Study of perinatal asphyxia and its outcome concerning nucleated RBC count in venous blood of term neonates

Introduction: Perinatal asphyxia is a serious problem globally and is one of the common causes ofneonatal mortality. Worldwide each year four million infants suffer from birth asphyxia. Of these onemillion die and an equal number develop serious sequelae. Perinatal asphyxia ranks as the secondmost important cause of neonatal death after infections accounting for about 23% of mortalityworldwide. Aim & objective: To establish the level of nucleated red blood cells as an indicator ofpoor immediate outcome in perinatal asphyxia. Method: It was a case-control study done in thedepartment of pediatrics, S C B Medical College & S V P PG I P, Cuttack. Observation: The NRBCcount was significantly higher in neonates with adverse outcomes than in those with favourableoutcomes (p-value <0.001). NRBC count cut-off of >27/100 WBC had a sensitivity of 75% andspecificity of 95.2% in predicting adverse outcome defined as death, hemiplegia, hypertonia orsignificant hypotonia, unreliable sucking and seizures resistant to Phenobarbital. Conclusion:Nucleated red blood cell count can be used as a surrogate marker for birth asphyxia. It has asignificant negative correlation with Apgar score at one minute and Apgar score at 5minutes &significant positive correlation with severity of hypoxic ischemic-encephalopathy, time is taken forrecovery of neurological impairment following birth asphyxia and duration of NICU stay.

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TO STUDY THE CORRELATION OF URINARY URIC ACID AND CREATININE RATIO IN BIRTH ASPHYXIA

10.36106/ijsr/0127075 ◽

2021 ◽

pp. 53-54

Author(s):

B Revanth Reddy ◽

Gauri Chauhan ◽

Anand Kumar Bhardwaj ◽

Sasanka Chakrabarti

Keyword(s):

Uric Acid ◽

Apgar Score ◽

Perinatal Asphyxia ◽

Birth Asphyxia ◽

Control Group ◽

P Value ◽

Creatinine Ratio ◽

Spot Urine ◽

Spot Urine Sample ◽

And Control

Introduction: Perinatal asphyxia is one of the leading causes of perinatal morbidity and mortality. Feasible and early biochemical markers to diagnose and predict the neurologic outcome is a great need of time as APGAR score alone is inuenced by various factors. The present study was performed to determine the urinary uric acid to creatinine ratio in perinatal asphyxia and its correlation with APGAR score and compare urinary uric acid to creatinine ratio with Sarnat and Sarnat staging. Materials and Methods: This study was carried out on 100 term neonates with an equal number of cases and control 50 each, control group being the neonates with Apgar score ≥ 7 at 1 minute of life and cases being the neonates who suffered from perinatal asphyxia with Apgar < 7 at 1 minute of life. The spot urine sample was collected within 24 hours of birth and their uric acid and creatinine levels were measured and the ratio calculated. Asphyxiated neonates were classied according to Sarnat and Sarnat staging. We Compare UA/Cr ratio with Apgar score and HIE staging using Sarnat and Sarnat staging.Results: On comparison of UUA/Cr among cases and controls we found that ratio was signicantly higher in asphyxiated neonates as compared to non asphyxiate neonates. (Control vs. Cases Group: 2.4 ± 1 vs. 3.6 ± 1.5; p –value < 0.0001). On comparison of UUA/Cr among cases with Sarnat and Sarnat staging of HIE, there is a signicant difference observed in mean UA/Cr ratio across Sarnat and Sarnat staging of HIE (F – Value = 68.760; p – value = 0.0001). Conclusion: Urinary uric acid and creatinine ratio can be used as markers for perinatal asphyxia for screening in centers where other markers for assessing perinatal asphyxia are not available. Urinary uric acid and creatinine ratio is a non-invasive, cheap and easily available marker for assessing the severity perinatal asphyxia.

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Association of Adverse Outcomes in Patients with Cirrhosis Presented with COVID-19

10.53350/pjmhs211551134 ◽

2021 ◽

Vol 15 (5) ◽

pp. 1134-1135

Author(s):

M. A. Chhutto ◽

A. H. Mugheri ◽

A. H. Phulpoto ◽

I. A. Ansari ◽

A. Shaikh ◽

...

