Congenital hernias of the diaphragm in children

Congenital diaphragmatic hernia [CDH] is a major congenital malformation. Different types have been described. Bochdalek hernia [BH] remains most prevalent with high mortality rates. Other variants are less common and carry good prognosis. Although, the diagnosis can be made antenatally, the presentation may be delayed. There is paucity of national literature on CDHs. We present our experience with these challenging paediatric malformations. Medical records of 18 patients [<14 years] treated by the group of authors between October 1998 and April 2002 were retrospectively reviewed and demographic data, clinical presentation, morbidity and outcome were studied. There were 13 [72%] children with Bochdalek hernia, 2 [11%] with eventration of the diaphragm, 2 [11%] with hiatus hernia and 1[6%] with a Morgagni hernia. The lesions were more common in girls and all the defects were left sided. The average age at the time of presentation of BH was 23 hours [2 to 72 hours] commonly presenting with cyanosis and respiratory distress. Associated anomalies were documented in 10 [77%] cases; six had multiple malformations and four died before surgery. In other types of CDHs, the mean age at presentation was 39 [18-60] months and they mostly presented with recurrent respiratory tract infections and/or mild gastrointestinal symptoms. Diagnosis was made on history, physical examination, plain x-ray chest, and gastrointestinal contrast study, when required. 14 [78%] children were operated and a sac was present in 5. Post-operative complications occurred in 5 [55%] patients with Bochdalek hernia, which were managed conservatively. The overall survival rate was 67% [n=12]. The different types of CDHs presented from neonatal age to later childhood with distinct symptoms. Surgery was safe and effective. Higher morbidity and mortality was observed in newborns with Bochdalek hernia

Feeding beliefs and practices of mothers/ caregivers for their infants

To evaluate the nutritional practices and beliefs for infants by mothers/care giversin our set up.A descriptive study.Liaquat University Hospital, Hyderabad - Sindh, from 7[th] November to 16th December,2001.One hundred infants admitted in paediatrics ward were selected for the study. Studywas based on a questionnaire, developed to collect information by interviewing mothers to ascertaintheir infant feeding practices and various beliefs/taboos affecting these practices.One hundred mothers belonging to urban and rural areas were interviewed. At birth,71% of mothers discarded colostrum. The frequency of breast-feeding was high initially but dueto variety of socio-cultural reasons, it declined rapidly with early supplementation of bottlefeeding.Pre-lacteal feeding was a major reason for breast feeding delay. Exclusive breastfeedingwas of short duration. Inadequate weaning in terms of quality and quantity was observedcommon. Cultural beliefs and taboos were affecting the weaning in majority of the cases.Lack of maternal education about feeding the infant is significant in our set up.There is, therefore, a need to educate the mothers about correct feeding practices so thathealthy growth of the infants can be maintained

Neonatal Umbilical cord care

To compare the effectiveness of various methods of umbilical cord care. Comparative study. From June 2004 to December 2004 at Hyderabad. Healthy full term, singleton new born with normal birth weight, whose cord was clamped with sterile plastic clips examined by author in the 1st 12 hours of life were included in the study. Four hundred newborns were included in the study. Four groups of 100 each were made according to the cord care provided, group A- cord care using only natural drying, group B - 70% alcohol application, group C - polymyxin-bacitracin ointment and group D - bacitracin-neomycin powder application. The babies treated with alcohol had earlier cord detachment with least bacterial colonization with no exudate or granuloma formation. 70% alcohol swab is a better choice for normal newborn umbilical care. The only drawback is it's cost and availability

