Neonatal Pain And Preventive Strategies: An Experience In A Tertiary Care Unit.

BACKGROUND: Little is known about neonatal pain in Pakistan. So, to know about neonatal pain, its scoring and the effectiveness of oral dextrose in neonatal pain management we carried this study in neonatal intensive care unit (NICU) of military hospital (MH) Rawalpindi. METHODS: This randomized control trial was carried out in NICU of MH, Rawalpindi from Jan to Dec 2013. Total of 252 babies were enrolled in the study. We assessed neonatal pain by using Modified Behavioural Pain Scale (MBPS). Babies were given 10% dextrose and sterile water two minutes before a painful procedure and pain assessment was done after the procedure. The different painful procedures included, heel prick, nasogastric (NG) tube insertion, cannulation, catheterization and venepuncture for blood sampling. RESULTS: A total of 252 babies were enrolled in the study. Of these 139 (55%) were male and 113 (45%) were female babies. Painful procedures included heel lancing 120 (48%), I/V cannulations 60 (24%), venepuncture 40 (16%), NG insertion 26 (10%) and Foley catheterization 6 (2%). Mean MBPS score with 10% dextrose and sterile water were 4.31 and 6.26 respectively and the difference between two was significant statically. CONCLUSIONS: Oral dextrose is a cheap and easily available solution and can be used in neonatal pain management during various painful procedures.

Methylmalonic Acidemia.

Methylmalonic Acidemia (MMA) is an inborn error of metabolism that results in accumulation of methylmalonic acid in blood and increased excretion in urine. The effects of MMA vary from mild to life threatening and it usually presents in early infancy. Affected infants can have vomiting, dehydration, hypotonia, developmental delay and failure to thrive. The emergency treatment of the newborn with MMA mainly comprises rehydration and promotion of anabolism, followed by long-term dietary management by both the restriction of precursor amino acids using a low protein diet and avoidance of prolonged fasting. Prognosis depends on the type of MMA and whether the condition is well controlled in general and during episodes of metabolic decompensation. We report here the presentation and management of a 2-year boy with MMA who failed to achieve expected milestones for age. To the best of our knowledge, only one case of MMA has been reported from Pakistan.

A five years old girl child with Takayasu arteritis.

Takayasu arteritis is a systemic vasulitis of large vessels that mainly involves the aorta and its branches. It normally presents in third decade of life and has rarely been reported in children under 10 years of age. We report here a case of Takayasu arteritis in a 5 years old girl who presented with headache, generalized body swelling, severe hypertension, proteinuria and minimal functioning kidneys. Conventional angiography demonstrated narrowing of descending aorta, right subclavian artery and right common iliac artery. She responded steroids, diuretics, antiplatelets and digoxin and discharged home on maintenance therapy.

4-Nitro-N'-[(1E,2E)-3-phenyl-prop-2-en-1-yl-idene]benzohydrazide.

In the title mol-ecule, C(16)H(13)N(3)O(3), the benzene and phenyl rings are linked through a propenyl-idene hydrazide fragment, C-C(=O)-N(H)-N=C(H)-C(H)=C(H)-, which is fully extended with torsion angles in the range 175.4 (2)-179.9 (2)°. The dihedral angle between the the benzene and phenyl rings is 58.28 (7)°. In the crystal structure, inter-molecular N-H⋯O hydrogen bonds link the mol-ecules into chains along the b axis and additional stabilization is provided by weak inter-molecular C-H⋯O hydrogen bonds.

4-Nitro-N'-[(E)-3-pyridylmethyl-idene]benzohydrazide.

In the title moleclue, C(13)H(10)N(4)O(3), the methyl-idene-hydrazide [-C(=O)-N-N=C-] fragment is essentially planar, with a maximum deviation of 0.0228 (7) Å. The mean planes of the benzene and pyridine rings make dihedral angles of 25.44 (6) and 5.47 (7)°, respectively, with the mean plane of the methyl-idene-hydrazide fragment. In the crystal structure, inter-molecular N-H⋯N hydrogen bonds link mol-ecules into chains along the b axis. Additional stabilization is provided by weak inter-molecular C-H⋯O hydrogen bonds. The O atoms of the nitro group are disordered over two sets of sites of equal occupancy.

