Background: Early transfer of baby to mother in step down ward is an approach that can improve ma... more Background: Early transfer of baby to mother in step down ward is an approach that can improve maternal satisfaction among parents of neonates admitted in NICU. Objective: To assess the satisfaction of mothers of neonates admitted in the neonatal step down ward of a public sector hospital. Methods: This cross sectional study was conducted in neonatal step down ward of a public sector hospital in North India. One hundred mothers of neonates (< 34 weeks gestation and/or <1800 g birth weight) admitted to the step down ward were included in the study. Mothers of neonates born with major congenital malformations, mothers who were HIV or Hepatitis B positive or had any other chronic illness were excluded. The mothers were interviewed on the day of discharge using a semi-structured questionnaire. It comprised of 35 questions, categorized into 8 domains, namely interpersonal relationships with staff, personal requirements of mother, health services provided by hospital, caregiver proficiency, education and guidance, kangaroo mother care, food provision, and environment of the ward. Maternal satisfaction was marked on a three-point Likert scale. Results: Among the mothers interviewed, a vast majority expressed the utmost satisfaction with the interpersonal relationships with the staff (97.5%). Deficit in satisfaction was observed with the health services (79.57%), and education and guidance by the hospital (78.87%). Conclusion: Neonatal step down set up with early involvement of mother in care of neonates makes mother-baby duo ready for discharge and offers new possibilities for neonatal management in resource-poor countries. Multicentric studies with objectivized outcomes and larger sample size are required for implementing this setup.
Background: Neonatal shock is associated with high mortality and morbidity. Shock index (SI), a r... more Background: Neonatal shock is associated with high mortality and morbidity. Shock index (SI), a ratio of heart rate (HR) to systolic blood pressure (BP), has been evaluated as a simple tool for early predictor of mortality in adult as well as pediatric patients. Objective: The objective of this study was to compare SI and modified SI (MSI) among survivors and nonsurvivors of neonatal shock and healthy controls. Materials and Methods: HR and BP were measured in neonates presenting with clinical shock at 0, 2, and 6 h after admission and in healthy controls. SI and MSI were calculated and compared between three groups. Results: The mean (standard deviation) SI was significantly higher at 2 and 6 h of admission (2.57 [0.54] vs. 2.93 [0.78], P = 0.029; 2.42 [0.41] vs. 3.04 [0.91], P = 0.0005) among nonsurvivors of neonatal shock as compared to survivors. MSI was also significantly raised at both 2 and 6 h of admission in nonsurvivors (3.32 [0.64] vs. 3.78 [1.05], P = 0.03; 3.16 [0.63] vs. 4.10 [1.85], P = 0.005). Conclusions: SI and MSI are significantly higher in nonsurvivors of neonatal shock than survivors and healthy controls. These metrics can be used as bedside tools for early identification of at-risk neonates with shock.
Lack of a standard definition of neonatal sepsis and a swift diagnostic method has proven detrime... more Lack of a standard definition of neonatal sepsis and a swift diagnostic method has proven detrimental in the management of this serious condition. Biomarkers have emerged as a beacon that might help us detect neonatal sepsis more effectively. The use of point-of-care biomarkers can aid in early diagnosis and timely initiation of treatment. Procalcitonin, presepsin, interleukin-6, highly specific C-reactive protein, and neutrophil gelatinase-associated lipocalin have been proven to aid in early diagnosis and timely initiation of treatment, thereby reducing sepsis-induced morbidity and mortality. These biomarkers have been found to be useful in reducing the duration of hospital stay and monitoring the response to therapy. When used in combination with each other, or with clinical scores, they have been proven to be advantageous over the gold standard by eliminating the waiting time for blood culture results. The use of biomarkers as a point of care investigation holds a future over th...
Dengue is the most common and widespread arthropodborne arboviral infection in the world today. T... more Dengue is the most common and widespread arthropodborne arboviral infection in the world today. The geographical spread incidence and severity of the dengue fever (DF) and dengue hemorrhagic fever (DHF) are increasing in America South-East Asia Eastern Mediterranean and the Western Pacific. WHO currently estimates that there may be 2.5-3.0 billion people at risk of dengue globally and this pandemic involves around 100 countries. Cyclical epidemics of dengue are becoming more frequent over the past two decades. Recently rural areas of Wardha district (Central Maharashtra) had an outbreak of dengue viral illness. We present our experience with these cases. Four hundred and ninety nine patients aged 0 - 12 yr admitted to a tertiary care hospital of Mahatma Gandhi Institute of Medical Sciences Sevagram Wardha from August 2004 to August 2005 were investigated for dengue infection. (excerpt)
Background and Objectives Laboratory surveillance of causative microorganism is crucial to formul... more Background and Objectives Laboratory surveillance of causative microorganism is crucial to formulate rational empirical treatment and preventive strategies for potentially fatal acute pyogenic meningitis (APM). This study was aimed to identify the causative microorganism of APM in children admitted in a tertiary care hospital of east Delhi. Materials and Methods Cerebrospinal fluid (CSF) was collected from 300 suspected cases of APM and subjected to cytology, gram staining, biochemical analysis and culture. Every fifth CSF sample was also subjected to antigen detection by latex agglutination test (LAT) for Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis, Escherichia coli, group B Streptococcus and TaqMan probe-based real time polymerase chain reaction (RTPCR) for S. pneumoniae, H. influenzae and N. meningitidis. Simultaneously, blood culture was also done from all these 300 cases. Result From CSF, 19 microorganisms were isolated in which hospital-acquired mu...
