Congenital Diarrhoea In A Neonate With Hypernatraemia And Dehydration.

Diarrhoea, vomiting, and dehydration are frequently encountered in neonatal emergency. However, it is challenging to manage resistant hypernatraemia and metabolic acidosis associated with it. Diagnosing the exact cause is even more difficult. Glucose-galactose malabsorption commonly presents with hypernatraemia and repeated dehydration. In the case described here, the baby started to have diarrhoea in the first week of life and presented in the neonatal emergency with severe dehydration and hypernatraemia. Higher sodium levels were difficult to manage throughout the course of illness. Hypernatraemia and diarrhoea worsened on feeding, whether formula or mother's feed, which raised suspicion of glucose and galactose malabsorption. So, genetic testing was performed and fructose based formula was started which led to improvement in the condition. Later, genetic testing confirmed our diagnosis. This case report emphasises that clinicians should consider the possibility that congenital diarrhoea could be due to glucose- galactose malabsorption while managing a case with loose stool and significant electrolyte imbalance in a neonate.

Efficacy and safety of surfactant administration by MIST and INSURE techniques in Neonates with Respiratory Distress Syndrome: A randomized controlled trial.

Objective: To measure the efficacy and safety of surfactant administered by MIST and INSURE to neonates with respiratory distress syndrome. Methods: A randomized controlled trial was conducted from June 2021 to August 2022 at the NICU of the University of Child Health Sciences, Lahore. Neonates meeting inclusion criteria i.e with RDS who worsened on nasal Continuous positive airway pressure (nCPAP) (fiO2 30%, pressure 6cmH2O) were enrolled in the study in both interventional arms (MIST, n=36 and INSURE, n=36) using simple random sampling. Data was analysed using SPSS 25. Results: The mean age of neonates in MIST was 1.27±0.40 days and 1.23±0.48 days in INSURE cohort. Neonates with MIST (n=8) required statistically significant reduced need for IMV than INSURE (n=17) technique (P-Value 0.047). This study could not achieve significant difference in duration of mechanical ventilation (1±1.67; 1.52±1.40 days, P=0.152) and duration of nCPAP (3.27±1.65;3.67±1.64 hrs, P=0.312) in MIST versus INSURE. The second dose of surfactant was administered in fewer cases in MIST (n=2) than INSURE (n=7) (P=0.075). Risk estimation, although not significant, determined less likelihood for the pulmonary haemorrhage (0.908 than 1.095), intraventricular hemorrhage (0.657 than 1.353), administration of the second dose of surfactant (0.412 than 1.690) and greater likelihood of discharge (1.082 than 0.270) at 95% confidence interval with MIST technique. Conclusion: Surfactant therapy through MIST is effective and there is significantly reduced need of IMV than in INSURE. Safety profile though could not achieve statistical significance yet determines less risk of complications associated with MIST than INSURE.RCT Registration Number: TCTR20210627001.

Blood Lactate Levels And Lactate Clearance As Predictors Of Mortality In Neonatal Sepsis.

BACKGROUND: Sepsis is life-threatening organ dysfunction caused by dysregulated host response to infection. Aim of the study is Neonatal sepsis refers to infection involving the blood stream in neonates. It is major health problem causing neonatal mortality and morbidity in developing countries. Our study aimed to assess the correlation between lactate clearance and blood lactate levels with outcome of neonatal sepsis. METHODS: Seventy-three eligible neonates recruited with convenience sampling technique. Study was conducted at the Neonatology department, The Children's Hospital & the Institute of Child Health, Lahore. After approval from institutional review board, and informed consent of parents/guardians, neonates with sepsis were selected through a present inclusion and exclusion criteria. Data was collected with the predetermined demographics, inflammatory markers and lactate levels. RESULTS: This research revealed 37% (n=27) mortality rate among septic neonates who were having higher blood lactate levels and low lactate clearance at 6 hours of admission in nursery. Hence higher serum lactate levels and low lactate clearance (<10%) at 6 hours were significant predictors of poor outcome in septic neonates (p-Value, <0.05). The lactate level of neonates who could not survive was 5.68±1.22 as compared to who were discharged 4.11±1.14 (p-Value, <0.05). CONCLUSIONS: Higher blood lactate levels and lactate clearance of less than 10% at 6 hours of admission in nursery are significant predictors of mortality in neonatal sepsis. Early lactate stabilization and sepsis management can improve the clinical outcomes.

In vitro comparison of root surface roughness and bacterial adhesion following treatment with three different instruments.

