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2.
Indian Pediatr ; 56(7): 608, 2019 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-31333221
3.
J Obstet Gynaecol ; 39(5): 606-611, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30917720

RESUMO

A deeply impacted foetal head in a second stage caesarean section is associated with an increased risk of maternal and neonatal complications. For the present study, we compared the maternal and neonatal outcomes during the use of the 'Push method' and of 'Patwardhan's method' for a foetal head delivery in a second-stage caesarean section. This was a retrospective observational study involving 298 women who underwent a second stage caesarean section with a foetal head at or below the level of their ischial spines and was conducted in a tertiary teaching hospital in South India. The rates of uterine incision extension and other maternal complications were similar in both methods (24.9% vs. 26.0%, p = .850). The rates of neonatal sepsis (2.3% vs. 9.2%) and admission to neonatal intensive care unit (36.7% vs. 60.0%) were higher when Patwardhan's method was used. Although the maternal complications were similar, the use of Patwardhan's method resulted in higher rates of neonatal complications compared to the Push method during a second stage caesarean section. Future randomised, controlled studies comparing these two methods are needed to confirm their safety and benefits, prior to its routine use in second stage caesarean sections. Impact statement What is already known on this subject? Use of a second-stage caesarean section increases the risk of maternal and neonatal complications. A deeply engaged foetal head, along with the stretching and thinning of the lower uterine segment predisposes to these complications. The recent literature mainly compares the complication rates of the Push method to a Reverse breech extraction, with only small studies reporting the use of Patwardhan's technique for the delivery of a deeply engaged foetal head. What do the results of this study add? This study suggests that the use of either the Push method or of Patwardhan's method results in similar maternal complications such as extension of a uterine incision or postpartum haemorrhage. But neonatal complications such as neonatal sepsis (2.3% vs. 9.2%) and admission to neonatal intensive care unit (36.7% vs. 60.0%) were higher when Patwardhan's method was used. What are the implications of these findings for clinical practice and/or further research? The extension of uterine incision is similar in both methods; however, the neonatal complications were noted to be higher in those delivered with Patwardhan's technique. A future, randomised controlled trial comparing these two techniques is required to confirm the findings, before either of the methods are used in routine practice.


Assuntos
Cesárea/métodos , Parto Obstétrico/métodos , Resultado da Gravidez , Adulto , Traumatismos do Nascimento/epidemiologia , Feminino , Humanos , Índia/epidemiologia , Recém-Nascido , Terapia Intensiva Neonatal/estatística & dados numéricos , Segunda Fase do Trabalho de Parto , Sepse Neonatal/epidemiologia , Gravidez , Estudos Retrospectivos
5.
Indian J Pediatr ; 86(3): 241-244, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30547428

RESUMO

OBJECTIVE: To study the incidence, clinical risk factors and outcome of thrombotic events in pediatric age group of 1 mo-12 y. METHODS: This prospective observational study was conducted in a tertiary care institute from September 2015 through October 2017. Forty nine children with thrombosis from 1 mo-12 y were enrolled. RESULTS: Out of 49 cases, 30 (61.2%) were due to venous thromboembolism (VTE) and 19 (38.8%) were of arterial thromboembolism (ATE). The cumulative average annual incidence for VTEs was found to be 38.2 (n = 30) and for ATEs it was found to be 24.2 (n = 19) per 10,000 hospital admissions over 2 y of study period. With total of 19 (38.7%), catheters were the leading cause of thrombosis followed by infection numbering to 10 cases (20.4%). Total 42.8% cases (n = 21) achieved complete resolution. Partial resolution was noted in 53.2% of cases (n = 26) and no resolution in 4% cases (n = 2). Total seven (14.3%) deaths were recorded during the study period. CONCLUSIONS: The present study showed that thrombosis is an emerging problem in tertiary care setting adding to both mortality and morbidity in children. Central venous catheters followed by infection were the leading cause of thrombosis in this study.


