Clinical profile and risk factors in late hemorrhagic disease of newborn: our experience

Background: hemorrhagic disease of the newborn [HDN] is not an uncommon entity in developing countries particularly in under privileged rural areas like southern pun jab, where the prophylactic administration of vitamin-K at birth is not routinely practiced. The commonest mode of presentation of late HDN is intracranial hemorrhage

Objective: the present study was conducted to assess the clinical profile and risk factors of patients with Late [HDN]

Patients and Methods: all infants above the age of 7 days were admitted in pediatric unit with vitamin K deficiency bleeding. An infant fulfilling the criteria of late HDN was included in the study Infants with clinical and laboratory evidence of liver disease were excluded from the study. In these selected infants a detailed history, physical examination and investigations were carried out with special emphasis on risk factors for vitamin K deficiency and clinical features secondary to bleeding. Vitamin K 5 mg intravenous was given to all the patients and investigations were repeated after 24 hours

Results: thirty two infants fulfilled the criteria of late HDN; 24 [75%] were males and 8 [25%] females. Majority of the babies [75%] were in the age group 4 to 12 weeks. Prophylactic Vitamin K was not given to any of the infants at birth or later. All were on exclusive breastfeeding, two had history of prolonged diarrhea and two had received antibiotics for one week. Majority of the infants 24 [75%] presented with neurological features i.e. convulsions 62%, altered sensorium 56%. Purpura and bleeding from other orifices were less frequent i.e. <10%. Six [18.75%] infants died

Conclusion: intracranial hemorrhage is the commonest mode of presentation of late HDN and carries significant morbidity and mortality. Hence, vitamin K prophylaxis at birth is a deadly desirable intervention to avoid this potentially preventable life threatening condition

Modified kenneth jones criteria for diagnosing tuberculous meningitis in children

To evaluate accuracy of modified Kenneth Jones scoring criteria [MKJSC] as a screening tool to diagnose tuberculous meningitis in children. Cross-sectional study. Paediatric Medicine, Unit-1, Bahawal Victoria Hospital, Bahawalpur, from May 2006 to March 2007. A total of 100 children admitted through emergency in Paediatric Medicine, Unit-l, were included who were having fever and features suggestive of central nervous system [CNS] infection. Lumbar puncture was done in all patients after written consent. Findings of lumbar puncture were taken as gold standard for the diagnosis of IBM. MKJSC was applied on each patient and accuracy determined against the gold standard. Out of 100 children, 47 were diagnosed as IBM on the basis of CSF results. All children had scored 0-7 or above according to MKJSC. A score 1-2, 3-4, 5-6 and 7 or more was obtained in 23, 25, 30 and 22 children respectively. Children who had scored 5 or more received ATT. Accuracy of MKJSC was calculated to be 91%. MKJSC is a simple and accurate tool to improve tuberculous meningitis case detection rate in children

Clinical presentation of neonatal malaria

To study the prevalence, clinical presentation and laboratory findings in neonates suffering from malaria. Paediatrics Unit-I Bahawal Victoria Hospital, Bahawalpur from April 2006 to March 2008. Neonates with negative blood culture but positive slides for malarial parasites were included. The prevalence rate of neonatal malaria was 3.06%. 54% cases were due to plasmodium falciparum and 40% were due to plasmodium vivax while in 6% cases species could not be identified. The male to female ratio was 1.5:1. 46% cases presented within 7 days of birth. 80% cases were born by spontaneous vaginal delivery, 16% by spontaneous vaginal delivery with episiotomy while 4% by Cesarean section. Fever was present in 100%, hypothermia on examination in 4%, splenomegaly in 24%, hepatomegaly in 28%, jaundice in 30%, irritability in 52%, reluctant to feed in 8%, vomiting in 48%, cough in 8%, diarrhea in 50%, abdominal distension in 8%, seizures in 8%, apnoea in 4%, lethargy in 24%, respiratory distress in 28%, bloody stool in 4%, leucopenia in 6%, anemia in 40%, thrombocytopenia in 6% and hypoglycemia in 10% cases. There was no statistically significant difference in the clinical features or laboratory findings of malaria due to both the species. Neonatal malaria is, although, uncommon but resembles to that of neonatal sepsis and clinical presentation of malaria due to falciparum or vivax is same