BACKGROUND: A novel device, piezoelectric 11 Gracey curet tip, reportedly combines benefits of a piezoelectric device and manual curet. The primary objective of this study was to compare root surface roughness outcomes between traditional manual curets and piezoelectric devices, as compared with this novel device. The secondary aim was to assess the level of adhesion of Streptococcus mutans on the root surface after instrumentation. METHODS: The groups consisted of the following: 1) Gracey curet; 2) piezoelectric scaler; 3) piezoelectric 11 Gracey curet tip; and 4) untreated control. Root specimens were obtained from extracted human teeth and randomly assigned to each group. Surface roughness measurements (Ra and Rz) were taken with a profilometer before and after instrumentation. After instrumentation, root specimens were inoculated with S. mutans and biofilm was dislodged. Various dilutions of resuspended biofilm were incubated on blood agar plates and colony forming units (CFU) values were measured. RESULTS: The experimental device resulted in significantly lower Ra and Rz compared with other groups (P < 0.01), and the Gracey curet was significantly lower than the piezoelectric tip and untreated control (P < 0.05). The Gracey curet and experimental device tip had significantly lower CFU values compared with the control (P < 0.05). There were no significant CFU value differences between the Gracey curet and both the piezoelectric and experimental device tips. There were no significant CFU differences between piezoelectric tip and both experimental device and control. There was no correlation between Ra and CFU values for Gracey curet, piezoelectric tip, or the control. However, correlation between Ra values and CFU approached significance for the experimental device (correlation = 0.66, P = 0.05). CONCLUSIONS: Piezoelectric 11 Gracey curet tip is effective at resulting in a significantly smoother surface compared with traditional piezoelectric and hand instruments. CFU values with piezoelectric 11 Gracey curet tip were significantly lower than non-instrumented surfaces, but there were no significant differences compared with conventional methods.

Correlation Of Severity Of Metabolic Acidosis At Admission And Outcome In Asphyxiated Neonates.

BACKGROUND: Blood gases can provide information about the perinatal, natal and postnatal condition of newborn. Severity of metabolic acidosis has deleterious effect on the outcome of babies. When the cord blood gases are not available the arterial blood gases are used for interpreting the status of newborn. The purpose of study was to determine the relationship between severity of metabolic acidosis at admission with the stage of hypoxic ischemic encephalopathy, and its outcome in asphyxiated neonates. METHODS: This was descriptive cross-sectional study of 384 neonates born at ≥35 weeks to <42 weeks from June to December 2018, admitted in Neonatology department of the Children's hospital & the Institute of Child Health, Lahore within first 6 hours of birth. The neonates with history of delayed cry at birth and arterial pH ≤7.30 and base deficit ≥10 were included in the study. The pH and base deficit of babies was analyzed in relation to the stage of HIE, duration of stay and death or discharge of the babies using SPSS-20. The p-value was calculated using chi-square test. RESULTS: Total of 470 neonates were eligible. Eighty-four neonates were excluded. Finally, 384 neonates were included and analyzed for the outcome variables. With severe metabolic acidosis pH <7.01, all the babies developed HIEII/III. Majority (82.1%) of the babies expired and 27.9% had prolonged hospital stay. CONCLUSIONS: Increasing severity of metabolic acidosis at admission increases the likelihood of adverse outcome in asphyxiated neonates.

Burnout among pediatric residents and junior consultants working at a tertiary care hospital.

OBJECTIVE: To determine the burnout among postgraduate residents' and junior consultants in a tertiary care hospital. METHODS: This cross-sectional study was conducted among the postgraduate residents (PGR) and junior consultants (JC) working at The Children's Hospital Lahore in 2018. Participants were asked to complete Copenhagen Burnout Inventory questionnaire about burnout on 5 point Likert scale. '100 (always), 75 (often), 50 (sometimes), 25 (seldom) and 0 (never/almost never or according to intensity ranging from 'a very low degree' to 'to a very high degree'. Data was analyzed using SPSS version 22. Three questions were added related to hospital factors but scored separately. Students t-test and chi square test were used to compare the burnout. RESULTS: A total of 227 participants including 177 PGR and 50 JC completed the questionnaire with a response rate of 84% and 86% respectively. There was a female predominance, 140 participants (61.7%) were female. Majority was from pediatric medicine 173 (76.2%). The mean personal and work related-burnout was high among PGRs as compared to JCs (18.68±5.01vs 16.62±4.57) (p=0.008) and (21.14±5.57 vs. 18.56±5.52) (p=0.004) respectively. Similarly, there was significantly more burnout among pediatric medicine study participants as compared to surgery and diagnostic in all domains (personal BO; p=0.030, work-related BO; p=0.021, patient related BO; 0.033 and hospital related BO; 0.001). No difference were noted based on gender and year of training. CONCLUSION: Tertiary care hospital postgraduate residents and junior consultants face moderate burnout. Postgraduate residents had significantly more burnout as compared to junior consultants and majority was from pediatric medicine.