Screening for Hearing Impairment in High-Risk Neonates in a Tertiary Care Centre in Central Kerala

BACKGROUND Hearing loss is a chronic condition, and many cases can be detected in the neonatal period. Recognizing it early is of crucial importance as early auditory rehabilitation would help in child’s comprehensive development. We wanted to assess the prevalence of hearing impairment among high risk newborns admitted to inborn unit of tertiary care centre in Central Kerala and screen for the associated risk factors in these newborns. METHODS Thousand consecutive inborn neonates from Neonatal ICU, Department of Paediatrics, tertiary care centre in Thrissur, Kerala, detected as high risk by Joint Committee on Infant Hearing (JCIH) criteria were enrolled for the study from December 2011 to November 2012 after the approval by Institute’s Ethics Review Board. Risk factor assessment was done before enrolment. A qualified audiologist conducted the test on babies in soundproof chamber. DPOAEs (Distortion Product Otoacoustic Emissions) were used for initial testing after checking ears for debris. Those who failed in the first test were asked to come for a retest after 2 weeks. Those who failed in the retest were asked to report for Brainstem Evoked Response Audiometry (BERA). Those who were diagnosed as having hearing impairment were advised auditory rehabilitation as well as auditory verbal therapy. RESULTS Of the 1000 eligible neonates born in our hospital during the study period (December 2011 to November 2012) 69 were lost to follow up. Among the remaining 931 babies the frequency of hearing impairment was 0.8 %. Among the 931 neonates, 130 had absent response with the first OAE test contributing to 13.9 %. Twenty-one neonates had absent response to second OAE test out of 130 contributing to 16.1 %. The failure rate for second test is 2.2 % of the total population of 931 newborns. Eight of the 21 neonates who were subjected to BERA had severe hearing loss. The prevalence of hearing impairment was 8 per 1000. CONCLUSIONS The prevalence (percentage) of hearing impairment by two staged screening protocol is 0.8 %. Risk factors which were present in these babies were prematurity, low birth weight, low Apgar score, history of exanthematous fever in mother, neonatal jaundice, ototoxic medication history, craniofacial anomalies, and family history of deafness, meningitis and mechanical ventilation. KEYWORDS Otoacoustic Emissions, Brain Stem Evoked Response Audiometry, Risk Factors, Hearing Impairment, Neonates

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High risk histopathological factors in retinoblastoma in upfront enucleated eyes: An experience from a tertiary care centre of Pakistan

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.38.icon-2022.5787 ◽

2021 ◽

Vol 38 (ICON-2022) ◽

Author(s):

Nausheen Yaqoob ◽

Salima Mansoor ◽

Kanwal Aftab ◽

Bushra Kaleem ◽

Ahmer Hamid ◽

...

Keyword(s):

Risk Factors ◽

Optic Nerve ◽

High Risk ◽

Anterior Chamber ◽

Tertiary Care ◽

Histologic Grade ◽

Care Centre ◽

Tertiary Care Centre ◽

High Risk Factors ◽

Pathologic Staging

Background & Objectives: The assessment of histopathological risk factors (HRFs) in retinoblastoma in upfront enucleated eyes is important in deciding treatment protocols. Limited data is available from the developing countries as very few studies were conducted on retinoblastoma. The study aims to report this data from Pakistan. Methods: This cross-sectional study included treatment naïve retinoblastoma patients who underwent upfront enucleation between 2017 to 2021. Various tumor characteristics i.e. laterality, size, histologic grade, anaplasia grade, growth pattern, extent and length of optic nerve invasion, pathologic staging, tumor involvement of ocular structures were assessed. High-risk factors such as involvement of anterior chamber, choroidal, scleral, extrascleral, and optic nerve were also noted. Results: A total number of 54 patients were enrolled, out of which 53.7% were females while remaining were males. Median age at presentation was 24 months. Unilateral tumor was seen in 92.6% cases. Most frequent histologic grade was G2 (64.7%) and moderate anaplasia was observed in 59.2% cases. Vitreous involvement was seen in (86.5%). Pathologic staging of most of the tumors was pT1 (39.2%). Assessment of high-risk factors revealed that optic nerve involvement (35.1%) was the most common finding with retrolaminar tumor invasion seen in 75% cases. Choroidal invasion (≤3mm) was seen in 55.6% of patients. Limited involvement of anterior chamber (3.8%), sclera (7.4%), and extrascleral (3.8%) tissue was also observed. Conclusion: The presence of high risk histopathological factors in enucleated eyes diagnosed with retinoblastoma are known to have a profound impact on the risk stratification as well as decision of future treatment plan. doi: https://doi.org/10.12669/pjms.38.ICON-2022.5787 How to cite this:Yaqoob N, Mansoor S, Aftab K, Kaleem B, Hamid A, Jamal S. High risk histopathological factors in retinoblastoma in upfront enucleated eyes: An experience from a tertiary care centre of Pakistan. Pak J Med Sci. 2022;38(2):369-374. doi: https://doi.org/10.12669/pjms.38.ICON-2022.5787 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Does gestational diabetes mellitus affect the hearing of the baby?

