Asian Journal of Clinical Pediatrics and Neonatology <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 Microbiological Profile of Ventilator Associated Pneumonia <p><strong>Background: </strong>Nosocomial gram negative bacterial pneumonias develop in hospitalized and are due to changes in the bacterial flora. Colonization of the upper respiratory tract by gram negative bacilli is mediated by alterations in the surface properties of the epithelial cells. In healthy individuals a film of fibronectin covers the epithelium lining the mucosa of the mouth and oropharynx and prevents the Gram-negative bacteria from adhering to the epithelial cells. This protective coating is lost in very ill individuals, so that pathogenic Gram- negative organisms adhere to receptors present on epithelial cells of the mucosa and soon colonize it. <strong>Subjects and Methods: </strong>The children aged between 1 month and 16 years who are included in this study are those who are on mechanical ventilator for more than 48 hours. All children&nbsp; who are admitted in PICU and mechanically ventilated for more than 48 hours as per definition in inclusion criteria are investigated clinically, radiologically and bacteriologically to determine presence of pneumonia and isolate causative microorganism. <strong>Results: </strong>Common organism isolated ET tip culture of patients studied was Klebsiella 29 (19.3%), followed by Pseudomonas 6(4%), E.coli6 (4%), MRSA 6(4%). Most common organism isolated in urine culture of patients studied was E.coli 8(5.4%) followed by Klebsiella 3(2%). <strong>Conclusion: </strong>The common organisms isolated in blood culture and ET tip culture were Klebsiella, Pseudomonas aerogenosa and E. coli.</p> Dr Shashikant Jayaraj Patil ##submission.copyrightStatement## 2019-02-10 2019-02-10 7 1 1 4 Correlation of Nature of Amniotic Fluid with Maternal Risk on Neonatal Outcome at GMC, Ratlam <p><strong>Background: </strong>After taking ethical clearance from hospital ethical board, this prospective study is being conducted at Govt. Medical College, Ratlam with a sample size of 149. All newborn babies born through MSAF will be included. Relevant history, clinical examination and relevant investigations would be done. <strong>Subjects and Methods: </strong>This prospective study is being conducted from 01/06/2016 to 01/6/2017 at Govt. Medical College, Ratlam with a sample size of 149. All newborn babies born through MSAF will be included. Relevant history, clinical examination and relevant investigations would be done. <strong>Results: </strong>Average number of maternal risk factors is 18(12%); of which 9 cases(6.82%) belong to thin MSL and 9 cases (50%) belong to thick MSL. The mean difference between two groups is statistically significant (p value= .000). It comprises: PIH-13 cases (8.67%) of which 5 cases (3.79%) are thin MSL and 8 cases (44.4%) belong to thick MSL; Oligohydraminos-3 cases (2%),all 3 cases (2.27%) are from thin MSL and 0 case from thick MSL;GDM-2 cases(1.34%),thin MSL comprises 1 case(0.76%) and thick MSL comprises 1 case (5.55%). <strong>Conclusion: </strong>Meconium stained liquor is more commonly associated with PIH, post-datism, oligohydroamnios and DM, etc. Risk factors which were associated with MSAF were PIH in 8.67%, oligohydramnios in 2% of the cases, GDM in 1.34% cases. (p value= .000),which is significant.</p> Devendra Nargawe Manish Rathore ##submission.copyrightStatement## 2019-02-10 2019-02-10 7 1 5 7 A Study on Indication for Mechanical Ventilation among Children at a Tertiary Care Hospital <p><strong>Background: </strong>Currently, pneumonia is the sixth leading cause of death in the United States and the leading cause of death of children worldwide. The mortality rate for patients of all ages with VAP is approximately 33% to 50%.Approximately 10-28% of critical care patients develop Ventilator Associated Pneumonia (VAP). It increases length of stay in ICU up to 28% and each incidence of Ventilator-associated pneumonia (VAP) is estimated to generate an increased cost of £6000-£22000. Mortality rate is 24%-71%. <strong>Subjects and Methods: </strong>All patients on mechanical ventilator admitted to the pediatric intensive care unit during the prescribed study period were considered for case identification and study was prospective study. <strong>Results: </strong>Most common diagnosis at presentation in patients studied was Severe dengue 50(33.3%), followed by Pneumonia 25(16.7%), Sepsis 14(9.3%). <strong>Conclusion: </strong>Most common indication for mechanical ventilation in patients studied was Severe respiratory distress (33.3%), followed by septic shock (20%), poor GCS (18.7%), Dengue shock (16.7%).