NEO/01(P) DIURNAL VARIATION IN NEONATAL MORTALITYAbhay Mahindre, Manjulata Arya, Dr V K bharadwaj Room no 37, Hostel no 3, NSCB medical college, Jabalpur.482003

Objective: To see the diurnal variation in neonatal mortality and to find various factors related to it. design: Prospective observational study. setting: NICU, Department of pediatrics, N.S.C.B.M.C.Jabalpur. subjects : All the babies who were declared clinically dead in the nursery between January2007 to June 2007. results: In our study total 118 death occurred in nursery during study period, out of which 35 (29.7%) occurred during 3.00AM-6.00AM and 17(14.4%)between 6.00AM-9.00AM.Factors which are statistically related to early morning death are: (1)Birth weight -As birth weight decreases probability of dying early in the morning increases (P<0.05). (2) Birth order :As birth order increases probability of dying early in the morning decreases(P<0.01). (3) Absence of seizure activity :Increase the probability of dying early in the morning(P<0.05). (4)Type of delivery: Normal vaginal delivery has higher probability of dying early in morning compared to LSCS (P <0.01). Though percentage of dying early in the morning is higher in following subjects, it does not reach the statistical significance i)Male baby compared to female. ii)Who required resuscitation(bag&mask,bag&tube ventilation) compared to those who did not required. iii)Who did not receive Aminophylline compared to those who received iv)Who did not receive Phenobarbitone compared to those who received. conclusion: Maximum number of death occurs early in the morning(3.00AM-6.00AM) and statistically significant factors are Low birth weight, Early birth order, Absence of seizure activity, normal vaginal delivery. Sex, resuscitation at birth, receiving drugs like Aminophyline and Phenobarbitone are not statistically associated with early morning death. key words: Neonatal mortality, Birth weight, Birth order, Seizure, vaginal delivery.

NEO/02(P) LEAD LEVELS IN UMBILICAL CORD BLOOD AND ITS DETERMINANTSPatel AB, Prabhu ASatuldr@hotmail.com

Introduction: Elevated cord blood lead has been shown to affect newborn’s gestational age (GA), weight, neurological maturation and mental development. There are no previous reports of umbilical cord blood lead levels (CBLL) of newborns in India. Aims & Objectives: To determine the neonatal CBLL and associated maternal factors. Methods: A cross section of 205 consecutively born neonates was sampled for their CBLL soon after birth and their demographics, personal history, birth history, GA, the weight and head circumference (HC) were obtained. 62 maternal venous lead samples were analyzed by Atomic Absorption Spectrophotometry. Results: The mean CBLL of all babies was 4.71 ± 12.06 µg/dl. In the sub sample of 62 neonates the mean CBLL was 1.602+ 2.49 µg/dl and their mean maternal lead levels was 1.994 ± 2.08 µg/dl. According to CDC categories of risk, 92.2% babies were in Class I of which 86.8 % babies were < 5 µg/dl. The mean birth weight in < 5 µg/dl category was 2639.66 ± 445.28 grams as compared to 2616.66 ± 408.32 grams in > 5 µg/dl category and the mean GAs were 39.129 ± 1.99 weeks in former and 38.111 ± 2.00 weeks in latter (p=0.0143). On multivariate analysis, GA was found to be highly significant (p<0.01) with CBLL and use of house paint and higher education was significantly correlated. Conclusions: Elevated CBLL was associated with lower GA and use of house paint. There is need for further studies along with implementation of environmental regulations to monitor CBLL in neonates and restricted use of lead.

NEO/03(P) CORRELATION OF UMBILICAL CORD LIPID LEVELS AND ANTHROPOMETRY AT BIRTH IN TERM NEWBORNS.A.K.Tiwari, H. JoshiB-1/461, Janak Puri, New Delhi-110058.ajaytiwari06@yahoo.com

Introduction : Many longitudinal studies have now established the interest in programmed changes during fetal life as origins of many diseases. The hypothesis of such imprinting was put forward by DJP Barker and numerous studies have evaluated various parameters in fetal and neonatal life and subsequent emergence of adult diseases . The initial epidemiological studies linked birth weight to subsequent disease risk. Later studies examined these risks in relationship to various body proportions at birth such as Ponderal Index [thinness], abdominal circumference etc. Aims & Objective: This study was conducted to study the cord blood lipid profile in term newborns and evaluation of its correlation with anthropometric measurement in newborns. Material & Methods : 100 newborns delivered by spontaneous vaginal route and elective LSCS at term gestation were included in study. Umbilical cord blood was evaluated for Cholesterol, Low Density Lipoprotein [LDL-C], High Density Lipoprotein [HDL-C] and Triglycerides were measured . Results : . Present study showed no correlation of LDL with either abdominal girth, birth weight and head circumference in term newborns (p= 0.875, p=0.221 and p=0.978 respectively). Similarly no correlates were found for Total Cholesterol , HDL ,Triglycerides and VLDL with either Weight, Length, Abdominal Girth, Ponderal Index or Head Circumference respectively of term newborns at birth in present study. Conclusions : The study concludes that in present set of 100 term newborns no correlation could be established between the anthropometrics variables viz. Weight, Length, Head Circumference, Ponderal Index and Abdominal Girth (Abdominal Circumference) with umbilical cord cholesterol or fractions mainly LDL , HDL , VLDL and Triglycerides.

NEO/04(P) KIDNEY SIZE IN NORMAL NEONATESGargi Gayen, Jaydeep Choudhury, Maya MukhopadhyayInstitute of Child Health, 11 Dr Biresh Guha Street, Kolkata 700017 iamgargi@yahoo.co.in

The size of kidneys in adults and older children are demarcated. But the normal kidney size in neonates is not clearly stated. It is often mentioned as large or small. We have analyzed the kidney size in healthy neonates admitted to The Institute of Child Health, Kolkata. Inclusion criteria: All healthy neonates admitted to the neonatal unit over 6 months. Exclusion criteria: Sick neonates, newborn with sepsis, renal problems, cardiac and respiratory disorders. Only neonates with hyperbilirubinemia without any other complication were not excluded from the study. Method: The kidney size was determined by USG done between 3rd and 5th day of life after initial stabilization. Result and analysis: Total 100 neonates were analyzed and were divided into 3 groups of 37 completed weeks and above, 34 completed to 37 weeks and 30 to 34 weeks. The right and left kidney sizes and means were corroborated with sex and birth weight of the neonates. The size of the kidneys correlates with the gestational age and birth weight of the neonates. This study has been done on a small population and needs further study. 37 completed weeks male BW (kg)

Rt kidney

Lt kidney (cm)

Mean (cm)

(cm)1.85 3.7 3.7 3.71.9 3.6 3.9 3.7

2 3.8 3.7 3.72.25 4 4.1 42.3 4.3 3.7 42.5 4.2 4.3 4.22.6 4.4 4.2 4.3

2.75 4.1 4.1 4.12.8 4.4 3.9 4.1

2.85 4.3 4.1 4.22.95 4.4 4.4 4.4

3 4.6 4.9 4.73.45 5.2 4.7 4.94.4 5.6 5.2 5.4

37 completed weeks female

BW (kg)

Rt kidney (cm)

Lt kidney (cm) Mean (cm)

1.7 3.5 3.9 3.71.75 3.8 3.7 3.72.1 3.7 3.9 3.8

2.25 3.9 3.8 3.82.35 4. 3.9 3.92.4 4.1 3.9 42..5 4.3 4 4.12.6 4.4 4 4.22.9 4.6 4.5 4.5

2.95 4.9 4.2 4.53 4.2 4.7 4.5

3.25 4.7 4.7 4.74 5.1 4.8 4.9

34 completed weeks-37 weeks male

BW (kg)

Rt kidney (cm)

Lt kidney (cm)

Mean (cm)

