Background: Kangaroo mother care is an evidence-based, low cost and high impact approach that has shown significant reduction in preterm mortality. Practising KMC in COVID 19 era, is a challenge for mothers and the NICU’s. Aim of the study was to assess the effect of this pandemic on the practice of KMC in our NICU and opine about the possible barriers.Methods: It was a retrospective observational cohort study. Data was collected from the NICU records. Neonates fulfilling the inclusion criteria were classified as pre COVID-19 epoch (January 2020 to March 2020) and post COVID-19 epoch (April 2020 to June 2020). KMC hours provided were compared between the two groups.Results: Forty-six neonates were included in epoch 1 and Forty-two in epoch 2. Outcomes were analysed between the groups for primary measures, cumulative KMC hours reduced significantly in after COVID-19 period compared to the other group (median of 2 hours v/s 17 hours respectively), p value<0.001. Similarly, time to introduce first feeds increased from 6 hours in epoch 1 to 12 hours in epoch 2, p value=0.004.Conclusions: COVID-19 pandemic has affected the duration of KMC inside the NICU. Lack of clear guidelines/training about continuing KMC in COVID times has further lead to decrease in KMC duration as reported in the present study. Training and awareness regarding the benefits of KMC which outweigh its possible risks and proper sanitization and hand hygiene for both healthcare providers and KMC providers need to be enforced to continue this good practice in the NICU’s and the community.
Background: Bronchiolitis is a common respiratory tract infection in young children. Respiratory Syncytial Virus (RSV) is the common etiological agent, with highest incidence occurring between December and March. 90% of children are infected in the first 2 years of life. Infants hospitalized are more likely to have respiratory problems as older children, especially recurrent wheezing. The treatment is mainly supportive. Mild cases are managed with antipyretics, hydration and home remedies/cough formulas. Moderate cases may require humidified oxygen, parenteral fluids to maintain hydration and nebulization with bronchodilators. Nebulization with adrenaline along with IV dexamethasone more effective in terms of reduction in the duration of the symptoms and length of hospital stay.Methods: This prospective study was done for 1 year from May 2015 onwards.120 clinically diagnosed cases of bronchiolitis were included. cases were classified into 2 groups on the basis of RDAI score, Mild cases with score of 4-15 &Severe cases with score of >15. All cases were divided in 3 therapeutic groups, A- nebulized with adrenaline alone, B- single dose of IV dexamethasone and nebulized adrenaline, C- nebulized with 3% hypertonic saline alone. Nebulization was done at 0,30,60 minutes interval and then 4 hourly till improvement of symptoms.Results: Out of total 120 cases,74(61.66%) belonged to age group of 2-6 months. Males were more affected than females with ratio of 2.15:1. Most of patients (83.3%) had hyperinflated lung field in X-ray finding. Children with preterm birth had severe disease. The mean RDAI score was found to be reduced highest in adrenaline plus dexamethasone group that is 2.37±0.80 within 24 hours of admission with 26.24% reduction in the length of hospital stay as compared to group A and 20.61% as compared to group C.Conclusions: combination of nebulized adrenaline and dexamethasone is better in terms of reducing clinical severity, length of hospital stay in children with moderate severity of acute bronchiolitis in comparison to adrenaline alone and 3% hypertonic saline alone.
A 34-wk preterm male neonate, with a birth weight 2.612 kg, born to a 27-y-old, 3rd gravida, antenatally showing polyhydramnios and fetal ascites, was referred to us immediately after delivery for severe abdominal distention. Mother was diagnosed case of cervical tubercular lymphadenitis since 20 wk of current pregnancy, for which she was taking Antitubercular treatment (ATT) with good compliance. At birth baby was hemodynamically stable with gross abdominal distention.X-ray erect abdomen was suggestive of pneumoperitoneum. Initially gastric lavage for acid fast bacilli (AFB) and CB-NAAT were negative. Chest X-ray was normal and liver morphology was normal on ultrasound. Placenta was not available for examination as it was transferred ex-utero to our facility. Exploratory laparotomy was done, which showed giant cystic cavity with meconium peritonitis and terminal ileum perforation with adhesions. Terminal ileum, cystic cavity and proximal colon were excised in toto and end-to-end anastomosis performed. Later feeds were initiated after 5 d and full feeds were established by day 10. Histopathological examination (HPE) of the specimen showed meconium peritonitis, serositis and reduplication cyst. There were no granulomas in HPE. The tissue specimen comprising of cyst wall was subjected to DNA based genetic testing for tuberculosis (TB) using GenoType MTBDRplus VER 2.0 kit. The test showed positive result for Mycobacterium tuberculosis, sensitive to Rifampicin and Isoniazid. This test has sensitivity of 96.4% and specificity of 100%; however as with any DNA detection method, the DNA recovered may be from viable or non-viable bacteria [1,2].Baby was started on 4 drug ATT regimen (2HRZE/4HR) as per RNTCP guidelines. Baby was discharged successfully on day 14 of life. On follow-up baby is thriving well, weighing 6.520 kg at 5 mo.Our case meets Cantwell's criteria for diagnosis of congenital TB as the primary focus was in abdomen, proved by gene study within 1 week of life, with a history of TB in mother [3]. TB demonstrated an approximately two-fold risk of prematurity as happened in our case [4]. Signs and symptoms of congenital TB are usually non-specific and include respiratory distress, fever and hepatosplenomegaly [4,5]. Our case presented with abdominal signs. TB is known to clinically present in varied forms and pose diagnostic challenges. To our knowledge this is first case report of Giant Cystic Meconium Peritonitis caused by intestinal perforation due to Congenital TB.
Background: Febrile seizure are seizure that occur between the age of 6 month to 60 months with a temperature of 100.4f or higher, that are not the result of central nervous system infection or any metabolic imbalance and that occur in the absence of a history of prior afebrile seizure. Febrile seizures are the commonest cause of seizures in children, occuring in 2-5% of children. The maximum age of febrile convulsion occurrence is 14-18 months, which overlap with the maximum prevalence of iron deficiency anaemia which is 1-2 year old. 7 So far, the dilemma of cause of febrile seizure could not be solved. Standard text book still mention iron deficiency is associated with an increased risk of febrile seizure, thus screening for that problem and treating it appears appropriate.Methods: This case control study was done from June 2015 to December 2016. 60 cases of first episode of simple febrile seizure in age group of 6 month to 5 years were included in the study. A control group was selected from age and sex matched children admitted with febrile illness but without seizure. In all cases detailed clinical history, anthropometry, clinical sign of iron deficiency, CNS examination, CBC, PBF, Red cell indices, serum iron, serum ferritin and serum TIBC level was done. These were analysed in three groups mild, moderate, severe deficiency of anemia. A clinical correlation is tried to establish between overt and subtle iron deficiency with seizure.Results: Majority of subjects with first episode of simple febrile seizure were males (63.3%). Majority of cases of febrile seizure occur in the 6-24 months age group (83.3%). Incidence of anemia among case group subjects was 90.0% whereas the same in control group was 30 %. Mean RDW and TIBC levels in cases were significantly higher as compared to that in controls. MCV, Mean Serum ferritin and Serum Iron levels in cases were significantly lower as compared to that in controls.Conclusions: The findings in present study established an association between iron deficiency anemia and first episode of simple febrile seizures.
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