A study of oxidative stress in neonates delivered through meconium-stained amniotic fluid.

To estimate the levels of malondialdehyde (MDA) and 8-hydroxy-2-deoxyguanosine (8-OH-dG) in cord blood plasma of newborns born through meconium-stained amniotic fluid (MSAF) and also to find out the correlation between their levels with birth weight and gestation, we measured the cord blood plasma levels of MDA and 8-OH-dG in 59 newborns born through MSAF and 50 newborns born through clear liquor. The levels of cord blood plasma MDA and 8-OH-dG were significantly higher in full-term and late-preterm newborns born through MSAF. On further comparison, it was found that both full-term and late-preterm intrauterine growth restricted (IUGR) neonates had higher levels of these markers as compared to babies born as appropriate for gestational age (AGA) through MSAF. Plasma levels of MDA and 8-OH-dG were significantly correlated with birth weight even after controlling the relationship with gestational age for all cases as well as all full-term cases. These markers are also significantly correlated to each other. CONCLUSIONS: The present study suggest that the neonates born through MSAF experience higher degrees of oxidative stress, as evidenced by increased levels of cord blood plasma MDA and 8-OH-dG. What is known: • Aspirated meconium has been found to induce free radical generation and cellular damage in animal studies. • Its role in free radical generation and oxidative damage in human neonates is scarce. What is new: • Neonates born through meconium-stained amniotic fluid experience significant oxidative stress.

The immunogenicity and safety of a reduced PRP-content DTPw-HBV/Hib vaccine when administered according to the accelerated EPI schedule.

BACKGROUND: Combination vaccines improve coverage, compliance and effectively introduce new antigens to mass vaccination programmes. This was a phase III, observer-blind, randomized study of GSK Biologicals diphtheria-tetanus-whole cell pertussis vaccine combined with hepatitis B and Haemophilus influenzae type b vaccines, containing a reduced amount of polyribosyl-ribitol-phosphate (PRP) and a DTPw component manufactured at a different site (DTPw-HBV/Hib2.5 [Kft]). The primary aim of this study was to demonstrate that DTPw-HBV/Hib2.5 [Kft] was not inferior to the licensed DTPw-HBV/Hib (Tritanrix(tm)-HepB/Hiberix(tm)) vaccine or the DTPw-HBV/Hib2.5 vaccine, also containing a reduced amount of PRP, with respect to the immune response to the PRP antigen, when administered to healthy infants, according to the Expanded Programme for Immunization (EPI) schedule at 6, 10 and 14 weeks of age. METHODS: 299 healthy infants were randomised to receive either DTPw-HBV/Hib2.5 [Kft] DTPw-HBV/Hib2.5 or DTPw-HBV/Hib according to the 6-10-14 week EPI schedule. Blood samples were analysed prior to the first dose of study vaccine and one month after the third vaccine dose for the analysis of immune responses. Solicited local and general symptoms such as pain, redness and swelling at the injection site and drowsiness and fever, unsolicited symptoms (defined as any additional adverse event) and serious adverse events (SAEs) were recorded up to 20 weeks of age. RESULTS: One month after the third vaccine dose, 100% of subjects receiving DTPw-HBV/Hib2.5 [Kft] or DTPw-HBV/Hib and 98.8% of subjects receiving DTPw-HBV/Hib2.5 vaccine had seroprotective levels of anti-PRP antibodies (defined as anti-PRP antibody concentration ≥0.15 µg/ml). Seroprotective antibody concentrations were attained in over 98.9% of subjects for diphtheria, tetanus and hepatitis B. The vaccine response rate to pertussis antigen was at least 97.8% in each group. Overall, the DTPw-HBV/Hib2.5 [Kft] vaccine was well tolerated in healthy infants; no SAEs were reported in any group. CONCLUSIONS: The DTPw-HBV/Hib2.5 [Kft] vaccine was immunogenic and well-tolerated when administered according to the EPI schedule to Indian infants. TRIAL REGISTRATION: http://www.clinicaltrials.gov NCT00473668.

H-reflex and motor nerve conduction studies in growth retarded newborn babies.

