Effect of Maternal Supplementation With Two Different Doses of Vitamin D During Lactation on Vitamin D Status, Anthropometry and Bone Mass of Infants: A Randomized Controlled Trial

Background: There is a high prevalence of vitamin D deficiency (VDD) in exclusively breast-fed infants in the absence of appropriate vitamin D supplementation. Objective: To evaluate the efficacy of two doses of maternal vitamin D supplementation on vitamin D levels of mother-infant pairs and to assess its effect on growth parameters (weight, length and head circumference) and bone mass of infants. Study design: Randomized controlled trial. Participants: Lactating mother-infant pairs (n=220). Intervention: Maternal oral vitamin D supplementation in two doses (group 1: 1,20,000 IU/month and group 2: 12,000 IU/month) for 12 months. Main outcomes: Maternal and infant serum 25OHD levels, and infants’ growth and bone mass. Results: There was high prevalence of VDD at baseline in mothers (94%) as well as infants (98.5%), which was reduced to 43.1% in (mothers) and 46.5% in infants after 12 months. Significantly higher median (IQR) serum 25OHD levels (ng/mL) were observed among mothers in group 1 compared to group 2 [46 (17-159) vs 18 (6-64); P<0.01] and in infants [36.5 (15-160) vs 17 (7-32); P<0.01]. No significant association was observed between growth parameters or bone mass and serum 25OHD levels of mother or infant between the two groups. Four mothers (3.6%) and two infants (1.8%) in group I had serum 25OHD>100 ng/mL, but without hypercalciuria or hypercalcemia. Conclusion: Bolus vitamin D supplementation in the dose of 1,20,000 IU/month was more efficacious in improving maternal and infant vitamin D status at 12 months, as compared to 12,000 IU/month.

Neonatal Varicella.

Varicella or chickenpox is primarily an infectious disease of childhood and majority of population is infected upto 15 years of age. Rarely, varicella is seen in newborns as congenital or perinatal infection, but in such cases mortality rate is very high. Here we present two cases of neonatal varicella with secondary complications, one with varicella pneumonia and other developing severe secondary skin infection and sepsis.

Breast feeding and insulin levels in low birth weight neonates: A randomized study.

Objective. To evaluate the influence of early infancy feeding practices on fasting insulin levels, as marker of insulin resistance, in low birthweight neonates. Methods. Eighty successive low birth weight (<2.5 kg) neonates <10 days of age born at >38 wk of gestation at this tertiary care centre, were successively invited for participation in the study; parents of 52 (65%) consented to participate. Group 1 children (n=26) were randomized to receive only breast feeding and Group 2 (n=26) received fortified breast feeding with a commercially available human milk fortifier. Routine anthropometry and evaluation of health status was performed. The babies were followed-up every 15 day up to three months. 4-hour fasting glucose and insulin levels were measured at baseline and at 3 month. Statistical analyses were performed using t-test and Mann-Whitney test. Results. In excusively breast-fed Group 1 neonates vs Group 2 the mean birthweight was similar (1.99+0.23 vs 1.87+0.30 kg). There was no difference in body length, head circumference and chest circumference. Mean hemoglobin levels, fasting glucose (63.9+9.8 vs 64.3+8.0 mg/dl) and fasting insulin levels (1.44+1.19 vs 1.73+1.38 μU/ml), were also similar. At three month follow-up in Group 1 children receiving exclusive breast feeding, there was significantly lower weight as compared to Group 2 (3.40+0.3 vs 4.75+0.5 kg, p<0.01). This was associated with significantly lower fasting glucose (79.0+9.4 vs 85.6+8.4 mg/dl) and fasting insulin levels (6.95+4.27 vs 15.73+3.29 μU/ml) (p<0.001).The difference persisted even after adjustment for weight gain in Group 2 (weight adjusted insulin 11.26+3.3 μU/ml; p<0.001). Conclusions. Low birthweight neonates fed fortified breast milk had greater fasting insulin levels compared to those with exclusive breast feeding, at three month of age. The difference persisted after adjustment for excessive gain in fortified milk fed neonates and, suggests adverse glucometabolic programming.

Kangaroo Mother Care (KMC) in LBW infants--a western Rajasthan experience.

OBJECTIVE: This study was taken to study the various beneficial effects of KMC in LBW babies. METHODS: 50 LBW babies (birth weight> 2 kg) two who delivered at Umaid Hospital, RIMCH Jodhpur included in this study and they have given KMC 4-6 hours/day in 3-4 settings. Maternal & Neonatal characteristics and complications prospectively recorded. RESULTS: Of 50 LBW babies enrolled, M:F ratio was 1.5:1 and mean birth weight was 1.487 +/- 0.175 kg. The mean age at which KMC started was 4+/-1.738 days. The mean weight gain was 29 +/- 3.52 g, mean age of discharge 23.6 +/- 3.52 days and mean duration of hospital stay was 15.5 +/- 11.3 days. CONCLUSION: KMC is effective and safe in stable preterm infants and as effective on traditional care with incubators. KMC because of its simplicity may have a place in home care of LBW babies.

Brainstem evoked response audiometry (BAER) in neonates with hyperbilirubinemia.

OBJECTIVES: To evaluate Brainstem Evoked Response Audiometry (BAER) as an objective testing of hearing assessment in icteric babies and correlate the abnormalities with serum bilirubin levels. METHODS: BAER recordings were taken in 30 icteric ferm neonates at birth, at peak of serum bilirubin levels and on a follow-up visit at 2-4 months of age. RESULTS: Mean latency of waves and interwave intervals on the BAER records were prolonged in icteric babies compared to the control group suggesting early bilirubin encephalopathy. Abnormal records were obtained in 73.3% cases and the abnormality persisted in the follow-up tracings of 23.3% of the study group. CONCLUSION: BAER is a sample, reliable and effective technique for determining auditory functions in the neonates especially changes of early bilirubin toxicity.

Keratomalacia in a neonate secondary to maternal vitamin A deficiency.

A 40-day-old male child was admitted with complaints of not opening eyes from 2-3 days after birth. A diagnosis of X3-B keratomalacia was made. The treatment was done with vitamin-A to which the patient had responded. The mother of the baby had a history of night blindness throughout the pregnancy for which she was also treated. Keratomalacia secondary to vitamin-A deficiency is rare in neonates, although in children it is reported form developing countries.