Serum biochemical changes which indicate predisposition to development of rickets or osteomalacia appear within 90 days of starting carbamazepine or valproic acid monotherapy. However simultaneous supplementation with oral calcium and 25-OHvit D is effective in preventing the development of these adverse biochemical changes.
Introduction: Neonatal Hyperbilirubinemia (NH) is a universal problem affecting nearly 60% of term and 80% of preterm neonates during first week of life. Early discharge of healthy term newborns is a common practice because of medical, social and economic constraints. Insignificant number (6.5%) of babies, NH is a cause for readmission. The present study was conducted to correlate the Cord Blood Bilirubin (CBB) level with subsequent NH. Methods: Study was performed at the Department of Pediatrics in a Medical College Hospital and Research Centre. Intramurally delivered, 113 Healthy fullterm newborns during 1-year period were prospectively enrolled. CBB was estimated. Serum Bilirubin estimation was done at 48 hours and 5 day of age and later if required. Results: Significant NH in our study is 3.5%. Mean total bilirubin on second postnatal day was 10.58 mg/dl and on fifth post natal day was 10.81 mg/dl. Using CBB level of ≥3 mg/dl as a cut-off, NH can be predicted with sensitivity of 100%, specificity of 98.17 %, positive predictive value of 66.67 % and negative predictive value of 100%. Conclusion: A 100% Negative Predictive Value in the present study suggests that in Healthy Term babies (without RH and ABO incompatibility with Cord Blood Bilirubin ≤3mg/dl) cord serum bilirubin can help to identify those newborns who are unlikely to require further evaluation and intervention. These newborns can be discharged with assurance to Parents. Babies with CBB level ≥3mg/dl should be followed more frequently.
Introduction: The present study was to emphasize the chief causative factors, clinical manifestations, various hematological and morphological types in children with severe anemia, admitted to the pediatric wards of a tertiary care hospital. Objectives: The primary objective was to study clinical profile of severe anemia in children with various risk factor and hematological parameters among children with severe anemia. Methods: This was an observational study conducted in a tertiary health care institute. Children with severe anemia satisfying eligibility criteria with Hb less than or equal to 7gm/dl in age group 6 Month to 59 months. Less than or equal to 8gm/dl in age group 5 years to 14 years were included. Associated complaints and Clinical features were studied. Complete blood cell count with RBC indices-MCV, MCH and MCHC peripheral smear examination, reticulocyte count, stool examination, urine examination and Mantoux test were done in all patients. Serum ferritin, Hb electrophoresis, bone marrow examination, liver function test and renal function test, and x ray, U.S.G. abdomen, CT scan in relevant cases were done. Result: In this series 59 patients were included. Incidence of severe anemia was more in < 3.5 years age group (50.85%). Male to female ratio was 1.45:1. Out of 59 cases studied, 47(79.66%) had varying degrees of malnutrition. Pallor is the most prominent and characteristic sign noted in 59 cases (100%). Nutritional anemia was most common in 32 cases (55.93%) out of which 28 were microcytic and 4 were dimorphic. Associated infections were noted in 35 cases (59.32%). Conclusion: Nutritional deficiency is the most common cause of severe anemia especially iron deficiency anemia. Most of the children were malnourished and had infection indicating that severe anemia is directly related to malnutrition and infection. Pallor is the most consistent clinical sign of severe anemia. Severe anemia is more common in children aged < 3.5 years.
Introduction: Allergic rhinitis and asthma are two very common allergic diseases of respiratory tract in pediatric patients. In this geographical area, where the prevalence of allergens exists, the role of allergens as the etiological factor is higher in allergic respiratory disorders. Confirmation of allergen as etiologic agent is cumbersome in a small setup, where IgE estimation and allergy tests are not accessible. In this study, the simple test of peripheral smear and nasal smear eosinophil count as a reliable diagnosis to solve the above problem and establishing allergy as etiological agent has been tried. Material and Methods: For the present study which was conducted over 2 years in children between 2 to 12 years who visited tertiary health care center, Nashik. The allergic respiratory cases based on typical history and clinical features were included in the study and investigated for nasal and blood eosinophilia. Children with TB, recurrent and chronic pneumonia, malnutrition, malignancy, collagen vascular disorders and those who are on steroid therapy were excluded from the study. The clinical profile of allergic rhinitis with or without asthma and nasal and blood eosinophils are studied. Result: Out of 100 patients, there was male predominance and incidence was increasing as age increases. Dust is the most common risk factor for allergic rhinitis followed by weather changes, whereas in allergic rhinitis with bronchial asthma, weather change is common risk factor followed by dust and family history. In children with allergic rhinitis with or without bronchial asthma, there is positive relation between nasal and peripheral smear eosinophil count. Conclusion: So, nasal eosinophil count which is simple, non-invasive, economical and reliable can be used as an alternative to invasive peripheral smear eosinophil count as both are equally efficacious in diagnosing allergic respiratory diseases.
