Asian Journal of Clinical Pediatrics and Neonatology http://aijournals.com/index.php/ajcpn <p><strong class="pull-left">Asian Journal of Clinical Pediatrics and Neonatology (AJCPN)</strong>&nbsp;&nbsp;is an open-access; freely accessible, online and print Quarterly peer-reviewed international journal publishes a wide spectrum of advanced research in different fields of pediatrics and neonatology, covering etiology, diagnosis, therapy and prognosis aspects. <br> <strong>Online ISSN: 2347-3363 | Print ISSN: 2347-3355</strong></p> Society for Health Care & Research Development en-US Asian Journal of Clinical Pediatrics and Neonatology 2347-3355 Role of Otoacoustic Emissions and Auditory Brainstem Response for Early Detection of Hearing Loss in Children 0-3 Months of Age http://aijournals.com/index.php/ajcpn/article/view/1106 <p><strong>Background: </strong>Hearing impairment has a huge adverse impact on the normal developmental outcome of an individual. The various newborn period risk factors may escalate hearing loss. Early detection of hearing impairment has been made possible with the use of universal tools like OAE (Otoacoustic emission) and ABR (Auditory brainstem response) and has resulted in the general awareness and timely intervention. This study highlights the use of OAE and ABR for early detection of hearing loss in children 0-3 months along with the associated risk factors taken into consideration.<strong>Subjects and Methods: </strong>The present study was conducted in Maharishi Markandeshwar medical college and hospital over a period of 12 months and included 1680 newborns who were subjected to two staged OAE examination( pre discharge and at 6 weeks) followed by ABR examination done over a period of 3 months. The various risk factors were also evaluated.<strong>Results: </strong>A total of 1680 newborns underwent pre discharge first OAE examination, 146(8.7%) failed. A total of 141 underwent the repeat OAE examination at 6 weeks and 23(16.3%) failed. ABR examination of 20 children resulted in failure in 3(15%) culminating in overall prevalence of hearing impairment of 1.79 per 1000 population. The prevalence of various risk factors taken into consideration was 23%.<strong>Conclusion: </strong>The two staged sequential OAE assessment followed by ABR examination has an important role for the early detection of hearing impairment and consequent improvement in the quality of life. This should be adopted by all the newborn care providers as a part of their routine examination of the newborns.</p> Hemant Gupta Smriti Anand Neelam Grover Vipen Gupta Deepika Sharma Copyright (c) 2019 Asian Journal of Clinical Pediatrics and Neonatology 2019-12-01 2019-12-01 7 4 01 04 Magnitude of Bacteriological Etiology in Acute Encephalitis Syndrome: A Cross-Sectional Study http://aijournals.com/index.php/ajcpn/article/view/1107 <p><strong>Background: </strong>Meningoencephalitis is an acute purulent infection within the subarachnoid space, it is associated with a CNS inflammatory reaction i.e. inflammation of brain and parenchyma both that may result in decreased consciousness, seizures, raised intracranial pressure and stroke. The present study was aimed to know the magnitude of bacteria that making picture of meningoencephalitis in AES among the children.<strong>Subjects and Methods: </strong>Present cross-sectional study was conducted in Children aged 1-15 yrs of age suffering from AES admitted in B.R.D Medical College, Gorakhpur.&nbsp; The study subject (children aged 1-15yrs suffering from AES) have been investigated for AES and bacterial etiology and subsequent comparison is made on the basic of clinical features, CSF findings and other lab findings. We divided our study in two parts, in first on the basic of our inclusion criteria we enrolled the patient and on a preplanned clinical proforma we did detailed clinical examination and investigate them accordingly. Cases with suspected AES were studied for their clinical features, recovery patterns and other biochemical and microbiological parameters. After the patient was admitted in the hospital, CSF, serum and stool samples were collected and stored at appropriate temperature. The samples were collected by resident