Endtidal carbonmonoxide and carboxyhemoglobin for prediction of significant hyperbilirubinemia in healthy Indian neonates >35 weeks of gestation

Background: Endtidalcarbonmonoxide (ETCOc) and Carboxyhemoglobin (COHB) levels correlate well to bilirubin production and an availability of non-invasive point of care (POC) device in predicting significant hyperbilirubinemia is of great advantage when compared to measurement of serum bilirubin. Objective of the study is to measure a value of ETCOc and COHB in the early neonatal period for the prediction of significant hyperbilirubinemia.Methods: This was the descriptive Cross Sectional Study. ETCOc and COHB were measured 12th hourly for 72 hours followed by TSB in whom the TCB was >14mg/dl. Neonates were classified as jaundiced whose TSB values were in phototherapy range as per AAP Recommendations. Receiver Operative Curves (ROC) were created by appropriate statistical software for ETCOc and COHb to predict significant hyperbilirubinemia. The Sensitivity, Specificity, Positive predictive value, Negative predictive value and likelihood ratios of each was determined and the correlation between ETCOc and COHb levels, ETCOc and TCB, COHB and TCB at different hours of age was evaluated.Results: Among the total 320 infants, 156 of them developed significant hyperbilirubinemia. The ETCOc and COHB level at 60 hours of age was the most predictive of significant hyperbilirubinemia by ROC analysis. ETCOc cut-off of 1.65 ppm at 60 hours of age has a sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio of 84.6%, 80.5%, 80.5% and 84.6%, 4.33 and 0.19. COHB cut-off of 1.32 ppm at 60 hours of age has a sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio of 84.6%, 81%, 80% and 84.2%, 4.34 and 0.19.ETCOc had a maximum correlation with COHB at 48 hours of age.Conclusions: An increased level of Endtidalcarbonmonoxide and Carboxyhemoglobin in the early neonatal period is useful as a screening test for prediction of significant hyperbilirubinemia.

Need of the hour? does breast milk bank reduces perinatal morbidity and mortality: a retrospective observational study

Background: Human milk bank plays an essential role by providing human milk to infants who would otherwise not be able to receive human milk. The aims and Objectives is to study the morbidity and mortality outcome' profile of babies fed with PDHM (pasteurized donor human milk) comparing data between Pre Human Milk Breast bank (2015) and Post Human Milk Breast bank (2016, 2017 and 2018).Methods: Milk bank collect, screen, store, process, and distribute human milk. Retrospective observational study was done in Department of Neonatology, Institute of Obstetrics and Gynaecology and Women and Children Hospital, Chennai. Data obtained retrospectively comparing data Pre HMB (2015) and Post HMB (2016, 2017 and 2018).Results: In this study authors collected the data comparing Pre human milk bank (Pre HMB) and Post human milk bank (Post HMB).' After starting human milk bank, around 1799 babies were benefitted and 14.45 lakh ml milk was collected from 16000 donor mothers in last 3 years. Bacterial contamination rate of PDHM has reduced to 4.39% (2018) compared to 7.73% (2016) with P Value 0.0042 (statistically significant). CONS and Staphylococcus aureus were the most common Organisms isolated. There was reduction in morbidity profile like sepsis rate, NEC/ Feed intolerance and ROP profile. Mortality profile also reduced to (7.73-9.31%). Duration of hospital and Duration to attain full feeds were improved all GA group babies.Conclusions: In this study, after starting human milk bank there was reduction in mortality, morbidity outcome, sepsis. Duration to attain full feeds' and duration of hospital stay reduced. We concluded that establishment of breast milk bank will be more useful and beneficial for all GA group babies for better outcome.

Study of clincial profile and outcome of Klebsiella sepsis in neonates at a tertiary care centre

