· Web viewAshirwad Maternity & Children's Hospital, Sharan Nagar, Gulbarga - 585103...

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NEO/01(O) ORAL SUCROSE ANALGESIA FOR PRETERM NEONATES Vinayak Patki, Vaibhavi Ghate Dept. of Pediatrics, Wanless Hospital,Miraj [email protected] Aims & objectives - To compare the pain reducing effect of orally administered glucose with that of placebo during iv canula insertion / heel stab in normal preterm infants. Methods: A Randomized, placebo controlled trial was carried out at the neonatal intensive care unit at wanless hospital Miraj, Maharashtra from February 2009 to January 2010. Hundred normal preterm newborns (gestational age < 37weeks ) undergoing iv canula insertion / heel stab for clinical purposes, were enrolled in the study. Subjects were given either 2ml 25% sucrose or distilled water 2 minutes prior to any painful procedure.. The behavioral pain reactions were scored with the Premature Infant Pain Profile (PIPP) and oxygen saturation and heart rate were measured. Statistical analysis :.by student t test , chi - square test and univariate analysis of variance Results The mean heart rate increase following a painful stimuli in sucrose group (143.56 ± 5.300 ) was significantly less when compared with placibo (161.90 ± 5.768 ) . There was no significant difference in drop of oxygen saturation. Total pain score (PIPP) was significantly lower in sucrose group (4.32 ± 1.058 vs 10.66 ± 1.803 ) during painful stimulus . Breast feeds as independent factor significantly reduced the total PIPP score .Although no effect was seen on heart rate and oxygen saturation .Type of procedure had no effect on total PIPP score , heart rate and oxygen saturation. Conclusion: Oral 25 % sucrose is useful and safe analgesic for minor procedures in preterm newborns. NEO/02(P) A RANDOMISED CONTROL TRIAL OF GRANULOCYTE -MACROPHAGE – COLONY STIMULATING FACTOR (GMCSF) IN PRETERM NEONATES WITH SEPSIS AND NEUTROPENIA IN A NICU Chaudhuri Jasodhara , Mitra Souvik, Mukhopadhyay Debadatta ,Chakraborty Swapna, Chatterjee Sukanta Department of Pediatrics, Medical College, Kolkata [email protected] Background: Bacterial sepsis in premature infants with high mortality rates. Neutropenia which is a common association comes with increased mortality. Aims and objectives: Whether therapy

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NEO/01(O) ORAL SUCROSE ANALGESIA FOR PRETERM NEONATESVinayak Patki, Vaibhavi GhateDept. of Pediatrics, Wanless Hospital,[email protected]

Aims & objectives - To compare the pain reducing effect of orally administered glucose with that of placebo during iv canula insertion / heel stab in normal preterm infants. Methods: A Randomized, placebo controlled trial was carried out at the neonatal intensive care unit at wanless hospital Miraj, Maharashtra from February 2009 to January 2010. Hundred normal preterm newborns (gestational age < 37weeks ) undergoing iv canula insertion / heel stab for clinical purposes, were enrolled in the study. Subjects were given either 2ml 25% sucrose or distilled water 2 minutes prior to any painful procedure.. The behavioral pain reactions were scored with the Premature Infant Pain Profile (PIPP) and oxygen saturation and heart rate were measured. Statistical analysis :.by student t test , chi - square test and univariate analysis of variance Results The mean heart rate increase following a painful stimuli in sucrose group (143.56 ± 5.300 ) was significantly less when compared with placibo (161.90 ± 5.768 ) . There was no significant difference in drop of oxygen saturation. Total pain score (PIPP) was significantly lower in sucrose group (4.32 ± 1.058 vs 10.66 ± 1.803 ) during painful stimulus . Breast feeds as independent factor significantly reduced the total PIPP score .Although no effect was seen on heart rate and oxygen saturation .Type of procedure had no effect on total PIPP score , heart rate and oxygen saturation. Conclusion: Oral 25 % sucrose is useful and safe analgesic for minor procedures in preterm newborns.

NEO/02(P) A RANDOMISED CONTROL TRIAL OF GRANULOCYTE -MACROPHAGE –COLONY STIMULATING FACTOR (GMCSF) IN PRETERM NEONATES WITH SEPSIS AND NEUTROPENIA IN A NICU Chaudhuri Jasodhara , Mitra Souvik, Mukhopadhyay Debadatta ,Chakraborty Swapna, Chatterjee SukantaDepartment of Pediatrics, Medical College, [email protected]

Background: Bacterial sepsis in premature infants with high mortality rates. Neutropenia which is a common association comes with increased mortality. Aims and objectives: Whether therapy with GMCSF decreases neutropenia and mortality in neonates with sepsis compared with conventional therapy without GMCSF in a control group. Materials and methods: Prospective RCT performed in 76(38 each arm) infants with neutropenia, signs of sepsis and positive sepsis screen. Subcutaneous injection of GMCSF (5 mug/kg/day) administered to 38 patients 12 hourly,3days Hematological parameters and outcome compared to 38 conventionally treated patients(control). The sample size was calculated by statistical formula (power of the study > 80 %).Inclusion criteria: patients weighing 1100-2500 g, vitals stable. Exclusion criteria: major congenital anomaly, stigma of intrauterine infections. Results: 36 patients from GMCSF treated group and 37 from conventionally treated group had early onset sepsis. There was no difference among the groups in terms of birth weight, gestational age, maternal age or degree of neutropenia. The absolute neutrophil count (ANC) after 72 hours was significantly increased in the GMCSF treated group compared to other group. [5012+/-2061 compared to 2673+/-1098 respectively]. The mortality rate in the GMCSF group was 15 % while in the other group was 28%. Mean duration of NICU stay in the GMCSF treated group was 8+/-2.36 days compared to12+/-3.05 days in conventionally treated group. Conclusion: GMCSF therapy is associated with increased ANC,decreased mortality and NICU stay

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in neutropenic septic neonates. The results suggest that GMCSF may be effective in treatment of neonatal sepsis though sample size is small.

NEO/03(P) A RANDOMISED TRIAL OF GRANULOCYTE -MACROPHAGE –COLONY STIMULATING FACTOR IN PRETERM NEONATES WITH SEPSIS AND NEUTROPENIA IN NICU OF A TERTIARY CARE CENTRE IN EASTERN INDIAChaudhuri Jasodhara , Mitra Souvik, Mukhopadhyay Debadatta ,Chakraborty Swapna , Chatterjee SukantaDepartment of Pediatrics, Medical College, [email protected]

Background: Bacterial sepsis occurs 1 to 10 per 1,000 term infants and is three to four times more common in premature infants. The mortality rate for neonates range from 15%-75% . Neutropenia commonly occurs in neonates with sepsis and is associated with increased risk of death. .Various studies done previously suggest the basis of new modes of treatment like increase in neutrophil supply which may be beneficial for newborn infants with bacterial sepsis. Aims and objectives: To study whether adjunctive therapy with rhgranulocyte macrophage colony stimulating factor(GMCSF) could reverse sepsis associated neonatal neutropenia and decrease neonatal mortality compared with conventional therapy in a control group. Materials and methods: Prospective randomized control trial was performed in 76 infants with neutropenia and clinical signs of sepsis. A subcutaneous injection of rhGMCSF (5 mug/kg/day) was administered to 38 patients 12 hourly for 3days Hematological parameters and outcome was compared to 38 conventionally treated patients(control). The sample size for the randomized control trial has been calculated by statistical formula assuming power of the study to be 80 %..Study area NICU of Medical College and Hospitals, Kolkata. Sample size 38 in each arm .Study period 6 months .Inclusion criteria all patients weighing between 1100 and 3500 g , had adequate renal and liver functions and vitals stable. Exclusion criteria were presence of major congenital anomaly or unstable vitals and stigma of intrauterine infections. Results:36 patients from the GMCSF treated group and 37 from the conventionally treated group had early onset sepsis. There was no difference among the groups in terms of birth weight, gestational age, gender, maternal age, severity of sepsis, mode of delivery or degree of neutropenia. The absolute count of neutrophils after 72 hours was significantly increased in the GMCSF treated group compared to the conventionally treated group. [5012+/-2061 compared to 2673+/-1098 respectively]. .Mean platelet count at 72 hours in GMCSF group was 260000+/-55120 compared to 160000+/-51034 in the conventionally treated group. The mortality rate in the GMCSF group was 15 % while in the conventionally treated group was 28%. Mean duration of hospital stay in the GMCSF treated group was 18+/-2.36 days compared to 22+/-3.05 days in conventionally treated group. Conclusion: Treatment with GMCSF is associated with increase in absolute neutrophil count , platelet counts and decreased mortality and reduced hospital stay in critically ill neutropenic septic neonates. The results suggest that GMCSF may be effective in treatment of neonatal sepsis with neutropenia and further trials are required to establish GMCSF use as an adjunctive treatment in neutropenic neonates.

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NEO/04(O) NEONATAL NEUROPROTECTION: FROM EVIDENCE TO IMPLEMENTATIONSharma A, Baral VDepartment of Neonatology Southampton University Hospitals Trust Southampton United [email protected]

Introduction: Therapeutic hypothermia is a standard of carein the UK and was implemented on the neonatal unit in Southampton (tertiary unit 24 intensive beds) in August 2009.We aim to present how we implemented a cooling programme, and an analysis of the outcomes in 27 cases, while discussing the ethical and risk related issues of providing such a service. Method: 27 cases that underwent total body cooling were audited against the TOBY study cooling guidelines. Issues looked at included meeting criteria, documentation of neurological assessment, temperature control, and complications. We also looked at ethical issues in withdrawal of care in 3 neonates. Results: Of 27 cases cooled so far 2 cases were cooled outside trial criteria. In 3 cases care was withdrawn. In a total of 1800 hours of cooling, temperature targets with a servo controlled machine were met 98% of the time. Among the side effects there were 5 episodes of temperature below 33C and 1 involving arrhythmia with only minor other complications. 85% of neonates were cooled within 6 hours. Thorough introspection was made in cases with complications. Conclusions: Therapeutic hypothermia implemented as part of a neuroprotection service needs training of staff and thorough guidelines prior to implementation. Some cases will be cooled outside trial criteria. We present our experience of such cases, including cases where continuing therapeutic hypothermia was not considered to be in best interests of the baby along with neuroimaging and CFM of such babies.

NEO/05(P) UNIVERSAL SCREENING OF NEWBORNS TO DETECT HEARING IMPAIRMENT WITH A VIEW TO EARLY INTERVENTION.Narendra Rai, Brig Mukti sharma, Brig W.V.B.S. Ramalingum, Col R Ghuliani, V K TiwariDepartment of Pediatrics, Army Hospital(R&R), [email protected]

Background: In contrast to the recommendations of the Joint Committee on Infant Hearing, neonatal hearing screening programs are still not universally available. Objectives: To prospectively evaluate the presence of hearing loss in newborn babies using the transient evoked otoactoustic emission as the primary screening tool followed by confirmation with brainstem evoked response audiometry before six months of age and to determine risk factors responsible for hearing loss. Design A prospective study of nonrandomized cohort Setting: NICU of Tertiary care centre. Participants 500 neonates (439: not at risk; 61: at risk) from a total of 610 neonates born in between 2009 to 2010 Measurements: Incidence of hearing impairment in the “at risk” and “no risk” group was compared, using proportion test. Main Outcome Measure(s): Incidence of hearing loss in newborns both “at risk” and in “no risk” group, risk factors responsible for hearing loss, importance of universal newborn hearing screening. Results: The overall incidence of hearing impairment was 8 per 1000 screened. The incidence in “no risk” and “at risk” group was 2.27 per 1000 screened and 49.18 per 1000 screened respectively. Statistically significant difference in the incidence of hearing impairment between the two groups. (p < 0.01; Proportion Test ) was seen. Common risk factors identified were culture positive postnatal infections, birth asphyxia, low birth weight, and prematurity. Conclusions: A high incidence of hearing impairment warrants the implementation of Universal newborn hearing screening. Considering the economic limitations of our country we may employ screening of “at risk” groups initially.

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NEO/06(P) BELL’S PALSY IN A NEONATE WITH RAPID RESPONSE TO ORAL STEROIDS- A CASE REPORTArushi Saini, Pratibha Singhi, K S Sodhi, Ajit GuptaDepartment of Pediatrics, Postgraduate Institute of Medical Education and Research PGIMER, [email protected]

Idiopathic facial nerve palsy, also known as Bell’s palsy is an acute, generally unilateral, peripheral facial nerve dysfunction causing paralysis or weakness of facial musculature that is not associated with other cranial neuropathies or brain stem dysfunction. Viral infections, vascular ischemia, autoimmune inflammatory phenomenon and heredity have been proposed as underlying mechanisms. Bell’s palsy is rare in the neonatal age group. Other commoner causes of facial nerve palsy such as birth trauma, infections especially otitis media and congenital malformations need to be excluded. We present here a 4 week-old neonate with Bell’s palsy who responded rapidly to oral steroids and physiotherapy. Such an early presentation of idiopathic facial nerve palsy and use of steroids in neonates is scarcely reported in literature. No standard treatment is recommended for neonates due to the rarity of the disorder in this age-group. We have documented a rapid response to oral steroids with significant recovery at 6 weeks of therapy, along with physiotherapy in the index case. As recovery rates for Bell’s palsy are 80-100%, early recognition and treatment are emphasized.

NEO/07(P) NEONATES ON MECHANICAL VENTILATION: ‘OUTCOME’H Veerabhadrappa, Basawarajpatil, G.V.HarishAshirwad Maternity & Children's Hospital, Sharan Nagar, Gulbarga - [email protected]

Objectives: To analyse the indications,complications and outcome of babies requiring mechanical ventilation Study Design: Prospective study done at sangameshwar hospital attached to M.R medical college, gulbarga. Methods: 106 Neonates ventilated in NICU from june 2010-may 2011 are included in my study. inclusion criteria: birth asphyxia,hyaline membrane disease,septicaemia,meconium aspiration syndrome,neonatal pneumonia results: Among 106 ventilated neonates birth asphyxia 80(42.45%) was the commonest indication followed by hyaline membrane disease 53(29.2%),septicaemia 28(15%),and meconium aspiration syndrome 23(11.%) and 2 cases of neonatal pneumonia. Out of them improved and discharged were 46, deaths 60, total survival rate is 43.4%. In the 106 ventilated neonates best outcome was seen in babies with gestational age of 37-41 weeks, with birth weight of 2-2.5kgs, and with mean duration of ventilation more than 120 hours. OUTCOME was good in Birth asphyxia(51%) ,followed by MAS(41.6%), and very poor outcome in babies with septicaemia. SEPSIS was the commonest complication followed by pulmonary haemorrhage,shock , airleaks and VAP

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NEO/08(P) TO STUDY THE CORRELATION BETWEEN CRP AND BLOOD CULTURE IN NEONATAL SEPSISSharja Phuljhele, H. Santosh Department of Paediatrics, Pt. J.N.M. Medical College Raipur - 492001 [email protected]

Introdution: The diagnosis of sepsis in newborns is generally made first on clinical criteria with due consideration to high risk factor. This is supported by necessary laboratory investigation, where CRP and blood culture are of paramount importance. The CRP has high sensitivity and blood culture has specificity. Aim and objectives: To evaluate the correlation between C-reactive protein and blood culture in neonatal sepsis. Material and method: The study was conducted at Dr.B.R. Ambedkar hospital, Raipur (CG); during November 2010 to july 2011. Total of 340 neonates were taken into the study, considering various high risk factors. CRP and blood culture were sent on same day and their correlation were studied. CRP values more than 10mg/L were considered positive. Odd’s ratio was calculated and Chi-square test was applied for statistical analysis. Observation: Out of 340 neonate 83 neonates were both CRP as well culture positive. Among this 27 patients were CRP negative but simultaneous culture were positive; whereas 86 patients were CRP positive but blood culture was negative. Remaining were both CRP and culture negative. The sensitivity of CRP for detection of neonatal sepsis is 75.5% and specificity 62%. The positive predictive value is 49.1% and negative predictive value of 83.8%. Conclusion: On the basis of the above study we conclude that, CRP has very good negative predictive value and correlates well with blood culture.

NEO/09(P) CORD BLOOD ALBUMIN AS A PREDICTOR OF NEONATAL JAUNDICESuchanda Sahu, Rebecca Abraham, Joseph John, Alina Ann Mathew, Anish Sam George C/o. Joseph John, Department of Pediatrics, Sree Narayana Institute of Medical Sciences, Chalakka, North Kuthiyathodu P.O. Ernakulam District 683 594 [email protected]

Introduction: Jaundice is one of the commonest problems occuring in a newborn. Many a times it is physiological because liver is not mature enough to handle the bilirubin and there is an increased load of bilirubin due to a higher circulating erythrocyte volume, a shorter erythrocyte life span and a larger early labeled bilirubin peak. Early prediction will help in early discharge and prevent prolonged hospitalization of babies and mothers. Albumin is synthesized by liver and it helps in transport of unconjugated bilirubin. There is paucity of reports on serum albumin or cord blood albumin levels as a predictor of hyperbilirubinemia. Aims and objectives: We aimed to estimate umbilical cord blood serum albumin levels and follow the babies for hyperbilirubinemia and those requiring phototherapy (PT). Materials and methods: Forty newborns were inducted into the study with the following inclusion criteria: sequentially born term babies (gestational age > 37 weeks) from any mode of delivery, both genders, any birth weight, APGAR score of more than 7 at first and fifth minutes of life, and without Rh incompatibility. Cord blood serum albumin was estimated. Wherever necessary further laboratory tests were done for bilirubin and those children having hyperbilirubinemia were managed as per protocol. Results and observations: Our study showed that 82 % of neonates who had albumin levels less than 2.8 gm/dl developed hyperbilirubinemia

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requiring phototherapy and 12% needed exchange transfusion. At higher levels of albumin that is 2.8 - 3.3 gm/dl, 40% needed PT and those with cord blood serum albumin > 3.3 gm/dl did not need any intervention for hyperbilirubinemia. Discussion: Albumin is the major binding protein for bilirubin and antibiotics. Low levels will lower its bilirubin transport and binding capacity. It is the “free” bilirubin which can cross the blood brain barrier and cause neurotoxicity. Cord blood albumin levels more than 3.3 gm/dl is probably safe for early discharge of baby. Hence we can conclude that umbilical cord blood albumin levels are useful in predicting the development of jaundice in healthy term neonates.

NEO/10(P) MULTIPLE MALFORMATIONS -CASE REPORTNeeraj Jain, Vibha Mangal Jain, Shiba Garg Department of paediatrics, HIHT [email protected]

A live female baby with multiple malformations was born on 7th Sep 2011 at our hospital by LSCS. After delivery the Apgar score was 7, 7, 7.After consent of parent we did not do any active intervention. In this case we found multiple malformations , so that we are reporting for our colleagues and students. Case report: On prenatal history, Maternal age was 24years, already having 3 female normal child and there were no history of any maternal illnesses and history of medications used during entire period of gestation except the Iron and calcium ,prescribed by health centre doctor. Foetal movements were felt throughout pregnancy. first perceived at the age of 21 weeks of gestation. There were no complications throughout the pregnancy except the excessive emesis in Ist trimester. No History of infections, Teratogen exposures, such as alcohol, tobacco, drugs and medications and peri –conceptional supplementation with folic acid. Ultrasonogarphy done at 36th weeks revealed that baby had a large hydrocephalus. Placenta was normal, Birth weight was 3.457 Kg, appropriate for gestational age. Length was 48 cm ,head circumference was 54 cm .Baby was survived only for 2 hours. On Family history ,all relatives, including parents, siblings, grandparents, uncles, aunts and cousins have no history of congenital anomalies. No history of Consanguinity in parents. Gestational age by physical parameters was 38 weeks. Tone was poor , posture was flexed ,peripheral cyanosis present, respiratory effort were sluggish and irregular. No any Skin pigmentation present except vesico popular erutions seen on whole body including the face.. There were no dimples, vascular or other lesions, or excessive peeling. Head shape was asymmetrical, fontanelles are wide open ,head size was very large . Facial features- cleft lip and cleft palate were present. Eyes pupils, were normal, Orbits had hypertelorism , Ears were malformed and patent, Nose appearances distorted, but nares were patent. Chest was abnormal in shape with pericardial bulging present, nipples were widely separated.Cardiovascular –heart was very feeble, 182/minute, no murmurs, all pulses were feeble, and blood pressure was 60/40 mm of Hg.Lungs bilaterally had poor entry air, Abdomen appearance bulged with hepatosplenomegaly. Genitals were normal and anus is patent. Spine was normal, there were no sinuses or hair tufts in intergluteal cleft. Extremities proportions were abnormal, both lower limbs had the phocomalia and both upper limbs had the seven digits. Further work up and autopsy was not due to unwillingness of parent.

