Significant advancement has occurred over the years in diagnosis, recognition, intervention and impact of acute kidney injury (AKI) on morbidity and mortality in critically-ill neonates. However an ...increased risk of chronic kidney disease (CKD) is still observed among neonates who survive an episode of AKI. Therefore, preventing and adequately managing AKI in neonates could help in controlling long-term renal morbidity in neonates who develop AKI. Thus, this study was undertaken with the aim of studying the incidence, contributing factors and outcomes of AKI in at-risk term neonates admitted to the neonatal intensive care unit (NICU).
One hundred and ninety-six term neonates admitted to the NICU with sepsis, hypoxic ischemic encephalopathy (HIE), dehydration and respiratory distress were enrolled and evaluated over a period of one year. Detailed maternal history along with neonatal history, anthropometry, vitals and clinical signs of neonates were recorded in a pretested proforma. Urine output was measured in all at-risk neonates. Serum creatinine was estimated to categorize AKI into stages as per modified KDIGO criteria.
Incidence of AKI was 21%, (n = 107 out of 510 admissions) in the study. Mortality was significantly higher in AKI stage III neonates (88.9%) (p < 0.001). Multivariate analysis revealed that hypoxic ischemic encephalopathy (HIE) had 35.293 (p < 0.001) times higher risk, while sepsis had 35.701 (p < 0.001), dehydration had 30.260 times (p < 0.001) and respiratory distress had 10.366 times (p < 0.001) higher risk of developing AKI.
Our study recorded a high incidence of AKI among at-risk neonates. KDIGO criteria for diagnosing AKI is feasible to apply in the at-risk neonates and helps in its early identification. Early diagnosis and timely intervention in neonates with HIE, sepsis, dehydration and respiratory can prevent the progression of AKI and thus improve prognoses.
Summary
In this randomized controlled trial, nasal high-flow therapy was compared with standard care (no nasal high-flow therapy or supplemental oxygen) in neonates undergoing oral endotracheal ...intubation at two neonatal intensive care units. The primary outcome was successful intubation on the first attempt without physiological instability (defined as an absolute decrease in the peripheral oxygen saturation of >20% from the pre intubation, baseline level or bradycardia with a heart rate of <100 beats per minute) in the infant. At the time of intubation, infants had a median postmenstrual age of 27.9 weeks and a median weight of 920 g. The primary intention-to-treat analysis included the outcomes of 251 intubations in 202 infants; 124 intubations were assigned to the high-flow group and 127 to the standard-care group. A successful intubation on the first attempt without physiological instability was achieved in 62 of 124 intubations (50%) in the high-flow group and in 40 of 127 intubations (31.5%) in the standard-care group (adjusted risk difference, 17.6 percentage points; 95% CI, 6.0 to 29.2), for a number needed to treat of 6 (95% CI, 4 to 17) for 1 infant to benefit. Successful intubation on the first attempt regardless of physiological stability was accomplished in 68.5% of the intubations in the high-flow group and in 54.3% of the intubations in the standard-care group (adjusted risk difference, 15.8 percentage points; 95% CI, 4.3 to 27.3). The authors concluded that among infants undergoing endotracheal intubation at two Australian tertiary neo-natal intensive care units, nasal high-flow therapy during the procedure improved the likelihood of successful intubation on the first attempt without physiological instability in the infant.
Cushing syndrome, a systemic disorder, is the result of abnormally high blood level of cortisol or other glucocorticoids. The most common cause of Cushing syndrome is prolonged exogenous ...administration of glucocorticoid hormones. Prolonged use of topical corticosteroids, particularly in children, may cause Cushing syndrome and suppression of the hypothalamopituitory-adrenal axis, which is less common than that of oral or parenteral route. However, iatrogenic Cushing syndrome in the infantile age group due to topical steroid is very rare and only a few patients have been reported to date in the literature. Here we report a case of iatrogenic Cushing syndrome due to topical steroid application in a 5-month-old female child admitted to the hospital for repeated episodes of fever and cough.
Introduction: Perinatal asphyxia is a significant cause of neonatal morbidity and mortality. Early recognition of perinatal asphyxia and timely referral to centers well equipped in postresuscitation ...management helps to minimize unfavorable consequences. We did this observational study with the aim of finding out the impact of referral timings on early (72 h) outcome of asphyxiated newborns. Materials and Methods: This is a prospective observational study conducted in the sick newborn care unit, of a teaching institute in central India, over a period of 12 months. We enrolled 150 full-term neonates admitted with perinatal asphyxia. Their early outcome was recorded and analyzed. Results: The short-term outcome of asphyxiated neonates at 72 h of admission was significantly better when they were admitted within 6 h of birth. Conclusion: Early recognition of birth asphyxia and timely referral helps in reducing morbidity and mortality in neonates.
