Neonatal hearing screening- time to make a noise- experience from a private medical college in South Rajasthan

Background: Neonatal Hearing Loss has a prevalence that is twice than that of disorders like congenital hypothyroidism, phenyl ketonuria etc. Early detection of hearing impairment is vital since early intervention in form of hearing aids and speech therapy would help lead a child a normal life. The aim of the study was to set up a neonatal hearing screening program and to study the various risk factors which could be associated with hearing loss.Methods: The prospective descriptive study was carried over a period of two years. All neonates before being discharged were subjected to OAE. OAE was done on Oto Read Machine (Intra acoustic) and BERA was done on BERA eclipse machine (Intra acoustic). Babies who failed the first OAE were called back for a repeat OAE at six weeks of age. Babies who failed the second OAE were referred to a trained audiologist for BERA which was performed on BERA Eclipse machine.Results: Out of 1114 neonates screened, 285 neonates failed the first OAE and were called back at six weeks for repeat OAE. Out of the 285 babies who were called for repeat OAE, 258 turned up 27(9.47%) were lost to follow up. Out of the 258 babies who turned up, 245 passed the test while 13 failed the test. 13 Babies who had failed the second OAE screening were called back 1 month later for BERA testing. Out of the 13 babies who turned up for BERA testing, 12 passed the test and 1 failed giving us a prevalence of 0.89 per 1000 population. Of the various risk factors studied only low birth weight was found to be having significant association with hearing loss.Conclusion: Neonatal hearing screening is the need of the hour. Larger multi centric studies are required to establish the prevalence of hearing impairment among newborns.

Spectrum of congenital malformations at birth among neonates in a private medical college in South Rajasthan

Background: Congenital anomalies contribute to about 12% neonatal deaths annually .Neonates with multiple congenital malformations pose a very difficult management problem for the treating physician. This study was done to know the incidence, pattern of congenital anomalies and to study various maternal risk factors leading to congenital anomalies which may help us in devising strategies for better patient counseling and management.Methods: Prospective cross sectional study carried out from 1st Jan 2014 to 31st December 2018 in a private medical college in India. Neonates (both live and still born) delivered in our hospital during this period formed the part of study group. All congenital anomalies present were documented and classified according to system involoved.Results: Total number of neonates with congenital anomalies were 90, out of which 73 were live births and 17 were still births. The overall incidence of congenital anomalies was 2.375%. The commonest system affected was musculoskeletal system (27.7%) followed by CNS (24.4%). Among the maternal risk factors studied, increased maternal age, consanguineous marriage, maternal gestational diabetes mellitus were all significant risk factors associated with congenital anomalies.Conclusion: Congenital anomalies are a global health problem. In our study we have documented that multiparity, consanguinity, diabetes mellitus, Pregnancy induced Hypertension (PIH), maternal anemia, maternal malnutrition to be major contributing factors for congenital anomalies. Present study highlighted that musculoskeletal and CNS systems to be the most commonly affected by congenital malformations. Antenatal scans remain an important diagnostic tool in screening for congenital anomalies. A good clinical examination at birth could help in early detection of life threatening congenital malformation thereby improving chances of his or her survival.

Kangaroo Mother Care (KMC) in LBW infants--a western Rajasthan experience.

OBJECTIVE: This study was taken to study the various beneficial effects of KMC in LBW babies. METHODS: 50 LBW babies (birth weight> 2 kg) two who delivered at Umaid Hospital, RIMCH Jodhpur included in this study and they have given KMC 4-6 hours/day in 3-4 settings. Maternal & Neonatal characteristics and complications prospectively recorded. RESULTS: Of 50 LBW babies enrolled, M:F ratio was 1.5:1 and mean birth weight was 1.487 +/- 0.175 kg. The mean age at which KMC started was 4+/-1.738 days. The mean weight gain was 29 +/- 3.52 g, mean age of discharge 23.6 +/- 3.52 days and mean duration of hospital stay was 15.5 +/- 11.3 days. CONCLUSION: KMC is effective and safe in stable preterm infants and as effective on traditional care with incubators. KMC because of its simplicity may have a place in home care of LBW babies.

Low birth weight and insulin resistance in mid and late childhood.

OBJECTIVE: Low birth weight is associated with adult insulin resistance and diabetes. We conducted this study to correlate low birth weight with insulin resistance in mid and late childhood. METHODS: Children whose birth weight records were available were successively enrolled from middle and low socioeconomic status urban schools in western India. 600 children in age groups 5-16 years were screened for availability of recorded birth weight in six schools. Detailed birth records were available for 158 children born full term. Parents of 134 (84.8%) agreed to participate in the study after informed consent. These children were evaluated for various anthropometric indices and fasting blood was obtained for determination of glucose and insulin levels. Insulin resistance was determined using homeostasis model assessment (HOMA) and HOMA-2 formula. Comparative, univariate and multivariate statistical analyses were performed. RESULTS: The mean age of the children was 10.0 +/- 2.4 years. Maternal diabetes was present in 3 (2.2%). Mean weight at birth was 2.84 +/- 0.61 kg and low birth weight (<2.5 kg) was in 49 children (36.6%). There was no significant statistical difference in current height, weight, body mass index, waist, hip, waist hip ratio, mid upper arm circumference, and systolic and diastolic blood pressure in children born with low or normal birth weight (P >0.10). In low birth weight as compared to normal birthweight children mean fasting blood glucose (80.1 +/- 16.1 vs. 70.1 +/- 14.8 mg/dL; P = 0.042), median (interquartile range) fasting insulin levels (10. 18, 6.08-18.54 vs. 2.12, 0.02-7.45 microU/mL; Mann Whitney U test, p<0.0001), and HOMA-derived insulin resistance (1.88, 1.06-4.52, vs. 0.35, 0.02-1.52, P < 0.0001) were significantly greater. There was a significant negative correlation of birth weight with fasting insulin levels after multifactorial adjustments (partial correlation coefficient r = -0.436, P <0.001). Multivariate conditional logistic regression analysis revealed that birthweight was significant determinant of fasting insulin levels after adjusting for age, gender, body mass index, waist and waist hip ratio (odds ratio 3.82, 95% confidence intervals 1.16-12.63, P = 0.028). CONCLUSIONS: Children born with low birth weight have significantly greater fasting glucose, fasting insulin levels and insulin resistance at mid and late childhood.

Keratomalacia in a neonate secondary to maternal vitamin A deficiency.

A 40-day-old male child was admitted with complaints of not opening eyes from 2-3 days after birth. A diagnosis of X3-B keratomalacia was made. The treatment was done with vitamin-A to which the patient had responded. The mother of the baby had a history of night blindness throughout the pregnancy for which she was also treated. Keratomalacia secondary to vitamin-A deficiency is rare in neonates, although in children it is reported form developing countries.