doctor. <strong>Results: </strong>Out of 160 cases 16 case show culture positive result and among them Gm +vecocci was found in only 2 cases (2.5%). Gram negative cocci in 10(6.25%) cases and gram negative bacilli in 4 (2.5%) cases. The most common presenting symptoms were fever in 16 (100) cases followed by vomiting in 12 (75.00), headache in 10 (62.55) a seizure was in 10 (62.5) cases that was generalized tonic type. The CSF examination was suggestive that the majority of cases of AES were due to viral encephalitis. And 10%&nbsp; culture show&nbsp; positivity of&nbsp; bacteria in CSF . Meningeal sign like neck rigidity and kernign have significant association with bacterial culture positive result.<strong>Conclusion: </strong>The most common illness among AES patients observed in our study is Non-Bacterial but Japanese Encephalitis is still a problem in this region and it must not be neglected. Better diagnostic tests and standards to link an agent to encephalitis are needed in this field.</p> Prabhat Bhardwaj Richa Tripathi Copyright (c) 2019 Asian Journal of Clinical Pediatrics and Neonatology 2019-12-01 2019-12-01 7 4 05 13 Diagnostic Utility of Measuring First Day Serum Bilirubin Levels in Management of Neonatal Hyperbilurubinemia http://aijournals.com/index.php/ajcpn/article/view/1108 <p><strong>Background: </strong>Hyperbilirubinemia is the commonest finding in the first week of life, cause of concern for the parents and pediatricians. Objectives: With this study was carried to evaluate the predictive value of serum bilirubin level on day one postnatal age for identifying term neonates at risk for subsequent hyperbilirubinemia.<strong>Subjects and Methods: </strong>Study was conducted in GSL Medical College. Study protocol was approved by institutional ethics committee. Informed consent was collected from the parents / guardians of all the study participants. Neonates ≥ 37 weeks who were otherwise healthy were included in the study. First serum bilirubin measurement was estimated initially within 24±2 hours of life. Second serum bilirubin estimation estimation was attempted if clinical assessment of serum bilirubin &gt;10 mg/dl.<strong>Results: </strong>Total 200 healthy term newborns were evaluated; male female ratio was 1.2.&nbsp; The mean gestation period was 39.24±1.12 weeks. Maximum (58%; 116) women had full term normal vaginal delivery. The range of bilirubin on day one was 2.2 – 8.5mg/dl; majority newborns (86.5%) did not develop significant hyperbilirubinemia.<strong>Conclusion: </strong>Early screening and appropriate management of hyperbilirubinemia is needed for prevention of complications in the newborn. This decreases the significant burden of untreated severe neonatal jaundice, causing potential neurological sequelae.</p> R Rama Krishna Paramahamsa Gangina Sriram Swetha Koneru T Jaya Chandra Copyright (c) 2019 Asian Journal of Clinical Pediatrics and Neonatology 2019-12-01 2019-12-01 7 4 14 16 Prebiotics in Management of Neonatal Jaundice: Open Label Randomised Control Trial http://aijournals.com/index.php/ajcpn/article/view/1119 <p><strong>Background: </strong>Approximately 5-35% of neonates develop jaundice requiring treatment during the 1st week of life. Prebiotics, a mixture of Galacto-oligosaccharides (GOS) and Fructo-oligosaccharides (FOS), has been postulated to reduce serum bilirubin levels on principle of interruption of entero-hepatic circulation. Objective: To evaluate the effect of oral supplementation with prebiotics (Fructo-oligosaccharides) in the management of neonatal jaundice. <strong>Subjects and Methods: </strong>Design &amp; Setting: Open Label, Randomized Control Trial at Level II NICU in public hospital over one year. Participants: Term exclusively breast-fed neonates with Jaundice requiring phototherapy. Intervention: Randomisation of Sixty eligible neonates into Control and Prebiotic groups (n= 30 each). Both groups received phototherapy, and Prebiotic group received additional oral prebiotics.&nbsp; Outcome: Primary outcome measure was a reduction in total serum bilirubin levels (TSB) and duration of phototherapy. The secondary outcome measure was the change in the frequency of stools.