Clinical profile of klebsiella septicemia in neonates.

A detailed clinical study of 51 consecutive cases of neonatal klebsiella septicemia was carried out prospectively over a 20 months period. The incidence was 6.27 per 1000 live births. Majority (85.5%) were either preterms or small for date. Almost fifty percent babies had associated perinatal risk factors. Mean age of onset was 5.7 +/- 2.2 days. General symptoms were the earliest to occur at mean age of 5.7 days followed by respiratory, alimentary, hematological and neurological symptoms at 6.2, 6.3, 6.6 and 7.9 days respectively. About half of the neonates had associated complications; commoner being meningitis (20%), bleeding manifestations and sclerema (17.6% each) and pneumonia (15.7%). Cefatoxime was found to be the drug of choice (86% sensitivity). Nine babies (17.6%) died during the study period at a mean age of 9.1 +/- 3.2 days. Mean duration of hospital stay in rest of neonates was 27.9 +/- 12.1 days. Neurological symptoms were commoner in late onset disease. Bleeding manifestations, sclerema and granulocytopenia were seen exclusively in preterms. Presence of respiratory symptoms, bleeding, sclerema, shock and granulocytopenia were identified as poor prognostic factors in neonatal klebsiella septicemia.

Strategies which reduced sepsis-related neonatal mortality.

PIP: A marked reduction in neonatal mortality was achieved during 1986, which can be attributed largely to the decline in the incidence of infections as a result of modification of a few of the routine practices in the Intensive Care Nursery of the All India Institute of Medical Sciences (AIIMS) in New Delhi. Over 80% of pregnant women attending the antenatal clinics of AIIMS have 1 or more perinatal high risk factors. All deliveries are performed by obstetricians, and each neonate is managed at birth by 1 or more residents of the neonatology unit. Data on every neonate is recorded on a specially designed case sheet. Cause of neonatal death is classified according to the criteria of Wigglesworth. A monthly report of the census and morbidity mortality data is recorded on a special proforma and discussed in a joint meeting of the staff of the obstetrics and neonatology services. The information presented is based on these monthly reports. A table shows the data on the live births in 1985 and 1986 and their distribution according to birth weight. The total number of live births in the 2 years were nearly the same. There was no significant difference in the neonatal population in different birth weight groups. There were 66 neonatal deaths in 1985 but only 43 in 1986. This significant decline in the neonatal mortality was attributable to reduction in the late neonatal deaths. The neonatal mortality rate (per 1000 live births) dropped from 36.6 in 1985 to 23.9 in 1986. There was a decline in the neonatal mortality rate in birth weight groups from 1001-2500 g. The reduction of deaths in the birth weight group of 1001-1500 g was most pronounced. Neonatal mortality rate (per 1000 live births) dropped from 525.4 in 1985 to 377.7 in 1986 in this group. The overall neonatal mortality rate in infants weighing 2500 g or less declined from 12.3 to 8.5%. The difference in the proportion of deaths in relation to individual causes was significant only in the case of sepsis. The decline in the sepsis-related neonatal mortality was a consequence of 2 factors: the incidence of neonatal sepsis declined from 38.2/1000 live births to 18.8/1000 live births; and a definite though less pronounced improvement occurred in the case fatality rate -- 24.6% versus 17.7% in 1985 and 1986, respectively. The significant decline in late neonatal deaths was largely attributed to the reduction in the sepsis-related late neonatal deaths -- 16 versus 3. Sepsis ranked as number 2 as cause of neonatal mortality in 1985; it ranked as number 4 in 1986.^ieng

Epidemiology of diarrhea in urban slums.

PIP: Findings are presented from an assessment of the impact of potable water supply, mother's literacy, toilet type, socioeconomic status, family size, housing, hygienic practices, and malnutrition upon the frequency of diarrheal episodes among children of low socioeconomic status living in the urban slums of East Delhi, India. The mothers of 450 consecutive children with acute diarrhea attending the UCMS and GTB Hospital's Diarrhea Treatment-cum-Training Unit (DTTU) clinic were included in the study. The mothers were 17-40 years old, of mean age 25.8 years, while their children were 1-98 months old, of mean age 18 months. The 450 children in the study experienced 726 episodes of diarrhea during the preceding month, with 205 of the children having more than 1 episode. Multivariate logistics analysis determined that malnutrition and poor hygienic practices were important, significant factors increasing children's risk of multiple bouts of diarrhea.^ieng

Factors influencing survival in esophageal atresia.

There is little published literature from the third World countries that described the factors influencing survival of babies with esophageal atresia. We analysed 25 consecutive neonates treated for esophageal atresia. The overall survival rate was 36%. All 4 babies in Waterston Group A, 37.5% in Group B, and 15.4% in Group C survived. All 9 preterm babies died. Only 2 of the 16 babies who had pre-operative chest infection survived. The mean delay in diagnosis was 54 h in outborn babies and 20 h in hospital-born babies. We believe that a survival rate of 40% is easily achieved with minimum infrastructural inputs. Simple methods and practices that would vastly improve operative results have been suggested.

Prognostic score for kerosene oil poisoning.

