Introduction: One to three per 1,000 live births suffers from significant hearing impairment. However, 2 to 4 per 100 infants who survived neonatal intensive care have some degree of sensorineural hearing loss. If hearing impairment in newborns is detected earlier, early management can prevent undesirable and often irreversible damage due to late detection. Early detection and the treatment of hearing impairment in children are essential for the development of communication skills, social skills, emotional well-being, and positive self-esteem. Unfortunately, this disability remains undetected for many newborns until it is too late to prevent undesirable and often irreversible damage. Unfortunately, not many studies were done on this topic in Bangladesh. The magnitude of the burden of hearing impairment in the study place might be identified by this study. The objective of the study: Hearing screening was done to see the status of hearing impairment in newborns admitted to NICU. Methodology: A prospective observational study was conducted in the department of neonatology, BSMMU. Newborn admitted to the NICU during the study period was the study population. The newborn who met the inclusion criteria was screened with TEOAE close to discharge from the NICU or before one month of age. A second screen was done with TEOAE again after one month of 1st screen but prior to 3 months of postnatal age if referred in 1st screen. Diagnostic ABR was done prior to 3 months of the postnatal age if referred in both the 1st and 2nd screen. Results: 426 valid recordings from 493 newborns admitted to the NICU enrolled consecutively constitute the basis of this study. Fourteen newborns were found to have hearing impairment among 426 newborns (3.3%). 2 newborns had unilateral hearing loss, and their hearing losses were moderate in nature. The other 12 newborns in their 24 ears had different grades of hearing loss. It was mild hearing loss in 3 ears, moderate in 9 ears, severe in 8 ears, and profound in 4 ears. Conclusion: Hearing screening showed that 3.3% of newborns in the NICU have a hearing impairment. It is still an underestimation considering the number of newborns who were lost to follow-up. TAJ 2022; 35: No-1: 77-82
Introduction: Hearing impairment has a devastating, detrimental, and adverse impact on the development of the newborn. Unfortunately, this hidden disability remains undetected for many newborns until it is too late to prevent undesirable and often irreversible damage. It has long been recognized that undiagnosed hearing loss, even a mild loss at birth, can negatively affect speech and language development, Resulting in poor academic achievement and social-emotional development. According to WHO 2009, newborns in the NICU are 10-20 times at higher risk of developing hearing loss. The risk factors associated with newborn hearing impairment vary from country to country and even within countries. There has been a paucity of studies on this topic from Bangladesh. This study was done to identify the risk factors associated with newborn hearing impairment in the study place. The objective of the study: To identify risk factors associated with newborn hearing impairment in the study group. Methodology: A prospective observational study was conducted in the department of neonatology, BSMMU. After taking consent from the parents/guardians, a thorough history of these newborns, including particulars of the neonates, family history of hearing loss, treatment history, antenatal, natal, and postnatal history, was recorded in a data collection form. Newborn admitted to the NICU during the study period was the study population. The newborn who meet the inclusion criteria was screened with Transient Evoked Otoacoustic Emissions (TEOAE) close to discharge from the NICU or before one month of age. A second screen was done with TEOAE again after one month of 1st screen but prior to 3 months of postnatal age if referred in 1st screen. Diagnostic Auditory Brain stem Response (ABR) was made to confirm the hearing impairment, and it was done prior to 3 months of postnatal age if referred in both the 1st and 2nd screens. Data were analyzed by statistical package for social sciences (SPSS) version 20. Results: 426 valid recordings from 493 newborns admitted in the NICU enrolled consecutively constitute the basis of this study. 14 newborns were found to have hearing impairment among 426 newborns. APGAR ≤ 6 at 5 minutes (odds ratio 20.34, p-value 0.01), TORCH infection (odds ratio 0.64, p-value 0.01), IUGR odds ratio 8.92, p-value 0.02) were independent significant risk factors for hearing impairment. Conclusion: APGAR ≤ 6 at 5 minutes, TORCH infection, and IUGR are independent significant risk factors for newborn hearing impairment. Newborns in NICU with these risk factors should have mandatory audiological evaluation. TAJ 2022; 35: No-2: 59-65
Background & objective: Gestational diabetes mellitus (GDM) is a common pregnancy complication and is associated with increase maternal and neonatal morbidity. Circulating Sex hormone-binding globulin (SHBG) levels are inversely associated with insulin resistance, and insulin resistance is the hallmark of GDM. This study was carried out to investigate SHBG level in pregnancy and to analyze the association of SHBG with GDM. Materials & Methods: This case-control study was carried out in the antenatal clinic of the department of obstetrics & gynecology, BSMMU, Shahbag, Dhaka, over a period of 12 months between August 2017 to July 2018. Participants were 80 in number, aged between 18 to 35 years, having singleton pregnancy with 24 to 28 weeks of gestation. 