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Discussion: The worldwide incidence of congenital disorder is estimated at 3-7%, but actual numbers vary widely between countries1 .Congenital malformations affect 2.5% of infants at birth and are responsible for about 15% of perinatal mortality in India2,3 Early intrauterine period during 3rd – 8th weeks of gestation is the vital period of life for the normal development of organs and organ system or organogenesis4. It was observed that better maternal care and improved standards of living have very little effect on the overall frequency of congenital malformations5, 6. A congenital anomaly may be narrowly defined in terms of physical structure as a malformation, an abnormality of physical structure or form usually found at birth or during the first few weeks of life; or defined more widely to include functional disturbance as a defect, any irreversible condition exiting in a child before birth in which there is sufficient deviation in the usual number, size, shape, location or inherent character of any part, organ, cell or cell constituent to warrant its designation as abnormal7,8 A malformation is a primary defect where there is a basic alteration of structure, usually occurring before 10 weeks of gestation. Example cleft lip, anencephaly or radial agenesis.A malformation could be major which requires surgical intervention e.g. spina bifida /CHD or minor malformation that requires no treatment or can be corrected totally e.g.polydactyly.Infants with multiple congenital anomalies (MCA) are typically infants with:• two or more major malformations (e.g., a neural tube defect, cardiac defect, missing limb), or• three or more minor malformations (e.g., syndactly, a club foot, abnormally formed pinnae).Common abnormalities include cardiac defects, cleft lip/cleft palette, neural tube. A congenital anomaly is thus any alteration present at birth of normal anatomic structure and has cosmetic, medical or surgical significance. The birth of an infant with major malformations, whether diagnosed antenatally or not, evokes an emotional parental response9.Congenital malformation will begin to emerge as one of the major childhood health problems. Treatment and rehabilitation of children with congenital malformations is costly and complete recovery is usually impossible.6 Approximately, 66% of major malformations have no recognized etiology and most of them have multifactorial inheritance10, 11, 12 These defects can

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occur for many reasons including inherited genetic conditions, poor diet, toxic exposure of the fetus for example, to alcohol, birth injury and, in many other cases, for unknown reasons.10 Available literature shows that congenital malformations contribute highly to prenatal mortality and postnatal physical defects, 13,14,15A significantly higher incidence of malformation observed among the stillbirths (13.30%) in the present study as compare to live birth (3.2%). It is consistent with earlier reports. Aiyar and Agrawal16 observed that the highest incidence of malformations was among full term normal weight babies. Thus, congenital malformations are emerging as important perinatal problem contributing to the perinatal mortality and morbidity. The difference between the frequency of types of congenital malformation in different parts of this country and reports from other countries may be due to genetic background and geographic nutritional and socioeconomic differences. More research is needed to determine the factors underlying the various types of congenital malformation encountered in this area. Congenital malformations also have implication in society as it leads to increase incidence of still birth and neonatal death. Inherited and chromosomal anomalies are associated with loss of physical or mental and intellectual abilities. Often emotion upset and social stigma to parents are beyond the limit of our imagination. Genetic counseling playa vital role for the high risk parents. It provides information regarding various procedure and diagnostic technique, the risk an consequences of some of the procedure as well as about options available. Genetic counseling at different time period helps in reduction of congenital anomalies, morbidity and mortality resulting from these anomalies.

NEO/11(P) ROLE OF VITAMIN K IN PREVENTING CLASSIC HEMORRHAGIC DISEASE IN HEALTHY TERM NEWBORNSNeha Sharma, K.K. Locham, Ish KumarDepartment of Pediatrics, Government Medical College / Rajindra Hospital, Patiala - [email protected]

Introduction: Hemorrhagic disease of the newborn (HDN) is a coagulation disturbance. Vitamin K is required to form Gamma ()-carboxyglutamate which helps in synthesis of coagulation factors II, VII, IX, X. These factors play a role in extrinsic, intrinsic and common pathways. Vitamin K deficiency results in HDN because of non-carboxylation of PIVKA-II. Aims & Objectives:Whether to give vitamin K or not at birth to prevent classic hemorrhagic disease in term healthy newborns. Methods: Randomized control single blind study conducted in tertiary care centre comprised of 50 control and study cases each. The cases in whom vitamin K1 was not given served as study group and cases in whom vitamin K 1 ( 1 mg I/M )was given constituted control group. Babies with underlying illness like Hepatitis, Jaundice, Sepsis, respiratory distress syndrome, G6PD deficiency was excluded from the study .At the end of 3rd day of life, Prothrombin Time Index was evaluated in both groups. HDN was diagnosed if newborn had deranged PTI (<80%) together with normal fibrinogen level and platelet count. The data was analysed using Chi Square test. Results: 15(30%) cases of study group had deranged PTI while no control case had deranged PTI.Of these 15 cases, 9 were males and 6 were females. The incidence of bleeding was found in 6 of these 15 cases while no bleeding was observed in rest of study or control cases. The results on comparison were found to be statistically significant. Conclusion: Injection vitamin K1at birth prevents classical hemorrhaghic disease of the newborn.

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NEO/12(P) PERINATAL TRANSMISSION OF HIV AND DBS STUDY IN THREE MAJOR HOSPITALS OF GULBARGA- DIST. GULBARGA(KARNATAKA)H. Veerbadhrappa, Basawaraj Pati, .Madhu. SProfessor in Paeditrics, Dept of Paediatrics, M.R. Medical College, Gulbarga [email protected]

Objective: Analysis of dried blood sample( DBS) test results in neonates born to HIV positive mothers Study Design: Retrospective study done at Basaveshwar and sangameshwar teaching hospital attached to M.R Medical college gulbarga and Govt. general hospital Gulbarga.METHODS: Neonates born to HIV Positive mother and brought to ICTC centre for DBS testing and there DBS test results were collected from the period of july 2010 to july 2011 from all the three major hospitals of Gulbarga.Inclusion Criteria : Neonates delivered in institutions to HIV positive mothers reporting to the ICTC centers for DBS test at these three major hospitalsRESULTS: From July 2010, the procedure of DBS testing was started in all 3 major hospitals ICTC centre. Since then In GGH- out of 64 collected DBS samples result, 53 were turned out to be negative, where as 9 were POSITIVE. All these were institutional deliveries and both mother and the child received ART. In GGH only neveripine is administered to the neonates by the ICTC centre.In STGH – out of 17 DBS Samples collected all were non reactive. Both mother and child received ART . In BTGH – out of 17 DBS samples collected 3 were positive. Here also both mother and child received ART. In these two major hospitals ( STGH and BTGH) the child received combination of both neverepine and zidovudine. In total out of 12 DBS positive test results ,10 babies were born by NVD. Female babies accounted for 8 in number out of 12. All the babies were born with birth weight above 2 kgs. All the mothers were aged above 20 years.DBS was very useful in early detection of HIV status in the newborn and early intervention

NEO/13(P) HOW DOES VIT A STATUS OF MOTHER AFFECT THE NEONATAL OUTCOME?Anuradha Sanadhya, Abhishek Ojha, Srishti Sareen, D.R.Dabi, Devendra SareenC/o. Dr Devendra Sareen, 27-F, New Fateh pura, [email protected]

Introduction: Maternal malnutrition is very important cause of growth retardation in newborn babies. Among various nutrients, proteins intake, energy consumption, various micronutrients like iron ,zinc, Folic acid and Vitamin A are supposed to play role in birth weight of newborns. Aims and objectives- The present study was undertaken to study the effect of Vit A status of mothers on birth weight of newborns. Material and method- The study was a case control study. Study group consisted of 50 mothers of TSGA neonates. Controls were mothers of TAGA newborns. Vitamin A status of mother was judged by history of night blindness, clinical assessment and biochemical estimation. Data for each variable was obtained and compared with each other. Biochemical assessment was done by ‘ultraviolet absorption spectrophotometry’ Result-Our study revealed that 80% of women in study group and 42% in control group were having some degree of Vitamin A deficiency while severe Vitamin A deficiency was present in 4% of study group. Mean Vitamin A levels in study group were very low (16.7%+-3.63 microgram/dl) in comparison to control group

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(21.1+-3.69 microgram/dl ) which was highly significant (p<0.001). Signs of Vitamin A deficiency were more prevalent in study group as compared to controls(36% versus 10%).History of night blindness was found in 10%cases and 4% controls. Conclusion- Vitamin A is having a positive role in the growth and development of fetus. Hence early detection of Vitamin A deficiency in pregnancy should be made to correct it by earliest by supplementing Mega dose of Vitamin A and improving dietary patterns of mothers.

NEO/14(P) CORRELATION OF MATERNAL ANEMIA TO BIRTH WEIGHT OF NEWBORN Anuradha Sanadhya, Srishti Sareen, Abhishek Ojha, NIshtha Sareen, D.R.Dabi, Devendra SareenC/o. Dr Devendra Sareen, 27-F, New Fateh pura, [email protected]

Introduction-Maternal nutrition plays important role in development of baby . Various nutrients like protein intake, Iron, Zinc, folic acid and vitamins are supposed to play role acid in intrauterine growth. Aim and objective-To study the effect of Haemoglobin levels of mother on birth weight of babies.Material and methoD-This study is having case control design. Cases were 50 mothers of TSGA babies and controls were 50 mothers of TAGA newborns. Detail history and Hb levels of mothers of both group were taken and data were analysed. Hb estimation was done by ‘Sahli’s method of haemoglobin estimation’Result-28% cases and 10%controls didn’t received haematinics at all. While 8%cases and 40%controls received iron and folic acid tablets in adequate number.92%of mothers in study group and 34% in control group were having anemia of some degree.6% of women in study group were having severe anemia and 72% moderate and 14%having mild anemia. Mean Hb levels in case groups were 7.95+-1.28 and in control group were 10.3+-1.45 gm/dl respectively which was highly significant ( p<0.001) Conclusion-Thus pregnant mother’s Hemoglobin level is having a positive role in the intrauterine growth of babies. Hence Iron and folic acid tablets should be supplemented to pregnant women to avoid occurrence of low birth weight newborns.

NEO/15(P) NEONATAL PROBLEM ASSESSMENT ACCORDING TO IMNCI PRACTICE IN SLUMS OF RAIPUR C.GN.L.Phuljhele, O.Khandwal, Deepti SinghKanchanganga Phase 2, P.O R.S.UNIVERSITY, Daganiya, Raipur - [email protected]

Background IMR in India is 50/1000 and in CG its54/1000[SRS-2008] Newborn care practices has to be improved to achieve RCH-2 goal of35/1000 Aims : To find out defecits in newborn care practises and care-seeking in 0-2 months age group in slums of Raipur. Method & design : Community based observational cross sectional study of mothers of 0-2months age group subjects. Statistical analysis : Data analysed using Epi- info version 6.04. chi square test was applied. A p-value of < 0.05 considered significant. Result and Conclusion :.0-2 months total subjects 411, (male 45% female 55%), maximum(63%) in grade IV socioeconomic [ Modified Prasad Classification][p<0.05],only28 % were referred for treatment(p<0.05).,44% Hospital delivery & 56% Home delivery. All 5 cleans were used only in 45% (p<0.05). Out of all 5 cleans, clean blade

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was used by maximum cases(78.8%)(p<0.005).,home deliveries(56%), in 30% cases oil & in 26% turmeric was applied on umbilical stump(p<0.05).,93% cried immediately after birth & in rest 7% who cried after 5minutes of birth most common practice was slapping on feet (80%)(P<0.05).,In 48% cases, some type of pre lacteal was given(p<0.05), In 41% home delivery & 7% of hospital delivery,.59.7% breastfed within 4 hrs after birth ,57% have exclusive breast feeding(p<0.05).,47% babies kept both head & body covered. Only 24% kept baby in contact with mother(p>0.05).,57% bathed immediately, home delivery 52.4% & hospital delivery 4.6%(p<0.05). . 19% were reported to have temperature below normal(p>0.05) according to coverage, BCG 46%, OPV1 52% DPT1 32.2%(p<0.05) & no immunisation in 14.1% cases.,16% were icteric ,(9.8%) after > 3 days after birth. Among cases of icterus appearing within 3 days of birth (6.6%) only 25% were referred(p>0.05)., (32.2%) were ‘keeping dull’ as a sign of sepsis. Out of which 24.1%(p>0.05) referred.,(37%) subjects had 2 episodes of diarrhoea, out of which dysentery in 10.3% cases. Total 19% referred(p>0.05) & 40% given ORS.(p<0.05) There is urgent need to reorient health workers and mothers about newborn care practices to decrease IMR.

NEO/16(P) ARE LOW BIRTH WEIGHT BABIES MORE PRONE TO INFECTIONS DURING THE FIRST YEAR OF LIFE AS COMPARED TO NORMAL BIRTH WEIGHT BABIES? Daljit Singh, Saumya Joshi, KS RanaCommand Hospital (Southern Command) & Armed Forces Medical College, [email protected]

Introduction: Low birth weight (LBW) babies are more vulnerable to infections in first years of life. In a study by Vik T et al, small for gestational age (SGA) infants had an increased risk (OR: 1.7, 95 % confidence interval: 1.1-2.6) of being admitted to hospital compared to non SGA infants. The principal cause was respiratory tract infections. Data on the subject from India is scarce. Aim: To find out whether the Low birth weight (LBW) babies are more prone to infections during the first year of life as compared to normal birth weight babies. METHODS: Mothers of 100 LBW and 100 normal birth weight babies between the ages of 1 to 5 years visiting the pediatric O.P.D were subjected to a comprehensible questionnaire on the medical history of their babies. Result and analysis: The incidence of upper respiratory tract infections (URTI), diarrhea, skin and ear infections in LBW babies during the first year of life was 90, 77, 17 and 25 percent respectively, whereas the incidence in normal birth weight babies was 84, 48, 5 and 8 percent respectively. The risk of hospitalization in the first year of life was 10.17 times more in a low birth weight baby compared to a normal birth weight baby (p < 0.05). Conclusions: This study highlights the inherent susceptibility of a LBW infant to infections and the resulting increased risk of hospitalization (OR: 10.17). URTI and diarrhea were the most common infections in LBW babies. We recommend more OPD based surveys on infections in LBW babies in our country.

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NEO/17(O) NEURODEVELOPMENTAL EVALUATION IN PRETERM NEONATE AND ITS ASSOCIATION WITH SERIAL CRANIAL ULTRASONOGRAPHIC FINDINGSSomosri Ray, Asha MukherjeeDepartment of Pediatrics, VIMS, [email protected] Introduction: Ultrasonography of brain is an integral part of neonatal care in high risk and premature infants. Early identification has predictive values for neurodevelopmental sequelae. Aims and objectives:To evaluate abnormal cranial ultrasound findings in preterms. To associate clinically neurodevelopmental evaluation with abnormal cranial ultrasounds. Materials and methods: A prospective observational study was performed on 100 preterm babies of 35 weeks or less. Ultrasound brain was done on day 3, day7, and at term (40 th wk of gestational age).All the babies followed up till twelve month of corrected age for neurodevelopmental assessment with the help of DDST (DENVER DEVELOPMENTAL SCREENING TEST) and AMIEL TISON METHOD Results: 43 anomalies were detected on USG brain at day 3 . Among these 31 were germinal matrix hemorrhage, 2 were congenital anomalies,10 were cerebral edema. Only 4 new bleed were detected on day 7 cranial usg . USG at 40th weeks of post natal age identified 2 porencephalic cysts, 5 cystic encephalomalacia, 6 hydrocephalus . In 1 year follow up- 8 expired , 6 lost ,7 had developmental delay . But 7children out of 74 showing normal USG brain had developmental caution.USG brain at 40th week of postnatal age showed best predictive value for neurodevelopmental outcome .Specificity of that USG for prediction of neurodevelopmental outcome at 1 year was 98.5%,negative predictive value was 90%.Conclusion: Though sensivity is low,high specificity and high negative predictive value signifies that normal USG brain predicts correctly a good neurodevelopmental outcome.

NEO/18(O) AN INTERVENTIONAL STUDY TO KNOW THE EFFECT OF COUNCELLING ON EARLY INITIATION OF BREAST FEEDING AND AVOIDANCE OF PRELACTEAL FEEDParveen Mittal, Naresh Kundra, Shinu SinglaHouse No.37, Khalsa College Colony, Near Saket Hospital, Patialadoc [email protected]

Introduction- Early initiation of breast feeding and not giving prelacteal feeds are two useful feeding practices which can protect the newborn from many complication. Counselling about these two practices is required in the antenatal period since in developing countries pregnant women usually don’t approach pediatricians and obstetricians are usually not concerned about the feeding of the newborn, so late initiation of breast feeding (usually upto 3 days) and giving prelacteal feeds is quite common in our setup. Present study was designed to know the effect of counselling on early initiation of breast feeding and avoidance of prelacteal feeds. Aims and objectives- 1)To study the effect of councelling on early initiation of breast feeding. 2)To study the effect of councelling on avoidance of prelacteal feed. Material and methods- The current study was done in Tripuri area having population of approximately 10,000 people under urban MCH Centre which is attached to Department of community medicine Government Medical College , Patiala. House to house survey was done. Two groups of pregnant women were made, with 50 women in each group. Out of these groups,one group was kept as interventional group and councelling was done in them through one visit during last trimester and one visit within 3 days after delivery.The other group was kept as

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control group,where no councelling was done.In the councelling visits to the interventional group,discouragement of prelacteal feeds with reasoning and encouragement for giving colostrum and telling its beneficial effect to the baby and promotion of exclusive breast feeding upto 6 months of age of infant was conveyed to the mother.In both the groups data was collected regarding prelacteal feeds and time of start of breast feeding after birth.The data collected was analysed statistically. Results- In the study group, 29 mothers (58%) started breast feeding within 1st hr, whereas in the control group, only 3 (6 %) started breast feeding within 1 st hr. the difference between the two groups was highly significant, ( P VALUE < 0.05). In the study group all the 50 mothers (100 %) started breast feeding within 1st 12 hrs and none of the mothers( 0%) delaying after 12 hrs, whereas in the control group 17 mothers ( 34 %) started breast feeding after 12 hrs and the difference was again significant.in the study group, 7 newborns (14 %) were given prelacteal feeds while in the control group 36 (72 %) mothers gave prelacteal feeds to the newborns, the difference being highly significant, ( P value < 0.05). the prelacteal feed was in the form of honey( 62%), jaggery (23 %), sugar water (7 %), cow’s milk ( 5 %), goat’s milk( 3 %). Prelacteal feed was given with finger, cotton wick or rarely with a spoon. Conclusion- Counselling the mothers about beneficial effects of early initiation of breast feeding and avoiding the prelacteal feeds can help to curb the harmful practices of delayed initiation of breats feeding and giving prelacteal feeds.