OBJECTIVE: To demonstrate the accelerated postnatal maturation/myelination in growth retarded babies compensating the deficit suffered by them during intrauterine life. METHODS: We studied 16 babies within the first 3 days of birth. These included 6 full term appropriate for gestational age babies (FT AGA) and 10 full term intrauterine growth retarded (FT IUGR). A separate group of 16 babies was examined at 2 months of age. In this group 7 were FT AGA and 9 were FT IUGR at the time of birth. H-reflex latency (HRL), motor nerve conduction velocity (MNCV) and H-reflex excitability (H/M) were measured in the right lower limb. Anthropometric measurements of the babies were also recorded meticulously. All the babies were neurologically normal on clinical evaluation. RESULT: At birth, MNCV was significantly lower in FT IUGR babies compared to FT AGA babies. However at the age of 2 months the MNCV of both FT AGA and FT IUGR was comparable. Other parameters (HRL and H/M) in the IUGR babies were comparable with normal babies both at birth and 2 months of age. In FT IUGR babies crown-heel length and weight was significantly lower than FT AGA babies both at the time of birth and at 2 months of age. CONCLUSION AND SIGNIFICANCE: The findings suggest that FT IUGR babies demonstrate accelerated postnatal peripheral neural maturation. At 2 months of age, the motor nerve conduction velocity of these growth retarded babies was comparable to that observed in normal AGA babies of similar age. This provides an insight into the functional aspect of the proven theories of decreased peripheral myelination in FT IUGR babies with subsequent rapid postnatal myelination that renders these babies neurologically equivalent to FT AGA babies despite not achieving comparable anthropometric parameters.

A study of clinico-haematological profiles of pancytopenia in children.

We report on the clinico-haematological profile of pancytopenia in children from the Departments of Pediatrics and Pathology, Institute of Medical Sciences, Banaras Hindu University, India, over a period of 30 months. Pancytopenia was defined as: haemoglobin <10 g/dL, absolute neutrophil count 1.5 x 10(9)/L and platelet count <100 x 10(9)/L. A detailed history, clinical examination and haematological parameters were recorded. Bone marrow aspiration and trephine biopsy were carried out in all cases. One hundred and five cases aged 1.5-18 years, with a mean age of 8.6 years, were included in the study. Aplastic anaemia was the most common cause of pancytopenia (43%) followed by acute leukaemia (25%). Infections were the third most common cause of pancytopenia of which kala azar was the most common. Megaloblastic anaemia was seen in 6.7%.

Correlation between clinical features and degree of immunosuppression in HIV infected children.

We conducted this study to find out correlation of CD4% with clinical status in 102 HIV infected antiretroviral naive children. Mean age of presentation was 4.8 years. Perinatal transmission was the commonest mode of transmission (94%). Fever (53%), chronic diarrhea (36%), and cough (29%) were the commonest presenting symptoms. Protein energy malnutrition was seen in 56.7% of children. 33.3% children were asymptomatic, whereas 45.1% were in WHO clinical stages III and IV at the time of presentation. The most common opportunistic infection was tuberculosis. CD4% correlated significantly with the deterioration of the WHO clinical stages (P<0.01) and increasing grades of protein energy malnutrition (P< 0.05).

A study of bone marrow failure syndrome in children.

BACKGROUND: Bone marrow failure syndrome (BMFS), or aplastic anemia, includes peripheral blood single cytopenias, as well as pancytopenia due to inability of the marrow to effectively produce blood cells. AIM: To study the clinico-hematological profile and etiological factors of bone marrow failure syndrome in children. SETTING AND DESIGN: This prospective study was carried out in the Department of Pediatrics of a university teaching hospital over 36 months. MATERIALS AND METHODS: Children with pancytopenia (Hb 9 /L, platelet count<100x10(9)/L) and bone marrow cellularity<25% were included in the study. History of exposure to drugs, socioeconomic status, ethnicity and occupation of father were noted. Bone marrow aspiration; trephine biopsy; Ham test; viral studies for hepatitis A, B and C; and cytogenetic investigations were carried out. STATISTICAL ANALYSIS: Relative risk was estimated by odds ratio (OR) with 95% confidence interval (CI) in matched cases and controls. RESULTS: Of the 53 children studied, 6 (11.3%) were diagnosed as Fanconi anemia. Two cases had features of myelodysplastic syndrome. Forty-five children were labeled as acquired aplastic anemia, of whom one had evidence of hepatitis B infection and two patients (5.8%) had paroxysmal nocturnal hemoglobinuria. Aplastic anemia was more common in children from family with lower socioeconomic status; in Muslims; and where the father's occupation was weaving, dyeing and painting. However, the number was small to make statistically significant conclusions. No correlation could be established with exposure to drugs. CONCLUSION: Fanconi anemia was responsible for approximately one-tenth of the cases of bone marrow failure syndrome. Majority of the patients had acquired aplastic anemia. Hepatitis B infection was an uncommon cause of acquired aplastic anemia.

