A study of serum-ionized calcium in neonates with unconjugated hyperbilirubinemia on phototherapy

Objectives: The objective is to study the occurrence of phototherapy-induced hypocalcemia in neonates with unconjugated hyperbilirubinemia and to compare the occurrence between pre-term and full-term neonates. Materials and Methods: The study was conducted in the Neonatology Unit of Department of Pediatrics, at a tertiary care teaching hospital for 12 months. A total of 230 full-term and pre-term neonates with jaundice were recruited. Of 230 neonates, 150 were given phototherapy (cases), while 80 did not receive phototherapy and were used as control. Serum-ionized calcium levels were measured at initiation, after 24 h and after 48 h, or at the end of phototherapy in the case duration of phototherapy was <48 h. Serum-ionized calcium was repeated at 24 h after the completion of phototherapy. In the control group, ionized calcium levels were measured at the time of development of jaundice and 24 h after the initial measurement. Results: Of 150 cases who received phototherapy, 105 were term and 45 were preterm. 69 babies (46%) developed hypocalcemia after 24 h of phototherapy. Of these, 28 (40.5%) were preterm and 41 were term (59.5%). 4 patients developed symptoms, which included jitteriness and seizures. 62.2% of the total pre-term and 39% of term neonates developed hypocalcemia after phototherapy. Conclusion: This study suggests that neonates exposed to phototherapy are at the risk of developing hypocalcemia. There is a significant decline in the ionized calcium levels after exposure to phototherapy, and this level can even fall to hypocalcemic levels. As the duration of phototherapy increases, the serum levels of calcium may decline further. The risk of developing hypocalcemia is higher in pre-term neonates

Correlation of Vitamin D levels with feto-maternal outcome

Background: Vitamin D deficiency in adult females may increase risk of pre-eclampsia, gestational diabetes, bacterial vaginosis. Various malpresentation, cephalo-pelvic disproportion and difficult deliveries increases the risk of caesarean section. It may also increase the risk of fetal hypovitaminosis D, neonatal rickets and tetany, lower respiratory tract infections, low birth weight, the largest cause of infant mortality in India. This study was under taken to study the impact of vitamin D deficiency on feto-maternal outcome.Methods: The study was conducted in the Department of Obstetrics and Gynaecology, Himalayan Institute of Medical Sciences (HIMS), Swami Ram Nagar, Dehradun, over a period of 12 months. Sample size was 100 pregnant females attending antenatal clinic.Results: Out of 100 subjects, pre-eclampsia was seen in 15, among which 5 (23.80%) had deficient, 9 (13.04%) had insufficient and 1 (10%) had sufficient vitamin D levels. Eclampsia was seen in 3 subjects, out of which 1 (4.76%) had deficient, 2 (2.89%) had insufficient vitamin D status. IUGR was seen in 8 subjects, out of which 4 (19.04%) had deficient vitamin D levels, 4 (5.79%) had insufficient vitamin D status. Neither of the two had sufficient vitamin D status. Deficient vitamin D status with birth weight ≤2.5 kg was seen in 9 (42.85%) subjects and 12 (57.14%) subjects with >2.5 kg Insufficient Vitamin D status was seen in 22 (31.88%) subjects with birth weight ≤2.5 kg and 48 (69.56%) with birth weight >2.5 kg.Conclusions: Prevalence of vitamin D deficiency and insufficiency was noted in this region and its association with pre-eclampsia (23.80%, 13.04% and 10% in deficient, insufficient and sufficient group respectively) was seen. Higher incidence of LSCS was also present among the deficient and the insufficient group

Vitamin D levels in pregnant women in Uttarakhand, India

Background: A balanced, nutritious diet is an important aspect of a healthy pregnancy and its outcome. Vitamin D plays an important role in regular bone growth and in adequate function of innate immune system, including barrier function of mucous membrane. Vitamin D deficiency in adult females may increase risk of pre-eclampsia, gestational diabetes, bacterial vaginosis. The present study was undertaken to find the prevalence of Vitamin D deficiency in the women of Uttarakhand, India.Methods: The study was conducted in the Department of Obstetrics and Gynecology, Himalayan Institute of Medical Sciences (HIMS), Swami Ram Nagar, Dehradun, India over a period of 12 months. Sample size was 100 pregnant females attending antenatal clinic.Results: Out of 100 subjects, 21 (21%) had deficient, 69 (69%) had insufficient and 10 (10%) had sufficient vitamin D status. Out of 21 deficient subjects, 18 (85.71%) were Hindus, 2 (9.52%) were Muslims, 1 (4.76%) was Sikh and no deficiency was seen in Christian. In the present study, deficient vitamin D status was seen in 1 (4.76%) in lower, 16 (76.19%) in middle and 4 (19.04%) subjects in upper socioeconomic status.Conclusions: It is concluded from our study that there is serious vitamin D deficiency and insufficiency in the women of Uttarakhand, India