NEO/19(P) IMPORTANCE OF FETAL ECHOCARDIOGRAPHYI B Vijayalakshmi, Chitra NarasimhanPediatric Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, [email protected]

Fetal echocardiography is a complete two dimensional and Doppler ultrasound evaluation of the human fetal cardiovascular system. It is completely noninvasive and harmless for the fetus. Fetal echocardiography also serves as the electrocardiogram for the foetus and helps monitoring during foetal life. Aim : To analyse the cases of fetal echocardiography referred to a cardiac centre. Materials and Methods: 90 cases of fetal echocardiography was done over a period of one year. The average age of the patients was 24 years and average gestational age at referral was 25 weeks. Referral for fetal echocardiography was done for maternal cardiac disease in 9, Diabetes mellitus in 3 and drug ingestion of antidepressant in one. History of previous sibling with heart disease was seen in 12 cases and in 10 cases the referral was as it was a high risk pregnancy. Results: Echogenic foci was observed in 10 patients. Abnormal fetal echocardiography was observed in 18 patients (20%) and which was mainly complex. Fetal Arrhythmia was observed in 3 patients , of which 2 were bradycardia. One case of fetal tachyarrhythmia was treated successfully antenatally. Conclusions: Early foetal echocardiography can effectively identify abnormal hearts. The concern in Indian scenario is the late referrals. Fetal cardiology represents one of the most exciting and rapidly evolving areas in the field of pediatric cardiology and with incredible advances in the prenatal diagnosis and management of CHD there is increased ability to intervene medically, percutaneously and perhaps surgically on the fetus. Thus this has enhanced the importance of prenatal detection of CHD and Fetal echocardiography has opened a new horizon and is the best tool in this direction.

NEO/20(P) INTRAPLEURAL FIBRINOLYTIC THERAPY IN A NEONATEAN Prasad Pediatrician, Command Hospital Chandimandir(WC), Panchkula, [email protected]

Pleural effusions are common complications of pediatric bacterial pneumonias. Failure to control the pleural effusions may lead to progressive disease and can result in complicated parapneumonic

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effusions. The natural history of a complicated parapneumonic effusion is to develop a single loculus or multiple loculations and then progress to an empyema cavity in untreated or inadequately treated patients. Simple chest tube drainage is often inadequate in complicated parapneumonic effusions, due to the presence of viscous fluid with fibrinous debris clogging the tube or multiple loculations in the pleural space. Chemical fibrinolysis, in the management of complicated parapneumonic effusions has been employed since 1949, with the initial use of a mixture of streptokinase and streptodornase. Although intrapleural fibrinolytic therapy has been reported for more than 50 years, experience is limited in children. Use of intrapleural fibrinolysis with streptokinase has never been reported in neonates. Here, we report a case of complicated parapneumonic effusion in a neonate, which was managed effectively with intrapleural streptokinase therapy. Case Report : A 24-days female neonate presented with clinical features suggestive of sepsis, with onset since 15 days of life. She had respiratory distress with cyanosis. The baby had toxic appearance with reduced sensorium, and was febrile. Clinical examination of the chest revealed features of pleural effusion or hydropneumothorax (right), and was confirmed on CT chest to have empyema with loculations of the right pleural space. The baby was managed with broad spectrum antibiotics and other supportives, in form of oxygen support and maintenance intravenous fluids. A chest tube (14 Fr) was inserted under GA, under USG guidance and fluid was drained/ suctioned intermittently, every 24 hourly. Intrapleural Streptokinase (50,000 units) was instilled every 24 hourly for 5 days, and chest tube was removed after 8 days. Culture of intrapleural pus had grown staphylococcus aureus. The baby showed complete recovery, and was discharged after 15 days.

NEO/21(P) HERPES SIMPLEX INFECTION IN A NEONATE: A CASE REPORTNeha Singla, Karuna ThaparProfessor & HOD, Sri Guru Ram Das Institute of Medical Sciences and Research, [email protected]

Introduction: Neonatal herpes simplex virus infections can result in serious morbidity and mortality. The incidence of infection is approximately one per 3,000 to 20,000 live births. Most (85%) neonatal HSV infections are acquired during delivery, although in utero (5%) and postnatal (10%) infections do occur. The risk for transmission to the newborn is much higher in women with primary HSV infections. Many of the infections result from asymptomatic cervical shedding of virus after a primary episode of genital HSV in the third trimester. Neonatal herpes can be localized to skin, eyes, and mouth (≈45% of cases), involve the central nervous system (≈30% of cases), or can cause disseminated infection involving multiple organs such as liver, lungs, adrenal glands, and brain (≈25% cases). We report a neonatal herpes infection localised to skin and CNS. CASE REPORT: A preterm female baby weighing 1.5 kg was born to a 25-year-old gravida 1 woman by normal vaginal delivery at 32 weeks of gestation. The mother had an uncomplicated pregnancy with no history of HSV infection. There was no intrapartum fever. Rupture of membranes was spontaneous and labor was augmented. Delivery occurred approximately 20 hours after rupture of membranes. Baby was sent home on 2nd day of life. Baby was brought to our hospital on day 6 of life with complaints of lethargy and refusal to feed. Baby was lethargic with mild jaundice. child started on i/v antibiotics. Sepsis work-up was normal. On 2nd day of admission child developed papulo vesicular rash over the chest. The rash increased despite antibiotics and involved even the genital area. Suspicion of HSV was made & screened for that. HSV IgM and IgG titres of baby were elevated. IgM-1.08, IgG- 3.57. Child was put on i/v acyclovir. Baby responded within 2 days, rash started subsiding and started accepting feed.10 days of acyclovir therapy given and baby was discharged home on breast feed. Infant was followed up in OPD and no complication was found. This case is being reported because of its rarity.

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NEO/22(P) NEONATAL AND MATERNAL OUTCOME OF DIRECT IMMEDIATE BREAST FEEDING,Pt JNM MEDICAL COLLEGE ,RAIPURN.L. Phuljhele, Rachana DaddhaPt. J.N.M. Medical College, [email protected]

Introduction: 1 million of neonatal deaths per year and in india 2.5 lakhs neonates can be prevented by early initiation of breast feeding.Other mammals like animals fed their baby as soon as they are born without pause but humans waste time.In India only 24.5 % of newborns are breastfeed within one hour with 1 hour feeding rate being highest in Mizoram ( 66.4%) and lowest in Bihar (3.7%). C.G. has 25% rate.Immediate and direct feeding within minutes can prevent neonatal sepsis,diarrhea,pneumonia & maternal depriviation. Aims & objectives : To study maternal and child effect of breastfeeding in newborns who were immediately fed and to compare it with those who were fed late. METHODS :A Prospective comparative study on 150 term healthy newborns who were immediately breast feed were taken from labour room in MCHR, RAIPUR as (GROUP A) and 50 term babies from postnatal ward who were fed within hours to days (GROUP B). Results: 100 % of GROUP A babies maintain blood sugar with 24% has bld sugar upto 110 mg % and 16% with bld sugar b/w 80-100 mg% where as group B 22 % had 40 mg %.98.6 % of Group A babies maintain temperature as compared to 84 % in other group B. 96% of group A had lesser crying episodes as compared to 50 % in group B.98% of GROUP A have good reflexes and activity, 96% have sound selep,97% had good weight gain,on follow up.98% are healthy and require no admission in nursery and 100% have good maternal bonding as to group B,36% has less weight gain, 10% are admitted to nursery and 22% had more crying episodes.Also in mother early expulsion of placenta (99 %),better HB control (90%),breast problems (1%), formula feeding (1%) were found in group A. Conclusion: Newborn if term healthy and cried immediately no time should be wasted in suctioning ,bathing instead Baby should be directly placed on mother breast for feeding and skin to skin contact which help in maintenance of temp,sugar level,, provide maternal child bonding& neurodevelopment of baby.Also oxytocin release helps in uterine contraction leading to early expulsion of placenta and prevents PPH and continuous expression of breast milk.So by proper training of birth attendants,education of mother and family by gyanaecologist and paediatrician can prevent neonatal mortality & morbidity.

NEO/23(P) CONGENITAL RUBELLA SYNDROMEManish Tiwari, Khamkar Anilkumar MohanDepartment of Pediatrics, SRTR Medical College, Ambajogai, Beed – [email protected]

A 1 yr old m/ch B/B mother with c/o weakly accepting since last 3 days, c/o increased abdominal movements since last 2 days Birth H/O-Antenatal h/o- No maternal h/o fever with rash USG done twice-5th & 7th month -WNL Natal h/o-FTND at home, cried well after birth Postnatal h/o-not significant Past h/o-not significant Developemental h/o-s/o global developemenatl delay O/E-mildly febrile,HR-168/min,RR-64/min., Lt sided cataract +, microcephaly + S/E- CVS-S1 muffled, loud P2, continuous murmur+ P/A-L3 firm in consistency S2 firm in consistency K-non ballotable RS-AEBE,B/L basillar crepts+, subcostal & intercostal retractions+ Course in ward-Pt started on antifailure treatment & antibiotics, Pt improved on Day 3 & fully recovered after 6 days. 

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NEO/24(P) A C/O EMPYEMA IN A 10 DAYS OLD NEONATEManish Tiwari, Khamkar Anilkumar MohanDepartment of Pediatrics, SRTR Medical College, Ambajogai, Beed – [email protected] A 10 days old m/ch B/B relatives with c/o increased respiratory movement and not feeding well since last 2 days BIRTH H/O-FTND at home, cried well after birth,was taking breast feeds till 8 days of life well without h/o s/o suck rest suck cycle. O/E-Wt-3.5 kg, cyanosis +, SpO2 without O2-72%, SpO2 with O2-98%, S/E-RS-AE absent in Rt middle zone & lower zone, severe respiratory distress +, COURSE IN WARD-X-RAY chest s/o Rt sided fluid collection with blunting of  CP angle. mediastinal shift could not be appreciated, as aX-RAY was rotated. USG chest was s/o fluid coolection on Rt side of chest.Pleural tap was done-pus & blood culture & sensitivity were sterile- immediate ICD insertion was done by Surgery people-Inj. vancomycine and Inj cefepime were started- drain gradually became nil-ICD removed-antibiotics continued for 4 weeks.PT recoverd completely. 

NEO/25(P) CASE OF FUNGAL PNEUMONIA  IN NEONATEManish Tiwari, Pallavi Saple, AshwiniDepartment of Pediatrics, SRTR Medical College, Ambajogai, Beed – [email protected] A preterm male neonate (32 weeks of gestation, birth weight 1700 gms) was admited to neonatal intensive care unit. It was a preterm vaginal delivery to a primi mother. At the time of admission baby was hypothermic, HR:140/min, RR:54/min with other general and systemic examination findings within normal limits. Supportive treatment in the form of oxygen inhalation, IV fluids and antibiotics was started. On day 3, patient developed sclerema, capillary refill time was prolonged with severe respiratory distress and intermittent gasping. Patient intubated and kept on assist control mode on ventilator. Laboratory investigations showed increased TLC with predominance of polymorphoneuclear cells, C-reactive protein:positive, blood culture negative. Ionotropes and broad spectrum antibiotics were added with other supportive care. Patient showed improvement within 48 hours and was weaned off the ventilator and extubated on day 7. Further treatment continued and patient was on continuous oxygen therapy by O2 tent. But on day 10, patient again showed signs of respiratory distress. Chest X-ray revealed appearance of infiltrates in right middle and lower zone. Again blood culture was sent this time it showed Candidal growth. Intra-venous Fluconazole was added in view of patient’s general condition and prolonged aritifical ventilation and broad spectrum antibiotics with a CULTURE diagnosis of fungal infection. Patient’s general condition stabilized within two days of starting Flucanozole. Same treatment was continued for further 5 days. With improvement of patient’s general condition, intra-gastric feeding started which later on shifted to breast feeding. Patient discharged on day 25.

NEO/26(P) DEVELOPING AN EQUATION FOR GESTATIONAL AGE ESTIMATION OF NEONATES USING ANTHROPOMETRYRajat Thawani, Pooja Dewan, Rajeev Kumar, MMA FaridiDepartments of Pediatrics and Biostatistics and Medical Informatics, University College of Medical Sciences & Guru Teg Bahadur Hospital, [email protected]

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Introduction: Gestational age assessment of newborns is based upon Modified Ballard Scoring for which a pediatric specialist is needed. Anthropomety of the newborn may be used to predict the gestational age of the neonate in peripheral health facilities where often a trained paediatrician is not available. Objective: To determine the anthropometric parameters which can reliably predict the gestational age. Design: Cross-sectional study Setting: Tertiary hospital-based study in Delhi Participants and Methods: Detailed anthropometric estimation (birth weight, crown heel length, head circumference, mid-upper arm circumference, lower segment, foot length, nipple umbilical distance, calf circumference, inter-mammary distance and hand length) of 1000 newborns was done within 48 hours of birth using standard techniques. Gestational age was estimated using Modified Ballard Scoring. First 800 newborns were used to devise the model and remaining 200 newborns were used to validate the final model. Multiple linear regression analysis using stepwise selection was used to build the predictive model. Variables that had quadratic relation with gestational age were considered after centring to avoid collinearity. Results: Birth weight (R2= 0.521), head circumference (R2= 0.360) and mid-upper arm circumference (R2= 0.453) were found highly correlated, and had a quadratic relation with gestational age amongst the anthropometric variables, when each variable was used separately. The final equationto assess gestational age was: ‘Gestational age = 5.437 BW – 0.781 BW2 + 2.815 HC – 0.041 HC2 + 0.285 MAC – 22.745’ (adjusted R2= 0.581). On validation, the predictability of this equation is 46% (±1 week), 75.5% (+2 weeks) and 91.5% (+3 weeks). Conclusion: Anthropometric assessment of newborns can be a simple and reliable tool to assess the gestational age.

NEO/27(P) FACTORS AFFECTING OUTCOME OF NEONATAL SURGERY IN NICU AT SGRD HOSPITAL, AMRITSARManmeet Kaur Sodhi, Karuna Thapar, Manu Sharma114-A, Guru Amar Das Avenue, Block A, Ajnala road, Amritsar, [email protected]

Introduction: In recent years, neonatal surgical mortality has steadily decreased in developed countries due to availability of neonatal surgeons and appropriate referral of newborn surgical emergencies. But the picture is still problematic in developing countries. Objective: To determine the various factors that can affect the outcome of surgical conditions/disorders of the neonate in a tertiary level NICU at SGRD medical college and hospital, Amritsar. Methods: A retrospective study of all neonates who had surgery over a 1-year period at NICU, SGRD Institute of Medical Sciences And Research, Sri Amritsar, India. Results: A total of 92 neonates underwent surgical management in the last 1 year period from July 1, 2010 to June 30, 2011.There were 62 males and 30 females. The mean age at presentation was 5.6 days with a range of 2 hours to 30 days. The weight at presentation was 1.3 to 3.9 kg (mean of 2.52kg).The most common conditions requiring surgery in NICU were Ano-rectal anomalies (29.3%), followed by necrotizing enterocolitis (19.6%) and trachea-esophageal fistula/esophageal atresia (18.5%).Colostomy was the most common surgical intervention.(46%). Overall, there were 26 deaths (35.4%). Low birth weight, prematurity, associated septicemia significantly influenced the outcome directly. Intestinal resection with anastomosis is associated with the highest mortality (55.5%). Sepsis/septicemia was the commonest postoperative complications accounting for 22 deaths. Conclusion: The morbidity and mortality following surgical management of the neonate is still very high in this environment. Lower birth weight, prematurity and sepsis are three most important factors for increased surgical mortality.

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NEO/28(O) ASSESSMENT OF VITAMIN D STATUS AND SUPPLEMENTATION IN PRETERM NEONATES AT BIRTH AND 6 WEEKS OF AGE Niranjan Thomas, Mintoo Tergestina, Anil Kuruvilla, Sridhar S, Binu Govind, Victoria Job, Arun Jose. Department of Neonatology and Clinical Biochemistry, Christian Medical College, Vellore, [email protected]

Introduction: Current literature suggests a high level of vitamin D deficiency in mothers and newborns even in tropical countries like India. Preterm babies are at high risk of metabolic bone disease. There is no current literature available on prevalence of vitamin D deficiency and adequacy of recommended supplementation in preterm infants from India Aims and objectives: To assess Vitamin D status of preterm newborns at birth and 6 weeks and assess if the current Vitamin D supplementation is adequate. Methods: This was an observational cohort study, set in a tertiary care neonatal unit. The subjects were inborn preterm babies (27 to 33 weeks). A cohort of term babies was used as controls for cord blood levels. The sample size calculated was 86 at 5% level of significance. Results: Ninety preterm babies were followed up with cord blood and 6 week levels of Vitamin D, calcium, phosphorus, alkaline phosphate and PTH. One hundred term babies’ cord blood levels were also analysed. Sixty-six percentage of the preterm neonates and 28% of the term neonates were Vitamin D deficient at birth. (p :<0.001) At 6 weeks 84% of preterm babies were vitamin D deficient (p :< 0.001) The median Cord blood Vitamin D level was 34.71. (5-100) Median Vitamin D level at 6 weeks was 19.34. (4-86)There was a significant fall in the Vitamin D levels (p<0.001) as well as the levels of phosphorus. (p<0.001) There was a significant rise in Alkaline phosphatase levels. (p<0.001) Conclusion: Preterm newborns are vitamin D deficient at birth. The deficiency significantly increases by 6 weeks despite supplementation. Thus the current recommended supplementation does not appear to be adequate. Further research is required to define an appropriate recommendation that will lead to vitamin D sufficiency in the preterm neonate.

NEO/29(P) A STUDY OF VARIOUS HEMATOLOGICAL PARAMETERS IN NORMAL TERM NEONATESSuresh Goyal, Mohammed Asif, Sohan Lal Kumavat, Kritika Chandra.Department of Pediatrics, R.N.T Medical College, [email protected]; [email protected]

INTRODUCTION- Transition from foetal to neonatal life is associated with major changes in hematological parameters due to homeostatic control. AIMS & OBJECTIVE-This study was planned to study physiologial changes of haematological parameters in cord blood and during first week of life. MATERIAL & METHOD:100 Normal term neonates with gestational age>37weeks & birth weight >2100gm were included in the study. Hemaogram and PBF were studied in cord blood, 24hrs,48hrs,7th day of life and mean, range & standard deviation were Calculated. RESULTS:CBC Parameter

Cord Blood at Birth

24 Hrs Of Life 48 Hrs Of Life 7 Days Of Life

Mean ± SD (Range)

Mean ±SD (Range)

Mean ± SD (Range)

Mean ± SD (Range)

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Hemoglobin(Gm%)

17.6 ± 2.40 (12.2- 23.2)

16.6 ± 2.46 (11.6 – 22.8)

16.4 ± 2.37 (11.5 – 21.3)

16.1 ± 2.28 (11.3 – 21.1)

Hematocrit (%) 51.5 ± 6.15 (36.8 – 64.3)

49.2 ± 6.19 (35.2 – 61.3)

48.4 ± 6.10 (34.4 – 60.6)

47.3 ± 6.05 (32.2 – 60.1)

MCV(fl) 100.3 ± 7.20 (82.2 – 126.5)

98.5 ± 7.16 (82.5 – 126.1)

98.9 ± 7.27 (82.1 – 126.3)

99.2 ± 7.29 (80.5 – 126.4)

MCH(pg) 34.3 ± 2.71(26.2 -40.9)

33.2 ± 2.70(26.0 – 39.7)

33.5 ± 2.70(26.0 – 40.5)

33.7 ± 2.61(25.4 – 39.4)

MCHC(g/dl)

34.2 ± 1.59 (29.6 – 38.0)

33.8 ± 1.57 (28.5 –37.7)

33.9 ± 1.51 (28.4 –38.6)

34.0 ± 1.52(28.4 – 38.5)

TRBC (Million/µl)

5.2 ± 0.72(3.7 – 6.9)

5.0 ± 0.74(3.3 – 6.9)

4.9 ± 0.73(3.3 – 6.7)

4.8 ± 0.72(3.3 – 6.3)

TLC (×103/µl) 16.8 ± 4.36(8.4 – 29.3)

15.2 ± 3.70(8.1 – 23.4)

14.0 ± 3.49(7.2 – 22.8)

11.9 ± 2.91(5.5 – 18.3)

Polymorphs(%)

62.9 ± 7.36(38.7 – 86.6)

68.9 ± 7.63(49.3 – 89.5)

63.4 ± 7.15(49.6 – 88.4)

53.4 ± 7.43(25.3 – 73.7)

Lymphocyte(%)

31.0 ± 7.27(9.1 – 55.5)

24.7 ± 7.02(8.1 – 43.2)

30.9 ± 6.80(8.0 – 45.1)

38.2 ± 6.50(19.3 – 62.0)

Monocytes(%)

3.2 ± 1.00(1.8 – 8.2)

2.5 ± 0.76(1.0 – 7.1)

2.5 ± 0.83(0.2 – 6.2)

4.2 ± 1.17(0.4 – 6.3)

Eosinophils(%)

2.4 ± 0.78(1.0 -5.7)

3.5 ± 1.65(0.2 – 8.8)

2.8 ± 1.15(0.4 – 6.0)

3.5 ± 1.41(0.5 – 9.8)

Basophils(%)

0.5 ± 0.24(0.0 – 1.2)

0.4 ± 0.35(0.0 – 3.0)

0.4 ± 0.14(0.1 – 0.9)

0.6 ± 0.19(0.1 – 1.6)

Platelets( ×103/µl)

249.3 ± 39.04(123.0 – 358.0)

281.2 ± 46.91(154.0 – 389.0)

296.1 ± 40.06(168.0 – 410.0)

355.6 ± 41.10(180.0 – 442.0)

SUMMARY- This study showed very wide range of haematological parameters that seems to be abnormally high/low in healthy term neonate in cord blood and during first week of life but these are actually normal for that neonatal period depending upon gestational and post natal age. Conclusion: The normal values of haematological parameters in neonates are different from other age groups and it varies with postnatal age and gestational age so same refrence range of hemogram should not be used in all neonates instead a refrence range derived from large neonatal datasets of varied gestational and postnatal age should be used,such as those presented here for term neonates.

