Postasphyxial encephalopathy in preterm neonates.

OBJECTIVE: Perinatal asphyxia is an important determinant of infant neurological outcome. There are very few studies looking exclusively at postasphyxial encephalopathy in preterm neonates. METHODS: We studied the neurologic and sonographic abnormalities in 40 preterm babies with severe birth asphyxia during their hospital stay and till 3 months corrected age. RESULT: 87.5 % of the asphyxiated preterm babies had neonatal neurologic abnormality, compared to only 17% of the control babies (p<0.0001). Generalised hypotonia and reduced activity were the commonest abnormalities (observed in 85% of asphyxiated babies) while depressed sensorium (60%) and seizures (35%) were seen in more severe cases. White matter disease (WMD-including periventricular flare, cerebral edema and periventricular leucomalacia) was significantly more frequent in the study cases (34.5% in study cases vs 7.5% in controls, p<0.0001) as was grade 3/4 intraventricular hemorrhage(IVH) (25% in study cases vs 2.5% in controls, p<0.0001). There was 11 fold higher mortality among the asphyxiated babies (23 deaths in study cases vs 2 in controls, p<0.0001). CONCLUSION: The survivors had a significantly higher incidence of both mild and severe neurological abnormalities at corrected age of 3 months among the asphyxiated babies. There was a good correlation between the severity of the neonatal encephalopathy as well as the sonographic findings and the outcome.

Sonography in pyogenic meningitis.

In this prospective study to evaluate usefulness of ultrasonography for early diagnosis and monitoring of complications of acute pyomeningitis, we performed serial sonographic examinations of skull in 50 infants (with open fontanelle) with proven pyomeningitis. One or more abnormal sonographic findings were detected in 32 infants. These were echogenic sulci (26%), ventriculomegaly with some or other complication (26%), brain abscess (20%), ventriculitis (14%), subdural effusion (6%) and cerebral edema (10%), and were detected mostly after the first week of illness. Ultrasonographic findings were in complete agreement with CT scan diagnosis of ventriculomegaly, ventriculitis, solitary brain abscess and cerebral edema. However, sonography missed cases of subdural effusion (2 out of 5), multiple brain abscesses (1 out of 2), and cerebral infarction (all the four), which were detected on CT Scan. Serial sonographic findings were useful in documenting progressive increase in ventricular size in all the 13 infants with ventriculomegaly and monitoring response to anti-edema therapy in 5 infants with cerebral edema. Sonography is a useful tool for diagnosis of complications of pyomeningitis after the first week of illness, and for monitoring the progress of ventriculomegaly.

Clinical & bacteriological profile of neonatal pneumonia.

In a prospective study of 44 neonates (33 outborn and 11 inborn) with pneumonia, the bacteriology of pneumonia was determined by blood culture and serum counterimmunoelectrophoresis (CIEP). Twenty-nine babies also underwent lung aspiration. The lung aspirate was subjected to bacterial culture and CIEP. CIEP was done to detect the bacterial antigens of Streptococcus pneumoniae and Haemophilus influenzae. Absence of tachypnoea, found more commonly in low birth weight babies, was a poor prognostic sign. Low birth weight babies had a significantly higher mortality than babies with normal birth weight. Altogether, a bacterial etiology of neonatal pneumonia could be established in 25 cases (56.7%). In 10 babies, Strep. pneumoniae antigen was detected in serum and/or lung aspirate. Micro-organisms were cultured from blood and/or lung aspirate from 17 babies. Eleven babies (25%) grew Gram negative bacteria. The common bacteria identified in decreasing order of frequency were Strep. pneumoniae, Klebsiella pneumoniae, Staphylococcus epidermidis, Acinatobacter lowfii, Staph. aureus, Pseudoamonas aeruginosa etc. All the Gram negative bacteria as well as staphylococci were sensitive to amikacin while only 23.5 per cent was sensitive to gentamicin. All staphylococci isolated were sensitive to methicillin.

Ultrasound in choledocholithiasis.

Twenty-five patients of obstructive jaundice due to choledocholithiasis, were prospectively evaluated by ultrasonography and cholangiography. Ultrasound could demonstrate choledocholithiasis in 10 patients (40%). Choledocholithiasis in non-dilated ducts could be demonstrated only in one patient. All cases were diagnosed by cholangiography. Ultrasound, though an accepted modality of choice for diagnosing cholelithiasis, has a limited role in the diagnosis of choledocholithiasis. Ultrasonography (USG) is the screening modality of choice to distinguish obstructive from non-obstructive jaundice. It is highly accurate in the diagnosis of cholelithiasis but its role in detection of choledocholithiasis is less clear. Choledocholithiasis complicates 10% of all cases of cholecystitis and occurs in 2-4% of postcholecystectomy patients. The present study deals with the diagnostic value of USG in cases of choledocholithiasis subjected to USG prior to cholangiography and surgery.

Mirizzi syndrome: a rare cause of obstructive jaundice.

Mirizzi syndrome is an uncommon cause of extra-hepatic obstructive jaundice. Gall stones impacted at the neck of gall bladder, causing compression in the common hepatic duct (CHD) was diagnosed on endoscopic retrograde cholangio pancreaticography (ERCP). There was necrosis of the septum between the CHD and gall bladder neck, which was seen at surgery. Cholecystectomy and serosal patch of gall bladder to cover the CHD defect was performed. Patient's management and review of the literature is discussed.

Ultrasound in obstructive jaundice.

One hundred and twenty-five consecutive patients with obstructive jaundice were prospectively studied by ultrasonography to determine the level and cause of obstruction. These were diagnosed precisely in 80 (72%) and 52 patients (41.6%) respectively. The results were compared with cholangiography. The final diagnosis was established at surgery (97 cases) and fine needle aspiration cytology (28 cases). While US is an excellent screening modality in distinguishing obstructive and non-obstructive jaundice, cholangiography is still the gold standard for determining the precise anatomic level and cause of obstruction.