Pattern and Risk Factors of Congenital Anomaly in Newborn in a Tertiary Level Private Medical College Hospital, Bangladesh.

The cross sectional study was done to estimate the prevalence of various congenital malformations among the patients delivered in Community Based Medical College Hospital (CBMCH), Mymensingh, Bangladesh and corresponding risk factors were also studied from July 2014 to December 2015. A total of 2560 babies who were born at Community Based Medical College Hospital (CBMCH) were enrolled in this study. The newborn babies were examined and assessed for detection of congenital malformation, system wise distribution and risk factors attributable. Out of total 2560 deliveries, 2548 were live births and 12 were still birth. The total number of babies with congenital malformation was 52(2.03%). Four of the 52(7.69%) malformed babies were still born. Maternal age; like increased or low maternal age, maternal disease and drugs were found to have a higher risk of congenital anomalies. Alimentary system and head neck malformation (25%) were most common. All of the still birth babies were born with central nervous system (CNS) malformation. Central nervous system (21.2%), Cardiovascular (17.3%), Musculoskeletal (13.5%), Genitourinary (11.5%), Chromosomal (5.8%) and other (5.8%) abnormalities fall in descending order of frequency. Congenital anomalies are one of the major causes to infant mortality. The study shows the prevalence of congenital anomalies 20.3/1000 live birth and most commonly involved body systems were alimentary system and head neck trunk 13(25%). A good number of mothers have got some definite diseases like diabetes mellitus, infections and hypertension. Consanguinity of marriage and exposure to some drugs has some correlation with congenital malformation. Early diagnosis of diseases and proper counseling with the parents will help in early intervention and reduce mortality and morbidity of neonates.

Risk Factors and Immediate Neonatal Outcome of Multiple Pregnancies in a SCANU of A Tertiary Care Hospital, Bangladesh.

Multiple pregnancies are a significant risk factor for maternal and perinatal morbidity due to inherent biological risks. The present study was aimed to determine the risk factors and to evaluate the immediate neonatal outcome of multiple pregnancies. This descriptive observational study was conducted in the newly established Special Care Neonatal Unit (SCANU) of Mymensingh Medical College Hospital (MMCH), Bangladesh from January 2015 to March 2015. Total 86 newborns of multiple pregnancies who were admitted during the study period were included in the study. Among them 34 pairs were twin, and 6 sets of triplets were present. Among all infants in the study 79.1% were twin and 20.9% were triplet. According to our observation most of the mother aged between 20-29 years (67.5%) and majorities of them were multi-para (62.5%). Preterm delivery occurred in 70.0% cases. 75% newborns were delivered by caesarian section and remaining by vaginal route. The most common risk factors in present study are use of ovulation induction drugs (52.5%) for sub fertility followed by family history of multiple gestations. In 35.0% cases we did not find any cause. Common morbidities of the infants were preterm low birth weight (95.3%), neonatal jaundice (81.3%), RDS (34.8%), perinatal asphyxia (PNA) (17.4%), neonatal sepsis (25.0%) and congenital anomalies (23.2%). Mortality rate of twin was 30% and for triplets it was 50%. Among total study population mortality rate was 30.2%. Main causes of mortality was preterm low birth weight (76%), RDS (57.6%), septicaemia (26%), PNA (19.0%). Morbidities and mortalities in infants of multiple pregnancies are observed much higher than singleton pregnancy. We hope that in light of our findings regarding risk factors like assisted reproduction and their consequences over mother and newborn, periodic reviews will be done in future to reduce the incidence and the unfavourable outcome of multiple pregnancy.

Assessment of renal function by estimation of fractional excretion of sodium in asphyxiated newborns.

