ABSTRACT
Objective: To compare the Conventional and Combined Apgar scoring systems in predicting adverse early neurologic outcomes in term and near term babies with birth asphyxia. Methods: A retrospective cross sectional study was conducted over a period of 2 years. All the neonates with gestational age more than 35 weeks delivered in this hospital with birth asphyxia requiring admission in NICU were included in the study. Neonates with gestational age less than 35 weeks, those with major congenital anomalies and death in delivery room were excluded from the study. The APGAR and COMBINED APGAR scores were noted. Convulsion, use of anticonvulsant drugs, requirement of mechanical ventilation, and duration of hospital stay were also noted. The data was analysed using fisher exact test. Results: Statistically significant associations were observed between Apgar score less than 3 at 1 minute and occurrence of convulsion (p=0.003) and requirement of ventilation (p<0.001), Apgar score less that 6 at 5 minutes” occurrence of convulsion (p=0.001) and requirement of ventilation (p<0.001), Combined Apgar score less that 7 at 1 minute and occurrence of convulsion (p=0.003) and requirement of ventilation (p=0.002), Combined Apgar score less that 10 at 5 minutes and occurrence of convulsion (p<0.001) and requirement of ventilation (p<0.001), and early neonatal death (within 7 days)” and Combined Apgar score less than 7 at 1 minute (p=0.09) and Combined Apgar score less than 10 at 5 minutes (p=0.09). Conclusion: Though a low combined apgar score was superior to the traditional apgar score in predicting early neonatal mortality, no difference was seen in prognostication of convulsion and mechanical ventilation.
ABSTRACT
Background: Children with Congenital Heart Disease have associated structural neurological abnormalities and those surviving infancy are even subjected to various environmental factors which might contribute to neurological abnormalities. Hence the objective is to study the neurological abnormalities of children with Congenital Heart Disease.Methods: A retrospective cross-sectional observation study was conducted over the period of 3 years (June 2016-May 2019). Data were collected from medical records department of 121 children of 2-12 years of age diagnosed with congenital heart disease. Neurological examination findings and neuro imaging and EEG findings where relevant were noted. To assess the association of adverse neurological outcome and congenital heart disease, data analysis was performed using Fisher's exact test.Results: 38% children of 2-12 years of age with congenital heart disease had adverse neurological profile. Neurological abnormalities were significantly associated with cyanotic heart disease (p value 0.0001). Statistically significant association were found between congenital cyanotic heart disease and seizure (p value=0.04), hemi paresis (p value=0.039), brain abscess (p value=0.012) and coma (p=0.01).Conclusions: Congenital cyanotic heart disease has significant associations with neurological abnormalities in children. These results demand attention for the neurological health of the largely uncorrected cardiac disease in Indian children
ABSTRACT
Background: The aim was to study the effect of ultra-short course of injectable steroid followed by oral steroid therapy for cumulative 14 days on clinical and hematologic parameters of secondary hemophagocytic lymphohistiocytosis in children.Method: A retrospective longitudinal study was conducted by collecting data from case records. Cases diagnosed with secondary hemophagocytic lymphohistiocytosis had been included. The cases with malignancy were excluded. Remaining cases had been given injectable methyprednisolone (30 mg/kg/day) for three days followed by oral prednisolone (1 mg/kg/day) for 11 days. The time' to cessation of fever and organomegaly were noted. The changes in mean hematologic parameters, ferritin and triglycerides were noted at the time of suspicion of HLH or MAS, after therapy and on follow up.Results: About 96% of children were afebrile within five days of therapy. There was regression of hepatospleenomegaly in all 100% surviving children by day seven of therapy. Improvement in hemoglobin (mean value 8.1 mg/dl to 8.7 mg/dl) and platelet count (mean value 0.89 lakh to 1.47 lakh) was seen by day seven of therapy. Fall in serum ferritn (mean value 1419 ng/ml to 298 ng/ml) and serum triglycerides (mean value 307 mg/dl to 176 mg/dl) was seen at one-month follow-up. 96% survival was observed. None of the survivors had any recurrence at 6 months follow up.Conclusion: Ultra short course of injectable methyprednisolone for 3 days followed by oral prednisolone for 11 days was successful in 95% survival in our study. This cost-effective regimen, with use of less toxic drugs leading to a shorter hospital stay maybe helpful in resource limited settings.