Study of Clinical Profile of Neonatal Seizures in Level III NICU

Background: During the neonatal age, seizures are the most distinctive sign of neurological disease. Convulsive symptoms are the most promi- nent forms of neonatal neurological disorders. The goal of this research was to have a better view of the epidemiology, etiology, incidence, forms and mortality of neonatal seizures in our hospital. This research was undertaken to evaluate the prevalence, forms of neonatal seizures, etiology, occurrence period and correlation with etiology, and to establish the mortality correlated with neonatal seizures. For research the etiology and its etiological connection, the occurrence of neonatal seizures. Subjects and Methods: A comprehensive history was collected for the antenatal, natal, postnatal and family history. Age of initiation, form, duration and amount of seizures, consciousness before and after the seizures were taken. Comprehensive neonate examination was performed after detailed history. Relevant investigations were carried out depending upon clinical presentation. Results: In our analysis of 200 neonatal seizures, 194 had one of the four classically identified neonatal seizures. Multifocal clonic seizures were among the most common type of seizures 36% (72 cases) followed by subtle 27% (54 cases), GTS 26% (52 cases), Myoclonic 7% (15 cases), mixed type of seizures 3% (6 cases) and focal clonic seizures 1% (2 cases). Conclusion: Because neonatal seizures are most frequently due to birth asphyxia, better antenatal and perinatal care reduces birth asphyxia and if mothers are identified as high-risk. The impact of neonatal seizures is thereby minimized. Subtle seizures are the most frequent form of psychiatric seizure; thus, close monitoring of newborns at risk is important.

Correlation Study of AIOS (Acute Illness Observation Scale) Score with Radiological Findings and Pulse Oximetry in Community-Acquired Pneumonia (Cap) Among Children Aged 2 To 59 Months

Background: Community-acquired pneumonia (CAP) is one of the primary causes of mortality in infants and young children. Acute Illness Observation Score (AIOS) - act as the best and accurate indicator for the same. Hence in this study, AIOS was used to relate X-ray abnormalities and pulse oximeter finding for early assessment in children with ARI. Subjects and Methods: This was a descriptive epidemiological study conducted for a period of 24 months. Children aged from 2 months to 59 months who had symptoms and signs suggestive of pneumonia were involved in the study. Pulse oximetry reading on admission was noted. AIOS scoring is done on each subject. Chest X-ray was taken and interpreted. Results: The majority of patients fall in the age group of 2- 12 months (57.2%). CXR showed abnormal radiological changes in 54.0%, among them endpoint consolidation, was seen in 40.20% and infiltrates seen in 59.7%. 67 patients had spo2 > 92% at admission, among them 44 (65.67 %) had normal & 23 (34.32 %) had abnormal chest X-ray. 57.3 % (43/75) children with AIOS of 10 had normal x-ray & 42.66% (32/75) had abnormal x-ray. AIOS with Spo2 reading showed a good correlation (p<0.05) indicating that high AIOS scores are associated with low SpO2 scores. Conclusion: This study shows that with the help of AIOS scoring, fair association with an initial pulse oximeter reading and X-ray abnormalities can be done which can be utilized as an early combining tool for risk assessment and management.

Iron Deficiency Anemia as a Risk Factor for First Febrile Seizures a Case Control Study

Background: Febrile seizures in children are a common problem. Iron deficiency anaemia is known, among other contributing factors, to be an aggravating factor in febrile seizures. Iron deficiency anaemia is a condition that can be avoided and managed. The study goal was to identify iron deficiency anaemia as a trigger factor for febrile seizures (FS). To determine the association between Iron Deficiency Anemia (IDA) and the first episode of febrile seizures (FFS). Subjects and Methods: Investigation like hemoglobin, blood indices (MCV, MCH), and serum iron and serum ferritin are done for detection of iron deficiency anaemia and their relationship with the first episode of febrile seizure was observed. Results: In our study comprising 50 cases and 50 controls, 58% (29) of cases were diagnosed as IDA with FS, 18% (9) of controls were diagnosed as IDA with Febrile Illness (FI). This suggests IDA as a risk factor for febrile seizures with a significant P value of <0.001. Among 50 cases 42% (21) cases have FS without IDA and among 50 controls 82% (41) controls have FI without IDA were present in the current study. Conclusion: IDA was more common in children with FS than in those with febrile illness (FI) disease alone. The result suggests that the IDA can be a contributing factor to the FFS. Screening of IDA of children with FFS should be regarded. Fever can worsen the negative effects of anaemia or iron deficiency on the brain, which can lead to seizures.

