The use of prophylactic enteral bovine colostrum in VLBW infants shows a trend toward increased stool IL-6 and features of NEC. We were unable to detect clinical benefits.

Acute abdomen can be defined as a medical emergency in which there is sudden and severe pain in abdomen with accompanying signs and symptoms that focus on an abdominal involvement. It accounts for about 8 % of all children attending the emergency department. The goal of emergency management is to identify and treat any life-threatening medical or surgical disease condition and relief from pain. In mild cases often the cause is gastritis or gastroenteritis, colic, constipation, pharyngo-tonsilitis, viral syndromes or acute febrile illnesses. The common surgical causes are malrotation and Volvulus (in early infancy), intussusception, acute appendicitis, and typhoid and ischemic enteritis with perforation. Lower lobe pneumonia, diabetic ketoacidosis and acute porphyria should be considered in patients with moderate-severe pain with little localizing findings in abdomen. The approach to management in ED should include, in order of priority, a rapid cardiopulmonary assessment to ensure hemodynamic stability, focused history and examination, surgical consult and radiologic examination to exclude life threatening surgical conditions, pain relief and specific diagnosis. In a sick patient the initial steps include rapid IV access and normal saline 20 ml/kg (in the presence of shock/hypovolemia), adequate analgesia, nothing per oral/IV fluids, Ryle's tube aspiration and surgical consultation. An ultrasound abdomen is the first investigation in almost all cases with moderate and severe pain with localizing abdominal findings. In patients with significant abdominal trauma or features of pancreatitis, a Contrast enhanced computerized tomography (CECT) abdomen will be a better initial modality. Continuous monitoring and repeated physical examinations should be done in all cases. Specific management varies according to the specific etiology.

Using oral diazoxide for SGA neonates with HH provided early hypoglycaemic control with no apparent adverse effects.

Lower gastro intestinal bleed (LGIB) is defined as any bleeding that occurs distal to the ligament of Treitz (situated at the duodeno jejunal junction). It constitutes the chief complaint of about 0.3 % of children presenting to the pediatric emergency department(ED). Among Indian children the most common causes are colitis and polyps. In most of the cases of LGIB the bleeding is small and self limiting, but conditions like Meckel's diverticulum often presents with life threatening bleeds. The approach in ED should include in order of priority-assessment and maintenance of hemodynamic stability, confirmation of LGIB and then to attempt for specific diagnoses and their management. This is achieved with help of rapid cardiopulmonary assessment, focused history and examination. The management of all serious hemodynamically significant bleeds includes, rapid IV access, volume replacement with normal saline 20 ml/kg, blood sampling (for cross matching, hematocrit, platelet, coagulogram and liver function tests), Inj. Vit K 5-10 mg IV, acid suppression with H2 antagonists/PPI and nasogastric lavage to rule out upper gastrointestinal bleed. Continuous ongoing monitoring of vital signs is important after stabilization. In ill looking infant, infectious colitis, Necrotizing enterocolitis (NEC), Hirschsprung enterocolitis and volvulus and in older infants and children, intussusceptions, typhoid fever, volvulus should be looked for. Proctosigmoidoscopy remains the first investigation to be done and reveals majority of etiology. Multidetector CT scan, Tc 99 m RBC scan, angiography and Push enteroscopy are the further investigation choices according to the clinical condition of the child. Intra operative enteroscopy is reserved for refractory cases with an obscure etiology.

U niversal newborn screening is quite well established in most of the developed countries. In India, the exact prevalence of various metabolic disorders is not known due to lack of any large scale multicentric study to screen metabolic disorders and absence of any organized system of universal newborn screening. Like other developing countries, India is facing an increasing challenge of noncommunicable diseases, of which many are preventable. Endocrinopathies and other genetic/metabolic diseases constitute an important proportion of such problems. The unique clinical dilemma with these disorders is that either they are asymptomatic or have only non-specific signs and symptoms in the early stages, thereby rendering their early diagnosis almost impossible without a screening program. Some of these disorders like congenital hypothyroidism have a debilitating impact on the developing neonatal brain, if not diagnosed early.The major hindrances for establishing an effective screening program in India are the costs involved, the nonavailability of demographic data about the diseases in question, massive annual birth cohort and the limitations of treatment modalities for some of the diseases. The Wilson criteria [1] mandates such factors and data for the cost effective and efficient running of a screening program, including diseases like congenital hypothyroidism. However, recent developments in the health infrastructure of India and the availability of data on some of these conditions have addressed these problems to a certain extent. For example, in a hospital based survey, 5.75% of all intellectual disability were attributed to metabolic diseases [2]. A previous pilot newborn screening program conducted in Southern India screened 1,25,000 infants and identified homo-cysteinemia, hyperglycinemia, Maple syrup urine disease, phenylketonuria, hypothyroidism and Glucose-6-phosphate dehydrogenase (G6PD) deficiency as the most common metabolic errors [3]. A more recent study documented similar results with particularly high incidence of congenital hypothyroidism (1 in 1700); congenital adrenal hyperplasia, G6PD deficiency and amino-acidopathies were the other common disorders. This study estimated the prevalence of any metabolic disease as 1 in 1000 [4]. More recent preliminary results from Chandigarh [5] and Andhra Pradesh [6] also indicate a high incidence of metabolic diseases in Indian population.The sample collection and processing have been simplified by the establishment of filter paper sampling method (dried blood) from a heel prick. This allows a convenient way for collection and transport of the sample. The advances in the tandem mass spectroscopy allow the detection of most of the inborn errors of metabolism relatively easily. One major obstacle in our country is the timing of sampling. The general guidelines of obtaining a heel prick sample between day 3 to 7 is very difficult to follow in India due to massive load of deliveries leading to early discharge from the hospital, and a high proportion of home deliver...