Incidence of hearing impairment in at risk babies

Babies treated in neonatal intensive care are prone for hearing problems and with the decrease in infant mortality, babies who survive many perinatal risk factors are increasing. Deafness in 1st three years of life may impair the full development & maturation of auditory system & it is well known that deafness in infancy & childhood interferes with normal development of speech & language. To prevent this & to initiate rehabilitative procedure as early in life as possible a screening method to detect auditory disabilities in newborns is of great importance. Based on this background the present study determine to evaluate to know the incidence of hearing impairment in infants at risk.This is a prospective observational study conducted in JJM Medical College, Davanagere, Karnataka. A total 940 patients attended to JJM Medical College and Hospital and diagnosed with hearing impairment according to American Joint Committee statement on infant hearing screening (JCIH) criteria. All the patients under 2 years with history of high risk factors – pre–term, low birth weight, birth asphyxia, neonatal seizures, and hyperbilirubinemia were selected for the study. Those who failed in this test underwent repeated OAE after 6 weeks, followed by brain stem evoked response audiometry (BERA) if the second OAE was negative. Out of 940 high risk cases, 350 had profound hearing loss, 83 had severe hearing loss, 125 had moderate hearing impairment, 36 had mild hearing impairment &346 had normal hearing sensitivity. Out of 48 patients with normal hearing sensitivity, 53 patients were preterm, 166 had hyperbilirubinemia, 23 had neonatal convulsions, 68 birth asphyxia, 89 were of low birth weight. Out of 147 cases 31 patients had mild/moderate hearing impairment.Neonatal jaundice carries the highest risk of hearing impairment followed by birth asphyxia, neonatal convulsions and low birth weight.BERA is the tool which can confirm the normal sensitivity of hearing whenever required & is very useful in early detection of hearing loss and planning rehabilitative procedures.

Analysis of Selected Risk Factors Depending on the Type of Cerebral Palsy

Background: Cerebral palsy (CP) is not a defined, separate disease classification, but a set of etiologically diverse symptoms that change with the child’s age. According to the up-to-date definition, CP is a group of permanent but not unchanging disorders of movement and/or posture and motor function, which are due to a nonprogressive interference, lesion, or abnormality of the developing/immature brain. CP is one of the most frequent causes of motor disability in children. The aim of the present study was to analyze whether selected risk factors may vary depending on particular types of CP. Methods: 181 children with CP (aged 4–17 years), hospitalized at the Department of Pediatrics and Developmental Age Neurology in Katowice in the years 2008–2016 were retrospectively analyzed in the present study. The assumed risk factors of CP were divided into two groups: 1—pre-conception and prenatal (mother’s age, family history of epilepsy, burdened obstetric history, mother’s systemic diseases, pregnancy order, multiple pregnancy, duration of pregnancy, bleedings from the genital tract during gestation, arterial hypertension during pregnancy, infections during pregnancy, preterm contractions, maintained pregnancy, premature rupture of membranes, abruptio placentae, and others), 2—perinatal and postnatal (mode of delivery, birth weight, Apgar score at the first and fifth minute, neonatal convulsions, respiratory failure, infections in neonatal and infant period, and intraventricular bleeding). The division into particular CP types was based on Ingram’s classification. Results: The following risk factors were the most frequent in the total group: respiratory failure, infections, intraventricular bleeding, and prematurity. Among the analyzed preconception and prenatal factors, the duration of pregnancy and preterm contractions during pregnancy significantly differentiated the subgroups of patients depending on the type of CP. The prevalence of almost all analyzed perinatal, neonatal, and infant-related risk factors (i.e., birth weight, Apgar score at the first and fifth minute, neonatal convulsions, respiratory failure, infections in neonatal and infant period, and intraventricular bleeding) significantly differed between CP types, apart from the mode of delivery. However, in multivariate regression, only intraventricular bleeding was an independent predictor for tetraplegic CP type when compared to joined extrapyramidal and ataxic types (OR = 2.801, p = 0.028). Conclusions: As CP is a syndrome of multifactorial etiology, the identification of CP risk factors entails the need for careful observation and comprehensive care of children in the risk group. The presence of certain risk factors may be a prognostic indicator for particular types of CP. The knowledge about the association between the risk factor(s) and the CP type could be a very useful tool for pediatricians looking after the child at risk of developmental disorders.

