Transmission of Anti-HCV from mother to infant and its natural course

Background: Anti HCV is transferred from positive mother to her newborn. To prevent this transfer of anti HCV, many health care providers stop the mother from breast feeding and recommend the checking of the newborn for anti HCV. If found positive, they take it as a chronic infection and recommend treatment of the child as soon as possible. Prohibition from breast feeding not only pushes these neonates towards nutritional deficiencies but also make them prone to infections. The testing also stigmatizes the mother and her newborn for life. The literature proves that this antibody transfer is passive and clears in majority of cases without any residual disease. Mother to infant transfer of anti-HCV and its natural course in Pakistani population is not known

Objectives: To determine the frequency of anti-HCV positivity and its natural course in infants born to anti-HCV reactive mothers

Subjects and Methods: Anti-HCV reactive mothers were registered from gynecology department and labor room of Nishtar Hospital Multan from 07-10-2010 to 07-04-2011, using non probability purposive sampling. The ALT of mothers was also checked. The babies born to these mothers were checked for anti- HCV by ELISA and ALT at 0 day [at the time of birth] and then at 6, 12, 18 and 24 months using venous blood samples. Data was entered and analyzed using SPSS-11

Results: Out of 35 anti-HCV reactive mothers; only one had ALT above the upper limit of normal [> 40 IU/L]. A total of 35 babies were born to these mothers, out of whom 34[97.1%] were reactive to anti-HCV at the time of birth and only one was non reactive. At 6 months 2 babies had expired and 3 were lost to follow up, leaving 30 babies. Out of these 30 babies 11 became non-reactive and 19 were still reactive for anti-HCV at 6months. At 12 months, all 19 anti-HCV reactive cases became non reactive, indicating passive transfer of antibodies from the mother to these neonates which they lost by 12 months. ALT of all babies except 3 was raised at 6 months [> 40 IU/L] which became normal during the subsequent visits

Conclusion: Almost all children born to anti-HCV positive mothers were reactive at the time of delivery but they all became non-reactive by the age of 12 months indicating passive transfer of anti HCV from the mother to the neonate

Risk factors and mortality among newborns with persistent pulmonary hypertension

Objective: To determine the risk factors for persistent pulmonary hypertension of newborns [PPHN] and their influence on mortality

Methods: This was an observational study conducted at The Children's Hospital and the Institute of Child Health, Multan, Pakistan, from July 2011 to June 2012. All admitted babies who had respiratory distress, cyanosis and evidence of hypoxia on ABG,s were diagnosed provided that they were having right- toleft or bidirectional hemodynamic shunting at the ductus arteriosus or at patent foramen ovale along with Tricuspid regurgitation [TR] jet > 40 mm of Hg on echocardiography. All the demographic, maternal, antenatal, natal and postnatal data were recorded on a predesigned Performa

Results: There were 79 patients, including 61 males and 18 females. The most common risk factors observed in our study were male sex [72.1%], cesarean section mode of delivery [54.2%], positive pressure ventilation while resuscitation [44.2%] birth asphyxia [40.4%] and meconium aspiration syndrome [MAS]35.4%. It was found that male sex [88.8%], cesarean-section delivery [77.7%], respiratory distress syndrome [RDS] 44.8% and sepsis [44.4%] were more associated with PPHN in premature infants than with term and post term infants. Out of the total 79 patients, death occurred among 7 preterm and 14 terms and post term infants. As a whole, cesarean section mode of delivery [71.4%], birth asphyxia [57.1%] and female sex [52.4%] were found major risk factors associated with mortality. However, respiratory distress syndrome [Relative Risk RR=5], birth asphyxia [RR=2.5] and male sex [RR=2]were found to be associated with increased risk of mortality in preterm than term and post term infants

Conclusion: Male gender, cesarean section mode of delivery, MAS and RDS are the major risk factors for PPHN in any age group. RDS, Birth asphyxia and male sex are associated with increased risk of mortality in pre term than term and post term infants

Pattern of neonatal admission at the children's hospital and the institute of child health, Multan

Neonatology is a rapidly growing paediatric sub-specialty all over the world. Neonatal disease pattern changes from time to time and place. Analyzing the neonatal admission pattern helps the policy makers to make the better strategies and health care givers to serve better. This was a descriptive study. The study data was collected of the patient admitted in neonatal unit of Children Hospital Complex and Institute of Child Health, Multan, Pakistan from 1[st] January 2010 to 31[st] December 2010. The data of all the admitted neonates was analysed according to their causes of admission in whole one year whether admitted through emergency department or OPD clinic. Total numbers of neonatal admissions were 3,560. Birth asphyxia was found to be major cause of admission, 1,230 patients [34.5%]. Among infections, sepsis was found in as a whole in 1,009 [28.3%] of admission, pneumonia in 170 [4.7%] and meningitis in 30 [0.8%]. Out of 3,560 patients admitted, 2,550 were discharged after improvement, 290 died, and 720 left against medical advice [LAMA]. Birth asphyxia, sepsis and prematurity are the main reasons for admission in neonatal age. By paying good attention to perinatal services, we can reduce morbidity and mortality in neonates.