Bilirubin Pigments in the first Meconium of newborn infants

To determine the pattern of excretion of total bilirubin IXa and IXb in the first meconium of newborn infants. First two newborns of varying gestational age were selected every week through random sampling from the neonatal unit. Of the 41 newborn infants selected 8 expired before meconium passage, hence the results are from 33 newborns. Meconium was collected and stored at -20°C, protected by aluminium foil. Samples were defrosted, vortex mixed with equal amount of dimethyl-sulfoxide, centrifuged, and analyzed by HPLC. Unconjugated Bilirubin-IXa and -IXb were identified and quantitative estimation of Bilirubin-IXa done. Bilirubin-IXb was greater than 50% of the total, in the first meconium of the newborn. Amount of bilirubin excreted in meconium was 29.2 - 90.8 mg [0.051 - 0.155 mmol] per sample of meconium passed. Amount was 9.7 mg/ Kg of body weight in term newborn and 12 mg / kg in preterm.The amount of bilirubin -IXb decreases and bilirubin-IXa increases with increasing gestational age. Newborns with birth asphyxia [BA] had significantly greater quantity of bilirubin in meconium, compared to infants without BA [JPMA 55:188;2005].

Lack of services - causes of morbidity and mortality at a neonatal care unit in Karachi?

The study was conducted to assess the mortality and mortality pattern at the neonatal care unit, Civil Hospital, Karachi and hence identify the need special equipment including ventilator support. All newborns admitted in the unit were included from Jan 1993-Dec 97. The total admissions in this period were 4107 of which 2193 [53.4%] were discharged and 1533 [37.3%] expired. 381 [9.3%] of the patients were transferred to another hospital left against medical advise, for cultural or religious reasons. Cause related admissions included 864 [21.0%] newborns with low birth weight, 1058 [25.8%] newborns with birth asphyxia and 535 [13.0%] with respiratory distress syndrome. Remaining 1658 [40.4%] were due to causes such as sepsis, congenital anomalies, meconium aspiration syndrome and other miscellaneous causes. Out of 1533 expired mortality at risk newborns was 1225 [79.9%] which included low birth weight 645 [42.1%], birth asphyxia 398 [26.0%] and respiratory syndrome 182 [11.4%]. In conclusion this study indicates that neonatal mortality in our units is about 37.3% and overall 59.8% of the admissions are due to low birth weight, birth asphyxia and respiratory distress syndrome. With improvement in antenatal and natal care service and investment in equipment and personnel to provide assisted ventilation to neonates at risk which consisted of 79.9% of the total mortality, we may be able to significantly reduce the overall mortality of 37.3%