ABSTRACT
Objectives: To study (i) the incidence and course of jaundice, and (ii) the predictors of ‘significant jaundice’ in late preterm infants. Design: Prospective analytical study. Setting: Urban perinatal center. Patients: Inborn late preterm infants (post menstrual age of 34 0/ 7 to 36 6/7 weeks). Methods: Infants were followed till day 14 of life or till onset of significant jaundice. Relevant maternal, perinatal and neonatal variables were prospectively recorded. Transcutaneous bilirubin (TcB) was measured in each infant twice daily for the first 48 hours of life. Outcomes: Significant jaundice defined as requirement of phototherapy/exchange transfusion as per hour specific total serum bilirubin (TSB) nomogram of AAP guidelines. Results: 216 infants were enrolled, of which 123 (57%) had significant jaundice. 36% of the jaundiced infants had TSB greater than 15 mg/dL. The mean duration of onset of significant jaundice was 61 ± 32 hours. The mean duration of phototherapy was 49 ± 26 hours. Large for gestation, lower gestational age, birth trauma and previous sibling with jaundice predicted severe jaundice. TcB measured at 24-48 hrs was a better predictor of ‘significant jaundice with onset after 48 hrs’ than clinical risk factors. Conclusion: There is a high incidence of significant jaundice in late preterm infants. TcB measured at 24-48 hrs of life better predicts ‘significant jaundice after 48 hours of life’, in comparison with clinical risk factors.
ABSTRACT
Background: Revised National Tuberculosis Control Programme (RNTCP) recognizes the need for involvement of all sectors, public and private, to create an epidemiological impact on Tuberculosis control .The private health sector in the country is an important source of care, even with the availability of public health services and Directly Observed Treatment Strategy (DOTS).The data regarding Private-Private mix in our country is lacking. Aim: To evaluate the contribution of {private health sector (Private Medical Colleges and Private practioners (PP)} in TB case-detection, diagnosis and treatment outcomes in Delhi NCR , Ghaziabad, India. Methodology: We analyzed the TB registers from May 2006-Dec 2010 from our institution and recruited the patients in our study, irrespective of the source. We strengthened the referral by promoting educational intra and inter departmental activities and awareness programme with more stress on retrieval action by contact tracing and counselling. We made a list of PP in our drainage area and regularly met them and tried to understand the barriers in referring cases to DOTS centre. During the study, we tried to maintain the flow of information working as a single window information system. We regularly passed on the information of follow up of patients to private practioners referred to us by them to generate confidence in them. During the study, no incentive was offered to any patient. Various indicators and data were collected annually and analyzed statistically. Statistics: Retrospective, Descriptive Analysis Results: There was a substantial increase of 116.3% in the total patients referred from all sources to Santosh Hospital. The proportion of extra-pulmonary cases was 29.1% to 34.4% of all total cases from the year 2006 to 2010. During subsequent years, we found a significant increase in referral from Private Practioners that was the result of our activities performed in private set up. It was 12.5%, 21.2%, 30.8%, 27.3%, and 29% during 2006, 2007, 2008, 2009 and 2010 respectively. The outcome in our study was in accordance with the outcome at national level under RNTCP. Conclusion: Because of extensive educational activities, single window information system and referring the patients back to private sector after completion of treatment increased the confidence amongst the private physicians. These results strengthen the Private - Private Collaboration and show that a stronger link can be developed between medical college and private setup, leading to implementation of successful Private-Private Strategy.
ABSTRACT
Objectives: To compare early neonatal morbidity (within first 7 days of life) in late preterm infants with term infants. Study design: Prospective cohort study. Subjects: All live inborn late preterm infants (34 0/7 to 36 6/7 weeks) and term infants (37 0/7 to 41 6/7 weeks). Outcome: Any of the predefined medical conditions listed in the study, resulting in post- delivery inpatient hospital observation, admission, or readmission in first 7 days of life. Results: 363 late preterm infants and 2707 term infants were included in study. Two hundred fifty seven (70.8 %) of late preterm and 788 (29.1%) of term infants had at least one of the predefined neonatal conditions. Late preterm infants were at significantly higher risk for overall morbidity due to any cause (P<0.001; adjusted Odds Ratio (OR): 5.5; 95% CI: 4.2-7.1), respiratory morbidity (P<0.001; adjusted OR: 7.5; 95% CI: 4.2-12.3), any ventilation (non invasive or invasive) (P=0.001; adjusted OR: 4.2; 95% CI: 2-8.9), jaundice (P<0.001; adjusted OR: 3.4; 95% CI: 2.7- 4.4), hypoglycemia (P<0.001; adjusted OR: 4.5; 95% CI: 2.6-7.7), and probable sepsis (P<0.001; adjusted OR: 3.2; 95% CI: 1.6-6.5). The incidence of morbidities increased from 23% at 40 weeks to 30%, 39.7%, 67.5%, 89% and 87.9% at 38, 37, 36, 35 and 34 weeks, respectively (P<0.001). Conclusion: Compared with term infants, late preterm infants are at high risk for respiratory morbidity, need of ventilation (non invasive or invasive), jaundice, hypoglycemia, sepsis, and probable sepsis. All gestations except 39 weeks were at significantly higher risk for morbidity with 40 weeks as reference term.