1.4 3.5 3.5 3.51.45 3.7 3.6 3.61.7 3.9 3.5 3.7

1.85 3.9 3.6 3.71.95 3.7 3.9 3.8

2 3.7 3.6 3.82.05 3.8 4 3.92.25 3.9 4.1 4

2.35 4 4.1 4

34 completed weeks-37 weeks female BW Rt kidney Lt kidney Mean

1.2 3.2 3.1 3.11.45 3.3 3.5 3.41.5 3.6 3.4 3.51.6 3.4 3..6 3.51.7 3.7 3.5 3.6

1.85 3..6 3.6 3..61.95 3.8 3.7 3.72.25 4 3.9 3.92.3 3.9 3.9 3.9

30 completed weeks-34 weeks male BW (kg)

Rt kidney (cm)

Lt kidney (cm)

Mean (cm)

1 3 3.1 31.15 3.4 3.5 3.41.45 3.5 3.6 3.51.5 3.5 3.7 3.6

1.65 3.8 3.6 3.71.7 3.9 3.7 3.8

2 3.9 4 3.92.25 4 4.1 42.3 4.1 4.2 4.1

30 completed weeks-34 weeks female

BW (kg)

Rt kidney (cm)

Lt kidney (cm)

Mean (cm)

1 3.3 3.2 3.21 3 2.9 2.9

1.25 3.4 3.3 3.31.85 3.5 3.4 3.41.9 3.9 3.7 3.82. 3.7 3.4 3.5

2.15 3.6 3.5 3.52.2 3.8 3.5 3.62.5 4.1 4.2 4.1

NEO/05(O) PROPHYLACTIC HIGH DOSE PHENOBARBITONE IN TERM ASPHYXIATED NEWBORN INFANTSKuruvilla KA, Ross BJNeonatology Unit, CMC, Vellore 632004, Tamil Naduanilkdj@hotmail.com

Prophylactic high dose phenobarbitone given soon after delivery to asphyxiated neonates has been tried to improve outcome for its cerebro-protective agent. Aim: To determine if prophylactic high dose phenobarbitone improves outcome in newborn infants with birth asphyxia. Setting & Methods: This study was conducted in Christian Medical College, Vellore. Asphyxiated babies with a cord pH <7.0 received phenobarbitone 40 mg/kg before the onset of seizures (Group 1). In Group 2, babies with Apgar <7 at 5 minutes of age with no cord pH or a cord pH more than 7.0 did not receive prophylactic phenobarbitone. Results: 76 term babies were enrolled over 1 year. Demographic profile of mothers and babies was similar in both groups. Babies in Group 2 had lower mean Apgar scores at 1 and 5 minutes of life (2.94 and 4.97) than those in Group 1 (4.71 and 8.37)(p=0.002); significantly more babies in Group 2 needed oxygen, intubation and ventilation than in Group 1. Progression and severity of HIE was similar in the two groups. 31.7% of babies in Group 1 and 31.4% of babies in Group 2 had seizures. Adverse effects such as hypotension and respiratory depression was not different. In Group 1, 82.9% of babies were discharged and 14.6% died; in Group 2, 82.9% of babies were discharged and 8.6% died. At follow up, developmental abnormalities and seizures was similar in the 2 groups. Conclusion: Prophylactic high dose phenobarbitone did not improve outcome of asphyxiated babies in the neonatal period and on follow up. NEO/06(O) CORRELATION OF BIRTH ASPHYXIA WITH NON-INVESIVE URINARY PARAMETER.S. Som, P. Basu, H. N. Das, N. Choudhuri.Assistant Prof., Dept. Of pediatrics, Burdwan Medical College, Burdwanbasu_pallab@yahoo.co.in

INTRODUCTION: Birth asphyxia is a clinical diagnosis with controversial opinion in definition and assessment. It is a combination of hypoxia, hypercarbia and metabolic acidosis. These factors lead to depletion of adenosine triphosphate (ATP) and increase in adenosine diphosphate (ADP), hypoxanthine, xanthine, uridine and hypoxanthine degradation product uric acid level in blood and urine. In few recent studies, biochemical parameters are used for diagnosis, severity detection and complications. AIMS & OBJECTIVES:- In this study, level of urinary uric acid, creatinine and their ratio in the early period of birth asphyxia, has been determined, and compared with normal newborn.MATERIALS AND METHODS:- Asphyxiated and normal newborn of baby nursery and intensive care unit of Pediatrics Dept. and laboratory of Biochemistry Dept. of Burdwan Medical College and Hospital. INCLUSION CRITERIA:- 1) Apgar Score: - 6 or less at 1 min, 2) Baby did not cry at birth and with resuscitation for more than 1 min. PARAMETERS USED: - (within 24 hours of birth) Uric acid estimation in spot urine. Creatinine estimation in spot urine. RESULT & ANALYSIS: Table 1 – showing Urinary Uric acid – Creatinine Ratio and Apgar score in cases and control subjects: -

Parameters Cases Controls P – valuesUrinary Uric acid –

3.0 ± 1.3 0.97± 0.57 < 0.000

Creatinine RatioApgar Score 4.0 ± 1.9 12.3 ± 0.95 < 0.02

Table 2 – showing correlation of Uric Acid to Creatinine Ratio to the stages of Hypoxic Ischemic Encephalopathy (HIE) in the asphyxiated cases in this study: -

Sarnat And Sarnat Staging Of Hypoxic Ischemic Encephalopathy (HIE) in cases under study

Uric Acid/ Creatinine Ratio in cases and control under study

Stage 1 1.54 – 1.81 (1.7± 0.09)Stage 2 1.91 – 2.87 (2.34 ± 0.27)Stage 33.1 Kg – 2.5 Kg2.4 Kg – 2 Kg1.9 Kg – 1.5 Kg

2.53 – 5.6 (4.25 ± 0.87)2.53 – 4.52.97 – 4.475.3 – 5.6

Control 3.4 Kg – 2.5 Kg2.4 Kg – 2.0 Kg1.9 Kg – 1.5 Kg

0.52 – 2.5 (0.97± 0.57) 0.52 – 1.140.53 – 1.62.0 – 2.5

CONCLUSION: Birth Asphyxia is an important cause of morbidity and mortality in neonates. Infants with birth asphyxia have a significantly higher urinary uric acid to creatinine ratio. This ratio can be used as a cost effective, simple, quick and non-invasive prognostic indicator in comparison to other markers like hypoxanthine, xanthine and ascorbic acid within 24 hours after birth. The Ratio can be used in the diagnosis of birth asphyxia, staging of HIE and determination of the prognosis in terms of severity. Early detection and intervention will reduce the morbidity and mortality.

NEO/07(P) THE USE OF NASAL CPAP IN NEWBORN WITH RESPIRATORY DISTRESS SYNDROME.A .K. SarmaOIL India Hospital, Duliajan, Assamajoy4781@rediffmail.com

The efficiency of applying continuous positive airway pressure (CPAP) by nasal route was retrospectively analyzed in 15 newborns with respiratory distress syndrome ( 9 uncomplicated hyaline membrane disease , 1 hyaline membrane disease with cardiac complication, 3 meconium aspiration syndrome, 2 transient tachypnoea of newborn) who underwent nasal CPAP treatment in oil India hospital Duliajan, Assam from 01.12.2006 to 31.08.2007 . 7 out of 9 cases of uncomplicated HMDwere successfully treated with CPAP. They showed a significant rise in Pao2 as well as a significant drop in respiratory frequency during nasal CPAP application, the Paco2 did not change significantly. The remaining 6 newborn in this group ( 6/15), 3had to be intubated and mechanically ventilated owing to persistent high Fio2 (2),technical difficulties (1). 2 of 3 meconium aspiration syndrome baby needed mechanical ventilation. Both TTN cases were doing well in nasal CPAP.Two of these 15 cases died, one of cerebral haemorrhage & another in sepsis. The nasal CPAP as described is a simple inexpensive and effective method of applying CPTPP in newborn with uncomplicated HMD, except radiological stage IV. In TTN it is an excellent modality but in RDS due to meconium aspiration syndrome the result of nasal CPAP treatment were not convincing.

