Vitamin D status of pregnant women and their infants in South India: VIPIS study

Background: Aim was to estimate the prevalence of vitamin D deficiency in pregnant women and their infants and to analyse the effect of maternal vitamin D deficiency on the infant.Methods: A prospective study was done in the Department of Obstetrics and Neonatology in a tertiary centre in South India with 150 women seen in the antenatal clinic after 36 weeks of pregnancy were recruited. Serum vitamin D levels were obtained. Babies were followed up and sampled once between 10 and 20 weeks of age for vitamin D, calcium, phosphate and alkaline phosphatase. Vitamin D levels less than 20 ng/ml was considered as deficiency. Analysis of the data was done using SPSS 16.0 version.Results: Vitamin D deficiency was seen in 64.8% of the pregnant women. Follow up of 76 babies showed vitamin D deficiency in 72.6% infants. Significantly high levels of alkaline phosphatase were noted in infants who were born to mothers with vitamin D deficiency, which indicates risk of developing bone disease.Conclusions: This study highlights the high prevalence of Vitamin D deficiency in pregnant women and their infants in South India in a region with abundant sunshine. This study also emphasises treating vitamin D deficiency in pregnancy to reduce the risk of developing rickets in infancy.

Direct and Indirect Costs of Pediatric Gastroenteritis in Vellore, India.

Objective: To determine costs of pediatric gastroenteritis in out-patient and in-patient facilities. Methods: Cross-sectional survey of children with acute gastroenteritis attending out-patient clinic (n=30) or admitted in the ward (n=30) for management in the Christian Medical College, Vellore, India from July-September 2014 to estimate direct (drugs, tests, consultation/hospitalization) and indirect (travel, food, lost wages) costs associated with the episode. Results: Median direct and indirect costs were Rs 590 and Rs 190 for out-patient management and Rs 7258 and Rs. 610 for hospitalization, constituting 1.1% and 11% of median annual household income, respectively. Conclusions: Escalating healthcare costs need tracking for evaluation of interventions.

Thrombocytopenic purpura as initial presentation of acute hepatitis A.

Extrahepatic immune manifestations are rare in hepatitis A virus infection. We report a 4 1/2-year-old girl who presented with thrombocytopenic purpura as initial manifestation of hepatitis A virus infection. She responded to steroid therapy.

Neonatal hypernatraemic dehydration and malnutrition associated with inadequate breastfeeding and elevated breast milk sodium.

The advantages of breastfeedng to both the mother and infant are well recognised. In rare instances if breasteding is inadequate or if the sodium content bast milk is high, malnutrition and hypernatraemia can result. A 15 days old exclusively breastfed baby presented with inadequate weight gain. On evaluation, he was found to have hypernatraemia and mother's breast milk showed high sodium concentrations. The infant needed parenteral fluid for correction of dehydration and hypernatraemia. His serum sodium and breast milk sodium of the other of the mother returned to normal gradually. He started gaining weight on exclusive breastfeeds. The present paper describes the case report and brief review of the literature.