</p> Dr Shashikant Jayaraj Patil ##submission.copyrightStatement## 2019-02-10 2019-02-10 7 1 8 11 Diagnostic Value of I/T2 Ratio in Neonatal Sepsis: A Prospective Comparative Study. <p><strong>Background: </strong>Neonatal sepsis accounts for early-half of all neonatal death in India. Although the gold standard for the diagnosis of neonatal sepsis is by blood culture, there is a need for a test that is cheap, accurate, easily performed with quick availability of reports so that prompt and appropriate treatment is ensured. In this study we try to analyse the diagnostic value of I/T2ratio in comparison to I/T ratio and absolute neutrophil count (ANC) independently to correctly predict neonatal sepsis. <strong>Subjects and Methods: </strong>A time bound, prospective comparative study was done on neonates with suspected neonatal sepsis for a 2 year period. Neonates were then analysed in three groups depending on their blood culture results as no sepsis, probable sepsis and proven sepsis. I/T2was calculated for all the babies and an optimum cut off was found for the same. The diagnostic accuracy of I/T2 ratio with septic screen positivity and blood cultures were assessed. <strong>Results: </strong>245 neonates included in the study were divided into three groups depending on whether they were blood culture positive sepsis, probable or clinical sepsis. The means of septic screen parameters including I/T2 were highly significant when compared between the three groups (p value &lt;0.001). ROC curve created showed the AUC for I/T, I/T2 and ANC was 0.822, 0.809, 0.610 (p value &lt;0.001) and a higher specificity. <strong>Conclusion: </strong>I/T2 shows promise as a parameter to screen for sepsis in neonates. Calculating the I/T2 ratio in conjunction with established septic screen parameters could enhance prediction of sepsis in newborns.</p> Swathi S Sanjee Aswathy Rajan Ashvij R Shriyan Santosh T Soans ##submission.copyrightStatement## 2019-02-12 2019-02-12 7 1 12 16 Utility of Cord Blood Albumin as a Predictors of Significant Neonatal Hyperbilirubinemia in Healthy Term Neonate. <p><strong>Background: </strong>Approximately 60% of term and 80% of preterm neonates develop jaundice in first week of life and significant neonatal hyperbilirubinemia occurs in 3-5% of healthy term neonates. Objective:&nbsp; To assess the cord blood albumin level as a tool to screen the risk of development of subsequent significant neonatal hyperbilirubinemia in term neonate. <strong>Subjects and Methods: </strong>A prospective observational study was conducted over a period of 2 years on 1040 healthy term neonates. Demographic profile, relevant maternal and neonatal information were recorded. Measurement of cord blood albumin, blood group/Rh typing and serum bilirubin at the end of 24 &amp; 72 hours was done to predict significant hyperbilirubinemia. <strong>Results: </strong>A total of 1040 healthy term neonates were enrolled with male to female ratio of 1.4:1. 120 neonates had developed significant hyperbilirubinemia and required phototherapy while 2 of them&nbsp; did not respond to phototherapy and needed exchange transfusion. Out of 245(23.55%) neonates with low cord albumin level (&lt;2.8gm/dl), 104(42.44%) neonates had significant hyperbilirubinemia at the end of 24 hours with sensitivity 86.67%, specificity 84.67%, positive predictive value 42.45% and negative predictive value 97.66%. While 105 (42.85%) neonates had significant jaundice at the end of 72 hours with cord blood albumin &lt;2.8 gm/dl with sensitivity 87.50%, specificity 84.78% positive predictive value-42.86% and negative predictive value-98.11%. <strong>Conclusion: </strong>Neonates with cord blood albumin level more than 2.8gm/dl can be safely discharged early whereas neonates with albumin levels &lt;2.8g/dl will need close follow up to check for development of significant jaundice. Hence cord blood albumin levels help to determine and predict the possibility of significant jaundice among healthy term neonates.