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Background: Accidental poisoning is an important cause of morbidity and mortality in children. Poisoning is one of the medical emergencies encountered in the emergency department. Accidental poisoning is common in toddlers and pre-school children. Aim of this study was to determine the agents of poisoning and demographic distribution of children brought to Rajarajeswari Medical College and Hospital with a history of accidental poisoning.Methods: The study method was descripitive study done in pediatric department at Rajarajeswari Medical College and Hospital for 18 months, from 1 December 2017 to 31 May 2019. 25 cases were of accidental poisoning. Data was analysed by statistical analysis.Results: The prevalence of accidental poisoning was 0.1%. There was male preponderance, 16 cases were male (64%) and 9 were female (36%), hydrocarbon (40%) was the most common household agent causing poisoning, followed by pyrethroid (24%), followed by NSAID’S (8%). Most common symptom was vomiting. The mean time elapsed to reach hospital was 97.80 minutes. In majority of the cases, hospital stay was for 2 days in (13 cases (52%)).Conclusions: Children become victims of accidental poisoning. Most common agents of poisoning are household products and medications.
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Background: Preeclampsia is a pregnancy-specific syndrome of reduced organ perfusion secondary to vasospasm and endothelial activation which is typically characterized by hypertension, proteinuria, edema and fetal compromise which is a leading cause of intra uterine growth restriction (IUGR). Elevated nucleated red blood cell (NRBC) count is introduced as a potential marker of intra-uterine growth restriction (IUGR) hence determination of NRBC counts is essentially helpful in predicting short term neurodevelopment outcome. Objective of the study Elevated nucleated red blood cell (NRBC) count is introduced as a potential marker of intra-uterine growth restriction (IUGR) in term babies born to preeclamptic mothersMethods: A cross sectional study conducted in a tertiary care hospital to evaluate the significance of cord blood NRBC count in term neonates born with pregnancy complicated by preeclampsia. It included 60 healthy mothers (control group) and 60 mothers with PIH. Collected data was analysed with SPSS software.Results: The nucleated red blood cell in cord blood of newborns in preeclampsia group was significantly higher than in the control group (p value 0.013). IUGR is significantly higher in PIH group (p value 0.008).Conclusions: From the observed data it is concluded that IUGR is an important cause of perinatal morbidity and mortality. The commonest maternal cause for IUGR was pregnancy induced hypertension. The other contributing factors were anemia, lack of awareness (unregistered, unbooked cases) among mothers, poor maternal nutrition and poor weight gain during pregnancy. Infants of preeclamptic women have higher nucleated red blood cell count at birth than control which means that preeclampsia may produce an erythropoietic response in the fetus. The positive correlation between cord nucleated red blood cell counts in preeclamptic patients and control group indicates that may be the hypoperfused placenta plays a role in this correlation.
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Background: Gestational age is a critical factor in the management, decision making and follow up of new born infants. Identification of gestational age especially within 48 hours of life is crucial for new born. Since decades attempts have been made to find an alternative measurement for gestational age and birth weight estimation of the newborns. Last menstrual period is an inexpensive method and potentially efficient for calculating gestational age. Objective of this study was to the present study aims to compare the gestational age by New Ballards score with LMP, in pre term babies.Methods: A total 150 pre term babies who are born to mothers remembering LMP were enrolled for the study group. During the study period new Ballard scoring was done for babies within 48hrs and Gestational age was compared with LMP. The collected data was analyzed by using SAS-6.50 version. Study design a prospective observational study was conducted over a period of one year from January 2018 till December 2018 at Rajarajeswari Medical College and Hospital, Bengaluru, IndiaResults: The New Ballard score is found to be significantly correlated with GA above 29 weeks (p<0.01). The LMP mean was 35±2.0 weeks. Total 60.6 % of the childbirth is lead to normal vaginal delivery. The analysis shows LMP were found to be strongly correlated with GA (p<0.01).Conclusions: LMP alone can be reliably used in assessing the gestational age and can be assessed more accurately and be confirmed with new Ballard’s scoring for preterm babies of >29 weeks.
