Lay summary The current pandemic of COVID-19 has affected all the countries globally. However, the adverse impact of the pandemic is more seen in the low-income and middle-income countries (LMICs). Although there is evidence on the adverse impact of the SARS-CoV-2 on the health of mothers and neonates, the evidence is mainly from high-income countries. For reducing the mortality and morbidity due to COVID-19 in LMICs, there is a need to generate evidence from the LMICs. The present study is a part of the National Registry of pregnant women with COVID-19 in India (PregCovid registry). Our study demonstrates a higher risk of adverse outcomes such as neonatal sepsis and death in the SARS-CoV-2 infected as compared to the non-infected neonates. The study also showed the risk of SARS-CoV-2 infection in 6.3% of neonates born to mothers with COVID-19. Introduction We describe the clinical characteristics, management, and short-term outcomes of SARS-CoV-2 neonates born to mothers with COVID-19 in a tertiary care hospital in Mumbai, India. Methods The study is a retrospective analysis of 524 neonates born to mothers with COVID-19 admitted from 14th April 2020 to 31st July 2020. Results SARS-CoV-2 infection was detected in 6.3% of the newborns of the mothers with COVID-19. No significant differences were observed between maturity at gestation, birth weight and sex of SARS-CoV-2 infected and non-infected newborns. The risk of sepsis was 4.09 (95% CI,1.28-13.00) fold higher in the neonates with SARS-CoV-2 as compared to the non-infected group (p = 0.031). Poor feeding was significantly more common among SARS-CoV-2 infected neonates (12.1%) as compared to the non-infected neonates (2.7%) (p = 0.017). There was a total of 13 neonatal deaths, of which 3 deaths occurred in SARS-CoV-2 infected neonates (9%) while 10 (3%) in the SAR-CoV-2 negative group. The risk of neonatal death was higher in SARS-CoV-2 infected newborns (OR 4.8; 95% CI 1.25-18.36). Conclusion Neonatal SARS-CoV-2 infection is observed in almost 6% of neonates born to mothers with perinatal COVID-19. There is a higher risk of adverse outcomes such as neonatal sepsis and death in the SARS-CoV-2 infected as compared to the non-infected neonates.
The term malnutrition involves both over nutrition, accompanying with overweight, obesity, and under-nutrition including acute and chronic malnutrition as well as micronutrient deficiencies. The present study was undertaken to assess clinical outcome at 8 weeks and 6 months in children with Severe Thinness on Medical Nutrition Therapy (MNT). A total of 52 severe thinness (ST) children were enrolled and given MNT. The anthropometry was recorded at every visit and analyzed at two time points viz.8 weeks and 6 months. The body mass index has been measured using formula: weight (kg)/height(metre)2. Mean weight on enrolment was 15.85±4.08 kg. At 8 weeks, mean weight was 17.35±4.55 kg and at 6 months it was 19.33±5.12 kg. Mean height on enrolment was 114.33±14.06 cm while at 8 weeks was 115.27±14.06 cm and at 6 months was 120.21±15.29 cm. Mean BMI on enrolment was 11.92±0.44kg/m2 while at 8 weeks it improved to 12.89±0.67kg/m2; at 6 months, it continued improved to 13.26±0.96kg/m2. Rate of weight gain from enrolment to 8 weeks was 1.67 grams/kg/day and from 8 weeks to 6 months was 0.36 gm/kg/day (P<0.001). At end of 8 weeks, in 73.33% subjects BMI improved to thin and 17.8% became normal while 8.9 % continued to remain ST. At 6 months, 22.22% remained ST, 33.33% subjects remained thin and 44.44% became normal. Improvement in mean weight and mean BMI as well as rate of weight gain was significant indicating the role of indigenously prepared MNT in improving acute malnutrition.
Background: The period from birth to 6 months is part of a larger critical ‘window of opportunity’ within which the impact of undernutrition has both immediate and long term adverse consequences. Protocols for older children are often extended to this age group owing to the absence of evidence-based treatment protocols. The following study was carried out to assess the effectiveness of supplementary suckling technique and lactation counselling over counselling alone in management of malnourished infants in the age group of 1- 6 months.Methods: After IRB clearance, all underweight infants with weight for age <-2SD by WHO charts were enrolled in the study. Once identified as lactation failure, the infants were randomly allocated into two groups using SAS 9.2 package. Both, cases and controls were counselled regarding breast feeding practices as per WHO module. Cases were additionally started on supplementary feeds by Supplementary Suckling Technique (SST) for the 1st week. Weight gain was monitored at enrolment, on day 7 and day 14. Weight gain >20gm/day in the 2nd week was considered successful re-lactation. Data was analysed using student unpaired t test and chi square test.Results: Mean weight gain per day in 1st and 2nd week in the cases was significantly higher than that in the controls (p= <0.001). In 2nd week, maximum weight gain i.e. 20-30 g/day was found in 93.3% cases as against 13.3% controls (p=0.01) depicting successful re-lactation.Conclusions: Lactation counselling along with supplementary suckling technique should be the standard of care in management of malnourished infants.
Enteric fever is a common infectious disease of the tropical world. Common age group involved is children aged between 5 and 10 years. In addition to diarrhea, it may lead to extraintestinal infections including aseptic meningitis, hepatitis, cholecystitis, acute abdomen, intestinal perforation, pneumonia, psychosis, and ataxia. Hematologic complications leading to hemophagocytosis have a prevalence of < 1%. Salmonella meningitis has an incidence of 6% with poor prognosis neurological sequelae. We report a rare case of enteric fever that presented with hemophagocytic syndrome and S. meningitis . Response to third-generation cephalosporins is dramatic, eventually giving good prognosis.
Background Injection for vaccinations is the most prevalent source of iatrogenic pain in infants. The facilitated rocking movement is a new technique which is to be evaluated to reduce vaccination-induced pain in newborns and young infants. Hence, the present study was designed to study the effect of facilitated rocking movement in reducing vaccination-induced pain in young infants. Method A total of 70 infants < 6 months attending vaccination clinic, full-term born babies with weight > 2.5 kg and clinically well infants were enrolled and randomized in two equal groups, i.e., facilitated rocking movement (treatment/group 1) and classical holding group (control/group 2). Results Both the groups were comparable and found no significant (p > 0.05) difference as regards education, occupation, socioeconomic status, type and number of deliveries, gestational age of mother as well as birth weight, gender and hemodynamic parameters of infants. The crying time was significantly (p = 0.0001) lower among children of group 1 (35.79 ± 5.12 s) than group 2 (59.71 ± 7.93 s). There was a significant difference (p = 0.0001) in NIPS score among the groups after baseline. At baseline, mild severity of pain was observed in the majority of children in both groups (92.9% in each), while at 1 min after prick mild severity of pain was more in group 1 (92.9%) than in group 2 (28.6%), (p = 0.0001). Conclusion The assisted rocking movement proved more helpful than the traditional holding position in alleviating pain caused by vaccinations in infants aged less than 6 months. As a result of its easy, cheap and noninvasive application, this position can be utilized in combination with pharmacological techniques during painful procedures. Further ascertainment by comparing other techniques such as the analgesic effects of sucrose, expressed breast milk and breast-feeding should be carried out.
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