Effect of alternative positions of neonates prior to delayed cord clamping on placental transfusion: a randomized control trial.

Objective: To determine the effect of alternative positions (relative to placenta) of normal term neonates, prior to the recommended delayed cord clamping, on placental transfusion and short-term neonatal outcome.Methods: Normal term neonates born vaginally were randomly assigned to be placed either on mother's abdomen (Group AL, n = 97) or 20 cm below the introitus (Group BL, n = 102) for 90 seconds after delivery. Subsequently the cord was clamped. Outcome measures were anthropometry, hematological profile including ferritin at birth and at 3-4 months; and adverse effects, polycythemia, and jaundice.Results: Both groups had comparable outcome measures at birth. At 3-4 months, mean hemoglobin (AL: 12.0 ± 0.9 g/dl, BL: 12.3 ± 1.1 g/dl; p = .02, 95% CI: 0.03-0.58) and hematocrit (AL: 36.1 ± 2.7%, BL: 37 ± 3.2%; p = .01, 95% CI: 0.1-1.75) were significantly higher in BL group. Anthropometry, serum ferritin, incidence of anemia and iron deficiency at 3-4 months were similar in both groups. There was no significant difference in polycythemia, jaundice requiring phototherapy or respiratory distress between the two groups.Conclusions: Placing the baby below the placenta resulted in a statistically significant increase in hemoglobin and hematocrit at 3-4 months without any adverse outcomes. However, this meager quantum of increase did not translate into reduction of risk of anemia or improvement in iron stores.

Burden of Severe Acute Malnutrition in under-five Children (2-59 Months) Admitted in a Tertiary Care Hospital of Delhi.

Objective: The aim of the present study is to assess the burden of severe acute malnutrition (SAM) and other malnutrition in a tertiary care hospital in Delhi. Methods: All patients aged 2-59 months admitted from August 2012 to July 2014 were screened for malnutrition by anthropometry using standard techniques, and SAM was diagnosed as per guidelines [1, 2]. Results: During the study period, 4520 children of age 2-59 months were admitted and complete data of 4354 children were available, which were analysed. Of these, 50.4% were underweight, 44.6% were stunted, 33.5% were wasted, 0.76% had oedematous malnutrition and 18.3% had SAM. Of all patients with SAM, 80% were <24 months old, with 54.1% males and 45.9% females. Moderate acute malnutrition was present in 21.4%. Associated co-morbidities were diarrhoea or respiratory infection or both. Conclusion: Hospitals of Delhi have a high load of complicated SAM and need adequate infrastructure and facilities for management of these children.

Discrimination in Seeking Medical Care for Female Child from Birth to Adolescence--A Retrospective Study.

OBJECTIVE: To study the bias in seeking medical care for female child in various age groups from birth to adolescence. METHODS: It is a retrospective analysis of the hospital records for the period January 2010 through December 2012. The sex ratio was calculated for different age groups including newborns delivered, patients attending OPD (0-12 y), children attending immunization centre (0-5 y), patients admitted in pediatric wards segregated in different age groups i.e., < 1 y, 1-4 y, 5-9 y and 10-14 y. Chi square test was used to find out if there was any variation in the sex ratio of patients attending the hospital against the sex ratio in the community. RESULTS: The mean sex ratio of patients (0-12 y) attending the pediatric OPD was 726 which is significantly lower than the sex ratio in the community (p < 0.00001). The sex ratio of patients (0-5 y) visiting immunization centre (846) was also significantly lower than sex ratio in the community (p = 0.0343). Among children delivered in the hospital mean sex ratio at birth was 934 against a sex ratio of 920 at birth in the reference population. The sex ratio of admitted patients was significantly lower in age groups <1 y (617, p value < 0.00001), 1-4 y (665, p value <0.00001), 5-9 y (665, p value <0.05). But the sex ratio improved for inpatients in the age group 10-14 y (794, p = 0.08). CONCLUSIONS: There is a strong bias against females for seeking medical attention both for outpatient and inpatient care. The bias is more for females in younger age groups as compared to adolescents.

Acute Disseminated Encephalomyelitis After Plasmodium Vivax Infection: Case Report and Review of Literature.

Acute demyelinating encephalomyelitis (ADEM) usually occurs after viral infections or vaccination. Its occurrence after Plasmodium vivax infection is extremely uncommon. We report the case of an 8-year-old girl who had choreo-athetoid movements and ataxia after recovery from P.vivax infection. Diagnosis of ADEM was made on the basis of magnetic resonance imaging findings. The child responded to corticosteroids with complete neurological recovery.

Iron stores in low and normal birth weight infants at birth and in early infancy.

Serum ferritin levels of low birth weight (LBW; BW < 2,500 g) and normal birth weight (NBW; BW ≥ 2,500 g) infants were evaluated at birth and at 3 mo using electrochemiluminescence immunoassay. At birth, levels were 318.6 (31.0-829.5) ng/mL in LBW (n = 217) and 366.2 (122.4-858.5) ng/mL in NBW infants (n = 116; p < 0.01), with 1.4 % of LBW and none of the NBW infants having levels <12 ng/mL (p = 0.20). At follow up, levels were 66.9 (4.5-567.7) ng/mL in LBW (n = 126) and 126.2 (6.8-553.7) ng/mL in NBW infants (n = 76; p = 0.27), with 11.9 % of LBW and 11.8 % of NBW infants having levels <12 ng/mL (p = 0.80).

Poor zinc status in early infancy among both low and normal birth weight infants and their mothers in Delhi.