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Background: Acute respiratory infections (ARIs) are the leading cause of death among children less than 5 years in India. Poverty and malnutrition underlie both the high incidence and deaths of young children from pneumonia in SEAR countries.Methods: A hospital based prospective observational study was conducted in a tertiary care hospital. A total of 200 children admitted with signs of ALRI were included in the study. A portable oximeter was used to measure oxygen saturation with an appropriately sized sensor on the finger or the toe. Weight was recorded on a standardized digital weighing scale and plotted on standard WHO weight for age chart. Chi-square test was used to test the significance.Results: Out of 200 children studied hypoxemia was present in 90 children with a percentage of 45% and absent in 110 children with a percentage of 55%. Out of 90 children who had hypoxemia, 40 children had weight less than 3rd centile. Out 110 children who had did not have hypoxemia, only 24 children had weight less than 3rd centile. It was observed that children with Weight for age less than 3rd centile according to standard WHO charts had higher incidence of hypoxemia. This correlation was statistically significant at p value of 0.001.Conclusions: Based on the results of this study hypoxemia is widely prevalent in children aged between six months to five years presenting with acute lower respiratory tract infection. There was significant correlation with weight and hypoxemia in children aged between six months to five years with acute lower respiratory tract infection.
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Background and Objective: Placental pathology has been implicated in the pathogenesis of preterm neonatal morbidity.However, the role of placental infection in the occurrence of neurological, lung, and infection morbidity among prematurely borninfant remains controversial. Furthermore, there is disagreement regarding the association between sepsis in preterm neonateand in utero exposure to placental infection.Objective: The present study was undertaken to investigate the association of placental pathology with the preterm and termdelivery.Materials and Methods: Design: This was a hospital-based observation study. The study included 100 placentas including60 preterm placenta and 40 term placenta from singleton live birth delivered at Rajarajeshwari Medical College and Hospitalfrom November 2018 to November 2019.Results: As placental weight is one of the key indicators of fetal intrauterine status, among term placenta 26% weighedbetween 501 and 750 g and 14% weighed between 251 and 500 g. In the late preterm placenta, 6% were within 501–750 gand 38%were within 251–500 g. Among the early preterm placentas, 2% were found to be within 100–250 g and 14% werefound to be within 251–500 g. Histopathological findings among term placenta in which 23% of the placentas were found to bewith normal morphology, having two arteries and one vein embedded in myxoid matrix and unremarkable, maternal surfacesshow mature vascularized villi and fetal parenchyma also shows mature villi and 5% showed features of chorioamnionitis,8% of the placentas revealed occasional focal areas of calcification on the maternal as well fetal surfaces, 15% showedinfarction, and 3% showed hemorrhagic changes. Histopathology findings among preterm placenta in which 14% normalmorphology, 21% of chorioamnionitis, 10% shows focal and extensive areas of infarction with increased syncytial knots, 4%had hemorrhagic and perivasculitis changes with focal hyalinized villi, and 5% had villitis with mixed inflammatory infiltratein the chorionic villi. Histopathology study among term and preterm comparison, it shows chorioamnionitis with Chi-square19.604 with confidence interval of 35.66–77.04% with P < 0.0001, calcification with P = 0.466, placental infarction withconfidence interval of 41.51–92.47% with P = 0.0002, placental hemorrhage with confidence interval of −31.33%–52.31%with P = 0.613, and villitis with confidence interval of 38.55–100% with P = 0.002. Relative risk with respect to histopathologyamong term and preterm placenta relative risk is 2.3 which means that preterm group has 2.3 times more risk of abnormalplacental histopathology than term group.Conclusion: Among histopathological study between term and preterm placenta, preterm placentas were most commonlyassociated with abnormal histopathological findings, among abnormal histopathological finding chorioamnionitis is the mostcommon.
