Short term Neurodevelopmental outcome of asphyxiated newborns at tertiary care unit

To find out the short term neurodevelopmental outcome of asphyxiated newborns. Cross-sectional study using prospective data. Neonatal unit of Children's Hospital, Lahore from August, 2000 to July, 2001. We included 150 cases of birth asphyxia and survivors were followed till the age of six months and neurodevelopmental status was assessed by Denver developmental screening test II [DDST-II]. Severity of asphyxia was categorized as no encephalopathy, three different stages of HIE. During follow up visits, normal to delayed developmental status was expected. Infants were divided into two groups. Group A included neonates without HIE and group B with encephlopathy. Among group B, newborns developmental delay was found in 9 neonates and 48 neonates died while in group A neonates there was no child who had developmental delay and only six newborns died.[P value<0.05] There were 117 [78%] males, 35 mothers [23%] had antenatal visits to trained medical professionals. Majority of mothers [76%] had their visits to non doctor personnel like midwives, lady health visitors or nurse. Majority [61%] of study population were home delivered, 24% at private clinics and maternity homes while only 14% came from hospitals. Different stages of HIE have strong correlation with the outcome of these neonates. More effort and resources should be directed to this preventable community problem

Glucose 6- Phosphate dehydrogenase deficiency associated with neonatal jaundice

Glucose-6 Phosphate Dehydrogenase [G-6PD] deficiency is the commonest enzymopathy in human beings. It is transmitted as X-linked recessive disorder. Acute hemolytic crisis is the most common presentation of G-6PD deficiency, but in neonatal period it usually presents as jaundice. To find out the proportion of G-6PD deficiency cases in patients with neonatal pathological hyperbilirubinemia and study the clinical course of disease. The study was conducted at the neonatal unit of The Children's Hospital and Institute of Child Health, Lahore from January 2000 - April 2001. One hundred jaundiced neonates with unconjugated hyperbilirubinemia in pathologic range [peak serum bilirubin more than 12 mg/dl in full term and more than 15 mg/dl in preterm neonates] were included. Screening for G-6PD deficiency was done by dye decolorization test, which is semi quantitative, visual colorimetric assay. Out of 100 study cases, 62% were male and 38% were female. 10% of the cases were found to be G-6PD deficient; all were male. One case of G-6PD deficiency developed jaundice during first 24 hrs of life, 8 cases between 1 -7 days and one case after 7 days of life. Peak serum bilirubin levels in neonates with G-6PD deficiency were < 20 mg/dl in 2 cases, 20-30 mg/dl in 6 cases and >30 mg/dl in 2 cases. Evidence of hemolysis [reticulocyte count >5% and Hb% <12.5 gm%] was present in two neonates. In the G-6PD deficiency group, 40% of the cases underwent exchange transfusion compared to 26.6% of cases in the G-6PD normal group. One neonate with G-6PD deficiency had kernicterus at admission. Two neonates with G-6PD deficiency died, due to culture proven sepsis. G-6PD assay should be included in all jaundiced neonates with unexplained neonatal unconjugated pathological hyperbilirubinemia. G-6PD deficiency associated neonatal jaundice is not only hemolytic in origin, but is also related to the impairment of hepatic bilirubin conjugation and excretion

etiology of neonatal sepsis and patterns of antibiotic esistance

To study the patterns of causative bacteria and antibiotic resistance in neonatal sepsis. Design: Descriptive study. Place and Duration of Study: Department of Neonatology, The Children's Hospital and the Institute of Child Health, Lahore from July 2000 to December 2000. Subjects and Two hundred and twenty-eight neonates [age 0-28 days] with clinical sepsis and positive blood cultures were selected. Blood cultures were taken before antibiotics [intravenous cefotaxime and amikacin] administration. The clinical and birth records were thoroughly analyzed. Blood culture reports [n=233] were analyzed for bacterial isolates and pattern of resistance to cefotaxime, ceftazidime, amikacin and ciprofloxacin were compared as percentage of reports showing resistance to the above antibiotics. Among 228 cases included in the study, the male to female ratio was 2.1 to 1. The gestational age was less than 36 weeks in 68 [30%] cases and low birth weight babies were 143 [62.6%]. History of birth asphyxia was present in 103 [45%] cases. There were 142 [62.3%] cases of early onset [< 7 days] sepsis and 86 [37.7%] cases of late onset [>7 days]. Out of 233 positive blood cultures Escherichia coli was found to be commonest [47.8%, n=111, p <0.05] both in early onset [47.8%, n=68, p <0.05] and late onset sepsis [47.3%, n=43, p<0.05]. Staphylococcus aureus was the most common among gram positive organism. Resistance to cefotaxime, ceftazidime and amikacin was 34% to 80% and to ciprofloxacin 13% to 72%. A total of 64 cases [28%] died. Mortality was four times higher in early onset sepsis [n=53 vs 11, 47% vs 12%]. Gram negative bacteria are the commonest cause of neonatal sepsis. The resistance to the commonly used antibiotics is alarmingly high. Mortality is four times higher in early onset sepsis

Transcutaneous bilirubinometry: clinical application

Simultaneous estimations of serum and transcutaneous bilirubin were done in 105 healthy, full term, jaundiced newborns. A good correlation was found between the transcutaneous and serum bilirubin values with coefficient of correlation 0.774. The observed sensitivity was 90%, specificity 78% and positive predictive value 64% at mean serum bilirubin concentration of 9.92 mg/dl. Two action levels at transcutaneous bilirubin values 15 and 18 were also generated that correlated with low and high serum bilirubin values; they can therefore be used for screening of jaundiced full term babies. This study indicates that the transcutaneous bilirubin meter is useful for screening of jaundiced neonates