RESUMO
Cerebral palsy (CP) is a form chronic motor disability in children. It is a non-progressive disorder of posture and movement, often associated with epilepsy and abnormalities of speech, vision and intellect. It results from a defect or lesion of growing brain before or during birth or in postnatal period. The damage to brain is permanent and cannot be cured but the consequences can be minimized. Cerebral palsy (CP) is a disorder of development in which abnormalities of motor function are the main characteristic features. Severity varies from mild to severe. Cerebral palsy is a very challenging disability for parents and professionals. Cerebral palsy is a heterogeneous group of disorders caused by intrapartum asphyxia and exposure to maternal infection such as chorioamnionitis, sepsis, urinary tract infection, and prematurity. The incidence of Cerebral Palsy is 2 to 2.5 per 1000 live births. During the past twenty years, there have been increases in the incidence and prevalence of CP that may be associated to enhanced records of cases, advances in neonatal health care and other factors.METHODSThis cross-sectional study was conducted in the Department of Paediatrics, Darbhanga Medical College & Hospital, Laheriasarai, Darbhanga, Bihar, from October 2018 to September 2019. A total of 100 Cerebral Palsy cases coming from various districts to inpatient and outpatient department of hospital were selected.RESULTSIn this study a total 100 CP children up to 12 years of age was included. 60% were boys and 40% were girls. The causes of CP included birth asphyxia (47%), prematurity (22%), pyogenic meningitis (8%), genetic (7%), neonatal sepsis (6%), intracranial bleed (5%), and idiopathic (5%). Among these cases, spastic type (65%), ataxic (15%), dyskinetic (10%) and mixed (10%) varieties were found. Among spastic, quadriplegic subtype was seen in 69%, diplegia in 23%, and hemiplegia in 8%. Comorbidities associated with CP patients were speech problem (80%), pain (75%), cognitive disability (50%), hip displacement (30%), seizure (25%), behavioural disorders (25%), sleep disturbances (20%), visual impairment (19%) and hearing impairment (4%).CONCLUSIONSPerinatal asphyxia is a leading and preventable cause of cerebral palsy. Spastic type was the most common type and in spastic type, quadriplegic subtype was most common. Mental retardation, speech problems, pain, cognitive disability, hip displacement and seizure were the major co-morbidities in children with cerebral palsy. Early diagnosis and appropriate management are important in such children to limit morbidity.
RESUMO
Pulse oximetry is an important screening technique to intensify timely diagnosis of critical cyanotic congenital heart disease in neonates which is a noninvasive, safe and an easy method. It is a highly specific test having low false positive rates. This screening test was conducted in Department of Pediatrics, Darbhanga Medical College & Hospital, Laheriasarai, Darbhanga, Bihar, between 24 hours and 36 hours after birth, with use of the right hand of infants and either foot to diminish false positive results.METHODSData for study has been collected from birth records from Darbhanga Medical College & Hospital, Bihar, and included- 1. saturation level from either feet and right hand for the primary and further recurrence of screening. 2. outcomes of the echocardiographic test findings. 3. important non-cardiac illness diagnosed at the hospitalization for infants which failed screening for cyanotic CHD. For the correction of errors related to data of the study, we satisfied autonomous investigations of pulse oximetry requiring AAP CCHD screening algorithm to identify infants to pass with a saturation ≥95% in hand or either foot and a ≤3% difference and those falling after finishing 3 transitional screening tests. After three consecutive measurements, there is difference of SpO2 of more than 3% between pre-ductal and post-ductal SpO2.RESULTSThe combination of pulse oximetry and physical examination improved the sensitivity to up to 57.14% with a specificity of 99.73%. The overall mortality rate of CCHD was 36.8% [7 out of 19]. The mortality rate of early detection were 37.5% [6 out of 16]. Late detection of CCHD has mortality rate of 33.3% [1 out of 3]. 123 [13.1%] and 70 [7.4%] newborns have either foot or right hand SpO2 level < 95% among 941 study newborns at the time of the initial screening. The mean SpO2 level of either feet and right arm of study newborns were 95.8% [SD 2.3] and 96.0% [SD 2.2] respectively. Either feet and right arm level of SpO2 <95% and either feet to right arm level of SpO2 difference of >3% among 142 [15.1%] study newborns.CONCLUSIONSPulse oximetry screening for primary diagnosis of critical cyanotic CHD is an easy, economical and non-invasive test which covers the essential criteria in addition to worldwide newborn screening panel. Extensive approval and implementation can considerably reduce the morbidity in newborns infants and is likely to be an additional important tool in low resource settings where most of newborn infants are born without prenatal diagnosis. Although, this study showed reduced sensitivity of pulse oximetry for critical cyanotic CHD nearly <50%.