Clinical profile of measles--a prospective study of 150 hospital based children.

The clinical profile of 150 hospital based cases (6 months-7 yrs) of measles presenting between May 1986 to May 1987 was analyzed. Nearly a quarter (28%) were less than 1 yr; 60% belonged to 1-3 yrs age group, 8.6% were 3-5 yrs old and 2.6% were in the 5-7 yrs age group. The male:female ratio was 1.2:1. Nearly half (53.3%) were well nourished, 36.6% had Grades I-II PEM and 9.9% had Grades III-IV PEM. About half (47%) showed no complications; 53% had some complications of which 15% had more than one system involvement. Respiratory complications were seen in 50%, nutritional deterioration in 17.3%, gastrointestinal and neurological in 14.6% each and cardiac in 1.3%. The respiratory complications included pneumonia (16%), bronchitis (12.6%), activation of TB (10.66%), otitis (7.3%) and miliary tuberculosis (4%). CNS complications were encephalitis in 8%, meningitis in 3.3%, convulsions -2.6% and limb paresis in 0.6%. Children below 1 yr had a greater incidence of complications and multisystem involvement. Children between 3-5 yrs had respiratory and GI system involvement and children greater than 5 yrs showed respiratory system involvement only. No complications were seen in the well nourished group while early grades of PEM had mild complications. Severe degree of malnutrition had higher incidence and severity of complications. The need for large coverage of measles vaccine in our country especially amongst the malnourished group is obvious.

Clinical profile of severe birth asphyxia.

In this retrospective analysis, 56 babies with Apgar score 3 and less were studied. In 33, successful bag-mask ventilation was carried out. Seventeen babies received endotracheal IPPV. In 9 out of them bag-mask ventilation was never tried whereas in 8 bag-mask ventilation had failed. In 6 babies physical stimulation and blast of oxygen on the face was adequate. Following this experience, in the subsequent years, endotracheal intubation was required mainly in extremely low birth weight babies or babies with Apgar score 0 at birth. During the study period, drugs were used in about 50% babies. In subsequent years this figure has come down to 10%, that too in special situations. This study helped us to evolve a policy in resuscitations severely asphyxiated babies. Bag-mask ventilation is the first choice. Failure to achieve progressively improving Apgar score by 1 minute, usually 4-5, is an indication for endotracheal intubation. Drugs are required in special situations only.