Idiopathic arterial calcification of infancy - a case report.

Idiopathic arterial calcification of infancy is a rare condition characterized by extensive calcification and stenosis of large and medium sized arteries. A ten day old female baby developed sudden shortness of breath and was treated with oxygen and antibiotics. Antenatal echocardiography showed calcification of the aorta and pulmonary arteries. Autopsy examination revealed extensive calcification in the walls of major arteries and vessels of several organs. The baby was found to have a karyotype of 47 chromosomes.

Neonatal nosocomial infection: profile and risk factors.

OBJECTIVE: To determine the incidence and risk factors for neonatal nosocomial infections. DESIGN: Cohort study. SETTING: Tertiary care Teaching Hospital. METHODS: Hospital born neonates transferred to the neonatal unit after birth and available in the unit 48 hours later comprised the cohort for the surveillance. Detailed maternal, intrapartum and neonatal variables were recorded. Risk factors for nosocomial infection were analyzed by both univariate and multiple logistic regression methods. RESULTS: One hundred and thirty-four neonates were enrolled in the cohort. The overall nosocomial infection rate was 16.8/1000 patient days. Device associated infection rate was 11.9/1000 device days. Multidrug resistant Klebsiella species was the commonest organism causing nosocomial septicemia and pneumonia followed by Pseudomonas aeruginosa. The risk factors detected to be significantly associated with infection on multiple logistic regression analyses were a birth weight < 1500 g (OR 3.3) and assisted ventilation > 72 h (OR 14.2). CONCLUSIONS: Very low birth weight (VLBW) neonates, especially those undergoing interventions such as mechanical ventilation are at the greatest risk for infection and death. Therefore, strict protocol for asepsis must be adhered to when handling these high risk infants.

PIP: The incidence and risk factors for neonatal nosocomial infection were investigated in a cohort study of 134 hospital-born infants transferred to a neonatal unit in New Delhi, India, after birth and observed for up to 72 hours. 22 of the 134 infants developed nosocomial infections. The median age at diagnosis was 184 hours. In 16 of these infants, both sepsis screen and blood culture were positive. Septicemia was diagnosed in 21 neonates; 11 had associated pneumonia and four had soft tissue infection. Multiresistant Klebsiella species was the infectious agent in 68% of cases. The overall nosocomial infection rate was 16.8/1000 patient-days and the device-associated infection rate was 11.9/1000 device-days. Factors significantly associated with neonatal nosocomial infection in the univariate analysis were low birth weight, prematurity, vaginal delivery, hyaline membrane disease, assisted ventilation, and use of peripheral venous and umbilical vascular catheters. In the final multivariate analysis, only birth weight under 1500 g (odds ratio, 3.3) and assisted ventilation for more than 72 hours (odds ratio, 14.2) remained significant risk factors. It was observed in 122 random observations in this hospital that 15-18% of nurses and residents failed to adhere to adequate hand-washing techniques. Strict adherence to aseptic protocols in neonatal units is essential to keep infection rates under control.

Perinatal asphyxia: multivariate analysis of risk factors in hospital births.

OBJECTIVE: To determine risk factors for perinatal asphyxia. DESIGN: Cohort study. SETTING: Teaching hospital. METHODS: All consecutive hospital births were evaluated during the study period. Asphyxia was defined on intrapartum and neonatal resuscitation criteria. Maternal, intrapartum and neonatal variables were recorded in all births. Data was analyzed after stratifying for live and stillbirths by univariate and logistic regression analyses. RESULTS: Amongst 2371 births (55 fetal deaths and 2316 live births), there were 86 cases of perinatal asphyxia (35 fetal deaths and 51 live births), providing an asphyxia rate of 36.3/1000 births. On multivariate analysis, risk factors significantly associated with asphyxia included prolonged second stage labor (OR 9.4), vaginal breech delivery (OR 6.6), elective cesarean delivery (OR 4.6), pregnancy induced hypertension (PIH) (OR 2.7) and fetal growth retardation (SFD) (OR 2.4). Amongst stillborn, the significant univariate factors associated with asphyxia were prolonged second stage labor (RR 1.7) and cord prolapse (RR 1.7). CONCLUSIONS: There is a need to strengthen intrapartum management and early identification of mothers with PIH or intrauterine growth retardation to reduce asphyxial morbidity and mortality.