Our aim was to study the incidence and outcome of antenatally detected renal malformations in rur... more Our aim was to study the incidence and outcome of antenatally detected renal malformations in rural Maharashtra. Among 7365 deliveries conducted during the study period, antenatal screening for renal malformations was done in 6682 (90.7 %) deliveries. Renal malformations were detected in 35 fetuses on antenatal screening. Postnatal investigations confirmed renal malformations in 27 babies (77.1%), giving an incidence of 0.4% among liveborn babies. Seven babies were operated and 2 were awaiting surgery (33.3%). Two patients expired and another two were lost to follow-up. The outcome was satisfactory in other patients. Antenatal screening was a useful tool in diagnosing renal malformations.
There is a lack of substantial data on the safety of Levetiracetam during pregnancy in the contex... more There is a lack of substantial data on the safety of Levetiracetam during pregnancy in the context of the potential teratogenic effect on the newborn. We report a probable case of levetiracetam birth defects in a newborn with multiple congenital anomalies.
Objective Positive CSF culture is the gold standard for the diagnosis of meningitis but it carrie... more Objective Positive CSF culture is the gold standard for the diagnosis of meningitis but it carries poor sensitivity. CSF procalcitonin (PCT) is shown to have some utility for the diagnosis of meningitis though there are limited studies in neonatal age group. We planned this study to compare CSF, serum, and CSF to serum PCT levels in neonates with confirmed, probable, and nonmeningitis groups to determine its optimal cut-off in CSF and serum for diagnosing meningitis Study Design Sixty-seven neonates who qualified for lumbar puncture were enrolled in the study. Neonates were categorized into confirmed meningitis, i.e., CSF cytochemistry and culture positive (N = 17), probable meningitis, i.e., CSF cytochemistry positive but culture negative (N = 25) and nonmeningitis, i.e., both cytochemistry and culture negative (N = 25). CSF and serum samples were stored at −80°C for PCT assay. Results Significant difference was seen in mean of CSF PCT in neonates with confirmed (0.31 ng/mL), proba...
Objective: To determine the prevalence and predictors of hypocalcaemia in under-five children (1–... more Objective: To determine the prevalence and predictors of hypocalcaemia in under-five children (1–59 months) hospitalised with severe acute malnutrition (SAM). Design: A cross-sectional study was designed to determine the prevalence of hypocalcaemia among children hospitalised with SAM. Serum Ca and 25-hydroxycholecalciferol (25-(OH)D) were estimated. Hypocalcaemia was defined as serum Ca (albumin-adjusted) <2·12 mmol/l. To identify the clinical predictors of hypocalcaemia, a logistic regression model was constructed taking hypocalcaemia as a dependent variable, and sociodemographic and clinical variables as independent variables. Setting: A tertiary care hospital in Delhi, between November 2017 and April 2019. Participants: One-hundred and fifty children (1–59 months) hospitalised with SAM were enrolled. Results: Hypocalcaemia was documented in thirty-nine (26 %) children hospitalised with SAM, the prevalence being comparable between children aged <6 months (11/41, 26·8 %) and...
Ventriculitis after meningitis is a serious complication in the neonatal age group. The role of i... more Ventriculitis after meningitis is a serious complication in the neonatal age group. The role of intraventricular antibiotics in treatment is controversial. We present five such cases which were refractory to conventional intravenous antibiotic therapy, had persistent features of ventriculitis and in whom raised intracranial pressure (ICP) necessitated insertion of an external ventricular drain (EVD). Three of the five infants required intraventricular antibiotics but also developed EVD-related complications. Early diagnosis of ventriculitis and treatment is necessary to avoid a fatal outcome. Intravenous antibiotics are the treatment of choice, but intraventricular therapy may be considered in refractory cases. As the incidence of EVD-associated ventriculitis is high, proper care of EVDs and their early removal is mandatory.