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Background: Breastfeeding is common in developing countries, but exclusive breastfeeding is rare, and complementary foods are introduced to babies at an early age. Despite the proven risks associated with not exclusively breastfeeding, few mothers exclusively breastfeed their babies for six months as recommended by the World Health Organization. The objective of this study was to determine the effect of breast-feeding promotion interventions on baby weight at three months of age.Methods: A randomized experimental study was conducted for a period of 6 months from February 2019 till July 2019 in a tertiary care hospital. Weight- for-age (WA) indices have been determined for 95 infants from three to four months of age, participating in this study. They included 49 that started received promotion interventions support after delivery (till 2 weeks) and 46 that received routine care (control group). Collected data were analysed using SPSS software ver.11.5.Results: Weight-for-age indices were significantly lower for the early group than the control group (p=0.012). They suggest that the breast-feeding promotion interventions are very important educational tools to ensure healthy weight gain in infants.Conclusions: There is evidence that breastfeeding for at least 6 months, compared with feeding formula, prevents the possibility of atopic dermatitis, cow’s milk allergy and early childhood wheezing. Poorer nutritional status was significantly associated with earlier complementary feeding. The results suggest that exclusive breastfeeding along with promotion of weaning education should be promoted in India.
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Background: Hypothermia, infections and ineffective breastfeeding are some of the commonest cause of deaths among premature and low birth weight infants. Kangaroo mother care is a well-known intervention to address the issues related to preterm births, such as hypothermia, infection and prolonged hospitalisation.Methods: This study was carried out in a tertiary care centre in Bengaluru on all preterm neonates of birth weight less than 2500 grams with stable hemodynamic conditions over a period of 18 months. Gestational age assessed by the new Ballard's score, within 24 hours of life and anthropometry details of the neonate were recorded at 24 hours of life by the single observer. Kangaroo mother care was given for a minimum of one hour at a stretch per day and the effect on the preterm neonate in terms of hospital stay was assessed.Results: Kangaroo mother care has positive effects on the infants growth, neurodevelopmental outcome, reduction in the morbidities associated with preterm infants, and breastfeeding practices in mothers of preterm neonates.Conclusions: The study promotes awareness of KMC on preterm neonates considering all the benefits and positive effects of KMC on the infant as well as baby, and to the family and nation amongst the health care personnel as well as the society.
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Background: Poisoning is one of the commonest cause of emergency hospital admission in children. The accidental poisoning is seen more commonly in toddlers and intentional poisoning is seen in adolescents. Rapid globalization and increased stress has increased the risk of suicidal poisoning. The accidental poisoning can be reduced by proper education to parents and by keeping poisonous substances out of reach of the child.Methods: The study was carried out over 18 months. Sociodemographic profile of pediatric cases was studied in department of pediatrics at Rajarajeswari medical college and hospital. Descriptive study analysis was done.Results: During 18 month study period, 34 cases were analysed. The incidence was found to be 1.64%. Male:female ratio was found to be 1:1.6. Majority belonged to upper lower class and majority were from urban class.Conclusions: The importance childhood poisoning with its association with socio-demographic factors were studied and intervention were done.
