An epidemiological study of neonatal necrotizing enterocolitis.

OBJECTIVE: To study epidemiology including various risk factors incorporated in neonatal necrotizing enterocolitis in Kashmir. METHODS: A retrospective hospital based study on 3235 neonates admitted in Neonatal Intensive Care Unit of Sheri-Kashmir Institute, were evaluated. Forty two were diagnosed as cases of Neonatal Necrotizing Enterocolitis on the basis of various clinical and radiological parameters and grouped in 3 stages as per modified Bell's classification. The case records of these 42 babies and 303 of the control group were reviewed for the purported risk factors and recorded on pretested proforma and finally statistically analyzed. RESULTS: Over a period of 10 years, we documented necrotizing enterocolitis in 42 neonates, with an incidence of 1% of all Neonatal Intensive Care Unit admissions and 1% of all live births. Eighty one percent were less than 2000 gms and 76% less than 36 weeks of gestation. Twenty four percent had stage I disease, 33% had stage II, and 43% babies had stage III disease. Multiple risk factors were present in these babies, with significant differences among Necrotizing Enterocolitis and the control group of patients, particularly hypothermia (P < 0.001), respiratory distress (P < 0.05), polycythemia (P < 0.001) acidosis (P < 0.01), sepsis (P < 0.001), enteral feeding and asphyxia (P < 0.001). Of the 59 babies (< 2000 gms) with hypothermia (< 35 degrees C), 39% developed Necrotizing Enterocolitis, compared to 4% babies (11/278), who did not have hypothermia, statistically a significant finding. Mean birth weight and gestational age were lower than in control group (P < 0.05). The age of presentation was 5.2 +/- 4.0 days and majority (81%) presented during first week of life, most severe cases presenting earlier than the mild cases. Severity of Necrotizing Enterocolitis as per modified Bell's classification and mortality was inversely related to birth weight and gestational age. One hundred percent mortality was noted in the babies, with birth weight less than 1000 gms and gestational age less than 28 weeks. The overall mortality was 45%, for stage I, 20%; for stage II, 36% and 67% for stage III. Necrotizing Enterocolitis cases accounted for maximum mortality in Neonatal Intensive Care Unit than in control group (P < 0.001). CONCLUSION: Recognition of factors such as prematurity, low birth weight, hypothermia, asphyxia and their timely prevention would help in reducing morbidity and mortality due to Necrotizing Enterocolitis.

Medical practitioners and their practices in acute diarrhea.

PIP: A study conducted in the Pediatric Outpatient Department of the Institute of Medical Sciences in Srinagar, India, assessed the acute diarrhea management strategies of various categories of health care practitioners. Of the total of 1030 infants enrolled at private clinics or other health units, 71.7% were treated by general practitioners and chemists, 11.6% saw hospital residents, and 16.7% were treated by pediatricians. Antidiarrheal and antispasmodic preparations were given to most infants, either alone (46.8%) or in conjunction with oral rehydration therapy (ORT) (45.4%). Only 4.1% of infants received ORT alone. 87.2% of pediatricians selected a combination of drugs and ORT. Both qualified and unqualified practitioners provided drugs such as lopermaide (57.9%), pipenzolate (2.1%), metoclopramide (13.7%), and steroids (2.5%). All categories of health workers prescribed marketed ORT preparations containing insufficient sodium; only 23.7% of cases received home-made sugar-salt solution. Parents in India express a preference for the use of drugs and parenteral fluids in acute diarrhea, and most practitioners appear to gear their practices to this preference. Education of both parents and health professionals about the adequacy of ORT in most cases of acute diarrhea is needed to prevent electrolyte imbalances, iatrogenic hazards, and the emergence of multidrug-resistant strains of microorganisms.^ieng

Serum lipid profile in Kashmiri children.

314 normal children in the age group of 5-14 years including 169 boys and 145 girls, were studied for their blood lipids and lipoprotein levels. Mean total cholesterol (Tch) of 172.8 mg/dl, triglycerides (TG) of 66.4 mg/dl, high density lipoprotein (HDLc) of 71.2 mg/dl, low density lipoprotein (LDLc) of 88.9 mg/dl and very low density lipoprotein (VLDLc) of 13.3 mg/dl was obtained. Lipid profile did not show any significant correlation with age and sex. Serum Tch and LDLc were higher in upper socio-economic group (P < 0.01). Tch and LDLc were higher in children taking high percentage of calories from fat and consuming more animal fats (P < .01) while HDLc value had an inverse relationship to these dietic rations.

Parental awareness and practices in acute diarrhea.

PIP: In 1992, in Srinagar, India, the Pediatric Outpatient Department of the Institute of Medical Sciences interviewed the parents of 1600 infants with acute diarrhea to learn their awareness and practices in infantile diarrhea. The parents were divided into two groups: Group A (physicians, engineers, teachers, professors, lawyers, clerks, and educated business professionals; N = 660) and Group B (all others and uneducated parents; N = 940). Most infants with acute diarrhea were boys (66.2%) and aged 6-9 months (58.7%). Only 15% of all parents knew the definition of diarrhea (3 loose stools/day) with Group B parents being more likely to know it than Group A parents (18.5% vs. 10%; p .001). 81.9% of all parents incorrectly considered frequent stools as constituting diarrhea. The parents considered weaning, maternal diet, and teething to be the major causes of diarrhea (58.1%, 42.5%, and 34.4%, respectively). Group A parents were more likely than Group B parents to report infections (27.4% vs. 9.5%) and formula and dirty feeds (7.6% vs. 2%) to be causes of diarrhea (p .001). Group B parents were more likely have no knowledge about the danger signs of diarrhea than Group A parents (30.2% vs. 9.1%; p .001). Group B parents were more likely to treat infantile diarrhea with antidiarrheal and antispasmodic drugs than Group A parents (77.7% vs. 22.7%; p .001). Group A parents were more likely to use both these drugs and oral rehydration therapy (ORT) than Group B parents (65.2% vs. 7.9%; p .001). Few parents (.6%) administered only ORT. Group A parents were much more likely than Group B parents to know the composition of various ORT brands, reconstitution of the solution, and their utility in diarrhea (65.6% vs. 7.7%; p .001). Group B parents preferred complete dietary restrictions during a diarrheal episode than Group A parents (28.7% vs. 6.2%; p .001). These findings reflect limited parental knowledge about diarrhea and its treatment.^ieng

Poisoning in children.

This study is a retrospective analysis of 670 cases of poisoning (including phenothiazine toxicity) admitted to this hospital in the past six years, accounting for 0.9% of all pediatric admissions. Nearly half (45%) of the cases were in the age group of 1-4 years. Medicines and chemicals were the commonest agents (53%), followed by pesticides (15%), kerosene (11.2%), plant poisons (9.4%), food poisoning (3.9%) and corrosives (1.9%). Accidental poisoning was the commonest (70%) followed by iatrogenic (29.6%) and suicidal (0.4%). Overall mortality was 1.8%. Stress is laid on judicious use of phenothiazines as antiemetics and replacing them with drugs of lesser toxicity.