RESUMEN
Background: No specific treatment is available for severe early-onset IUGR. To best of my knowledge, very few studies have assessed the potential benefit of Sildenafil therapy targeted to improve perinatal outcomes in pregnancies complicated by severe early-onset IUGR in Indian pregnant women.Methods: The present hospital based prospective study was carried out on one hundred ANC pregnant women with early and late fetal growth restriction and oligohydrominos at Pannadhai Mahila Chikatsalya, Rabindra Nath Tagore (RNT) Medical College, Udaipur, during Jan to Dec 2017. Sildenafil citrate 25 mg three times in a day was administered until delivery. Study subjects were subjected to fetal Doppler and ultrasound twice a week after the Sildenafil administration.Results: After sildenafil therapy, out of total 45 cases of IUGR alone, 39 cases (86.66 %) had improvement. Out of 35 cases of oligohydramnios alone, 28 cases (80 %) had improvement. Out of 20 cases having both IUGR and Oligohydramnios 16 had improvement (80 %) and only 4 cases did not show any improvement. Among gestation age 27-30 weeks group at the time of admission, there were total 10 cases out of which 5 (50 %) had early premature delivery (32-34 weeks), 3 (30 %) had late premature delivery (34-37 weeks) and 2 cases (2 %) had term delivery i.e. between 37-39 weeks after giving sildenafil treatment.Conclusions: The findings of the present study indicate that sildenafil citrate may offer a potential therapeutic strategy to improve outcomes in pregnant women facing foetal growth restriction and oligohydrominos.
RESUMEN
Objective: To determine the role of oral vitamin D supplementation for resolution of severe pneumonia in under-five children. Design: Randomized, double blind, placebo-controlled trial. Setting: Inpatients from a tertiary care hospital. Participants: Two hundred children [mean (SD) age: 13.9 (11.7) months; boys: 120] between 2 months to 5 years with severe pneumonia. Pneumonia was diagnosed in the presence of fever, cough, tachypnea (as per WHO cut-offs) and crepitations. Children with pneumonia and chest indrawing or at least one of the danger sign (inability to feed, lethargy, cyanosis) were diagnosed as having severe pneumonia. The two groups were comparable for baseline characteristics including age, anthropometry, socio-demographic profile, and clinical and laboratory parameters. Intervention: Oral vitamin D (1000 IU for <1 year and 2000 IU for >1 year) (n=100) or placebo (lactose) (n=100) once a day for 5 days, from enrolment. Both the groups received antibiotics as per the Indian Academy of Pediatrics guidelines, and supportive care (oxygen, intravenous fluids and monitoring). Outcome variables: Primary: time to resolution of severe pneumonia. Secondary: duration of hospitalization and time to resolution of tachypnea, chest retractions and inability to feed. Results: Median duration (SE, 95% CI) of resolution of severe pneumonia was similar in the two groups [vitamin D: 72 (3.7, 64.7- 79.3) hours; placebo: 64 (4.5, 55.2-72.8) hours]. Duration of hospitalization and time to resolution of tachypnea, chest retractions, and inability to feed were also comparable between the two groups. Conclusion: Short-term supplementation with oral vitamin D (1000-2000 IU per day for 5 days) has no beneficial effect on resolution of severe pneumonia in under-five children. Further studies need to be conducted with higher dose of Vitamin D or longer duration of supplementation to corroborate these findings.