Linear and skull growth in extremely low birth weight babies with rickets of prematurity.

Preterm birth results in poor accretion of bone minerals and development of rickets of prematurity. Poor skeletal growth is one of the long term morbidities of this condition, which is said to have a lesser effect on the skull growth. The present study was a retrospective observational study to compare the effect of rickets of prematurity on the linear and skull growth in the first year of life. In this retrospective analysis, 1 y follow-up records of extremely low birth weight (ELBW) babies born in five consecutive years and their anthropometric data were evaluated. ELBW babies with confirmed rickets of prematurity were taken as the study group and those without were taken as the control group and anthropometric values (head size and length) at various ages in the first year of life were compared using relevant statistical software. Both the lengths and head sizes of the babies in the two groups were found to be comparable until the age of 12 mo.

Red cell distribution width (RDW) in the diagnosis of iron deficiency with microcytic hypochromic anemia.

OBJECTIVE: To study the utility of red cell distribution width (RDW) in the diagnosis of iron deficiency among children with microcytic hypochromic anemia. METHODS: 151 children (6 months-12 years) with microcytic (MCV<75 fl) anemia were classified into iron deficient (IDA) and non-iron deficient anemia (non-IDA) on the basis of serum ferritin and total iron binding capacity (TIBC). RDW values were obtained on an automated hematology analyzer. Receiver operator curves (ROC) were constructed and the utility of RDW in diagnosis of iron deficiency was studied. RESULTS: The mean RDW value was 18.37+/-2.22% in IDA group (97 children) compared to 16.55+/-1.51 % in the non-IDA group (54 children) (p<0.0001, unpaired t test). In IDA group, the mean RDW value was 16.60+/-1.78%, 17.95+/-1.91% and 20.55+/-1.32% among mild, moderate and severely anemic children (p<0.0001, ANOVA test). The corresponding values in non-IDA group were 16.03+/-1.25%, 16.76+/-1.20% and 16.77+/-2.68% respectively (p=0.269, ANOVA test). At a cut-off value of 17.4%, as obtained from the ROC curve, the sensitivity and specificity of RDW in diagnosis of IDA were 81.0% and 53.4% and a positive and negative predictive value of 63.0% and 72.2% respectively. CONCLUSION: RDW has a limited specificity for diagnosis of IDA among children with microcytic hypochromic anemia.

Transfusion associated GVHD.

Transfusion-associated graft-versus-host disease (TA-GVHD) is an under-diagnosed condition in clinical practice. It can occur in immunocompromised as well as immunocompetent hosts and may follow allogeneic bone marrow transplant or transfusion from a related donor. The clinical course is stormy with a high mortality rate. Avoiding the use of blood transfusions from related donors and irradiation of blood products can prevent graft versus host disease. A case of graft versus host disease following related donor transfusion is presented here.

Early onset neonatal sepsis.

OBJECTIVE: To study the maternal risk factors and clinico-bacteriological profile of early onset sepsis (EOS), in a tertiary care neonatal unit. METHODS: Relevant data of neonates born during the study period were obtained from their case records. A diagnosis of early onset sepsis was made if either clinical sepsis developed within 72 hours of life or if positive blood/CSF cultures were obtained in those with potential maternal risk factors. Statistical analysis was done using Odds Ratio or Chi-square and Fisher's exact t-test as applicable. RESULTS: Among 1743 live births, a total of 69 episodes of sepsis occurred in 65 neonates (43% culture proven) with an incidence of 37.2 per 1000 live births. The incidence of EOS was 20.7 per 1000 live births and it constituted 55.4% of overall sepsis. Among the perinatal risk factors assessed, a significant association of EOS with prolonged rupture of membranes, foul smelling liquor, dai (midwife) handling and maternal urinary tract infection was observed (p < 0.05). Among infants at risk of EOS, 20.6% developed sepsis compared to only 0.5% of those without these risk factors (p 0.001). Even among those at high risk such as low birth weight, preterm, and asphyxiated neonates, incidence of EOS was negligible in the absence of a maternal risk factor. Pneumonia (66.7%), shock (27.7%), metabolic acidosis (19.4%) and meningitis (8.3%) were the comorbidities seen among the cases. Culture proven EOS occurred in 41.6%, Pseudomonas being the commonest (60%) isolate. The case fatality rate was 19.4%. CONCLUSION: Screening for sepsis in an asymptomatic neonate is warranted only in the presence of a maternal risk factor even if the neonate is at high risk of developing sepsis due to associated problems of prematurity, low birth weight or asphyxia. Knowledge of likely causative organisms of EOS can aid in instituting prompt and appropriate therapy, in order to minimise morbidity and mortality.

A case of TRAP sequence: acardiac twin.

Monochorionic twinning contributes significantly to neonatal morbidity and mortality. The twin-twin transfusion syndrome complicates 5-35% of monozygotic twin pregnancies with monochorionic placentation. The most severe and a rare manifestation of this condition is acardiac twinning which is seen in 1 in 35,000 pregnancies. The acronym TRAP (Twin Reversed Arterial Perfusion) sequence is used to describe this condition. The acardiac twin does not survive while the mortality for the normal twin is about 50%. Proper timing of the delivery is of prime importance to survival of the normal fetus for which emphasis is placed on close sonographic monitoring for early antenatal diagnosis. We present such a case of TRAP sequence because of its rarity.