PIP: The risk factors for perinatal asphyxia were investigated in a cohort study of all 2371 deliveries at Maulana Azad Medical College in New Delhi, India, in the study period. There were 86 cases of asphyxia (35 fetal deaths and 51 live births), for an overall asphyxia rate of 36.3/1000 births. Asphyxia prevalence was 2.2% among live births compared with 63.6% among still births. Multivariate analysis identified the following significant risk factors for asphyxia: prolonged second stage labor (odds ratio (OR), 9.4), vaginal breech delivery (OR, 6.6), elective Cesarean delivery (OR, 4.6), pregnancy-induced hypertension (OR, 2.7), and fetal growth retardation (OR, 2.4). These findings indicate that most perinatal asphyxia is associated with pregnancy-related complications such as hypertension and preventable intrapartum problems. Decreases in the incidence of perinatal asphyxia require the identification of pregnant women at risk for institutional delivery and training of medical personnel to manage complicated labor and delivery.

Effect of timing of cord clamping on the iron status of infants at 3 months.

OBJECTIVE: To determine the effect of timing of cord clamping on iron stores of term infants at 3 months of age. DESIGN: Prospective randomized clinical trial. SETTING: Tertiary hospital. SUBJECTS: 107 term neonates born to mothers with uncomplicated pregnancies and with hemoglobin more than 10 g/dl. METHODS: The 107 infants were randomized to either early (n = 48) or late (n = 59) clamping groups at the time of delivery. Outcome measures evaluated were serum ferritin and hemoglobin in the infant at 3 months age. RESULTS: The groups were comparable for maternal age, parity, weight, supplemental iron intake in pregnancy, infant's birth weight, gestation and sex. Maternal and cord ferritin and hemoglobin values at birth were comparable. The infant ferritin at 3 months were also similar. CONCLUSIONS: Iron stores at 3 months in term infants are not influenced by timing of cord clamping at birth.

Incidence of congenital heart disease among hospital live births in India.

Ten thousand nine hundred and sixty four consecutive live births weighing more than 500 g and more than 28 weeks of gestation were subjected to a thorough clinical examination within 24 h of birth. Those suspected of having congenital heart disease (CHD) were followed up every 4-6 weeks for a period of 6 to 18 months (mean 9.75 months). Forty three of 10,964 infants had CHD, i.e., 3.9/1000 live births. Incidence of CHD was higher in pre-terms as compared to full term live births (22.69 vs 2.36/1000 live births). Diagnosis was confirmed by echocardiography including 2D, Doppler and color flow imaging. Twenty eight per cent of the infants with CHD had other associated somatic anomalies, Down's syndrome being the commonest (9.3%). Patent ductus arteriosus (41.9%) and ventricular septal defects (VSD) (34.9%), were the commonest lesions with an incidence of 1.6 and 1.4/1000 live births, respectively. Incidence of PDA was higher probably because of larger number of pre-term deliveries. During follow up of 6-18 months, 34.9% of the infants with CHD died. The diagnosis of CHD was confirmed at autopsy in 20% of the deaths.

Simultaneous administration of hepatitis B vaccine with other E.P.I. vaccines.