Background: Early transfer of baby to mother in step down ward is an approach that can improve ma... more Background: Early transfer of baby to mother in step down ward is an approach that can improve maternal satisfaction among parents of neonates admitted in NICU. Objective: To assess the satisfaction of mothers of neonates admitted in the neonatal step down ward of a public sector hospital. Methods: This cross sectional study was conducted in neonatal step down ward of a public sector hospital in North India. One hundred mothers of neonates (< 34 weeks gestation and/or <1800 g birth weight) admitted to the step down ward were included in the study. Mothers of neonates born with major congenital malformations, mothers who were HIV or Hepatitis B positive or had any other chronic illness were excluded. The mothers were interviewed on the day of discharge using a semi-structured questionnaire. It comprised of 35 questions, categorized into 8 domains, namely interpersonal relationships with staff, personal requirements of mother, health services provided by hospital, caregiver proficiency, education and guidance, kangaroo mother care, food provision, and environment of the ward. Maternal satisfaction was marked on a three-point Likert scale. Results: Among the mothers interviewed, a vast majority expressed the utmost satisfaction with the interpersonal relationships with the staff (97.5%). Deficit in satisfaction was observed with the health services (79.57%), and education and guidance by the hospital (78.87%). Conclusion: Neonatal step down set up with early involvement of mother in care of neonates makes mother-baby duo ready for discharge and offers new possibilities for neonatal management in resource-poor countries. Multicentric studies with objectivized outcomes and larger sample size are required for implementing this setup.
Background: Neonatal shock is associated with high mortality and morbidity. Shock index (SI), a r... more Background: Neonatal shock is associated with high mortality and morbidity. Shock index (SI), a ratio of heart rate (HR) to systolic blood pressure (BP), has been evaluated as a simple tool for early predictor of mortality in adult as well as pediatric patients. Objective: The objective of this study was to compare SI and modified SI (MSI) among survivors and nonsurvivors of neonatal shock and healthy controls. Materials and Methods: HR and BP were measured in neonates presenting with clinical shock at 0, 2, and 6 h after admission and in healthy controls. SI and MSI were calculated and compared between three groups. Results: The mean (standard deviation) SI was significantly higher at 2 and 6 h of admission (2.57 [0.54] vs. 2.93 [0.78], P = 0.029; 2.42 [0.41] vs. 3.04 [0.91], P = 0.0005) among nonsurvivors of neonatal shock as compared to survivors. MSI was also significantly raised at both 2 and 6 h of admission in nonsurvivors (3.32 [0.64] vs. 3.78 [1.05], P = 0.03; 3.16 [0.63] vs. 4.10 [1.85], P = 0.005). Conclusions: SI and MSI are significantly higher in nonsurvivors of neonatal shock than survivors and healthy controls. These metrics can be used as bedside tools for early identification of at-risk neonates with shock.
Lack of a standard definition of neonatal sepsis and a swift diagnostic method has proven detrime... more Lack of a standard definition of neonatal sepsis and a swift diagnostic method has proven detrimental in the management of this serious condition. Biomarkers have emerged as a beacon that might help us detect neonatal sepsis more effectively. The use of point-of-care biomarkers can aid in early diagnosis and timely initiation of treatment. Procalcitonin, presepsin, interleukin-6, highly specific C-reactive protein, and neutrophil gelatinase-associated lipocalin have been proven to aid in early diagnosis and timely initiation of treatment, thereby reducing sepsis-induced morbidity and mortality. These biomarkers have been found to be useful in reducing the duration of hospital stay and monitoring the response to therapy. When used in combination with each other, or with clinical scores, they have been proven to be advantageous over the gold standard by eliminating the waiting time for blood culture results. The use of biomarkers as a point of care investigation holds a future over th...
Dengue is the most common and widespread arthropodborne arboviral infection in the world today. T... more Dengue is the most common and widespread arthropodborne arboviral infection in the world today. The geographical spread incidence and severity of the dengue fever (DF) and dengue hemorrhagic fever (DHF) are increasing in America South-East Asia Eastern Mediterranean and the Western Pacific. WHO currently estimates that there may be 2.5-3.0 billion people at risk of dengue globally and this pandemic involves around 100 countries. Cyclical epidemics of dengue are becoming more frequent over the past two decades. Recently rural areas of Wardha district (Central Maharashtra) had an outbreak of dengue viral illness. We present our experience with these cases. Four hundred and ninety nine patients aged 0 - 12 yr admitted to a tertiary care hospital of Mahatma Gandhi Institute of Medical Sciences Sevagram Wardha from August 2004 to August 2005 were investigated for dengue infection. (excerpt)
Background and Objectives Laboratory surveillance of causative microorganism is crucial to formul... more Background and Objectives Laboratory surveillance of causative microorganism is crucial to formulate rational empirical treatment and preventive strategies for potentially fatal acute pyogenic meningitis (APM). This study was aimed to identify the causative microorganism of APM in children admitted in a tertiary care hospital of east Delhi. Materials and Methods Cerebrospinal fluid (CSF) was collected from 300 suspected cases of APM and subjected to cytology, gram staining, biochemical analysis and culture. Every fifth CSF sample was also subjected to antigen detection by latex agglutination test (LAT) for Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis, Escherichia coli, group B Streptococcus and TaqMan probe-based real time polymerase chain reaction (RTPCR) for S. pneumoniae, H. influenzae and N. meningitidis. Simultaneously, blood culture was also done from all these 300 cases. Result From CSF, 19 microorganisms were isolated in which hospital-acquired mu...