Assuntos
Trombose/diagnóstico , Trombose/tratamento farmacológico , Trombose/etiologia , Resistência à Proteína C Ativada , Anticoagulantes/uso terapêutico , Antitrombina III , Criança , Pré-Escolar , Feminino , Heparina/uso terapêutico , Heparina de Baixo Peso Molecular , Humanos , Incidência , Lactente , Masculino , Estudos Prospectivos , Fatores de Risco , Resultado do Tratamento , Tromboembolia Venosa , Trombose Venosa , Varfarina/uso terapêutico
6.
J Matern Fetal Neonatal Med ; 32(16): 2653-2656, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29463144

RESUMO

OBJECTIVE: The objective of this study is to assess the diagnostic accuracy of a novel hypothermia monitoring and alert bracelet device (BEMPU Bracelet) in low birth weight (LBW) neonates weighing less than 2000 g. DESIGN: This was a controlled prospective study. SETTING: This study was done in the step-down nursery of a tertiary level newborn unit of a major teaching hospital in India. METHODS: Eligible cases fulfilling inclusion criteria were given BEMPU Bracelets for a period of 24 h. A comparison was made between skin temperatures taken at the axilla by a mercury thermometer and skin temperatures taken at the wrist by the BEMPU Bracelet. Temperatures were taken every 6 h and every time the BEMPU Bracelet alarmed. Trained nurses obtained temperature measurements on newborns during their 24-h stay in the hospital step-down nursery. RESULTS: A total of 461 neonates were screened for hypothermia, giving 2428 temperature readings. Three hundred and eleven of 461 babies experienced hypothermia at some point. The 461 babies studied experienced 495 episodes of hypothermia in total. The sensitivity and the specificity of the bracelet in diagnosing hypothermia were 98.6% and 95% respectively. The positive and negative predictive values of the bracelet were 83.6% and 99.6%, respectively. The accuracy of the bracelet in diagnosing hypothermia was 95.8%. CONCLUSION: The BEMPU Bracelet is an accurate screening tool to detect and alert for neonatal hypothermia, thereby facilitating prompt management, which could prevent complications.


Assuntos
Hipotermia/diagnóstico , Temperatura Cutânea , Feminino , Idade Gestacional , Humanos , Índia , Recém-Nascido , Recém-Nascido de muito Baixo Peso , Masculino , Monitorização Fisiológica/instrumentação , Monitorização Fisiológica/enfermagem , Valor Preditivo dos Testes , Estudos Prospectivos
7.
J Matern Fetal Neonatal Med ; 32(18): 3016-3019, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29587541

RESUMO

Objective: The objective of this study was to study the effect of Holder pasteurization on macronutrients and immunoglobulin profile of pooled donor human milk. Methods: This descriptive study was conducted in a Human Milk Bank of a tertiary care teaching institute in south India. Thirty random paired pooled donor human milk samples (before and after pasteurization) were analyzed for macronutrients (protein, fat, carbohydrates) using infrared spectroscopy. Similarly, immunoglobulin profile (IgA and IgG) before and after pasteurization was quantified using ELISA. Results: The mean values of protein, fat, and carbohydrates in pooled donor milk pre-pasteurization were 1.6, 3.6, and 6.1 g/dl compared with post-pasteurization values 1.4, 2.7, and 5.9 g/dl, respectively. Pasteurization reduced protein, fat, and energy content of pooled donor milk by 12.5%, 25%, and 16%, respectively. However, carbohydrates were not significantly reduced. Pasteurization decreased IgA by 30% and IgG by 60%. Conclusion: Holder pasteurization of pooled donor human milk decreases protein, fat, and energy content and also reduces the levels of IgA and IgG.


