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Sharma D.,Fernandez Hospital | Shastri S.,ACPM Medical College
Journal of Maternal-Fetal and Neonatal Medicine | Year: 2016

Neonatal sepsis and necrotizing enterocolitis (NEC) are two most important neonatal problems in nursery which constitute the bulk of neonatal mortality and morbidity. Inflammatory mediators secondary to sepsis and NEC increases morbidity, by affecting various system of body like lung, brain and eye, thus causing long term implications. Lactoferrin (LF) is a component of breast milk and multiple actions that includes antimicrobial, antiviral, anti-fungal and anti-cancer and various other actions. Few studies have been completed and a number of them are in progress for evaluation of efficacy and safety of LF in the prevention of neonatal sepsis and NEC in field of neonatology. In future, LF prophylaxis and therapy may have a significant impact in improving clinical outcomes of vulnerable preterm neonates. This review analyse the role of lactoferrin in prevention of neonatal sepsis and NEC, with emphasis on mechanism of action, recent studies and current studies going on around the globe. © 2015 Informa UK Ltd.

Gundabattula S.R.,Fernandez Hospital | Pochiraju M.,Fernandez Hospital
Journal of Clinical and Diagnostic Research | Year: 2014

Primary abdominal pregnancy has a higher mortality rate than other ectopic gestations. Delayed diagnosis can be associated with catastrophic haemorrhage. This report describes a spontaneous conception which occurred in the uterosacral ligament in a woman with no known risk factors for an ectopic pregnancy. Extrauterine pregnancy was diagnosed by ultrasound and laparoscopy was performed secondary to haemoperitoneum, which revealed a pregnancy implanted in the right uterosacral ligament. The rarity of this condition signifies the need for reporting all cases to facilitate future research and clinical management.

Kumar N.,Fernandez Hospital | Murki S.,Fernandez Hospital
Indian Pediatrics | Year: 2013

Umbilical venous lines are sometimes complicated with pleural and or pericardial effusion, often due to line migration. Case Characteristics: Bilateral chylous pleural effusion without pericardial effusion in a 28 weeks, extremely low birth infant who was on total parenteral nutrition. Observations/Investigations: Investigations including chest x ray and 2D echocardiogram showed bilateral chylous pleural effusions but appropriate tip position of the umbilical venous line. Outcome: Removal of the umbilical venous line and cessation of total parenteral nutrition resulted in complete resolution of the pleural effusion. Message: In any newborn with central venous catheter in situ, acute deteriorations specially, those related to pleural and pericardial effusions should alert the clinicians to remove the catheter and should not be misguided by apparently appearing normal correct catheter position by x-ray or 2D echocardiogram. © 2013 Indian Academy of Pediatrics.

Case 1: A term male child was re-admitted on day 10 of life due to acute onset of respiratory distress. Physical examination revealed tachypnoea, tachycardia and blood pressure (BP) above the 95th centile in all four limbs. Cardiovascular examination revealed a short systolic murmur on the sternal border. Abdomen showed hepatomegaly of 3 cm below the costal margin. Chest X-ray showed a cardiothoracic ratio of 0.65 with normal vascularity. Ultrasound and Doppler of the kidneys and brain were normal. The high parasternal view showed a large ductus arteriosus aneurysm (DAA) of 2.0 × 2.5 cm. The baby was managed with inotropes and antihypertensives. CT angiogram showed 1.6 × 0.6 cm thrombosed DAA, which was extending from the posterior descending aorta to the ampulla. With the resolution of aneurysm BPs normalised and antihypertensives were stopped at 6 weeks of age. Case 2: A premature male neonate weighing 1.2 kg was admitted to the neonatal intensive care unit for respiratory distress syndrome. On the 4th day of life during routine measurement of vitals, the BP was consistently above 95th centile in all four limbs. Blood tests revealed thrombocytopenia that persisted inspite of single donor transfusions. The evaluation for sepsis was negative. The ultrasound and Dopplers of the kidneys and brain were all normal. A transthoracic echocardiogram showed a large DAA measuring 5 × 1.8 mm. Hypertension was managed with antihypertensives. Serial transthoracic echocardiogram showed organising DAA. CT angiogram showed 6 mm × 2 mm thrombosed DAA. As the arterial BP normalised, antihypertensives were stopped on day 15 of life. The baby was discharged on day 29 of life and on follow-up BP remained normal.

