Background and objectiveThe exact burden of hemolytic disease of the newborn (HDN) attributed to neonatal unconjugated hyperbilirubinemia (NUH) in developing nations is still unclear. Still, anti-D is reported to be the most common cause of HDN in India. ABO incompatibility has emerged as a leading cause of exchange transfusion (ET) in many countries. But many centers in our country rely on direct antiglobulin test (DAT) as a screening tool to evaluate immunological causes, whereas advanced immunohematological workup like antibody screening, identification, and elution tests are also required. Early identification of implicated antibodies resulting in HDN can aid in the proper selection of blood units when ET is indicated, and hence also in managing the subsequent pregnancy. This study focused on determining the causes of neonatal hyperbilirubinemia (NH), especially with respect to immunohematological evaluation. This cross-sectional study was conducted on 240 neonates requiring neonatal intensive care unit (NICU) support for NUH at a tertiary care hospital. Materials and methodsDemographic data, along with detailed history pertaining to the cause of hyperbilirubinemia, was collected. Clinical and laboratory evaluation and complete immunohematological work including DAT, heat elution, antibody screening, antibody identification, and Rh Kell phenotyping were performed from neonate blood samples. Data were analyzed using SPSS Statistics version 19 (IBM Corp., Armonk, NY). ResultsPathological jaundice was more common (62.1%) than physiological jaundice (37.9%). The various pathological causes identified were HDN (42.6%), sepsis (12%), cephalohematoma (5.4%), and idiopathic (1.7%). Among HDN cases, ABO incompatibility (39.2%) was the most prevalent cause, followed by Rh HDN and G6PD deficiency (1.7% each). DAT was positive in only 14 cases out of 94 ABO-incompatible cases. Elution revealed antibodies in four DAT-negative neonates with ABO incompatibility and more specificity to the OA setting. DAT was positive with 100% sensitivity in Rh HDN cases (n=4). Elution demonstrated the presence of anti-D (n=2), anti-D + anti-C (n=1) and anti-E (n=1), confirming Rh HDN. DAT strength was found to be significantly associated with hemoglobin (Hb) level (p=0.048). The majority of cases were treated with phototherapy only (94.1%), and 10 cases received both ET and phototherapy. Four neonates' condition improved without any intervention. ConclusionThis study highlighted the shift in the trend from Rh HDN to ABO incompatibility as the cause of hemolytic jaundice in NICU neonates. Elution tests can aid in the diagnosis of DAT-negative ABO-incompatible hemolytic anemia. Early diagnosis, along with timely intervention and appropriate measures, can prevent neonatal morbidity and mortality. Negative DAT does not rule out HDN. Sensitive techniques like elution must be used in the presence of clinical suspicion.
Background: Patency of ductus arteriosus is vital for fetal survival. Ductus often fails to close in premature infants called patent ductus arteriosus (PDA). Our objective is to find the clinical profile and assess the outcome of preterm infants diagnosed to have clinically significant PDA. Methods: 20 infants diagnosed as PDA clinically and confirmed by echocardiography. Symptomatic infants initially treated with fluid restriction and frusemide. Non responders treated with per rectal ibuprofen with dose of 10 mg/kg stat followed by 5 mg/kg x 2 doses at 24 hour intervals. Failure to ductal closure followed by similar second course of ibuprofen. Echocardiography repeated after 72 hours of each therapy. Surgical ligation of ductus was carried after failure to drug therapies. Secondary outcomes during hospitalization were documented. Results: PDA was diagnosed in seventeen infants during first week and three after seven postnatal day. Mean gestational age and birth weight were 31±2 weeks and 1466±378grams respectively. Three babies responded well to fluid therapy. Thirteen infants out of seventeen had ductal closure after first course and two to second course of ibuprofen. Two had undergone surgical treatment. Six infants detected with sepsis, five with intraventricular hemorrhage and retinopathy of prematurity. Two developed bronchopulmonary dysplasia. Pulmonary hemorrhage and NEC were found in one each. Two babies died. Conclusions: PDA is inversely related to gestational age and birth weight. Prostaglandin synthase inhibitors are essential in ductal closure. Surgical ligation is reserved for medical therapy failure. Co-morbidities in PDA are less in well treated babies.
Empyema thoracis in children is a disease of significant morbidity and mortality. In most patients the disease process develops due to lung infection-pneumonia resulting in parapneumonic effusion in the pleural space which is subsequently complicated into empyema (pus in pleural fluid). A combined approach of antibiotics, intercostal chest tube drainage (ICD) and fibrinolytics in case of loculated empyema are usual recommended treatment in empyema. In this prospective observational study 36 paediatric patients having bacterial empyema, attending the paediatric surgery department of Institute of Medical Science and SUM hospital, Bhubaneswar-Odisha, were taken. VATS was performed as primary intervention in all the cases along with proper antibiotics and post operation ICD. All cases were followed up for 12 weeks with continuation of appropriate antibiotics for 3 to 4 weeks post discharge. The most common symptom noted in patients was fever (100%), cough (88.88%), chest pain (80.55%), and breathlessness (77.77%). Common organism isolated in empyema fluid were staphylococci (36.11%), Pneumococci (30.55%), H. Influenza (27.77%) and anaerobes (5.55%). As per staging of empyema, 19 patients had stage-1and 17 had stage-2 disease. The mean time for ICD removal in stage-1cases was 4.7days and for stage-2 was 6.8 days. The mean time of hospital stay for stage-1 diseases was 5.2days and for stage-2 was 7.1 days. No VATS-related complications or recurrence was found in follow up. Early intervention by VATS in empyema thoracis in children is highly effective in terms of quick drainage of pleural space, early removal of ICD, less duration of hospital stay, and without any post-operative or future complication and recurrence. So VATS as primary treatment in empyema of children is highly recommended.
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