Mortality in meconium aspiration syndrome in hospitalized babies

To determine the outcome of the babies in terms of mortality with the diagnosis of Meconium Aspiration Syndrome [MAS]. An observational study. The Neonatal Unit of Services Institute of Medical Sciences and Services Hospital, Lahore, Pakistan, from February 2008 to January 2009. All the babies admitted to the neonatal unit during the period of study with the diagnosis of MAS were included. At admission, demographic, maternal, antenatal and natal data were recorded on a specific form. The progress of the baby, including need for ventilation, medications, complications and outcome were also followed and documented. One hundred and nine babies admitted with MAS, 32% died. Most of the babies [n=73] were admitted from our obstetrical unit and the rest through the emergency department. Majority [60 of 109] were admitted within the 1st hour of life. Most [14 of 15] of the newborns requiring intubation within 1st hour of life, died. Forty four babies were ventilated and 35 of these babies succumbed. Of ventilated babies, 11 developed pneumothoraces. Seventy two percent [13 out of 18] of expired babies stayed for less than 24 hours. Mortality rate for MAS was higher in the study group as compared to international figures. It was especially high in babies requiring mechanical ventilation in 1st hour of life or with co-existing severe hypoxic ischemic encephalopathy

Risk factors for hypoxic ischemic encephalopathy in children

To determine underlying risk factors in neonates with hypoxic ischemic encephalopathy. Case-control study. Neonatology Unit at the Children's Hospital and the Institute of Childhealth, Lahore, from March to July 2005. All neonates [153] with the diagnosis of Hypoxic Ischemic Encephalopathy [HIE] were included in the study. Controls [187] were selected from admissions on the same day. Possible risk factors such as maternal age, parity, antenatal monitoring, place of delivery, prolonged second stage of labour, type of delivery, type of attendant at delivery and the gestational age were noted and compared. Sixty one [39.9%] mothers of asphyxiated babies reported no antenatal visits compared to 24.1% in the control group [OR 2.1, 95% Cl 1.3-3.2; p=0.002]. Only 6.5% of cases were born in government hospitals [teaching and district] in comparison to 20.9% of controls [OR 3.8, 95% Cl 1.9-7.6; p=0.001]. In 28.1% of cases, mothers had history of prolonged 2nd stage of labour in comparison to 5.9% of controls [OR 6.3, 95% Cl 3.3-11.9; p<0.001]. Fifty five cases [35.9%] were delivered by unskilled birth attendants compared to 28 [14.9%] controls [OR 3.2, 95% Cl 1.9-5.3; p<0.001]. No significant difference was found in maternal age, maternal parity, gestational age and the mode of delivery between the two groups. Delivery by unskilled birth attendant, prolonged second stage of labour, birth in a non-government hospital setup and absence of antenatal care were significant risk factors for hypoxic ischemic encephalopathy in neonates. Improvement in antenatal and intrapartum care may be helpful in decreasing the frequency of this problem

Frequency, risk factors and outcome in admitted Neonates presenting with hypothermia

Neonatal hypothermia is a significant cause of morbidity and mortality, particularly in preterm and low birth weight babies especially in developing countries. This study was performed to describe the frequency, associated risk factors and outcome of neonatal hypothermia in admitted cases. This was an observational study carried out in prospective manner. Study population consisted of 500 neonates admitted to neonatal unit of the Children's Hospital, Lahore during the months of January and February 2006. Various variables were recorded in a predesigned proforma and outcome was analyzed. The overall frequency of hypothermia was 34.8%. It was significantly associated with low birth weight [p<0.05], prematurity [p<0.0.5], shifting from outside Lahore [p<0.05], and history of birth asphyxia [p<0.05]. Mortality in hypothermic neonates was significantly higher than the non hypothermic ones [p<0.05]. The risk of mortality was recognized to be higher in hypothermic than the non hypothermic admitted neonates