Assuntos
Leite Humano/química , Pasteurização/métodos , Adulto , Gorduras na Dieta/análise , Proteínas na Dieta/análise , Feminino , Humanos , Imunoglobulinas/análise , Índia , Bancos de Leite , Nutrientes/análise
8.
J Matern Fetal Neonatal Med ; 32(6): 902-905, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29046116

RESUMO

OBJECTIVE: The objective of this study is to study the impact of a Human Milk Bank (HMB) on neonatal mortality, incidence of necrotizing enterocolitis (NEC) and rate of exclusive breastfeeding. METHODS: This pre-post intervention study was conducted in a tertiary care teaching institute in south India. Data regarding neonatal mortality, incidence of NEC, and exclusive breastfeeding rates were collected for a period of 6 months before and after establishing a modern HMB and compared. RESULTS: The number of deliveries, live births, and incidence of preterm and VLBW neonates during pre- and post-HMB periods were comparable. Neonatal mortality was 11.32/1000 live births pre-HMB compared with 10.77/1000 live births post HMB. The incidence of NEC was 1.26% of live births pre-HMB compared with 1.07% post-HMB. Exclusive breastfeeding rate pre-HMB was 34% compared with 74% post HMB (p < .001). CONCLUSION: There is a decreasing trend in neonatal mortality and incidence of NEC after establishing a HMB. Human milk banking significantly improved exclusive breastfeeding rate in the population studied.


Assuntos
Aleitamento Materno/estatística & dados numéricos , Enterocolite Necrosante/epidemiologia , Mortalidade Infantil , Doenças do Prematuro/epidemiologia , Bancos de Leite , Leite Humano , Adulto , Enterocolite Necrosante/prevenção & controle , Feminino , Hospitais de Ensino/estatística & dados numéricos , Humanos , Índia/epidemiologia , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/prevenção & controle , Gravidez , Estudos Prospectivos , Adulto Jovem
12.
J Matern Fetal Neonatal Med ; 31(12): 1548-1553, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28412854

RESUMO

BACKGROUND: Preeclamptic mothers are likely to have increased oxidative stress during pregnancy which can adversely affect the outcome in their neonates. OBJECTIVES: To measure the oxidative stress in preeclamptic mother- newborn dyads and correlate it with the immediate neonatal outcome. METHODS: This case control study conducted in a tertiary care teaching hospital, South India included 71 preeclamptic mothers - newborn dyads (cases) and 72 normal mothers - newborn dyads (controls). Biochemical parameters including total antioxidant status (TAS), protein carbonyls and malondialdehyde levels (MDA) were measured in both maternal and cord blood. Association between these oxidative stress parameters and early neonatal outcome was studied. RESULTS: All oxidative stress markers were higher in the preeclampsia group compared to the controls. Cord blood protein carbonyl levels had significant correlation with maternal levels. Prematurity, low-birth weight, respiratory distress syndrome (RDS), early onset sepsis (EOS) and intra-uterine growth restriction (IUGR) were more among cases. Early neonatal outcomes like death, IUGR, EOS, and RDS had significant correlation with protein carbonyl levels among the cases. CONCLUSIONS: Oxidative stress is increased in preeclamptic mother - newborn dyads. Increased protein carbonyl levels in preeclampsia correlate with adverse early neonatal outcome.


Assuntos
Doenças do Recém-Nascido/metabolismo , Estresse Oxidativo , Pré-Eclâmpsia/metabolismo , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Recém-Nascido , Gravidez , Adulto Jovem
13.
J Matern Fetal Neonatal Med ; 31(5): 666-669, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28264615

RESUMO

OBJECTIVES: To estimate the proportion of mothers who continued to practice Kangaroo mother care (KMC) at home and evaluate potential factors influencing this practice. METHODS: This descriptive study was conducted in a tertiary care teaching hospital in south India. Mothers of preterm and low birth weight infants were trained in KMC during hospital stay. During follow up after 45 days, data regarding their perceptions and the practice of KMC at home and the factors influencing them were collected using questionnaires. RESULTS: Among 200 mothers interviewed, 82.5% continued to practice KMC at home after discharge. The mean total duration of KMC was 30.2 days and average duration per day was 1.3 h. Support of family members was facilitatory in 70% and lack of privacy at home was hindering in 25%. CONCLUSION: After KMC training in hospital, majority of the post natal mothers were able to continue the practice satisfactorily at home despite hindering factors including lack of privacy. KMC training modules should emphasize continuing the practice at home after discharge and address the potential barriers for KMC continuum in the community.


