Growth and Neurodevelopmental Outcomes of Very Low Birth Weight Infants From Southern India at Corrected Age of One Year

Objective: To assess the growth and neurodevelopmental outcome of very low birth weight (VLBW) infants at corrected age of one year. Methods: This prospective cohort study enrolled VLBW infants delivered in a tertiary care hospital, and followed up till oneyear corrected age. The WHO Anthropo version 3.2.2 software was used to calculate weight for age, length for age, and head circumference z-score during follow up. Neurodevelopmental assessment was done using Developmental Assessment Scale for Indian Infants (DASII) at the age of one year. Results: The mean (SD) z-scores at one-year for weight for age, length for age and head circumference were -2.1 (1.1), -1.4 (1.03) and -2.2 (1.2), respectively. The mean (SD) DASII motor and mental scores were 90.8 (13.4) and 96.5 (13.2), respectively. Major and minor developmental abnormalities were noted in 9.4% and 18.2%, infants, respectively. Cerebral palsy was noted in 5.8% infants. Conclusion: VLBW infants showed impaired growth and significant developmental abnormalities at the corrected age of one year.

Clinical Profile and Outcome of Newborns Discharged Against Medical Advice From a Tertiary Care Centre

Objective: To determine the clinical profile and outcome of neonates discharged against medical advice (DAMA) from the neonatal intensive care unit (NICU) of a tertiary care public hospital. Methods: We retrieved information from hospital records of infants who had been discharged against medical advice from the NICU between January, 2016 and December, 2020. This was followed by a telephonic interview to document the infant’s outcome. Results: Out of the 187 (7.7%) neonates that had left DAMA, 165 case records were available, and 65 (39%) families could be contacted telephonically. Congenital malformations accounted for 96 (58%) of the cases; cardiac malformations accounting for 42 (43.7%). 52 (80%) out of the 65 infants had died after median (IQR) 11 (5-35) days of DAMA, and 13 (20%) were alive at a median (IQR) age of 31 (18.5-31.5) months. Post-DAMA medical care was continued at another health facility in 12 (18%). Conclusions: One out of every five infants was alive for a median age of 31 months after having left DAMA. Mechanisms to ensure continuation of care after DAMA need to be explored.

Hemophagocytic Syndrome in a Child with Brucellosis.

The authors report case of a two and half years old female child presented with fever for one month with hepatosplenomegaly. Though the child had been symptomatic for a prolonged period, she did not appear very unwell at presentation. However, after admission there was sudden rapid deterioration of her clinical status. Investigations revealed hemophagocytosis with brucella infection.

Clinical Profile of Swine Flu in Children at Puducherry.

Objective To study the clinical profile and outcome of children screened and diagnosed for Swine flu at a tertiary care hospital. Methods All Children with suspicion of swine flu infection attending our hospital during the epidemic from August 2009 through January 2010 were screened and categorized into A, B and C as per guidelines of National Health and family welfare. Patients in Category A were advised home quarantine, Category B tested and treated with ostelamivir and Category C were hospitalized. Results Among 424 cases screened for Swine flu, 79 were children in the age group 0–12 years of age (18.6%). The median age of presentation was 5 years. Children belonging to Category A were 43(54.4%), Category B were 31 (39.2%) and Category C were 5(6.3%). Out of the cases that were screened, 19 children were confirmed positive for H1N1 infection(30.2%).Out of positive cases 8 were in category A (42%), eight were in category B (42%) and five were in category C (26.3%). Conclusions During the epidemic of swine flu at puducherry, majority of cases were category A with mild symptoms. Home quarantine and preventive measures during the epidemic were found to be far more important than testing and treating with Oseltamivir.

Oxidative stress in perinatal asphyxia in relation to outcome.

Objective. To study the serum levels of oxidative stress markers - malondialdehyde (MDA) and protein carbonyl in babies with perinatal asphyxia and to correlate their levels with the outcome in terms of mortality and neurodevelopmental sequelae. Methods. A group of 40 term AGA (appropriate for gestational age) infants with perinatal asphyxia were selected as cases and same number of healthy babies as controls. Serum levels of oxidative stress markers - malondialdehyde and protein carbonyl were determined in cord blood and at 48 hours of life. Their levels were correlated with the outcome of perinatal asphyxia in terms of mortality and the long term neurological outcome. Results. MDA and protein carbonyl, in cord blood were significantly higher among cases (5.88±1.40 μmol/L and 1.50±0.48 nmol/mg of protein respectively) than controls (3.11±0.82 μmol/L and 0.83±0.19 nmol/mg of protein respectively). Among the cases, MDA and protein carbonyl values at 48 hours of life (7.52 ± 1.06 μmol/L and 2.91 ± 0.62 nmol/mg of protein respectively) were significantly higher than those at birth. MDA at birth and 48 hours was significantly higher among babies who had seizures than those who remained seizure free. These values were also significantly higher in babies who expired as compared to those who survived. Protein carbonyl values though higher in those who had seizures and in those who expired, were not statistically significant from controls. MDA and protein carbonyl at birth and 48 hours were higher in babies with developmental delay but the association was not statistically significant. Conclusions. In hypoxic ischemic encephalopathy (HIE), oxidative stress markers MDA and protein carbonyl are high at birth and rise further at 48 hours and the values correlate with the morbidity and mortality. Therefore, determining the serum levels of oxidative stress markers MDA and protein carbonyl will be of benefit in predicting the outcome in perinatal asphyxia.