This case control study was conducted in Neonatal unit of Dhaka Shishu (Children) Hospital to assess the validity of fractional excretion of sodium (FENa) as a reliable renal function test in asphyxiated newborns. Seventy five appropriate newborns aged between 0-120 hours were randomized in two groups, (Group I; n=50, cases or study group) and (Group II; n=25, controlled group). Blood urea, serum creatinine, serum electrolytes, urinary electrolytes, creatinine, osmolalities, specific gravity, FENa were estimated. Blood urea, Serum creatinine and FENa are increased in perinatal asphyxia. Controls were selected from newborns who had spontaneous breathing immediately after birth and with Apgar score >8 to 10 at 5 minutes. Mean blood urea and serum creatinine were raised in asphyxiated newborn. Blood urea mean±SD was 7.1±3.1mmol/L and serum creatinine mean±SD was 120.8±73.6µmmol/L. Thirty four percent (34%) patients had raised level of blood urea and serum creatinine both, 18% patients had raised (>2.5%) FENa and 48% patients had raised blood urea in asphyxiated newborns. Hyponatremia was also found in asphyxiated newborns. Urinary sodium and creatinine excretion were also higher in the asphyxiated newborns than non asphyxiated newborns. Urinary volume and osmolality were similar in cases and controls. In this study 24% patients died, of which 62.5% were in HIE stage 3, 4.16% were in HIE stage 2 and 1% was in HIE stage 1. Elevated level of serum creatinine (130.0±60.0) and FENa (2.9±1.4) were found in dead patients. Oliguria (0.99±0.6) was also found in dead asphyxiated newborns. Increase in fractional excretion of sodium (FENa) is shown to be directly related to the degree of renal impairment which is again directly related to the degree of asphyxia in the newborns. FENa can be used as an indicator of renal tubular dysfunction in the asphyxiated newborns.

Urinary tract infection in children in a tertiary level hospital in bangladesh.

An observation study was carried out in the department of Paediatrics in Mymensingh Medical College Hospital, Mymensingh regarding urinary tract infection (UTI) in children aged ≤15 years from January 2008 to December 2008. The objectives of this study were to review symptoms, causative agents, antimicrobial sensitivity test, abnormalities of urinary tract and treatment of children with UTI. Fifty cases of childhood UTI, based on urine routine examination and culture, were analyzed and male female ratio was 1:1.3. Sixteen (32%) children were less than one year old. Fever was the most common clinical presentation (82%). Pyuria was detected in 92% of cases. Most common causative organism was Eschericia coli (E. coli) (70%). Susceptibility of E. coli to ceftriaxone, levofloxacin, amikacin and nitrofurantoin was greater than 80% and less susceptible to cotrimoxazole, ampicillin, cephradine and ciprofloxacin. Most of the patients became afebrile within 5 days after starting antimicrobial therapy.

Morbidity pattern and mortality of neonates admitted in a tertiary level teaching hospital in Bangladesh.

This retrospective study was conducted to determine the morbidity and mortality pattern of neonates admitted in to Mymensingh Medical College Hospital (MMCH). A total of 4826 neonates were admitted and reviewed during the period January 2003 to December 2003 in MMCH. Neonatal admission comprises 31.6% of total paediatric admission. Majority of the patients were 1 to 3 days of age and male. The top five causes for neonatal admission in MMCH were perinatal asphyxia (38.7%), low birth weight (25.7%), septicemia (19.2%), neonatal jaundice (5.9%), meconium aspiration syndrome (2.9%). The death rate of neonatal admission was 20.6%. The mortality was found among the neonates admitted with low birth weight (28.1%), perinatal asphyxia (22.8%), septicemia (18.9%). The average duration of hospital stay was higher among the septicemia patients than neonates suffering from other diseases. The finding of this study could be used by professionals, managers and policy makers to design neonatal health programmes to achieve millennium development goal (MDG) by the year 2015.

Effect of oral zinc supplementation on the growth of preterm infants.