NEO/08(P) MORBIDITY PATTERN IN VAGINAL DELIVERY V/S EMERGENCY LSCSK Locham, Manpreet Sodhi, Harprasad Deptt. Of Pediatrics, Govt. Medical College / Rajindra Hospital. Patiala.147001kklocham@hotmail.com

Objective: To compare morbidity pattern in vaginal V/s Emergency LSCS Setting and Methods: 100 neonates (50 each with vaginal delivery and Emergency LSCS) admitted to Neonatology section of Department of Pediatrics, Govt. Medical College, Patiala were the subjects of study. Sex, gestation, antenatal risk factors, Apgar score, mode of delivery and disease pattern were recorded. Results: 19 babies in vaginal group and 24 in LSCS group had antenatal risk factors. Maximum contribution was by PIH which was 63.2% and 45.8 % in vaginal and LSCS group respectively. Morbidity was reported in 18% of babies delivered vaginally whereas it was observed in 44% babies delivered by LSCS (P<0.005). In PIH group (PIH alone) delivered by vaginal route, 90% babies had normal neonatal outcome whereas in LSCS group 50% had normal outcome. In 3 babies delivered vaginally with Meconium Stained Amniotic Fluid (MSAF alone) 66% were normal whereas, 5 babies delivered by LSCS with MSAF alone, 20% were normal. When comparison was made in both groups without any risk factors, none of the babies had birth asphyxia. 3 babies in LSCS group and 1 baby in vaginal group had pneumonia. One baby each had Hyaline Membrane Disease (HMD) and septicemia in LSCS group. 2 babies in vaginal group had septicemia. Transient Tachypnea of Newborn (TTN) was observed in 1 baby delivered vaginally and 4 babies by LSCS group without any risk factor. Conclusion: Babies delivered by Emergency LSCS had more morbidity than vaginally delivered.

NEO/09(P) IMAGING IN BIRTH ASPHYXIAKK Locham, Manpreet Sodhi, Prasad A.P.Deptt. Of Pediatrics, Govt. Medical College / Rajindra Hospital. Patiala.147001kklocham@hotmail.com

Objective: To study changes in brain by imaging in birth asphyxia. Setting and Methods: The study included 50 neonates with birth asphyxia delivered consecutively and admitted to Neonatology section of Deptt. of Pediatrics, Govt. Medical College, Patiala. Sex, gestation, birthweight, Apgar score, mode of delivery, antenatal risk factors and HIE staging were recorded. MRI was done in 2nd

wk of life in all babies. Findings were recorded. Results: Twenty eight (56%) babies were term and 22 (44%) were preterm. Equal number of babies (50%) were delivered by LSCS and vaginal route. Severe, moderate and mild birth asphyxia was observed in 21, 11 and 18 babies respectively. Twelve babies developed HIE. Seven babies were in HIE stage I and 5 were in HIE stage II. Imaging revealed abnormalities in 7 babies. Two babies each had bilateral white matter hypodensities, periventricular leucomalacia (PVL) and intraventricular hemorrhage (IVH). One baby had middle cerebral artery (MCA) infarct on left side. In babies with imaging findings, 4 had severe, 2 had moderate and one had mild birth asphyxia. Out of 7 babies, 2 each had HIE stage I and II respectively. Rest did not develop HIE. Babies with PVL and IVH were delivered vaginally where as those with left MCA infarct and white matter hypodensities were delivered by Cesarean Section. White matter hypodensities were seen in term babies whereas left MCA infarct, PVL and IVH were seen in preterm babies. Conclusion: Brain imaging was abnormal in 14% of babies with birth asphyxia.

NEO/10(P) BLOOD GLUCOSE ALTERATION AFTER EXCHANGE TRANSFUSIONKK Locham, Manpreet Sodhi, Prasad A.P.Deptt. of Pediatrics, Govt. Medical College / Rajindra Hospital. Patiala.147001kklocham@hotmail.com

Exchange blood transfusion (EBT) is an important modality of treatment for neonatal hyperbilirubinemia. Exchange with CPD blood leads to hyperglycemia due to high dextrose content. Objective: To assess blood glucose alteration after EBT Setting and Methods: Twenty neonates with hyperbilirubinemia who underwent EBT in Deptt. of Pediatrics, Govt. Medical College, Patiala were the subjects of study. Sex, gestation, birthweight, Apgar score, mode of delivery and antenatal risk factors were recorded on a predesigned proforma. Random blood sugar (RBS) was estimated immediately before, immediately after and 2 h after EBT. Data so obtained was analysed statistically. Results: There were equal number of term and preterm babies in the study (10 each). Seventy percent babies were delivered by vaginal route and 30% by LSCS. Fifteen babies were AGA and 5 babies were SGA. Septicemia was the predominant cause of hyperbilirubinemia (9cases). ABO incompatibility was present in 7 cases. Three babies had birth asphyxia and one each had Rh incompatibility and cephalohematoma. Cause was idiopathic in one case. Mean RBS immediately before and after was 82.10 + 19.13 and 148.55 + 23.87 mg/dl respectively. The rise in mean RBS was statistically significant (p<0.001). Mean RBS 2 h after EBT was 112 + 21.37mg/dl. The fall in mean RBS 2 h after EBT with respect to values immediately after EBT was also significant (p<0.0001) Conclusion: EBT with CPD blood leads to hyperglycemia after EBT. Though significant fall in blood sugar occurs at 2 h but there was no hypoglycemia

NEO/11(P) RESPIRATORY MORBIDITY IN ELECTIVE VS EMERGENCY LSCSKK Locham, Manpreet Sodhi, Prasad A.P.Deptt. Of Pediatrics, Govt. Medical College / Rajindra Hospital. Patiala.147001kklocham@hotmail.com

Objective: To compare the respiratory morbidity between Elective and Emergency LSCS Setting and Methods: One hundred neonates randomly selected (50 each from Elective and Emergency LSCS) with respiratory distress admitted to Neonatology section of Deptt. of Pediatrics, Govt. Medical College, Patiala, were the subjects of study. Sex, gestation, birthweight, Apgar score, mode of delivery and antenatal risk factors were recorded Results: Thirty two percent babies in Emergency LSCS had meconium stained amniotic fluid and 20% had Bad Obstetric History (BOH). Eight percent each had pregnancy induced hypertension (PIH) and ante-partum hemorrhage. 4% each had foul smelling liquor and dai handling. In Elective LSCS group, 32% had PIH and 14% had BOH. Twelve percent babies in Elective group and 36% in Emergency group had birth asphyxia. 16%babies in Elective group had respiratory distress in contrast to 62% in Emergency group (p<0.001). In Elective group, 2% had Hyaline Membrane Disease (HMD), 6% had pneumonia and 8% had Transient Tachypnea of Newborn (TTN). In Emergency LSCS group, 4% had TTN, 10% had meconium aspiration syndrome (MAS), 20% had HMD, 28% had pneumonia. HMD and Pneumonia were more in Emergency group whereas TTN was more in Elective LSCS group. When babies without any ante-natal risk factors were compared, in Elective LSCS, out of 26 babies, only 2 had TTN. In Emergency LSCS group, out of 12 babies without any antenatal risk factors, 4 had HMD and 3 had pneumonia. Conclusion: There is increased respiratory morbidity in Emergency LSCS as compared to Elective group.

