scholarly journals Neurological assessment and immediate outcome of newborns treated with therapeutic hypothermia at tertiary care hospital of southern Rajasthan-a randomized control trial

2021 ◽  
Vol 8 (5) ◽  
pp. 844
Author(s):  
Suresh Goyal ◽  
Anuradha Sanadhya ◽  
Juhi Mehrotra ◽  
Bhupesh Jain ◽  
Ritika Kachhwaha
Keyword(s):  
Therapeutic Hypothermia ◽  
Neurological Outcome ◽  
Tertiary Care ◽  
Birth Asphyxia ◽  
Standard Of Care ◽  
Developed Countries ◽  
Control Group ◽  
Care Hospital ◽  
Not Given ◽  
Neurological Assessment

Background: Therapeutic hypothermia (TH) is standard-of-care for infants with moderate and severe HIE in developed countries; TH has been shown to decrease the risk of brain injury in asphyxiated newborns. Observations were like: 1) Asses morbidity and mortality in neonates with moderate and severe birth asphyxia treated with TH and 2) Asses neurological outcome in neonates.Methods: A RCT was done in NICU of Balchikitsalaya, RNTMC, Udaipur. Phase changing material, FS 21, FS 29 used to provide TH for 72 hours, started within 6 hours of birth and neurological outcome was assessed.Results: Total 60 neonates were enrolled 30 cases given TH and 30 control not given TH. Neurological assessment on basis of Thompson scoring, done on admission, 24, 48, 72 and 96 hours for both groups. At 48 hours, mean score in controls 14.5±1.67 and cases 11.47±2.34 (p<0.05). At discharge, mean score for controls was 11.31±3.67 and for cases was 5.24±2.72 (p<0.005). Mortality was 4 (13.3%) in cases and 11 (36.7%) in control group. Among 45 survivors, 25 (55.5%) required anticonvulsant at discharge; 15 from controls, 10 from cases group.Conclusions: There was significant decrease in mortality in birth asphyxia babies given TH as compared to babies not given TH. Also, significant improvement in Thompson score among the cooled neonates at and after 48 hours of age suggestive of better immediate neurological outcome in these babies. Anticonvulsant’s requirement was also significantly less in therapeutic hypothermia group.

scholarly journals A randomized control trial on early open patient department-based assessment tool for prediction of neurological outcomes at the age of 1 month of life in asphyxiated neonates who underwent whole body cooling at tertiary care hospital in Southern Rajasthan

2021 ◽  
Vol 8 (10) ◽  
pp. 1689
Author(s):  
Anuradha Sanadhya ◽  
Suresh Goyal ◽  
Juhi Mehrotra ◽  
Sunny Malvia
Keyword(s):  
Therapeutic Hypothermia ◽  
Neurological Outcome ◽  
Randomized Control Trial ◽  
Tertiary Care ◽  
Birth Asphyxia ◽  
Whole Body ◽  
Care Hospital ◽  
Neurological Assessment ◽  
Neurological Outcomes ◽  
Randomized Control

Background: Therapeutic hypothermia (TH) is standard-of-care for infants with moderate to severe hypoxic ischemic encephalopathy (HIE) in developed countries. It should be implemented within 6 hours after delivery, and it has shown to significantly decrease the risk of brain injury in newborns exposed to perinatal hypoxemic ischemic insult with improved neurological outcomes. Objectives of the study were to assess early neurological outcome of neonates with moderate to severe birth asphyxia treated with TH.Methods: A randomized control trial was done in NICU of Balchikitsalaya, RNT medical college, Udaipur, on neonates with evidence of grade II/III HIE. We used phase changing material-FS 21, FS 29 to provide whole body hypothermia for 72 hours within 6 hours of birth and observed the babies for early neurological outcome. Results: A total of 60 neonates were enrolled in the study, 30 as cases, treated with therapeutic hypothermia and 30 as controls in normothermic environment. Neurological assessment was made on the basis of Thompson scoring and Ameil-Tison neurological assessment at term (ATNAT) at one month of age. We observed a better ATNAT score in TH group as compared to controls (p<0.05). Thompson score was significantly less in surviving neonates suggestive of better early neonatal outcome. Conclusions: Statistically significant data suggestive of better early neurological outcomes were seen in the cases treated with 72 hours of hypothermia. These babies not only had lesser Thompson scores, but also showed better tone, and Improved ATNAT scores at 1 month of age, making this study important as an early marker of neurological injury/morbidity in later life.