NEO/30(P) EVALUATION OF MULTIPLE ORGAN DYSFUNCTION AND IMMEDIATE OUTCOME IN PERINATAL ASPHYXIA

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Suresh Goyal, Mohammed Asif, Vinay Gill, Subhash MeenaDepartment of Pediatrics, R.N.T Medical College, [email protected]; [email protected]

INTRODUCTION:-Perinatal asphyxia is an important cause of perinatal mortality and morbidity. OBJECTIVES :-The present study was conducted to evaluate the frequency and spectrum of severity of multiple organ dysfunctionin neonates with perinatal asphyxia. METHOD :- 80 neonates with a birth weight of 1500 grams or more and gestational age of 35 weeks or more who needed resuscitation at birth and had apgarscore of 6 or less at 1 minute were studied. Investigations were done after 12hour ofbirth and before72hour of life. Daily follow-up and monitoring of events was done till the discharge or death of the baby. RESULTS:-In the present study, CNS was the commonest organ system to be involved(in 88.75% cases), followed by involvement of Hepatic, Respiratory , Renal , Metabolic , Hematologic , CVS and GIsystem (75%, 61.25%, 56.25%, 42.5%, 36.25%, 30%and 20% respectively). Mortality rate was significantly higher when 5 or more organ were involved (69.44%) and mortality rate was lower (13.64%) when 4 or less organ were involved. CONCLUSION:- The present study suggest that CNS involvement is common in perinatal asphyxia as compared to other organ systems and mortality rate increases as the number of organ systems involvement increases.

NEO/31(P) PREDICTION OF SIGNIFICANT HYPERBILURUBINEMIA USING FIRST 24 HOUR SERUM BILURUBIN LEVELS IN TERM NEONATES.Suresh Goyal, Mohammed Asif, Subhash Meena, Abhishek AryaDepartment of Pediatrics, R.N.T Medical College, [email protected]; [email protected]

INTRODUCTION:-The recognition, follow-up and early treatment of neonatal jaundice has become more difficult since the early discharge from hospital has become common practice. OBJECTIVES :-The present study was undertaken to predict the development of significant hyperbilirubinemia by measuring first 24 hour serum bilirubin level. METHOD:-50 Healthy full term neonates were included in the study and a total serum bilirubin level was estimated at 24±6 hour of age. Thesebabies were followed-up clinically for first 5 postnatal days for development of significant jaundice andaTSB level was estimated again on fifth day. RESULTS :-Of the 50 neonates, 6 (12%) had significant hyperbilirubinemia. A TSB level <6 mg/dl at 24± 6 hour was present in 32 (64%) neonates and only one (2.7%) developed hyperbilirubinemia. In remaining 18 (36%) neonates with TSB≥6 mg/dl, subsequent hyperbilirubinemia developed in 5 (27.77%). Using serum bilirubin cut off level of≥6 mg/dl during first 24 hour of age, hyperbilirubinemia could be predicted with sensitivity of 83.33%, specificity of 70.45%, positive predictive value of 27.77% and negative predictive value of 96.87%. The correlation between first 24 hour bilirubin and development of significant jaundice in the first 5days is statistically significant (p < 0.05). CONCLUSION:-Term neonates havingbilirubin level of ≥6 mg/dl in first 24 hour of life are more prone to develop significant hyperbilirubinemia during first five postnatal days so these babies require close supervision and should not be discharge early from hospital.

NEO/32(P) A STUDY OF SERUM ELECTROLYTES IN NORMAL TERM NEONATES

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Suresh Goyal, Mohammed Asif, Rohit Anand.Department of Pediatrics, R.N.T Medical College, [email protected]; [email protected]

INTRODUCTION- Transition from foetal to neonatal life is associated with major changes in water & electrolyte homeostatic control. AIMS & OBJECTIVE-This study was planned to study physiologial changes of serum electrolyte in cord blood and during first week of life. MATERIAL & METHOD:100 Normal term neonates with gestational age>37weeks & birth weight >2100gm were included in the study. Serum Sodium ,Potassium calcium were studied in cord blood, 24hrs,48hrs,7th day of life and mean, range & standard deviation were Calculated.RESULTS:ELECTROLYTE CORD BLOOD 24HRS 48 HRS 7th dayS.Na+(meq/L)- Range 128-156 128-150 134-154 128-150 - Mean (141.7) (139.0) (143.3) (138.7) S.K+(meq/l) - Range 4.2-7.2 4.0-6.6 4.0-6.5 3.8-6.2 - Mean (6.0) ( 5.4) (5.2) (4.9)S.Ca++(meq/l) Range 7.9-13.2 7.6-11.7 7.0-11.1 7.4-10.9 - Mean (9.9) (9.1) (8.9) (9.2)

SUMMARY- This study showed very wide range of electrolyte that seems to be abnormally high/low in healthy term neonate in cord blood and during first week of life but are actually normal for that neonatal period depending upon gestational and post natal age. Conclusion: The normal values of serum electrolyte in neonates are different from other age groups and it varies with postnatal age and gestational age so same refrence range of electrolytes should not be used in all neonates instead a refrence range derived from large neonatal datasets of varied gestational and postnatal age should be used,such as those presented here for term neonates.

NEO/33(P) POSTNATAL CHANGES OF BODY WEIGHT OF TERM NEONATES AND CONSTRUCTION OF A PREDICTION GROWTH CURVE UPTO 28 DAYS Bhaswati GhoshalAssistant Professor, Department of Pediatric Medicine, Calcutta National Medical College, Kolkata-700 014  [email protected]

INTRODUCTION- A norm of postnatal growth of neonates would be a very useful tool to assess growth locally. AIMS AND OBJECTIVES- To produce a postnatal prediction curve for term neonates to judge the adequacy of growth during that period. MATERIALS AND METHODS- 460 hospital born stable term AGA, as per Lubchenco, neonates were studied. 245 of them were male (53.2%) and 215 (46.8%) were female. The gestation was calculated by New Ballard Scoring. 31.8% of neonates were born by normal delivery, 54.7% by cesarean section 13% by forceps and 0.5% by breech delivery. They were breastfed and received care as per unit policy in postnatal ward of a referral teaching hospital. Their birthweights were recorded and followed by subsequent record of body weight every 12 hours till discharge by triple beam balance with least count of 1gm. Multiple regression equation was calculated to detect the relationship among birthweight ,subsequent bodyweight, age in days using SPSS version 16 software and prediction curves were constructed for different birth weights for ages upto 28 postnatal days using Microsoft Excel. RESULTS- Mean birth weight was 2749.6±425.93 gm, mean gestational age was 38.605 ± 1.338 wks. There was initial fall from birth weight by 112±10.058 gm on 4.5±2.02 postnatal days. Birth weight was regained on 8.5±2.11 postnatal days. No statistical difference was found among

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male and female neonates growth pattern. CONCLUSION- Prediction curves of postnatal changes of body weight of neonates would be a ready to use local norm for term neonates.

NEO/34(O) DO LATE PRETERMS HAVE INCREASED MORBIDITY AND MORTALITY COMPARED TO TERMS?Reeta Bora, Uttam MondalDepartment Of Paediatrics, Assam Medical College, [email protected]

Background: Elective caesarean section(CS) at 35-36 wks of gestational age(GA) has become common practice. Objective: To compare morbidities in late preterm with term infants. To estimate impact of CS delivery on incidence of respiratory morbidity. Study design: Prospective cohort study Setting: Tertiary care neonatal unit in North East India Subjects: 3166 live newborns delivered in AMC(217 late preterm & 2949 term) within six months. Methods: Babies (GA of 35 wks and above) were divided into late preterm(35-36 wks) (group1)and term (groupII), followed for morbidities and mortality. Results: There were 6.8%preterms and 93%term infants. Gr1 constituted 6.6% of all births & 65.2% of all preterms. In NICU 43% grI vs19.9% grII infants were admitted(p <.005 ). Incidence of morbidities in gr1 vs gr2 infants were neonatal jaundice (NNJ) 31.8%vs14.9%(p<.005), Sepsis 11.98%vs3.5% (p<.005), birth asphyxia 7.8%vs2.2%,(P<.005), respiratory distress 11.52%vs4.7% (p<.005).Mean days of phototherapy was 70.49hrs in gr1 vs 55.6hrs in grII(P<.005).Mean hospital stay was 12.75days in gr1 vs 5.86days in grII(p<.005).Mortality among gr1 was 4.6% vs 0.8%in grII. Infants delivered by CS had RD in 6.2%vs 4.2% by spontaneous vaginal delivery(p<.005). Conclusion: Late preterm babies have increased risk of Respiratory distress ,NNJ , birth asphyxia, sepsis and babies born by CS are more likely to develop RD.

NEO/35(O) STUDY TO ASSESS THE ROLE OF PENTOXIFYLLINE IN NEONATAL SEPSIS Gaurav Monga, Ram Dinesh Singh, Rajeev KrishakPushpanjali Hospital & Research Centre, Delhi Gate, [email protected]

Introduction: with global emergence of antibiotic resistance there has been need to search for new modalities to enhance neonatal host defence mechanisms, which could be used as adjuncts to antibiotics in treating neonatal sepsis. Aims and Objective: To assess the effect of intravenous pentoxifylline as an adjunct to antibiotic therapy on the mortality, length of hospital stay in neonates with suspected/confirmed sepsis and to determine safety and adverse effects attributable to pentoxifylline. Methods: total of 70 neonates admitted with suspected sepsis were divided into study and control group with 35 in each group. All neonates were subjected to detailed history and clinical examination and there results recorded and analyzed statistically using 2 and ‘t’ test. Results: Mortality in newborns with sepsis was found to be 13.33% in study group and 25% in control group. The observed difference between two groups was statistically insignificant (p=0.245). Mean duration of hospital stay among survivors in study group was 11.35±2.46 days and in control was 13.62±3.48 days. The difference was statistically significant (p=0.01). Mean duration of hospital stay of preterm survivors in study group was 12.23±2.62 days and in control group was 14.62±3.62 days and difference was statistically significant (p=0.03). Need for ventilation in study group was recorded to be 20% where as in the control group it was 34.38%. There was no adverse effect attributable to pentoxifylline in study group, Conclusion: The effect of

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intravenous pentoxifylline as an adjunct to the standard antibiotic therapy in neonates with sepsis is beneficial. There are no significant adverse effects of pentoxifylline therapy when used for the management of neonatal sepsis.

NEO/36(P) CARDIAC TROPONIN I AS AN EARLY PREDICTOR OF HYPOXIC ISCHEMIC ENCEPHALOPATHYGeeta Gathwala, Sonal singal, Poonam Dalal, Jagjit Singh Dalal, Veena Singh8/6J, Medical Enclave, Pt.B.D.Sharma PGIMS Rohtak, Haryana 124001 [email protected]

Introduction: As the therapeutic window for neuronal protection in newborns with hypoxic ischemic encephalopathy (HIE) is very brief, there is need for a simple, rapid, early and reliable test for identification of neonates who are at high risk for developing HIE. Objective: To evaluate cord blood cardiac troponin I (cTnI) as an early predictor of hypoxic ischemic encephalopathy (HIE). Patients and Methods: This prospective observational study was conducted in 100 newborns over a period of 20 months. A total of 50 full term (≥37 weeks) inborn neonates with an Apgar score of less than 6 at 5 minutes formed the study group (asphyxia group) and 50 consecutive asymptomatic full term(≥37 weeks) inborn neonates with a 5 minute Apgar score of more than 7 formed the control group. Infants with gross congenital malformation,mothers who received magnesium sulphate or beta-sympathomimetics or with evidence of infection were excluded. Cord blood venous samples were collected at delivery. Blood gas analysis was performed and cord blood cardiac troponin I levels were estimated using the ADVIA Centaur CP system using direct chemiluminescent technology. Results: Infants with asphyxia (0.590.41) had significantly higher cord blood cardiac troponin I levels than controls (0.040.03, p< 0.001). Cord blood cardiac troponin I levels positively correlated with the occurrence of HIE (Pearson’s correlation coefficient r=0.746) and the severity of HIE in the asphyxia group(r=0.915).There was significant negative correlation with 5 minute and 10 minute Apgar scores and cord pH and Cord blood base deficit.Eighteen neonates in the asphyxia group (n=50) expired of which Tn I levels in those who expired (1.04±0.19ng/ml) were significantly higher than those who survived. (0.33±0.25ng/ml, p<0.001). Conclusion: Cord blood cardiac troponin I (cTnI) levels can be reliably used as an early predictor of the occurrence of HIE in asphyxiated term neonates and the levels correlate significantly with the severity and mortality in HIE.

NEO/37(P) ATYPICAL ERYTHEMA TOIXICUM NEONATORUM IN A TERM INFANTPranav Gupta, Payal Mittal, Vandana Sharma, Veena DevganDepartment of Pediatrics and Dermatology, Hindu Rao Hospital, New [email protected]

Introduction Erythema toxicum neonatorum (ETN) is the most common neonatal pustular eruption of unknown aetiology. In this report we describe an atypical case of ETN. Case Report: Forty week male infant with birth weight 2900 gms was born by normal vaginal delivery to a 22-year-old primigravida following a uneventful prenatal course. Apgar scores were 9, 9 and 9 at 1, 5, and 10 minutes respectively. The infant was healthy and had no skin eruptions at birth. The exclusively breast fed, otherwise asymptomatic infant had sudden appearance of a rash at around 12 hours of life. Physical examination revealed an afebrile, alert and healthy infant with numerous firm and discrete pustules, ranging from 1 to 2 mm in diameter, localised to bilateral upper eye-lids and bilateral pinna, with a normal background skin. No rash was observed elsewhere. Mucous membranes were not involved. Smears from the pustular content showed eosinophilic predominance (70%) with a significant number of neutrophils. Gram’s stain and KOH preparation of pustules failed to reveal any microorganisms. The rash resolved overnight after three days

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without any residual signs. No squeale were observed at 1 month follow-up. Discussion: Transient Neonatal Pustular Melanosis (TNPM) presents with fragile, superficial, vesiculo-pustules appearing at birth or within the first day of life, which rupture leaving pigmented macules surrounded by collarette of scales. There is absence of peri-pustular edema. Smear from the lesion demonstrates neutrophils or occasional eosinophil. In our patient, the rash appeared on the first day and there was absence of typical background erythema, however, eosinophilic predominance in firm pustules and the lack of collarettes of scale or residual hyperpigmentation contradict this diagnosis. Eosinophilic pustular folliculitis, infantile acropustolosis, miliaria and bacterial pyoderma are important differentials. Features suggestive of any of the above were not detectable in our case. Infectious agents such as Varicella, Herpes Simplex, Cytomegalovirus and Candida and impetigo should be ruled out using appropriate methods.

NEO/38(P) ASSESMENT OF ERYTHROCYTE INDICES, SERUM IRON AND FERRITIN IN NEONATES AT BIRTH Patidar S, Shrivastava J, Dwivedi R.Department of Pediatrics, Gandhi Medical College, Bhopal [email protected]

Introduction: At birth, hematological values are higher as compared to older children. This is in response to increased erythropoiesis caused by intrauterine hypoxia. In addition, hematological values and iron reserve in newborns vary according to fetal growth. Aims and objective: This descriptive, cross-sectional study was design to describe hematological profile and iron reserve in newborns at birth. Material and method: 90 healthy term Newborns (40 small for gestational age and 5o appropriate for gestational age) delivered either vaginally or by cesarean section with gestational age of ≥37 weeks and birth weight of at least 1.5 kg were enrolled. Newborns venous blood samples were obtained with in 24 hrs of birth for measurement of hematological profile (hemoglobin, RBC count, hematocrit, MCV, MCH, MCHC, RDW), serum iron, and serum ferritin. Results: Mean values of Hb (16.4g/dl±2.8 vs. 15.0g/dl±2.09; P<0.01), RBC count (4.3×108/µl±0.7 vs. 4.0×108/µl±0.5; P<0.01), and Hematocrit (43.12%±8.4 vs. 38.75%±7/.6; P<0.01) were observed significantly higher in SGA newborns. Serum ferritin levels were significantly low in SGA group [mean 103µg/dl vs. 158µg/dl; P<0.01; 95% CI=85.5 to121.7 in SGA and 130.9 to 185.3 in AGA] than in AGA newborns. In SGA group serum iron, MCH, MCV were low and MCHC and RDW were high but the difference was not statistically significant (P>0.05). Conclusion: Term SGA newborns have low iron stores despite high hemoglobin,hematocrit,and RBC count as compared to term AGA neonates at birth (both statistically significant).

NEO/39(P) COMPARISON OF SERUM APOLIPOPROTEIN B (APO-B) AND APOLIPROTIEN A-1 (APO-A-1) AND THEIR RATIO IN HEALTHY FULLTERM SMALL FOR GESTATIONAL AGE (SGA) AND APPROPRIATE FOR GESTATIONAL AGE (AGA) NEWBORNS.Siddiqui M.H., Shrivastava J, Dwivedi R.Department of Paediatrics, GMC, [email protected]

Introduction: David Barker pioneered the “foetal origin of adult disease hypothesis” which states that intrauterine growth restriction is associated with an increased propensity to develop adult-onset diseases. Elevated apolipoprotein B levels and apolipoprotein B to A-1 ratio are considered to be the most sensitive predictors of atherogenesis in adults. This study was designed to compare apolioprotiens in fullterm SGA and AGA newborns.

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Aims and Objective: 1. To determine the concentrations of serum lipids and apo-B and apo-A-1 and their ratio in a population of healthy fullterm SGA and AGA newborns. 2. To assess the impact of birth weight on these values.Material and Method: Among 100 healthy newborns enrolled, 50 full term SGA comprised the cases and 50 terms AGA were taken as controls. Their venous samples were collected within 24 hours of birth and assays of apolipoprotiens are performed via nephelometry.Results: Among 50 SGA and 50AGA newborns, the difference between mean values of apo-B/apoA-1 ratio [O.87vs0.55; p <.01; 95% CI=0.80 to 0.94 in SGA and .495 to .605 in AGA) was significantly high and apo-A1 [87.59vs118.87; p <.01] was significantly low in SGA newborns. Serum apo-B did not show any significant difference. There was large negative correlation between birth weight and apo-B/apo-A1 (r = -0.596 at 0.01 level). Conclusion: The study reinforces the Barker’s hypothesis, showing altered apolipoprotiens in SGA newborns thus predicting the future risk of athterogenesis in adult life.