Our aim was to study the incidence and outcome of antenatally detected renal malformations in rur... more Our aim was to study the incidence and outcome of antenatally detected renal malformations in rural Maharashtra. Among 7365 deliveries conducted during the study period, antenatal screening for renal malformations was done in 6682 (90.7 %) deliveries. Renal malformations were detected in 35 fetuses on antenatal screening. Postnatal investigations confirmed renal malformations in 27 babies (77.1%), giving an incidence of 0.4% among liveborn babies. Seven babies were operated and 2 were awaiting surgery (33.3%). Two patients expired and another two were lost to follow-up. The outcome was satisfactory in other patients. Antenatal screening was a useful tool in diagnosing renal malformations.
There is a lack of substantial data on the safety of Levetiracetam during pregnancy in the contex... more There is a lack of substantial data on the safety of Levetiracetam during pregnancy in the context of the potential teratogenic effect on the newborn. We report a probable case of levetiracetam birth defects in a newborn with multiple congenital anomalies.
Objective Positive CSF culture is the gold standard for the diagnosis of meningitis but it carrie... more Objective Positive CSF culture is the gold standard for the diagnosis of meningitis but it carries poor sensitivity. CSF procalcitonin (PCT) is shown to have some utility for the diagnosis of meningitis though there are limited studies in neonatal age group. We planned this study to compare CSF, serum, and CSF to serum PCT levels in neonates with confirmed, probable, and nonmeningitis groups to determine its optimal cut-off in CSF and serum for diagnosing meningitis Study Design Sixty-seven neonates who qualified for lumbar puncture were enrolled in the study. Neonates were categorized into confirmed meningitis, i.e., CSF cytochemistry and culture positive (N = 17), probable meningitis, i.e., CSF cytochemistry positive but culture negative (N = 25) and nonmeningitis, i.e., both cytochemistry and culture negative (N = 25). CSF and serum samples were stored at −80°C for PCT assay. Results Significant difference was seen in mean of CSF PCT in neonates with confirmed (0.31 ng/mL), proba...
Objective: To determine the prevalence and predictors of hypocalcaemia in under-five children (1–... more Objective: To determine the prevalence and predictors of hypocalcaemia in under-five children (1–59 months) hospitalised with severe acute malnutrition (SAM). Design: A cross-sectional study was designed to determine the prevalence of hypocalcaemia among children hospitalised with SAM. Serum Ca and 25-hydroxycholecalciferol (25-(OH)D) were estimated. Hypocalcaemia was defined as serum Ca (albumin-adjusted) <2·12 mmol/l. To identify the clinical predictors of hypocalcaemia, a logistic regression model was constructed taking hypocalcaemia as a dependent variable, and sociodemographic and clinical variables as independent variables. Setting: A tertiary care hospital in Delhi, between November 2017 and April 2019. Participants: One-hundred and fifty children (1–59 months) hospitalised with SAM were enrolled. Results: Hypocalcaemia was documented in thirty-nine (26 %) children hospitalised with SAM, the prevalence being comparable between children aged <6 months (11/41, 26·8 %) and...
Ventriculitis after meningitis is a serious complication in the neonatal age group. The role of i... more Ventriculitis after meningitis is a serious complication in the neonatal age group. The role of intraventricular antibiotics in treatment is controversial. We present five such cases which were refractory to conventional intravenous antibiotic therapy, had persistent features of ventriculitis and in whom raised intracranial pressure (ICP) necessitated insertion of an external ventricular drain (EVD). Three of the five infants required intraventricular antibiotics but also developed EVD-related complications. Early diagnosis of ventriculitis and treatment is necessary to avoid a fatal outcome. Intravenous antibiotics are the treatment of choice, but intraventricular therapy may be considered in refractory cases. As the incidence of EVD-associated ventriculitis is high, proper care of EVDs and their early removal is mandatory.
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