ASSESSMENT OF BURDEN OF ASPHYXIATED BABIES ACCORDING TOMETHOD OF RESUSCITATION AT TERTIARY CARE HOSPITAL

2019 ◽  
Vol 3 (10) ◽  
Author(s):  
Dr. Satya Narayan Bijarnia ◽  
Dr. Deveshwar Dev ◽  
Dr. R K Gupta
Keyword(s):  
Clinical Symptoms ◽  
Perinatal Asphyxia ◽  
Tertiary Care ◽  
Birth Asphyxia ◽  
Control Group ◽  
Care Hospital ◽  
Term Infants ◽  
Female Ratio ◽  
New Born ◽  
Male Female Ratio

Background: Perinatal asphyxia is characterized among the fetus or new born due to deficiency of perfusion to the various organs of the fetus or new born. Birth asphyxia is the single most important perinatal cause of brain damage in term infants. When asphyxia is followed by an abnormal neonatal behavior a syndrome has been described known as hypoxic ischemic encephalopathy. Material & Methods: The new born with congenital malformation of CNS were excluded from the study. Each selected newborn was subjected to Apgar scoring at birth and assessment of gestational age. The Apgar scoring was done at one and five minutes after births and infants were categorized into mild, moderate and severe birth asphyxia according to Apgar score at 1 minute of age after birth Results: In the present study, on the basis of clinical symptoms we found that asphyxiated group males comprised 62% cases and females 38% cases male female ratio was 1.63:1.0 it is statistically in significant. as compared to control group where male female ratio was 2.59:1. In Mild and moderate asphyxia male preponderance was seen while in severe asphyxia the difference was not marked There was no statistically significant sex difference in birth asphyxia. Conclusion: We concluded from the present study that in resuscitation of mild and moderately asphyxiated babies Bag and Mask was used more frequently (40% and 82.5% respectively) and endotracheal tube with Ambubag was used more (75%) frequently for severely asphyxiated babes. Key words: asphyxia, resuscitation, Ambubag.

scholarly journals The effect of care transition pathway implementation on patients undergoing joint replacement during the COVID-19 pandemic: a quasi-experimental study from a tertiary care hospital orthopedic department in Beijing, China

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Ya-ping Xu ◽  
Pei-yu Zhao ◽  
Yi-tong Bai ◽  
Shuang Li
Keyword(s):  
Joint Replacement ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Transition ◽  
Control Group ◽  
Care Hospital ◽  
Quasi Experimental ◽  
And Control ◽  
Beijing China

Abstract Background The coronavirus disease (COVID-19) pandemic has had a massive impact on individuals globally. The Chinese government has formulated effective response measures, and medical personnel have been actively responding to challenges associated with the epidemic prevention and control strategies. This study aimed to evaluate the effect of the implementation of a care transition pathway on patients that underwent joint replacement during the COVID-19 pandemic. Methods A quasi-experimental study was designed to evaluate the effect of implementing a care transition pathway for patients who underwent joint replacement during the COVID-19 pandemic in the orthopedic department of a tertiary care hospital in Beijing, China. Using a convenient sampling method, a total of 96 patients were selected. Of these, 51 patients who had undergone joint replacement in 2019 and received treatment via the routine nursing path were included in the control group. The remaining 45 patients who underwent joint replacement during the COVID-19 epidemic in 2020 and received therapy via the care transition pathway due to the implementation of epidemic prevention and control measures were included in the observation group. The quality of care transition was assessed by the Care Transition Measure (CTM), and patients were followed up 1 week after discharge. Results The observation group was determined to have better general self-care preparation, written planning materials, doctor-patient communication, health monitoring, and quality of care transition than the control group. Conclusions A care transition pathway was developed to provide patients with care while transitioning through periods of treatment. It improved the patient perceptions of nursing quality. The COVID-19 pandemic is a huge challenge for health professionals, but we have the ability to improve features of workflows to provide the best possible patient care.

