Diabetes mellitus is the most common metabolic disorder complicating pregnancy. 1 About 1-14% of all pregnancies are complicated by diabetes mellitus, 90% of them are Gestational Diabetes Mellitus 2 (GDM). Diabetes has long been associated with maternal and perinatal mortality & morbidity. 3 The Neonatal mortality rate is over five times that of infants of non-diabetic mothers & is higher at all gestational ages & in every birth weight for gestational age category. 4 Compared with weight matched controls Infants of Diabetic Mothers (IDM's) have double the risk of serious birth injury, triple the likelihood of caesarean section & quadruple the incidence of admission to newborn intensive care unit. Studies have indicated that the ABSTRACT Background: Diabetes mellitus is the most common metabolic disorder complicating pregnancy. About 1-14% of all pregnancies are complicated by diabetes mellitus, 90% of them are Gestational Diabetes Mellitus (GDM). The present study was undertaken to describe clinical outcome & metabolic profile of neonates born to mothers with diabetes mellitus. Methods: It was a hospital based prospective, non-randomized study conducted at department of paediatrics in G.B. pant hospital (neonatology section) an associated hospital of GMC Srinagar. The hospital is a referral tertiary care hospital of entire Kashmir valley. All infants born to diabetic mothers admitted at G.B. Pant hospital during the study period of one year (March 2011 to February 2012) were included in study. Results: A total of 96 new-borns of diabetic mothers were included in study. 38 (40%) of these new-borns were large for gestational (LGA), 56 (58%) were Appropriate for Gestational Age (AGA) & two (2%) were Small for Gestational Age (SGA). Hypoglycemia was the leading morbidity & occurred in 34 (36%) of these new-borns. Hyperbilirubinemia (26 babies-27%), Hypocalcemia (5 babies-5%) & Hypomagnesemia (5 babies-5%) were other morbidities present. Out of all babies respiratory distress syndrome occurred in 12 (13%), birth asphyxia in 10 babies (12%), polycythemia in 9(10%), congenital heart disease in 3 babies (3%) & other congenital malformations in 3 babies (3%), viz-myelomeningocele, tracheoesophageal fistula, cleft lip & palate respectively. All these morbidities were managed as per standard protocols outlined for these conditions. Out of these 96 study neonates death occurred in 1 neonate having congenital heart disease (mortality of ≈1/100 cases). Conclusions: Infants born to diabetic mothers remain at high risk for development of clinical &metabolic complications. Optimal care of these infants is based on prevention, anticipation, early recognition & treatment of these conditions.
Background: Cerebral palsy is a common pediatric disorder occurring in about 2-2.5/1000 live births. It is a chronic motor disorder resulting from a non-progressive static insult to the developing brain. There are various risk factors associated with it. Also it is accompanied with varied comorbidities and MRI findings depending on the etiology. Aims and objectives: To study the various risk factors, comorbidities and MRI findings in patients with cerebral palsy patients. Methods: A hospital based observational study was undertaken in the post graduate department of pediatrics, GB pant hospital, GMC Srinagar, Northern India. The study was carried out over a period of one year from September, 2009 to August 2010. During this year 22036 patients were admitted in this hospital, of which 2077 (9.42%) were neurological cases. Of these 2077 neurological cases, 145 (6.98%) were cerebral palsy patients, however only 57 children were included in our study. Other 88 CP cases were excluded as they were not fulfilling the inclusion criteria. After thorough clinical history and examination relevant investigations were done including MRI brain. Results: The commonest type of CP was spastic diplegia 28 (49.1%). Other types were spastic quadriplegia in 11 (19.29%), spastic hemiplegia 11 (19.29%), choreoathetoid 4 (7.01%) & mixed in 3 (5.29%). Seizures 27 (47.36%), aspiration pneumonia and bronchopneumonia 8 (14.03%) each were the commonest comorbidities associated. Most common risk factors for cerebral palsy in our study were prematurity and perinatal asphyxia in 7 (31.8%) each. Other risk factors in decreasing order of frequency were, pregnancy induced hypertension (PIH) in mothers 5 (29.41%), multiple gestations 5 (29.41%), neonatal meningitis 4 (18.18%), hypothyroidism in mothers 3 (17.64%), toxoplasmosis 2 (1.76%), rubella 2 (11.76%), maternal diabetes mellitus 2 (3.5%), neonatal hyperbilirubinemia 3 (13.6%) and neonatal seizure in 1 (1.75%). MRI was abnormal in 49 (85.96%) patients with PVL in 22 (38.59%), cortical atrophy in 7 (12.22%), post HIE changes in 4 (7.01%),followed by basal ganglion lesions, lissencephaly, porencephalic cyst , schizencephaly cortical dysplasia, dilated ventricles and infarctions. Conclusions: The commonest type of CP was spastic diplegia 28 (49.1%), followed by spastic quadriplegia, spastic hemiplegia, choreoathetoid and mixed. Most common risk factors for cerebral palsy in our study were prematurity and perinatal asphyxia, followed by Pregnancy Induced Hypertension (PIH) in mothers, multiple gestations, neonatal meningitis, hypothyroidism in mothers, toxoplasmosis, rubella, maternal diabetes mellitus, neonatal hyperbilirubinemia and neonatal seizure. Seizures, aspiration pneumonia and bronchopneumon were the commonest comorbidities associated. MRI was abnormal in 49 (85.96%) patients with PVL, cortical atrophy, post HIE changes being the most common changes followed by basal ganglion lesions, lissencephaly porencephalic cyst, schizencephaly, cortical dysplasia, dilated ventricles and infarctions.
