A study of gross congenital malformation at birth

Background: A congenital anomaly is a structural anomaly of any type that is present at birth. Congenital anomalies may be induced by genetic or environmental factors. Most congenital anomalies, however, show the familial patterns expected of multi-factorial inheritance. The aims and objective of this study were to study the incidence of visible congenital malformations at birth, to study risk factors, to find associated internal malformations.Methods: It is a retrospective cross-sectional study carried out in a tertiary care hospital affiliated to a medical college. The Inclusion criteria include all new-borns delivered in the hospital with visible congenital malformations examined within 48 hours of birth. Extramural babies were included if they had presented within 48 hours after birth. The Exclusion criteria include still births were excluded from the study.Results: Percentage of congenital malformation was 1.32%. Most common systems involved were musculoskeletal system (46.34%) followed by genitourinary system (21.34%) and gastrointestinal system (14.02%).Conclusions: All Babies with gross congenital malformation should be screened for internal malformation. The incidence of CNS malformation has reduced than observed in previous studies which suggest awareness about antenatal folic acid supplementation. Other than CNS anomalies, other system anomalies were not diagnosed antenatally despite antenatal ultrasound being done in maximum number of mothers, which suggest use of 3D or 4D scan antenatally.

Comparison of midupper arm circumference and weight-for-height z score for assessing acute malnutrition in children aged 6-60 months: an analytical study

Background: In clinical settings, wasting in childhood has primarily been assessed with the use of a weight-for-height z score (WHZ), and in community settings, it has been assessed via the mid upper arm circumference (MUAC) with a cutoff <115mm for severe wasting and 115-125mm for moderate wasting. Our recent experience indicates that many wasted children were not identified when these cutoffs for MUAC were used.Methods: Authors determined the cutoffs for MUAC to detect wasting in Indian children aged 6-60 mo. A secondary analysis was carried out on data from 1446 children aged 6-59 mo. The area under the receiver operating curve was used to indicate the most appropriate choice for cutoffs that related MUAC with WHZ. The MUAC measurement of each subject was taken using standard technique. Following the World Health Organization (WHO) age and sex-specific cut-off points, nutritional status of children was determined.Results: The mean'SD age for the entire group was 19.8'13.6 mo, MUAC was 132'13mm, and 45% of subjects were girls. Age-stratified analyses revealed that, for ages 6-24 mo, MUAC cutoffs were <120mm for a WHZ <-3 and <125mm for a WHZ <-2 with a sensitivity of 68.3% and 64.7%, respectively, and a specificity of 82.6% and 83.4%, respectively; for ages 25-60 mo, MUAC cutoffs were <135mm for a WHZ <-3 and <140mm for a WHZ <-2 with a sensitivity of 63.7% and 65.4%, respectively, and a specificity of 81.6% and 78.3%, respectively.Conclusions: The respective cutoffs for MUAC to better capture the vulnerability and risk of severe (WHZ <-3) and moderate (WHZ <-2) wasting would be <120 and <125mm for ages 6-24 mo, <135 and <140mm for ages 37-60 mo.

Predischarge risk factors for predicting significant hyperbilirubinemia in term of infants

Background: The objective of the study to compare the predictive ability of predischarge serum total bilirubin (STB) and clinical factors for significant hyperbilirubinemia (SHB) in newborn to observe the prediction of the hyperbilirubinemia.Methods: In the prospective study, enlist of healthy newborn infants with >35 weeks gestation, in a tertiary hospital in western India. The serum bilirubin between 36-48 hours of age and risk factors for SHB were identified before discharge. SHB was distinct as a bilirubin level that exceed or was within 1mg/dL (17'mol/L) of the hour-specific phototherapy conduct threshold recommended by American Academy of Pediatrics (AAP) guideline on the management of neonatal hyperbilirubinemia.Results: Of 505 infants, 380 infants were included in final analysis, among which 70 babies (22.5%) developed SHB. On univariate analysis STB, gestational age (GA) and percentage of weight loss were found to be predictive of SHB. On multiple logistic regressions, the prognostic ability of predischarge STB is higher than that of percentage of weight loss and GA. The predictive accurateness of predischarge (<48 hours) STB level was comparable to that of percentage of weight loss (AUC=0.88, 95% CI 0.84-0.93). However, the prediction model that combined multiple risk factors such as predischarge STB, GA and percentage of weight loss have the best accuracy for predicting SHB.Conclusions: Combination of specific clinical factors (gestational age and percentage of weight loss) with predischarge serum total bilirubin described best predicts development of considerable hyperbilirubinemia.