Keyword(s):

Liver Disease ◽

Chronic Liver Disease ◽

Adverse Outcomes ◽

Chronic Liver ◽

P Value ◽

College Hospital ◽

Medical College ◽

Group A ◽

Group B ◽

Disease Study

Objective: To determine the association of adverse outcomes in term of mortality in patients with cirrhosis presented with coronavirus disease. Study Design: Retrospective/observational study Place and Duration of Study: Department of Medicine, Chandka Medical College Hospital, Larkana from 1st March 2019 to 31st December 2020. Methodology: Two hundred and twenty covid-19 patients of both genders with or without chronic liver disease were enrolled in this study. Patients were categorized in to two groups. Group A (with cirrhosis 60 patients) and group B (without cirrhosis 60 patients). Outcomes in term of mortality between both groups were examined. Results: There were 38 (63.33%) males and 22 (36.67%) were females with mean age 46.14±8.44 years in group A while in group B, 40 (66.67%) and 20 (33.33%) patients were males and females with mean age 45.26±9.34 years. Patients with cirrhosis had high mortality rate as compared to patients without cirrhosis (33.33% Vs 13.33%) with p-value 0.0001. Conclusion: A significant association of adverse outcomes was found in cirrhotic patients with coronavirus disease. Keywords: Chronic Liver Disease, Corvid-19, Mortality

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Analysis of umbilical cord blood gas in term and near term asphyxiated newborn babies

Journal of Patan Academy of Health Sciences ◽

10.3126/jpahs.v4i2.24555 ◽

2017 ◽

Vol 4 (2) ◽

pp. 3-8

Author(s):

Amrit Ghimire ◽

Laxman Shrestha ◽

Merina Shrestha

Keyword(s):

Cord Blood ◽

Umbilical Cord ◽

Apgar Score ◽

Perinatal Asphyxia ◽

Birth Asphyxia ◽

Gas Analysis ◽

Blood Gas ◽

Cross Sectional ◽

Maternal Risk ◽

Blood Ph

Introductions: Birth asphyxia is failure breathing causing severe consequences or death. This study aims to determine the incidence of perinatal asphyxia in neonates with low Apgar and Hypoxic Ischemic Encephalopathy (HIE) in asphyxiated babies. Methods: This was a cross sectional study from November 1, 2010 to July 30, 2011. Babies with Apgar score of less than seven at five minute were enrolled in the study. Blood was drawn from umbilical cord artery for blood gas analysis. Neonates were followed up in every six hours for at least 48 hours. Staging of HIE according to Sarnat staging was done in babies with Apgar score of <7 at five minutes within 24 hours of birth. Data was analysed using SPSS version 16.0. Results: Total of 2,425 live births, 56 (2.30%) were born with an Apgar of < 7 at five minute, six were excluded (due to set exclusion criteria) and remaining 50 were analysed. Thirty-four (68% of 50) of babies with low Apgar score had maternal risk factors – meconium stained liquor being the commonest risk factor. Majority (46%) had cord blood pH of >7.2, 40% had between 7.1 to 7.2, 12% between 7 to 7.1 and remaining 2% had pH < 7. HIE developed in 22% (11/50) of the asphyxiated babies. Conclusions: More than 1/3rd (46%) of babies with low Apgar had low cord blood pH, 1/4th (26%) had base excess, and 22% developed features of HIE. Cord blood pH were better predictors than Apgar in asphyxiated babies.

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Electrolyte abnormalities in asphyxiated newborns

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20181537 ◽

2018 ◽

Vol 5 (3) ◽

pp. 1036

Author(s):

Satheesh Kumar D. ◽

Thenmozhi M. ◽

Kumar .

Keyword(s):

Serum Sodium ◽

Perinatal Asphyxia ◽

Mode Of Delivery ◽

Birth Asphyxia ◽

Neonatal Morbidity ◽

Postnatal Period ◽

P Value ◽

Sodium Potassium ◽

Neonatal Deaths ◽

Electrolyte Abnormalities

Background: Perinatal asphyxia is the most common cause of neonatal morbidity and mortality in worldwide. It accounts for 23% of all neonatal deaths. Electrolyte abnormalities are more common in the immediate post asphyxiated period and influence neonatal the outcome effectively. Aim of this study was to measure the serum sodium, potassium and calcium levels in immediate postnatal period of asphyxiated newborns and assess the correlation with different degree of birth asphyxia.Methods: The serum sodium, potassium and calcium levels were measured in asphyxiated newborns in the early post-natal period. Both intramural and extramural newborns were included irrespective of their mode of delivery but according to the Apgar score. The measured electrolyte values were compared with the different severity of asphyxia. Results: Out of 100 newborns 53 had hyponatremia, 10 had hyperkalemia and 3 had hypocalcemia. The serum sodium and potassium levels showed significant P value (<0.00) with the different degree of both asphyxia but calcium levels were not significant (p valve = 0.06). There was a negative linear correlation with sodium and calcium levels and positive correlation with the serum potassium levels.Conclusions: Hyponatremia was significant in all stages of birth asphyxia, hyperkalemia was significant with increased severity of birth asphyxia and hypocalcemia was only weakly significant even in severe birth asphyxia.