<strong>Results: </strong>Baseline Features were similar in both groups. Overall serum bilirubin levels decreased significantly from enrolment till the omission of phototherapy (17.24 + 1.16 vs. 12.74 + 0.48; P: 0.00). ANOVA depicted no statistical difference between the groups in 12 hourly reductions of TSB (F [3, 232] = 0.14, P: 0.94). Mean duration of phototherapy (in hours) required in prebiotic and control group was similar (50.40 + 9.66 vs. 47.60 + 8.62; P = 0.24). Secondary outcome measures were also similar in both groups.<strong>Conclusion: </strong>Prebiotics, containing only fructo-oligosaccharides, administered for upto three days, do not have any additional effect on reduction of serum bilirubin levels in neonates with jaundice receiving conventional treatment.</p> Trupti Amol Joshi Amol Kalyanrao Joshi Laxmikant Sheshrao Deshmukh Copyright (c) 2019 Asian Journal of Clinical Pediatrics and Neonatology 2019-12-08 2019-12-08 7 4 17 21 Management of Acute Renal Failure in Septicemic Neonates at a Tertiary Care Hospital http://aijournals.com/index.php/ajcpn/article/view/1179 <p><strong>Background: </strong>Neonatal septicemia or Sepsis neonatorum refers to systemic bacterial infection of infants during the first month of life. Infections are significant cause of mortality and long-term morbidity in neonates. The problem is that neonatal sepsis is a disease that may start with minimal or nonspecific symptoms and has a relatively low incidence, yet a high risk of mortality. Because the treatment is benign, relative to the disease and babies who develop sepsis often die rapidly, clinical practice has evolved such that many more babies are evaluated and treated for sepsis than have the condition, on the basis of subtle signs or risk factors, which resulted in over treatment. <strong>Subjects and Methods: </strong>This study was carried out in the neonatal intensive care units of the Pediatric Department of Medical College. The study includes the clinical profile of 100 cases of normal full-term neonates with septicemia admitted to the above centre during the period of study. <strong>Results: </strong>Most of the cases of acute renal failure required only conservative management (48.2%) whereas 11.1% of cases required peritoneal dialysis.Most of the cases of intrinsic renal failure (66.7%) required other modalities than conservative line in management, whereas most of the prerenal failure cases (60.0%) required only conservative management. All instances of peritoneal dialysis were in intrinsic renal failure group. <strong>Conclusion: </strong>Blood culture was the diagnostic criteria used for septicemia and the commonest organisms isolated were E. Coll, Klebsiella, Coagulase positive staphylococci and Group-B streptococci.</p> Sajan. T. Nair Varun P G Copyright (c) 2019 Asian Journal of Clinical Pediatrics and Neonatology 2019-12-25 2019-12-25 7 4 22 26 Clinical Spectrum of Acute Renal Failure in Septicemic Neonates http://aijournals.com/index.php/ajcpn/article/view/1180 <p><strong>Background: </strong>In a full-term neonate, kidney functions are not fully mature and functional maturation continues postnatally. Normally they are able to cope up with most of the rapidly changing functional demands of the body and adapt to various endogenous and exogenous stresses. However in stressful conditions like septicemia, this capacity may be overcome leading to renal dysfunction. Neonatal septicemia or Sepsis neonatorum is a clinical syndrome resulting from the pathophysiologic effects of local or systemic infection in the first month of life. <strong>Subjects and Methods: </strong>All normal, full term, appropriate for gestational age neonates, delivered normally or by Caesarean section, who were without antenatal, perinatal or immediate postnatal complications and without congenital anomalies, admitted after the first day of life to the N1CU, during the above mentioned period, with a clinical suspicion of septicemia were evaluated. <strong>Results: </strong>Feeble cry (or the shrill cry of meningitis in some cases) was present in all cases (100.0%). Next important symptom was not sucking at breast which was present in all cases where breast feeding was initiated (In two babies it was not initiated) giving a total incidence of 92.6%. Other major symptoms included decreased urine output (70.4%), hurried respiration (70.4%) and vomiting (63.0%). Other symptoms more commonly found were convulsions (48.1%), hypothermia (48.1%) and fever (37.0%). <strong>Conclusion: </strong>Major differences between intrinsic and prerenal failures in septicemia in their presenting complaints were hurried respiration, cyanosis, grunting, convulsions, vomiting, fever and oedema were more in intrinsic renal failure where asoligoanuria, hypothermia, and loose stools were more in prerenalfailure.