Activation of Toll-like receptors in meconium aspiration syndrome.

OBJECTIVE: Meconium aspiration syndrome (MAS) is a common cause of neonatal morbidity and mortality. Incomplete understanding of the pathogenesis of MAS has hindered the development of specific therapies. We hypothesized that activation of Toll-like receptors (TLRs) might play a role in the pathogenesis of MAS. The present study evaluated the expression of TLR 1, 4, 7, 8 and 9 in neonates with MAS. STUDY DESIGN: The study included 39 neonates with MAS and 17 healthy gestational age-matched neonates as controls. Neonates with maternal chorioamnionitis, perinatal asphyxia, sepsis and congenital malformations were excluded. Good-quality total RNA from umbilical cord blood was reverse transcribed to prepare cDNA using Bio-Rad reverse transcription kit. This cDNA was used to study the expression status of TLR 1, 4, 7, 8 and 9 by real-time quantitative polymerase chain reaction. RESULTS: Compared with controls, TLR1 and TLR4 were highly expressed, TLR9 was moderately expressed, TLR7 was weakly expressed and TLR8 expression was neutral in neonates with MAS. Within the MAS group, no difference in TLR expression was observed with respect to consistency of meconium, severity of the disease, oxygenation index and outcome. CONCLUSION: There is activation of TLRs in neonates with MAS. We speculate that these TLRs probably act as endogenous ligands for various components of meconium that initiate the inflammatory cascade of MAS and contribute to its pathogenesis.

Clinicodemographic Profile of Children with Seizures in a Tertiary Care Hospital: A Cross-Sectional Observational Study.

Seizures are one of the common causes for hospital admissions in children with significant mortality and morbidity. This study was conducted to study the prevalence and clinicodemographic profile of children with seizures in a tertiary care hospital of western Nepal. This prospective cross-sectional study conducted over a period of 2 years included all admitted children (2 months-16 years) with seizures. Among 4962 admitted children, seizures were present in 3.4% (n = 168) of children, with male preponderance. 138 (82.1%) children had generalized tonic-clonic seizures (GTCS) and 30 (17.9%) children had partial seizures. GTCS were more common than partial seizures in both sexes (male = 82.7%; female = 81.2%) and age groups. There was no statistical significance in the distribution of seizures (GTCS and partial seizures) with sexes (P = 0.813) and age groups (P = 0.955). Mean ages of children having GTCS and partial seizures were 8.2 ± 4.6 years and 8.2 ± 4.2 years, respectively. Loss of consciousness (55.4%), fever (39.9%), vomiting (35.1%), and headache (16.1%) were common complaints in seizure patients. Significant number of GTCS cases had fever (P = 0.041) and neurocysticercosis (n = 72; 43%) was the most common etiology in seizure patients. Idiopathic epilepsy (38 (22.6%)), meningoencephalitis (26 (15.5%)), and febrile convulsions (14 (8.33%)) were other leading disorders in children with seizures.

Paroxysmal nocturnal hemoglobinuria in childhood: an uncommon presentation.

An eight year old boy presented with severe anemia and bleeding spots. Complete blood count showed pancytopenia. There was mild reticulocytosis. Bone marrow was hypocellular with normoblastic erythroid hyperplasia. Ham's test (acidified serum test) was positive which confirmed the diagnosis of Paroxysmal nocturnal hemoglobinuria (PNH). Although PNH is rare in childhood, it should be considered as a diagnostic possibility in cases of aplastic anemia as the two conditions can coexist. The presence of PNH in association with aplastic anemia can influence the outcome of the latter.

Spinal motor neuron excitability in newborns following fetal distress: sub-clinical depression revealed by soleus H-reflex.

OBJECTIVE: To explore possible spinal cord dysfunction in clinically unaffected newborns emerging from fetal distress, using H-Reflex. METHODS: This cross-sectional study comprised 48 full-term newborn infants investigated between 8h and 10 days after birth. Twenty-one (21) had fetal distress defined by late-decelerations in fetal heart rate, out of which 11 had also meconium release in utero; 5 passed meconium in utero with normal FHR patterns; and 22 normal controls had uneventful birth. All had normal birth-weight and Apgar scores. All were found normal on neurological examination, except one showing hypotonia following fetal distress. Soleus H-reflex was studied in right lower limb. RESULTS: Newborns delivered with fetal distress showed significant reduction in H-reflex excitability (H/M ratio) within 2 days of birth. Tests performed closer to the birth event revealed more severe depression. Meconium did not contribute to this effect. CONCLUSIONS: Fetal distress can lead to transient, subclinical depression of spinal motoneurons in the newborn. SIGNIFICANCE: This neonatal H-reflex study focuses on excitability of a spinal motoneuron pool rather than conduction parameters (reflecting myelination) available in literature. It reveals excitability changes missed on clinical examination of newborns apparently unaffected by intrapartum hypoxic-ischemic spells. It also draws attention towards spinal cord dysfunction in birth-hypoxia.