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Effect of oral 25% dextrose on pain relief in newborn infants undergoing venepuncture

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20201149 ◽

2020 ◽

Vol 7 (4) ◽

pp. 891

Author(s):

H. N. Yashwanth Raju ◽

Rudrappa Sudha ◽

Shwetha B. N.

Keyword(s):

Heart Rate ◽

Pain Relief ◽

Pain Score ◽

Gestational Age ◽

Perinatal Asphyxia ◽

Newborn Infants ◽

Blood Sampling ◽

Clinical Indication ◽

P Value ◽

Medical College

Background: Aim of this study was to study effect of oral 25% dextrose for pain relief in newborns undergoing venepuncture.Methods: This is a case control study conducted in NICU, Cheluvamba hospital attached to Mysore medical college and research institute during the period between September 2018 to November 2018. Babies with gestational age between 34 to 40 weeks of gestation who had clinical indication for blood sampling were included in the study. Neonates who are critically ill, suffered perinatal asphyxia and having congenital anomalies were excluded from the study. Hundred newborn babies admitted to NICU who had clinical indication for blood sampling were enrolled in the study. Study population were divided into 2 groups, dextrose (cases) and non-dextrose group (controls). The data analysis included gestational age, postnatal age, weight, sex, heart rate, oxygen saturation, crying time and behavioural pain assessment.Results: Mean pain score, crying time and heart rate at 5 minutes of venepuncture were studied in both the groups. Mean pain score in dextrose group was 2.68 and in non-dextrose group was 7.18 with significant p value of 0.0062. Mean crying time in dextrose group was 8.98 minutes and in non-dextrose group was 42 minutes with significant p value of 0.001. Mean heart rate in dextrose group was 142 beats/minute and in non-dextrose group was 146bpm with p value of 0.08.Conclusions: Pain in the newborns should be recognised and adequately treated. Lingual 25% dextrose can be used as safe and effective analgesia in neonates undergoing minor invasive procedures like venepuncture.

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Maternal factors and feeding pattern in neonates admitted with dehydration

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20182565 ◽

2018 ◽

Vol 5 (4) ◽

pp. 1561

Author(s):

Suresh Goyal ◽

Sunny Malvia ◽

Lakhan Poswal ◽

Bhupesh Jain

Keyword(s):

Breast Feeding ◽

Birth Asphyxia ◽

Postnatal Period ◽

Feeding Pattern ◽

Control Group ◽

P Value ◽

Maternal Factors ◽

Medical College ◽

Delayed Initiation ◽

Education Status

Background: Some healthy breast-fed infants do not establish an adequate milk intake, continue to lose weight and may develop dehydration. The aim of the study is to find out the maternal factors and feeding pattern of neonates admitted with dehydration.Methods: Hospital based prospective study on neonates (>34 week gestation and >2kg birth weight) with signs/symptoms of dehydration and >10% weight loss after birth admitted in the NICU, MBGH, RNT Medical college, Udaipur, Rajasthan, India for period of 12 months from July 2015-June 2016. Sick neonates with sepsis, birth asphyxia and congenital anomalies were excluded. One apparently healthy neonate and mother selected randomly for each study group dehydrated neonate. Ethical clearance and informed consent for the study was taken.Results: 384 neonates with dehydration were enrolled. Most neonates (96.6%) with dehydration were admitted between Day 3-14 of birth. Dehydration was found in 2.5% caesarean section and 0.8% normal vaginal delivered neonates (p value<0.00001). Dehydrated neonates groups (n=384) was compared with non dehydrated healthy control group (n=384) neonates. Primiparous mothers (p value <0.00001), Pregnancy related complications (p value=0.02), delayed initiation of breast feeding (>1 hour) after birth (p value<0.00001), poor attachment during breast feeding (p value <0.00001), absent let down reflex (p value<0.00001), decreased (<8/day) breast feeding frequency (p value<0.00001), presence of nipple problems (p value<0.001) were more significantly present in dehydrated group as compared to control group. Socioeconomic status, education status and position of mother during breast feeding among mothers in dehydrated group were not significant. 379 neonates were discharged successfully, and 5 neonates expired.Conclusions: Dehydration is a serious problem in breastfed neonates, and early initiation of breast feeding, with proper counselling of breast feeding practices with breast examination in antenatal as well as postnatal period can help in its prevention.