Assuntos
Atitude Frente a Saúde , Método Canguru/psicologia , Método Canguru/estatística & dados numéricos , Comportamento Materno/psicologia , Percepção , Adulto , Feminino , Seguimentos , Humanos , Índia , Lactente , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Inquéritos e Questionários
14.
J Matern Fetal Neonatal Med ; 31(18): 2418-2423, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28629243

RESUMO

OBJECTIVE: To evaluate the effect of therapeutic hypothermia on myocardial dysfunction in term neonates with perinatal asphyxia. MATERIAL AND METHODS: This randomized controlled trial (RCT) conducted in a tertiary care teaching hospital, south India included 120 newborns with perinatal asphyxia that were randomized to two groups (therapeutic hypothermia and normothermia). Cardiac enzyme profile changes between groups were assessed at 0, 24, 72 h CPK-MB and troponin I levels were estimated by immune inhibition and quantitative immunochromatography methods, respectively. Electrocardiography (ECG) and Echocardiography (ECHO) were done at 0 and 72 h to evaluate the cardiac function and pulmonary hypertension. Neurodevelopment was assessed at 6 months of age in both groups using Developmental Assessment Scales for Indian Infants. RESULTS: The median values of CPK-MB in the normothermia and hypothermia groups at 0, 24, and 72 h were 198, 127, and 92 IU/L and 202, 111 and 64 IU/L, respectively. The median values of troponin I in normothermia and hypothermia groups at 0, 24, and 72 hrs were 2.45, 1.53, and 0.9 ng/mL and 1.97, 0.93, and 0.01 ng/mL, respectively. ECG and ECHO findings also suggest lesser myocardial dysfunction in therapeutic hypothermia group compared with the normothermia group. CONCLUSIONS: Therapeutic hypothermia significantly decreases the myocardial damage in term asphyxiated neonates.


Assuntos
Asfixia Neonatal/terapia , Cardiomiopatias/terapia , Hipotermia Induzida , Asfixia Neonatal/complicações , Cardiomiopatias/complicações , Cardiomiopatias/congênito , Feminino , Hospitais de Ensino , Humanos , Índia , Recém-Nascido , Masculino , Gravidez , Nascimento a Termo , Centros de Atenção Terciária , Resultado do Tratamento
15.
J Matern Fetal Neonatal Med ; 31(18): 2396-2401, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28633556

RESUMO

BACKGROUND: Hyperglycemic mothers have increased oxidative stress during pregnancy, which can adversely affect the outcome in their neonates. OBJECTIVES: To measure the oxidative stress and DNA damage in newborns born to mothers with hyperglycemia and correlate their immediate outcome with the amount of oxidative stress and DNA damage. METHODS: This prospective cohort study conducted in a tertiary care teaching hospital, South India included three groups - newborns born to pregestational diabetic mothers, gestational diabetic mothers, and euglycemic mothers with 24 newborns in each. Oxidative stress parameters - malondialdehyde (MDA), total antioxidant capacity (TAC), and DNA damage (comet assay) were assessed in umbilical cord blood. Association between these parameters and immediate neonatal outcome among three groups were studied. RESULTS: Newborns born to diabetic mothers had more MDA levels and DNA damage compared to euglycemic mothers. There was a positive correlation between comet parameters and MDA levels. There was an inverse correlation between comet parameters and TAC. Newborns born to diabetic mothers were at high risk to develop respiratory distress syndrome, hypoglycemia, and sepsis. CONCLUSIONS: Newborns born to diabetic mothers had increased oxidative stress and DNA damage compared to those born to mothers with euglycemia.