Study of Meconium Aspiration Syndrome in Neonates.

Meconium is the first faeces of a newborn. The incidence of meconium stained liquor is 10-25% of deliveries; out of which 10% develop meconium aspiration syndrome. It is regarded as a sign of foetal compromise. Aim: To study the babies born with meconium stained amniotic fluid (MSAF) developing Meconium aspiration syndrome (MAS) and factors associated with it. The study also aimed to find out the complications and outcome of MAS. Method: A total 90 babies born with MSAF and admitted to the NICU were studied. Detail maternal history was taken. All babies underwent routine septic screen and a chest x-ray. MAS was designated in a baby as per the defined criteria. Results: Out of the total 90 babies born with MSAF, 41 were female and 49 were male. Majority (95.6%) cases with MSAF occurred either in full term or post term babies. MAS was found in 68 of the total 90 babies, of which 48(70.5%) were vigorous and 20 (19.5%) were non vigorous. Abnormal X-ray was found in 39(43.3%) babies. 23.5% babies required ventilator care. Overall mortality rate was 15.5%. Conclusion: MSAF affects mostly full term and post term babies. History of antenatal foetal heart rate abnormalities and MSAF together are good predictors of non vigorous babies. The duration for which baby remains in contact with MSAF also affect the ultimate outcome. The management of babies born of MSAF should be a combined approach of obstetrician and paediatrician, right from proper monitoring of maternal risk factors to meticulous newborn resuscitation.

Clinical Profile of Children with Celiac Disease in Gujarat.

Introduction : Celiac Disease (CD), an autoimmune enteropathy, triggered by the ingestion of gluten in genetically susceptible individuals, is one of the commonest causes of malabsorption in the west. It is now well documented from north India where wheat is the staple diet. We report here 22 children of CD from Gujarat to bring the awareness amongst the pediatricians for its early diagnosis. The clinical presentation, serological tests & duodenal biopsy confirms the diagnosis. The results of Gluten Free Diet (GFD) are quite gratifying. Methodology : Retrospective analysis of presentation of children diagnosed to have CD was done from maintained database of CD patients of last 5 years. Results : Twenty two children were diagnosed to have CD at our centre in last 5 years. The age of presentation was from 14 months to 11 years. Short stature, pallor & chronic diarrhoea were the commonest features. Distention of abdomen, anorexia, pain in abdomen & oedema were other manifestations. Vomiting, voracious appetite, irritability & dermatitis were also noted in some cases. Rickets, rectal prolapse & clubbing were less common findings. Serological tests, besides routine investigations & duodenal biopsy confirmed the diagnosis. Gluten Free Diet (GFD) showed impressive results in 3 to 6 months time. Conclusion : CD is well documented in north India, but it also exists in Gujarat. With clinical presentation of stunted growth, chronic diarrhoea & unexplainable anaemia, one should think of CD. Some other less common & atypical features should also be kept in mind. The results of serological tests for CD are fairly reliable. Still, it is mandatory to confirm the diagnosis by duodenal biopsy. The results of GFD are quite rewarding. To emphasize for compliance of GFD & to provide the list of GFD to the parent & regular follow up are essential components of management.

A study on Developmental delay among children less than 2 year attending Well Baby Clinic - Prevalence and antecedents factors.