Etiology and Immediate Outcome of Neonatal Convulsions : A Hospital Based Study

Background: Neonatal seizures are the most common manifestation ofneurological disorders in the newborn period and an important determinant ofoutcome To evaluate the causes and immediate outcome in hospital of neonatalconvulsions. Materials and methods: This hospital based prospective study was conducted inSpecial Care Neonatal Unit (SCANU) Department of Paediatrics and Child HealthBangabandhu Memorial Hospital (BBMH) USTC, including 30 neonates sufferingfrom convulsion from 1 to 28 days of age during the period of 1st July to 30thOctober, 2003. Results: Twenty-four (80%) cases were under 5 days age, 4 (13.33%) cases wereranged 6 to 15 days age. The mean age of the patients was 3 days. 18 (60%)babies were male and 12 (40%) were female. Male:female ratio was 1.5:1.Twenty (66.67%) babies had normal body weight (2500-4000 g). Maternalcomplications during pregnancy were present in 10 (33.33%) cases. Convulsionwas present in all 30 (100%) cases. Depressed primitive reflexes were found 16(53.33%) cases, cyanosis in 5 (16.67%) cases, fever in 7 (23.33%) cases. Subtleseizures were present in 16 (53.33%) cases, focal clonic and focal tonic seizureswere present in 7 (23.33%) and 4 (13.33%) cases, respectively. Generalized tonicseizures were present in 3 (10%) cases and none (0%) cases had myoclonicseizure. Onset of convulsion in relation to age revealed that 13 (43.33%) caseshad convulsion before 24 hours of age, 10 (33.33%) developed convulsionbetween 1-3 days of age, 5 (16.67%) and 2 (6.67%) had convulsion between 4-7days and 8-21 days of age respectively. Commonest cause of neonatalconvulsion was found to be Hypoxic-Ischaemic Encephalopathy (HIE). It wasfound in 17 (56.67%) patients. Hypoglycaemia as primary metabolic cause wasfound in 4 (13.33%) patients, and septicaemia was found in 3 (10%) patients.Eighteen (60%) cases stayed in hospital for 7-10 days, out of which 16 (53.33%)were cured and 2 (6.67%) died. Three (10%) cases stayed in hospital for 4-5days, all of them were cured, Two (6.67%) cases stayed in hospital for 3 daysand among them 1 (3.33%) died and another was cured and discharged onrequest. Five cases (16.67%) stayed for 11-14 days in hospital, out of them 3(10%) were cured and 2 (6.67%) expired. Only 1 case (3.33%) stayed for morethan 14 days and died at day 20. The mortality rate in this study is 20%. Conclusion: The most common cause of neonatal seizure was HIE (56.67%).Other causes of neonatal convulsions are septicaemia, meningitis, primarymetabolic disorders like hypoglycaemia and hypocalcaemia, intraventricularhaemorrhage and some causes are still unknown. Mortality due to neonatalconvulsion is still very high, and in this series, it was found to be 20 percent.Survival while staying in hospital occurred in 24 (80%) cases. Chatt Maa Shi Hosp Med Coll J; Vol.19 (1); January 2020; Page 8-14

Evaluation of Risk Factors for Epilepsy in Pediatric Patients with Cerebral Palsy

