Effect of prophylactic dose of vitamin K on occurrence of hemorrhagic disease in newborn

To determine the effect of prophylactic dose of Vitamin K on occurrence of hemorrhagic disease in newborn. Non randomized controlled study was conducted in Children Hospital Quetta during June to December 2009. Total 300 healthy full term neonates between 2[nd] to 7[th] days of life were included in the study. They are divided into 2 groups; group 1 consisted of 100 neonates who were given prophylactic dose of vit K in a dose of 1.0mg intramuscularly and group 2 consisted of 200 neonates who did not receive prophylactic dose of Vit K as their parents did not agree. They were followed up till 12 weeks of life, for development of bleeding from any site. There are 3 types of Hemorrhagic disease of newborn according to age of manifestation. In early onset bleeding occurred within 24 hours of life, in classical onset bleeding occurred from 2[nd] to 7[th] days of life and in late onset bleeding occurred during 2[nd] to 12[th] week of life. In group 1 only 2 neonates [2%], out of 100 presented with late onset of hemorrhagic disease of newborn, one [50%] with gastrointestinal tract bleeding and other [50%] with subcutaneous bleeding. In group 2, out of 200neonates 14[7%] developed bleeding, 9 [64.3%] presented with classical onset and 5 [35.7%] with late onset. Commonest clinical manifestation in group 2 was gastrointestinal tract bleeding [28.8%], 2nd common manifestation was haematuria [21.4%] and umbilical cord bleeding [21.4%], followed by prolonged bleeding after circumcision [14.2%] and subcutaneous [14.2%]. Male to female ratio was 1.3:1

Risk factors for neonatal sepsis

To determine the risk factors for Neonatal Sepsis. This study was conducted in Children Hospital Quetta from January 2008 till December 2009. A hospital based cross sectional study was conducted to determine the risk factors of neonatal sepsis. 255 Neonates were included in the study who were clinically diagnosed as cases of sepsis. 116 neonates were confirmed to be septic on the basis of positive blood culture. 107 neonates developed sepsis during first 7 days of life [early onset of neonatal sepsis] and 9 neonates developed sepsis during 8[th] to 28[th] day of life [late onset of neonatal sepsis]. 55.4% cases of early onset of neonatal sepsis presented with respiratory distress, 23.2% with gastrointestinal tract infection, 13.2% with complaints of inactivity, lethargy and reluctance to feed, 4.6% presented with skin infection, 1.8% with convulsions and 1.8% with septic shock. Most of the neonates 44.4%, in late onset presented with gastrointestinal tract problems, 22.2% neonates has nonspecific signs e.g. inactivity, lethargy and reluctance to feed. Just 11.1% came with skin manifestations [pustules, rashes, petechai and cord infection], 11.1% with convulsions and 11.1% as arthritis. One of the most common risk factor of early onset neonatal sepsis was low birth weight [<2.5 kg] in 47 cases [44%] out of these 47 cases, 40 [85%] were preterm and 7 [15%] were IUGR. Second most common risk factor was prolonged rupture of membranes > 18 hours in 28% cases, 11% neonates developed sepsis after meconium aspiration and 8.5% had some form of invasive procedure like exchange transfusion, abscess at I/V injection site and mechanical ventilation. Only 4.8% had history of maternal fever >101 f at the time or 48 hours before delivery. Only 3.7% neonates had no risk factors other than instrumental deliveries[forcep or vaccum extraction[, Low birth weight was also one of the most common risk factors in late onset neonatal sepsis [345] cases but associated with prolonged hospitalization >10 days and I/V fluid. All of them were premature. Inadequate cord care and poor maternal hygiene were also found to be important risk factors [22%]. Only 11 neonates had some history of contact with infectious mothers and family members [suffering from diarrhea and cough], and bottle feeding was the risk factor in 11% of neonates. Overall mortality was 19%. The findings of this study demonstrate that low birth weight, PROM, meconium aspiration syndrome, maternal fever, instrumental deliveries, prolonged hospitalization, invasive procedures, inadequate cord care, poor maternal hygiene, contact with infectious mothers, and bottle feeding are the risk factors of neonatal sepsis