Background: Objective of the study is to study clinical profile and outcome of Klebsiella sepsis in neonates.Methods: A retrospective observational study from January 2018 to Sep 2018. After getting approval of institute ethics committee, admitted neonates whose blood culture showed Klebsiella growth were enrolled. A detailed history, birth weight, sex , age, APGAR, need for resuscitation at birth, distress at birth, ventilator support, CPAP, central line, blood products, species of Klebsiella and drug sensitivity and outcome-discharge or death were taken. Data were entered into Microsoft excel data sheet and was analyzed using SPSS 23 version software.Results: Out of the total 252 positive blood culture, 110 (43%) grew Klebsiella in blood culture. 92 cases were included in the study. Male to female ratio was 1.24:1. Mean age at admission was 1.22 days. 40 (43.5%) died and 52(56.5%) were discharged. Birth weight was 1.635'802 gm for babies who died and 2211'939 gm among discharged. Mean gestational age were 32.5 weeks in died and 34.8 weeks among discharged. Mortality was 23(57.5%) in males, low birth weight babies 23(59%), thrombocytopenia 28 (78%), invasive mode of ventilation 19(67%). By Univariate analysis, it was found that pregnancy induced hypertension (PIH), premature rupture of membrane (PROM), abnormal APGAR, Birth weight, shock, invasive ventilation, DIC, inotropes, blood products, abnormal total count, thrombocytopenia, umbilical venous catheterization were factors which influenced outcome. Regression analysis identified only thrombocytopenia and umbilical venous catheterization as factors that influenced outcome in Klebsiella sepsis. Klebsiella isolated was uniformly sensitive to Meropenam.Conclusions: No single risk factor was ascertained but thrombocytopenia and umbilical venous catheterization possibly influence the outcome of Klebsiella sepsis. Mortality is high in neonates.

Pharyngocutaneousfistula; its causes and management

Objective: to study the various causes and management of Pharyngocutaneous fistula in total laryngectomy

Material and Methods: 40 patients underwent total laryngectomy in service hospital Lahore from May 2003 to December 2014. The patients were prospectively studied regarding formation of Pharyngocutaneous fistula in the following aspects age, tumor site, and stage of disease, primary repair, infection and recurrence of tumor

Results: pharyngocutaneous fistula was diagnosed in 9 patients [22%] out of 40. Fistula developed in 2 patients [22%] on 3rd day due to rent in repair. 5 patients [55%] had fistulae due to infection on 8th day and 2 patients [23%] due to presence of residual tumor on 15th day. Pharyngocutaneous fistula is common complication which occurs after total laryngectomy. Three patients previously submitted to tracheostomy had fistula out of 5patients 6O %[ higher incidence] as compared to the 6 patients out of 35[17%] without tracheostomy. The reported incidence ofpharyngocutaneous fistula is extremely variable in literature ranging from 13% to 25% and in our series it is about 22 %

Conclusions: spontaneous closure is possible with proper wound care, good nutrition and antibiotics. 7 cases out of 9 in our series heeled with conservative treatment. Incidence of Pharyngocutaneous fistula formation is more in supraglottic, previously tracheostomised patients and also in advanced stage. In some patients surgical intervention is needed to close the fistula by flap. We used deltopectoral flapin two patients

Etiological determinants of congenital pelviureteric junction obstruction

Congenital ureteropelvic junction obstruction is an important and treatable cause of neonatal hydronephrosis. It may be due to congenital absence of nerves leading to adynamic segment causing functional obstruction. It may also be due to defective muscular arrangement and replacement of muscles by fibrosis leading to anatomical obstruction or it may be caused by extrinsic compression by aberrant lower polar vessel. The aim of the present study is to define the etiological determinants of congenital PUJ obstruction

Objectives: To study the macroscopic abnormalities of congenital PUJ obstruction and correlating theses abnormalities with the microscopic and immunohistological findings

Material and Methods: It was a cross sectional observational study and patients presenting to outpatients department, irrespective of age and sex, with the diagnosis of PUJ obstruction and needing surgery were included in the study. Anderson Hynes Pyeloplasty was done in all cases and resected portion of redundant pelvis and narrow segment was submitted for histopathological and immunohistological examination

Results: Congenital PUJ obstruction was more common in males with a male to female ratio of 2:1 and it was common on left side in 55.55% cases. Presentation was in wide age range patients [2-40 years]. In 33.33% patients it was structural abnormality where we were unable to pass feeding tube and in 66.66% patients it was functional abnormality where it was distensible PUJ. Predominantly circular muscle arrangement was seen in 15[57.69%] cases. Varying degree of replacement of muscle fibers with fibrous tissue was seen in all cases and total replacement in those where kidney was nonfunctional due to PUJ obstruction. Nerves were present in 5/26 [19.23%] cases. In 4/5 [80%] cases of crossing vessels, nerves were present

Conclusion: Most cases of congenital PUJ obstruction are due to functional obstruction but anatomical obstruction also has a significant contribution [33.33%].Predominant circular muscle arrangement is the abnormality leading to impaired peristalsis. Absence of nerves leading to functional obstruction is the major defect in congenital PUJ obstruction. Crossing vessel is the real cause of PUJ obstruction mechanically compressing the PUJ in vascular tangle cases