N'-(2,4-Dinitro-phen-yl)acetohydrazide.

In the title compound, C(8)H(8)N(4)O(5), the nitro groups ortho and para to the hydrazone group are twisted by 10.0 (2) and 3.6 (2)°, respectively, relative to the aromatic ring. The structure exhibits an intra-molecular N-H⋯O hydrogen bond between the hydrazide and ortho-nitro groups. There is a strong inter-molecular C=O⋯H-N hydrogen bond, giving rise to chains, and weaker ONO⋯NO(2) [2.944 (2) Å] and C-H⋯O-N inter-actions linking the mol-ecules into a three-dimensional network.

Diagnostic value of C- reactive protein and haematological parameters in neonatal sepsis.

OBJECTIVE: To analyse various parameters of sepsis screen singly and in combination to formulate a guideline for the diagnosis of neonatal sepsis. DESIGN: A cross-sectional analytical study. PLACE AND DURATION OF STUDY: The neonatal intensive care unit at the Paediatric Department, Military Hospital, Rawalpindi, over a period of seven months from 1st June to 31st December 2003. SUBJECTS AND METHODS: One hundred neonates having clinical features of sepsis and 100 normal asymptomatic neonates were evaluated with a set of investigations. C-reactive protein (CRP), erythrocyte sedimentation rate, total leukocyte count, absolute neutrophil count (ANC), immature neutrophils to total neutrophil count ratio (I/T ratio), thrombocytopenia, degenerative changes in the neutrophils and gastric aspirate cytology (GAC) for polymorphs were used for diagnosis of neonatal sepsis. RESULTS: CRP was positive in 24/28 (85.7%) of group-A (proven sepsis) and 58/72 (80.5%) of group-B (probable sepsis) and had a specificity of 95%. ANC was the second most sensitive test having sensitivity of 71.4 % for group-A and 63.9 % for group-B and 88% specificity. For group-A, sensitivity of GAC for polymorphs and platelet count was 71.4% and 64.3% respectively. The sensitivity, specificity and predictive values (PV) of the individual tests and different tests combination was also calculated for group-A and B. CONCLUSION: A set of investigations including CRP, TLC, ANC, thrombocytopenia, cytoplasmic vacuolization in the neutrophils and GAC for polymorphs are highly sensitive in detection of culture negative cases of neonatal sepsis. Moreover, a combination of three tests enhances the sensitivity of these tests.

Incidence of respiratory distress syndrome.

OBJECTIVE: To determine the incidence of respiratory distress syndrome (RDS) in hospital born babies. DESIGN: A prospective study. PLACE AND DURATION OF STUDY: The study was conducted in the neonatal intensive care unit (NICU) at the Pediatric department, in collaboration with the Obstetrics and Gynecology Department, Military Hospital, Rawalpindi, over a period of one year from January to December 2000. SUBJECTS AND METHODS: All live born infants delivered at the hospital and who fulfilled the diagnostic criteria of respiratory distress syndrome (RDS) were included in the study. RESULTS: Ninety-four neonates developed RDS. Out of these, 88 (93.61%) were preterm and 06 (6.38%) were term infants. There was a male preponderance (65.95%). RDS was documented in 1.72% of total live births, 37.28% of preterm and 0.11% of term neonates born at the hospital. The incidence of RDS was 100% at 26 or less weeks of gestation, 57.14% at 32 weeks, and 3.70% at 36 weeks. The mortality with RDS was 41 (43.61%). CONCLUSION: RDS is the commonest cause of respiratory distress in the newborn, particularly, in preterm infants. It carries a high mortality rate and the incidence is more than that documented in the Western world.