Ninety five consecutive children with kerosene oil poisoning were studied, the first 70 retrospectively (internal group) and the rest 25, prospectively (external group) over a period of 3 years and 8 months. Based on clinical features and severity of illness in initial 70 cases, a weighted scoring system to determine the outcome was evolved. This included: (i) fever--absent 0, present 1; (ii) severe malnutrition--absent 0, present 1; (iii) respiratory distress--absent 0, present 2, with cyanosis 4; and (iv) neurological symptoms--absent 0, present 2, with convulsions 4. The scores ranged from 0 to 10 in the internal group. Using discriminate function analysis, a score of 4 or more was found to be associated with prolonged hospital stay and complications. The risk of dying increased if the score was equal to or more than 8. The predictive value of the score was 85.7%. For validation, this scoring was applied to the external group as well and 84% of cases could be correctly predicted.

Evaluation of social marketing of oral rehydration therapy.

Attempts, at social marketing of oral rehydration therapy (ORT) through television, in changing the knowledge and practice of mothers with regard to its use was assessed. One hundred and eighty seven consecutive mothers (38 excluded due to non use of ORT) were administered a preplanned questionnaire to assess their socio-economic profile, educational status, concept of diarrhea and correct use of ORT. Fifty nine mothers who watched these programmes on TV regularly formed the study group. These were compared with 90 mothers who had gained such knowledge from non-television sources. The correct application of knowledge of ORT was significantly better in study group compared with control group. The educational status of mothers had a positive impact on motivation to use ORT at home in the study group. Mass media campaigns through "TV spots" is an effective way of improving knowledge of mothers on ORT in a developing country.

PIP: Researchers interviewed 149 mothers from the slums of East Delhi, India who knew about oral rehydration therapy (ORT) to evaluate the effectiveness of the Ministry of Health's mass media campaign to promote ORT use during diarrheal episodes. As of September 1991, India has distributed oral rehydration solution (ORS) packets free of charge. The Ministry of Health has conducted the campaign since 1989. They compared the 59 mothers who watched the television (TV) ads with celebrities delivering simple and clear images to the 90 mothers who had received ORT messages from other sources such as health workers. Mothers who watched the TV ads were considerably more likely to know how to correctly prepare ORS than those who learned about ORT from other sources (62.7% vs. 37.7%; p.01). No significant difference in use of ORT at home between the 2 groups existed, however (69.49% and 53.33%, respectively). Yet when the mothers were divided by educational status, they learned that TV ads were more likely to teach educated mothers how to correctly prepare and to use ORT at home than health staff (81.5% vs. 35.5% and 81.5% vs. 41.9%, respectively; p.01). Most mothers (88.13% and 81.11%, respectively) in both groups still fed their child during diarrheal episodes. TV ads and health staff were equally effective for both educated and uneducated women. These results showed that social marketing of ORS packets via the TV ads was successful in increasing ORT acceptability, knowledge, use, and especially among educated mothers. Similar studies in Bangladesh showed that education incites changes in attitude and behavior of mothers which makes them more receptive of new knowledge and modern medicine. Another possibility for the education difference may be that TV was better able to interest educated mothers than health staff.

An outbreak of poliomyelitis in Andhra Pradesh (South India).

An outbreak of poliomyelitis that occurred in the year 1992 in Telangana region of Andhra Pradesh, South India was investigated to understand the reasons for persistence of poliomyelitis in the general population and for the outbreak in Andhra Pradesh in particular. The study comprised of a detailed investigation of epidemiological and clinical features, serology and vaccination status and a case control study to calculate vaccine efficacy by matched pair analysis. The outbreak occurred after a relative quiescence of 3 years. The age group of the patients ranged from 2 months to 5 years, 26.5% being infants and 70.2% being children between 1 and 5 years. The outbreak was mainly caused by Type 1 poliovirus. Vaccine efficacy was found to be 70%. Antibody response was not high in cases. Seventy six per cent of the children with poliomyelitis were unvaccinated. Ignorance of the mothers and family interference were the main causes for not vaccinating the children. The study indicates the need to increase the vaccination coverage and inclusion of children upto 5 years in the programme. Absence of vaccination is the major risk factor for the outbreak. The persistence of poliomyelitis in older children, low antibody response and suboptimal vaccine efficacy point out the problem of achieving control with OPV in tropical countries and suggest the need for alternate strategies. Better health education strategies need to be developed.

Kerosene oil poisoning--a childhood menace.

This study documents 3-year retrospective analysis of accidental kerosene oil poisoning in 70 children with regard to clinical profile, radiological changes and outcome. About 77% of cases were between 1 and 3 years old. Fifty children (71.4%) developed significant symptoms, with onset soon after to within 10 hours of ingestion. These included breathlessness (55.7%), fever (47.1%), cough (31.4%), restlessness (25.7%) and abdominal distension (15.7%). Chest X-rays were obtained in 65 children. Abnormal radiographs were seen in 45 (69.2%) children with right basal infiltrates being the commonest picture (21.4%). Ingestion of more than one ounce of kerosene oil adversely affected the clinical and radiological profile. Severely malnourished children had extensive radiological changes and poorer clinical outcome. One case developed myocarditis, a complication which has not been reported to the best of our knowledge. Mortality rate was 4.3%. All deaths occurred within 48 hours of admission.

Multi drug resistant Salmonella typhi infection: clinical profile and therapy.

Multiple drug resistant Salmonella typhi infection was observed in thirty five recent cases among forty eight children with bacteriologically proven enteric fever. Incidence of complications such as shock, myocarditis, encephalopathy and paralytic ileus was higher among these. A combination of cephalexin and gentamicin was successfully used in the management of these children.