NEO/40(P) DELAYED PRESENTING CONGENITAL DIAPHRAGMATIC HERNIA: A NEONATAL SURGICAL EMERGENCYBhawna Malik, P.D.Sharma, Anand BhardwajDepartment of Pediatrics, MMIMSR, Mullana, Ambala, Haryana [email protected]

Background: Congenital Diaphragmatic hernia(CDH) is defined as a communication between the abdominal and thoracic cavities with or without abdominal contents in the thoracic cavity. Postero-lateral (Bochdalek) hernia of left diaphragm is the commonest. The incidence of CDH is estimated to be 1 per 5000 live births, delayed presentation being still rarer. The symptoms and prognosis depend on the location of defect and associated anomalies like short abdominal cavity. In such patients primary closure of abdomen may have to be defered after surgery. A 13 day neonate with an uneventful early neonatal period presented to us with complaints of hurried breathing, chest indrawing and episodes of vomiting virtually after every feed for few days. He was diagnosed and successfully operated on same day in emergency but due to short peritoneal cavity the abdominal contents were covered with sialo bag instead of primary closure of abdomen. Conclusion; The case is being presented for its rarity and unusual delayed presentation. A high index of clinical suspicion, good clinical examination corroborated by chest x-ray can easily diagnose this rare but definitely correctable pathology. This exhibit also highlights the need for combined efforts by pediatric and surgical team to improve the survival of such patients even in setup where the specialized pediatric surgical care is unavailable.

NEO/41(P) RELIABILITY OF VISUAL ASSESSMENT OF JAUNDICE IN NEONATES WITH DIFFERENT SKIN TONES.Piyush Jaiswal, V. Dandge, N. Mujawar, Meenakshi Girish, G. [email protected]

Introduction: Neonatal Jaundice is one of the commonest finding, it could range to be a normal physiologic finding to being pathologic enough to cause significant brain damage. Investigations for bilirubin estimations are usually done on recommendations when one notices yellow discolouration of skin.Aims & Objectives: Correlations of visual assessment of Jaundice in fair skin and dark skin neonates with laboratories values. Materials & Methods: All new-borns of post natal wards and those admitted in Lata Mangeshkar Hospital who appeared jaundice were classified according to their skin tones and were visually assessed for appearance of jaundice and blood sample was drawn on the same day for laboratory assessment. Study Design: Cross –Sectional Analysis: it will be done by using Epi info software - chi square test Results: To be computed

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NEO/42(P) CONGENITAL  TUBERCULOSIS – CASE REPORTSBipsa Singh , Snehamayee Nayak , Pravakar Mishra,P.G. Department of Pediatrics, SCB  Medical College, [email protected]

INTRODUCTION :- Congenital tuberculosis is rare in spite of tuberculosis being socommon . Now in the decade spanning from 1995 to 2005 there have been a number of case reports with rare manifestations of this rare disease. We present three cases of congenital tuberculosis. Case Report: - 1 A 2 months old Indian female infant presented with respiratory distress since birth, fever, abdominal distension since 1 month, swelling of right inguinal region since 1 month, vomiting, poor feeding, failure to gain weight inspite of adequate feeding since birth,Antenatally infant mother was having continuous low grade fever,productive cough with leaking membrane since 4 months  of gestation with chest x ray showing milliary mottled opacities. On investigations the chest X-ray showed bilateral lung infiltrates. Biopsy of the right inguinal lymphnode revealed caseating granuloma suggestive of tubercular lymphadenitis. The tuberculin test in the infant is 15mm .So the infant was diagnosed to be Congenital Tuberculosis &  responded to treatment with antitubercular drug.  Case Report: - 2. A 2 months old Indian female infant presented with respiratory distress since birth,failure to thrive, fever, since 1 month, The baby didn’t respond to IV antibiotics. After 1 month of hospital stay the mother disclosed and showed RNTCP card with sputum positive Pulmonary-TB on DOTS(CAT II) just before the birth of the baby.Then the baby was started with ATT.But we couldn’t save the baby due to delayed treatment. Case Report :-3   A two days old new born admitted to new born ward since the mother was admitted to hospital with tubo-ovarian mass,the biopsy of which confirmed to be tubercular origin. But the baby was stable and on artificial feeding since birth.The gastric lavage samples of baby was found to be AFB positive.The baby was started immediately with ATT.Hence the baby was survived. Outcome:- The case 1 & 2 couldnot be survived due to delay in diagnosis and treatment. The Case 3 was  survived due to early diagnosis and treatment. Conclusion :- Congenital tuberculosis is rare ; Due to some non-specific symptoms and signs , sometimes the early diagnosis is difficult and treatment is delayed for which outcome may be fatal. Hence any case with congenital tuberculosis  should be diagnosed immediately and treated with ATT immediately, so that infant mortalitycan be reduced.

NEO/43(P) OUTCOME OF SCLEREMA NEONATORUM IN A RURAL MEDICAL COLLEGE HOSPITALD.Y. Shrikhande, P.V. Nigwekar, Abhijeet Singla, Neeraj ShahaDepartment of Pediatrics, Rural Medical College, PIMS, Loni, [email protected]

Introduction: Sclerema Neonatorum is a harbinger of death in majority of neonates. It is associated with many underlying disorders with sepsis being the commonest. It is a disease of subcutaneous adipose tissue characterized by hardening of the skin that gets bound to the underlying muscle & bone, giving waxy appearance & feel, hindering respiration & feeding & is associated with respiratory illnesses & sepsis. The virtual irreversibility and eventual fatality which was the norm earlier, can be reversed and neonate given a fresh life & future by appropriate & energetic specific & supportive management. Aims & Objectives: To find out etiology of the underlying disorder & institute appropriate management. To find out whether significant number of sclerema cases can be reversed and survival made possible. Material & Methods: All neonates inborn and outborn with developing sclerema were included All neonates without Sclerema & neonates with congenital malformations were excluded. Results: 62 cases of sclerema neonatorum were observed during a

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period of 12 months, of these 29 survived. Mean birth weight was 1768.17 gms. 36 were males & 26 were females. Among survivors, 20 were males, 9 were females. All 62 cases of sclerema had clinical, hematological & microbiological evidence of sepsis. In addition, 14 presented with respiratory distress syndrome, 9 with apnea, 8 with thrombocytopenia, 9 with meningitis, 10 with shock, 5 with asphyxia, 8 required ventilation. There was no case of pulmonary hemorrhage. Conclusions: Early detection of septicemia & prevention of hypothermia as well as hypoglycemia along with prompt institution of appropriate antibiotics and good supportive management proved to be more effective in this study.

NEO/44(P) CLINICO- LABORATORY PROFILE OF CULTURE POSITIVE NEONATAL SEPSIS IN A TERITIARY CARE HOSPITAL N.Kamalakar Rao, Abani kanta Sahu, Laxmi Aparna,K.Umamaheswar Rao,P.SudarsiniDepartment of Pediatrics, Alluri Sitarama Raju Academy of Medical Sciences, Eluru, [email protected]

INTRODUCTION : Neonatal sepsis is the commonest diagnosis among admitted newborns in neonatal ICU. Culture positive neonatal sepsis is a special entity in view of increased mortality and morbidity associated with it. SETTING & DESIGN : A prospective hospital based study during Feb’2010 – Aug’2011 at ASRAMS, Eluru, Andhra Pradesh. METHODS : This study included prospective cases (n=50) of clinically suspected neonatal sepsis admitted in NICU of ASRAMS hospital. Sepsis screen and blood culture was sent for all cases and CSF analysis done when needed. AIMS & OBJECTIVES : To evaluate the sensitivity of presenting clinical symptoms in predicting culture positive neonatal sepsis. To find out the role of laboratory parameters as early predictor of culture positive neonatal sepsis. RESULTS : Among the study cases, Males :26(5 2%) > female : 24(48%), LBW : 28(56%) > normal wt : 22 (44%), EONS : 26(52%) >LONS : 24(48%), EONS : 15(75%) > LONS : 5 in preterms(20), LONS : 19 (79%) > EONS : 11 in terms (30%) Blood culture was positive in 26 cases , Pathogenes grown were coagulase +ve staph – 12 (46%), Coagulase –ve staph – 5 (19%), Pseudomonas – 4 (16%), Klebsiella – 4 (15%) ,Enterococci -1 (4%)

Clinical symptoms Present in

% of cases sensitivity specificity PPV Accuracy

Jaundice 74 % 76.9 % 29.2 % 54 % 54 %Refusal of feeds 72 % 69.2 % 17 % 50 % 48 %Temp. instability 50 % 36.4 % 54.2 % 56 % 54 %Lethargy 32 % 26.9 % 62.5 % 43.8 % 44 %Resp.Distress 36 % 34.6 % 62.5 % 50 % 48 %

LABORATORY PARAMETERS Present in

% of cases sensitivity specificity PPV Accuracy

CRP > 12 µg/ml 90 % 92.3 % 12.5 % 53.8 % 54%TWBC <5000) 44 % 46.2 % 52 % 58 % 46 %Micro ESR >10mm 20 % 18.8 % 60.5 % 42 % 40 %Ban cell count>20% 10 % 20.4 % 83 % 52 % 52 %

CONCLUSION: Despite of their low specificity Jaundice and refusal of feeds shown good sensitivity in predicting culture positive neonatal sepsis. Among Lab parameters CRP > 12 µg/ml was the best predictor with a sensitivity of 92.3% of a severe condition like neonatal sepsis. Though widely advised other screen parameters performed poorly in predicting the same.

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NEO/45(P) CLINCO-BACTERILOGICAL PROFILE OF CULTURE PROVEN NEONATAL SEPTICEMIA & ANTIBIOTIC SENSITIVITY PATTERN OF ISOLATED ORGANISM IN A TERTIARY CARE HOSPITAL IN JAIPURAnand Jain, Kailash MeenaDepartment of Pediatrics, SMS medical college, [email protected],

OBJECTIVE: To determine bacterial isolates & its antimicrobial senstivity pattern. MATERIAL & METHOD: Retrospective hospital based study in inborn babies of Zenana hospital, attached to SMS medical college, Jaipur. The data was collected from their case records from Jan 2010 to Dec 2010. All the babies with maternal risk factors and all symptomatic babies in whom sepsis was considered were subjected to blood culture( BACTEC). Organisms causing sepsis and their sensitivity pattern were analysed in the study. RESULTS: 241 neonates with suspected sepsis were sent, out of which 85(35.5%) were culture positive, presented as early ( 77.6%) & late ( 22.5%) onset sepsis. The most common symptom was respiratory distress, refusal to feed, abdominal distension and fever. Majority (41%) isolated gram negative bacilli, most commonly Enterobacter(21.1%), E.coli(15.2%) & Klebsiella(4.7%). Also Non Albicans Candida were 37.6% among the isolates. CONS ( 30.5%) being the most common among Gram positive bacilli. Gram negative bacilli were sensitive to Amikacin, Ciprofloxacin, Meropenem but resistance is increasing with Gentamycin ,Cefotaxim, Ampilcillin-Sulbactam. The sensitivity for cephalosporins & aminoglycosides has declined significantly. Vancomycin resistance is also increasing among gram positive bacilli most common isolates being Staphylococcus aureus. 31 out of 85( 36.4%) culture positive cases died. CONCLUSION: Resistance to commonly used antibiotics is increasing. Emergence of Non Albicans Candida even in 1st week of life in LBW babies. Establishment of proper antibiotic policy is essential to control resistance.

NEO/46(P) AETIOLOGICAL PROFILE OF NEONATAL SEIZURES IN A TERTIARY CARE NURSERYDevika M, Warrier A, Jana AK, Kuruvilla KANeonatology Department, CMC Hospital, Vellore 632004, Tamil Nadu. [email protected]

Seizures are more common in the neonatal period than at any other time throughout life. Investigation leading to prompt diagnosis of the underlying condition is important because many of the aetiologies have specific treatments which, when used early, may improve the prognosis. The aetiological profile of neonatal seizures was studied over 1 year in CMC Hospital, Vellore and the role of neuroimaging in these babies was also investigated. Methods: All newborn babies admitted with seizures in the nursery were enrolled, excluding major congenital anomalies. Baseline information was collected, including the clinical profile, relevant perinatal history, and essential investigations were done in all subjects. Ultrasound head and other neuroimaging was done when feasible. Results: 175 babies had seizures during the study period: 65 inborn (among 9441 livebirths) and 110 outborn babies. 155 babies were term, 39 were low birth weight. Multifocal clonic (40%) and subtle (22%) seizures were the most common types. The most common aetiology was HIE (50%), sepsis and metabolic causes (hypocalcemia, hypoglycemia, IEM). There was no obvious cause for seizures in 32 babies. Infarcts were found in 28%, structural anomalies and IVH

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in 6% each. However, no cause could be detected in 53% despite ultrasound and CT scan. Conclusions: Incidence of neonatal seizures was 7/1000 livebirths. Majority of babies with seizures were term; commonest cause for seizures was perinatal asphyxia. The aetiology of seizure could not be determined in 9.7% of babies even after neuroimaging.

NEO/47(P) EFFECTIVENESS OF PROPHYLACTIC PHOTOTHERAPY IN PRETERM LOW BIRTH WEIGHT NEONATE FOR PREVENTION OF UNCONJUGATED HYPERBILIRUBINEMIA: A RANDOMIZED CONTROLLED TRIAL.Samrat GangulyKolkata Medical College, [email protected]

Background: Preterm low birth weight neonates are at greater risk of complications of hyperbilirubinemia due to immaturity of hepatic enzyme system and blood-brain barrier. Objective: To evaluate the role of prophylactic phototherapy from birth in preterm low birth weight neonates in preventing high rise of serum unconjugated bilirubin (UCB) and associated complications. Methods: In this prospective, randomized, controlled trial 50 low birth weight (weighing < 1500gms. in birth weight, gestational age < 37 weeks) neonates were randomly allocated into intervention and control groups. Intervention group received phototherapy following initial stabilization after birth and control group received phototherapy after serum UCB level reached 7 mg/dl. The peak serum bilirubin level were compared among the two groups along with time to reach the peak UCB level, no. of exchange transfusions and incidence of kernicterus. Results: The intervention group (n=25) with mean birth weight 1232.6±167.1 g, gestational age 32.16±1.8 weeks was demographically comparable with the control group (n=25) (1230±194.1 g, 31.8±1.7 weeks respectively). The peak UCB level and average rate of rise of bilirubin was significantly lower in the intervention group compared to the control group (9.048±2.05mg/dl and 0.076±0.02 mg/dl/hr in intervention group vs. 12.16±2.38mg/dl and 0.11±0.03 mg/dl/hr in control group, respectively) (p<0.0001). There is no significant difference in time to reach peak bilirubin level between prophylactic group (120.48±18.8 hr) and control group (110.6±19.6 hr)(p=0.07). Neonates in intervention group required significantly less exchange transfusions(1 vs 5, p<0.05). No neonate was diagnosed with kernicterus among intervention group against two cases among control group.

NEO/48(P) ERYTHROCYTE INDICES, SERUM IRON AND FERRITIN IN NEONATES, AT BIRTH.Patidar S, Shrivastava J, Dwivedi R.Department of Pediatrics, Gandhi Medical College, Bhopal (M.P.)[email protected]

Introduction: At birth, hematological values are higher as compared to older children. This is in response to increased erythropoiesis caused by intrauterine hypoxia. In addition, hematological values and iron reserve in newborns vary according to fetal growth. Aims and objective: This descriptive, cross-sectional study was design to describe hematological profile and iron reserve in newborns at birth. Material and method: 90 healthy term Newborns (40 small for gestational age and 5o appropriate for gestational age) delivered either vaginally or by cesarean section with gestational age of ≥37 weeks and birth weight of at least 1.5 kg were enrolled. Newborns venous

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blood samples were obtained with in 24 hrs of birth for measurement of hematological profile (hemoglobin, RBC count, hematocrit, MCV, MCH, MCHC, RDW), serum iron, and serum ferritin. Results: Mean values of Hb (16.4g/dl±2.8 vs. 15.0g/dl±2.09; P<0.01), RBC count (4.3×108/µl±0.7 vs. 4.0×108/µl±0.5; P<0.01), and Hematocrit (43.12%±8.4 vs. 38.75%±7/.6; P<0.01) were observed significantly higher in SGA newborns. Serum ferritin levels were significantly low in SGA group [mean 103µg/dl vs. 158µg/dl; P<0.01; 95% CI=85.5 to121.7 in SGA and 130.9 to 185.3 in AGA] than in AGA newborns. In SGA group serum iron, MCH, MCV were low and MCHC and RDW were high but the difference was not statistically significant (P>0.05). Conclusion: Term SGA newborns have low iron stores despite high hemoglobin,hematocrit,and RBC count as compared to term AGA neonates at birth (both statistically significant).

NEO/49(P) CLINICO ETIOLOGICAL PROFILE OF NEONATAL SEIZURESAli Mehdi Johar, S. P. Verma, Nilesh Jain [email protected]

INTRODUCTION : Neonates are at particular risk for development of seizures because of immature brain. The increased susceptibility of neonates to convulsion made us to identify the etiological profile in this age group of patient along with associated clinical presentation. AIMS & OBJECTIVES : To study the incidence, clinical presentation, and etiological factors of seizure disorder among 0-1 month age group in hospitalized patient. To compare the characteristics of neonatal seizures between preterm and full-term infants. Material and Methods : Prospective study conducted in deptt. of Pediatrics, CNBC & MYH, Indore. 100 consecutive cases of seizure admitted in our NICU were included in the study and cases were studied from clinical & biochemical aspects. Data was analyzed using Chi-square test. Results : Out of 100 cases HIE (47%) was the most common cause followed by meningitis (20%), hypocalcaemia (15%), hypoglycemia (14%). Commonest age of presentation of babies with HIE and seizures was the first 24 hours. Tonic seizures (43%) were most common type of seizure followed by subtle (38%) seizures. In preterm most common were subtle seizures (42%) while in term most common were tonic seizures (50%). Conclusions : The commonest cause of seizure in term babies was birth asphyxia with majority presenting to us within the first 48hrs. Sepsis contribute maximum to seizure in preterms. 