Assuntos
Dano ao DNA , Hiperglicemia/metabolismo , Recém-Nascido/metabolismo , Estresse Oxidativo/fisiologia , Complicações na Gravidez/metabolismo , Adulto , Antioxidantes/metabolismo , Estudos de Casos e Controles , Diabetes Gestacional/metabolismo , Diabetes Gestacional/patologia , Feminino , Sangue Fetal/metabolismo , Humanos , Hiperglicemia/patologia , Índia , Masculino , Malondialdeído/sangue , Mães , Gravidez , Complicações na Gravidez/patologia , Gravidez em Diabéticas/metabolismo , Gravidez em Diabéticas/patologia , Adulto Jovem
16.
Indian J Pediatr ; 85(5): 351-357, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29264827

RESUMO

OBJECTIVES: To measure the oxidative stress and antioxidant status in preeclamptic mother-newborn dyads and correlate them with neurodevelopmental outcome at one year of corrected age. METHODS: This cohort study conducted in a tertiary care teaching hospital, south India included 71 preeclamptic and 72 normal mother-newborn dyads. Biochemical parameters including total antioxidant status (TAS), protein carbonyls and malondialdehyde levels (MDA) were measured in both maternal and cord blood. Infants in both the groups were followed up to one year of corrected age and neurodevelopmental assessment was done using Developmental Assessment Scale for Indian Infants (DASII). Correlation and multivariate regression analysis was done to evaluate the oxidative stress markers in relation to neurodevelopmental outcome. RESULTS: All oxidative stress markers were higher in maternal and cord blood of pre-ecclampsia group compared to the normal group. Maternal Total antioxidant status (M-TAS) was lower in pre-eclampsia group than normal group. More neonates in the pre-ecclampsia group were preterm and intrauterine growth restriction (IUGR) and had higher incidence of morbidities like respiratory distress syndrome (RDS) and early onset sepsis (EOS). Infants in the preeclampsia group had lower motor age, motor score and motor developmental quotient (MoDQ). On multivariate logistic regression analyses, lower M-TAS levels were strongly associated with poor neuro-motor outcomes at 1 y of corrected age. Maternal TAS with a cut-off value of 0.965 mmol/L had a sensitivity of 77.8% and specificity of 55.3% in predicting MoDQ <70 at one year corrected age in infants born to preeclamptic mothers. CONCLUSIONS: Oxidative stress is increased in preeclamptic mother-newborn dyads. Low maternal TAS levels are associated with poor neuro-motor outcomes. Maternal TAS in preeclampsia is useful in predicting poor motor development at one year corrected age.


Assuntos
Sistema Nervoso/crescimento & desenvolvimento , Estresse Oxidativo , Pré-Eclâmpsia/fisiopatologia , Cesárea , Desenvolvimento Infantil , Estudos de Coortes , Feminino , Humanos , Índia , Lactente , Recém-Nascido , Masculino , Mães , New York , Gravidez , Resultado da Gravidez
18.
Indian J Pediatr ; 84(10): 763-767, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28512725

RESUMO

OBJECTIVE: To evaluate the efficacy of oral clofibrate as an adjunct to phototherapy for unconjugated hyperbilirubinemia in term neonates. METHODS: This randomized controlled trial was done in the level III neonatal intensive care unit (NICU) of a tertiary care hospital. Ninety term neonates with unconjugated hyperbilirubinemia with serum bilirubin 15-25 mg/dl were randomized to either intervention group (single dose of clofibrate in a dose of 50 mg/kg prior to starting phototherapy) or standard care group (only phototherapy). Primary outcome was absolute fall in bilirubin by 48 h. Secondary outcomes were duration of phototherapy, absolute fall in bilirubin levels at 12, 24, 36, 48 h, need for exchange transfusion and incidence of side-effects. RESULTS: After 48 h of intervention, significantly lower bilirubin levels were noted in the intervention group compared to standard care group with a mean difference of 7 mg/dl (95% CI 6.7 mg/dl to 7.2 mg/dl). Duration of phototherapy required was less in the intervention group compared to standard care group with mean difference of 23.82 h (95% CI 30.46 h to 17.18 h). Exchange transfusion was needed for 4 neonates in the standard care group and none in the intervention group. No side-effects were noted with clofibrate. CONCLUSIONS: Single dose clofibrate prior to starting phototherapy in term neonates with uncomplicated unconjugated hyperbilirubinemia reduces the duration of phototherapy significantly.