OBJECTIVE: To compare the effect of oral zinc supplementation on growth of preterm infants. DESIGN: Randomized controlled trial. SETTING: Dhaka Shisu Hospital (Tertiary care hospital). SUBJECTS: 100 appropriate for date preterm infants weighing between 1000 to 2500 g were randomized to receive zinc and multivitamin supplement (Group I; n=50) or only multivitamin supplement (Group II). INTERVENTION: Zinc supplementation was given 2mg/kg/day for 6 weeks along with multivitamin in Group I and only multivitamin to Group II. PRIMARY OUTCOME VARIABLE: Increment of weight and length. RESULTS: At enrollment, serum zinc (62.1 ± 12.4 ug/dL in Group I and 63.1 ± 14.6 ug/dL in Group II) and hemoglobin levels (14.9 ± 2.4 g/dL in Group I and 14.4 ± 1.7 g/dL in Group II) were almost similar in both groups. Serum zinc levels were in lower limit of normal range. After supplementation, serum zinc and hemoglobin levels were significantly higher in Group I (105 ± 16.5 ug/dL) than Group II (82.2 ± 17.4 ug/dL) (P<0.05). Weight, length and head circumference were comparable in both groups at enrollment. Significant differences in weight gain and increment in length were found in first and second follow up between two groups but OFC increments were not significant (P>0.05). Reduction of morbidity was apparent in zinc supplemented group. No serious adverse effect was noted related to supplementation therapy. CONCLUSION: Zinc supplementation for preterm low birth weight babies is found effective to enhance the growth in early months of life.

Evaluation of simple hematological screen for early diagnosis of neonatal sepsis.

This prospective study was undertaken in Dhaka Shishu Hospital from 15th March 2005 to 15th October 2006 to evaluate the role of simple hematological test for early diagnosis of neonatal sepsis. Eighty suspected cases of septicaemia admitted in neonatal ward of Dhaka Shishu Hospital were included in this study. Patients those who had history of perinatal asphyxia, infant of diabetic mother, congenital cyanotic heart disease etc. were excluded from the study. Thirty neonates without sign symptoms of septicaemia admitted for other causes like jaundice, feeding problems etc. were taken as a control group. After taking informed consent data were collected in structured questionnaire. Following laboratory investigations like total WBC count, differential count, absolute neutrophil count, band cell count, platelet count, CRP, blood culture were done. Micro-ESR was done as bed side test. Immature and total neutrophil ratio (I/T ratio) detected from total neutrophil and band form count. Patients with positive blood culture were categorized as definite sepsis. Patients with negative blood culture but abnormal hematological report suggestive of sepsis were categorized as probable sepsis. Those who had no signs of sepsis were categorized as control group. Absolute neutrophil count (ANC) had low sensitivity (13%) but Micro-ESR, CRP, I/T ratio, platelet count had moderately high sensitivity and specificity. These simple hematological screen are useful marker for early diagnosis of neonatal sepsis.

Role of micro-ESR and I/T ratio in the early diagnosis of neonatal sepsis.

This prospective study was undertaken in Dhaka Shishu Hospital from 15th March 2005 to 15th October 2006 to determine the role of micro-ESR and immature and total neutrophil (I/T) ratio in early diagnosis of neonatal septicaemia. Eighty suspected cases of septicaemia admitted in neonatal ward of Dhaka Shishu Hospital were included in this study. Patients those who had history of perinatal asphyxia, infant of diabetic mother, congenital cyanotic heart disease etc. were excluded from the study. Thirty neonates without sign symptoms of septicaemia admitted for other causes like jaundice, feeding problems etc. were taken as a control group. After taking informed consent data were collected in structured questionnaire. Following hematological investigations like total WBC count, differential count, absolute neutrophil count, band cell count, platelet count, CRP, blood culture were done. Micro-ESR was done as bed side test. I/T ratio detected from total neutrophil and band form count. Patients with positive blood culture were categorized as definite sepsis. Patients with negative blood culture but abnormal hematological report suggestive of sepsis were categorized as probable sepsis. Those who had no signs of sepsis were categorized as control group. Micro-ESR more than age of the patient in days+3 mm in 1st hour were considered significant for sepsis. I/T ratio more than 0.2 was considered positive for sepsis. Sensitivity and specificity of micro-ESR was 63.3% and 60% respectively. Sensitivity and specificity of I/T ratio was 70% and 56% respectively. Combination of micro-ESR and I/T ratio showed high sensitivity (80%) and specificity (70%).