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Maternal Anemia Prevalence and Subsequent Neonatal Complications in Iraq

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2020.3593 ◽

2020 ◽

Vol 8 (B) ◽

pp. 71-75

Author(s):

Shaymaa Kadhim Jasim ◽

Hayder Al-Momen ◽

Farah Al-Asadi

Keyword(s):

Birth Weight ◽

Gestational Age ◽

Apgar Score ◽

Birth Asphyxia ◽

Adverse Outcomes ◽

Delivery Mode ◽

Severe Anemia ◽

Maternal Anemia ◽

Tertiary Center ◽

Anemia Group

BACKGROUND: Anemia during pregnancy is still a challenge throughout the world, and it may cause severe health consequences in the maternal and fetal sides. AIM: This study aims to find out the prevalence of maternal anemia and potential adverse outcomes in Iraq. METHODS: In Medical City Tertiary Center in Baghdad, singleton pregnant ladies came for delivery were involved over 6 months’ period. Based on hemoglobin (Hb) readings; they were divided into no anemia group (Hb>11 g/l) and anemia group which were further subdivided into mild, moderate, and severe (Hb =10–10.9, =7.1–9.9, and <7 g/l, respectively). Full history and examination were performed by attending obstetrician and pediatrician for the upcoming babies. RESULTS: Maternal anemia prevalence was 84.84% out of 4473 cases. No anemia group was 15.16%, mild 40.73%, and moderate 40.73%, while severe anemia group (24.93%). Maternal occupation, educational status, and Hb levels were significantly associated with anemia (p < 0.001), unlike parity, body mass index, and delivery mode. Neonatal preterm delivery, birth weight and length, small for gestational age (SGA), Apgar score, respiratory distress, and high death rate were strongly related to mothers’ anemia (p < 0.001), on the contrary of septicemia, birth asphyxia, and hypoglycemia, in spite of their higher frequency rates in anemia groups. Birth weight, and length, and gestational age were lowered significantly in moderate and severe anemia, while Apgar score was low throughout all anemia categories. SGA was significant in severe anemia. CONCLUSION: Maternal anemia is highly prevalent in Iraq with significant adverse neonatal events and elevated rates of mortality.

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Serum Magnesium and Calcium Status among Term Asphyxiated Newborns with Moderate to Severe Hypoxic-ischemic Encephalopathy (HIE)

Journal of Dhaka Medical College ◽

10.3329/jdmc.v26i2.38833 ◽

2018 ◽

Vol 26 (2) ◽

pp. 148-152

Author(s):

Rifat Zaman ◽

Md Abid Hossain Mollah ◽

Mohammad Mahfuzur Rahman Chowdhury ◽

Shamima Yeasmin ◽

Abu Sayeed Chowdhury ◽

...

Keyword(s):

Serum Calcium ◽

Apgar Score ◽

Calcium Level ◽

Perinatal Asphyxia ◽

Pearson Correlation ◽

Statistical Significance ◽

Serum Magnesium ◽

The Body ◽

Medical College ◽

Calcium Status

Background & objective: Perinatal asphyxia affects all organs of the body and brain is the most affected organ. The study was undertaken to find out the status of serum magnesium and calcium level and their significant association among asphyxiated term newborns with moderate to severe HIE.Material & methods: The Cross sectional study was done in the Department of Neonatology, Dhaka Medical College Hospital during January 2012 to July 2012. A total of 102 asphyxiated term neonates were enrolled , who has H/O perinatal asphyxia and had Apgar score of 6 or <6 at 5 minutes. Clinical grading of HIE into moderate and severe was done according to modified Sarnat and Sarnat scoring system .Under aseptic precautions with standard protocol , estimation of serum magnesium and calcium level in venous blood was done at 48 hours and 7th day of birth . Among the study population , 17 patients had died during follow up and 4 patients were absconded. Finally 81 patients were evaluated by both blood samples though initial 102 cases were evaluated by their first sample. 50 normal healthy infants were also evaluated for serum magnesium and calcium at their 48 hours of birth. Chi-square test was used to assess statistical significance, Pearson correlation coefficient test was done to find out correlation between serum magnesium and calcium status and APGAR score & t test was done to assess the comparison between the values of serum magnesium and calcium found on two occasions.Results: Of 102 cases majority (58%) were male. Most of the cases (65.68%) were moderate HIE. Mean serum magnesium was 1.36(0.9-2.8) mg/dl and 1.16(.88-2.6) mg/dl among HIE II and HIE III respectively (p<0.05). Mean serum calcium of HIE II and HIE III were 7.14(5.1-9.6) mg/dl and 6.58(5.3-9.0) mg/dl respectively (p<0.05). There is positive correlation with individual APGAR score with serum magnesium (r=0.229, p=0.02) and serum calcium (r=0.231, p=0.019) level. Hypocalcaemia was found 35.82% and 57.14% among HIE II And HIE III cases respectively(p<0.01). Hypomagnesaemia was found 28.36% and 45.71% among HIE II and HIE III (p<0.05).Conclusion: Hypomagnesaemia and hypocalcaemia are significantly associated with the degree of severity of HIE.J Dhaka Medical College, Vol. 26, No.2, October, 2017, Page 148-152