A Prospective Randomized Study on Dietary Predictor of Anaemia Among Children Aged 6 Months to 3 Years

Background: The present study aimed to record anemia and predictor of anemia in 6 months to 3 years children. Subjects and Methods: The present study was conducted on 280 children age ranged 6 months -3 years of both genders. Children with Hb level <11 g/dL were considered anemic, and graded as mild (10–10.9 g/dL), moderate (7–9.9 g/dL), and severe (<7 g/dL). Results: There were 150 male and 130 female children and anemia was seen in 56 male and 70 female children. Anemia was detected in 25 children age ranged 6-12 months, 45 in age group 1-2 years and 56 in 2-3 years. 85 anemic children were <2.5 kgs at birth whereas 41 were >2.5 kgs at birth. 68 were not breastfed while 58 were on exclusive breastfeed. Conclusion: Authors found that low birth weight, female gender, not on breastfeed, vegetables and meat non consumers are determinants of anaemia in children.

Assessment of the Different Modalities of Treatment in Paediatric Cerebral Palsy Patients

Background: To assess the effects of injection of citicoline in combination with physiotherapy versus physiotherapy alone, to advance the functional outcome in paediatric patients with cerebral palsy. Subjects & Methods: A total of 150 paediatric patients diagnosed with cerebral palsy were incorporated into the study. The average age of the patient included in the study was found to be 36 months. All the patients enrolled in the study were referred to the paediatric neurological department. Results: The mean age of the patient was 36 10 months. Out of the 150 total patients, 60% were boys and 40% were girls. When the percentage of improvement was compared between the groups, the study group was established to be statistically significant. (P = 0.02). Conclusion: Citicoline is efficient and secure in the treatment of gross motor function combination with physiotherapy in patients with cerebral palsy. Physical therapy is frequently the first move in managing cerebral palsy.

A Cross-Sectional Study to Determine the Prevalence of Gastroesophageal Reflux in Children with Persistent Cough and Wheezing

Background: Gastroesophageal reflux (GER) occurs in more than two-thirds of otherwise healthy infants and is the topic of discussion with pediatricians at one-quarter of all routine 6-month infant visits. GER is considered a normal physiologic process that occurs several times a day in healthy infants, children, and adults. GER is generally associated with transient relaxations of the lower esophageal sphincter independent of swallowing, which permits gastric contents to enter the esophagus. The Objective to find out the prevalence of GER in children with cough and wheezing and its associated factors. Subjects and Methods: A cross-sectional study was done at A tertiary care hospital at the Institute of Naval Medicine, INHS, Mumbai from August 2016 to December 2017. A total of 30 study subjects Aged between the age of one to twelve years with persistent cough and wheezing lasting for more than three months despite treatment were included for the study. Results: The prevalence of gastroesophageal reflux (GER) in our study was 63.3%.The logistic regression analysis showed that Age, Height, Weight, BMI, duration of cough, Duration of asthma were not significantly associated with Gastroesophageal reflux (GER) (p>0.05). Conclusion: GER seems to have a high prevalence in children with chronic cough. However, no definite recommendations can be made regarding the management of such cases from our study.

Clinical and Demographic Profile of Diarrheal Patients of Pediatric Age: A Cross-Sectional Study

Background : Sometimes, diarrhea may co-exist with vomiting, fever, abdominal pain, etc. depending upon its etiology. Diarrheal diseases can also lead to significant malnutrition and dehydration. Thus, at the tertiary care center, a study was conducted with an aim to center on the clinical and sociodemographic profile of infants and children presenting with acute diarrhea. Subjects and Methods: It was a prospective, observational clinical study that began after obtaining approval from the Institutional Ethics Committee. It was conducted at the Department of Pediatrics, Gujarat Adani Institute of Medical Science, Bhuj, Kutch for a period of 2 years. The sample size was 200 with 2 groups A and B having 100 patients each. Accordingly, their clinical and demographic profile was also noted and studied in 2 groups. Various parameters analyzed were age and gender distribution, chief complaints, feeding practices, nutritional status and assessment of dehydration. Results: Mean age S.D were (2.25 1.40) and (2.49 1.39) years in group A and B respectively. Exclusive breastfeeding (EBF) for 6 months was given in a large no. of group A and B patients i.e. 52 (52%) and 58(58%) respectively. Few others were given for 4, 5, or 7 months. Maximum patients 58 (58%) of A and 52 (50%) of B group had no dehydration whereas remaining 42 (42%) and 48 (48%) patients had some dehydration respectively. Conclusion: Fever and vomiting were the complaints mainly regularly linked with diarrhea. a bit fewer than half of the children under research had some-dehydration. Greater parts of the patients were completely breastfed for six months.

