Neurosonographic abnormalities in neonates with hypoxic ischemic encephalopathy.

Pattern of neurosonographic (NSG) abnormalities in 150 term newborn infants with hypoxic ischemic encephalopathy (HIE) was studied. Sonographic abnormalities, presumably indicating cerebral edema and or ischemia, were observed in 86% (n = 129) cases. Obliteration of the ventricles occurred as the sole abnormality in 30 (20%) cases. Eighty (53%) patients had diffusely increased echogenicity of the brain parenchyma (DPE) in addition to the compression of the ventricles, sulci and the interhemispheric fissure. Focal parenchymal echodense (FPE) lesions occurred in nine (6%) neonates with HIE. Ten (6.6%) patients, however, had increased periventricular echogenicity (PVE). Two patients, one with focal parenchymal lesions and the other with PVE had obliterated ventricles in addition. Regarding temporal sequence earliest NSG abnormalities were DPE or slit like ventricles that were observed on day-1 itself. Focal or periventricular echogenic lesions, however, made their first appearance on day-3 of life. Twenty one patients had normal scans. Fifty patients with abnormal scans died. None of the infants with normal scans, however, died (p < 0.001). At 4 weeks of age, scans performed in 100 survivors revealed no abnormality in 51 cases. Others showed development of cerebral atrophy (n = 21), multicystic encephalomalacia (n = 2), porencephalic cyst (n = 1), or persistence of PVE without cystic changes (n = 4). The results of this study highlight the diagnostic efficacy of neurosonography in cases of HIE. We suggest that it should be incorporated in the routine evaluation of patients with hypoxic brain injury.

Do insults to the developing lung increase the incidence of wheezing in infants.

This study reports on the possible role of perinatal and early infantile factors in the aetiology of the 'wheezy baby syndrome'. Over a 2 year period we recruited 150 infants from the outpatients department who had a typical wheezing attack, with chest X-ray showing only hyperinflation and non-specific increased markings, and who had been born in hospital with available perinatal and postnatal records. One hundred and fifty control infants were also recruited. A retrospective study was then undertaken comparing the two groups of infants for the incidence of neonatal problems and the incidence of previous lower respiratory tract infections. The results showed that 40 per cent of cases had previously had meconium aspiration syndrome compared with only 2.6 per cent of controls, and that 26.6 per cent of cases had previously had at least one lower respiratory tract infection compared with 5.3 per cent of controls. Other factors, including the incidence of transient tachypnea, and personal and family history of atopy, showed no significant trends. Meconium aspiration syndrome and lower respiratory tract infections are important aetiological factors in the pathogenesis of 'wheezy baby syndrome', rather than inheritance of atopic diathesis.

Ultrasound evaluation of kidney dimensions in neonates.

This study was done to measure normal renal dimensions of neonatal kidney at various gestational ages sonographically. Knowledge of these measurements may allow earlier diagnosis of a variety of abnormalities. Kidney dimensions (maximum longitudinal length, width, and anteroposterior diameter) were measured within 48 h after birth in 100 healthy neonates with gestational ages from 26.14 to 41.28 weeks and birth weights from 540 to 3250 g using a real time sector scanner with a 7.5 mHz transducer. Renal volume was calculated by volume (V) = L x W x T x 0.5233. Total body surface area (BSA) was determined by BSA = Wt0.425 x Lt0.725 x 71.84. Ponderal index was determined by PI = Wt (g) x 100/(Ht[cm])3. On linear regression analysis, a highly significant correlation was found between renal dimensions and body surface area, gestational age, body weight and length of the baby (p < 0.05). On step wise regression analysis, renal dimensions correlated only with body surface area and the gestational age of the neonate. Regression equations have been provided for rapid computation of renal length, width, and thickness in a given case based on body surface area and the gestational age. Mean (+/- 2 SD) renal volume and renal length were determined based separately on gestational age and body surface area. The data provided can be valuable for evaluating renal abnormalities in preterm neonates.