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20214904 ◽

2021 ◽

Vol 8 (1) ◽

pp. 74

Author(s):

Gangadhara K. S. ◽

Amrutha V. Bhat ◽

Nagaraj M.

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Hearing Impairment ◽

Otoacoustic Emissions ◽

Hearing Screening ◽

The Third ◽

History Of ◽

Evoked Response Audiometry

Background: Hearing screening results of babies born to mothers with and without gestational diabetes mellitus done within 24-48 hours of delivery using otoacoustic emissions was compared. Babies who failed the screening were recalled for further testing.Methods: A prospective institutional based study was conducted between December 2018 and May 2020. All the babies were screened for hearing impairment using handheld OAE apparatus within 24-48 hours of delivery. History of gestational diabetes mellitus in the mother was enquired. Any baby with a “refer” result in the OAE study was recalled for a repeat OAE testing after a month. This was repeated two more times if the baby failed the test every time. In case of failing the test for the third time, the baby was sent for brainstem evoked response audiometry for confirmation of hearing loss.Results: Screening was done for 14226 babies. Among them, 44 babies were born to mothers with gestational diabetes mellitus. The hearing screening results did not show a significant association between gestational diabetes mellitus and hearing impairment in the baby.Conclusions: Gestational diabetes is considered as one of the risk factors for deafness in the baby. This study could not establish such a relationship.

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Study of risk factors of acute respiratory infections in children admitted in a tertiary care hospital of Southern Maharashtra

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20173692 ◽

2017 ◽

Vol 4 (9) ◽

pp. 3129

Author(s):

Alka C. Kaware ◽

Nitin H. Kamble ◽

S. K. Mangulikar

Keyword(s):

Risk Factors ◽

Respiratory Infections ◽

Tertiary Care ◽

High Morbidity ◽

Acute Respiratory Infections ◽

Care Hospital ◽

Care Centre ◽

Tertiary Care Centre ◽

History Of ◽

Tract Infections

Background: Acute respiratory infections (ARI) is an important cause of mortality and morbidity in children. In India, it constitutes 15% of under five deaths. Various risk factors are responsible for ARI in children. Study of risk factors will help to reduce the high morbidity and mortality due to ARI. The objectives were to study risk factors responsible for acute respiratory infections in children and to find out case fatality rate &/ outcome of acute respiratory infections ARI in children.Methods: A hospital based cross sectional study was done in 2013-14 in a tertiary care centre to study the risk factors associated with ARI in children. All the pediatric patients between 0-12 years admitted in a tertiary care centre at Solapur were enrolled in the study.Results: Acute respiratory tract infections (ARI) were more common in 1-4 years age group i.e. 57.31% (196). It was more common in males i.e. 64.33% (220) than females i.e. 35.67% (122). ARI was more common in lower socio-economic classes i.e. class V (50.58%), class IV (22.52%); in patients whose mothers were illiterate 43.28% and who had history of parental smoking 84.21%. Maximum patients of ARI were having history of overcrowding 75.73%, inadequate cross-ventilation 81.87% and use of smoky chullah 78.65% in their home. Statistically significant association found between ARI cases and these socio-demographic factors. 46.78% (160) were incompletely immunized and 16.37% (56) were not immunized at all. Only 36.84% (126) were completely immunized for their age. Maximum cases of ARI (50.88%) occurred in winter season followed by rainy season (26.90%). Outcome showed that 91.52% (313) were cured, while 1.75% (6) patients died due to ARI.Conclusions: The present study has identified various socio-demographic, nutritional and environmental risk factors for ARI which can be prevented by effective health education and an appropriate initiative taken by the government.