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Background: This study was conducted to analyse the immediate outcome of late preterm babies and also to evaluate the various maternal risk factors in these babies so that close monitoring of these babies for the complications is done and immediate problems can be addressed.Methods: Prospective observational study done in level 3 NICU setting for 6 months. All babies born between 34-36/7 weeks are included in the study and they constitute the cases. Term (above 36 weeks 6 days gestation) newborns babies born during the study period are controls. Maternal history is taken in detail. Risk factors during pregnancy including maternal age, gravida, mode of delivery, medical conditions and birth details. Baby details like gestational age, sex, birth weight, and neonatal morbidities are recorded. The babies are either shifted to NICU or to mother's side based depending on the baby's condition. All of them are followed up till discharge.Results: 89 late preterm babies born in the hospital during the study period are included in the study. Out of 89 babies 45are females constituting 50.6% and 44are male babies constituting 49.4%. 20 (22.5%) babies had gestational age between 34-35 weeks.29 babies (32.5 %) had gestational age between 35-36 weeks and 40 babies (45%) are between 36-37 weeks of gestation. 47 babies (52.9%) have birth weight between 1.5-2.49 kg.42 babies (47.1%) have birth weight between 2.5-3.5 kg. The number of babies born by LSCS were 48 (54%) and 41 babies 46% are born through vaginal route.42 babies constituting 48.3% are appropriate for gestational age and 43 babies (49.4%) are small for gestationalage.34 (39.1%) babies required NICU admission and 55 (60.9%) babies did not require NICU admission. Among the maternal risk factors PIH was the commonest risk factor in 22babies (24.7 %), followed by PROM13 (14.6 %), oligohydramnios 6 (6.7 %) ,twin gestation 6 (6.7 %), MSAF 3 (3.4%), IDM 3 (3.4%), Antepartum hemorrhage 3 (3.4%), eclampsia 1 (1.1%) and maternal cardiac disease 1.1%. Neonatal morbidities are 25 late preterm babies had jaundice (28.7%) followed by RDS in 15 (17.2%), sepsis in 9 (10.3%), NEC 2 (2.3%), Hypoglycemia 5 (5.6%) late preterm babies required ventilation/ CPAP constituting 5.7%. Surfactant was used in 2 late preterm babies 2.3%. 87 babies (97.8%) got discharged and mortality is 2.2%.Conclusions: Late prematurity is associated with significant neonatal morbidity.
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Background: The optimal timing of cord clamping has been a controversial issue for decades. Most practitioners in developing countries clamp and cut the cord immediately after birth and this takes place during the third stage of labour. World Health Organization advises late cord clamping, however there is a debate on the optimal time for cord clamping. Delayed umbilical cord clamping appears to be beneficial for term and preterm infants.Methods: This observational study was undertaken at Rajarajeswari Medical College and Hospital, Bangalore, Karnataka, India from June 2018 to January 2019.Results: Total 100 neonates were studied of which 48 were females (48%) and 52 were males (52%). 76 babies (76%) were 3 day old in this study and 24 babies were (24%) 4 day old during the study period. 92 babies (92%) didn't receive phototherapy in this study and 8 babies (8%) required phototherapy during the study period. No babies were polycythemic during this study period. Mean TB was 11.832 whereas mean DB was 0.5. Mean HCT was 56.332 and mean HB was 18.3002.Conclusions: Present study concluded that there are various advantages if authors practiced delayed cord clamping including higher levels of haemoglobin and haematocrit levels.
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Background: The aim of this study was to determine the clinical profile of neonates admitted with dehydration fever and ascertain the maternal and neonatal factors affecting it.Methods: A observational descriptive study was conducted at Rajarajeswari Medical College and hospital, population included neonates who were admitted in NICU with dehydration fever.Results: The study were conducted among 50 neonates admitted with dehydration fever. Majority of neonates (72%) were diagnosed with dehydration fever on day 3 of life. 84 % neonates were born to primiparous mothers. In the study there was significant difference in mean birth weight, weight at admission and percentage of weight loss between birth weight and weight at admission with respect to symptoms on presentation. Mean % of weight loss was 12.06 when dehydration fever was presented with fever, 11.29 when dehydration fever presented with decreased urine output, 18.44 when presented with both fever and decreased urine output and 12.73 when presented with jaundice these values were statistically significant.Conclusions: Dehydration fever occurs most commonly on day 3 or after, effective measures should be initiated for early diagnosis and prevention of complications like effective breast-feeding counselling, proper techniques, good latching and supplementation of artificial feeds if required and monitoring of daily weight and daily urine output.