40 GDM cases were enrolled as the case, and 40 non-GDM cases were enrolled as the control. Pregnant women with overt diabetes/diabetes in pregnancy, previous history of GDM, pre-eclampsia, gestational/chronic hypertension, known case of liver disease, thyroid disorder, acute or chronic renal disease, congenital fetal anomaly, multiple pregnancies, smoking, H/O polycystic ovary syndrome (PCOS) was excluded from the study. Comparison of means made by using Student t-test and categorical data were analyzed by Chi-square Test, and Pearson's correlation was utilized between serum sex-hormone binding globulin level nmol/L with fasting plasma glucose (mmol/L) and 2-hour after 75g glucose (mmol/L). Statistical significance was set at p < 0.05. Results: The median value of serum SHBG was 245.0nmol/L (195.8-278.1) in the case group and 390.1nmol/L (310.2-465.3) in the control group. Women with GDM were found to have significantly lower levels of SHBG compared to the controls (p<0.05). There was a moderate negative significant correlation (r=-0.621; p=0.001) between fasting plasma glucose (mmol) with serum SHBG (nmol/l) in GDM patients. On the other hand, there was a weak negative but not significant correlation (r=-0.229; p=0.155) was found between 2 hours after plasma glucose with serum SHBG in the GDM group. Conclusion: A significantly lower SHBG level is associated with GDM. TAJ 2021; 34: No-1: 80-85
Background: Jaundice is most common problem in neonatal period. It is commonly managed by phototherapy. However, phototherapy may cause hypocalcaemia and create serious complications like convulsion. So, neonatal hyperbilirubinemia associated with hypocalcaemia has increased risk of neurotoxicity. Objective: To determine the effects of conventional single surface phototherapy on serum calcium and serum bilirubin in neonatal hyperbilirubinemia. Methodology: This longitudinal type of descriptive study was conducted in the neonatal unit of Rajshahi Medical College Hospital during January 2016 to December 2017. One hundred forty neonates both term and preterm with jaundice were included into this study. Conjugated hyperbilirubinemia, blood group, Rh incompatibilities, jaundice on 1stday, very LBW babies and very sick neonates were excluded from this study. All neonates were under conventional single surface phototherapy. Total calcium, direct and indirect serum bilirubin were estimated before starting phototherapy and serum calcium level and total bilirubin estimated every 24 hours interval . Results were analyzed statistically by paired student t’ test and z’ test. Results: Total serum bilirubin and calcium level fall significantly and among all groups after phototherapy. Mean SD of serum bilirubin 17.14±4.20 mg/dl before phototherapy and 13.37±3.80 mg/dl after receiving (p <0.001). Mean SD of serum calcium level significantly decreased from baseline value of 9.45±10 mg/dl and 9.24±1.24 mg/dl after phototherapy. Analysis of complications revealed 19(13.6 %) developed hypocalcaemia and has significant difference between serum calcium level before and after phototherapy (p<0.04). Conclusion: Total serum bilirubin and calcium level was reduced by single conventional phototherapy. Phototherapy causes hypocalcaemia in neonate but phototherapy associated hypocalcaemia causing convulsion was not noted. TAJ 2020; 33(1): 5-10
Background & objective: The complex anatomy of the distal end of the humerus with its unique orientation of articular surfaces supported by cancellous bone makes its fracture a constant challenge to orthopaedic surgeons. Internal fixation techniques seek to stabilize these fractures by using a plate on both columns. Without this dual plate arrangement, stability of fixation can be inadequate. Materials & Methods: This observational, descriptive, longitudinal, prospective study was carried out in the outpatient and inpatient at Department of National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Dhaka over a period of two years, between July 2014 to June 2016. Participants were 18 in number and aged between 18 to 50 years. Fractures are classified according to AO classification system and only closed intra-articular fractures of distal humerus AO type 13-C1 was included in this study. Patients with open fractures, fracture more than 2 weeks old and fractures in children were excluded from this study. Majority of cases 11(61.11%) were operated within 1 week of injury. Open reduction internal fixation by pre-contoured 90-90 locking plate was performed in all cases through triceps sparing approach. The plaster cast was removed 2 weeks after operation and rehabilitation was encouraged during this period and afterwards. Patients were advised to come for follow up after discharge in different scheduled date till the fracture union was achieved. The final outcome of the patient was graded according to Mayo Elbow Performance Index (MEPI). Chi-square test was used for testing statistical significance. Statistical significance was set at p < 0.05. Results: Most of the injury was caused by motor vehicle accident 9(50.00%) and rest of the injury caused by fall 5(27.77%). Final outcome by MEPI showed that 15(83.33%) were excellent, 2(11.11%) were good, 1(05.56%) was fair, there was no poor Result. Complications were seen during the follow up period that included wound scar, delayed union which was treated conservatively and union occurred at 18th week. Conclusion: Open reduction and internal fixation of closed intra-articular fractures of distal humerus AO type 13-C1 by 90-90 plate in sagittal plane on medial column and in coronal plane on lateral column through triceps sparing approach is an effective procedure to provide sufficient stability for the postoperative rehabilitation with an excellent union rate and a very good clinical outcome. TAJ 2021; 34: No-2: 71-79
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