</p> Rajkumar M. Meshram Saira Merchant Sartajbegam N. Pathan ##submission.copyrightStatement## 2019-02-12 2019-02-12 7 1 17 21 Adherence and Early Initiation of Breastfeeding in Institutional Deliveries – Prospective Observational Cohort Study. <p><strong>Background: </strong>Aim: 1. To assess the effect of early initiation of breastfeeding within 1hour on sustain exclusive breastfeeding, 2. To assess the correct position, attachment and effective suckling in the breastfeeding of infants as practiced by mothers, 3. To assess the educational background of mother as factor for adherence to breast feeding, 4. Involvement of various healthcare personnel in successful breastfeeding. <strong>Subjects and Methods: </strong>An observational, prospective cohort study was done at KBNIMS and GIMS Hospital in Kalaburagi from March 2018 to August 2018. Mother-newborn units were observed for mother's and baby's position, attachment and quality assessed by fish bone diagram (Ishikawa). Data thus collected were analysed using Chi-Square test. <strong>Results: </strong>The results of the study revealed that the highest percentage (47.8%) of the sample their age were ranged between (18-21) years, (49%) of them were graduated from primary school and less, (91%) initiate their breastfeeding during 24 hours in previous baby, In primipara average latch score was 4 and in multipara it was 8 whereas score of 7 in normal vaginal and score of 4 in lscs. <strong>Conclusion: </strong>Neonatal and infant deaths can be decreased to significant level if breast feeding is initiated within 1 hour. LATCH score is excellent tool for caregivers at all level in hospital. Early initiation will help to sustained and maintain breastfeeding till 6 months of age and avoid top feeding by the mother.</p> Sandeep H Vinod Uplaonkar ##submission.copyrightStatement## 2019-02-12 2019-02-12 7 1 22 26 Low Cost Pulse Oximeter in Outpatient Department to Detect Severity of Respiratory Infection: Retrospective Study <p><strong>Background: </strong>On an average, children below 5 years of age suffer about 5 episodes of ARI per child per year, thus accounting for about 238 million attacks. ARI is responsible for about 30-50% of visits to hospital under 5-mortality rate, pneumonia consists 19% of deaths as compared to diarrhea (17%), measles (4%). This reduction in death rate in diarrhea is due to cheap and effective oral rehydration therapy diseases. <strong>Subjects and Methods: </strong>The study was conducted over period of one year from feb 2017 to feb 2018, overall hospitalized children with age group from 2months-60 months were included in the present study. Children who were with respiratory complaints like fever, cough, breathing difficulty were included. <strong>Results:</strong> In present study, all the children presenting with respiratory symptoms were analyzed and pulse oximeter were used when clinical findings were in conclusive for hospitalization. <strong>Conclusion:</strong> It was found that hypoxemia was common in patients with ALRI more show in infants then in children.</p> Sandeep H Vinod Uplaonkar ##submission.copyrightStatement## 2019-02-12 2019-02-12 7 1 27 29 Growth Pattern of School Going Children with Asthma: A Case Control Study <p><strong>Background: </strong>To compare growth pattern of children with asthma against healthy controls and to assess the quality of life score in children with asthma. <strong>Subjects and Methods: </strong>The study was conducted in the outpatient and inpatient departments of Department of Pediatrics amongChildren between 5-15 years with clinical diagnosis of asthma were enrolled in this study. It was a cross sectional study. <strong>Results:</strong> Our study included 100 children between 5 – 10 years age group which had 50 children having asthma and rest were normal children. Out of 50 asthma children, 5 (10%)had obesity and study was significant (p=0.028). And 20 of the 50 asthma children(40%) had stunting.