Development of recombinant DNA vaccine against hepatitis B grown on cultured yeast cell has made it possible to mount a world-wide effort to control and eradicate Hepatitis B infection. However, the currently recommended schedules (0, 1 & 2 months, and 0-1 and 6 months) do not coincide with the scheduled visits for other E.P.I. vaccines, and necessitate additional visits for Hepatitis B vaccination. This study was therefore carried out to find out if adequate seroconversion occurs to Hepatitis B vaccine when given with other EPI vaccines or not? Thirty nine infants born to Australia antigen positive mothers from among 850 screened pregnant mothers were recruited to receive Hepatitis B vaccine (Engerix B-10 micro gram each) at 0, 6 and 14 wks (group A) or at 0, 1 and 2 months (group B). Thirty-one infants were recruited in group A and 8 in group B. The cord blood was collected and the first dose of vaccine was given within 48 hours of birth. Simultaneous B.C.G. was given at the left deltoid. Other E.P.I. vaccines were given qt 6, 10 and 14 wks in group A and at 2, 3 and 4 months in group B. Repeat blood samples were collected prior to giving each dose of Hepatitis B vaccine, and 4 weeks after the last dose. All blood samples were assayed for HBsAg and HBsAb at the National Institute Of Communicable Diseases, utilizing standard ELISA kits. The seroconversion rates following one, two and three doses of Hepatitis B vaccine were 3.33%, 55.5%, 96.15% and 0%, 62.5% and 100% in group A and B respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Resuscitation of asphyxic newborn infants with room air or 100% oxygen.

To test the hypothesis that room air is superior to 100% oxygen when asphyxiated newborns are resuscitated, 84 neonates (birth weight > 999 g) with heart rate < 80 and/or apnea at birth were allocated to be resuscitated with either room air (n = 42) or 100% oxygen (n = 42). Serial, unblinded observations of heart rates at 1, 3, 5, and 10 min and Apgar scores at 1 min revealed no significant differences between the two groups. At 5 min, median (25th and 75th percentile) Apgar scores were higher in the room air than in the oxygen group [8 (7-9) versus 7 (6-8), p = 0.03]. After the initial resuscitation, arterial partial pressure of oxygen, pH, and base excess were comparable in the two groups. Assisted ventilation was necessary for 2.4 (1.5-3.4) min in the room air group and 3.0 (2.0-4.0) min in the oxygen group (p = 0.14). The median time to first breath was 1.5 (1.0-2.0) min in both the room air and oxygen groups (p = 0.59), and the time to first cry was 3.0 (2.0-4.0) min and 3.5 (2.5-5.5) min in the room air and oxygen groups, respectively (p = 0.19). Three neonates in the room air group and four in the oxygen group died in the neonatal period. At 28 d, 72 of the 77 surviving neonates were available for follow-up (36 in each group), and none had any neurologic sequelae.(ABSTRACT TRUNCATED AT 250 WORDS)

Cranial sonography in preterm infants.

Fifty preterm newborn infants with gestational age of 28-36 weeks were subjected to real time cranial sonography to (a) evaluate the ventricular system and brain parenchyma, (b) determine the incidence of intracranial abnormalities, and (c) to establish the utility and advantages of routine cranial sonography in preterm infants. The lateral ventricular width varied from 6-12 mm (8.67 +/- 1.85 mm) while hemispheric width ranged between 3.68 to 3.95 cm with a mean of 3.84 +/- 0.25 cm. The lateral ventricular ratio ranged from 20.9 to 26.4% and it showed progressive decrease with increasing gestational age. Cavum septum pellucidum was found in 68% of the preterms. Incidental intracranial pathologies were detected in 12% of the preterms screened.

Clinical and bacteriological study of normal and inflamed neonatal conjunctivae.

Maternal vaginal and neonatal conjunctival flora were prospectively studied in a 117 mother baby pairs. The commonest isolates from both vaginal and conjunctival flora were E. coli, Staphylococcus aureus and Klebsiella species. In 85% of mother-baby dyads, isolates from vagina and conjunctiva were similar. The commonest bacterial isolates in neonates with conjunctivitis were Staphylococcus aureus (37.4%), E. coli (27.9%) and Klebsiella species (19.3%). Maternal coitus, infections, rupture of membranes and baby's birth weight and sex did not influence the occurrence of conjunctivitis.

Diagnostic and prognostic utility of C-reactive protein, alpha-1-antitrypsin and alpha-2-macroglobulin in neonatal sepsis: a comparative account.