NEO/12(O) CORRELATION OF CORD BILIRUBIN TO CLINICAL JAUNDICE IN BLOOD GROUP INCOMPATIBILITIESK.K. Locham, Kiranjeet Kaur, Kulbir Kaur, Manpreet Sodhi, Rahul Gandhi, Narinder SinghDeptt. Of Pediatrics, Govt. Medical College / Rajindra Hospital. Patiala.147001kklocham@hotmail.com

Objective: To study the correlation of cord bilirubin to clinical jaundice in blood group incompatibilities. Setting and Methods: Fifty healthy newborn babies with either Rh or ABO incompatibility admitted to Neonatology section of Deptt. of Pediatrics, Govt. Medical College, Patiala were the subjects of study. Twenty healthy newborns without any evidence of blood group incompatibilities served as controls. Cord blood was collected for bilirubin estimation. Direct Coombs Test and blood group of the babies was done by tube method. Clinical assessment for jaundice was done upto 24 hours of age. Serum bilirubin was estimated by Malloy and Evelyn method whenever jaundice appeared. Statistical methods used were coefficient of correlation, t test and probability value. Results 8 babies in study group developed clinical jaundice. Seven babies with cord bilirubin level > 2.3mg/dl developed clinical jaundice whereas one baby with cord bilirubin <2.3 mg/dl developed clinical jaundice. The statistical comparison of cord bilirubin of Rh and ABO incompatibility respectively with control group was not significant (p >0.05). The difference in mean cord bilirubin of babies with and without clinical jaundice in both Rh (p<0.01) and ABO incompatibility (p<0.1) was significant. The mean cord bilirubin and serum bilirubin in jaundiced babies in study group had a positive coefficient of correlation (r= +0.18) but it was not statistically significant (p >0.05). Conclusion: The cord bilirubin of 2.3 mg/dl had sensitivity, specificity, positive and negative predictive value of 87.5%, 97.6%, 87.5% and 97.6% respectively for development of jaundice in blood group incompatibilities

NEO/13(O) THE EFFECT ON NEWBORN OF MATERNAL MAGNESIUM SULPHATE USED IN PRE-ECLAMPSIAKK Locham, Kiranjeet Kaur, Jaswir Singh, Parveen Marwah, Manpreet Sodhi, Ravneet Kaur, HarprasadDeptt. Of Pediatrics, Govt. Medical College / Rajindra Hospital. Patiala.147001kklocham@hotmail.com

Objective: To study the effect on newborn of maternal magnesium sulphate used in pre-eclampsia. Setting and Methods: It was a randomized trial conducted in Neonatology section of Deptt. of Pediatrics, Govt. Medical College, Patiala. 30 term, appropriate for gestational age (AGA) newborns born to mothers with severe pre-eclampsia on magnesium sulfate (MgSO4) constituted study group. 30 normal term, AGA newborns born to mothers without having any disease bearing any effect on newborn were chosen as control group. Sex, mode of delivery, gestation, birthweight, Apgar score, resuscitative measures, detailed CNS examination and time for first passage of meconium were recorded on a predesigned proforma. Cord blood was collected for magnesium estimation by colorimetric method using titan yellow. Results: 3 (10%) newborns in study group had birth asphyxia. Two had severe birth asphyxia (Apgar score of 0,1,2 at 1 min) and 1 had moderate birth asphyxia (Apgar score of 3, 4 at 1 min). 9 newborns in study group had elevated cord magnesium levels (>2.6mg/dl). All the 3 babies with birth asphyxia had normal cord magnesium levels (1.2-2.6 mg/dl). All babies in study group had normal CNS outcome and passed meconium within 12 hours of life. Conclusion: Apgar score, CNS outcome and time for first passage of meconium were not affected by cord magnesium levels in study group.

NEO/14(P) CORRELATION OF DERMAL ICTERUS WITH SERUM BILIRUBIN IN NEWBORNS WEIGHING < 2000GRAMSKK Locham, Kiranjeet Kaur, Prabhat Shobha, Manpreet Sodhi, Seeema Rai, Prasad A.P.Deptt. Of Pediatrics, Govt. Medical College / Rajindra Hospital. Patiala.147001kklocham@hotmail.com

Objective: To study correlation of dermal icterus with serum bilirubin in newborns weighing <2000 g Setting and Methods: The study was conducted on one hundred neonates randomly selected weighing <2000 g admitted to Neonatology section of Deptt. of Pediatrics, Govt. Medical College, Patiala. All babies were examined in well-lighted room under natural light once a day till baby is placed under phototherapy. 15 babies had double observations. The dermal icterus was noted in different dermal zones as described by Krammer. The point of most distal progression of dermal icterus was determined by blanching the skin with pressure of thumb and noting color of underlying skin when thumb was removed. Total and differential serum bilirubin was estimated by Malloy and Evelyn method. Results: Out of 115 observations, 4 were in dermal zone I, with mean total serum bilirubin of 5.85 + 0.59 mg/dl. 32 were in dermal zone II, mean serum bilirubin was 9.49 + 1.76mg/dl. 48 were in dermal zone III with mean total serum bilirubin of 11.9 + 1.81mg/dl. 25 were in dermal zone IV, mean total serum bilirubin was 13.08 +1.28 mg/dl. 6 were in dermal zone V, mean total serum bilirubin was 16.05 + 4.25 mg/dl. The statistical analysis was highly significant (p<0.001) in between dermal zones except between zone III and V where it was significant (p<0.05) Conclusion: With cephalo-caudal progression of jaundice, there was rise in serum bilirubin. The statistical comparison of total serum bilirubin between different dermal zones was significant.

NEO/15(O) ROLE OF EARLY BIOCHEMICAL MARKERS IN NEONATAL SEPSISSrivastava A., Kulkarni A., Kaul S., Gupta V., Balan S., Sardana R.Department of Neonatology, Indraprastha Apollo Hospitals, New Delhimahajanamita@hotmail.com

Objective: To analyse the role of Procalcitonin (PCT) & C-Reactive Protein (CRP) as reliable early diagnostic indicators in neonatal sepsis & compare them with other standard tests. Materials & Methods: Hundred consecutive neonates upto four weeks of age with clinically suspected sepsis were studied prospectively.CRP, PCT, Total WBC, Platelet counts & Blood cultures were performed for all babies on the day when clinical diagnosis of septicemia was made. The cases were grouped into those found culture positive (Study group) & culture negative (Control group). Results: The break-up of the cases was: 69 male ; 31 female; 25 term ; 75 preterm; 22 normal vaginal delivery ; 78 Caesarean section; 89 early onset ; 11 late onset cases. In 22 evidence of antepartum maternal infection was found. In 7 of these, maternal high vaginal swab was positive & of these 5 correlated with culture positivity in babies. 61 were found to be culture positive (Study group) & 39 were culture negative (Control group). In the study group, we found: Leukocytosis- 40, Leukopenia-5, Thrombocytopenia-25, CRP-41, PCT-56. In the control group, we found: Leukocytosis- 21, Leukopenia-5, Thrombocytopenia- 11, CRP-31, PCT-30. Chi Square Test was applied on the various markers. In culture positive sepsis, PCT was found to have p-value <0.01 (statistically significant) & the values for CRP, WBC & Platelet counts were >0.05 each. In culture negative sepsis, both CRP & PCT had p-values <0.05 (statistically significant) whereas WBC & Platelet counts had p-values >0.05 in that order.Conclusion: In our study, in culture positive cases, PCT was found to have a higher sensitivity in detecting sepsis early & in culture negative cases, both CRP & PCT were found to be sensitive. WBC & Platelet counts were less reliable in both the groups.

NEO/16(O) MEDICAL DISORDERS IN PREGNANCY AND FETAL OUTCOMEArchana Kher, Vishal Sachade, Jimmy Abraham 6/A, Anand Bhavan 36 rd, Bandra west , Mumbai 400050kheras@vsnl.com

Introduction: Maternal well-being and freedom from illness is essential for the optimum growth and development of the fetus. Aims and objectives: To study the outcome of neonates [weight, maturity, perinatal complications] born to mothers with medical disorders. To estimate the acute complications in these babies. Material and Methods: A prospective study over a period of 2.5 years was initiated at the tertiary hospital. All neonates born to mothers with medical disorders who were admitted to the NICU or postnatal ward were enrolled. Babies born to mothers with disorders in pregnancy like gestational diabetes, anemia, PIH were excluded. Mothers who tested positive for HIV and had opportunistic infections were also excluded. Details of the maternal obstetric history, medical history, and relevant investigations were noted. The babys weight, gestational age, birth details, course in the ward was closely observed. Specialty opinions for the mother and baby were taken when deemed necessary. Results: Medical disorders in 118mothers-included hepatitis [62], TB [14], malaria [5], heart disease [8], Thyroid disease [5], Diabetes mellitus [5] others [19]. On analysis the details of 118 babies, premature delivery noted in [30 cases, 25.4%], LSCS in 25 cases 21.2%, 5.9% deliveries complicated by meconium stained amniotic fluid. 32 babies 32.4% were between 32 to 36 weeks gestation, 8 were < 31 weeks. 21 babies had birth weight <1.5, 18 were between 1.5 to 2.5 kg .72 babies were AGA and 25 were SGA. 46 babies required admission to NICU for prematurity, asphyxia, RDS, MAS etc. 20 of the 118 mothers expired, mortality amongst mothers being 16.9%. 6 mothers died with baby in utero. 32 [27.1%] babies expired. Most neonatal

deaths were observed in those born to mothers with hepatitis E. Mortality in neonates born to mothers with infectious illnesses is 3 times more than those born to mothers with non infectious illness, p value < 0.05. The incidence of prematurity is also higher 46%[33 babies] vs. 25 % [7 babies], p value <0.05.Conclusions: Medical illnesses in mothers are associated with premature delivery, perinatal complications, and higher mortality particularly with maternal infections like hepatitis E.