Microfinance clients' awareness index: A measure of awareness and skills of microfinance clients

AbstractThe promotion of financial education for poor people in developing countries calls for work on several fronts, one of which is to develop a measure to evaluate the outcome of financial education in relation to broader development goals. This paper proposes a Microfinance Clients' Awareness Index (MCAI) to determine the level of financial awareness of microfinance clients. This index is a comprehensive measure that incorporates information on several aspects of financial awareness in one single number lying between 1 and 2, where 1 denotes complete ignorance and 2 indicates complete financial awareness of the microfinance product

Pregnancy and labor outcomes in squat versus western style sitting toilet users: a pilot study

Background: Squatting posture may appear outdated and primitive, but in the antenatal period, it is an important resistance exercise to strengthen the abdominal and pelvic floor muscles which are believed to potentially prepare the women for a more natural delivery. No study till date has evaluated the effect of type of toilet seat regularly used during pregnancy. This was a pilot study to assess obstetric outcomes in antenatal women using squat versus western style sitting toilet seat.Methods: In an observational prospective pilot study, low risk primigravida at 28-32 weeks gestation were recruited from the outpatient department and divided into two groups after matching baseline characteristics. Group I (n=50) included women regularly using squatting type toilet seat and group II (n=50) comprised women using western style toilet seat. Pregnancy was followed till delivery; obstetric and neonatal outcomes were noted.Results: Squatting group, as compared to sitting type seat users, had lower incidence of vaginal discharge (10% vs 16%), urinary tract infection(12% vs. 24%), constipation (2% vs. 6%), labor induction (52% vs. 58%), shorter second-stage duration (0.60 vs. 1.24 hours) and a higher incidence of normal vaginal delivery (94% vs. 86%), albeit not statistically significant. NICU admissions (16% vs. 20%) and mean birth weight (2.83 vs. 2.97 kg) were comparable in the two groups.Conclusions: Squatting type toilet seat users had many favourable obstetric outcomes, especially a higher incidence of normal vaginal delivery; although, the difference was not statistically significant. Large community based surveys in this regard can reveal the true effects of squatting type toilet seat on pregnancy and labour outcomes

Cord bilirubin levels as a predictive marker for neonatal hyperbilirubinemia: A prospective study

Background: Hyperbilirubinemia is the most common medical problem in newborn infants. Early discharge is recommended but hospital readmission is a cause of concern among clinicians. This in turn carries a risk of delayed recognition of significant hyperbilirubinemia. Objective: A cross-sectional analytical study was done to evaluate the predictive value of cord bilirubin level for identifying term and near-term neonates for subsequent hyperbilirubinemia. Materials and Methods: Cord bilirubin levels at birth and subsequently serum bilirubin levels at 72 h were assessed in 100 neonates. The cutoff value was estimated beyond which there was significant hyperbilirubinemia. Results: The cutoff value of cord bilirubin >2.02 mg/dl had sensitivity and specificity of 87.5-70.8%, respectively, with positive predictive value of 0.39 and negative predictive value of 0.965 for subsequent hyperbilirubinemia. Conclusion: The cutoff value of cord bilirubin level estimated is 2.02 mg/dl can be used to predict significant neonatal hyperbilirubinemia

Vitamin D levels in pregnant women in Uttarakhand, India

Background: A balanced, nutritious diet is an important aspect of a healthy pregnancy and its outcome. Vitamin D plays an important role in regular bone growth and in adequate function of innate immune system, including barrier function of mucous membrane. Vitamin D deficiency in adult females may increase risk of pre-eclampsia, gestational diabetes, bacterial vaginosis. The present study was undertaken to find the prevalence of Vitamin D deficiency in the women of Uttarakhand, India.Methods: The study was conducted in the Department of Obstetrics and Gynecology, Himalayan Institute of Medical Sciences (HIMS), Swami Ram Nagar, Dehradun, India over a period of 12 months. Sample size was 100 pregnant females attending antenatal clinic.Results: Out of 100 subjects, 21 (21%) had deficient, 69 (69%) had insufficient and 10 (10%) had sufficient vitamin D status. Out of 21 deficient subjects, 18 (85.71%) were Hindus, 2 (9.52%) were Muslims, 1 (4.76%) was Sikh and no deficiency was seen in Christian. In the present study, deficient vitamin D status was seen in 1 (4.76%) in lower, 16 (76.19%) in middle and 4 (19.04%) subjects in upper socioeconomic status.Conclusions: It is concluded from our study that there is serious vitamin D deficiency and insufficiency in the women of Uttarakhand, India