BACKGROUND Babies of the gestational age group 28 -34 weeks (Moderate-to-Severe Preterm) constitute a major proportion of preterm births, and in a country like ours they have better outcome in terms of mortality, morbidity, long-term adverse consequences and financial implications when compared to extreme preterm (< 28 weeks) babies. Therefore, surveying of these babies is a need for planning interventional strategies to reduce neonatal mortality and morbidity rate. MATERIALS AND METHODSThis is a retrospective, observational, record-based study done in the Department of Neonatology, Government Medical College, Ernakulam over a period of 3 years. All preterm babies in the gestation 28 +0 to 33 +6 weeks admitted to the Neonatal Intensive Care Unit (NICU) during the period were included in the study. The main outcome measures were major morbidities prior to hospital discharge. RESULTSThere were 2491 deliveries during the study period, of which preterm deliveries (< 37 weeks) constituted 20.75%. The incidence of inborn preterm delivery in the gestation 28 +0 -33 +6 weeks was 50 per 1000 live births (5.02%). Severe preterm babies (28 +0 -31 +6 weeks) constituted (48.72%) with mean weight of 1.29 ± 0.27 kg and moderate preterms (32 +0 -33 +6 ) constituted (51.28%) with mean weight of 1.72 ± 0.35 kg. The mortality in the study group was only (4.48%). Hyperbilirubinaemia was the most common morbidity (63.46 %) followed by respiratory distress syndrome (58.33%) and blood culture positive Sepsis (27.56%).

BACKGROUND Congenital Hypothyroidism (CH) is one of the most common disorders related to mental impairment and growth retardation in newborns. The main objective of screening is to detect and treat them early so as to prevent or minimize the neuropsychological damage which can be irreversible if the treatment is delayed beyond the first few weeks of life. In our institution, we do concomitant T4 and TSH after 48 hours of birth for screening. This study is aimed at assessing the usefulness of cord blood thyroid stimulating hormone (CBTSH) screening compared to TSH on 3 rd postnatal day. METHODS A retrospective study was done in 272 term neonates at birth to analyse the cord blood TSH levels and TSH levels were tested for on 3rd postnatal day. The values were statistically analysed using Fisher's exact test. RESULTS 272 babies were enrolled in the study. 17 (6.25%) babies had cord blood TSH above 20 mIU/ml and 11 (4.04%) babies had TSH values more than 10 mIU/ml in the 3 rd day sample. The mean value of CBTSH was 9.68 microU/ml (SD +/-8.47) and that of 3 rd day TSH was 3.76 microU/ml (SD +/-3.17). 4 out of the 11 babies with elevated TSH levels on 3 rd day was found to have congenital hypothyroidism on further follow up. CONCLUSIONS This study reveals a high proportion of congenital hypothyroidism when compared to national and international references, thus highlighting the need for universal screening. According to our study, cord blood TSH cannot substitute the 3 rd day TSH for diagnosing congenital hypothyroidism.

BACKGROUND Incidence of Congenital Hypothyroidism in India is relatively high when compared to that of other parts of the world. The fact that only 5-10% can be diagnosed clinically signifies the role of screening program for early diagnosis and early initiation of therapy to treat this preventable cause of intellectual disability. Cord blood TSH (CB TSH) estimation has high sensitivity, but various maternal and perinatal factors affect the CB TSH levels, which may interfere with the interpretation. This study was done to find out the various maternal and perinatal factors affecting CB TSH level. MATERIALS AND METHODS A hospital-based cross-sectional study was conducted in the Department of Neonatology, Govt. Medical College, Ernakulam over a period of one year from February 2016 to January 2017. We enrolled 127 live neonates selected by systematic random sampling method. Cord blood TSH level was estimated and the results were statistically analysed with respect to various maternal and perinatal factors. RESULTS Mean CB TSH in the study population was 9.713 ± 7.286. The risk factors for a significantly high CB TSH level were low Apgar at 1 minute, Preterm babies and Primigravida mothers (p < 0.05). A significantly low CB TSH was noted in preterm neonates who received antenatal steroids (p < 0.05). The other factors like gestational diabetes, gestational hypertension, gender of the baby, birth weight and meconium stained liquor were found to have no significant relationship with the CB TSH level. CONCLUSION Mainly low Apgar at 1 min which is an indicator of foetal distress/ perinatal asphyxia, prematurity and parity contributed to the significant elevation of CB TSH level. Antenatal steroids can significantly blunt the TSH surge. Due consideration should be given to these factors while interpreting CB TSH levels.

BACKGROUND: Umbilical sepsis is an important cause of neonatal morbidity and mortality. Severe omphalitis necessitates the administration of parenteral antibiotics with a consequent prolongation of hospital stay. AIMS: To assess whether simple protocolised interventions for cord care with locally available chlorhexidine is effective in reducing the incidence of umbilical sepsis. METHODS: This is a retrospective study. A protocol was introduced for daily cord care using 0.5% chlorhexidine gluconate followed by cleaning with sterile water for all newborns in Government Medical College, Ernakulam (formerly Cooperative Medical College, Kochi, Kerala). The incidence and severity of omphalitis was audited for a 3 month period subsequent to this practice change and was compared with the incidence of omphalitis during the same 3 month period in the preceding year. RESULTS: Eighty six babies were in the pre-intervention group and seventy seven in the chlorhexidine group were compared and both the groups were similar with respect to gestational age, sex, mode of delivery and parenteral antibiotic use. There was a significant difference with regard to the overall incidence of omphalitis after chlorhexidine use. Incidence of omphalitis was 44% in the pre-intervention group as compared to 6.5% in the chlorhexidine group (p value<0.05). CONCLUSION: Local administration of 0.5% chlorhexidine is effective in preventing umbilical sepsis.