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Risk factor and perinatal outcome of preterm delivery in a tertiary care centre in rural Haryana

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20204311 ◽

2020 ◽

Vol 9 (10) ◽

pp. 4187

Author(s):

Sunaina Singla ◽

Banashree Das

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Preterm Delivery ◽

Perinatal Outcome ◽

Neonatal Intensive Care ◽

Tertiary Care ◽

Preterm Births ◽

Care Centre ◽

Tertiary Care Centre ◽

History Of

Background: Aim of the study was to identify risk factors and to assess neonatal mortality and morbidity associated with preterm delivery in patient attending a tertiary care centre in rural Haryana.Methods: This retrospective cohort study was conducted in Shree Guru Gobind Singh Tricentenary Medical College, over a period of one year (January to December). All pre-term deliveries were included in the study. They were followed up from admission till delivery and till discharge from hospital. Various, parameters like maternal age, associated medical disorder, obstetric complications, gestational age, neonatal mortality, need of neonatal intensive care and condition of baby at discharge were analyzed.Results: In the present study, incidence of preterm deliveries was 16.1%. The most common risk factor found to be history of previous abortion (23.6%), preterm premature rupture of membrane (17.1%), Intra-uterine growth restriction (IUGR) with oligohydramnios (10.5%), hypertensive disorder during pregnancy (5.9%), and antepartum hemorrhage (4.6%). But majority of the patient (56.5%) no cause could be identify. Out of total 160 preterm births 3 were still born and 157 live preterm births, and out of which total Neonatal intensive care (NICU) admission were 60. Mortality rate was 100% in neonate weighing less than 1000 gm and 18% in babies weighing less than 2000 gm.Conclusions: The commonest risk factor for preterm delivery is previous history of abortion and adverse perinatal outcome is inversely proportionate to the period of gestation at the time of delivery. All efforts should be made to prolong the pregnancy beyond 34 weeks by identifying and actively managing the risk factors for better neonatal outcome.

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Current placenta previa management and outcome in a rural tertiary care centre

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20171975 ◽

2017 ◽

Vol 6 (5) ◽

pp. 2050

Author(s):

Reena Sood ◽

Swati Sharma ◽

Madhu Nagpal ◽

Madhurima Arora

Keyword(s):

Risk Factors ◽

Placenta Previa ◽

Tertiary Care ◽

Care Centre ◽

Tertiary Care Centre ◽

Gestational Age At Delivery ◽

History Of ◽

Obstetric Services ◽

The Mean ◽

Present Case Study

Background: The reported incidence for placenta previa averages 0.3% or 1 case in 300 to 400 deliveries. Multiparity, advanced maternal age, cigarette smoking, previous caesarean delivery, history of abortions or uterine surgical procedures are some of the risk factors contributing to the development of placenta previa. Massive obstetrical haemorrhage in placenta previa is associated with severe maternal morbidity and mortality. A significant number of mothers can be saved if right approach of management is followed in placenta previa.Methods: The present case study is a retrospective analysis carried out in a tertiary care centre to study the risk factors and maternal and perinatal outcome in cases of placenta previa. The study included antenatal patients diagnosed as placenta previa on sonography at or >26 weeks of pregnancy. Data was compiled and statistically analysed.Results: Incidence of Placenta Previa in our study was 0.54%. 73.2% patients had history of previous cesarean sections. 53.6% patients were referred from outside. 98.2% patients delivered by caesarean section. Obstetric hysterectomy was required in 3.5% of total cases. 10.7% cases required the ICU admission after delivery. There was no maternal mortality in the study group. The mean gestational age at delivery was 35±2.4weeks. The mean APGAR at 5 min was 9±2.2.Conclusions: Increasing rates of caesarean sections in present era indicate that incidence of Placenta Previa is expected to rise. Good antenatal care, availability of emergency obstetric services, infrastructure, blood bank facility, HDU and ICU care and NICU services can improve maternal and neonatal outcome.