NEO/17(O) HYPOGLYCEMIA AMONGST BABIES ADMITTED IN THE NEONATAL UNIT.B.D.Gupta, Manish Parakh, Pramod Sharma, Rajesh MalviyaDepartment of Pediatrics, Umaid Hospital for Women & Children, Dr. S.N.Medical College, Jodhpur.drpramodsh@hotmail.com

INTRODUCTION : Hypoglycemia is one of the most common metabolic problem in neonatal wards with incidence varying from 0.2 to 47% . It occurs in 8.1% of term LGA babies and in 14.7% SGA infants. Persistence of hypoglycemia may have far reaching consequences for the developing brain of the neonate. OBJECTIVE : To evaluate the Clinico- epidemiological profile of patients with hypoglycemia in NICU and the study the influence of various factors on this metabolic emergency. MATERIAL AND METHODS: Open prospective study in which a total of 1501 neonates admitted in NICU were enrolled. They were subjected to glucose estimation at birth (within half hour) and then at 2 hours and 4 hours. Levels less than 40 mg/dl irrespective of the birth weight and gestational age were considered diagnostic of hypoglycemia. Babies with detectable hypoglycemia were monitored 4-6 hourly. One touch test strips were used. Hypoglycemia was managed as per standard protocol. RESULTS: A total of 49 babies were detected to have hypoglycemia giving an overall incidence of 3.26%. Incidence in LBW babies was 3.09% and in LGA babies it was 9.5%, 10.2% babies had history of maternal toxaemia and 8.16% were associated with maternal diabetes. 48.97% hypoglycemic neonates were SGA, 36.73% were AGA and remaining 14.28% were LGA. Illnesses associated with hypoglycemia neonates were birth asphyxia (10.2%), neonatal septicemia (30.6%), ICH (6.12%) and respiratory distress in 18.36%. In our study 18.36% hypoglycemic neonates were asymptomatic and it constituted 0.59% of total NICU admissions. Symptomatic hypoglycemia constituted 2.66% of total NICU admissions. Commonest sign noted in these babies was refusal to feed (46.93%) followed by cyanosis in 24.4% and lethargy in 20.4% cases. 20.5% of hypoglycemic neonates were detected within 12 hours of birth and 46.9% within 24 hours of age. 95.9% cases were given IV glucose and 10.2% cases needed hydrocortisone. CONCLUSION: Hypoglycemia is a common problem and needs a mandatory routine cot side screening. Clinical signs are non specific. Early feeding helps prevent hypoglycemia and one touch test strip method is good and effective food for screening babies.

NEO/18(P) CLINICO-INVESTIGATIVE PROFILE OF G6PD DEFICIENCY IN PATIENTS WITH NEONATAL HYPERBILIRUBINEMIA.Lalita Bahl, Alpa Gupta, Vineet Mehrotra, Manish TiwariDepartment of Pediatrics and Biochemistry, H.I.M.S, Jollygrant, Dehradun.manish15j75@yahoo.com

Introduction: G6PD deficiency is most common red cell abnormality associated with hemolysis. It is known to be associated with neonatal jaundice, kernicterus and even death. Aims and Objectives: To study the clinico-investigative profile of G6PD deficiency in patients with neonatal hyperbilirubinemia. Material and methods: This study was carried out in all clinically jaundiced

neonates(Total Serum.Bilirubin>5mg/dl)over a period of one year. Detailed history with relevant clinical examination was performed and a quantitative estimation of G6PD was done by U.V kinetic method. Results: Among 106 cases of neonatal jaundice,08(7.54%)had G6PD deficiency out of which 07 (87.50%) were males and only 01(12.5%) was female. Mean period for appearance of jaundice was 1.870.64 days in G6PD deficients. As evidenced by mean serum bilirubin levels, G6PD deficient group had more severe jaundice (22.60 5.8mg/dl).Hemoglobin level was above16 gm/dl in 05 cases,01 between 14-16 gm%, 01 between 12-14 gm% and 01 had <12 gm% suggesting 01 case with severe anaemia. 62.5%(n=05) cases had serum bilirubin levels >20mg/dl. 01 G6PD deficient neonate had a reticulocyte count of > 4% and rest i.e. 07 had between 2-4% suggesting hemolysis as not the main determinant of jaundice in G6PD deficient group. In all cases anisopoikilocytosis was noticed,75% showed Heinz bodies,37.5% showed fragmented RBCs,12.5%showed Spherocytes. Conclusion: The occurrence of G6PD deficiency in neonatal hyperbilirubinaemia was found to be 7.4% with higher prevalence in males as compared to females, and had higher risk of developing severe hyperbilirubinemia(serum bilirubin >20mg/dl),hence should be properly investigated and managed.

NEO/19(O) EPIDEMIOLOGY OF NEONATAL SEPTICEMIA IN HOME DELIVERED BABIES CONDUCTED BY UNTRAINED DHAI IN THE RURAL AREA OF BURDWAN DISTRICTSNabendu Choudhuri, Nabamita ChoudhuriPower House Para, Burdwan, Pin: 713101hellomilan_hazra@yahoo.co.in

Introduction: In spite of remarkable improvement in health facilities and mass media awareness program there is only 50.5% delivery is conducted at hospital PHC at Burdwan districts, W.B. Plenty of has been done in Neonatal septicemia but the exact spectrum of neonatal septicemia in home delivery conducted by Dhai is not know. The present study has been conduct among of the babies who are delivered at home conducted by untrained Dhai and developed the septicemia within 5 days of life & has been treated by quack. AIM: This study will help to find out the risk factors responsible for early neonatal septicemia and the causative organism. and sensitivity of antibiotics will help to guide for introduction the health care system as well as administration as proper antibiotics will decline the incidence of neonatal septicemia as well as better out come of septicemia babies. This will help to increase the delivery rate in hospital. Materia & Methods: All the babies who are delivery at home conducted untrained Dhai and developed septicemia with in 5 days of life. The weight of the babies should be more than 1.5 kg. The babies having any congenital malformation or mother suffering from any disease either acute or chronic are exploded form this study. All the babies were investigated like TC, DC,MicroESR, CRP, Blood culture and surface culture (uambilica). Result: Fifty babies was study amongst which 36male and 26 female : Hindu 30, Muslim20. Educational statuses of the patients wear 4 to 10 standard. 18% were cultivator and 20% were daily worker. 80% had one or more antenatal checkup with TT. All delivery was conducted by Dhai. And the duration of the labour pain was 6 to 30 hours. No internal examination was done, Cod was cut with blade. In 60% cases the blade was boiled with water and 40% cases it was flamed. Ordinary thread was used to tie the Cord. None of the baby has received immediately breast milk or injection vitiamin K. The first feed was boild water in 80% cases suger water in 20% cases. Their continuaton of the feed was done with breast milk along with cows milk and boild water in all the cases. The axphyxia was noted in 40% cases and revived by mechanical stumolation. Investigation reveled Leucocytosis, raised micro ESR & presence of toxic granules in the 80% cases. In 10% cases organisms were detective from umbilicus swab which were e.coli –2 streptococcus -2, Klebsella—1. Blood culture showed grooth of staph, 1—Klebsella—1. These organism were sensitive to Amikacin, Ceftrioxone, Sulbectum & Tazobactum but resistant to