NEO/50(P) ETIOLOGICAL SPECTRUM OF NEONATAL SEIZURES AND CORRELATION WITH EEG AND SHORT TERM OUTCOME-A STUDY FROM SOUTH INDIAN TERTIARY CARE CENTRELokesh Lingappa, Swapna Neharika , Dinesh Kumar Chirla, Venkatalaksmi Alla, Preetham KumarDepartment of Pediatric Neurology, Rainbow Children’s Hospital and Perinatal Centre, [email protected]

Aims- To study etiological spectrum of neonatal seizures, correlate with EEG findings and short term outcome Methods- Prospective Observational Study, Consecutive Neonates with seizures admitted included, data, investigations and management done according to protocol. July 2009 to dec 2010. Follow up data using DDST II at 6 months. Results -103 were enrolled, 95% out born, 87% term, 18% SGA. 33% had HIE, 26% Sepsis, intracranial bleed 6.5%, Hypoglycemia- 9.7%, hypocalcemia 8.7%. Neurometabolic disorders in 4.8%, Vascular and structural abnormality in 2.7%each and 6% unknown etiology. EEG performed 89 babies, normal in 47 and abnormal 42. 23 had diffuse cerebral dysfunction, 14 had epileptiform discharges, 4 –burst suppression, one excess

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of beta. Of 12 with HIE and cerebral dysfunction 4 died, 5 had developmental delay on FU. HIE with epileptiform discharges 3 died, 3 developed infantile spasms and one normal. HIE with normal EEG in 12, six were normal at 6 months, five had developmental delay. Neonates with sepsis and normal EEG 12/13 had normal development, with abnormal EEG 3/5 died and two were normal. Hypoglycemia with normal EEG 3/4 were normal, 2/3 with abnormal EEG had delay and one died. Two with Nonketotic hyperglycinemia with burst suppression died. In 10 Levetriacetam used as third line medication without any adverse effects Midazolam infusion use reduced by 75%. Three on levetriacetram died of unrelated severe illness. MRI in 10/27 normal, 10 had HIE changes, 3 stroke, 2 structural malformation. Conclusion- Neonatal EEG is useful tool in prognostication, Levetriacetam reduced Midazolam usage

NEO/51(P) AN UNUSUAL PRESENTATION OF NEONATAL ADRENAL HAEMORRHAGE Anup Joshi, Sushma Malik, Charusheeela Warke, Shweta Shirke, Varun Bansal Division of Neonatology, Dept. of Pediatrics, BYL Nair Ch. Hospital and TN Medical College, [email protected]

Introduction: The incidence of neonatal adrenal haemorrhage (NAH) ranges from 1.9 to 5.5 per 1000 live births, with male preponderance. NAH is frequently associated with large fetal size, birth trauma, fetal or perinatal asphyxia, shock and septicaemia. Incidence of neonatal hypertension ranges from 0.7 to 3.2%. Here we report an unusual case of unilateral adrenal haemorrhage presenting as neonatal hypertension. Case History: A G2P1 mother delivered a male child (3.5Kg) vaginally with an antenatal scan showing bilateral hydrocoele. At birth patient was asymptomatic and a USG scrotum and abdomen revealed moderate hydrocoele and large echogenic areas within the right suprarenal region (3.7×3.2 cm) suggesting an adrenal hemorrhage. This was confirmed with a CT scan, and malignancy and renal vein thrombosis was ruled out. On day 3 patient was observed to have hypertension (average- 100/70 mmHg) and mild jaundice. Patient had no hypoglycemia or electrolyte imbalance and renal function was normal. Baby was started on enalapril and was extensively worked up for hypertension and adrenal hemorrhage. Renal Doppler, urinary VMA levels, serum cortisol, beta HCG, alpha fetoprotein were all normal. Repeat USG done weekly showed resolution of the hemorrhage (2.5 cm), however the hypertension continued even till followup at 6months. Discussion: The clinical presentation of NAH is variable, ranging from asymptomatic (unilateral incidentally diagnosed cases) to severe (bilateral massive affection) leading to adrenal insufficiency or shock; common manifestations being poor feeding, vomiting, hypotension, persistent jaundice, anemia and abdominal mass, however, our case had persistent hypertension. The common causes of neonatal hypertension are renal artery thrombosis, bronchopulmonary dysplasia, and co-arctation of aorta and rarer causes include hypocalcemia, total parental nutrition and idiopathic arterial calcification. Symptomatic treatment and follow up serial USGs are necessary for documenting resolution of the adrenal lesion and also for hypertension to subside. Conclusion: Unilateral NAH must be differentiated from other cystic lesions like adrenal cyst, abscess and tumors like neuroblastoma. These cases can be asymptomatic and incidentally detected and can rarely present as neonatal hypertension.

NEO/52(O) A STUDY OF PROFILE OF NEONATES BORN TO RH ISOIMMUNISED MOTHERSAradhana Dwivedi, Suprita Kalra, Daljit SinghInstitute: Command Hospital (Southern Command), Pune [email protected]

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Background & Objectives: Rh isoimmunisation has continued to remain a common cause of hydrops fetalis in our country due to relative lack of antenatal care and non provision of Anti-D. Due to timely provision of Anti-D it has become rare in developed countries. Methods: In our centre we had 24 newborns with h/o Rh isoimmunisation from the period of May 2007-July 2009. The mothers of these babies underwent antenatal evaluation including ICT titres & serial USGs as indicated. These babies were given intrauterine transfusions as per protocol using middle cerebral artery velocities. At delivery the babies were started immediately on intensive double surface photototherapy & given prophylactic intravenous immunoglobulin (IVIg) 1gm/kg. Samples for serum billirubin, hemoglobin & reticulocyte count were monitored at birth, at 6 hrs, 12hrs & 12 hrly thereafter till indicated. IVIg 1gm/kg was repeated for neonates when their serum billirubin was found to be approaching exchange transfusion levels for gestational age as per AAP charts. Results: Of the total 24, three babies had severe hydrops fetalis at birth. A total of 12 mothers’ had received intrauterine transfusions & 9 babies were given a second dose of IVIg . Maximum serum billirubin levels were 22 gm/dl at day 3 & average days of phototherapy were 6. 4days.No babies required exchange transfusion & none had any sequelae of kernicterus on follow-up visits.All babies underwent OAE to screen for hearing which was normal in all babies. Interpretation & Conclusion: With intensive double surface phototherapy & prophylactic dose of IVIg the morbidity & mortality in neonates born to Rh isoimmunised mothers is brought down. It also reduces the number of babies requiring exchange transfusion.

NEO/53(P) RENAL SODIUM HANDLING IN PERINATAL ASPHYXIAJyoti Bagla, Roli Srivastav Deptt. Of pediatrics, ESI PGIMSR Basaidarapur, New [email protected]

Background : Kidneys are one of the target organs for hypoxic ischemic damage. Hyponatremia is one of the consequences of hypoxic injury to the kidneys. Study design : Prospective case control study. Methods : Severely asphyxiated 70 babies (APGAR 7 or less at 5 min) were enrolled and compared against 28 matched controls. Renal function parameters like blood urea, serum electrolytes, serum creatinine, urinary sodium and creatinine were monitored and Fractional excretion of sodium (FENA) calculated within 24 hrs and thereafter until recovery. Results : Incidence of Hyponatremia ( sodium <135mEq/l) in asphyxiated neonates was 74.28%(52 /70) with mean sodium 129.8mEq/l in cases Vs 135.8mEq/l in controls (p<0.001). Majority 62.8% (44/70) were having mild hyponatremia ( Serum sodium 135 to 126mEq/l), 8(11.43%) subjects were having moderate to severe hyponatremia (sodium 107- 125mEq/l). 18/52(34.6%) asphyxiated neonates with hyponatremia had no signs of HIE, 7/52(13.46%) were having HIE I, 18/52(34.6%) were having HIE II and 9/52(17.3%) were having HIE III. Overall mortality was 6 / 70 (8.57%) and all of them were having hyponatremia (mean sodium 128mEq/l). Mean FENA in asphyxiated neonates (0.6±0.56%) was significantly higher than in controls (0.29±0.27%) (p<0.05) . 40/70(57.14%) neonates were having FENA more than 1 including 3 babies with FENA>2.5, out of them 25 (62.5%) were having HIE. Serum sodium normalized in majority of cases with in 72 hrs but in 11 of them (15.7%) hyponatremia persisted for more than 72 hrs with mean sodium being 127.7mEq/l that again normalized later on. Conclusion : Hyponatremia is a significant problem in babies with perinatal asphyxia. Severity of hyponatremia correlates with the severity of HIE. Hyponatremia is a predictor of mortality in asphyxiated newborns in the current study. Thus, meticulous sodium monitoring is required in babies born asphyxiated.

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NEO/54(P) EFFECT OF BIRTH ASPHYXIA ON THYROID PROFILE OF TERM NEWBORNSomnath Pal , Debadatta Mukhopadhyay, Sukanta Chatterjee Junior Resident, Medical College, [email protected]

BACKGROUND : Birth asphyxia causes alteration in the level of several hormones. Thyroid hormone levels are also altered though some studies produce conflicting results. OBJECTIVE : To compare the thyroid hormone levels in term , asphyxiated newborn with term non asphyxiated newborn in cord blood & venous blood collected on day 1 & day 7 respectively.MATERIALS AND METHODS: STUDY DESIGN : case- control study STUDY POPULATION : 25 term newborn ( apgar score =>8 & =>9 at 1st min & 5th min ) as control and 25 term, asphyxiated newborn( apgar score ≤3 and ≤5 at 1st min & 5th min)as case. Both groups were matched with respect to possible confounding factors. EXCLUSION CRITERIA : congenital malformations Newborns whose mother used steroids, thyroxine , antithyroid medications during pregnancy RESULTS: COMPARISON OF THYROID HORMONES IN CORD BLOOD OF ASPHYXIATED & NON-ASPHYXIATED TERM NEWBORN :- revealed no significant difference ; p value ( student t test ) for T3, T4 and TSH were – 0.227, 0.347 and 0.079 respectively ). COMPARISON OF THYROID HORMONES IN VENOUS BLOOD OF DAY 1 :Asphyxiated newborns showed significant fall of TSH, T3 , T4 from cord blood value. (p value for T3 -0.029, T4 -0.006, and TSH – 0.015). Control newborns had significant rise of T3,T4,TSH from cord blood value (p value for T3 – 0.001, T4 –0.001 and TSH -<0.001 ) COMPARISON OF THYROID HORMONES IN VENOUS BLOOD OF DAY 7 No significant difference for T3 ( p=0.324 ), T4 ( p=0.093 ) and TSH ( p=0.077 ) COMPARISON OF T3,T4,TSH and SEVERITY OF ASPHYXIA T3,T4,TSH levels were significantly lower in HIE2/HIE3 than HIE or no encephalopathy group; p< 0.001( ANOVA ) CONCLUSION : 1. Birth asphyxia causes reversal of TSH surge in asphyxiated newborn 2. Change in thyroid hormone levels are temporary 3. There is greater reduction of thyroid hormone level in severely asphyxiated newborn

NEO/55(P) CONGENITAL MALARIA IN A TWO DAY OLD NEWBORN-A CASE REPORTShivani Deswal,Akhilesh kumar,Pratima Anand,Harish ChellaniDepartment of Pediatrics, Safdarjung hospital & V.M.M.C, New [email protected]

Malaria is considered to be congenital in the neonate when asexual parasites are detected in the peripheral blood within the first week of life. However, the disease can be seen in a day old baby or be delayed for weeks or months{commonly 10 to 30 days}.Congenital malaria is a rare disease.Only 300 cases are reported in a literature. We report a case of Preterm girl Baby {34-36 weeks} large for gestational age {Wt-3.75kg} born to 35yrs old booked immunized G8 P4 L2 A3 with 8 months of gestation with uncontrolled diabetes on regular insulin 8/8/8 units with Bad Obstetric History (3 abortions and 2 still births) ,delivered by Emergency LSCS in view of breech with fetal distress. Mother had fever for 20 days with jaundice 1 year prior to pregnancy which was

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diagnosed as malaria and treated. Mother also had history of fever 2 months before pregnancy for 4 days for which she took some over the counter medication. Baby Cried immediately after birth with Apgar score- 8 and 9 at 1 and 5 minutes respectively. Baby was put on breast feed and maintaining blood sugar. Baby developed fast breathing at 48 hrs of life .On examination-H.R- 174/min; regular, peripheral pulses palpable.Resp. rate- 84/min with mild subcostal and intercostal retractions present .Temp.- 102.5°F (axillary), Blood Pressure 60/34 mm of Hg in right arm.SpO2 in all 4 limbs (off O2)- 93%.Per abdomen-Liver 4 cm below costal margin, span8cm and spleen 3cm,firm.Baby was Investigated for fever and hepatosplenomegaly . Hb-18.9 g%,TLC-12100cc/m3 ,Platelet count-165000cc/m3 ,PCV-58.8 % ABG - pH-7.29,PO2-65.8,PCO2-46.0,HCO3s-21.6 ,SBE- -4.2, PS - Normocytic Normochromic with ring and ameboid schizont forms, suggestive of P.Vivax . RMAT and P/S for Malaria parasite of mother were negative.TORCH Profile of baby and mother – negative.X ray chest was normal.CRP – negative .Blood and CSF culture/sensitivity -no growth after 7 days.KFT &LFT-normal. Syp chloroquine given for 3 days.After 3 days baby was afebrile and spleen was just palpable .Repeat PS at day 8 and 1 month for both baby and mother was negative.Mother received primaquine for 14 days. Transmission of congenital malaria can occur in antenatal or perinatal period. Parasites hide in placenta and interferes with transfer of oxygen and nutrients to the baby, increasing risk of: Spontaneous abortion, Preterm birth, Low birth weight, Stillbirth and Neonatal deaths. Fever, anemia, and splenomegaly are seen in 80 % cases while hepatomegaly, jaundice, regurgitation, loose stools, and poor feeding, drowsiness, restlessness, and cyanosis are other manifestations. Congenital infection has been described after uncomplicated asymptomatic pregnancies also.

NEO/56(P) NEONATAL OUTCOME OF DELIVERIES WITH MECONIUM STAINED LIQUOR Garima Gautam, Amit Gupta, Sanjeev Dutta, Anjoo Bhatnagar, Hitesh PantDepartment of Paediatrics, Fortis Escorts Hospital and Research Centre, Neelam Bata Road, NIT, Faridabad-121001. [email protected]

Introduction: Babies born through meconium stained liquor (MSL) may aspirate meconium which may occur in-utero, during delivery or immediately after birth, blocking air passages and causing atelectasis and air leak, constituting Meconium Aspiration Syndrome(MAS) which is a significant cause of neonatal morbidity and mortality. Aim: To find the incidence of MSL amongst all the deliveries, and analysing outcome of the same in a tertiary care multispeciality hospital. Method: Observational study, done at FEHRC, Faridabad, carried out from January 2010-September2011. All newborns born with MSL were analysed on parameters as follows: a) Requirement of resuscitation (endotracheal intubation and suctioning with/without positive pressure ventilation), b) Requirement of respiratory support (oxygen by hood/ mechanical ventilation/ CPAP) and, c) Incidence of MAS. Result: A total of 90 newborns with MSL were identified in 21 months. Incidence of MSL amongst total deliveries (n=1079) was found to be 8.3 %( n=90). 11 newborns (12.2% of MSL) required endotracheal suctioning, and 8 (8.8% of MSL) required resuscitation with positive pressure ventilation. Later 7.7% (n=7) developed MAS. Among neonates who underwent tracheal suctioning 27.2% (n=3) developed MAS as compared to 5% (n=4) who had MSL, but did not undergo tracheal suctioning. Respiratory support in the form of oxygen by hood was required in

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17.7% (n=16), mechanical ventilation and CPAP in 2.2% (n=2) each, with no mortality. Conclusion: Proportion of births complicated with MSL was comparable with that of National Neonatal Perinatal Database 2002-2003, suggesting that there is still need for improvement in antenatal survelliance and intrapartum fetal monitoring as incidence of MSL remains the same in last 9 years. However, proportion of MSL complicated births developing MAS is much lower (7.7% versus 15.6%) attributable to widespread use of NALS guidelines.

NEO/57(P) THROMBOCYTOPENIA AS A MARKER OF SEPSIS AND ITS RELATION TO ORGANISM SPECIFICITYShivprasad Dubey, Amit Gupta, Anjoo Bhatnagar, Hitesh Pant, Sanjeev DuttaDepartment Of Pediatrics and Neonatology, Fortis Escorts Hospital and Research Centre, Neelam Bata Road, N.I.T, Faridabad-121001,[email protected]

Introduction: Sepsis is a common complication in the neonatal intensive care unit and it remains a diagnostic challenge due to its non-specific symptoms. The sensitivity and specificity of leukocyte count changes (leucopenia/leucocytosis) ranges from 17-90% and 31-100% respectively. Thrombocytopenia is also a frequent hematological change seen in neonatal sepsis. It is not yet clear whether thrombocytopenia can be used as a diagnostic marker of sepsis. Also it is controversial whether thrombocytopenia is an organism specific response. Aim: To evaluate the utility of thrombocytopenia as a marker of neonatal sepsis and its relation to organism specificity. Methods: An observational cohort study carried out at Level III NICU on 210 neonates admitted from August 2010 to August 2011 with suspected sepsis or with risk factors for sepsis. Through database search, data on platelet counts, sepsis, clinical course, and microbiological culture were collected and analyzed. Results: Sepsis was diagnosed as per microbiological criteria (Blood Culture) in 35 patients (16.6%) and thrombocytopenia was detected in 29 patients (13.8%). Thrombocytopenia occurred in 19 of 35 blood culture positive patients (54.2%), P value <0.001.The sensitivity, specificity, positive predictive value and negative predictive value of thrombocytopenia were 54.2% and 94.2%, 65.5% , 91.1% respectively. There were 57.1% cases of Gram-ve, 25.7% cases of Gram+ve and17.2% cases of fungal sepsis. Thrombocytopenia occurred in 55% of Gram-ve, 44% of Gram+ve and 67% of fungal sepsis cases with no statistically significant difference between these groups. (P value=0.898) Conclusion: Thrombocytopenia is a good sepsis marker with its sensitivity and specificity comparable to leukocyte count changes, and thus may be used as a sepsis marker in conjunction with/ or in place of leukocyte count changes. In contrast to previous reports, thrombocytopenia might not be an organism-specific marker of sepsis.

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NEO/58(P) NEONATAL SCREENING FOR G6PD DEFICIENCY IN OUR HOSPITAL SETUP- A PROSPECTIVE PRELIMINARY STUDYK.L. Srivastava, Shitanshu Srivastava, Shivam Shingla.Department of Pediatrics, ERA Medical College and Hospital, [email protected]

Objective: 1.To perform preliminary screening of Glucose-6-Phosphate Dehydrogenase G6PD deficiency in AGA newborns. 2. To evaluate the onset of bilirubin rise in G6PD deficient newborns. Methods: Cord blood samples from 196 AGA newborns during 8-month period were examined for G6PD activity using quantitative test. G-SIX (kinetic method) estimation was used for quantitative assessment to know the level in normal subjects. The relation between G6PD deficiency and the variables of gestational age, sex, jaundice, haemolysis and anaemia was examined and their statistical correlations were done. Results: Six neonates (4 males and 2 females) were found to be G6PD deficient. The incidence of G6PD deficiency was 3.0% (2 % for boys and 1% for girls), this is in accordance with the international and national figures (1). Two male subjects had low WBC with normal haemoglobin level and normal packed cell volume (PCV), but none of them had high reticulocyte counts. There was no correlation between G6PD deficiency and the gestational age, haematocrit and reticulocyte counts of the cord blood. The mean cord bilirubin levels in G6PD deficient group and normal newborns were comparable (1.27±.08mg/dl vs 1.39±0.52 respectively, P=0.54). Cord haematocrit was also similar in both the groups (50.4±3 vs 49.0±4 respectively, P=0.40). Conclusions: G6PD deficiency in newborns in this preliminary study was 3.0%. In utero rise of serum bilirubin in patients with G6PD deficiency was not observed in Indian population studied by us. Universal newborns screening for enzyme deficiency by examining the cord blood is recommended (2).

NEO/59(P) PROFILE OF NEONATAL TETANUS: A HOSPITAL BASED STUDY IN NORTH INDIAKirtisudha Mishra, Srikanta Basu, Dipti Kumar, Ashok Kumar Dutta, Bimbadhar Rath Kalawati Saran Childrens’ Hospital, Lady Hardinge Medical College, New [email protected]

Introduction: Neonatal tetanus (NT), an important preventable cause of neonatal mortality, accounts for nearly 1% of the total number of deaths in children below 5 years of age in India. Aims and objectives: To study the epidemiological and clinical profile, the outcome and the factors affecting the outcome of neonatal tetanus cases admitted in our hospital.Material and methods: A retrospective observational study was conducted in Kalawati Saran Children’s Hospital, New Delhi, to review the records of all cases of NT between January 2009 and December 2010. Possible factors affecting mortality were compared between survivors and non-survivors for statistical significance. Results: A total of 55 cases with NT were admitted in the hospital during the study period with a mean age of presentation 9.4 ± 1.2 days. Three mothers had received single dose of tetanus toxoid, rest being unimmunised. Only 8.8% neonates were born out of institutional deliveries, while 91.1% were born at home. 77.8% of the home deliveries were attended by untrained birth attendants. 33% cases gave history of application over umbilicus. Case fatality rate was 60%. Mortality was significantly higher in newborns with low birth weight (p=0.05), duration of spasms lasting more than 3 days (p=0.008), those delivered by untrained birth attendants (p=0.029) and those with aspiration pneumonia (p=0.002). Conclusion: The current admission rate of cases shows that the elimination of NT remains a major challenge. Improving maternal immunization, increasing

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deliveries by skilled birth attendants, prevention of low birth weight babies, prompt and careful management of cases should be the main areas of focus to reduce the case fatality rate.

