Human milk fortification and gastric emptying in the preterm neonate.

Fortification of expressed breast milk (EBM) is widely recommended for preterm feeding. Fortification of EBM results in increased caloric density and osmolarity, both of which may retard gastric emptying. As gastric emptying is a major determinant of feed tolerance, we investigated the effect of fortification (with Lactodex HMF) of EBM on gastric emptying in preterm neonates. The half gastric emptying time was measured using real time ultrasonography in 25 consecutive preterm neonates first on EBM alone, then on EBM + Lactodex HMF. Each baby served as its own control. The students t-test was used for statistical analysis. The mean gestation age was 34.48 +/- 0.77 weeks. The mean birth weight was 1.92 +/- 0.14 kg. The mean half gastric emptying time at an age of 5.4 +/- 0.86 days on EBM was 24.00 +/- 5.00 min and 24.40 +/- 5.06 min on EBM + human milk fortifier (HMF). The same at 2nd assessment (15.2 +/- 1.79 days), with EBM was 22.80 +/- 4.58 min vs. 23.60 +/- 4.89 min when given EBM + HMF. These differences were not statistically significant. Fortification of EBM with Lactodex HMF does not affect the gastric emptying in preterm neonates and therefore is unlikely to affect feed tolerance in them.

Waardenburg syndrome Type II.

Two rare cases of Waardenburg type II are reported. First case had three main features of WS--profound SN hearing loss, hetrochromia iris and white forelock of hair. Second case had moderate SNHL and depigmentation of hair.

Nasal mucociliary clearance in healthy children in a tropical country.

INTRODUCTION: Nasal mucociliary clearance is an important physiological function of nasal cavity that helps in protecting the lower respiratory tract from undesirable organic and inorganic matter including the micro organisms. The study was designed to establish normal mucociliary clearance time in healthy children in a tropical environment. MATERIAL AND METHODS: The study was carried out in 100 randomly selected normal school children aged 4--15 years using saccharin method. The diseases that are known to affect the nasal mucociliary clearance were excluded. The study variables were age and sex. RESULTS: Mean nasal mucociliary clearance time was 5.7+/-2.59 min with no significant difference between males and females. The clearance time was found to be impaired in groups A and B including children of 4--7 and 8--11 years of age respectively. CONCLUSION: Nasal mucociliary clearance is impaired in children of either sex between 4 and 11 years probably due to subclinical adenoiditis. However clearance returns to normal level at the time of puberty, which coincides with adenoids involution.

Myiasis in children: the Indian perspective.

A retrospective analysis of 94 cases of childhood myiasis admitted over a 6-year period is presented. Children formed 37.9% of all cases of myiasis. More than 50% of the children were less than 5 years of age and most (96.8%) belonged to a rural background. Of the 94 cases, 81 (86.16%) were of aural, 11 (11.7%) of nasal and 2 (2.12%) of ocular myiasis. The peak incidence was seen from September to October. The main symptoms in aural myiasis were passage of worms (81.48%), discharge (44.44%) and pain (41.97%). In nasal myiasis epistaxis (100%), foul smell (100%) passage of worms (90.9%) and pain (72.72%) were the prime presenting symptoms. All patients were treated with chloroform and turpentine oil in the ratio 1:4 which was followed by manual removal of the maggots and were made maggot-free in 2-3 days. No complications were seen.

Neuronal protection with magnesium.

Delayed neuronal death following hypoxic ischaemic insult is primarily mediated by the N-methyl D-aspartate (NMDA) receptor. The NMDA receptor antagonist MK 801, has been shown to limit neuronal death following hypoxic ischaemic injury but is too toxic to be used in the human neonate. Magnesium blocks the NMDA channel in a voltage dependent manner. Its administration after a simulated hypoxic ischaemic insult limits neurological damage in several animal models. The efficacy of magnesium in providing neuroprotection in the human neonate, however needs to be established in controlled clinical trials.

Oxidative stress, phototherapy and the neonate.

Phototherapy is the most widely used form of therapy for unconjugated hyperbilirubinaemia. Its non-invasive nature and few side effects reported earlier have led to the assumption that it is innocuous. Recent research has revealed that phototherapy is a photodynamic stress and can induce lipid peroxidation. There is increasing evidence that many severe diseases of the neonate are caused by oxidative injury and lipid peroxidation. In the present communique, we review the oxidative susceptibility of the neonate and the evidence now available that phototherapy induces oxidative stress. Although intensive phototherapy (up to 40 mwatt/cm2/nm) has been reported to be increasingly effective, a little caution, we believe is warranted, till more definite data in the human neonate, help resolve the issue.

Proboscis lateralis of nose.

A rare case of congenital malformation of the nose that was successfully corrected surgically is reported.

Foreign body airway in neonates.

Two cases of foreign body in neonates less than one month of age are reported. Although foreign bodies in neonates are unknown but the possibility should not be overlooked even in neonates especially with sudden onset of respiratory distress, cough or hoarseness in absence of fever.

Maternal and cord plasma selenium levels in full-term neonates.

Selenium is a part of the enzyme glutathione peroxidase and has an important role in the prevention of oxygen free radical injury. Hence good selenium nutrition is of special relevance to the neonate. The present study evaluated plasma selenium levels in cord plasma of 82 full term, appropriate for gestational age babies and their mothers at delivery. The plasma selenium levels in babies were 54.17 +/- 1.34 ppb which was significantly lower than 70.63 +/- 1.62 ppb seen in their mothers. Anemic mothers with a Hb < 8 g/dl had a plasma selenium level (60.74 +/- 4.57 ppb) which was lower than those with a Hb > 8 g/dl i.e. 74.19 +/- 2.17 ppb. Maternal age, parity, literacy and socio-economic status did not affect the plasma selenium levels.