ALKALINE PHOSPHATASE AS A PROGNOSTIC MARKER IN CANCER BREAST PATIENTS IN A TERTIARY CARE HOSPITAL

2021 ◽  
pp. 14-16
Author(s):  
Asha Premlata Omega Oraon ◽  
Bela Rose Ekka
Keyword(s):  
Alkaline Phosphatase ◽  
Cancer Patients ◽  
Prognostic Marker ◽  
Prognostic Markers ◽  
Tertiary Care Hospital ◽  
Serum Alkaline Phosphatase ◽  
Tertiary Care ◽  
Control Group ◽  
Care Hospital ◽  
Cancer Breast

OBJECTIVE: To estimate the value of Alkaline Phosphatase in cancer breast patients in a tertiary care hospital. MATERIAL AND METHODS: The study was conducted to estimate the value of Serum Alkaline Phosphatase in 50 cancer breast patients and 50 normal patients of same age as a control group. RESULTS: The level of serum Alkaline Phosphatase was signicantly increased (p<0.05)in cancer patients compared to the control group. CONCLUSION: There is an increase in serum Alkaline Phosphatase in cancer patients compared to the control group and can be a prognostic markers for the progress of the disease.

MATERNOFETAL OUTCOME IN MECONIUM STAINED LIQUOR AT TERTIARY CARE HOSPITAL

2021 ◽  
pp. 48-50
Author(s):  
Neha Agarwal ◽  
Samta Bali Rathore ◽  
Shivani Baberwal-
Keyword(s):  
Caesarean Section ◽  
Perinatal Asphyxia ◽  
Tertiary Care ◽  
Mode Of Delivery ◽  
Birth Asphyxia ◽  
Meconium Aspiration Syndrome ◽  
Care Hospital ◽  
Pregnancy Induced Hypertension ◽  
Meconium Aspiration ◽  
Induced Hypertension

BACKGROUND: Occurance of meconium-stained amniotic uid (MSAF) during labour may be considered as a measure for prediction of poor fetal outcomes such as meconium aspiration syndrome and perinatal asphyxia ,resulting in perinatal as well as neonatal morbidity and mortality. It constitutes about 5% of deliveries with meconium stained amniotic uid and death results in about 12% of infants with MAS. METHODS: 40 cases of meconium stained liquor detected after spontaneous or artical rupture of membranes taken during labour from june 2020 to december 2020 and their outcome in terms of mode of delivery(whether vaginal delivery or lower segment caesarean section) and fetal outcome and associated maternal high risk were studied RESULT: Anemia was co existant in around 15%, pregnancy induced hypertension(PIH) in 25%and premature rupture of membrane in 10%.Pregnancies complicated with Pregnancy induced hypertension had signicant higher rate of meconium stained liquor among all cases. Caesarean Section was commonly performed in meconium stained amniotic uid cases and accounted for about 65%of all cases. CONCLUSIONS: Meconium Stained amniotic uid increases the chances of caesarean rates,leading to birth asphyxia ,Meconium Aspiration Syndrome and hence increases the chances of neonatal intensive unit admission.

scholarly journals A prospective case control study of the effects of oligohydramnios on fetomaternal outcome in mothers with term pregnancy in a rural medical college

2018 ◽  
Vol 7 (11) ◽  
pp. 4706
Author(s):  
Dipak Mandi ◽  
Sayantan Sen ◽  
Vasundhara Goswami
Keyword(s):  
Demographic Data ◽  
Tertiary Care ◽  
Birth Asphyxia ◽  
Case Control ◽  
Control Group ◽  
Case Group ◽  
Perinatal Complications ◽  
Medical College ◽  
Increased Risk ◽  
Nicu Admission

Background: The aim of the current study was to assess the fetomaternal effects of oligohydramnios on term pregnancies in a rural tertiary care setup.Methods: A perspective case control hospital-based trial was conducted at Burdwan Medical College and Hospital for a period of one year. Pregnancies at term (37-42 weeks) were included in the study. 103 patients with sonographically diagnosed oligohydramnios were included in the case group. The control group comprised of 103 mothers at term with normal liquor volume. Demographic data and fetomaternal outcome parameters were assessed and compared.Results: There was increased incidence of fetal and perinatal complications including low birth weight, birth asphyxia and NICU admission. There were more perinatal deaths in the case group compared to the control group. Induction of labour, operative delivery, meconium stained liquor and incidence of preeclampsia were also increased in mothers with low AFI.Conclusions: Oligohydramnios is associated with an increased risk of labour and perinatal complications. Adequate antenatal surveillance and intranatal monitoring coupled with correction of underly-ing factors is the mainstay of management.

scholarly journals 1225. How Frequently Should Sink Drains Be Disinfected?

