Infants born extremely prematurely have significant calcium and phosphate depletion by the time they reach full term compared with the normal fetal accretion rate. This is exacerbated if there is poor tolerability to feeds where extra calcium and phosphate could not be added either by additives or via human milk fortifier. Serum calcium and phosphate levels may be normal despite inadequate intake or stores due to the counter-regulatory effect of PTH. In infants at risk of MBD, testing serum alkaline phosphatase, vitamin D and PTH with calcium and phosphate may assist in the monitoring and management of MBD.
Sickle cell disease (SCD) is one of the most common monogenic diseases worldwide. Although there have been some advances in the management of SCD, much remains to be learned about the mechanisms underlying the wide phenotypic diversity of the disease. In resource poor countries, basic facilities for diagnosis and management are lacking, systematic screening is not common practice, and diagnosis is made late. Common and important morbidities associated with SCD are vaso-occlusive episodes, infections, acute chest syndrome, stroke and hip necrosis. These morbidities are often not managed effectively due to lack of proper infrastructure, expertise, and economical burden. Inadequate laboratory facilities and prenatal diagnostic services hamper proper management of disease complications as well as prevention. Newborn screening is yet to be implemented at national level in countries like India. Population screening programs are not universally undertaken, and some of the diagnostic strategies used have limitations. Advanced therapeutics like bone marrow transplantation are expensive, and gene therapy and stem cell therapy are still at an experimental stage. Emphasis should be placed on early counseling, newborn screening, anti-microbial prophylaxis, vaccination against infections and training of healthcare workers, patients and caregivers. Natural history of sickle cell disease in specific geographic areas like Africa and India is still unknown, where infections, malaria and malnutrition are key factors affecting the outcome. Further, in these countries, management guidelines used have been largely extrapolated from resourceful countries where most of the research has been done. There is need to develop tailor made guidelines for specific countries and areas. Global burden of SCD is rising, highlighting the need to develop specific prevention and management related national policies for appropriate public health planning. In resource poor countries where SCD is a major public health concern, basic facilities for management are usually not available, systematic screening is not common practice and diagnosis is usually made late, when patients present with severe complications. This article highlights the challenges faced at all levels including patients, relatives, health care personnel, international health organizations, and government health policy makers.
Background: Assessment of gestational age (GA) based on the last date of menstrual period is often inaccurate. Scores to predict GA of newborns are difficult to use particularly by health workers. An accurate, easy to use the method of assessing GA, particularly in low birth weight (LBW) babies, is needed to detect and link premature newborns to the appropriate level of care. Objectives: The objectives were (1) to develop a "simplified GA score" (SGAS) by selecting items from 3 standard GA scores that significantly predict the GA as measured by the best obstetric estimate (BOE), (2) to validate the accuracy of SGAS against the BOE, (3) to compare the accuracy of SGAS to assess the GA as compared to the accuracy of GA assessment by the New Ballard Score (NBS), and (4) to assess inter rater agreement of SGAS as compared to that of NBS. Materials and Methods: Both the development and validation studies were cross-sectional studies. In the development study, two neonatology residents trained in the use of the 3 scores assessed LBW (<2,500 g) newborns within 24 h of birth. The residents were blinded to each other's assessment and the BOE (GA obtained from last menstrual period [LMP] and confirmed by ultrasound (USG) to be within 2 weeks of the GA ascertained by LMP). Items significantly predictive of GA in multiple regressions were included in the SGAS. In the validation study, two different neonatology residents trained in the use of SGAS assessed the same LBW newborns within 24 h of birth, blinded to each other's assessment and the BOE. Results: In 171 LBW newborns enrolled in the development study, 4 items (Skin, breast, genitals, and posture) were selected for the SGAS. The prevalence of very preterm (<32 weeks) was similar to the actual prevalence. Agreement between the two ratters for SGAS (Cohen's kappa 0.825) was better than that for the NBS (Cohen's kappa 0.709). SGAS had higher positive predictive value for <32 weeks and for ≥32 weeks to ≤35 weeks as compared to the NBS. Conclusions: SGAS is a promising scale for assessment of GA. It needs further validation by public health nurses and community health workers of low resource settings.
Introduction: Globally, 2.6 (2.5–2.8) million newborns died in 2016 or 7000 every day. High neonatal mortality rate reflects the presence of unfavorable social, economic, and environmental conditions. Objectives: To find morbidities and causes of poor outcome in a tertiary care neonatal unit of eastern part of Maharashtra. Materials and Methods: The present prospective observational study was conducted in the neonatal intensive care unit of a tertiary care center, Gondia, in Central India which is situated in remote, tribal place during. Data were collected by interview method using a predesigned, semi-structured questionnaire. Neonatal variables used were total number of admissions, gender, birth weight, and gestational age, diagnosis at admission, final outcome, and duration of stay. Results: There were a total of 2017 admissions during the study period and out of them, 62.96% were inborn neonates and 37.04% were outborn. Males (56.67%) had slightly higher admission rate than females (43.33%). Pre-term admissions were 40.06%. The majority of admissions were due to low birth weight (LBW) (60.19%). Preterm and related complications (49.43%) were ranked highest followed by jaundice (16.46%). Out of the total 2017 neonates, 218 died following admission. Prematurity (45.41%) followed by sepsis (22.48%) were reasons for mortality among neonates. Conclusion: We have tried to present neonatal morbidity pattern and outcome parameters from a tertiary care neonatal center in a developing country. Prematurity, sepsis, and birth asphyxia were accounting for morbidities and mortalities. The preterm and LBW babies had significantly higher mortality even with standard intensive care.
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