Birth hypoxia and spinal reflex in newborn babies.

Birth hypoxia is detrimental to neuronal function. In this study, its effect on spinal monosynaptic reflex was investigated on two different age groups of human newborn babies using few non-invasive electrophysiological parameters. A total of 57 newborns (25 hypoxic + 32 non-hypoxic) were the study subject. Out of which, 31 newborns (11 hypoxic + 20 non-hypoxic) were examined within 48 hours of birth, and the rest 26 (14 hypoxic + 12 non-hypoxic) were examined between 48h and 120h (five days) of birth. H-reflex latency (HRL), distal motor latency (DL), and H-reflex conduction velocity (HRCV), were estimated for understanding the transmission of impulse in the monosynaptic reflex pathway. Moreover, Hmax, Mmax, and H/M ratio were observed for studying the spinal motor neuronal excitability. The injurious effect of hypoxia was detected on HRL, HRCV, Hmax and H/M ratio in babies who were examined within 48h of birth. The HRL was significantly increased and other parameters were significantly reduced. In the older group of babies, however, Hmax was the only parameter affected by hypoxia. The relatively older babies of hypoxic or non-hypoxic group had higher Hmax and H/M ratio compared to younger ones of their own group.

Neurocysticercosis (NCC) with Hydrocephalus, Optic Atrophy and Vision Loss: A Rare Presentation.

Neurocysticercosis (NCC) is one of the most common parasitic infestations (Taenia solium) of central nervous system (CNS) in children. Seizures are the common presenting symptoms. Hydrocephalus and optic atrophy are rare complications which may require neurosurgical interventions. We report a case of NCC with hydrocephalus and bilateral optic atrophy associated with vision loss in a Nepalese patient who improved with anti-parasitic therapy followed by ventriculo-peritoneal (VP) shunting.

Relationship of Oxygen Saturation with Neonatal and Maternal factors in Vaginal and Cesarean Deliveries.

INTRODUCTION: Hypoxemia is the major cause of neonatal morbidity and mortality. The study aims to determine the influence of birth weight, Apgar score, gestation age, body mass index and hemoglobin of mother on levels of SpO2 in healthy newborns born vaginally and through cesarean section. METHODS: A hospital Based, observational study conducted in Department of Pediatrics, Universal College of Medical Sciences-Teaching Hospital, Bhairahawa, Lumbini, Nepal; on 49 vaginal and 49 cesarean deliveries with Apgar Score ≥ 6. SpO2 was estimated by pulse oximeter post-ductally between 1 to 30 minutes of birth. The observed SpO2 values were correlated with neonatal and maternal factors. RESULTS: Vaginal and Cesarean deliveries SpO2 were comparable for birth weight, gestational age, Apgar score of neonates, body mass index and hemoglobin of the mother. Birth weight in vaginally delivered babies and Apgar score in cesarean births showed significant change in SpO2 (P<0.05). At all points of time the SpO2 values were higher in neonates, born by cesarean than those born out of spontaneous vaginal deliveries (P<0.001). CONCLUSIONS: SpO2 levels in neonates born through cesarean section were higher in comparison to thoseborn by vaginal route. Birth weight and Apgar score had correlation with SpO2 in vaginal and cesarean births, respectively.

Erythrocytic enzymes and amino acids related to glutamic acid metabolism in childhood hypoproteinemic states.

The erythrocyte enzymes of glutamic acid metabolism (glutaminase I, glutaminase II, glutamic acid decarboxylase, glutamine synthetase, and transaminases) and related amino acids (glutamine, glutamic acid, aspartic acid, alanine, and gamma-aminobutyric acid) were estimated in 69 children with protein-energy malnutrition, 13 with nephrosis, and 10 with Indian childhood cirrhosis. Twenty-one apparently healthy children served as controls. There was a significant increase in the activities of erythrocytic glutaminase I, glutaminase II, glutamic acid decarboxylase, and glutamine synthetase in all the three hypoproteinemic states, while the activities of the transaminases showed a decrease in all the conditions. The concentrations of all the amino acids were significantly increased in both the varieties of protein-energy malnutrition (edematous and nonedematous). In nephrosis and Indian childhood cirrhosis, aspartic acid, alanine, and gamma-aminobutyric acid showed a significant rise. The concentration of glutamic acid was also significantly increased in nephrosis. The observations of the present study suggest an increase in intracellular production of glutamic acid in hypoproteinemia.

