ABSTRACT
Objectives: The study was conducted to evaluate the effect ofbreastfeeding counseling and breastfeeding support by trainedcounselors during the ante-natal period at health facility and post-natal period at home on breastfeeding practices during the first sixmonths of life.Design: This was a randomized controlled study that comparedthe effect of counseling on breastfeeding during the first 6 monthsof life.Setting: study was done in a government medical college innorthern India, which is situated in an urban area.Participants: 300 healthy pregnant women from an urbanpopulation attending the antenatal clinic at Jawaharlal NehruMedical College, Aligarh Muslim University were recruited for thestudy.Intervention: Subjects were equally assigned randomly to theintervention (2 antenatal and 8 postpartum home counseling visitsby the counselors) and control (non-counseling) group.Main Outcome Measures: Infant feeding practices includingrates of initiation of the breastfeeding within one hour of birth;exclusive breastfeeding and bottle-feeding during the first 6months of life.Results: Initiation of breastfeeding within one hour of birth was73.4% in intervention group as compared to 33.6% in controlgroup (P=0.001). More mothers in the intervention group (88.1%)were able to sustain exclusive breastfeeding rates at 6 months ofage in comparison to the control group (50%) (OR 7.44, 95% CI3.98-13.92).Conclusions: This study substantiates positive role of skilledcounseling by a trained dedicated breastfeeding counselorduring the antenatal and post-natal periods on breastfeedingpractices during the first six months of life.
ABSTRACT
Background: Cyanotic Congenital heart defect (CHD) is the high risk group which requires prompt medical attention. Immediate management can drastically alter the natural history otherwise most of the children will succumb to their defect very early in infancy. It is thus important to have reliable information of the profile of various cyanotic CHDs as well as their mode of presentation for the early detection. Methods: The study was carried out in Department of Pediatrics and Center of Cardiology, Jawaharlal Nehru Medical College, Aligarh. All patients referred with complaints or clinical examination suggestive of congenital heart defects were further evaluated with echocardiography. On echocardiography patients having congenital heart defects were included as cases which were further divided into cyanotic and acyanotic heart defects, preterms having PDA and PFO and those with acquired heart defects were excluded. The profile and mode of presentation of various cyanotic CHDs was further described in detail. Results: Acyanotic heart defects were 290(72.50%) of the total heart defects, while the contribution of cyanotic heart defects was 110 (27.50%). Out of all CHDs, VSD was the most common lesion with contribution of 152 (38.00%) cases, while among the cyanotic heart defect, Tetralogy of Fallot (TOF) was the most common lesion (18% of total cases). Spectrum of various cyanotic lesions were TOF 65.45%, Single Ventricle 12.72%, TAPVC (Total Anomalous Pulmonary Venous Connection) 8.18%, TGA(Transposition of Great Arteries) 7.27%, Tricuspid Atresia 3.63%, Ebsteins malformation 1.81% and Truncus Arteriosus 0.90%. Conclusion: Profile of various cyanotic CHDs was similar to the previous studies, however spectrum of various CHDs was quite wide, a large number of cases were missed in infancy and presented late.
ABSTRACT
Background: Acyanotic CHD constitute majority of heart defect with significant morbidity, Profile of various defects is essential for identifying children who need urgent intervention and who need to be medically followed. Methods: The study was carried out in Department of Pediatrics and Center of Cardiology, Jawaharlal Nehru Medical College, Aligarh. All patients referred with complaints or clinical examination suggestive of congenital heart defects were further evaluated with echocardiography. On echocardiography patients having congenital heart defects were included as cases which were further divided into cyanotic and acyanotic heart defects, preterms having PDA and PFO and those with acquired heart defects were excluded. The profile and mode of presentation of various acyanotic CHDs was further described in detail. Results: Acyanotic heart defects were 290(72.50%) of the total heart defects, while the contribution of cyanotic heart defects was 110 (27.50%). Out of all CHDs, VSD was the most common lesion with contribution of 152 (38.00%) cases, followed by ASD (20.34%) , PDA (13.10%), PS (6.90%), Subaortic Membrane (2.00%), AV Canal valve defect (1.00%), RSOV (1.00%), Bicuspid Aortic Valve (1.00%), PAPVC (0.66%), Cortriatriatum (0.33%), Coarctation of Aorta(0.33%), ALCAPA(0.33%) and Aortic stenosis (0.33%). Age of presentation for most of the children was between 1 to 5 years. Conclusions: The profile and mode of presentation of various acyanotic heart defects was similar to other studies but diagnosis was delayed in majority of cases. The prevelance of various obstructive lesions like AS, coarctation and bicuspid aortic valve was much lower.
ABSTRACT
Introduction: Congenital heart defects are commonest birth defects and is an important cause of mortality and morbidity in newborns. The current study was done aiming at determining profile and clinical spectrum of various congenital heart diseases (CHD) in neonatal period. Methodology: An observational study was carried out in the NICU, Department of Pediatrics, Jawaharlal Nehru Medical College, Aligarh from Feb 2014 to Aug 2015 with the objective to determine profile of various congenital heart defects. All patients with clinical suspicion of congenital heart defect were further evaluated with echocardiography. Patients who were preterm having PDA and PFO were excluded from cases. Prevalence of various congenital heart defects was calculated. Clinical Spectrum of various congenital heart defects was observed. Observations: Total newborns screened 238 and 52 congenital hearts defect were detected. Acyanotic heart defect contributed 67% while cyanotic heart defect contributed 23%. VSD was the most common lesion while TOF (11.5%) was commonest among cyanotic heart defects. Most of the cyanotic heart defects were detected on screening as murmur on auscultation while PDA of bigger size presented as fast breathing. In cyanotic heart, defect classical TOF presented with only murmur while TOF with PA presented as cyanosis. Conclusion: VSD was the most common congenital heart defect detected while Tetralogy of Fallot was commonest among the cyanotic heart defects.
ABSTRACT
Objective: To compare the safety and efficacy of isotonic versus hypotonic maintenance fluid in children. Design: Randomized controlled trial. Setting: Tertiary-level teaching hospital. Participants: 60 children (age 0.5 to 12 years) who were admitted and anticipated to receive intravenous fluid for the next 48 hours. Intervention: Hypotonic fluid (Standard maintenance volume as 0.18% NaCl in 5% dextrose) or Isotonic fluid (60% Standard maintenance volume as 0.9% NaCl solution in 5% dextrose). Outcome measures: Primary: Incidence of hyponatremia. Secondary: Serum sodium, serum osmolality, blood sugar, blood urea, serum creatinine, serum potassium, serum chloride, pH, urine output, change in weight, morbidity and death. Results: At 24 hours, hyponatremia was noted in 7 (24%) patients in the isotonic and 16 (55%) in hypotonic group (P=0.031). At 48 hours, hyponatremia was noted in 4 (14%) and 13 (45%) patients in isotonic and hypotonic group, respectively (P=0.02). There was significant change in sodium levels in both isotonic (P=0.036) and hypotonic (P<0.001) intervention groups. The peak fall in mean serum sodium level was noted at 24 hours (-6.5, 95%CI: -3.5, -9.6 mEq/L; P<0.001) in hypotonic group. In isotonic group, there was significant increase between 24 and 48 hours (4.3, 95% CI: 0.1, 8.4 mEq/L; P=0.04). Conclusions: Reduced volume isotonic fluid results in fewer episodes of hyponatremia than hypotonic fluid in sick children during the first 48 hours of intravenous fluid therapy.