Jaiman S.,Fernandez Hospital | Nalluri H.B.,Bhaskar Medical College
Congenital Anomalies | Year: 2013

Anomalies of the umbilical venous system are perplexing essentially due to dissection errors and vascular connection delineation failure. Continuation of umbilical vein into the extra-hepatic portal vein is classified as group IV umbilical vein anomaly and involves the vitelline vein or its remnants. Despite this categorization most examiners ascribe fetal extra hepatic abdominal vascular abnormality as an umbilical vein anomaly. Since these anomalies involve vitelline vein, the term "umbilical vein anomaly" is inappropriate and should be referred to as "vitelline vein abnormalities". Vitelline vein abnormalities are exceedingly rare and to the best of our knowledge only three cases have been reported prenatally. We report three cases presenting with intrauterine fetal demise and on perinatal autopsy demonstrating aneurysmally dilated group IV umbilical vein anomaly. Review of the literature, embryological basis and clinical implications of persistent vitelline vein and its varix are discussed. © 2013 Japanese Teratology Society.

Sharma D.,Pandit Bd Sharma Postgraduate Institute Of Medical Science | Sharma D.,Fernandez Hospital | Gathwala G.,Pandit Bd Sharma Postgraduate Institute Of Medical Science
Journal of Maternal-Fetal and Neonatal Medicine | Year: 2014

Aim: To study the impact of chlorhexidine cleansing of the umbilical cord on cord separation time and neonatal mortality in comparison to dry cord care. Methods: This is the secondary analysis of the data of the study which was conducted in the NICU of a teaching hospital in north India between 2010 and 2011. Newborns (>32 weeks of gestation and weighing >1500g) were randomized into chlorhexidine application and dry cord care groups. Here, we analyze the data regarding time of cord separation, umbilical sepsis and mortality in both the groups. Results: One hundred and forty (dry care group 70, chlorhexidine group 70) were enrolled and finally analyzed. A significant difference was observed among groups in terms of time to cord separation (8.92±2.77 days versus 10.31±3.23 days; t=2.20; p=0.02, significant) and neonatal mortality (χ2=4.11; p=0.042, significant). Conclusion: Use of chlorhexidine for umbilical cord care shortens duration of cord separation and decreases neonatal mortality in NICU. This simple intervention can be used as mode for decreasing neonatal mortality. © 2014 Informa UK Ltd. All rights reserved: reproduction in whole or part not permitted.

Kandraju H.,Fernandez Hospital | Murki S.,Fernandez Hospital | Subramanian S.,Fernandez Hospital | Gaddam P.,Fernandez Hospital | And 2 more authors.
Neonatology | Year: 2013

Background: Preterm neonates with respiratory distress syndrome (RDS) benefit from early application of nasal continuous positive airway pressure (nCPAP). However, it is not clear whether surfactant should be administered early as a routine to all such infants or later in a selective manner. Objective: It was the aim of this study to compare the efficacy of early routine versus late selective surfactant treatment in reducing the need for mechanical ventilation (MV) during the first week of life among moderate-sized preterm infants with RDS being supported by nCPAP. Methods: Infants born at 28 0/7 to 336/7 weeks of gestation with RDS and on nCPAP were randomly assigned within the first 2 h of life to early routine surfactant administration by the InSurE technique (early surfactant group) or to late selective administration of surfactant (late surfactant group). The primary outcome was need for MV in the first 7 days of life. Results: Among 153 infants randomized to early (n = 74) or late surfactant (n = 79) groups, the need for MV was significantly lower in the early surfactant group (16.2 vs. 31.6%; relative risk 0.41, 95% confidence interval 0.19-0.91). The incidence of pneumothorax (1.9 vs. 2.3%) and the need for supplemental O2 at 28 days (2.7 vs. 8.9%) were similar in the two groups. Conclusion: Early routine surfactant administration within 2 h of life as compared to late selective administration significantly reduced the need for MV in the first week of life among preterm infants with RDS on nCPAP. Copyright © 2012 S. Karger AG, Basel.

