Congenital heart disease in pregnancy in a low-income country.

OBJECTIVE: To assess maternal and perinatal outcomes among pregnant women with congenital heart disease (CHD) in a low-resource country. METHODS: A prospective, observational study was conducted at a teaching hospital in Kolkata, India, between January 1, 2008, and December 31, 2010. All pregnant women with CHD were followed up from first prenatal visit to discharge. Both maternal and perinatal outcomes were analyzed. RESULTS: Of 174 pregnant women with heart disease, 27 (16%) had CHD. Mean age was 23.5±3.6 years. Four (15%) patients were diagnosed with CHD during the index pregnancy. Nine (33%) women had undergone surgical correction before conception. Cesarean delivery was performed in 12 (44%) women. Fifteen (56%) neonates weighed less than 2500 g, and 4 (15%) were born preterm. Mean birth weight was slightly higher in women with corrected heart lesions than in those with uncorrected ones (2593±480 g vs 2294±620 g; P=0.22). Three (11%) neonates died, but no stillbirths occurred. One (4%) woman died after delivery owing to atonic postpartum hemorrhage. CONCLUSION: Delayed diagnosis, lack of treatment, and unplanned pregnancy are major challenges for women with CHD, which need to be addressed to improve maternal and neonatal outcomes in low-resource countries.

Effect of kangaroo mother care on growth and development of low birthweight babies up to 12 months of age: a controlled clinical trial.

AIM: Kangaroo mother care (KMC) is a nonconventional low-cost method of newborn care. Our aim was to assess the effect of sustained KMC on the growth and development of low birthweight Indian babies up to the age of 12 months. METHODS: We enrolled 500 mother and baby pairs, in groups of five, in a parallel group controlled clinical trial. The three infants with the lowest birthweight in each group received KMC, while the other two received conventional care. All babies were exclusively breastfed for 6 months. Babies in the intervention group were provided KMC until the infant was 40 weeks of corrected gestation or weighed 2500 g. Weight, length and head, chest and arm circumferences were evaluated at birth and at the corrected ages of 0, 3, 6, 9 and 12 months. Development was assessed using the Developmental Assessment Scales for Indian Infants (DASII) at 12 months. RESULTS: The KMC babies rapidly achieved physical growth parameters similar to the control babies at 40 weeks of corrected age. But after that, they surpassed them, despite being smaller at birth. DASII motor and mental development quotients were also significantly better for KMC babies. CONCLUSION: The infants in the KMC group showed better physical growth and development than the conventional control group.

Aetiology and antimicrobial resistance of neonatal sepsis at a tertiary care centre in eastern India: a 3 year study.

OBJECTIVE: To review aetiological agents of neonatal sepsis and their antibiotic resistance pattern over the past 3 years, at a 20 bedded Level III neonatal intensive care unit (NICU) in eastern India. METHODS: Blood culture reports of culture positive sepsis were reviewed for the period 2007-2009. Demographic data of the babies was collected. RESULTS: Blood culture was done for 997 neonates with suspected clinical sepsis. The incidence of culture proven neonatal sepsis among inborn babies was 14.8/1,000 live births. The proportion of culture positive sepsis for outborn babies admitted in neonatal intensive care unit was 8.3%. Gram negative aetiology was predominant (71.6%), with Klebsiella pneumoniae being the most common isolate. Non fermenting Gram negative bacilli like Acinetobacter sp emerged as an important cause of infection. The aetiology of early onset and late onset sepsis was similar. The proportion of resistance to common first and second line antibiotics like ampicillin (98.5%), gentamicin (84.4%), amikacin (65.6%) and cefotaxime (81.3%) was high. CONCLUSIONS: The present study is the first in recent years from eastern India on aetiology and antimicrobial resistance in neonatal sepsis. Two areas of concern were the emergence of non fermenting Gram negative bacilli as causative organisms and the alarming degree of antibiotic resistance observed for commonly used antibiotics.