Epidemiology of Pseudomonas aeruginosa infections in a neonatal intensive care unit.

During the 19-month study period, 48 (2 per cent) of the 2177 neonates admitted to the neonatal intensive care unit (NICU) yielded Pseudomonas aeruginosa growths in blood cultures. All these neonates had clinical and haematological evidences of sepsis. Prominent clinical features included sclerema, violaceus necrotic patches, necrotizing enterocolitis (NEC), conjugated hyperbilirubinaemia, and DIC. Over all mortality was 23 per cent, distinctly higher in premature neonates with RDS. The mean gestational age and birth weights (+/- SD) of these neonates were 36.42 (+/- 2.73) weeks and 2173.34 (+/- 567.33) g, respectively. Approximately half of the total cases had low birth weight. Other adverse perinatal events before the development of sepsis included birth asphyxia (60 per cent), neonatal resuscitation (67 per cent), meconium aspiration syndrome (29 per cent), hyaline membrane disease (8 per cent), prolonged hospitalization (44 per cent), closed incubator care (17 per cent), prolonged intravenous fluids (42 per cent), repeated blood sampling (63 per cent), and umbilical catheterization (4 per cent). Analysis of the trend of Pseudomonas sepsis in our NICU revealed six definite outbreaks (more than two cases) interspersed with occasional (one or two) cases. Six study months, however, remained free of Pseudomonas sepsis. Index case was demonstrable on seven occasions. Bacteriological surveillance of the NICU after onset of initial case/cases revealed statistically significant colonization of resuscitation equipment, baby placement sites, and various cleansing solutions by the same bacterial species (P < 0.05). It is possible that Pseudomonas was introduced to our NICU from transfer admissions from other hospitals since on four occasions index case was the one transferred from outside.(ABSTRACT TRUNCATED AT 250 WORDS)

Ultrasonic evaluation of neonatal subependymal-intraventricular hemorrhage and its complications.

This study demonstrates the value of neurosonography in the evaluation of subependymal-intraventricular hemorrhage (SEH-IVH) and its major complications in the premature infant. Real time sector scans were performed on 150 premature neonates within first 24 hours of life (mean, 10 hrs), and then at 48, 72, and 96 hours and thereafter at weekly intervals. The incidence of SEH-IVH was 22% (n = 33). Twenty seven of the 33 infants had small hemorrhages (Grade I & II), 4 infants sustained Grade III hemorrhage and 2 infants had Grade IV hemorrhage. All hemorrhages occurred in the first 96 hours of life; 50% being diagnosed with the first scan. Larger grades of hemorrhages were generally symptomatic while majority of patients with small hemorrhages had no associated symptoms. The infants especially at risk were those less than 32 weeks' gestation (odds ratio, 29 fold) and/or birth-weight < 1200 gms (odds ratio, 6 fold). Three infants developed post hemorrhagic ventriculomegaly which subsided spontaneously in two of them by the age of 4 weeks. One infant progressed to post hemorrhagic hydrocephalus. The mortality in the study group was 11.3% (n = 17) and correlated to the severity of hemorrhage (39% vs 3.4%; hemorrhagic vs non hemorrhagic group, p < 0.001). At least one screening sonogram is essential within first 4 days of life to diagnose SEH-IVH, which may be otherwise clinically silent. Once the hemorrhage is diagnosed, followup evaluations may be done at weekly intervals to detect post-hemorrhagic ventriculomegaly.

Prevention of hypoglycemia: a controlled evaluation of sugar fortified milk feeding in small-for-gestational age infants.