Assuntos
Clofibrato/uso terapêutico , Hiperbilirrubinemia Neonatal/terapia , Fototerapia/métodos , Clofibrato/administração & dosagem , Terapia Combinada , Feminino , Humanos , Hiperbilirrubinemia Neonatal/tratamento farmacológico , Recém-Nascido , Masculino
19.
J Matern Fetal Neonatal Med ; 30(7): 834-838, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27160763

RESUMO

INTRODUCTION: Adequate antenatal counseling combined with postnatal lactation support is likely to improve exclusive breastfeeding rates. OBJECTIVE: To assess the impact of a postnatal video based health education program in promoting exclusive breastfeeding among primiparous mothers. METHODS: This interventional study was done in a tertiary care teaching hospital, south India. Primiparous mothers in one postnatal ward (group A) received routine lactation counseling. A similar group of primiparous mothers in another postnatal ward (group B) were administered a video based health education program on exclusive breastfeeding in the local language Tamil in addition to the routine lactation counseling. The exclusive breastfeeding rates of these two groups of mothers were compared. Their knowledge and perceptions after intervention were also compared using a pretested questionnaire. RESULTS: Among 878 primiparous mothers, 94% fed colostrum and 43% initiated breastfeeding within one hour of delivery. Correct attachment was noted with 96% and 13% had lactation issues. Group B had marginally better exclusive breastfeeding rate at six months but not statistically significant. Mothers in group B had a statistically significant better knowledge score post-intervention compared to those in Group A. Use of gripe water was more in group A compared to group B. CONCLUSION: The video based health education program when combined with routine lactation counseling improved the knowledge regarding exclusive breastfeeding among postnatal primiparous mothers better than with routine lactation counseling alone. However, both interventions had similar effect on exclusive breastfeeding rate at six months.


Assuntos
Aleitamento Materno , Aconselhamento/métodos , Gravação em Vídeo , Adulto , Recursos Audiovisuais , Feminino , Hospitais de Ensino , Humanos , Índia , Mães/psicologia , Educação de Pacientes como Assunto/métodos , Cuidado Pós-Natal/métodos , Gravidez , Estudos Retrospectivos , Atenção Terciária à Saúde , Adulto Jovem
20.
Indian J Pediatr ; 83(10): 1125-30, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27206687

RESUMO

In developing countries, meconium aspiration syndrome (MAS) is an important cause of morbidity and mortality among neonates. The concepts of pathophysiology and management of meconium stained amniotic fluid (MSAF) and meconium aspiration syndrome have undergone tremendous change in recent years. Routine intranatal and postnatal endotracheal suctioning of meconium in vigorous infants is no longer recommended. Recent studies have challenged its role even in non-vigorous infants. Supportive therapy like oxygen supplementation, mechanical ventilation and intravenous fluids are the cornerstone in the management of meconium aspiration syndrome. Availability of surfactant, inhaled nitric oxide, high frequency ventilators and extracorporeal membrane oxygenation has made it possible to salvage more infants with meconium aspiration syndrome. In this review the authors have discussed the current concepts in the pathophysiology and management of MAS. Drugs in trials and future therapeutic targets are also discussed briefly.


Assuntos
Síndrome de Aspiração de Mecônio/terapia , Respiração Artificial , Sucção , Humanos , Recém-Nascido , Mecônio , Surfactantes Pulmonares
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