C-reactive protein (CRP), alpha-1-antitrypsin (alpha-1-AT) and alpha-2-macroglobulin (alpha-2-MG) levels were evaluated serially in 25 healthy and 20 septicemic neonates and then compared as early diagnostic aids and prognostic indicators in this illness. Compared to healthy controls, septicemic neonates had significantly higher mean CRP levels (p less than 0.01). Neonates with septicemia, who recovered, had higher mean CRP levels than the group which died (p less than 0.05). As an early diagnostic aid CRP had a low Youden index, whereas for prognosis its index was higher. Septicemic neonates also had significantly higher mean alpha-1-AT levels (p less than 0.05), 12-24 hours after onset of illness, as compared to healthy neonates. Alpha-1-antitrypsin could not be used as an early diagnostic aid in septicemia, but was useful for predicting outcome. Mean alpha-2-macroglobulin levels did not show significant variation in healthy and septicemic neonates. Lower mean alpha-2-MG levels were observed in neonates recovering from septicemia. As an early diagnostic aid alpha-2-MG had a low Youden index, whereas for prognosis its index was higher. CRP had a higher Youden index than alpha-2-MG for early diagnosis of neonatal septicemia and had a higher index than both alpha-1-AT and alpha-2-MG for predicting outcome in septicemia. Serial use of CRP alone is, therefore, recommended for both purposes.

Evaluation of ceruloplasmin in neonatal septicemia.

Serial serum ceruloplasmin (Cp) levels were estimated in healthy and septicemic neonates, using single radial immunodiffusion. In 25 healthy neonates mean Cp levels were 19.82 mg/dl at birth, 18.20 mg/dl at 12-24 hours, 17.26 mg/dl at 14 +/- 4 days and 17.68 mg/dl at 28 +/- 4 days of life. For the entire neonatal period the mean Cp levels were computed to be 18.24 mg/dl. In 20 culture positive, septicemic neonates, mean Cp levels were 27 mg/dl at onset of disease, 28.65 mg/dl 12-24 hours later and 36.2 mg/dl after 7 +/- 3 days of start of illness (p less than 0.001 for all sampling intervals as compared to healthy group values in first month of life). The mean Cp levels were unaffected by gestational age in both groups. In the septicemic neonates, the mean Cp levels in dying neonates did not differ significantly from recovering neonates for all sampling intervals. It is concluded that estimation of serum Cp levels may help in diagnosis of neonatal septicemia, but it is not useful as an early diagnostic aid or for prognostication.

Complement components in neonatal sepsis.

Complement components C3, C1q, factor B and breakdown products of C3, i.e. C3c and C3d, were evaluated in the diagnosis and prognosis of sepsis in 24 neonates with proven sepsis. The complement components were measured by electroimmunodiffusion and breakdown products by counterimmunoelectrophoresis (CIEP). The babies with sepsis were found to have decreased levels of C1q and factor B as compared with suitably matched healthy controls. No statistically significant depression was observed in C3 levels of infected babies. However, breakdown products of C3, i.e. C3c and C3d, were detected in 58.3% of these babies. The breakdown products of C3 were not present in any of the healthy controls. The degree of depression of complement components was of no prognostic significance in neonatal sepsis.

Cord blood lipid levels in low birth weight newborns.

Cord blood cholesterol, triglyceride and FFA levels were estimated in 73 newborns, subdivided into various gestation weight categories (FTAGA, PTAGA, FTSGA and PTSGA). Cholesterol levels were not influenced by birth weight and gestation. Prematurity and growth retardation caused a significant elevation in triglyceride values. FFA levels were not influenced by prematurity, but growth retardation produced a significant increase. Birth weight and gestational age should be taken into consideration before labelling the newborn as hyperlipidemic.

Specific antibodies in colostrum of north Indian mothers with special reference to their nutritional status.

The anti-S. typhi antibody is predominantly IgA class, and the anti-polio-antibody, antimeasles antibody, anti-E. Coli enterotoxin antibody and anti-S. typhi agglutinins were found adequate in the colostrum samples of well- and under-nourished mothers. No antibody against tetanus toxin was detectable in colostrum samples from mothers of both the groups, although they have been immunized against tetanus toxoid during pregnancy, suggesting thereby that the presence of specific antibody in the mother's breast secretions is associated with the enteromammary axis, leading to the homing of B-lymphocytes which have been specifically sensitized in the gut.