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MECONIUM STAINED LIQOUR AND ITS IMPACT ON PERINATAL OUTCOME

10.36106/ijsr/3726830 ◽

2021 ◽

pp. 47-49

Author(s):

Ranjana Sharma ◽

Manju Agarwal

Keyword(s):

Prospective Observational Study ◽

Perinatal Asphyxia ◽

Birth Asphyxia ◽

Neonatal Morbidity ◽

Meconium Aspiration Syndrome ◽

Morbidity And Mortality ◽

Medical College ◽

Increased Risk ◽

Nicu Admission ◽

One Year

Background- The occurrence of meconium-stained amniotic uid (MSAF) during labor has long been considered the predictor of adverse fetal outcomes such as meconium aspiration syndrome and perinatal asphyxia, which leads to perinatal and neonatal morbidity and mortality Methods- A Prospective observational study was carried out in Smt. Hira Kunwar Ba Mahila Hospital, Jhalawar attached to Jhalawar Medical College,over one year from January 2020 to January 2021. Total 278 cases taken at random basis having following inclusion criteria Result- MSL is responsible for neonatal morbidity in 15.1% of cases. Rate of neonatal morbidity was higher in thick meconium group (24.9%) as compared to thin meconium group (6.2%) and this difference was statistically signicant. In our study birth asphyxia (5.8%) was the most common complication followed by MAS (4%), Pneumonitis (3.6%) and Sepsis (1.8%). Conclusion- Passage of meconium still remains as an enigma to the obstetrician and equally worries the paediatrician. As shown in the study, thick meconium is associated with increased operative intervention, low apgar score, increased rate of NICU admission and increased risk of neonatal morbidity and mortality as compared to thin meconium.

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FEBRILE SEIZURES

The Professional Medical Journal ◽

10.29309/tpmj/2018.25.03.395 ◽

2018 ◽

Vol 25 (03) ◽

pp. 461-465

Author(s):

Nathumal Maheshwari ◽

Om Perkash ◽

Mehmood Shaikh ◽

Bilawal Hingorjo ◽

Yasmeen Kazi ◽

...

Keyword(s):

Venous Blood ◽

Tertiary Care ◽

Serum Zinc ◽

Febrile Seizures ◽

P Value ◽

Care Hospital ◽

Cross Sectional ◽

Medical College ◽

Zinc Levels ◽

Serum Zinc Levels

Objectives: To determine the serum zinc levels in children with simple febrileseizures reporting at a tertiary care hospital of Sindh. Study Design: Cross sectional study.Place and Duration: Department of Paediatrics, Layari General Hospital Shaheed MuhtramaBenazir Bhutto Medical College from January 2015 to February 2016. Methodology: A sampleof 120 children (60 cases and 60 controls) was selected through non- probability (purposivesampling) by pre defined inclusion and exclusion criteria. 3 ml venous blood was taken from aperipheral vein. Blood was process, centrifuged and sera were used for the analysis of serumzinc. Data of cases and controls was analyzed on Statistix 10.0 software (USA). P-value of≤0.05 was considered statistically significant. Results: Age of controls and cases was notedas 13.68±8.74 and 15.75±9.11 months respectively and most common age group was 12 - 24months in the cases. Male children predominated. Means± SD serum zinc was 79.03±24.17and 62.82±14.66 in controls and cases respectively (P=0.0001). Low serum zinc was noted in66.6% of cases compared to 40% in controls (P=0.0001). Conclusion: We noted low serumzinc levels in children with febrile seizures which may provoke febrile seizures. Children with lowserum zinc levels are prone to febrile seizures.

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