NEO/60(P) CHOANAL ATRESIA – UNCOMMON CAUSE OF CARDIOVASCULAR COLLAPSE IN A PRETERM NEWBORN BABYSK Roy, KD Sodhi, S Mehrotra, Sr. adv. & HOD, Department of Paediatrics Command Hospital Lucknow [email protected]

This preterm (period of gestation 34 weeks), very low birth weight (1.4 kg), female newborn baby born by LSCS, cried at OT table subsequently developed apnea followed by cyanosis and cardiac arrest, requiring intubation, chest compression and inj adrenaline in OT and shifted to NICU with bag and tube ventilation. As baby was maintaining spO2 with FiO2 of 40 – 50% with minimal ventilator support, baby was extubated. Within few minutes of extubation, baby developed severe sub-costal and supra-sternal retraction, so was placed on mechanical ventilation. During weaning when placed on nasal CPAP, baby again developed severe supra-sternal retraction. At that time, nasogastric tube could not be passed bilaterally more than 03- 04 cm. So diagnosis of bilateral choanal atresia was suspected which was corroborated by CT nasopharynx as bilateral 05 mm bony septum. Following endoscopic guided Diode Laser perforation of B/L choanal atresia, 2.5 mm ETT was placed in both nosopharynx with stay at collumella, which was replaced one by over 10 – 12 weeks. Screening for CHARGE association revealed bilateral sensory neural hearing loss as well as low set ears clinically. Subsequent follow up revealed global developmental delay.

NEO/61(P) SUCCESSFUL TREATMENT OF MULTIDRUG RESISTANT ACINETOBACTER BAUMANNII IN A NEONATESoume Bhattacharya, Pooja Dewan, MMA Faridi, Prerna BatraDivision of Neonatology, Department of Pediatrics, University College of Medical Sciences, [email protected]

Ventriculitis is a known complication of neonatal meningitis associated with a high mortality of upto 70%. While, gram negative organisms like E.coli are common etiological agents, over the last decade Acinetobacter baumannii is an emerging pathogen in the neonatal intensive care setting with a still higher fatality rate. Herein we report a neonate successfully treated for Acinetobacter ventriculitis. A female neonate, delivered at 31-weeks’ gestation to a primigravida mother weighed 1.315 kg at birth, was admitted for respiratory distress to the intensive care unit. The neonate was started on parenteral antibiotics as the mother had a history of prolonged rupture of membranes associated with foul smelling liquor. On day 7, the baby developed seizures. CSF examination revealed: 120 polymorphs/mm3, protein: 320 mg/dl, sugar: 10 mg/dl, venous sugar: 125 mg/dl. Blood culture and CSF culture revealed Multidrug resistent Acinetobacter baumanni (MDRAB) sensitive to Polymixin B and resistant to gentamycin/ciprofloxacin/cefotaxime/meropenem. CECT revealed communicating hydrocephalous with ventriculitis. USG cranium revealed ventricular debris. Treatment started with intravenous polymixin B (40,000 units/kg/d divided q6hr) on day 10 of life; in view of persistent seizures and non-improvement intraventricular polymixin B (20,000 units/day) was started on day 17 of life. After seven days of intraventricular therapy, the CSF was

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normal and intraventricular polymixin B was discontinued. Intravenous polymixin B was continued till three sterile CSF and blood cultures, completing about 6 weeks of therapy. The baby was discharged successfully on day 52 of life. Our case illustrates that aggressive intraventricular therapy may facilitate successful treatment of MDR Acinetobacter baumanniii ventriculitis in neonates. Polymixin B is a useful drug for MDRAB in neonates.

NEO/62(P) PFEIFFER SYNDROME TYPE 1: A RARE CASESoume Bhattacharya, Ruchita Negi, Pooja DewanDepartment of Pediatrics, University College of Medical Sciences, [email protected]

Pfeiffer syndrome is a rare craniofacial anomaly with an incidence of 1 in 100,000 births worldwide. It is rare in the Asian population, with only a few cases reported. Inherited in an autosomal dominant manner, this syndrome is characterized by craniosynostosis, mid face abnormalities, broad and deviated thumbs and big toes, and partial syndactyly on hands and feet. Some children with Pfeiffer Syndrome may have only one or both mid-face problems and craniosynostosis. Here we report a case of Pfeiffer syndrome type 1 with only midface problems. The male baby was delivered at 39 weeks of gestation, to a second gravida mother. He weighed 2.5 kg, with a length of 52 cm, head circumference of 35 cm, and an upper segment : lower segment ratio of 1.7:1. The baby had high forehead, underdeveloped mid face, flat nasal bridge, widely spaced eyes, broad thumbs & toes, syndactyly of 2nd and 3rd toes bilaterally. Anterior fontanelle was palpable (1 × 1 cm) while the posterior fontanelle was closed. Digital X-ray of bilateral hands & feet showed bulbous terminal phalanges of hands, without bony fusion. CT scan revealed maxillary hypoplasia without any evidence of craniosynostosis. At follow up, the child was developmentally and neurologically normal. Our case had only mid facial and digital anomalies. This case illustrates that mere absence of craniosynostosis at birth does not rule out Pfeiffer syndrome type 1.

NEO/63(P) NONPROGRESSIVE CONGENITAL UNILATERAL VENTRICULOMEGALY.Sujay Kumar E, Sushma Malik, Charusheela Warke, Manju Kumari, Anender DhariwalDivision of Neonatology, Dept. of Pediatrics, BYL Nair Ch. Hospital and TN Medical College, [email protected]

Introduction: Unilateral ventriculomegaly is a rare medical condition. It usually occurs due to the obstruction of the foramen of Monro from a neoplasm like thalamic tumor, choroid plexus cyst, abscess, vascular anomaly, gliomatosis, TORCH infections and in many it is idiopathic. Here we report a case of unilateral dilatation of the lateral ventricle in a neonate. Case history: A 2.45 kg baby delivered after a 36 week of gestation had been diagnosed by ultrasound examination as having a unilateral ventriculomegaly at 33 weeks of gestation. The head circumference at birth was 35 cm. The child was active, neurologically normal, without any signs of raised intracranial tension. The MRI brain demonstrated a moderately dilated left lateral ventricle with no apparent space

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occupying lesion or vascular malformations. Further, investigations done for this unilateral hydrocephalus of the child revealed that the mother’s and infant’s toxoplasma IgG titres were positive. Therefore this unilateral dilation was probably due to congenital toxoplasmosis or was an incidental finding. Confirmation with further IgG or IgM titres were not done as patient took discharge against medical advice. Discussion:- Unilateral hydrocephalus is an uncommon disorder of the newborn. Overall, congenital hydrocephalus occurs between 1.8 and 3 per 1000 live births; however, vast majority of these cases are bilateral, symmetric hydrocephalus. The etiology is usually due to obstruction of the foramen of Monro, which may be atretic, stenotic or occluded by a membrane. Acquired etiologies include thalamic and intraventricular neoplasms, colloid cysts, tuberculous masses, ventriculitis, vascular malformations, infections and inflammatory conditions. If ventriculomegaly is an isolated finding, then emergent surgical intervention may not be required. However if there is progressive ventricular dilatation, cortical thinning, or abnormal rapid intracranial growth, then surgical intervention is warranted. Ventriculoperitoneal shunting in the first month of life is critical in order to prevent thinning of the cortical matter and poor neurological outcome. Conclusion:- Unilateral hydrocephalus is a rare anomaly that can be recognized by prenatal sonography. Even though unilateral ventriculomegaly may be marked, early diagnosis and treatment may result in a favorable outcome.

NEO/64(P) HEALTH SUPERVISION OF NEONATES WITH NEUROFIBROMATOSIS-1Sandip P. Bandewar , Sushma Malik, Charusheela Warke, Umakant Marde, Rameshwar Gore Pediatric Resident, Department of Pediatrics, 1st Floor, College Building, TNMC & BYL Nair Hospital, Mumbai Central, [email protected]

Introduction:-Neurofibromatosis-1 (NF1) is a multisystem disorder that primarily involve skin and nervous system, in which some features may be present at birth and others are age related. Health supervision of affected neonates involves early detection of symptoms, complications and their management. Case history:- At our tertiary care hospital form Jan2009 to June 2011, amongst 7425 deliveries we had seven neonates with neurofibromatosis-1 (as per the diagnostic criteria), which were diagnosed at birth, giving a high prevalence of nearly 1 in 1000 births . Amongst these cases the predominant presenting feature was multiple café-au-lait spots. Four neonates had a parent who was also having NF-1 and in three cases there was no family history. All parents on discharge were asked to follow up regularly and to note any further skin changes. Discussion :-.NF1 is often asymptomatic at birth and most commonly presents with Café au lait spots. Other rare findings in neonates includes tibial dysplasia (bowing of leg), plexiform neurofibroma and MRI Brain may reveal unidentified bright objects in brain ( in 60%) which may suggest optic glioma or may predict propensity for learning and cognitive disabilities. Management of neonatal NF1 includes thorough screening of first degree relatives, advise to parents to report any unusual or new findings. Emphasis should be made for regular followup visits, careful cutaneous, skeletal, ophthalmologic and neurological examination and neurodevelopmental progress. Conclusion :- Neonatal NF1 can be detected by simple skin examination and family history. Parental Education and counseling regarding regular scheduled visits for detecting complications will improve quality of life and decrease morbidity.

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NEO/65(P) A STUDY OF CERTAIN FACTORS RELATED TO THROMBOGENIC STATES IN NEWBORNS WITH HYPOXIC ISCHEMIC ENCEPHALOPATHY IN RELATION TO NEURO-IMAGING FINDINGSP. K. RajeevHouse # 24-88/48/1C, East Anandbagh, Post Malkajgiri, Hyderabad – [email protected]

BACKGROUND: There are very few studies on factors related to thrombogenic states in relation to Hypoxic Ischemic Encephalopathy and Neuro-imaging studies. Aims and Objectives: To study the relationship between blood levels of certain factors related to thrombogenic states in neonates with Hypoxic Ischemic Encephalopathy. To study the role of the above factors in the causation of neuro-imaging findings if any in Hypoxic Ischemic Encephalopathy in newborns. Materials & Methods of Study: 34 neonates inborn and outborns, admitted in NICU, Gandhi Hospital with features of Hypoxic Ischemic Encephalopathy according to Sarnat & Sarnat staging clinically were subjected to cross sectional study. All cases were subjected to Neurosonogram,MRI. .EEG could be done in 30 cases.ProteinC,ProteinS, Antithrombin-lll, Antiphospholipid antibody and Homocysteine were sent. Inclusion Criteria: Neonates admitted in Gandhi Hospital NICU with clinical features of Hypoxic Ischemic Encephalopathy, whether inborn or referred from other govt. or private hospital. Exclusion Criteria: The neonates were excluded if they had sepsis or meningitis at the time of admission, inborn errors of metabolism or had dysmorphic features or syndromic malformations. Results: (Regression Analysis of various factors related to thrombosis: with MRI brain & EEG) By regression analysis), protein C levels were statistically related with EEG abnormalities (P = 0.045); greater EEG abnormalities are associated with greater mean protein C levels. Protein S levels were statistically related with both EEG and MRI brain abnormalities (P = 0.039, 0.036 respectively). There is an observed higher mean level of Protein S in relation to EEG abnormality and decreased levels of Protein S in relation to MRI brain abnormality. Antithrombin III is statistically related with MRI brain abnormalities (P = 0.032). Lesser mean levels of Antithrombin III were associated with greater MRI abnormalities. Homocysteine levels are statistically related to MRI brain abnormalities (P = 0.004), greater levels of Homocysteine are associated with greater MRI brain abnormalities. CONCLUSIONS: Sarnat & Sarnat staging05 remains to be a useful modality in classifying the stages of HIE as often APGAR scores and arterial blood gases are not available. Sequential neuro imaging may be more helpful. Neonatal stroke is probably under-recognized, and may be better picked up by neuro-imaging especially MRI of the brain. Levels of factors related to thrombosis have no association to the stages of HIE in this study, but are associated with abnormalities on MRI. Assessing factors related to thrombosis in those with MRI brain abnormalities

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NEO/66(P) PROPHYLACTIC INSTILLATION OF SURFACTANT IN HIGH RISK INFANTS – A CLINICAL OBSERVATIONS. Radha madhavi, S.Uday Shankar, P. Yashodhara, Pasha Department Of Paediatrics, Guntur Medical College, [email protected] Background : RDS [HMD], a major problem of premature births is due to the deficiency of surfactant in the lung. Added to the prematurity of birth, the issue of a diabetic mother, elderly primi, multiple gestation etc also add a risk factor. In our centre,a study was carried out to see the prophylactic surfactant in preventing neonatal morbidity and progression to mechanical ventilation. All cases were given prophylactic surfactant instillation. No rescue surfactant were given. Methods : A scoring system was deviced as followsScoring factor score 1) Maternal age > 35 1 2) Maternal diabetes, PROM 1 each 3) Maternal sepsis, multiple gestation 2 each 4) Male 1 5) Female 0 6) Term 0 7) Preterm >32 wks 1 <32wks 2 8) Weight Normal 0 LBW 1 VLBW 2 ELBW 3 9) RR <60 / min 0 60-80/min 1 >80/min 2

Results : 65 infants were identified as high risk infants and prophylactic surfactant was administered. Excepting for two mortalities all others did well. 63 were shifted to the mother side within a duration of 1 hr to 5 days. The NICU stay in this study was comparatively less compared to the previous trials of rescue surfactant instillation. Conclusion: Prophylactic surfactant instillation in our study identified by our score positively helped reduction in the development or progression of RDS. We believe prophylactic surfactant prevented the progression of many of the babies who normally would have needed ventilator support. Most babies were healthy and feeding well by the 2nd day.

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NEO/67(P) CASE REPORT – CONGENITAL SYPHILISRashmi D, Gangadhar Belavadi, SaralaBangalore Medical College & Research Institute, [email protected]

We report a case of early congenital syphilis in a day 1 old male, second born to a non consanguineously married couple who presented with history of abnormal shape of both lower limbs, swelling of right thigh, abnormal mobility of right thigh and crying on handling right thigh. The antenatal history of mother was uneventful (VDRL – negative) . The obstetric scan done at 32 weeks revealed ?short femur (4.81cm) ,? Skeletal dysplasia . The neonate was of low birth weight of 2. 25 kg and No h/o difficult / prolonged labour . There were no skin lesions, no microcephaly or snuffles. X ray showed fracture of right femur and hyperosteosis. The mother and the neonate’s TPHA was positive and the neonate’s CSF VDRL was reactive. The mother and child were both treated for syphilis. The father was tested negative .The neonate was discharged after 21 days. The unusual features of this case was that mother’s VDRL was negative, the neonate presented with a fracture and had no skin lesions. This emphasizes that the diagnosis of congenital syphilis remains complicated and requires high index of suspicion. Because of the high morbidity associated with congenital syphilis , screening of all pregnant women should be done at the first prenatal visit, in the third trimester and at delivery is important. An additional screening of infants born to high- risk mothers may be appropriate at 4 to 8 weeks of age.

NEO/68(P) CASE REPORT – HARLEQUIN ICTHYOSISRashmi D, Gangadhar Belavadi, Sarala2nd Year PG Pediatrics, Bangalore Medical College & Research Institute, [email protected]

We report a case of Harlequin ichthyosis in a male newborn , first born to a non consanguineously married couple with an uneventful antenatal and birth history and with no significant family history. The prenatal ultrasound was normal.The neonate had parchment like skin, ectropion, eclabium, and low set dysplastic ears and linear scars on the scalp and upturned nostrils. The neonate had no respiratory distress but had feeding difficulties and was given intravenous fluids and nasogastric feeds. The neonate was discharged against medical advice and the prognosis was explained to the relatives. Harlequin ichthyosis is a rare and extremely severe form of congenital ich-thyosis, with an incidence of about 1 in 300 000 births . Prenatal diagnosis is usually difficult because of non-specific signs in the ultrasonographic examination and rareness of the disorder. Delivery of a child with congenital ichthyosis identifies a family at risk, and for subsequent pregnancies prenatal diagnosis can be offered. ABCA12 gene (on chromosome 2q35) product is a protein that functions in the intracellular lipid keratinocytes and is involved in transport of substrates across both plasma membrane and intracellular membranes . Defective gene causes excessive transcutaneous loss of water and electrolytes which contributes to the development of polyhydramnios and also causes significant morbidity and mortality after delivery. Neonates usually die within the first days of life from infections and dehydration-related complications. Prenatal diagnosis remains difficult but may

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be possible in high risk pregnancies by performing a fetal skin biopsy or by three-dimensional

ultrasonograhy.

NEO/69(P) A RARE CASE OF ACUTE GASTRIC DILATATION SECONDARY TO SEPTICAEMIA IN NEWBORNRajiv Singh, Vineeta Pande, S.R. AgarkhedkarDepartment of Pediatrics. Dr. D Y Patil Hospital, SantTukaram Nagar, Pimpri Pune Maharashtra [email protected]

Acute gastric dilatation in a newborn is a rare clinical entity. Such dilatation without any obstruction is furthermore rare. We hereby present a rare case of acute gastric dilatation that developed in a three days old baby who was born premature and was suffering from septicaemia and respiratory distress. A 33-weeks baby was born by emergency lower segment Caesarian section in view of fetal distress. There was a history of meconium stained liquor . The newborn cried immediately after birth. Antenatal ultrasound done wasnormal and did not reveal any congenital malformation including gastrointestinal obstruction. The child was admitted in NICU. Clinical examination revealed hypothermia,respiratorydistressThere was no cyanosis. Auscultation revealed decreased air entry on both sides with presence of few crepts. Abdomen was soft with bowel sounds on auscultation. Rest of the clinical examination was unremarkable.Onthird day baby started abdominal distension and started deteriorating. .She passed stool and bowel sounds were sluggish. Investigations revealed high titres of CRP , thrombocytopenia , and deranged renal functions. X ray abdomen revealed distension of stomach .Ultrasonography did not show any evidence of obstructive lesion. Blood culture revealed Pseudomonas aeruginosa. Antibiotics were upgraded to MeropenumThe baby was administered IVIg, FFP and blood alongwith antibiotics and vasopressors were added. On 10th day the baby started showing improvement in the form of reduction of abd girth, reduced bloody aspirate and better general condition cry. Antibiotics were continued for 3 wks and the baby was discharged on breastfeeds Acute gastric distension in a newborn is a rare entity but can occur secondary to sepsis and

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dyselectrolytemia. Early recognition of condition and its underlying treatable cause is mandatory to reduce the morbidity and mortality associated with this condition.  

NEO/70(P) NEONATAL INCONTINENTIA PIGMENTI – RARE INHERITED ECTODERMAL DISORDER Rameshwar Gore, Charusheela Warke, Sushma Malik, Samruddhi Khopkar, Chitra Nayak.Pediatric Resident, Department of Pediatrics, 1st Floor, College Building, TNMC & BYL Nair Hospital, Mumbai Central, [email protected]

Introduction:- Incontentia pigmenti (IP) is a rare (incidence is 1:40000) sporadic or ‘X’linked dominant disorder of ectoderm, characterized by four distinctive, transient stages of cutaneous lesions with variable systemic involvement. Case history:- .FTND female born to primi mother presented on day of life 3 with complains of multiple vesiculobullous lesion over both upper limb and lower limb, trunk and face. On day one the lesions resembled neonatal pustulosis but the rash gradually became extensive and was characterized by linear vesicular, pustular and bullous lesions with surrounding erythema. Baby was accepting feeds well with no signs of sepsis. Neurological, ophthalmological and other systemic examination were normal. There was a history of similar lesions were also present in the mother in her childhood. Skin biopsy done in the neonate was classical of incontinentia pigmenti. On follow up after 21 days, the vesicles had subsided leaving a dry scaly skin. Discussion: IP is an uncommon X-linked dominant multisystem disorder, caused by random inactivation of ‘X’gene, lethal in the majority of affected males and has variably expression in females. Cutaneous manifestations of IP are benign, classically occurring in four stages: vesicular, verrucous, hyperpigmented, and hypopigmented (atrophic) which can overlap with each other. They are usually present at birth and typically spread along the lines of Blaschko. Skin biopsy during the bullous phase shows characteristic intraepidermal vesicles filled with eosinophils. It may be variably accompanied by dental 90%, ocular 35%, neurologic 40%, bones 40% and joints, and development anomalies. Morbidity and mortality primarily result from neurologic and ophthalmic complications including visual loss, seizures, mental retardation. Regular follow up with neurologist, ophthalmologist and dentist are required. Conclusion: Genetic counseling may be

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helpful for those with a family history of IP who are considering having children. Early diagnosis, regular monitoring and therapy can prevent or slow down the systemic complications of IP.