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Background: The aim of this study was to find out immediate fetal outcome in meconium-stained amniotic fluid in relation to perinatal asphyxia.Methods: This retrospective study includes medical records of all neonates admitted to Neonatal Intensive Care Unit (NICU) between December 2016 and July 2018. The variables reviewed are age, sex, weight, mode of delivery, gestational age, presence of meconium aspiration syndrome (MAS) and perinatal asphyxia.Results: Out of 408 total admissions in NICU, 69.1% were male babies and remaining 30.9% were female babies. In the study out of 36 subjects with Perinatal Asphyxia, 38.9% had MAS and 61.1% had not MAS. Out of 372 subjects without perinatal asphyxia, 93.8% had no MAS and 6.2% had MAS. There was significant association between MAS and perinatal asphyxia. Odds ratio was 9.656. i.e. those with MAS had 9.656 times higher risk for perinatal asphyxia.Conclusions: The management of MAS, which is a perinatal problem, requires a well concerted and coordinated action by the obstetrician and pediatrician. Prompt and efficient delivery room management can minimize the sequelae of aspirated meconium and decrease the chance of perinatal asphyxia in the new born babies.
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Background: Millions are infected with dengue every year.' Early diagnosis of dengue infection is important for proper treatment of DHF and DSS to avoid fatal outcome. Thrombocytopenia is a common hematological abnormality in dengue, which demands platelet transfusion in most of the severe dengue cases. Platelet transfusion though life-saving has its own hazards. Hence, we can use some new parameter like immature platelet fraction (IPF) which is a measure of reticulated platelets that reflects the rate of thrombopoiesis. The risk of platelet transfusion may be decreased by rapid identification of immature platelet fraction. This study was performed to establish reference of IPF values for the assessment of thrombopoiesis.Methods: Blood samples from 150 children were obtained on day of illness 3, 5 and 7. The IPF is identified by sysmex XE2100 hematology analyser in the reticulocyte channel using a fluorescent dye and a carefully designed gating system and counted by a special software termed IPF master7. IPF values against platelet count were assessed separately on day 3, 5 and 7.Results: The reference intervals of IPF > 8 % and IPF < 8 % were assessed against platelet count. Increase in IPF favored increase in platelet count on day 5 which was statistically significant with the p value <0.001.Conclusions: A rapid and inexpensive automated measurement of IPF can be integrated as a standard parameter to evaluate the thrombopoietic state of the bone marrow. From the study it can be concluded that IPF is an important predictor of increase in platelet count.' Increase in IPF>8 % suggests that platelet count will be increased in next 24 to 48hrs indicating that further blood transfusion will not be required.
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Background: Dengue fever is a mosquito borne viral infection which has become a global health hazard, especially in tropical and subtropical areas. Children have higher risk of developing severe forms of dengue fever, however, studies show that paediatric complications/fatalities from dengue fever are potentially avoidable by proper management. Data about drug usage patterns for dengue are particularly lacking, especially in the paediatric age group, therefore this study will help facilitate the rational use of drugs and aid in establishing a more specific management for dengue fever. The objective of the present study was to identify the prescribing pattern of dengue fever in paediatric inpatients admitted to RajaRajeswari Medical College and Hospital and assess according to the WHO core prescribing indicatorsMethods: This prospective observational study took place from March 2017 to September 2017 in the paediatric general wards. Data was collected from case files of NS1 positive patients of both genders between 1-18years. Data was analysed using descriptive statistics and expressed as percentages, means and standard deviations. The prescription pattern was analysed using the prescribing indicators mentioned in the World Health Organization core drug use indicators.Results: Total of 300 drugs were prescribed for 110 prescriptions that were analysed excluding IV fluids and blood products. Mean number of drugs prescribed was 2.7±0.8. Drugs prescribed by a generic name was 7.33%. Patients prescribed an antibiotic was 12.73%. Patients prescribed with an injection was 62.72% Majority of drugs prescribed in this study come from essential medicines list created by regulatory bodies. Intravenous fluids were administered to all patients with majority receiving normal saline (60.9%).Conclusions: Mainstay of treatment of dengue fever for paediatric patients is symptomatic along with focus on fluid management. Majority of drugs prescribed are from essential medicines lists formed by regulatory bodies. With dengue infections being a worldwide health hazard, more studies are needed to facilitate rational use of drugs in this disease.