Icterometer: a useful screening tool for neonatal jaundice.

One hundred and sixty one jaundiced newborns were investigated for the usefulness of perspex icterometer as a screening tool for neonatal jaundice. Along with serum bilirubin estimation, icterometer score was simultaneously obtained in all the cases. The correlation between serum bilirubin and icterometer score was high (r = 0.99). The icterometer was useful in various subgroups. A high sensitivity, specificity, positive and negative predictive value was seen in all the groups. A possible role of icterometer in India for screening newborns with jaundice at peripheral level is highlighted.

Breath holding spells: an analysis of 50 cases.

Of 50 preschool children having breath holding spells (M:F::3:1) (BHS), 80.0% were less than 18 months of age (mean age 16 +/- 5 mo). More children came from a lower social class (70.0%) and a nuclear family (64.0%). Seventy four per cent cases had onset of BHS within 12 months of age (mean 9.6 mo) and the commonest frequency was 1 to 3 spells per week (56.0%). Cyanosis and tonic-clonic spasms were seen in 96.0 and 84.0% cases, respectively. Anger and frustration were the common triggering factors in 90.0% cases. No ante-, peri- and postnatal factors were significantly associated with the study group as compared to the control cases. The mean scores on Behaviour Screening Questionnaire measuring child's habits related to feeding, toilet and sleep were not significantly different in the study and control groups but the difference was significant (p less than 0.05) for behaviour measuring child's social habits. Parental attitudes, measured on Attitude Screening Questionnaires, were also not significantly different in the study and control groups. Mean hemoglobin and percentage transferrin saturation were significantly lower in the study group as compared to the controls (p less than 0.001). There was a significant decrease in severity and frequency of spells with oral iron therapy.

Plain radiograph skull: is it really needed in epilepsy?

One hundred and three children with seizure disorder were studied. Plain radiograph skull was normal in all the cases. CT scan skull done in 34 patients, showed abnormalities in 24 cases. More than 80% children in partial seizures group had treatable lesions on CT scans, mainly CNS tuberculoma. The need for omitting plain radiograph skull as a routine investigation for epilepsy cases is emphasized.

Alopecia with rickets: an end organ unresponsiveness to 1,25-dihydroxyvitamin D--a case report.

Two siblings of a rare syndrome of vitamin D dependent type II rickets are reported for the first time from India. The clinical and biochemical picture was characterised by florid rickets, alopecia, hypocalcemia and resistance to therapy with high dosages of vitamin D3. Due to lack of facilities for estimation of 1,25(OH)2D, alopecia remains the only clue to the diagnosis of this rare syndrome in association with resistant rickets.

Premature infant feeding: role of diluted formula.

The role of half strength, double volume milk feeds for initiating feeding in preterm newborn infants was evaluated. Thirty eight premature infants were included in the study and divided into Groups A and B having 20 and 18 babies, respectively. Group A babies were fed half strength (10 cal/oz) formula feeds but the volume was doubled, while Group B babies were fed full strength formula feeds (20 cal/oz) with standard volume. A pre-set schedule was evolved for feed increments in the two groups. The amount of feeds was increased daily till a volume of 150 ml/kg/day was reached. The end point of the study was achieved when the caloric intake became 100 cal/kg/day. It was observed that Group A babies attained enteral energy intake of 100 cals/kg/day much earlier and experienced lesser complications, viz., persistent gastric aspirate and abdominal distension. They required intravenous supplementation for a shorter duration thus reducing the associated complications.

Spinal muscular atrophy: some easy clues to diagnosis.

Seven cases of benign form of spinal muscular atrophy were studied to evaluate the importance of detecting hand tremors, muscle fasciculation, evertion of foot and ECG tremors to distinguish these cases from muscular dystrophy. Taken in combination, diagnosis of all the seven cases was possible without the need for application of more sophisticated and invasive investigations, e.g., EMG, nerve conduction study, CPK levels and muscle biopsy.

Epidemiological evaluation of BCG vaccine efficacy in Delhi--1989.

A field evaluation of efficacy of BCG vaccine to prevent tubercular meningitis was undertaken in a case control study in Delhi during 1988-89. Each case of tubercular meningitis was matched by age and neighbourhood with 2 controls from the community. Thirty-seven cases of tubercular meningitis were matched with 74 controls and thus 37 triplets were analysed. ODDS RATIO between BCG vaccinated and non vaccinated individuals for acquisition of tubercular meningitis was 11.3. This gives 84 per cent efficacy of BCG vaccine in the prevention of TB meningitis under the field conditions prevailing in Delhi. Paired matched analysis of tubercular meningitis with the control group 1 and 2 separately revealed the ODDS RATIO to be 9.5 and 15 respectively. The corresponding BCG vaccine efficacy worked out were 90 and 93 per cent respectively. Authors suggest that this method of evaluating BCG vaccine efficacy is fairly reliable and cost effective. This methodology could be further simplified by using hospital patients as control and be introduced to evaluate BCG vaccine efficacy in different areas with reference to its role in preventing tubercular meningitis under the programme of immunisation.

Immune status following measles vaccination in infants and evaluation for the need of revaccination.

In this prospective study, immune status of children vaccinated in infancy was determined at age 12-18 months. In 200 children, preimmunization protective measles hemagglutination (HI) antibody titres (greater than or equal to 1:8) were present in 38.5% of children of 6-8 months, the frequency decreased to 17.6 and 14.3% in age groups 9-11 and 12-18 months, respectively followed by an increasing incidence of 52.5% in those more than 18 months of age. Paired measles HI titre was estimated in 56 children, the post vaccination sample was taken at age 12-18 months, 3-9 months after measles vaccination. Most of the children (98.0%), with no detectable antibody titre, had a protective titre. Again a significant number (p less than 0.001) of children aged 12-18 months had protective HI titres compared to non-vaccinated. These findings suggest that when vaccinated at 9-11 months in our country, there is no need for revaccination later.

Immunoglobulins profile of measles.

Immunoglobulins profile was carried out in 60 cases of measles (30 each with and without complications) and 30 age and sex matched controls. Antibody titres and immunoglobulins levels (IgG, IgM and IgA) were determined by hemagglutination inhibition and single radial immunodiffusion techniques, respectively. Though higher IgG and IgM levels were found in complicated cases compared to controls, more importantly lower IgA levels were seen in these cases. As most of the measles complications are secondary bacterial infections of mucosal surfaces, it is postulated that these patients might have been selected for a relatively severe form of the disease due to either a pre-existing or induced IgA deficiency.

Outcome of low birth weight babies with special reference to some maternal factors.

Neonatal outcome of 178 low birth weight (LBW) babies in this study was associated with 26.4% neonatal mortality. A significantly higher mortality rate was noted in presence of adverse maternal factors, birth weight less than 1.5 kg, prematurity and respiratory distress at birth. Premature rupture of membranes and leaking (greater than 12 h) were recorded in 75 cases. Significant association was observed for septicemia. Maternal postpartum weight less than 40 kg was associated with higher incidence of neonatal infections than when mother's weight was greater than 45 kg.