BACKGROUND: Low birth weight (LBW) infants are at high risk of zinc deficiency, but there is a paucity of data on their zinc status. OBJECTIVE: To evaluate zinc status of LBW (BW <2,500 g) and normal birth weight (NBW; BW ≥ 2,500 g) infants at birth and in early infancy. METHODS: A total of 339 infants (LBW, n = 220; NBW, n = 119) were enrolled, and venous blood samples of mother-infant dyad were taken within 48 h of birth. Infants' levels were repeated between 2 and 10 months of age. Serum zinc levels were estimated using an inductively coupled plasma mass spectrometer. Primary outcome was zinc deficiency, defined as serum zinc <65 µg/dl. RESULTS: Zinc results were available for 182 LBW and 103 NBW infants at birth and for 100 LBW and 66 NBW infants at follow-up with a median postnatal age of 14 and 15.5 weeks, respectively. Median zinc levels were low and comparable at birth as well as at follow-up, with zinc deficiency being present in 51.0% of LBW and 42.4% of NBW infants at birth and in 79.0% of LBW and 66.7% of NBW infants at follow-up. Zinc levels decreased significantly in both groups from birth to follow-up, irrespective of zinc multivitamin supplementation. Zinc levels of infants with BW <2,000 g at follow-up were significantly lower compared to infants with higher BW. CONCLUSION: Zinc status was poor in many infants at birth irrespective of BW. Zinc status worsened significantly during early infancy, with infants with BW <2,000 g having the lowest zinc levels.

Does cord clamp affect the proper positioning of breastfeeding?

To determine the appropriateness of breastfeeding position as assessed by 4 point standard objective criteria in the presence of commercial plastic cord clamp. 50 babies each with and without cord clamp were selected randomly in post natal ward. Mean gestational age in both the periods was comparable (39 ± 1.13 and 39 ± 1.34 weeks). On evaluation by the standard 4 points of proper positioning, babies with cord clamp failed to keep their head and body straight (66% vs 94%, P=0.001), keep their baby's body touching mothers abdomen (16% vs 94% P 0.000), and body well supported (72% vs 96%, P 0.002). However, both groups were appropriately able to turn baby's body towards mother and nose opposite the nipple (98% vs 88%, P 0.112). On evaluation of mothers satisfaction score, there was no significant difference except in the mother's concern about care of cord clamp (P<0.001).

Vitamin D status of low birth weight infants in Delhi: a comparative study.

OBJECTIVE: To evaluate vitamin D status of preterm and term low birthweight (LBW) and term normal birth weight (NBW; weight ≥ 2500 g) infants at birth and in early infancy. METHODS: We enrolled 220 LBW and 119 NBW infants along with their mothers. Blood samples of both infants and mothers were taken within 48 h of birth, and that of infants were repeated at 3 months. Serum levels of calcium, phosphate, alkaline phosphatase, 25 hydroxyvitamin D (25OHD) and parathormone (PTH) were estimated using standard tests. Our primary outcome was vitamin D deficiency (VDD; serum 25OHD <20 ng/ml in mothers and <15 ng/ml in infants). Other outcomes were raised PTH (>46 pg/ml), raised AlkP (>120 U/l in mothers and 420 U/l in infants), and clinical rickets. FINDINGS: VDD was present in 186 (87.3%) of LBW and 103 (88.6%) of NBW infants at birth, and in 77 (60.6%) of LBW and 55 (71.6%) of NBW infants at a median corrected age of 12 and 15 weeks, respectively. VDD was almost universal (93-97%) among mothers of both groups. Raised PTH was present in 138 (63.6%) of LBW and 48 (41.4%) of NBW infants at birth, and in 58 (45.7%) of LBW and 38 (49.3%) of NBW infants at follow-up. Clinical rickets was present in 17 (13.4%) of LBW and 4 (4.9%) of NBW infants at 12-14 weeks of corrected age. CONCLUSIONS: High prevalence of VDD in LBW as well as NBW infants with clinical rickets at an early age underlines the need to study the effect of various vitamin D supplementation regimens in these infants to identify the optimal dose.

Ellis-van Creveld syndrome: report of two cases.

BACKGROUND: Ellis-van Creveld syndrome (EVC syndrome, MIM 225500) or chondroectodermal dysplasia is a rare, autosomal recessive disorder. This syndrome is characterized by a tetrad of chondrodystrophy, post axial polydactyly, and hidrotic ectodermal dysplasia, mostly involving teeth and nails and a high frequency of congenital cardiac anomalies, most frequently a common atrium. The genetic basis of this disorder has been identified as mutations in the Evc and Evc2 genes. We present a report of two affected siblings with features consistent with those of the syndrome. METHODS: A 2-month-old child with features of lower respiratory tract infection was admitted to the pediatric emergency department. Detailed examination revealed skeletal anomalies such as limb shortening and polydactyly in both hands. On cardiac evaluation, ventricular septal defect was found. There were no neonatal teeth. A diagnosis of EVC syndrome was made based on the findings. RESULTS: Screening of family members revealed that the elder sibling had features consistent with those of EVC syndrome. He was 4 years old, yet undiagnosed with short bones, polydactyly, partial anodontia and ventricular septal defect. The third child and the parents were unaffected. The treatment of this disorder is primarily supportive particularly for associated cardio-respiratory problems. The parents were extensively counseled for regular follow-up. CONCLUSIONS: The diagnosis of this syndrome is based on clinical grounds supported by radiological evaluation. Prenatal diagnosis is possible by ultrasonography and genetic testing. Genetic counseling is required to make the parents aware of the risk of recurrences.