Clinical profile and outcome in enteric fever.

Sixty five blood culture positive cases of S. typhi were studied for clinical profile. A total of 64.6% were multidrug resistant and 35.4% were chloramphenicol sensitive. In patients with multidrug resistant S. typhi the age was higher (p < 0.01), and incidence of complications such as shock (35.7%), encephalopathy (42.9%), myocarditis (14.3%) and gastric hemorrhage (4.7%) were more frequent, compared to chloramphenicol sensitive group. Cases with multidrug resistant S. typhi (MDRST) were treated with oral ciprofloxacin; the period of defervescence of fever was significantly less (p < 0.05) compared to the chloramphenicol group. Our study suggests the use of ciprofloxacin in the treatment of MDRST without any side effects.

Cesarean section and delayed contact: effect on baby's behaviour.

Fifty two babies were assessed by the Brazelton Neonatal Behaviour Assessment Scale (BNBAS) first at 24-48 hours after birth and next at 28 days of age. Of these 26 belonged to the normal vaginal delivery (NVD) group where the babies were roomed in with their mothers immediately after birth. The other 26 were delivered by Cesarean Section (CS) and had a mean separation of 2.8 +/- 1.0 day from their mothers. Babies in the NVD group performed better for the interactive processes at both the initial and follow-up assessment. They were more active initially and on follow up. Although no differences were obtained at the initial assessment for organisational processes (physiological response to stress and state control) the follow up revealed that the NVD babies smiled more, cried less and were less irritable.

Influence of cesarean section on mother-baby interaction.

Fifty two mother-infant pairs were studied. Twenty six of these were delivered by the normal vaginal route (NVD group) and twenty six by Cesarean section (CS group). The NVD babies were roomed in with their mothers soon after birth whereas the CS babies had a mean separation of 2.8 +/- 1.0 days. The mother baby interaction was evaluated by (a) direct observation of the mother's behaviour during feeding, (b) observation of mother's behaviour during BNBAS (Brazelton Neonatal Behaviour Assessment Scale) on her baby, and (c) interview of the mother with attachment questions. Mothers in the NVD group showed significantly greater affectionate behaviour and encompassing compared to mothers in the CS group. They (NVD mothers) were more often involved in the care-taking activities of their babies and scored significantly higher for the interview implying a greater mother-baby attachment in this group.

Delayed contact and breast feeding.

Fifty two mother-infant pairs were studied. Of these, twenty six belonged to the normal vaginal delivery group where babies were roomed in with their mothers immediately after birth. Twenty six belonged to the cesarean group where the mother and baby were separated for 2.8 +/- 1.0 days. The social support was comparable in the two groups. No significant difference was found in the number of mothers breast feeding their infants at four weeks postpartum.

Neonatal behavior in full-term small for date.

Fifty newborns, 25 full term SFDs (small for date) and 25 full term AGAs (appropriate for gestational age) were taken up for comparative study of their behavior using BNBAS (Brazelton's neonatal behavior assessment scale). The study revealed that full term SFDs performed significantly poorly on all items under cluster interactive processes compared to their counterparts full term AGAs on day 1. They also showed similar poor performance in clusters of motor processes and organizational processes (State control). Follow up assessment on day 30 revealed significantly better performance in these clusters. However, the performance of SFD babies in all items of cluster of organizational processes (physiological response) was comparable to that of AGA babies in the initial as well as follow up assessments.

Liver dysfunction in severe birth asphyxia.

A total of 46 full term, appropriate for gestational age neonates were included in this study. Out of this, 31 infants had suffered severe birth asphyxia, while 15 normal babies formed the control group. The liver function tests of the asphyxiated group was deranged in 64.52% babies. There was 60% mortality in asphyxiated babies with deranged liver function. The serum levels of transaminases (SGOT, SGPT) and alkaline phosphatase in non-survivors were significantly higher than those of survivors.

A study on plasma selenium level among pregnant women at Rohtak, Haryana.

Selenium is an important trace element for human health. Selenium levels in mothers may have significant effects on fetal and neonatal nutrition. In a cross-sectional study undertaken in Rohtak, Haryana, plasma selenium level in mothers was investigated at the time of delivery. The mean plasma selenium level in full term mothers (n=82) was 70.63 +/- 1.62 ppb and in preterm mothers (n = 58), it was 63.28 +/- 2.31 ppb. The difference was statistically significant (p < 0.05). These levels were, however, below the reported normal level of 75-120 ppb in adults. Rura/urban stay, parity, maternal age, socio-economic and literacy status etc. did not influence the selenium level of mothers in either of the groups.

Acid-base disorders in critically ill neonates.

OBJECTIVE: To study acid-base imbalance in common pediatric diseases (such as sepsis, bronchopneumonia, diarrhea, birth-asphyxia etc.) in neonates. DESIGN AND SETTING: An observational study was conducted in an emergency room of a tertiary teaching care hospital in Haryana, India. PATIENTS AND METHODS: Fifty neonates (from first hour to one month) attending pediatric emergency services with various ailments. Blood gas analysis, electrolytes, plasma lactate, and plasma albumin were estimated in neonates. RESULTS: Metabolic acidosis was the most common acid-base disorder. Hyperlactatemia was observed in more than half of such cases. Birth asphyxia was another common disorder with the highest mortality in neonates followed by bronchopneumonia and sepsis. Significant correlation between mortality and critical values of lactate was observed. CONCLUSION: Birth asphyxia with high-lactate levels in neonates constituted major alterations in acid-base disorders seen in an emergency room of a tertiary teaching care hospital. Plasma lactate concentration measurement provides an invaluable tool to assess type of metabolic acidosis in addition to predicting mortality in these neonates.