A comparative study of morbidity pattern among term and late preterm infants in a tertiary care hospital

Background: The incidence of preterm birth, defined as delivery before the end of the 37th week of pregnancy from the first day of the last menstrual period, is increasing. India accounts for the 40% of the global burden of low birth weight babies with 7.5million babies born with a birth weight of <2500g. The objective of the study is to compare the morbidity suffered by the late preterm infants with that of term infants.Methods: This was a retrospective study and the data for this study came from the medical records of maternal and neonatal case sheets and discharge summaries. The data was collected for the period between January 2014 and December 2014. All the late preterm infants born and admitted during early neonatal period were compared with term infants who were born and admitted during early neonatal period to the Aditya Hospital on the basis of maternal, infant and clinical characteristics.Results: A total 292 infants including LPTI and term infant records were obtained. LPTI group had significant problems compared to term infants. The predominant clinical problems at birth and during the early neonatal period are neonatal jaundice, transient tachypnea of newborn, feeding difficulty and probable sepsis.Conclusions: LPTI are at increased risk of morbidity compared to term infants and hence require special attention and care for possible complication during their early neonatal period.

A study on clinical correlation of EEG in neonates with perinatal asphyxia

Background: Perinatal asphyxia is the most common and important cause of preventable cerebral injury occurring in the neonatal period. The WHO has estimated that 4 million babies die during the neonatal period every year. According to WHO, perinatal asphyxia is defined as the failure to initiate and sustain breathing at birth. The objective is to study the electroencephalographic changes and correlation between severity of Perinatal asphyxia with EEG changes.Methods: It is prospective observational study, which includes 40 term neonates admitted in NICU with perinatal asphyxia in GMCH Aurangabad. EEG analysis focused on background activity and classified into four categories.Results: The EEG was normal in 45%, mild abnormal in 25%, intermediate in 15%, and severely abnormal in 15%.' Outcome at discharge was normal in 19(47.5%) and abnormal in 21(52.5%) including 1 death. Abnormal outcome was seen in 27% of newborns with normal EEG and 72% of abnormal EEG.Conclusions: Severity of perinatal asphyxia correlated well with abnormality of EEG. EEG changes and severity showed good correlation with immediate outcome of newborn in terms of duration of hospitalization and normal neurological examination.

Prediction of neonatal hyperbilirubinemia using umbilical cord blood bilirubin

Background: Neonatal hyperbilirubinemia is a common problem among newborns.' Neonatal hyperbilirubinemia has a potential complication of kernicterus which is still seen in many newborns. In present study authors used umbilical cord blood bilirubin to predict the development of significant hyperbilirubinemia in the early neonatal period. The objective of this study is to evaluate the correlation between concentration of bilirubin in the cord blood and occurrence of hyperbilirubinemia in term newborns.Methods: In this prospective study authors included 500 term healthy consecutively born babies whose umbilical cord blood was collected and were followed up for first 7 days for the appearance of jaundice. The clinical assessment of jaundice was done by Kramer rule. The data was analyzed by using SPSS 17 statistical software.Results: Study found that umbilical cord blood bilirubin was 90% sensitive and 87% specific with a PPV of 75% and NPV of 92% in predicting significant neonatal hyperbilirubinemia.Conclusions: The study conducted clearly points that the use of cord blood bilirubin for identifying newborns at risk of hyperbilirubinemia helps in early detection and treatment of jaundice. There by preventing the potential complication kernicterus. This method is economical and socially acceptable. Hence cord blood bilirubin should be done on all healthy term newborns.

A study of survival of very low birth weight neonates in a tertiary care hospital

Background: Preterm birth is one of the major clinical problems in Obstetrics and Neonatology as it is associated with perinatal mortality, serious neonatal morbidity and in some cases childhood disability. Very low birth weight (VLBW) neonates comprise between 4-8% of live-births but about one-third of deaths during the neonatal period occur in this group of newborns. Data on the probability of survival of infant in high risk pregnancies can be of great value in guiding management. The objective is to study the survival at discharge of VLBW neonates admitted in a tertiary care hospital.Methods: Retrospective observational study of all VLBW infants admitted in Aditya Hospital NICU over 3 years between 1-7-2011 to 30-6-2014. Descriptive and inferential statistical analysis has been carried out in the present study.Results: In the present study maternal PROM was seen in 32.9% of cases, Preeclampsia in 31.7% of cases which constituted the most important antenatal risk factor for VLBW followed by multiple gestations in 25.2%. Common morbidities in VLBW neonates are Neonatal jaundice, Probable sepsis, Apnea of prematurity and RDS. Survival improved with increasing gestational age and weight.Conclusions: Birth weight and gestational age specifically predicts survival of preterm VLBW babies, facilitating decision making for obstetricians, neonatologists and parents. In the present study total survival rate was 86.6% with a mortality of 13.4%.

A prospective open-label randomized comparative study in Alzheimer’s disease between two commonly used drugs in coastal Indian population.

Background: Currently, therapy for Alzheimer’s disease (AD) is only symptomatic. Only two classes of drugs are approved by the United States Food and Drug Administration. Our study aimed at comparing effi cacy and safety of memantine and donepezil in moderate to severe AD patients. Methods: Totally, 22 patients with moderate to severe AD were randomized into the 2 arms of the study. The study was divided into an initial 4 weeks for determination of onset of effi cacy and subsequent 28 weeks of the treatment phase. Onset of effi cacy and response was defi ned as >20% and >50% reduction in the mean total score of functional dementia scale (FDS) and clinical global impression scale (CGIS) from baseline to the study end, respectively. Results: Onset of effi cacy on FDS and CGIS was 16.7% (mean-time 61.25 days) and 80% (mean-time 36 days) with memantine and donepezil, respectively. Response was 89.3% and 40% with memantine and Donepezil, respectively. Total reduction in FDS and CGIS score of from baseline to the study end was 39.50, 40.00, and 25.60, 27.20 with memantine and donepezil, respectively. Tolerability was 86.33% and 20% with memantine and donepezil, respectively. Anorexia, muscle cramps, constipation, headache, and insomnia, were the common side-effects and self-limiting. Safety was 100% in both groups. Conclusions: Onset of effi cacy was faster with donepezil seen at 2 weeks. Response, improvement in CGIS, FDS, and tolerability were better seen with memantine at 40 weeks. Thus, in similar clinical settings, memantine can be preferred.