</p> Sajan. T. Nair Varun P G Copyright (c) 2019 Asian Journal of Clinical Pediatrics and Neonatology 2019-12-25 2019-12-25 7 4 27 31 Evaluation of Different Treatment Modules for Respiratory Distress Syndrome in Preterm Neonates http://aijournals.com/index.php/ajcpn/article/view/1188 <p><strong>Background: </strong>RDS is mainly caused by a lack of a slippery substance in the lungs called surfactant. This substance helps the lungs fill with air and keeps the air sacs from deflating. Present study is to assess the difference between intravenous and inhalational ambroxol in prevention of respiratory distress syndrome in preterm infants. <strong>Subjects and Methods: </strong>Out of those 56 were assigned under group A i.e.&nbsp; being treated with intravenous ambroxol and others were assigned under group B i.e. being treated by atomizing or inhalational ambroxol. The intravenous group was injected with 15mg/kg ambroxol in umbilical vein immediately after birth followed by intravenous infusion of ambroxol 30mg/kg for 2 days. <strong>Results: </strong>Early administration of either intravenous or atomizing ambroxol can produce a positive efficacy for the prevention of RDS in preterm infants but inhalation or atomizing has better outcomes as compared to intravenous ambroxol. <strong>Conclusion: </strong>There are good results of aerosolized ambroxol in the management of RDS and it is the easy, economic and ideal treatment module for RDS.</p> Rajeev kumar Mittal S.P. Goyal P.K. Gupta Copyright (c) 2019 Asian Journal of Clinical Pediatrics and Neonatology 2019-12-25 2019-12-25 7 4 32 34 A Clinical Study of Kerosene Poisoning Among Children in a Rural Medical College Hospital http://aijournals.com/index.php/ajcpn/article/view/1197 <p><strong>Background: </strong>Acute poisoning in children adversely impacts on global child health and the patterns and morbidity of poisoning vary across different geographic regions due to variable cultural, social, economic, and geographic factors.Kerosene Poisoning is an important and preventable cause of morbidity and mortality in the developing world. Kerosene is a hydrocarbon product of petroleum distillate, made up of paraffin and naphthalenes. <strong>Subjects &amp; Methods: </strong>The complications of kerosene poisoning include hypoxia, pneumonitis, bacterial pneumonia, pneumatocele, pleural effusion, pneumothorax, subcutaneous emphysema and empyema. The usual gastrointestinal symptoms of kerosene poisoning are abdominal pain, vomiting and diarrhoea. Its Central Nervous System manifestations include drowsiness and convulsions. <strong>Results:</strong>Out of 22 children with kerosene poisoning 18 (81.81%) were male and 4 (18.18%) were female. There was only one case (4.54%) of kerosene poisoning with less than one year, between 1-5 years there were 19 (86.36%) cases and above 6 years there were 2 (9.09%) cases of kerosene poisoning.There were 11(50%) cases were seen during summer followed by 6 (27.27%) cases seen in monsoon and there were 5 (22.72%) cases in winter season.Toddler age, children from rural area, summer season was found major risk factors in our study for kerosene ingestion and is mostly due to improper storage of kerosene.Respiratory complaints like cough and dyspnoea are the two most common symptoms in kerosene poisoning. <strong>Conclusion:</strong>There is a need to create public awareness regarding kerosene oil storage and accessibility at home from the younger children.</p> Mohammed Anees Ur Rahman Mohammed Nayaz Ahmed Ananda Kumar T S Kumar G V Copyright (c) 2019 Asian Journal of Clinical Pediatrics and Neonatology 2019-12-29 2019-12-29 7 4 35 37