The mean UVBI was highest between 11 am and 1 pm throughout the year in all locations. No increase in the serum 25(OH)D levels was observed following sun exposure in winter, emphasizing the need for vitamin D supplementation during these months.

In asphyxiated term neonates, early cTnT elevation is a marker for predicting myocardial dysfunction and elevated cTnT levels had high sensitivity and specificity. There was significant relation with increasing cTnT values and increasing grades of HIE.

Introduction: In India, in spite of improvement in perinatal-neonatal care, perinatal asphyxia accounts for 23% of the neonatal deaths. Objective: The objective of the study was to study the clinical profile and short-term outcome of perinatally asphyxiated term neonates. Materials and Methods: This prospective study conducted at a tertiary care teaching hospital in Southern Kerala from June 2011 to June 2015. 120 term asphyxiated neonates fulfilling the inclusion criteria admitted in the NICU were followed up till death or survival. Results: 49.2% babies were inborn and 50.8% babies were outborn. Of the total, 53 (44.2%) were delivered vaginally, 54 (45%) by cesarean section, and 13 (10.8%) by instrumental delivery. Antenatal complications were seen in 58 (48.3%) and intrapartum complications in 93 (77.5%). Hypoxic ischemic encephalopathy (HIE) was diagnosed in 78.3%, with HIE 1 in 19.3%, HIE 2 in 27.5%, and HIE 3 in 31.6%. The mortality was 31 (25.8%) and it was more in out born babies compared to inborn. Factors associated with development of severe HIE (HIE 3) were male gender (p=0.0057), need for endotracheal intubation (p=0.0114), instrumental delivery and pH <7.2 (p=0.0013). Factors associated with mortality were instrumental delivery (p=0.0032), place of birth (p=0.0012), pH ? 7 (p=0.0006), HIE 3 (p<0.0001), and 5 min Apgar ?3 (p=0.0372). Conclusion: HIE was seen in 78.3% perinatally asphyxiated babies with HIE 3 contributing to 31.6%. The mortality rate in HIE 3 was 81.6% which was significantly associated with place of birth, instrumental delivery, pH <7, and 5 min Apgar ?3.

Objective: The aim of this study is to find the characteristics of nutritional rickets and the proportion of cases diagnosed prospectively. Methods: Details of 54 cases of nutritional rickets in the age group of 1 month-12 years diagnosed during 2013-2015 in a tertiary care teaching hospital in Kerala were collected. The criteria taken for diagnosis were clinical features, biochemical parameters such as calcium, phosphorous, alkaline phosphatase (ALP), radiological features, and response to vitamin D treatment. Vitamin D level and serum parathyroid hormone levels were collected whenever it is available. The data were then analyzed statistically. Results: Among the 54 cases analyzed, 61.11% were male. A maximum number of cases were identified in the age group of 1-2 years (44.44%). Nearly 88.89% of patients were born term. About 83.3% of patients were intermediate or dark skinned. The most common clinical feature identified was bowlegs. Radiological features were identified in 70.4% of cases. The most common biochemical abnormality noted was elevated serum ALP (83.33%). Hypocalcemic seizures were a predominant manifestation in <6 months’ age group. Rickets was detected prospectively in 26 patients (48.15%) during evaluation for other illnesses. The mean ALP level was found to be significantly lower in patients with clinical or radiological features of rickets compared to those without clinical or radiological evidence. Conclusions: Rickets is very common in the age group of 1-2 years and among exclusively breastfed term babies. The significant number of cases of nutritional rickets was detected prospectively during evaluation for other illnesses. ALP level may be routinely checked in the vulnerable high-risk age group for identification of early rickets as it is significantly elevated even before clinical and radiological changes appear.

Introduction: Hypoglycaemia is common in babies at risk. Without early detection, timely diagnosis and treatment, hypoglycaemia can cause disastrous consequences on neurological and developmental outcomes. Therefore, continuous monitoring of blood glucose levels in babies at risk should be done to reduce its impact. Aim: To describe the clinical profile and sequential blood sugar levels in the first four postnatal days in at-risk neonates and to identify the risk group of neonates with recurrent hypoglycaemia. Materials and Methods: This was a longitudinal study done in the Neonatal Intensive Care Unit (NICU) and Special Newborn Care Unit (SNCU) of a tertiary care teaching institute; Sri Avittam Thirunal Hospital (SATH), Government Medical College, Thiruvananthapuram, Kerala, India, from October 2017 to October 2018. Neonates admitted with risk factors for hypoglycaemia according to ‘National Neonatology Forum’ clinical guidelines with low capillary blood sugar (<40 mg/dL) within the first two to four hours of life were included in the study. These neonates were followed-up clinically till fourth postnatal day with glucose monitoring. Statistical analysis was done using Statistical Package for the Social Sciences (SPSS) software version 22. Categorical variables were expressed as proportions and compared using the Chi-square test. A p-value <0.05 was considered statistically significant. Results: A total of 368 ‘at risk’neonates had hypoglycaemia at admission (2 to 4 hours) and of these 200 (54.3%) developed recurrent hypoglycaemia. Out of the neonates with recurrent hypoglycaemia, 150 (75%) were preterm and 50 (25%) were term. The preterm Small for Gestational Age (SGA) had a higher chance of developing recurrent hypoglycaemia than preterm Appropriate for Gestational Age (AGA) and Large for Gestational Age (LGA) (p-value=0.0256). Although, 102 (40.2%) preterm had asymptomatic hypoglycaemia, 90 (78.9%) term neonates showed symptoms of hypoglycaemia. The major clinical manifestation was jitteriness in those with a single episode 31 (18.45%) and lethargy/poor activity in those with more than one episode 66 (33%). The blood glucose levels less than 25 mg/dL at admission was significantly associated with the occurrence of a repeat episode of hypoglycaemia (p-value=0.028). Conclusion: Blood glucose monitoring in neonates with risk factors is mandatory as 54.3% of neonates developed recurrent hypoglycaemia. Of these, preterm SGA had a high chance of developing recurrent hypoglycaemia. The variable presentations in neonatal hypoglycaemia indicates the need for detailed and thorough clinical examination with glucose monitoring in these at-risk neonates. Initial blood glucose level less than 25 mg/dL was significantly associated with recurrent hypoglycaemia.