(p=0.015). In11 to 15 years age group 4 (8%) had obesity(p=0.072) and 24%had stunting and the study was significant(p=0.029). <strong>Conclusion: </strong>Stunting and obesity are more seen in children with asthma compared to normal children. Children with severe forms of asthma and children were whose asthma was poorly controlled were more prone for stunting and obesity.</p> Jayasree P ##submission.copyrightStatement## 2019-02-21 2019-02-21 7 1 30 34 Role of Single Dose Intramuscular Betamethazone in Reducing Hospitalization Rates in Acute Asthma <p><strong>Background: </strong>Children with asthma are predisposed to exacerbations. This holds irrespective of the type of asthma the reason for exacerbation can be a viral illness, physical activity or exposure to allergens.&nbsp; Hospitalization of patients with acute attack poses financial and other problems. <strong>Subjects and Methods: </strong>The participants of the study were children aged 1-12 years with acute attack of asthma coming to OPD/casualty of department of Paediatrics, Mount Zion medical College, Adoor. <strong>Results: </strong>Among 74 responders, there were 32 patients had mild type asthma (mild persistent and intermittent) (43.2%), 32 had moderate (moderate persistent) type asthma (43.2%) and 10 had severe (severe persistent) type asthma. The corresponding groups among non- responders were mild-8 (30.8%), moderate 11 (42.3%) and sever e 7 (26.9%). Though it seems that percentage of severe asthma is more among non- responders, (26.9 % v/s 13.6%), the two groups are comparable when analysed statistically (standard error of difference between proportions was 9.5 and observed difference 13.3). the other groups were also comparable. Thus the type of asthma did not affect the response. <strong>Conclusion: </strong>Thus this study emphasizes the role of single dose IM betamethasone in preventing hospitalization rate in patients with moderate attack of asthma if used early.</p> Jayasree P ##submission.copyrightStatement## 2019-02-21 2019-02-21 7 1 35 39 Correlation of Metabolic Acidosis in Neonate with Morbidity, Mortality and Neurodevelopmental Outcome. <p><strong>Background: </strong>In metabolic acidosis there is risk of neonatal encephalopathy with symptoms varying from lethargy to coma. The neonates with encephalopathy usually present with decreased level of consciousness with abnormality in neuromotor tone and associated with seizure like activity, hypoventilation or apnea. <strong>Subjects and Methods: </strong>In the present study the children were followed upto 9 months of age and assessment of neurodevelopment was done and the correlation of acidosis with neurodevelopment outcome was analyzed. <strong>Results: </strong>Of 100 neonates with metabolic acidosis, 26 babies had necrotizing enterocolitis, 20 had seizures, 15 had intraventricular/periventricular hemorrhage and 33 babies had renal dysfunction. Out of 100 neonates with metabolic acidosis, 10 babies died and 23 had good outcome. There exists correlation between pH and neurodevelopmental outcome. The p value is 0.000 i.e it is significant. Thus with decreasing pH, there is increased incidence of neurodevelopmental delay. The incidence of developmental delay is more in neonates with pH &lt;7.20, 4 (21.1%) babies had transient abnormalities, 2 (10.5%) had persistent abnormalities. There exists correlation between base deficit and neurodevelopmental outcome. The p value is 0.000 i.e it is significant. Thus with increasing base deficit, there is increased incidence of neurodevelopmental delay. <strong>Conclusion: </strong>With based deficit of &gt;12 mmol/l, there is increased incidence of neurodevelopmental delay i.e 25% had persistent abnormality and 10% transient abnormality hence it can be used as one of the early predictors of neurodevelopmental delay.