OBJECTIVE:To study pH disorders in severe acute malnutrition. DESIGN: A prospective, cohort, observational study. SETTING: Severe malnutrition treatment unit in a tertiary level care hospital in central India. PARTICIPANTS: 202 children between 6 to 60 months of age. METHODOLOGY: Radial artery sample was taken at admission which was analyzed by automated blood gas analyzer; results were studied and correlated with nutritional status at discharge/outcome. STATISTICAL ANALYSIS: The data were analyzed using SPSS 20. Univariate and bivariate analysis of data was done using the Student t test and two-tailed Fisher exact or chi-square test. RESULTS: Out of 202 children studied 51.5% were males and 48.5% were females, 16.8% children had pH <7.35, 43.6% had pH between 7.35 to 7.45 and 39.6% had pH >7.45. The mean values of pH, HCO3 -, PCO2, PO2 and Cl -were 7.42, 17.1mmol/l, 25.22 mmHg, 93.71mmHg and 109.05mmol/l respectively. Most children (n = 173/202; 85.6%) were discharged, 11(5.4 %) expired and 18 patients left the treatment. In pH < 7.35 group, mortality rate was highest (P value < 0.00001). Rate of weight gain in all groups were comparable and duration of stay was 16½ days in normal pH group and was 19 days in pH < 7.35 and 17 ½ days in pH > 7.46 group. CONCLUSION: In this study, metabolic acidosis with hyperchloremia was associated with poor outcome. There is no significant change in the duration of hospital stay and rate of weight gain in any pH group. KEYWORDS: pH, severe acute malnutrition, metabolic acidosis INTRODUCTION:Severe acute malnutrition is a metabolic disorder, characterized by profound disturbance of water, electrolytes, minerals, protein, fat, carbohydrates and energy metabolism, along with disturbances in function and composition of almost all tissues of the body. Nutrition has long been known to strongly influence acid-base balance. Malnutrition is a state of catabolism and severe malnutrition is a state of severe catabolism. In a healthy body homeostasis is maintained mainly by kidney, lungs, minerals and body fluids, and it is altered in malnutrition.The present work is an attempt to study the prevalence of acid base disorder in severe acute malnutrition and its effect on outcome. Few studies have demonstrated the acid base disturbances in SAM children with associated diarrhea and pneumonia but their main focus was the underlying comorbidities rather than SAM. 1, 2, 3 The present study was conducted to evaluate prevalence of acid base disturbance in all SAM children irrespective of underlying etiology.

Klippel-Feil Syndrome (KFS) is defined as congenital fusion of two or more cervical vertebrae. The most common signs are short neck, low hairline at the back of head and restricted mobility of neck. We report a case of a neonate who presented with complaint of respiratory difficulty and later diagnosed as case of Klippel-Feil syndrome.

AIM:To study the determinant of mortality on extramural arrival of sick newborns and mode of neonatal transport at tertiary care Centre. BACKGROUND: Neonatal transport system in our country is major gap in holistic newborn care and acute neonatal physiology is deranged during transport which adversely affects the mortality and morbidity of sick newborns. MATERIAL & METHODS: This is prospective observational cohort study carried out in out born neonatal intensive care unit over a period of one year. Inclusion criteria were age up to 28 days, delivered at home or private nursing home or any health centre; and exclusion criteria were age more than 28 days, abandoned newborns and those delivered in the institution of study. A predesigned and tested proforma was used to record information by the pediatric resident on duty at time of neonatal admission. Data were analysed and tabulated, for analysis of data software STATISTIX was used, chisquare test for dichotomous variables and multiple logistic regression for predictors of mortality. RESULT: Out of 200 newborns 146 were male and 54 were female, 140 were term and 59 were preterm, 39 newborns expired and common mode of transport was taxi 47%, bus 16%, auto 16% and ambulance 2.5%. The common factors determining the outcome were low admission weight, prematurity, longer duration of transport and deranged physiological factors e.g. hypothermia, respiratory distress, prolonged CRT and central cyanosis. CONCLUSION: This study concludes that neonatal transport in our country is self-supported; the ideal element of neonatal transport is major gap in holistic neonatal care. Thus we suggest RUSH-IN FACILITY for neonatal transport.

Background: To identify the determinants of mortality in neonates admitted in sncu of tertiary care hospital with respiratory distress. Neonatal intensive care unit in a tertiary level care hospital in central India. Study Design was a prospective observational study. Neonates admitted with respiratory distress over a period of 8 months. Methods: Neonates with respiratory distress i.e. respiratory rate >60/min, chest retraction, grunting, central cyanosis, were included in the study. Surgical problems causing respiratory distress i.e., congenital malformations affecting respiratory tract and congenital heart disease were excluded from the study. All the cases were divided in two groups based on outcome with good outcome defined as those babies who were discharged and poor outcome defined as those babies who expired during the treatment and analyzed. Results: On analysis, Antenatal history of per vaginal bleed, meconium stained liquor, prolonged rupture of membrane, VLBW, prematurity, pre-ductal SpO 2 , shock, apneic attacks, positive sepsis screen were found to be significantly associated with death. Conclusions: India in recent times has made huge improvement in neonatal care with establishing special care new born units. But, still the neonatal mortality rate is in higher range and needs further intense approach to reduce it. The antenatal and neonatal factors discussed above can be used as referral criteria for early referral of a new born with respiratory distress to a tertiary level new born unit for further management. The early identification and referral of a neonate with above risk factors may help in reducing the associated mortality and hence will reduce neonatal mortality.

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Objective This cross sectional study was done to assess the developmental status in children (6-30 mo old) with severe acute malutrition (SAM). Methods Study subjects were enrolled from children in SAM therapeutic unit, and controls were selected from well-baby clinic of the institute. Neurodevelopment of both groups was assessed using the Developmental assessment scale of Indian infants (DASII). Developmental quotient (DQ) ≤70 was considered delayed. Results Mean (SE) motor DQ 59.04 (0.74) and mental DQ 62.1 (0.57) was lower in SAM as compared to controls (both P<0.0001). Clusters of early age were normal but clusters with items of later infancy were delayed. Conclusions Children with SAM show significant delay in development, and motor DQ is affected more than mental DQ.

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