age. Methodology: This is a prospective case controlled study done over a period of two years. The study was conducted in S C B Medical College, Cuttack, Odisha. Results: The poisoning constitutes 1.15% of total paediatric admissions. The commonest type of poisoning was due to Non-Medicaments (56 cases – 78.87%), out of which the commonest poisoning was due to hydrocarbons. Conclusion: Non medicament ingestions particularly kerosene still one of the very common toxic ingestion in children used in accidental poisoning cases

Study of renal function test in asphyxiated newborns and their outcome

Introduction: There is a high incidence of acute kidney injury (AKI) among asphyxiated term. AKI manifests by changes in urine output and blood chemistries & can have serious clinical consequences. Oliguria has been reported in higher number of neonates affecting nearly 25%- 70% babies. Methodology: This study was undertaken to study renal failure in asphyxiated neonates. This is a prospective case controlled study done over a period of two years. Various clinical, biochemical and radiographic parameters pertaining to renal injury among asphyxiated neonates were studied. Results: About 64 asphyxiated newborns were studied. Majority (53.12%) was term weighing between 2.5-3 kg & most of them were in HIE-2 grade (43.75%). Oliguria was mostly noted among HIE - 3 (31.57%). Birth asphyxia and subsequent acute renal failure was more in babies delivered vaginally. Biochemical parameters also showed correlation with the severity of asphyxia. Premature babies were more prone to develop renal failure secondary to asphyxia. Mortality was directly related to severity of perinatal asphyxia and presence of oliguria. Conclusion: The incidence of acute renal failure due to perinatal asphyxia was high. Incidence with oliguria was high in severe asphyxia. Prevention of asphyxia & prompt management of morbidities like ARF can improve the outcome of perinatal asphyxia

Study of association and significance of hyponatremia in patients with lower respiratory tract infection (LRTI)

Introduction: Pneumonia, the severe form of lower respiratory tract infection (LRTI) is one of the most important causes of morbidity and mortality in children especially from the developing nations. Pneumonia is the infection and associated inflammation of the lung parenchyma. Pneumonia is the leading infectious killer of under 5 children claiming more lives than any other diseases. The burden is more in the developing nations. Around 15% of under 5 mortality is attributed to pneumonia. Hyponatremia is a common electrolyte imbalance which occurs in children with pneumonia. Many studies have reported the incidence of hyponatremia around 40 to 45%. Aim & Objective-: To see the frequency of hyponatremia in patients with LRTI & its significance in relation to disease severity. Materials & Methods:  It was a hospital based observational study. The study has been conducted in the Department of pediatrics, S C B Medical college hospital & SVPPPGIP, Cuttack. Result: Hyponatremia was a frequent finding in children with bronchopneumonia (44.6%). Patients with hyponatremia group had initial high body temperature in present study (101.9ºc vs99.7). Conclusion: There is importance of measuring serum electrolytes in patients with LRTI. Appropriate fluid should be done in case of LRTI

THE PREDICTORS AND PROFILE OF HEARING LOSS IN HIGH RISK NEONATES: A CROSS-SECTIONAL ANALYTICAL HOSPITAL BASE STUDY.

Introduction: Loss of hearing during early infancy leads to delayed development of language, communication, and cognition which affects the social, emotional, and academic achievements of a child. Early identification of hearing impairment improves age-related language and communication skills. Aim & Objectives: To find out the prevalence and profile of hearing loss among high-risk neonates in a hospital setup. Material and Methods: This was a prospective observational study being conducted over two years at VIMSAR, Bulra, Sambalpur, Odisha. 264 high-risk neonates admitted to Neonatal Intensive Care Unit were screened using evoked otoacoustic emission (EOAE) and Brainstem Evoked Response Audiometry (BERA). Neonates who tested refer on EOAE were subjected to BERA and those having a unilateral or bilateral hearing threshold for more than 40 dB in BERA were defined as hearing impaired. Results: Most of the study neonates were having multiple significant risk factors. Multivariate logistic regression analysis of significant risk factors for hearing loss revealed gestational diabetes of the mother, mechanical ventilation for more than 5 days, hyperbilirubinemia requiring exchange transfusion, hypo-glycemia during the early neonatal period, and duration of hospitalization for more than 5 days were the independent risk factors associated with hearing loss. Conclusion: This study implies a high incidence of hearing impairment in neonatal intensive care unit(NICU) graduates and a change in the distribution of risk factors for hearing loss. Gestational diabetes, mechanical ventilation for more than 5 days, hyperbilirubinemia with exchange transfusion, neonatal hypoglycemia, and NICU stay for more than 5 days were significant independent clinical risk factors for predicting hearing impairment in high-risk neonates. Recommendation: Universal newborn screening for hearing loss in high-risk neonates and early identification of risk factors and exposure reduction should be done, so that the devastating effects of hearing impairment could be prevented before it starts