</p> S Srikrishna Kadukuntla Swapna Reddy M Ravi Kiran ##submission.copyrightStatement## 2019-02-12 2019-02-12 7 1 40 45 Effectiveness of a Pulse Oximetric Screening for the Detection of Congenital Heart Disease in Asymptomatic New-Borns- An Observational Study. <p><strong>Background: </strong>This study was designed to evaluate the effectiveness of routine postnatal clinical examination and pulse oximetry screening in detecting congenital heart disease in new-borns. <strong>Subjects and Methods: </strong>The term new-born babies born in narayana medical college and Hospital during the study period of 12months had a thorough clinical examination on day 2 of life with emphasis on peripheral pulses, cyanosis, tachypnea, cardiac pulsations and murmurs. Pulse oximetry screening was done within 4hrs of birth and at 48-72hrs of life. Chest X-ray, ECG and Echocardiogram were done for those babies with either abnormal clinical examination or pulse oximetry reading. Clinical examination was done again 2 weeks after discharge. <strong>Results: </strong>The sensitivity 26% for oximetry alone and 60% for clinical examination alone. Specificity was 99.8% for pulse oximetry alone, and 98% for clinical examination alone. <strong>Conclusion: </strong>Pulse oximetry can enhance the clinician’s ability to detect life threatening CHD in a timely manner.</p> Shaik Nazeer Ahmed ##submission.copyrightStatement## 2019-03-24 2019-03-24 7 1 46 50 Role of Electroencephalogram and Neuroimaging in First Afebrile Seizure in Children: A Retrospective Study <p><strong>Background: </strong>To evaluate the role of EEG and Magnetic resonance imaging (MRI) in first episode of unprovoked afebrile seizure in a child. <strong>Subjects and Methods: </strong>Data was collected retrospectively from case records of patients admitted with seizures during the period between January 2016 to December 2018. All children with first episode of unprovoked afebrile seizure (1-15 years of age) were included in the study. <strong>Results: </strong>Case records of 108 patients with first episode of unprovoked afebrile seizures were reviewed . Out of these , 65 patients were investigated with MRI and EEG.54 children (83.1%)had&nbsp; generalized tonic clonic seizures(GTCS), 11 had partial seizures&nbsp; (16.9 %) . EEG abnormalities were seen in 21 children, predominantly in GTCS type. The most common EEG abnormality observed was sharp and spike wave discharges .7 children (10.7 %) had abnormal (MRI). The accuracy of MRI detecting the abnormality when EEG was abnormal was 33.3 % (p &lt; 0.05). <strong>Conclusion: </strong>This study illustrates that routine neuroimaging for all children with first episode of unprovoked afebrile seizures is gratuitous. Neuroimaging can be reserved for those patients with recurrence of seizures or those children with clinical findings suggestive of intracranial pathologies.</p> Shwetha. G Sinchana Bhat Santosh T Soans ##submission.copyrightStatement## 2019-04-04 2019-04-04 7 1 51 54 A Clinico- Haematological Profile of Dengue Fever among Pediatric Patients in a North Indian Tertiary Hospital <p><strong>Background: </strong>Over the years, Dengue fever outbreaks are increasing both in number and distribution in India. <strong>Subjects and Methods: </strong>In this study all probable cases of dengue fever in age group 2-14 years were included in study. Their detailed clinical and laboratory profile were recorded in pre designed proforma. Cases were classified according to WHO 2009 classification. Patients with positive for Dengue markers (IgM/NS1 antigen) are considered as Dengue fever. <strong>Results: </strong>Total of 50 cases were included in the study out of these 56% were males and 44% were females with majority of them were in 6-14 years of age.&nbsp; Majority of patients presented with headache (88%) followed by muscular pain(82%). Hess test, positive in (24%), with Spleenomegaly in 16% and Hepatomegaly in 14%. Lab parameters revealed thrombocytopenia and leucopenia. Only 2% patient expired with 88% were discharged with improvement. A total of 38% subjects had dengue like fever, 26% subjects presented with dengue, 34% had dengue with warning signs and 2% subjects had severe dengue. <strong>Conclusion: </strong>Dengue fever can presents with varied clinical and laboratory manifestation. Early diagnosis and appropriate management can reduce morbidity and mortality markedly.</p> Mahima Bansal Manish Agrawal ##submission.copyrightStatement## 2019-04-04 2019-04-04 7 1 55 59