Cerebral palsy (CP) is a set of etiologically diverse symptoms that change with the child’s age. It is one of the most frequent causes of motor disability in children. CP occurs at a frequency of 1.5 to 3.0 per 1000 live-born children. CP often coexists with epilepsy, which is drug-resistant in a high number of cases. The aim of the present study was to analyze the associations between preconception, prenatal, perinatal, neonatal, and infancy risk factors for epilepsy in a group of pediatric patients with CP. We retrospectively analyzed 181 children with CP (aged 4–17 years at diagnosis), hospitalized at the Department of Pediatrics and Developmental Age Neurology in Katowice in the years 2008–2016. Division into particular types of CP was based on Ingram’s classification. Data were analyzed using STATISTICA 13.0 (STATSOFT; Statistica, Tulsa, OK, USA). Epilepsy was diagnosed in 102 children (56.35%), of whom 44 (43%) had drug-resistant epilepsy; only in 15 cases (14.71%) was epilepsy susceptible to treatment. The incidence of epilepsy varied between the types of CP. It occurred significantly more often in children with tetraplegia (75%), ataxic form (83%), and mixed form (80%) in comparison to diplegia (32%) and hemiplegia (38%). Maternal hypertension was found to be a risk factor for epilepsy in CP patients (OR = 12.46, p < 0.001) as well as for drug-resistant epilepsy (the odds ratio (OR) = 9.86, p = 0.040). Delivery by cesarean section increased the risk of epilepsy in the CP patients over two-fold (OR = 2.17, p = 0.012). We observed also that neonatal convulsions significantly increased the risk for epilepsy (OR = 3.04, p = 0.011) as well as drug-resistant epilepsy (OR = 4.02, p = 0.002). In conclusion, maternal hypertension, neonatal convulsions, and delivery by cesarean section were the most important factors increasing the risk of epilepsy as well as drug-resistant epilepsy in the analyzed group of patients with CP.

Maternal “Oxygen and Fluids Therapy” to Correct Abnormalities in the Cardiotocograph (CTG): Scientific Principles vs Historical (Mal) Practices

Some Guidelines on Cardiotocograph (CTG) trace continue to recommend the administration of oxygen and fluids to the mother to correct the abnormalities observed on the cardiotocograph. However, the fetus has a separate autonomic nervous system, blood volume, haemoglobin concentration, oxygen saturation and cardiovascular responses as compared to the mother. Therefore, administration of oxygen and fluids to the mother to correct observed “suspicious” CTG traces should be questioned in contemporary obstetric practice. This commentary examines the scientific principles and current scientific evidence on these historical practices, and all practising midwives and obstetricians should urgently review their individual clinical practice, based on the knowledge of anatomy, physiology and biochemistry as well as a critical review of current scientific evidence to prevent avoidable patient harm. Current evidence suggests that administration of oxygen to the mother, who has a normal oxygen saturation does not correct the observed abnormalities on the CTG trace, and it may in fact lead to harm. Similarly, administration of fluids (oral or intravenous) to a woman during labour who is not dehydrated or hypotensive may not only cause maternal dilutional hyponatremia and resultant complications, but also, it may cause neonatal convulsions. Women and babies expect every healthcare provider to practice evidence-based medicine during the intrapartum period, which is based on logic, common sense and robust scientific principles, irrespective of what is erroneously stated by some CTG guidelines.

TO COMPARE THE MORBIDITY AND MORTALITY PATTERN OF LATE PRETERM AND TERM NEONATES.

This is a hospital based prospective observational study, carried out at Gajara Raja Medical College, Gwalior. All the inborn late preterm babies have been included in the study. Selection of late preterm neonates is done by determination of gestational age. In our study Neonatal convulsions were more common among the late preterm neonates as compare to term group. In our study jaundice, septicemia, respiratory distress and hypoglycemia were found as major morbidities, among late preterm the rate was found to be 9%,7.8%,7.6% and 6% respectively while in term group the rate was 3.34%, 3.38%, 3.41% and 2.56% respectively. Occurrence of these morbidities among late preterm neonates as compared to term group is at higher aspect. Keywords: Morbidity, Mortality, Preterm, Term & Neonates