Kumar S.D.,Fernandez Hospital
Iranian Journal of Neonatology | Year: 2014

NEC is inflammatory necrosis of the intestine, with the most common sites in preterm babies being the terminal ileum and the ascending colon (1). The condition is typically seen in premature infants, and the timing of its onset is generally inversely proportional to the gestational age of the baby at birth; i.e. the earlier a baby is born, the longer the time of risk for NEC in premature babies. The incidence of NEC is inversely proportional to the gestational age and birth weight (2). The baby may have initial symptoms that include feeding intolerance, increased gastric residuals, abdominal distension, and bloody stools (3). The laboratory triad includes metabolic acidosis, hyponatremia, and thrombocytopenia. Pneumatosis intestinalis is the pathognomonic radiological finding in the NEC. Modified Bell's staging is used to stage the NEC. Treatment involves Nil per Oral, supportive care, antibiotics, surgery in advanced stages, and parenteral nutrition (4, 5). Complication of NEC includes mortality, prolonged NICU stay, intestinal strictures, enterocutaneous fistula, intra-abdominal abscess, cholestasis, and short-bowel syndrome, and neurodevelopmental, motor, sensory, and cognitive problems (6-9). © 2014, Mashhad University of Medical Sciences. All rights reserved.

Lanka S.,Fernandez Hospital | Surapaneni T.,Fernandez Hospital | Nirmalan P.K.,Fernandez Hospital
Journal of Obstetrics and Gynaecology Research | Year: 2014

Aim The aim of this study was to compare the efficacy of combined intracervical Foley catheter and low-dose vaginal misoprostol with low-dose vaginal misoprostol alone for induction of labor. Material and Methods This prospective non-blinded randomized controlled trial was conducted over a 2-year period in 126 pregnant women planned for induction of labor at a tertiary care centre. Women at ≥28 gestational weeks with a singleton fetus in cephalic presentation, intact membranes and a Bishop score of ≤4 were randomized for labor induction with either a combination of Foley catheter and misoprostol or only misoprostol. The primary outcome variable was the induction-to-delivery interval between the two groups. The secondary outcome variables included rate of vaginal deliveries, uterine hyperstimulation, cesarean section rate, Apgar scores at 1 and 5 min, neonatal intensive care unit admissions and chorioamnionitis. Results The mean induction-to-delivery interval and rate of vaginal deliveries were not significantly different between the groups (26.52 h in the combination group and 27.64 h in the misoprostol group, P = 0.65; 65.07% and 65.07%, respectively, P = 0.9). Uterine hyperstimulation and meconium-stained liquor were significantly more prevalent in the misoprostol group (P = 0.001). Neonatal outcomes did not differ significantly between the groups. Conclusion The addition of Foley catheter to misoprostol did not cause any statistically significant benefit in reducing the induction-to-delivery time. However, it reduced the incidence of uterine hyperstimulation and meconium-stained liquor. © 2014 The Authors. Journal of Obstetrics and Gynaecology Research © 2014 Japan Society of Obstetrics and Gynecology.

Surapaneni T.,Fernandez Hospital | Patil Bada V.,Fernandez Hospital | Praveen Kumar Nirmalan C.,Fernandez Hospital
Journal of Clinical and Diagnostic Research | Year: 2013

Background: Pre-eclampsia (PE) is the commonest type of pregnancy induced hypertension and it affects nearly 5% of pregnant women. Besides short term morbidity and mortality that are associated with pregnancy, PE is associated with long term morbidity in women. There is a lack of information on the risk of recurrence of PE in pregnant Asian Indian women. Aim: To determine the rates and risk factors which were associated with recurrence of PE in the subsequent pregnancies of women with PE in index pregnancies Settings and Design: A retrospective, observational study done at a single tertiary care centre in south India Material and Methods: The study included pregnant women with PE, who delivered at the study institute in 2008 and received care for their subsequent pregnancies at the study institute. Hypertension in pregnancy was categorized, based on the criteria of the International Society for the Study of Hypertension in Pregnancy. Point estimates and the 95% confidence intervals around point estimates of rates of recurrence of PE and associations of potential clinical and laboratory parameters with recurrence were determined by using bivariate analysis, logistic regression models and area under Receiver Operator Characteristic (ROC) curves. Results: The study included 82 pregnant women with PE in their index pregnancies. Twenty two (26.83%, 95% CI: 17.03, 36.62) of these 82 women developed recurrence of PE in their subsequent pregnancies. Recurrence of PE was significantly higher (OR 3.94, 95% CI: 1.05, 14.80, p=0.04) among women who were nulliparous in their index pregnancies. Recurrence of PE was not significantly associated with clinical factors or laboratory parameters in the index pregnancies. Conclusion: Nearly one in four of pregnant women with PE developed recurrences in their subsequent pregnancies, although a large proportion of pregnant women with PE (63.38% to 82.97%) in their index pregnancies were normotensive in their subsequent pregnancies.

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