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S440-S440
Author(s):  
Jorge A Ramos-Castaneda ◽  
Matthew L Faron ◽  
Joshua Hyke ◽  
Blake W Buchan ◽  
Rahul Nanchal ◽  
...  
Keyword(s):  
Hydrogen Peroxide ◽  
Horizontal Transmission ◽  
Tertiary Care ◽  
Multidrug Resistant ◽  
Control Group ◽  
Care Hospital ◽  
Bacterial Reduction ◽  
Post Intervention ◽  
Bacterial Colony ◽  
Healthcare Facilities

Abstract Background New evidence shows the relevance of sink drains in the horizontal transmission of multidrug-resistant organisms. We recently demonstrated that a peroxide-based disinfectant (product B) was better than bleach at disinfecting sink drains; however, we did not determine the duration of this effect. In this study, we evaluate the duration of bacterial reduction in sink drains treated with product B and compared it to an enhanced hydrogen peroxide agent (product A). Methods Testing was performed in a 26-bed medical intensive care unit at a 566-bed tertiary care hospital in Milwaukee, WI. Two disinfectants were compared: product A (hydrogen peroxide, octanoic acid, and peroxyacetic acid; Virasept, Ecolab) and product B (hydrogen peroxide-based disinfectant; Peroxide Multi Surface Cleaner and Disinfectant, Ecolab). Sinks were randomly assigned to product A, product B, and control (no disinfection). On day 0, baseline cultures were obtained and disinfectant agents were applied. On post-intervention days 1, 3, 5, and, 7, samples from each drain were collected using E-swabs (Copan, Italy). Quantitation of Gram-negative burden was determined by serial dilution in saline plated to MacConkey agar and dilutions that contained 20–200 colonies were used for bacterial colony-forming units (CFU). Multivariate multiple linear regression and analysis of variance were used to compare mean Ln(1+CFU) between groups using R v3.5.0. Environmental sampling, cultures, and statistical analyses were performed blinded to the disinfected used. Results All three groups had similar CFU counts at baseline (P > 0.05). On day 1, a statistically significant reduction in bacterial CFUs was observed in the group treated with product A compared with sinks treated with product B (P = 0.04) or the control group (P < 0.01). The same differences were observed on day 3 post-intervention. There were no significant reductions on days 5 and 7. Conclusion Product A was the most effective product at disinfecting sink drains but its effect disappeared at 5 days post-disinfection. These results suggest that treating sink drains every 5 days with a hydrogen peroxide mixture would be ideal for healthcare facilities dealing with sink drain contamination. Disclosures All authors: No reported disclosures.

scholarly journals Adverse perinatal outcome in diabetic mother treated with oral hypoglycemic agents vs. insulin

2017 ◽  
Vol 6 (6) ◽  
pp. 2252
Author(s):  
Leena Das ◽  
Bijay Kumar Meher ◽  
Sagar Parida ◽  
Deepti Damayanty Pradhan ◽  
Lucy Das ◽  
...  
Keyword(s):  
Glycemic Control ◽  
Tertiary Care ◽  
Birth Asphyxia ◽  
Perinatal Outcomes ◽  
Educational Background ◽  
Diabetic Mother ◽  
Hypoglycemic Agents ◽  
Care Hospital ◽  
Oral Hypoglycemic Agents ◽  
Significant Difference

Background: Insulin has been the primary mode of therapy in diabetic mother for glycemic control as oral hypoglycemic agents (OHA) were initially thought to have teratogenic effect. Recent data supports the use of certain OHA; this study was designed to compare the perinatal outcomes in infants born to diabetic mother treated with insulin vs. oral hypoglycemic agents and to find out the relation of adverse perinatal events to glycemic control in both groups.Methods: This prospective observational study was conducted in a tertiary care hospital. 108 neonates born to diabetic mother between October 2014 to September 2016 were taken for study immediately after delivery after excluding the mothers who were treated with lifestyle modification and/or dietary modification alone only. 60 mothers had received insulin and 48 OHA for glycaemic control. Glycemic control was assessed by HbA1C estimation on the day of delivery. The infants were followed up in neonatal care unit for perinatal complications. Main outcome measure(s): birth weight, gestational age, respiratory problems, birth injury, birth asphyxia, congenital anomalies, hypoglycemia, hypocalcaemia, hyperbillirubinemia.Results: Out of 108 infants, 27 were born to pregestational and 81 to gestational diabetic mothers. 60(55.5%) were treated with insulin and rest with OHA, 53(49.1%) had optimal glycemic control. Both the groups had similar glycemic control in the third trimester. None of the perinatal outcomes showed significant difference between insulin and OHA group except neonatal hyperbillirubinemia. (p=0.013, RR=8 and OR=0.106). Within the optimal glycemic control (HbA1C <8), LGA has significant association with the insulin group than OHA (p=0.012, RR=2.217 and OR=4.2018).Conclusions: As compared to insulin, oral hypoglycemic agents have similar glycemic control and no adverse perinatal outcomes and can be used in pregnant mothers with diabetes mellitus from poor socioeconomic and educational background for its low cost and better patient compliance. Within the glycemic control, maternal treatment with insulin showed significant difference in LGA compared to OHA which needs further studies for validation.

