Study of neonatal acute kidney injury based on KDIGO criteria.

BACKGROUND: Significant advancement has occurred over the years in diagnosis, recognition, intervention and impact of acute kidney injury (AKI) on morbidity and mortality in critically-ill neonates. However an increased risk of chronic kidney disease (CKD) is still observed among neonates who survive an episode of AKI. Therefore, preventing and adequately managing AKI in neonates could help in controlling long-term renal morbidity in neonates who develop AKI. Thus, this study was undertaken with the aim of studying the incidence, contributing factors and outcomes of AKI in at-risk term neonates admitted to the neonatal intensive care unit (NICU). METHODS: One hundred and ninety-six term neonates admitted to the NICU with sepsis, hypoxic ischemic encephalopathy (HIE), dehydration and respiratory distress were enrolled and evaluated over a period of one year. Detailed maternal history along with neonatal history, anthropometry, vitals and clinical signs of neonates were recorded in a pretested proforma. Urine output was measured in all at-risk neonates. Serum creatinine was estimated to categorize AKI into stages as per modified KDIGO criteria. RESULTS: Incidence of AKI was 21%, (n = 107 out of 510 admissions) in the study. Mortality was significantly higher in AKI stage III neonates (88.9%) (p < 0.001). Multivariate analysis revealed that hypoxic ischemic encephalopathy (HIE) had 35.293 (p < 0.001) times higher risk, while sepsis had 35.701 (p < 0.001), dehydration had 30.260 times (p < 0.001) and respiratory distress had 10.366 times (p < 0.001) higher risk of developing AKI. CONCLUSION: Our study recorded a high incidence of AKI among at-risk neonates. KDIGO criteria for diagnosing AKI is feasible to apply in the at-risk neonates and helps in its early identification. Early diagnosis and timely intervention in neonates with HIE, sepsis, dehydration and respiratory can prevent the progression of AKI and thus improve prognoses.

Hypoxia as a predisposing factor for the development of early onset neonatal thrombocytopenia.

BACKGROUND: Thrombocytopenia in hypoxic neonates admitted in NICU is a morbid condition encountered very commonly. Early-onset thrombocytopenia (<72 h) is most commonly associated with fetomaternal conditions complicated by placental insufficiency and/or fetal hypoxia. Chronic intrauterine hypoxia is the most frequent cause of early-onset thrombocytopenia in preterm neonates. AIMS: In this study incidence and clinical impact of early thrombocytopenia in hypoxic neonates was investigated. SETTING AND DESIGN: Neonatal intensive care unit of a tertiary level hospital attached to a medical college in Central India. A cross-sectional, observational hospital based study in hypoxic neonates for development of thrombocytopenia. MATERIALS AND METHODS: 603 hypoxic newborns were evaluated for development of thrombocytopenia. 155 (25.07%) developed thrombocytopenia and were the cases. Non thrombocytopenic babies 448 (74.29%) served as controls. The two groups were compared for birth weight, sex ratio, gestational age, severity of asphyxia, platelet counts and mortality rate. STATISTICAL ANALYSIS: Descriptive statistics of continuous variable were expressed in mean and SD. P value less than or equal to 0.05 were statistically significant. RESULTS AND CONCLUSIONS: We found thrombocytopenia to be associated with male gender, prematurity and low birth weight. Most babies had mild to moderate thrombocytopenia. Mortality was higher in preterm thrombocytopenic babies as compared to term. We suggest screening for thrombocytopenia in all asphyxiated newborns, as hypoxia can lead to neonatal thrombocytopenia.

Familial clustering of a rare syndrome.

Ectrodactyly, ectodermal dysplasia and cleft palate syndrome is a rare autosomal dominant multiple congenital anomaly syndrome with variable expressivity and reduced penetration. The cardinal features are cleft palate/lip, lobster hand deformity, sparse hypopigmented hair, dry scaly skin, and lacrimal and urogenital anomalies. A neonate presented to us with typical features, his mother and other two siblings were also affected.

Quality of life in children with epilepsy.

BACKGROUND: Epilepsy is a chronic medical condition with many co-morbid features. It has been observed that children with epilepsy (CWE) have a compromised quality of life (QOL). OBJECTIVE: To assess the QOL in CWE and to study the various factors affecting QOL among CWE. MATERIALS AND METHODS: The sample consisted of 102 CWE aged 5-15 years of either sex. QOL was measured by Quality of Life in Childhood Epilepsy (QOLCE) questionnaire, a 76-item, parent-reported questionnaire. Cronbach alpha was used to determine the internal consistency of the subscales and Pearson correlation to determine construct validity. The t-test and analysis of variance were used to compare mean QOLCE scores. RESULTS: Factors affecting QOL included age, place of residence, socioeconomic condition, maternal education, seizure type and frequency and number of antiepileptic drugs. CONCLUSION: CWE have a relatively compromised QOL and comprehensive care needs to go beyond the attempt of controlling seizures.

Thyroid hormone status in malnourished children.

This study sought to find out the correlation between serum concentration of thyroid hormones and grade of malnutrition among 60 children between 1-5 year having PEM. With increasing severity of malnutrition, the serum concentration of T3 and T4 progressively decreased and that of serum TSH increased.