The study population included 110 term healthy small-for-gestational age (SGA) infants having a blood sugar of > 30 mg/dl at the age of < 30 minutes. They were randomized into two groups; (a) Group I (study group) received sugar-fortified milk formula and (b) Group II (control group) received standard milk formula. A minimum of 80 ml/kg/24 hour of milk was given. The first feeding was given within 45 minutes of birth and subsequently at 2 hours of age and then every 2 hourly till the age of 24 hours. The blood sugar (initial within 30 minutes of birth) was monitored at the age of 2, 4, 12 and 24 hours by dextrostix. The babies on fortified feeds received significantly (p < 0.001) higher amount of carbohydrate (8.1 mg/kg/min) as compared to those on standard milk (5.1 mg/kg/min). The incidence of hypoglycemia was reduced significantly (p < 0.01) by the sugar-fortified feeds. The mean blood sugar level in babies receiving fortified feeds was significantly higher at all the ages as compared to those receiving standard feeds. Nearly all the babies who subsequently developed hypoglycemia had a preceding blood sugar value of less than 60 mg/dl. The study highlights that sugar-fortified milk feeds are useful in preventing hypoglycemia in SGA infants and should be routinely recommended along with breast feeding in developing countries especially when facilities for monitoring of blood sugar are unsatisfactory or not available.

Role of bacteriological monitoring of the hospital environment and medical equipment in a neonatal intensive care unit.

The aim of this study was to evaluate the usefulness of performing routine monthly bacteriological surveillance of the nursery environment, resuscitation equipment, baby placement sites, medications, formula feeds, cleansing solutions and miscellaneous medical items such as intravenous cannulae in relation to development of hospital-acquired bacteraemia in a Neonatal Intensive Care Unit (NICU) over a period of 19 months. The study is based on a retrospective review of records from the neonatal division and the microbiology laboratory. On discriminant analysis, only three NICU sites, namely baby placements, resuscitation equipment and various cleansing solutions were found to be significantly associated with hospital-acquired infections (HAI) (P less than 0.001). The probability that a batch of newly admitted babies would develop HAI if all three sites were colonized was 0.602. Similarly, the probability if none of these sites was colonized was 0.10. On multiple logistic regression analysis, however, the relative risk of infection was greatest if baby placement sites were colonized (Odds ratio = 7.48; P less than 0.01). In contrast, pathogens present in the inanimate NICU environment, e.g. floors, walls, sink-drains or furniture were not associated with HAI. Routine bacteriological surveillance of the inanimate nursery environment, is not therefore justified. However, our results suggest that routine bacteriological monitoring of medical equipment and cleansing solutions may have a role in the prevention of HAI.

Coagulase negative staphylococcal septicemia in newborns.

The case records of 2177 newborn infants admitted in the Neonatal Intensive Care Unit (NICU) from January, 1989, through July, 1990, with positive blood cultures for coagulase-negative staphylococci (C-NS) were evaluated. Seventy four (3.4%) neonates yielded C-NS in blood cultures during the study period. Of these, 58 (2.7%) infants had clinical and hematological features compatible with the diagnosis of septicemia. Remaining 16 babies with positive cultures had no evidence of sepsis, and were designated as "C-NS bacteremia". The age at which positive cultures were obtained differed between the bacteremic and septicemic groups. In bacteremic group, the onset occurred between one to four days of age. In contrast, in septicemic group the range was 6-20 days, with a mean of 10.22 (+/- 3.53) days. More than two third of total cases of C-NS sepsis were premature and low birth weight (LBW). Prominent clinical features included lethargy, poor feeding and fever. Besides this apneic spells were seen predominantly in babies weighing less than 1500 g. Further, before the diagnosis of C-NS sepsis, more than half of neonates had received prolonged intravenous fluid therapy, a quarter had undergone umbilical catheterization and a further quarter needed a ventilator support. Overall mortality in C-NS sepsis was 17.24%, distinctly higher in neonates with RDS and those requiring mechanical ventilation (p less than 0.05). Only 1.34% C-NS isolates were resistant to all routinely used antibiotics and sensitivity was maximum with newer cephalosporins, ciproflox and amikacin.