Background: Early detection of neurodevelopmental abnormalities is important because of possibility of instituting early intervention program for that child. Trivandrum developmental screening test (TDSC) has sensitivity of 66.7% and specificity of 78.8%. This makes it a reasonably good test to screen children. Aims & Objective: To study the prevalence of developmental delay among children less than 2 years attending well baby clinic using TDSC and antecedents factors of developmental delay. Material and Methods: This cross sectional study was conducted on 200 patients visiting well baby clinic starting from age of 1 month till 2 years. Study was conducted for a period of 3 months from February 2013 to May 2013. Details pertaining to exact age, term or preterm status, maternal and paternal h/o was taken. Developmental screening was done using TDSC chart. Bell, pen, keys were used for assessment along with chart. Results were analyzed using SPSS 16.0. Results: Total of 200 patients was screened.181 children were found to be normal with 85.6%- 94.2 % CI. In 19 children, delay was found with 5.8%-14.4 % CI. Preterm, IUGR, respiratory distress, sepsis, seizures in neonatal period showed significant p value for developmental delay. Microcephaly patients when screened for TDSC showed developmental delay with p value less than 0.05.All growth parameters (head, weight and length) when less than third centile showed significant association to developmental delay. The study also showed linear regression curve significant for awareness of developmental as maternal education improves. Conclusion: Developmental screening with TDSC showed developmental delay prevalence 9.5%. All children should be screened in well baby clinic for developmental delay. In India, sources have found prevalence of 1.5-2.5% of developmental delay in children less than 2 years of age. High incidence of our study can be due to study done at tertiary care centre. Preterm and IUGR were found to have developmental delay with significant p value. Various antecedents’ factors responsible for early brain injury showed significant p value. Hence every child attending well baby clinic should be screened for developmental delay with effective screening method such as TDSC.

Clinical spectrum, complications & treatment outcomes of malaria (in pediatric patients).

Malaria is one of the foremost public health problems in India. Objectives: To study the clinical spectrum, complications & treatment outcome in smear positive hospitalized children having malaria. Method: this prospective observational study enrolled 190 smear positive malaria patients admitted in pediatric wards of general hospital during 6 months. History taken & examination done. All patients were investigated & treated according to WHO guidelines & followed twice daily till their hospital stay. Results: 88% of patients were having P. vivax malaria. Males were 2.1 times more commonly affected. Age group most commonly affected was 5 to 10 years. Highest no of cases were reported in month of August. All patients were having history of fever. Thrombocytopenia was frequently associated (87%). Cerebral malaria was the commonest complication. Almost all patients with uncomplicated vivax malaria responded to Chloroquine. CFR was 1.05%.

Assessment of immunization status of 1000 children attending pediatric OPD of a teaching hospital in Ahmedabad.

Objective: Assessment of immunization status of children attending Pediatric OPD of a tertiary care hospital and the common causes for not giving the vaccines on time. Methods: A cross sectional study was performed with the help of a semi- structured questionnaire. Vaccination status was confirmed referring to the records of immunization available with the mothers. Site and age-specific details of the vaccines administered were also probed to ascertain the vaccine given whenever required. Results: Immunization coverage was 52.7% which was less than the national average of 61%. Coverage was highest for BCG and OPV zero vaccines (94.4%). Significant reductions in the coverage of the first and third doses of DPT, OPV and Hepatitis B vaccine were observed. There was absolutely no coverage of dT/ TT vaccine. Most common reasons for denial of vaccination were found to be negligence (35.8%) and ignorance (14.8%). The immunization coverage was higher in residents of rural areas (72.32%) and in children of literate mothers (76%). There was no significant reduction in eventual booster doses of DPT. Conclusions: Day by day, universal immunization is increasing but gaps are still visible even at tertiary care settings. Efforts are needed to strengthen the already existing policies. Aggressive sensitization and behaviour change drives targeting mothers can go a long way in achieving the same.