Background: The rate of preterm births ranges from 5% to 18% across 184 countries. Almost 12% births are preterm in low-income countries compared with 9% in high-income countries. Almost 1 million ...children die each year due to complications of preterm birth. Of those who survive, suffer from face developmental disabilities and undernourishment.
Aims and Objectives: To assess the physical growth and its relation with the development of babies taken into study.
Materials and Methods: A prospective study was conducted on 159 preterm babies of gestational age 32 to 36 weeks. All the treatments given during hospitalization, course of stay, and special procedures done were recorded. Baby’s weight, length, and head circumference were again noted at the time of discharge. Anthropometric measurements were done at every follow-up visit. Neurodevelopmental screening was performed at each follow-up. At the end of 12 months the risk factors contributing to the delayed development were analyzed.
Results: 95.5% infants born as preterm had a length of more than 58 cm (– 3SD) and weight 5.6 kg at 1 year and 50% infants had a head circumference of more than 39 cm (– 3SD).
Conclusion: Preterm babies when followed-up for 1 year of age did attain appropriate weight and length of their corrected age. Microcephaly was observed in 30% of babies at 1 year of age, of which 15.7% were found with developmental delay.
Background: To identify current evidence in order to guide scaling up of initial management of diarrhoea among children of age group 2-60 months in rural areas of the country.Methods: This hospital ...based cross sectional study included all children 2 months to 60 months of age admitted with chief complains of loose stools in the last 7 days over a period of one year. A pre-tested questionnaire was used as the data collection tool and face to face interviews were conducted on mothers of children. All the data were analyzed using IBM SPSS version 20 software. Chi-square/Fisher Exact/ Student t-test and ANOVA test has been used. Significance was assessed at 5%.Results: Data showed the use of antibiotic in 55.9% cases, IV fluids in 50.3%, ORS in 6.7%, zinc in 2.0% and blood transfusion in 13.8% cases as an initial management of diarrhoea in peripheral health care centers. Of these, 37.6% cases were severely dehydrated, and 8.14% cases were in shock at the time of admission. 10.1% mothers did not intervene in the first 3 days of the disease whereas 45.2% consulted some health care center only in the later part. 4.5% cases expired after admission of which 69% were malnourished.Conclusions: This study summarizes the importance of initial management of a child with diarrhoea in defining the further course of the disease and also the failure of effective promotion and propagation of the most appropriate and cost-effective therapy (ORS and Zinc) for diarrhoea in this part of the country. Pre-existing malnutrition further complicates the situation.
Background: Diarrhoeal infections are the second leading cause of death worldwide in under-five children covering 9% of the total deaths. The objective of the study was to assess and compare mothers’ ...knowledge, attitude and practice regarding prevention and management of diarrhoea in children.Methods: A cross-sectional hospital-based observational study was conducted in a tertiary centre amongst all 356 children between age group 2 months to 60 months admitted with acute watery diarrhea. A pre-tested questionnaire and face-to-face interviews with the mothers was used as a data collection tool.Results: Most of the mothers 282 (79.2%) were 20-30-year-old, 51.4% were illiterate, 57.3% were unemployed and 27.2% were daily wage labourers. 44.6% people came from rural background and 78.9% belonged to lower socio-economic strata. 30.3% were exclusively breastfed and 69.7% were on top feeds. Animal milk was taken by 62.1%, 46.6% had dilution and 50.6% used bottles for feeding. 70.5% of mothers washed their hands at the time of feeding of their child, 93.8% mother covered food in their houses while only 26.7% of mothers gave freshly cooked food. Mother’s outlook on various aspects of diarrhea was sought. Very few mothers considered poor sanitation (2.5%) andcontaminated water (12.6%) as a source of diarrhea. Only 8.7% mothers knew about the role of ORS in diarrhea and maximum (53.4%) considered that diarrhea could not be avoided by any measure.Conclusions: Mother’s knowledge regarding causes, management and prevention of diarrhea needs to be upgraded to allow better utilisation of health resources by the families.
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