NEO/71(P) PANNICULITIS OR SUBCUTANEOUS FAT NECROSIS IN A NEONATESushma Malik, Charusheela Warke, Nisha Iyer, Ashwin Saboo, Rachita DhuratBlock No 3, Flat No 7, Brady’s Flats, Sorab Bharucha Road, Colaba, [email protected]

Introduction: Subcutaneous fat necrosis (SCFN) or Panniculitis is a rare, self-limited pathology affecting adipose tissue of full term or post term neonates associated with cold exposure, obstetrical trauma, asphyxia etc. Here we report a neonate admitted to our NICU with SCFN. Case History: A Full term 2.9 kg female born to G2P1L1 mother with meconium stained amniotic fluid requiring under cord suction and apgar score - 3,5,8. After the initial resuscitation, baby active, good cry, suck, tone and there was no respiratory distress. On day 5 of life neonate developed two 5 x 6 cms irregular, erythematous, tender indurations were noted bilaterally over lateral aspect of thighs. Gradually similar lesions appeared over the deltoid region, back and gluteal region. Septic screen and CRP were positive. The serum calcium levels were normal. A punch biopsy from the thigh lesion was done and it revealed fat necrosis with needle shaped crystals and inflammation with multinucleate giant cells which was consistent with SCFN. The lesions resolved over a few months and no fresh indurations appeared and also calcium levels regularly done were normal. Discussion: SCFN / panniculitis is an uncommon, benign, temporary process characterised by necrosis of the subcutaneous fat with needle shaped crystal formation within the fat cells which initiates a localised inflammatory process with foreign body giant cell formation. It occurs in the first few weeks of life and presents clinically as multiple subcutaneous, indurated, erythematous plaques and nodules with or without pain in a neonate with history of birth asphyxia, hypothermia, traumatic birth etc. Exact pathogenesis remains unknown and a hypothesis is crystallisation of the saturated subcutaneous fat leading to necrosis. It may be associated with hypercalcemia due to increased non-renal absorption of calcium secondary to increased level of 25 dihydroxy Vitamin D3 alpha hydroxylase within the granulomatous infiltrate. Hypercalcemia must be looked for as it can lead to lethargy, seizures, blindness, poor weight gain, cardiac rhythm disturbances and can be treated with fluids, calcium losing diuretics like furosemide, low calcium and Vitamin D in diet. Diagnosis is confirmed by punch biopsy from the lesion and differential diagnosis includes sclerema neonatarum, plexiform neurofibromas and skin tumours. SCFN is generally self resolving but one needs to watch for hypercalcemia for at least 6 months after the skin lesions resolve. Conclusion: SCFN is a benign condition that resolves spontaneously and requires parental counselling and follow up especially for appearance of new lesions and hypercalcemia.

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NEO/72(P) STUDY ON END OF LIFE CARE SUPPORT AND PARENTAL DECISION MAKING IN NICU OF SVPPGIP.Nayak Snehamayee, Priyadarshini Lipsa, Meher B K, Satpathy S K,Mohanty NDept Of Paediatrics ,SCBMCH & SVPPGIP, [email protected]. INTRODUCTION:-survival rates of VLBW,ELBW & critically ill infants are increasing raising complex ethical issues for health care providers and parents who face the challenge of making end of life decision for newborns.The purpose of this study was to evaluate parental involvement and the underlying causes in end of life care of babies in NICU. MATERIALS AND METHODS:-This is a cross-sectional observational study conducted in NICU of SVPPGIP from mar2011-aug2011 on newborns admitted to NICU in whom life sustaining medical management methods were discontinued.Information regarding all of them were gathered and analysed. RESULTS:-Life sustaining measures were withdrawn with consent from 54 patients during study period.85%(46) of babies were from BPL card holder families.Females dominated by 55%(30 in number).92%(50) babies were on ventilator.Total duration of ICU stay categorised as upto 3days,3-7 days,>7days were 50%,22%,28% respectively.Duration of ventilator requirement 3days(52%),3-7days(24%),>7days(24%).HIE was the most common diagnosis(44%) followed by prematurity with complications.In 72% cases(39) treating physician had positive opinion regarding good outcome of treatment. CONCLUSION:-Parents should be given clear,accurate and timely information regarding diagnosis management plan along with the anticipated costs for further management.There should be a hospital policy and separate counsellor for counselling of parents regarding termination of life sustaining medical treatment.

NEO/73(P) WARFARIN EMBRYOPATHY: A CASE REPORTMehndiratta S, Suneja A, Gupta B, Bhatt SJunior Specialist, Department of Pediatrics, Lok Nayak Hospital, New [email protected]

Introduction: Warfarin embryopathy (WE) is a consequence of maternal intake of warfarin during the antenatal period. The manifestations are varied, ranging from still births and abortions to varying degrees of dysmorphology and malformations that may involve different organ systems. We present a case of a neonate with WE whose mother was on unsupervised warfarin prophylaxis throughout pregnancy. Case report: A male baby was delivered by a 25-year-old woman. The baby was born at term with a birth weight of 2 kg (SGA). The medical history revealed that the mother had rheumatic heart disease and left-sided hemiparesis. She had been started on warfarin prophylaxis by a cardiologist. It was found that the neonate had a depressed nasal bridge. The systemic examination was essentially normal and there were no hemorrhagic manifestations. Radiology of the skull revealed thinning of the bones of the skull and that the nasal bone was absent. An infantogram revealed the presence of stippled epiphyses of the femoral head along with stippling of the calcaneum bones (chondrodysplasia punctata) on both sides. Discussion: Warfarin is a potent anticoagulant. It readily crosses the placenta because of its low-molecular weight and can achieve significant levels in the fetus. The consequences of maternal ingestion of warfarin are a specific pattern of anomalies known as WE. Nasal hypoplasia and epiphyseal and vertebral

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stippling (chondrodysplasia punctata) are the two most consistent and classical features of WE. The reported incidence of WE ranges from 0% to almost 30%. The severity and range of manifestations are variable. The management is entirely supportive depending on the presentation. Conclusion: The choice of appropriate anticoagulation in pregnancy is still debatable in women that require anticoagulation. The risk to benefit ratio needs to be explained to parents.

NEO/74(P) CORRELATION BETWEEN TRANSCUTANEOUS BILIRUBIN AND SERUM BILIRUBIN IN NEONATES WITH HYPERBILIRUBINEMIA ON PHOTOTHERAPY. M.R.Savitha, Ajay M, Kumar G.M, Venugopal B.L Department of Pediatrics, Mysore medical college and research institute, [email protected]

Introduction: There are conflicting reports on efficacy of Transcutaneous bilirubin(TCB) measurement during phototherapy. Aims and objectives:To study correlation between TCB and serum bilirubin(SBR) in jaundiced neonates during phototherapy Materials and Methods:Present crossectional study included jaundiced neonates requiring phototherapy. SBR and TCB on patched and unpatched skin over forehead were simultaneously measured at the start of phototherapy and at the end of 24, 48 and 72 hrs. Results:Of 72 neonates studied there were 52 term, 20 preterm neonates. Mean age was 4.63 days. At the end of 24hrs of phototherapy there was a significant correlation between TCB at the unpatched skin and SBR with correlation coefficient of 0.718(p=0.000). At the end of 48 hrs of phototherapy the correlation coefficient was still significant, with correlation coefficient of 0.674(p=0.008). At the end of 72 hrs of phototherapy there was no significant correlation between TCB at unpatched skin and SBR(p=0.207) When separately studied for preterms, there was a significant correlation between TCB at unpatched skin and SBR at the end of 24hrs with correlation coefficient of 0.783(p=0.000) but the correlation was lost after 48hrs of phototherapy(p=0.375). There was statistically significant correlation between TCB at patched and unpatched skin during first 72hrs of phototherapy(p<0.05) Conclusions:1) Transcutaneous bilirubin measurement shows a significant correlation with SBR during first 72hrs of phototherapy. However, correlation was lost at the end of 48hrs of phototherapy in preterm neonates. 2) There is no added advantage of transcutaneous bilirubin measurement on patched skin during phototherapy in the first 72hrs of phototherapy.

NEO/75(P) THE ROLE OF EARLY VS LATE ENTERAL NUTRITION IN PRETERM NEONATES WITH RESPIRATORY DISTRESS SYNDROME Rahul Sinha167 Military Hospital, Pathankot, [email protected]

INTRODUCTION: The respiratory distress syndrome in preterm neonate is mostly due to surfactant deficiency. The early nutritional support not only decreases the need for prolonged ventilation but also maintains positive nitrogen balance in the body. AIMS/OBJECTIVE: To compare early(first 24 hr) vs late(after 24 hrs) enteral nutrition in preterm neonates suffering from respiratory distress syndrome METHODS: Retrospective study, data collected from medical case sheet of NICU born in between 1st June 2010 to 1st May 2011 in 167 Military hospital Pathankot Punjab. 30 preterm neonate were given expressed breast milk(10-15 ml/kg/day) using feeding tube

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within 24 hrs of birth (early group) which was gradually increased and 30 other preterm neonate was given enteral nutrition after 24 hrs of birth ( late group). The two group were similar in terms of birth weight, APGAR score, gestational age, mode of delivery and diagnosis of respiratory distress syndrome. RESULTS: In comparison to neonates in late nutrition group, the early nutrition group required less days of mechanical ventilation, fewer days of aminophylline, less days of intravenous fluids, early weight gain and less chances of neonatal sepsis. CONCLUSION: So early nutrition in preterm neonates with respiratory distress syndrome is beneficial on many parameters.

NEO/76(P) A STUDY OF COMPARISON OF APOLIPOPROTEIN B (APO-B) AND APOLIPROTIEN A-1 (APO-A-1) AND THEIR RATIO IN HEALTHY FULLTERM SMALL FOR GESTATIONAL AGE (SGA) AND APPROPRIATE FOR GESTATIONAL AGE(AGA) NEWBORNS.Mohsin Hasan, Siddiqui M.H., Shrivastav J, Dwivedi R.Department of Paediatrics, GMC, [email protected]

Apolipoprotein B is elevated in small for gestational age (SGA) newborns compared with normally grown appropriate for gestational age(AGA) newborns , demonstrating a link between low birth weight and risk of subsequent atherosclerosis. Increased apolipoprotein B levels and an elevated apolipoprotein B to A-I ratio are predictors of atherogenesis. Elevated apolipoprotein B levels in young adults have been linked to atherosclerosis in later life, whereas impaired fetal growth has been linked to higher than normal apolipoproteinB levels in adulthood.We conducted this research to test the hypothesis that circulating apolipoprotein A-I and B concentrations and their ratio differ in SGA compare to AGA newborns. Venous samples of newborns were collected within 24 hours of delivery under all aseptic precautions and assays of Apoliprotiens were performed by nephelometry with a nephelometre 100 analyzer

NEO/77(P) A STUDY ON ETIOLOGY AND OUTCOME OF NEONATAL HYPERBILIRUBINEMIA REQUIRING EXCHANGE TRANSFUSIONNayak Snehamayee, Priyadarshini L, Mohanty A K, Beriha S S Dept. of Pediatrics, SCBMCH & SVPPGIP, [email protected]

INTRODUCTION: Jaundice is a common physical finding in newborn. Over 2/3rd of newborn babies develop clinical jaundice out of which very few require invasive procedures like exchange transfusion . AIMS AND OBJECTIVES: To study the incidence of neonatal hyperbilirubinemia requiring exchange transfusion and their underlying etiologies and complication during procedure. MATERIALS AND METHODS: We have conducted a hospital based cross sectional observational study at SCBMCH&SVPPGIP during a period of June 2011 to Aug 2011 on newborns presenting with jaundice at the time of admission or during hospital stay. Exchange transfusion was done on newborns with bilirubin level above the cutoff range as per Bhutani chart and according to weight in preterm babies in NICU and they were observed till discharge. RESULTS: Out of total 195 patients admitted with neonatal hyperbilirubinemia 14(7%) required exchange transfusion .3(21%) required transfusion within 48 hrs of life, 5 (36%) within 48-120 hrs of life and 6(43%) beyond 120 hrs. 3(22%) babies were preterm and 11(78%) were term .Most common underlying etiology was ABO incompatibility 6(43%). Incidence of Rh incompatibility was 2(14%). 65% of babies had associated risk factors like sepsis , birth asphyxia ,iso immune hemolytic disease and 35% had no risk factors .Complications during the procedure were rare like 2(16%)developed hypoglycemia

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and 4(32%) had seizure due to hypocalcemia .4(28%) of patient had features of bilirubin encephalopathy prior to exchange. Only 2 patients required repeat transfusion. CONCLUSION: If performed appropriately it can prevent mortality and neurological damage. It is quiet safe in experienced hands.

NEO/78(P) OUTCOME OF SEPSIS IN VERY LOWBIRTH WEIGHT BABIES Sharath Chandra N, Usha B K, Sudha RudrappaDepartment of Pediatrics, Mysore Medical College and Research Institute, [email protected]

INTRODUCTION: Very low birth weight (VLBW) babies constitute approximately 4%–7% of all live births but need a major share of effort, time and resources for their care. AIMS AND OBJECTIVES: To study the outcome of early onset sepsis(EOS) in very low birth weight. MATERIALS AND METHODS: This study was conducted from Jan to July 2011. Neonates who were born with weight less than 1500 gms were included in the study. The babies were evaluated for sepsis with sepsis screen and blood culture. Babies below 1000 gms, with congential malformation and who died within 12 hrs of birth are excluded in study. RESULTS: There were 64 neonates studied with male: female (1.13:1) .There were 27 (42.12%) inborn, 37(57.72%) out born babies, 60(93.6%) born vaginally, 7(10.92%) cases with prolonged rupture of membrane, 10(15.6%) were twins. 57(88.92 %) appropriate for gestational age.

N %Preterm 28±2 wks 9 14.0430± 2wks 23 35.8832± 2wks 21 32.7634± 2wks 11 17.16Blood Culture positive 22 34.32Acinetobacter 8 12.88MR CONS 6 9.36Pseudomonas 2 3.12Klebsiella 2 3.12Citrobacter 1 1.56MRSA 2 3.12Shock 11 17.16RDS 10 15.6Neonatal Hyperbilirubinemia 30 46.8Discharge 42 65.52Death 8 12.48

CONCLUSIONS: Early onset sepsis is one of the factors which influence survival of VLBW babies. Other comborbid conditions like RDS,NNH & shock play a role in morbidity and mortality. If managed with nutritive, supportive care, thermo neutral environment and appropriate antibiotics survival of VLBW babies can be improved.

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NEO/79(P) MECONIUM ASPIRATION SYNDROME IN MECONIUM STAINED AMNIOTIC FLUIDBhawna Malik, P. D. Sharma, Anand BhardwajDepartment of Pediatrics, MMIMSR, Mullana, [email protected]

Introduction: Passage of meconium in-utero is a serious neonatal disorder carrying high morbidity and mortality. Meconium passage may be a physiological response of increasing level of motilin or parasympathetic(vagal) stimuli. Aims & Objectives: This study was done to determine the incidence of meconium aspiration syndrome in babies born with meconium stained amniotic fluid. Materials and Methods: The study was conducted in the Neonatology section of the Department of Pediatrics of MMIMSR, Mullana, Ambala in 75 neonates born to mothers having meconium stained amniotic fluid. The study period was from Oct. 2009 to July 2011. Meconium aspiration syndrome(MAS) was labeled on the basis of development of respiratory distress along with radiological evidence in babies born to mothers with meconium stained amniotic fluid(MSAF). The babies were observed for a period of 72 hours after birth. Cases with septicemia were excluded from the study. Assessment of gestation age was done by Ballard scoring and babies classified as preterm, term and post term. Birth weight was recorded immediately after birth. The results were subject to statistical analysis. Results: 8 out of 75 babies(10.7%) with MSAF developed MAS. Majority of the babies with MSAF(56.7%) and MAS(62.5%) were from rural areas. Babies born to Para1 mothers were highest(46.3% for MSAF & 37.5% for MAS). Anaemia(45%) and PIH(28%) were the commonest risk factors for both MSAF and MAS(68.75% and 31.25% respectively). Majority of the babies with MSAF(82.1%) and MAS(62.5%) were term. Majority of the babies with MSAF had no asphyxia(70.1%).In babies with MAS, 37.5% had severe asphyxia and no asphyxia each. In babies with MAS, tachypnoea, expiratory grunt and chest indrawing were present in majority and commonest radiological changes observed on the right side alone (50%) followed by bilateral changes. Conclusions: The incidence of MAS in present study was 10.7 % in babies born with MSAF.

NEO/80(P) FOLLOW UP STUDY OF PRETERM NEONATES – NEURODEVELOPMENTAL OUTCOMERajendra Shinde, Madhavi Shelke, L.S. Deshmukh [email protected]

Introduction: Prematurity (born≤ 37 weeks of gestation) is commonly associated with high rates of medical and developmental sequelae like Respiratory issues, Immunisation, Growth: Anemia, Rickets, Feeding problems. Aim: To study the neurodevelopmental outcome of preterm neonates admitted in NICU. Methods: Retrospective analysis type of study. Preterm infants admitted in NICU of GMCH, Aurangabad were followed up in high risk OPD of GMCH. The neurodevelopmental assessment was done with Amiel Tison angles and Denver Developmental screening test II. The correlation with various risk factors was done with respect to presence of sepsis, RDS, Multiple gestation, neonatal seizures, etc. Results: Total 43 preterm newborns were followed up in high risk OPD at 3 months, 6 months, one year period. preterm  with gestation age ≤ 32 weeks were 8/43 (23%) preterm  with gestation age ≥ 32 weeks were 35/43 (87%) Total % of developmental delay notice on follow up was 10/43(23%). The commonest risk factor associate with neurodevelopmental delay was meningitis & sepsis.followed by presence of respiratory distress syndrome. Conclusion: The risk factor associated with adverse neurodevelopmental delay of preterm newborn were presence of sepsis and meningitis and respiratory distress syndrome. Gestation age did not correlate with adverse outcome.

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NEO/81(P) CLINICAL AND ETIOLOGICAL PROFILE OF NEONATAL SEIZURESBalwant Ramteke, Madhavi Shelke, L.S. Deshmukh, P. [email protected]

Introduction: Neonatal seizures have different clinical manifestations and etiology as compare to childhood seizures. Future neurological outcome depends on the cause of neonatal seizure. Aim: The study the clinical profile, etiology of neonatal seizures. Methods:Retrospective analysis type of study. Newborns admitted in NICU, having seizures in neonatal period were enrolled. They were analyzed with respect to etiological factors like perinatal asphyxia, meningitis, sepsis, intracranial bleed, metabolic derangement like hypoglycemia, hypocalcaemia, etc.Results: The total 31 newborns with neonatal seizures were analyzed. Age group ranged from 1 day to 14 days, M:F ratio 1.2:1. The commonest etiology was perinatal asphyxia. 12/31 (38%) followed by infections like meningitis & sepsis 7/31 (22%) and metabolic seizures like hypoglycemia, hypocalcaemia 6/31 (19%) and other etiology were intracranial hemorrhage 2/31 (6%), hypoxia with meconium aspiration, etc. Conclusion: The most common etiology of the neonatal seizures in our NICU was perinatal asphyxia followed by infections like meningitis and sepsis.