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

Neonatal seizures, experience at children hospital and institute of child health Multan

Objective: The study was conducted to determine the etiology of seizures in neonates

Methods: This was a descriptive Cross-sectional study. This study was conducted at neonatal unit of children hospital and institute of child health Multan from June 2012 to April 2013. A total of 285 neonates who presented with seizures were enrolled for the possible causes. First line investigations including blood glucose, serum calcium, serum magnesium, serum sodium, complete blood counts, serum creatinine, liver function tests, ABGs, cerebrospinal fluid examination, cranial ultrasound and EEG were done in all neonates. Second line investigations [blood culture, CT scan, MRI, screening for inborn error of metabolism and Torch antibody titer] were done in selected neonates. The data was analyzed using SPSS-10

Results: Out of 285 neonates, 175[61.4%] were male and 110[38.6%] female. There were 199[69.8%] term and 86 [30.2%] preterm. Birth asphyxia was the commonest cause of seizures and present in 53.7% neonates and metabolic disturbance in 17.5%. Seizures with unknown etiology were present in 5.3% neonates

Conclusion: In most of the cases, the causes of neonatal seizures were present. Birth asphyxia was the main etiology identified. However, to establish the exact cause of seizures, more extensive work up is needed

Awareness of malnutrition and diarrheal diseases among mothers in multan region

To assess the knowledge, attitude and practices of mothers about malnutrition and diarrheal diseases; perceptions about signs and symptoms of dehydration; preparation and use of ORS; breast feeding and weaning practices. A cross -sectional descriptive study. The study was carried out in [CDDU-CHC] Control of Diarrheal Disease Unit, Children Hospital Complex, Multan, over a period of six months [March-Aug 2005]. A total of 400 mothers, with children of age group 2 months-5 years, were randomly selected and knowledge, attitude, behavior and practices regarding malnutrition and diarrheal diseases were determined on a pre-coded questionnaire. The data was analysed using SPSS-10 software. The baseline knowledge of the mothers about malnutrition, diarrheal diseases, breast feeding, weaning practices and hand washing was not adequate, probably because of low literacy rate. Considering high prevalence of malnutrition and diarrheal diseases and the relative lack of knowledge, it is imperative that a public health intervention program be initiated in the communities. This must include the education of caretakers as well as health workers