scholarly journals Retrospective analysis of the most common cause of rejection of donors for blood donation

2021 ◽  
Vol 8 (3) ◽  
pp. 444
Author(s):  
Garima Vijayvergiya ◽  
Parag Fulzele ◽  
Naveen Vairyamoorthy
Keyword(s):  
Blood Pressure ◽  
Blood Donor ◽  
Blood Donation ◽  
Tertiary Care ◽  
Geographical Area ◽  
Rejection Rate ◽  
Developed Countries ◽  
Care Hospital ◽  
Systemic Examination ◽  
Safe Blood

Background: A significant imbalance in access to safe blood is seen between the developing and developed countries. Donor selection has a pivotal role in preventing transfusion related complications and provide safety to the recipients. In this study, we aimed to find out rate and causes of blood donor rejection in our hospital.  Methods: A retrospective study conducted in a tertiary care hospital involving both the voluntary and replacement donors during the period September 2017 to December 2018. We included all those donors who were considered unfit for blood donation. All those who came for blood donation at our hospital were asked to fill up an enrolment form for a blood donor. A general and systemic examination were done. We calculated the rejection rate, listed the reasons for donor rejection, and analyzed the data.Results: Among 150 rejected blood donors, most were males [129 (86%)], and the rest were females [21 (14%)]. The rejection rate in our study was 3.29%. We found that the rejection rate of donors was different among voluntary and replacement donors. It showed that the most common reason for the temporary rejection of blood donation was low hemoglobin level, followed by abnormal blood pressure.  Conclusions: A vast majority of donors were rejected temporarily [132 (88%)], while the rest of them were rejected permanently [18 (12%)]. Low Hb in females and abnormal blood pressure in males were the commonest causes of blood donor rejection. Many factors affect the similarities and variations between the most typical causes of blood donor rejection, such as geographical area, cultural, socio-economic, and educational factors.  

scholarly journals A profile on the spectrum of neonatal mortality and morbidity pattern of extramural neonates in the Specialised Neonatal Care Unit (SNCU) in a tertiary care hospital

2018 ◽  
Vol 5 (2) ◽  
pp. 427 ◽  
Author(s):  
Anuradha D. ◽  
Rajesh Kumar S. ◽  
Aravind M. A. ◽  
Jayakumar M. ◽  
J. Ganesh J.
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Respiratory Distress ◽  
Neonatal Mortality ◽  
Low Birthweight ◽  
Tertiary Care ◽  
Birth Asphyxia ◽  
Newborn Care ◽  
Care Hospital ◽  
Neonatal Deaths

Background: Every year, nearly four million newborn babies die in the first month of life. India carries the single largest share (around 25-30%) of neonatal deaths in the world. Neonatal deaths constitute two thirds of infant deaths in India. 45% of the deaths occur within the first two days of life. It has been estimated that about 70% of neonatal deaths could be prevented if proven interventions are implemented effectively at the appropriate time. It was further estimated that health facility-based interventions can reduce neonatal mortality by 23-50% in different settings. Facility-based newborn care, thus, has a significant potential for improving the survival of newborns in India. This research has been planned with an aim to study the profile of pattern of admissions in a SNCU and their outcomes following admission and management in the unit.Methods: All babies referred for neonatal problems (less than 28 days) and admitted in NICU will be included. Both term and preterm babies will be considered. The criteria for admission includes various causes like low birth weight, preterm, birth asphyxia, respiratory distress, hyperbilirubinemia, congenital anomalies, risk factors (maternal, neonatal, prenatal), infections and outcome will be analysed.Results: Among the 2927 admissions term babies and boys outnumbered. The common causes for admission were birth asphyxia, respiratory distress, low birthweight and preterm. Most babies had an uncomplicated stay. The mortality in the extramural neonates was due to neonatal sepsis, extreme preterm and congenital malformations.Conclusions: Intensive and interventional management, along with good neonatal monitoring and care can reduce the mortality and improve the survival of low birth weight babies and other treatable problems. Thus, a combined effort of management by pediatricians, nursing care, neonatal intensive care unit can improve the survival rates of neonates.

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