common antibiotic. Unclean delivery to absence of hand washing, unclean way of cord cutting and cird tieing, devoid of breast milk administration of sugar or plain water were the contributing factor for septicemia. Conclusion: The process of labour conduction, and cord cutting, or tieing and neonatal filling are unhygienic and potentially risk for the life of the baby.Inclination to home delivary and conduction by untrained Dhai are the family belives associated with inadequate knowledge.Inadequate and Injudistious administration of antibiotic lid to deficulty in identificaqtion of the organism from the culture as well as canges at the blood pictures lied to deficulti for assessment of the babies. This problem only can be minimized by proper family conduct and counclling of the untrained Dhai. NEO/20(O) ANTENATALLY DETECTED HYDRONEPHROSIS: EXPERIENCE OF A TERTIARY CARE CENTRESurg LCdr Bal Mukund, Maj A Simalti, Col M Kanitkar, Surg Capt SS Mathai, Sqn Ldr Vivek GuptaArmed Forces Medical College, Punebmdoc2002@rediffmail.com

Introduction: Hydronephrosis is the most frequent abnormality detected by prenatal ultrasonography (USG), with an incidence of 1% globally. Most of them do not require an active intervention.Aims and objective: To study the outcome of antenatally detected hydronephrosis(ANHDN) at a tertiary care service hospital. Material and methods: Seventy eight cases detected to have ANHDN between Jan 03 to Dec 06 were included in the study. All babies underwent an abdominal USG at 72 hours of age. When clinically indicated babies underwent Micturating Cystourethrograpy (MCU), Diethylene Tetra Penta-acetic Acid (DTPA) scan and Dimurcepto Succenic Acid (DMSA) scan. Subsequently they underwent a 3 monthly clinical and imaging evaluation for one year. Antibiotic prophylaxis was started until further evaluation. Results: Post natal USG revealed unilateral hydronephrosis in 65(83.3%), bilateral hydronephrosis in 13(16.7%) and 11(14.10%) had no abnormality. The abnormalities detected were pelvi-ureteric junction obstruction (PUJ )in 14(17.94 %),Vesico-ureteric reflux (VUR) in 5 (6.41%), Posterior urethral valve (PUV) in 5 (6.41%), extramedullary pelvis in 4(5.13%), Vesico-uretric junction obstruction in 3(3.85%) and medullary cystic disease in 2(2.56%).17 (21.79%) patients showed improvement on follow up, 8 (10.26%) had complete resolution while 9 (11.54%) showed partial improvement. 9(11.54%) babies showed no change in degree of hydronephrosis but 10 (12.82%) deteriorated over one year and 6(7.69%) cases required surgery after deterioration. Conclusion: ANHDN is commonest detected renal abnormality in antenatal ultrasonography. For further management and to detect early deterioration, a careful evaluation and follow-up is required.

NEO/21(O) RESPIRATORY DISTRESS IN SURGICAL NEONATES: EXPERIENCE OF A TERTIARY CARE CENTRESurg LCdr Bal Mukund, Col Uma Raju, Surg Capt SS Mathai, Col M Kanitkar, Sqn Ldr V GuptaArmed Forces Medical College and Command Hospital, Punebmdoc2002@rediffmail.com

Introduction: Respiratory distress is a common emergency seen in newborn period. Though most etiologies of respiratory distress are medical in origin, some of surgical conditions present with this symptom. Aims and Objective: To study incidence, surgical etiologies and outcome of surgical causes of respiratory distress in newborn Material and methods: A retrospective study between Jan 05 to Sep 07 was carried out among all NICU admission. Information was retrieved from the NICU database. Antenatal & natal history, presentation at admission, detailed examination, management and outcome was evaluated. Results: Out of total deliveries of 6758, NICU admission required in

778(12%).29 cases of respiratory distress had definitive surgical etiology for respiratory distress. Cases diagnosed were Tracheo-esophageal fistula (TEF) in 11(37.93%), various gastro-intestinal tract anomalies except TEF in 10(10.34%), Congenital diaphragmatic hernia (CDH) in 3(10.34%), Neural tube defect and meningomyelocele in 3 (10.34%), choanal atresia in 1(3.45%), tracheal agenesis in 1(3.45%). Mechanical ventilation was required in all cases either pre-surgery or after the surgery. 17 babies developed complications, sepsis in 5(17.24%), pneumonia in 5(17.25%)), air leak in 3(3.45%), perforation and peritonitis in 2 (6.9%), persistent pulmonary hypertension in 2(6.9%). 11(37.93%) babies died of either primary disease or due to complications.Conclusion: Respiratory distress due to a cause other than lung pathology needs to be kept in mind when encountering such a baby. Causes requiring surgical intervention forms a sizeable number and a careful management will save many lives from these fatal conditions.

NEO/22(P) ROLE OF COPPER IN PREMATURITYSridevi A Naaraayan, L.Umadevi,Thayumanavan, M.A.Arvind, A.VengatesanD-4, P.S.Annamalai Homes, Jaswanth nagar, Mogappair west, Chennai. 600037childdoctorsri@yahoo.co.in

Introduction: Copper deficiency is said to have been observed in infants with prematurity, but direct evidence is lacking. Aims and Objectives: Aim of this study was to elucidate the role of copper in prematurity. Objectives were to assess the level of maternal and cord copper and determine its role in etiology of prematurity and to determine the relationship between copper levels and maternal and baby factors. Materials and Methods: This case control study was done in delivery room of an urban tertiary care centre. 100 preterm babies with gestational age between 28-36 weeks were recruited randomly as cases and 60 term appropriate for gestational age babies served as controls. After noting certain baseline parameters and obtaining informed consent, 5ml of cord blood and 5ml of maternal blood were collected at the same time. Anthropometric assessment of all infants was carried out and all infants were followed up for a period of 2 weeks for any complication/death. Copper level was estimated by atomic absorption spectroscopy. Statistical analysis was done using student‘t’ test, Pearson chi square test and Pearson correlation coefficient. Results: There was no statistically significant difference in Mean maternal copper levels in preterm (2.85+/-1.02) and term (2.58+/-0.58). Mean cord copper levels in preterm (0.63+/-0.29) and term (0.59+/-0.22). It was observed that maternal copper had significant direct relation with maternal disease (r=0.45 p=0.001) and neonatal complications (r=0.35 p=0.01) and significant inverse relation with birth weight (r= -0.43 p=0.002). Conclusions : The fact that maternal and cord copper do not vary significantly in preterm compared to term eliminates copper as a probable cause of prematurity. Significantly increased maternal copper level was noted to be associated with complications in the mother as well as the neonate and low birth weight.

NEO/23(P) INCIDENCE OF HYPOTHERMIA AND HYPOGLYCEMIA IN OUT BORN NEW BORN & THEIR EFFECT ON FINAL OUTCOME.Deepak Dwivedi , G.S.Patel , Sharad Thora Room no 39 Boys Hostle, PG Block,Medical nagar, MGM Medical College, Indore-452001deepakdwi@yahoo.com Objective: To analyze incidence & causes of hypothermia & hypoglycemia amongst outborns neonates admitted in MYH & CNBC .To study signs & effect of the same & to formulate methods for there prevention. Introduction: Hypoglycemia & hypothermia are important determinants of neonatal morbidity & mortality in developing countries. They are associated with many neonatal diseases. Study was planned to evaluate the incidence of these determinants and there influence in morbidity & mortality of babies. Methods: A prospective study for the out born new born was done

in MYH& CNBC Indore. Temperature of the new born was measured at the time of admission by skin probe of radiant warmer which was Standardized with clinical thermometer& blood glucose was measured by glucometer which was rechecked by standard techniques. Result: .Out of the 100 babies studied 16% were normothemic, 29% were admitted with mild hypothermia, 49 % were admitted with moderate hypothermia, 6 % with severe hypothermia. Out of 100 babies admitted 28 % were admitted with hypoglycemia (<40mg/dl) .Mortality rate among the total new born admitted was 39 %(P value<0.05)Conclusion: Hypoglycemia & Hypothermia is a very important determinant in mortality of new born , not only they alone leads to increased morbidity but they also leads to worsen prognosis of other neonatal . conditions when associated with them. Seeds for the hypothermia & Hypoglycemia are sown at the birth place & during transportation & both of which are largely preventable.

