OBJECTIVEThis study was performed to determine the occurrence of hypoxic hepatitis in full-term neonates after perinatal asphyxia and to correlate between the rise in enzymes and severity of asphyxia with Apgar score and hypoxic ischemic encephalopathy (HIE) grading of the neonates.METHOD AND MATERIALThis prospective case-controlled study was conducted in a tertiary-level hospital in India for a period of 12 months. The study group A comprised 70 newborns suffering from birth asphyxia, while 30 healthy neonates were included in group B (control). All biochemical parameters of liver function, ie, serum alanine transferase (ALT), aspartate transferase (AST), alkaline phosphatase (ALP), lactate dehydrogenase (LDH), total protein, serum albumin, bilirubin (total and direct), and international normalized ratio (INR), were measured on postnatal days 1, 3, and 10 in both study and control groups.RESULTSIn group A, 22.8% newborns had severe (Apgar score 0–3), 47.1% had moderate (Apgar score 4–5), and 30% had mild (Apgar score 6–7) birth asphyxia at five minutes. In all, 14.28% babies were in HIE stage I, 25.73% babies were in HIE stage II, and 11.42% babies were in HIE stage III. The rest of the newborns, 48.57%, were normal. The prevalence of liver function impairment was seen in 42.85% of asphyxiated neonates. On day 1, ALT, AST, ALP, LDH, PT, and INR were significantly higher, and total protein and serum albumin were significantly lower in group A than in group B. However, ALT and AST correlated well with increasing severity of HIE score. On day 3, there was a rising trend observed in the concentration of mean LDH as HIE staging of neonates progressed from stage 0 to stage III, and among various HIE stages, the difference in LDH was statistically significant.CONCLUSIONWe concluded that AST, ALT at 24 hours, and LDH at 72 hours of animation can be a utilitarian diagnostic tool to differentiate asphyxiated neonates from non-asphyxiated neonates and to discover the severity of perinatal asphyxia because of easy accessibility and feasibility of tests. The outcomes of this survey would be useful for physicians who receive neonates for whom birth details are not easily documented as most of the time the referred newborn infants lack asphyxia history either because the attendants do not know clearly the whole birth history or it was an unattended delivery, or the referring health-care professional has not been observant because of legal threats. The neurological assessment also becomes difficult and inconclusive as ventilator treatment, sedative drugs, and anticonvulsant therapy would produce an evaluation of severity of hypoxic ischemic brain disease and neurological insult difficult.

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Budesonide nebulization in meconium aspiration results in significant early improvement in general condition (early improvement in respiratory distress and early normalization of Downe's score) of the newborn with lesser oxygen requirement, thus early discharge from NICU but has no impact on final outcome.

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Background: A missed opportunity of immunization is one of the important contributing factors for poor immunization status of western desert part of India. The present study is aimed to know the prevalence of MOI in children visiting the Health facility.Methods: Immunization status was assessed via interview method using standard protocols recommended by the WHO, in a total of 600 children aged less than two years (200 indoor and 400 outdoor patients) enrolled randomly. The children who had missed an immunization opportunity were compared with those who had not, for socio-demographic variables and reasons for same were determined.Results: 45.64% of children had missed an opportunity for immunization in health care visit Illiteracy, higher birth order, rural residence; poor socioeconomic status emerged as the risk factors. Failure to assess Immunization during health visit was found in 82.39%, lack of knowledge of the parents regarding immunization schedule in 79.40% and false contraindications (mild acute illness in 21%, current antimicrobial therapy in 8.22%, convalescent phase of illness in 7.86%, recent exposure to infectious disease in 5.24%, fever precipitating seizures in 1.12%, pre-maturity 0.74% in that order) were the main causes.Conclusions: Immunization is an important but yet neglected part of child health visits. Each child’s immunization status should be assessed at every health care visit to avoid missed opportunities.

Background: Immunization is the most cost effective ways to improve the health of a community and to avert vaccine-preventable diseases associated morbidity and mortality in children. The immunization status of young children of Western Rajasthan is not up to the mark despite of all the efforts and Missed opportunities of immunization is one of the important contributing factors. The present study is aimed to know prevalence of missed opportunities of immunization in children and the reasons for the same at our centre. Methods:Immunization status was assessed via interview method using standard protocols recommended by the WHO, for a total of 600 children aged less than two years (200 indoor and 400 outdoor patients) picked up through a table of random numbers. The children who had missed an immunization opportunity were compared with those who had not, for socio-demographic variables and reasons for missed opportunity were determined.Results: 48.5% of the children were immunized up to date, 33.82% were partially immunized not up to date and 15.17% were completely un-immunized. The status of 2.5% children could not be assessed and were excluded from the study. 45.64% of children had missed an opportunity for immunization. Illiteracy, higher birth order, rural residence, poor socioeconomic status emerged as the risk factors. Immunization status not assessed during health visit in 82.39%, lack of knowledge of the parents regarding immunization schedule in 79.40% and false contraindications (mild acute illness in 21%, current antimicrobial therapy in 8.22%, convalescent phase of illness in 7.86%, recent exposure to infectious disease in 5.24%, fever precipitating seizures in 1.12%, pre-maturity 0.74% in that order) were the main causes. Conclusions:Immunization is an important but yet neglected part of child health visits. Each child's immunization status should be assessed at every health care visit to avoid missed opportunities

Objective: The objective of the study was to evaluate the adverse effects of phototherapy both total and ionic calcium levels in neonates. Methods: A case–control prospective study was conducted in the Department of Pediatrics, over a period of 15 months. All neonates preterm or term with icterus in phototherapy range formed the study group(s). Serum calcium total and ionized were measured on a serial basis. Results: Neonates in the study group had significant fall in total serum calcium after phototherapy (0.94±0.49 mg/dl). Similarly, ionized serum calcium also decreased after phototherapy in study group (0.56±0.36 mg/dl), p<0.001 statistically significant. The overall incidence of hypocalcemia was 9.6%, higher in preterm (11.7%) than term (8.5%) neonates. Jitteriness and irritability both were seen in 25% of the neonates. None of the neonate had convulsion, but it may occur if the level falls further. Conclusions: While giving phototherapy to a premature baby or a sick baby we should monitor serum calcium levels. Prophylactically oral supplementation of calcium may be considered in newborns receiving phototherapy as it induces hypocalcemia.

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