Blood group incompatibility

A hospital based prospective observational study was carried to know the distribution of various blood group in pregnant female population and babies delivered to them in this area to assess incidence of Rhesus and ABO incompatibility, its consequences and various treatment method required. A hospital based prospective !observational study. The study was conducted from 1st June 2004 to 30 May 2005 at Hyderabad. All live newborn babies admitted under author's care were included in this study All the new born babies admitted for various reasons under author care and the mothers were tested for their blood group. Those with blood group mismatch were further investigated according to their clinical situation. Blood group incompatibility was cause of jaundice in 7.7% of neonates with 5% having ABO and 2.7 Rhesus incompatibility as cause of jaundice. 6% of these babies were full term and 1.7% were preterm. The Kernicterus occurred only in 0.2% of total and 7.4% of those with Rhesus incompatibility. Routine determination of blood group of mothers and babies born to them and serial determination of bilirubin can prevent the dangerous consequences of blood group incompatibility. Exchange transfusion for Rh-incompatibility and phototherapy for ABO incompatibility are best option available in our setup

Drug fever - A Hospital based study

To study the frequency, causative agents, symptomatology of drug fever in children. A hospital based descriptive study. The study was carried out from Jan 01,2005 to Dec 31,2005. All children examined by author were included, both in private and public sector hospitals at Hyderabad. Children 1 to 12 years of age with febrile illness of more than 10 days duration and prior use of drugs for at least 5-7 days were included in this study and were evaluated for having drug fever. 62 [0.72% of total 8560] febrile children, 32 of them males and 30 females, were diagnosed as having drug fever, with Cephalosporins being the common group responsible for causing fever in 33 [53.22%] followed by penicillins in 14 [22.60%], antituberculous in 12 [19.35%],Phenytoin in 2 [3.2%] and carbamezapine in 1 [1.61%].1] Drugs should be considered as a cause of fever of obscure origin. 2] Judicious use of drugs especially antibiotics can not be over emphasized

Maternal risk factors affecting birth weight of newborn

To determine the association of maternal biosocial, medical and obstetric risk factors with low birth weight [LBW]. A case control study. Department of neonatology and paediatrics, Liaquat University Hospital, Hyderabad - Sindh from 1[st] September to 31[st] December 2001. One hundred live born LBW babies were selected against 65 normal birth weight babies as control for this study. Information regarding maternal biosocial, medical and obstetric problems during pregnancy was recorded on a specified proforma and data analysis was done through SPSS 10.0 version and results were interpreted in terms of P-values. The mean birth weight of LBW babies was 1.96 kg as compared to 3.2 kg in control group. Sixty-nine percent of cases were preterm with male predominance. Main factors identified were poverty, maternal malnutrition, short birth interval, teenage mother, lack of antenatal care, anemia, toxemia, antepartum hemorrhage, renal disease and malaria. Maternal biosocial, medical and obstetric factors have strong association with LBW. To overcome this problem, health education of mothers and strengthening of the health care facilities for mother and children in the community are required

Neonatal Antropometry

One thousand neonates were examined for anthropometric measurement i.e. weight, crown heel length, occipito frontal diameter, mid arm circumference. Ponderal index and ratio of mid arm circumference [MAC] and occipito frontal circumference [OFC] were calculated. The mean maternal age was 28 + 6 year. Out of 1000 women whose babies were examined 20.4 percent were primigravidas, 54.0 percent were multigravidas and 25.6 percent were grandmultigravidas. The commonest mode of delivery was spontaneous vertex delivery [80.3 percent], followed by vaccum extraction 9.1 percent, cesarian section 9.0 percent and forceps delivery 1.6 percent. Out of the total 52 percent were males and 48 percent females with 19 percent having preterm delivery and 81 percent term delivery. Low birth weight i.e. less than 2500 gram was observed in 10.6 percent of babies with 5.5 percent males and 5.1 percent females. The mean birth weight was 3.16 Kg, length 49.76 cm, OFC 34.91 cm, MAC 9.27 cm. The mean ponderal index was 2.47 and MAC: OFC ratio was 0.266. It was concluded that the population under study has lower preterm delivery rate, lower low birth weight rate but more or less similar anthropometric measurements, as reported from other parts of the country