Motor nerve conduction velocity & Hoffman's reflex latency in newborns.

A total of 72 newborns and their mothers were studied to assess the influence of various variables on the motor nerve conduction velocity (MNCV) and Hoffman's reflex latency (H-RL) of the babies with a view to differentiate fullterm and preterm low birth weight babies. MNCV were significantly lower and H-RL significantly higher in preterm appropriate for gestational (PT-AGA) age babies compared to fullterm appropriate for gestational age (FT-AGA) and fullterm intrauterine growth retarded babies (FT-IUGR). In FT-IUGR babies, only MNCV was significantly reduced as compared to FT-AGA babies.

Cellular immunity status in anaemia in pregnancy.

Fifty pregnant women (25 anaemic and 25 non-anaemic) and 20 non pregnant women (10 anaemic and 10 non-anaemic) were studied. All pregnant women delivered full term (37-41 wk) singleton babies. Maternal blood lymphocyte stimulation indices (SI) at 0 and 24 h were lower in anaemic and non-anaemic pregnant women, compared to anaemic and non-anaemic non-pregnant women. This difference was more marked in anaemic pregnant women, as compared to non pregnant anaemic women at 0 and 24 h respectively. The SI of maternal and cord blood lymphocytes were significantly lower in severely anaemic mothers both at 0 and 24 h and in those with maternal serum iron levels below 50 micrograms/dl or maternal per cent transferrin saturation was below 15 per cent. The anaemic mothers and their offspring were found to have significantly lower blastogenic response to PHA added at 24 h indicating depression of T-suppressor cell function.

An unusual case of heteropagus twinning.

A 3-day-old boy baby presented with a cystic umbilical swelling covered mostly by skin and partly by amnion. On the surface, an early embryo-like structure was attached (facial features and limb buds). The deeper aspect of it was composed of large cystic and tubular structures and solid organs resembling liver and spleen. It was labeled as acardiac amorphous parasitic twin, the first of its kind to be reported.

H-reflex latency: a maturity criterion for newborn babies.

One hundred newborn babies were investigated for H-reflex latency (H-RL) in between 33 to 40 weeks (wk) of post-conceptional age (PCA). Weekly data of both preterms (33 to 36 wk PCA) and fullterms (37 to 40 wk PCA) were compared. A significant reduction in H-RL was noticed at 37 wk PCA when newborns attain their term. The babies could be classified into preterms and fullterms by using their H-RL values.

Electrophysiological studies in preterm and growth retarded low birth weight babies.

Twenty-six fullterm intrauterine growth retarded (FT-IUGR) and 17 preterm appropriate for gestational age (PT-AGA) babies constituted study subjects. Offsprings were subjected to anthropometry (weight, crown-heel length and head circumference) and motor nerve conduction velocity (MNCV) as well as H-reflex latency (H-RL) at right median nerve. The PT-AGA babies had significantly lower MNCV and higher H-RL compared to FT-IUGR babies. When intrauterine growth retardation was severe (weight group 1500-1800 g) the means for MNCV and H-RL between FT-IUGR babies and PT-AGA babies of comparable weight were similar. FT-IUGR babies weighing between 1800-2100 g had significantly higher MNCV and lower H-RL compared to FT-IUGR babies weighing < 1800 g. The FT-IUGR babies where all the three anthropometric parameters were retarded (symmetrical intrauterine growth retardation) had significantly lower MNCV and higher H-RL compared to FT-IUGR babies where weight alone or in combination with crown-heel length was retarded.

Neurobehavioural assessment of newborns.

Twenty-one full term appropriate for gestational age (FT-AGA), 18 full term small for gestational age (FT-SGA), 18 preterm appropriate for gestational age (PT-AGA) and 15 babies who suffered birth anoxia constituted study subjects. They were subjected to neurobehavioural assessment using Brazelton neurobehaviour assessment scale. FT-SGA babies performed significantly poorly on motor and interactive processes only. No differences were found in terms of overall state organisation. PT-AGA also performed poorly on interactive and motor processes but were placed better than SGA babies. Here also no definite pattern was observed in organisational dimension. No significant effect of asphyxia on behavioural pattern of FT-AGA babies was observed when compared to FT-AGA non-anoxic babies.