Outcome of Patients Admitted To PICU and NICU In Relation To PRISM III Score in a Tertiary Care Hospital

Introduction: Pediatric intensive care units (PICU) are an indispensable component of a successful health care establishment. They play a crucial part in reducing morbidity and mortality in the adolescent group. Several models and scores have been tried for internal auditing and in detecting the case fatality rate of a patient admitted in PICU and NICU. This helps the clinician in triaging patient care as and when required. The PRISM III score is widely used in PICU and NICU for the same. To evaluate the validity of the PRISM III score in predicting mortality in children admitted to PICU and NICU in a tertiary care hospital and to predict the probability of death of various PRISM III scores. Subjects and Methods: 260 patients admitted to PICU and NICU were included in the study after obtaining informed consent from parents/guardians. Each patient was evaluated for the parameters in the PRISM III score and blood was drawn to send for investigations and results were entered in the proforma and were evaluated. Results: There was an increase in mortality rate with raise in PRISM III score. PRISM III offered a fair predictive power with the area under the curve 0.7 with 95% C.I. Out of 260 patients included in the study 24(9.2%) were dead. Variables like systolic BP, abnormal mental status, pupillary reflex, acidosis, and low platelet counts were significantly associated with a higher mortality rate. Conclusion: Evaluation of mortality and outcome of a patient admitted in PICU in a tertiary care hospital is best predicted by PRISM III score.

Correlation of Cord Lactate with Cord pH as a Morbidity Predictor in Term Neonates Delivered with Non-Reassuring Fetal Heart Status

Background: Perinatal asphyxia is accounting to 20% of neonatal mortalityin India. Cord lactate can be an alternative that is more readily available than cord pH and may help in early identification of birth asphyxia in resource limited settings. The aim of the current study is to correlate cord lactate levels with cord pH in term neonates with non-reassuring fetal heart status and thereby its use as a surrogate for cord pH. Subjects & Methods: Study design: Cross-sectional study. Setting: Neonatology unit at NRI general hospital, Chinakakani from August 2018 to July 2019. Study participants: All singleton term neonates delivered by assisted vaginal delivery or emergency caesarean section due to non-reassuring fetal heart status. Umbilical cord blood gas and lactate was obtained. Lactate was analysed by colorimetric method. Results: A total of 74 neonates were included. An analysis of cord pH & lactate, using correlation coefficient showed statistically significant p-values. Cord lactate was found to be statistically significant predictor for admission to NICU, post resuscitation care, invasive/noninvasive ventilation, and therapeutic hypothermia on multiple logistic regression analysis. Cord Lactate was found to have an Area under the curve (AUC) of 0.88 with no significant difference to cord pH on ROC curve analysis. Conclusion: Cord Lactate can be used as an objective test in predicting the neonates requiring NICU admission for morbidities related to fetal hypoxia similar to that of cord pH in term neonates.

Ferritin as a Marker of Severe Dengue in Children

Background: The aim is to evaluate ferritin levels in fever caused by dengue virus and their association with the severity of infection with dengue virus in children. Subjects and Methods: It is a Prospective that was done for 1 year in the department of pediatrics. 56 reported cases with a history of dengue fever for clinical evaluation by positive IgG and IgM antibodies and positive NS1 antigen and were included in the sample. All 16-year-old subjects with clinical dengue suspicion presenting in the department of emergency. Results: Out of total of 56 children with mean age of the children were 11.5 years and SD 3.5 years, and 59% were male who were majority. Mean hospital stay duration was 5 3 days. Most of the patients in study discharged in 5-7 days of admission in hospital. The mean serum ferritin levels among cases with DHF were raised than those with DF with significant p-values of< 0.05 on Day 5 and 6 of illness. During Days 5, 6, and 7 after the onset of fever, the results for sensitivity were 83, 86, and 92 per cent respectively. Conclusion: The incidence of hyperferritinaemia in patients infected with dengue virus is suggestive of highly active use of ferritin level in serum is 1,200 ng/ml as a method for predicting progression to DHF starting on Day 4 of the disease and continuing to recover.