Background & Objective: More than 20 million infants worldwide, representing 15.5 per cent of all births are born with low birth weight. More than 95 percent of them are born in developing countries. The incidence of low birth weight in developing countries (16.5 per cent) is more than double the incidence in developed regions (7 per cent). In India, nearly 8 million babies are born with a Low Birth Weight every year. In India, we are still struggling to get minimum care facilities for our neonates. The neonatal mortality rate in India is still 5 to 6 times higher compared to that in developed countries. Because of their susceptibility to complications, low birth weight neonates require specialized and expert care during the neonatal period. This study was undertaken to study the role of various morbidities in the mortality of LBW neonates admitted in the N.I.C.U. Material and Methods: The study was conducted in the N.I.C.U. of a Tertiary Health Care Centre, in Department of Pediatrics. 106 neonates with birth weight less than 2500 grams from among the neonates admitted in the NICU were included in the study. Results: There were 48 deaths out of 106 cases studied thus making the mortality rate of 45.28% and the survival rate of 54.72% (58/106 cases). Respiratory distress contributed maximum to mortality, followed by Septicemia/Sepsis. Neonatal Hyperbilirubinemia followed septicemia in prevalence. Among the spectrum of Respiratory distress, Hyaline Membrane Disease (HMD) contributed maximum to mortality.
Background: Neonatal seizures are clinically significant because very few are idiopathic. Further investigation leading to prompt diagnosis of the underlying condition is important because many of the etiologies have specific treatment. Time of onset of seizures has correlation with etiology. Objectives: The objective of the present study is to know the etiology of neonatal seizures, to know the time of onset of neonatal seizures and its relation to etiology and to know the various types of seizures in neonates. Methodology: The present study included 127 neonates presenting with Neonatal seizures admitted to NICU (Neonatal Intensive care Unit) of tertiary care hospital from August 2014 to December 2016. Detailed antenatal, natal and post natal history were taken and examination of baby done and HIE staged according to Modified Sarnat's staging. Then relevant investigations were done and etiology of neonatal seizures was diagnosed. Results: In the present prospective study, out of 127 neonates studied, 118 were full-term, among these 88 (69.3%) were AGA (Average for gestational age) and 30 (23.6%) were SGA (Small for gestational age). 7 babies (5.5%) were preterm. Male: Female ratio in our study was 1.6:1. In our study onset of seizures within first 3 days of life was seen in 101 neonates (79.5%). After 3 days of life, 26 neonates developed seizures (20.5%). Onset of seizures within first 3 days of life of had statistically significant correlation with birth asphyxia as the etiology with p<0.001. Subtle seizures were the commonest type of seizures in our study (49 cases-38.6%), followed by GTS (Generalized tonic seizures-42 cases-33.1%), multifocal clonic (19 cases-15%) and focal clonic seizures (8 cases-6.3%). Birth asphyxia was the commonest cause of neonatal seizures in our study (84 cases-66.1%) followed by hypoglycemia (22 cases-17.3%) and meningitis (11 cases 8.7%). Out of 84 cases of birth asphyxia 66 (78.6%) mothers had prolonged second stage of labour and 28 (33.3%) had MSAF (Meconium Stained Amniotic Fluid). Hypoglycemic seizures were more common in LBW (Low Birth Weight) babies with statistically significant p<0.001. Conclusion: The recognition of etiology of neonatal seizures is often helpful with respect to prognosis and treatment. The most common etiology for neonatal seizure is HIE (Hypoxic ischemic encephalopathy) and is frequently associated with perinatal risk factors. Onset of seizures during first 3 days of life has significant correlation with HIE as etiology. Hypoglycemic seizures are more common in LBW babies. Subtle seizures are commonest type of clinical seizures, which is difficult to identify, therefore careful observation of at risk newborns is necessary.
Congenital Diaphragmatic Hernia of Morgagni occurs through the foramen of Morgagni, is rare in children. It is usually asymptomatic and detected accidentally. If symptomatic, then symptoms are variable and nonspecific making diagnosis difficult . Our patient presented with signs and symptoms suggestive of congenital heart disease, gastroesophageal reflux disease and recurrent pneumonia.
Congenital Diaphragmatic Hernia of Morgagni occurs through the foramen of Morgagni, is rare in children. It is usually asymptomatic and detected accidentally. If symptomatic, then symptoms are variable and nonspecific making diagnosis difficult . Our patient presented with signs and symptoms suggestive of congenital heart disease, gastroesophageal reflux disease and recurrent pneumonia.
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