Effect of zinc on growth of preterm babies.

Zinc is being recognized increasingly as an important element in human growth, development and immunological function. It is probably the most intensely studied microelement in newborn nutrition. Zinc deficiency is common in young infants in the developing world and is associated with reduced immunocompetence and increased rates of serious disease. Preterm neonates are especially vulnerable because of preterm delivery and low birth weight. The preterm baby has very limited stored energy and needs an adequate supply of nutrient. Preterm infant have high zinc dietary requirements as 60% fetal zinc is acquired during third trimester of pregnancy. Low concentration of zinc was found in pre-term low birth weight babies in different studies. Studies showed that before supplementation serum zinc level in preterm low birth weight babies were 62+/-12.4 microgm/dl, 65 microgm/dl, 54+/-14.4 microgm/dl and after supplementation serum zinc level were 105.8+/-16.6 microgm/dl, 86.4+/-24.7 microgm/dl respectively. At the same time mean weight & length of supplementation and without supplementation group were 6084 gm vs. 5280 gm, 2779+/-638.7 gm vs. 2474.6+/-441.8 gm and length 23.7 cm vs. 21.4 cm, 46.49+/-2.6 cm vs. 44.1+/-2.8 cm respectively. So supplementation of zinc in preterm babies causes improved growth and development. Various reports showed beneficial effect of long supplement in early growth of pre-term babies. However long term follow up studies are needed to evaluate the beneficial effect of zinc supplementation on growth of preterm babies.

Serum zinc level in preterm low birth weight babies and its comparison between preterm AGA and preterm SGA babies.

Low birth weight (LBW) is a major child health problem in Bangladesh and continuing to great threat to child health and child survival in Bangladesh. LBW is a silent emergency but crisis is real and its persistence has profound and frightening impact on neonatal mortality. This observational study was conducted in Dhaka Shishu Hospital, Dhaka, Bangladesh during July 2004 to June 2005. Serum zinc levels were estimated between two groups: group-I preterm AGA (n=50), group II preterm SGA (n=50) babies. Blood samples were collected from the study population in neonatal unit and serum zinc levels were measured by flame atomic absorption spectrophotometry in Atomic Energy Center, Dhaka, Bangladesh. Observed data were made comparison among groups by Students 't' test. It was observed serum zinc level (60.2+/-15.2) in group I and (62.1+/-12.4) in group II. Serum zinc level was in lower limit of normal range in both groups with more lower level in preterm AGA babies but their difference was not statistically significant (p>0.05). So zinc supplementation may enhance the growth of preterm LBW babies in their early months of lives.

Efficacy of azithromycin in the treatment of childhood typhoid Fever.

An intervention study was carried out in Paediatric wards for a period of one year from January 2003 to December 2003 to determine the efficacy and safety of azithromycin in the treatment of uncomplicated childhood typhoid fever. A total of 50 cases were enrolled in the study. The inclusion criteria of the cases were: documented fever for more than 7 days plus two or more of the following clinical features: toxic appearance, abdominal tenderness, hepatomegaly, splenomegaly, diarrhoea, constipation and coated tongue plus positive Widal test and/or blood culture positivity. Patients who had complication like gastrointestinal tract (GIT) haemorrhage; intestinal perforation and/or shock were excluded from the study. Data were collected in a structured questionnaire. Azithromycin was given at a dose of 10mg/kg /day for a period of 07 days. The time to defervescence was 3.82+/-1.49 days. The minimum defervescence time was 02 days and maximum was 07 days. Clinical cure rate was 94%. No serious adverse effect was noted related to azithromycin therapy except nausea, vomiting, and jaundice. Prior treatment with antibiotics did not affect defervescence time (P>0.05). Pre-treatment febrile period has got positive and linear correlation with clinical response (r = +0.593). It was found that once daily administration of oral azithromycin for seven days in the treatment of uncomplicated typhoid fever was effective and reasonably safe.