ABSTRACT
Objective To determine epilepsy and neurodevelopmental outcomes beyond 2 y of age and their putative prognostic factors in children with West syndrome (WS). Methods This cross-sectional study was initiated after approval from Institutional Ethics Committee. A follow-up cohort of 114 children (aged?2 y) diagnosed and treated for WS at the authors' center were assessed in-person for epilepsy and neurodevelopmental outcomes using Vineland Social Maturity Scale - Malin’s adaptation for Indian children. Subsequently, age at onset, lead-time-to-treatment, etiology, and response to any of the standard therapies were analyzed as possible predictors of these outcomes. Results Of 114 children (mean age: 55±32 mo, 91 boys), structural etiology was the predominant underlying etiology (79.8%) for WS. At 2 y of age, 64% had ongoing seizures. At the last follow-up, 76% had social quotient<55, and 39% had cerebral palsy (spastic quadriparesis in 21%). An underlying structural etiology was associated with ongoing seizures [OR (95% CI) 3.5 (1.4–9); p=0.008] at 2 y of age and poor developmental outcomes [OR (95% CI): 3.3 (1.3–8.9); p=0.016]. Complete cessation of spasms with the standard therapy was signifcantly associated with better seizure control [OR (95% CI): 5.4 (2.3–13); p<0.001] and neurodevelopmental outcome [OR (95% CI): 5.2 (1.8–14.9); p<0.001]. Conclusion The majority of children with WS have a poor neurodevelopmental outcome and epilepsy control on follow-up. The underlying etiology and response to initial standard therapy for epileptic spasms have a prognostic role in predicting the neurological outcome in these patients on follow-up.
ABSTRACT
Background: Kangaroo Mother Care (KMC) was developed for caring of low birth weight (LBW) babies in developing countries. Study was done with the objective to evaluate the factors affecting initiation of breast feeding and effect of Kangaroo Mother Care (KMC) on morbidity problems and developmental outcome in Low Birth Weight (LBW) and Very Low Birth Weight (VLBW) babies.Methods: Prospective follow-up cohort study was carried out at Neonatal Intensive Care Unit (NICU) at Narayana medical college hospital Nellore from January 2018 to December 2019 and details of neonates were recorded on prestuctured proforma. Kangaroo mother care was given to one group. ASQ 3 questionnaire was used to assess the developmental outcome of the infants.Results: In this study, 100 babies were divided into two groups, case group consists of 50 babies where KMC is given and another control group consists 50 babies where KMC is not given. Mean gestational age for case and control group babies were 34.5 and 33.7 weeks respectively. Mean Birth weight in cases (1700 gr) and control (1580) grams respectively. Number of Male babies were more in cases (51%) and Group B (53%). Main factors affecting the initiation of breastfeeding in babies are LSCS (62% and 48%), RDS (50% and 40%), Apnea (24% and 25%) and seizures (20% and 14%) respectively in case and controls. Rates of exclusive breastfeeding is significantly increased in cases (90%) when compared to control (72%). Morbidity in cases is comparatively lesser than controls. At 6 months of corrected gestational age, mean weight in cases (5.2 kg) is significantly more than mean weight in control (4.7 kg). Significant development is noticed in communication (p=0.036), gross motor (0.04), and fine motor (0.05) compare to controls. Percentage of babies who acquired better personal social skills are more in cases (80%).Conclusions: The main factors affecting the initiation of breastfeeding in LBW and VLBW babies are LSCS, RDS, not secreted milk and seizures. KMC helps to achieve smooth and early transition to direct breastfeeding, increases the exclusively breastfeeding rate, better growth and developmental outcome and reduces the morbidities in LBW neonates.