NEO/24(O) SPONTANEOUS BILIARY PERITONITIS PRESENTING AS FETAL ASCITESPoonam Mahajan, Ashish Lothe, Pallavi Saple.drpoonammahajan@gmail.com Fetal ascites presents with respiratory distress & abdominal distension with various etiologies including Chylous ascites, Urinary, Biliary, Pancreatic, & Hydrops fetalis. Here we present a rare case of spontaneous biliary perforation with peritonitis presenting as massive ascites at birth. Full term female child delivered by emergency LSCS done for large baby with abdominal distension but cried after birth. Antenatal USG showed gross fetal ascites with pericardial effusion with clumped bowel loops with pulmonary hypoplasia with normal AFI. Baby had severe respiratory distress, tense abdominal distension with ascites, & no abdominal guarding, rigidity. There was no pallor, icterus, anasarca. Investigations revealed normal hemogram, renal & liver parameters. USG & CT abdomen showed ascites with multiple septae & no organomegaly. Ascitic fluid was bile stained with high bilirubin & normal proteins.surgical exploration delayed for 24 hrs due to unstable general condition .intraoperative cholangiography showed leak at the junction of cystic duct with CBD.there was no perforation in bowel.peritoneal drainage done.However child succumbed to the illness postoperatively.biliary ascites manifests as acute form with abdominal distension,vomiting,absence of bowel sounds and unstable vitals, jaundice may be absent.Chronic :in 80% of pts with early jaundice followed by gradual abdominal distension.this patient presented as acute biliary peritonitis.

NEO/25(O) THINFAT PHENOTYPE IN NEWBORNS:THE PREVALENCE AND THE PROBABLE ETIOLOGICAL FACTORS IN CENTRAL KARNATAKA" Mythri H P S, M L KulkarniProfessor and HOD, Department of pediatrics, J J M Medical college, Davangere babloodvg@yahoo.co.in

Introduction:People of Indian origin have a characteristic adult body phenotype namely, a relatively low body mass index but increased total subcutaneous and central body fat. This phenotype is known to be associated with increased incidence of syndrome X. Objective: The objective of our study was to know whether the ‘thinfat’ phenotype exists in newborns, in Central Karnataka and to correlate various factors that contribute to this phenotype.Design: Observational Study. Setting : Chigateri General Hospital, Davangere, Karnataka, India. Subjects : 1000 consecutive singleton term newborns. Methods : weight, length, head, mid arm, abdominal circumferences, biceps and subscapular skinfolds were measured at birth and compared with measurements of white Caucasian babies born in Southampton (UK), by calculating the Standard deviation scores. Results: The Davangere babies were significantly smaller in all measurements at birth (p < 0.001) compared to

Southampton babies. The deficit varied according to the measurements; It was greatest for birth weight (- 1.6 SD, CI – 3 .0, – 0.2), mid arm (- 2.0 SD, CI – 3.3, - 0.8), head circumference (- 1.8 SD, CI- 3.1, - 0.5) and least for length (- 0.4 SD, CI – 1.9, 1.1) and subscapular skin fold (- 0.3 SD, CI – 0.25, – 0.12). Predictors of skinfold thickness were maternal body mass index (p < 0.05) and mid arm circumference (p < 0.001). An interesting finding in our study was association of higher subscapular skinfold thickness in babies born to consanguineously married couple (p < 0.05), indicating the role of genes in determining ‘thinfat’ phenotype. Conclusion : Despite being small, truncal adiposity was present in Davangere newborns confirming the ‘thinfat’ phenotype. The role of consanguinity is important in determining this ‘thinfat’ phenotype in newborns.

NEO/26(O) EFFECT OF INTENSIVE PHOTOTHERAPY ON METABOLIC STATUS IN HEALTHY TERM NEONATESAnn Mathew, Neeraj Verma, Nirmal KumarSt Stephen’s Hospital, New Delhidrvermaneeraj@gmail.com

Background: Phototherapy plays a significant role in the treatment and prevention of hyperbilirubinemia as well as the management of subsequent complications in the newborn. However, hypocalcaemia, decrease in serum uric acid levels and increased insensible losses has been reported with the conventional phototherapy (lux 7-9 microwatt/cmsq/nm). Aims and objective: This study was undertaken to investigate the effect of intensive phototherapy (lux 25- 30 microwatt/cmsq/nm) on levels of sodium, potassium, calcium, magnesium, urea, creatinine and uric acid in a term healthy neonates with unconjugated nonhemolytic hyperbilirubinemia. Material & Methods: A prospective observational study was done on 50 term and near term healthy neonates. Babies having total serum bilirubin > 95th centile received intensive phototherapy. Same baby served as case as well as control. The levels of sodium, potassium, calcium, magnesium, urea, creatinine and uric acid were compared in prephototherapy and postphototherapy samples. Paired t test was used to look for statistically significant difference between the two sample groups. Results: Total no of 51 babies formed the study group. The mean serum bilirubin level was 17.3 in prephototherapy samples. The mean duration of phototherapy received was 30hours. The difference between pre and post phototherapy plasma uric acid levels were found to be statistically significant (p<0.05). No significant difference was found in any other metabolic parameters. Discussion: In our study we found that the serum uric acid levels fell significantly under intensive phototherapy. The direct photodecomposition on one hand and the inhibitory effect of riboflavin deficiency on uric acid formation, both these factors have been proposed as the possible explanation to this. Conclusion: In healthy term neonates, intensive phototherapy lowers serum uric acid levels. It does not affect the calcium, magnesium, sodium, potassium, urea, and creatinine levels.

NEO/27(P) CLINICAL PROFILE OF FUNGAL INFECTION IN A NICU    Ayush Manchanda ,Upasana Kapoor,Ajay Kumar    Division of Neonatology,Department of Pediatrics ,Lady Harding Medical College, New Delhi ayush2k2@yahoo.co.in

A prospective observational study was carried out to estimate the prevalence, clinical presentation and outcome of neonates admitted to a tertiary care neonatal unit with fungal sepsis. All the neonates admitted to the NICU at the Kalawati Saran Children Hospital,New Delhi from March 2004 to Feb 2006 were analyzed prospectively for the occurrence of systemic candidiasis. They were evaluated for gestation age, sex, birth weight, days on antibiotic, mechanical ventilation, peripheral catheterization, clinical features, fungus isolation , bacteria isolated in the candida

positive cases, treatment details, parenteral nutrition and final outcome.Results: Out of the total of 1346 admission in the NICU between March 2004 and Feb 2006, 47 neonates acquired systemic candidiasis (3.49%). The mean age of the onset of systemic candidiasis was 12.8 days, the range being 6-19 days. The mean gestational age was 31 wks (28-37) and the mean birth weight was 1040gms (760-3100). The predominant candidal species found in our study was C.albicans in 44/47(93.61%), followed by C.tropicalis in 2/47(04.25%) and an isolated case of C.krusei (02.10%). There were total 8 (17%) deaths in the study group and associated causes that contributed to their deaths were present in 4(50%) of them.Conclusions: Fungal sepsis remains one of the most important causes of high morbidity and mortality in the neonatal intensive care units. Early recognition and prompt treatment would go a long way in decreasing the severe systemic and disseminated complications occurring due to this disorder.