Background: Malnutrition is significant contributor of childhood morbidity and mortality in developing countries. More than 1/3rd of world’s severely malnourished children live in India. The aim was to evaluate the clinical-epidemiological profile and co-morbidities of SAM (severe acute malnutrition) children and to recognize socio-demographic risk factors of SAM children.Methods: It was a prospective hospital based case study. The prospective hospital based study was conducted from September 2018 to February 2020 and included children less than 5 years admitted to an paediatrics ward and satisfying the WHO definition of SAM. Data were entered in Microsoft excel sheet and SPSS software version 16 for windows was used for analysis.Results: 112 patients were taken for study. Mean age of admitted children were 16±3 months. Male:female ratio was 1:1.22. SAM is more common in nuclear families (N=67, 59.83%), illiterate mothers (N=72, 62.48%), children with high birth order more than 3 (N=42, 37%) and low socioeconomically status Kuppaswamy IV (N=72, 64.28%).The most common associated infections were acute gastroenteritis (82.14) and respiratory tract infections (54.20%). Hypoglycaemia (14.28) was the most common metabolic complication. The most commonly used supplementary food used was over diluted cow milk (43.67%).Conclusions: The problem of SAM is multifactorial (rural background, low socioeconomic status, maternal illiteracy, incomplete immunization). The findings of this study confirm the association of severe acute malnutrition with appropriate infant and young child feeding practices. NRCS provide life-saving care for children.
Objectives: The objectives of this study were to study the clinical profile and outcome of children Admitted in NRC of MCCH-associated hospital of GMC-Anantnag. Methods: Children in the age group of 1 month-5 years, admitted to NRC of our hospital between April 2019 and May 2022 with severe acute malnutrition (SAM) were enrolled for the study. As per a predesigned pro forma, a detailed history was taken from mothers or caregivers and nutritional status assessment using standard anthropometric methods was performed. Classification of malnutrition was made according to the WHO guidelines. Anthropometric measurements including weight in kg and length/height in cm, weight for height, Z score, mid-upper arm circumference, and presence of edema were used to classify the grades of malnutrition. After basic workup and starting nutrition rehabilitation, serial weight gain was recorded. Outcome of patients (home discharge, referral to higher center, and death) was recorded and analyzed. Results: A total of 306 children with SAM admitted to NRC of our hospital were enrolled for the study. Majority were of 7–12 months of age (n=93; 30.4%), of female gender (n=178; 58.2%), were from nuclear families and from families with spacing between two children <2 years. SAM was more among children of illiterate and unskilled parents and of parents in the lower and upper lower socioeconomic status (288, 94%). Acute gastroenteritis (n=206; 67.32%) and acute respiratory tract infection (n=158; 51.6%) were most predominant comorbidities seen among hospitalized children. Hypoglycemia (n=183; 59.80%) and hypokalemia (n=56; 18.30%) were most common metabolic derangements. Among the admitted children 119 (38.88%) had good weight gain (10 mg/kg/day), 136 (44.44%) had moderate weight gain (5-10gm/kg/day) and 51 (16.66%) had poor weight gain (<5 g/kg/day). Out of 306 children admitted, 276 (91%) children were discharged after successful rehabilitation and 27 (9%) were transferred to higher center. No death was documented among SAM children during the study period. Conclusion: Malnutrition in under five children is high and multi-factorial. Hospital-based management of SAM is an important step in reducing the morbidity and mortality among such children.
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