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Prevalence and risk factors of hearing impairment among neonates admitted in NICU in a tertiary care centre in South India

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20182478 ◽

2018 ◽

Vol 5 (4) ◽

pp. 1342

Author(s):

Varsha S. Nair ◽

Prarthana Das ◽

Palanisamy Soundararajan

Keyword(s):

Risk Factors ◽

Hearing Loss ◽

Hearing Impairment ◽

Otoacoustic Emissions ◽

Tertiary Care ◽

Newborn Infants ◽

Multiple Gestation ◽

Initial Screening ◽

Tertiary Care Centre ◽

Distortion Product

Background: Present study was conducted to assess the prevalence of hearing impairment using measurements of Otoacoustic Emission (OAE) in newborns admitted to NICU and to determine the risk factors predictive of hearing impairment in these newborns.Methods: The study was conducted from January 2016 to June 2017 in the NICU under the Department of Pediatrics. All neonates admitted for more than 48 hours in the NICU were included. Neonates who died during the study period were excluded. All candidates underwent hearing loss in a sound treated room in the department using Distortion Product Otoacoustic Emissions (DPOAE) test at the time of discharge. Babies who failed this initial screening underwent another OAE test within 1 month after discharge, and those who failed the test again were referred to an Otologist for comprehensive audiological assessment at 3 months.Results: Of the 200 neonates included in the study, 101cases (50.5%) failed the initial screening. 1 case (0.5%) failed the second OAE screening and moderate hearing loss was diagnosed in this child using BERA. Risk factors included mechanical ventilation (p=0.01), prematurity (p=0.01), low Apgar scores (p<0.01) and multiple gestation (p<0.05). Other conditions predominating in neonates who failed hearing screening included TTN, MAS, LBW and neonatal jaundice.Conclusions: Newborn infants admitted to the NICU are at a higher risk for hearing impairment due to exposure to multiple risk factors. The two staged screening protocols with DPOAE is a useful protocol for detecting hearing loss in newborns and can be implemented as a national program.

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Clinicosociodemographic profile of ruptured ectopic pregnancies at a tertiary care centre

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20171942 ◽

2017 ◽

Vol 6 (5) ◽

pp. 1885

Author(s):

Soumya Ranjan Panda ◽

Anjali Rani ◽

Mahendra Meena

Keyword(s):

Risk Factors ◽

Socioeconomic Status ◽

Ectopic Pregnancy ◽

Tertiary Care ◽

Care Centre ◽

Tertiary Care Centre ◽

Factors Associated ◽

Number Of Patients ◽

History Of ◽

Ectopic Pregnancies

Background: Rupture of an ectopic pregnancy remains the most dreaded complication of a pregnancy related event and is the commonest cause of maternal mortality in the first trimester of pregnancy. In the developing countries, the maternal death rate among patients admitted with ectopic pregnancy was found to be as high as one in ten. In addition to high risk for mortality, rupture of an ectopic pregnancy could affect future fertility of a woman. The objectives of this study are to analyse the sociodemographic and clinical characteristics and find out the incidence rate and risk factors associated with ruptured ectopic pregnancies in a tertiary care institution.Methods: This is a retrospective study and was conducted over a period of one year from September 2015 to September 2016 in Department of Obstetrics and Gynecology at Institute of Medical Sciences, BHU, Varanasi, India. It is a tertiary care centre getting referrals not only from nearby cities and hospitals but also from major cities of neighbour states. During this time frame a total of 2601 deliveries have taken place and 57 cases of ruptured ectopic pregnancies were reported. Data were collected in a preconceived format.Results: Total numbers of vaginal deliveries were 2601 during the study period. Out of which 63 (2.42%) were found to be ectopic pregnancies and 57 (1.99%) were diagnosed as ruptured ectopic pregnancies. Maximum number of patients (70.17%) were between 21 and 30 years of age. As far as parity is concerned only 12.29 % of patients were primigravida where as 70.71% patients were multigravida. Previous history of pelvic inflammatory disease was associated among maximum number of cases i.e 50.87% of total number of cases. Among other risk factors, previous abortions, previous ectopic pregnancies and history of infertility treatment were the prime ones. Maximum number of patients were from lower and lower middle class socioeconomic status. Ampullary type of Tubal ectopic pregnancies were found to be the commonest ones. Two cornual pregnancies and two ovarian pregnancies were also found in this series. In 85.97 % of patients the amount of hemoperitoneum was found to be more than 500 ml.Conclusions: There is high incidence rate of ectopic pregnancy and low rate of diagnosis before rupture occurs in developing nations as in our scenario. Pelvic inflammatory disease, Maternal education, socioeconomic status, parity and history of subfertilty are the risk factors associated with ruptured ectopic pregnancy. Effective efforts should be taken to encourage the level of education and improve the rate of diagnosis among health care providers before the occurrence of rupture.

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