NEO/28(O) EFFECT OF CIPROFLOXACIN ON GROWTH AND DEVELOPMENT, RENAL AND HEMATOLOGIC PROFILE IN LOW BIRTH WEIGHT BABIES.Arpita Chattopadhyay, Jayant K Ghosh, Malay K Sinha, Mrinal K Das, S Chatterjee.Neonatology Unit, Department of Pediatrics, Medical College, Kolkata.drjayantkg@yahoo.co.uk

Objectives: To determine the effect of ciprofloxacin on growth and development, renal and hematologic profile in Low Birth Weight (LBW) babies in infancy. Methods:This was a prospective cohort study on LBW babies followed up until 12 months Corrected age (12-m CA).Exclusions were :infants with no length record taken at 12-m CA, who received ciprofloxacin after the neonatal period, who were neurologically abnormal or congenitally malformed. Cases were defined as those who received intravenous ciprofloxacin (10 mg/kg/dose 12-hourly) for at least 7 days in the neonatal period, whereas controls were those not exposed to ciprofloxacin during neonatal life. Of 75 babies included in the study, there were 35 cases and 40 controls. Multi-variate linear regression analysis was done. Results: The mean body weight at 12 –m CA was similar in both groups [6600gm,6900gm],length was [69.5cm,72cm],Hb was[16gm%,17gm%],TLC [16,800,19,000],platelet count was [2,00,000,2,40,000],urea[20,22]and creatinine[0.4,0.5].Conclusions: The findings suggest that ciprofloxacin administered at a dose 10 mg/kg/dose for a period of 7 days or more to LBW babies does not affect the growth, development, hematological and renal profile until 12 months corrected age.

NEO/29(P) ROLE OF PROPHYLACTIC PROBIOTICS FOR PREVENTION OF NECROTIZING ENTEROCOLITIS IN VERY LOW BIRTH WEIGHT NEWBORNMihir Sarkar, Jayant Kumar Ghosh, Malay K Sinha, Sukanta ChatterjeeProfessor and Head, Department of Pediatrics, Medical College & Hospital, Kolkatadrjayantkg@yahoo.co.uk

Objective: Necrotizing enterocolitis (NEC) is a worldwide problem in very low birth weight (VLBW) infants, but effective preventive strategies are lacking. Here we evaluate the efficacy of Probiotics to promote food tolerance and in reducing the incidence and severity of necrotizing enterocolitis (NEC) in very low birth weight (VLBW) infants. Materials and Methods: A prospective, randomized control trial was conducted in neonatal intensive care unit of Medical College and Hospital from May 2007 to August 2007. VLBW (<1500g) who started feed enterally were randomized in two groups after parental informed consents were taken. The infants in study group receive a daily feeding supplementation with a probiotic mixture (Bifidobacteria infantis, Bifidobacteria bifidum, Bifidobacteria longum and Lactobacillus acidophilus each 2.5 billion CFU) with expressed breast milk twice daily in a dose of 125mg/kg. Control group did not get this supplementation. NEC was graded according to Bell's criteria. NEC grade 2 considered sever. We

excluded the babies who expired due to other neonatal illnesses. Result : For 56 study and 59 control infants, respectively, demographic variables like birth weight (1221 +/- 253 g vs 1215 +/- 261 g), gestational age (31 +/- 3 weeks vs 30 +/- 2 weeks) were not different. Thee wee no statistical differences in clinical variables. The incidence of NEC was reduced in the study group (2 out of 56 (3.58%) vs 10 out of 59 (16.94%) P=.03). NEC was less severe in the probiotic-supplemented infants (Bell's criteria 1.4 +/- 0.5 vs 2.4 +/- 0.5). Three of 12 babies who developed NEC died, and all NEC-related deaths occurred in control group. Lactobacillus and Bifidobacteria species were not isolated from blood culture. Conclusion: Probiotics are very useful prophylactic measure for prevention of NEC in VLBW preterm infants.

NEO/30(P) PHOTOTHERAPY INDUCED HYPOCALCEMIA IN NEONATES     Rajiv Kumar, Nomeeta Gupta, Anil Vaishnavi, Deepti Singh, Asif SiddquiE-03, Housing Complex, Batra Hospital & Medical Research Centre, New Delhi - 110062.     drrajivkumar@hotmail.com

INTRODUCTION: Neonatal hyperbilirubinemia is a cause of concern for the parents as well as for the pediatricians. It is the most common reason for readmission after early hospital discharge. Phototherapy plays a significant role in the treatment and prevention of neonatal hyperbilirubinemia as well as the management of subsequent complications in the newborn. However, this treatment modality may itself result in the development of hypocalcaemia and create serious complications including convulsion and related conditions. Hypocalcaemia as a complication of phototherapy has been reported. OBJECTIVE: To investigate the effect of phototherapy on serum calcium in hyperbilirubinemic neonates. DESIGN: Prospective hospital based study. SETTING: Neonatal Intensive Care Unit of tertiary care hospital. MATERIAL & METHODS: All healthy neonates with term gestation in absence of any significant illness or Rh hemolysis were included in this study. Sixty four healthy term newborns of >2.5 Kg admitted in NICU of our hospital undergoing phototherapy were selected from January 2007 to July 2007. Serum bilirubin and calcium levels were determined before and after termination of phototherapy. Statistical computing was performed and the data were analyzed statistically by using Epi Info Version 6.04d. RESULTS: 64 neonates with hyperbilirubinemia were included in the study. 48 (75%) neonates developed hypocalcemia after being subjected to phototherapy. The difference between pre-phototherapy and post-phototherapy serum calcium levels were found to be statistically significant (P<0.01). The decline in serum calcium level at times reached hypocalcemia threshold. CONCLUSION: Phototherapy in the icteric neonates lowers serum calcium level. It is recommended that neonates under phototherapy should be given supplemental calcium to prevent hypocalcemia.   NEO/31(P) BACTERIOLOGICAL PROFILE OF NEONATAL SEPTICEMIA      Rajiv Kumar, Nomeeta Gupta, Anil Vaishnavi, Deepti SinghE - 03, Housing Complex, Batra Hospital & Medical Research Centre, New Delhi – 110062.     drrajivkumar@hotmail.com

INTRODUCTION: Neonatal septicemia constitutes an important cause of morbidity and mortality amongst neonates in India. However, with presently available antimicrobial agents, neonatal septicemia may be treated successfully. An early diagnosis and an appropriate management of neonatal septicemia can lower the morbidity and mortality substantially. Blood culture though considered gold standard for the diagnosis takes 48 -72 hours for result and is positive only in 30-75% of cases. OBJECTIVE: To determine the bacteriological profile of neonatal septicemia cases and their antibiotic sensitivity pattern of the cultured isolates for planning strategy for the management of these cases. MATERIAL AND METHODS: The present prospective study includes 80 cases of clinically suspected neonatal septicemia admitted in the Neonatal Intensive Care Unit of

Batra Hospital & Medical Research Centre, New Delhi. Antenatal, perinatal and obstetric history was obtained to record the risk factors. Blood samples were collected under all aseptic precautions for culture and sensitivity studies. Blood cultures were processed using the standard technique and the antibiotic sensitivity was performed by Kirby-Bauer's disc diffusion method. The aerobic isolates were studied in detail by Gram's staining, colony characteristics, biochemical properties and antibiotic sensitivity. RESULTS: Blood culture was positive only in 32.5% of cases. There was no growth in 67.5% of cases. Gram negative bacilli constituted 87.1% of the total isolates. Klebsiella and Enterobacter species were the predominant pathogens amongst Gram negative organisms. Salmonella species was isolated from 2.5% of cases. Staphylococcus aureus was the predominant isolate (79%) amongst Gram positive organisms. CONCLUSION: E.coli, Klebsiella and Staphylococcus aureus were most common organisms of neonatal septicemia. An early diagnosis and an appropriate management of neonatal septicemia can lower the morbidity and mortality substantially.        NEO/32(O) TO STUDY THE INCIDENCE, INDICATION & COMPLICATIONS OF PARENTERAL NUTRITION AND ITS EFFECT ON NUTRITIONAL ACCRETION IN SICK NEONATES.Harmeet Singh Arora,Uma Raju, Sheila Mathai, Kirandeep Sodhi.Dept of Paediatrics, Command Hospital & Armed Forces Medical College, Punevicky_arora18@rediffmail.com

Introduction: Judicious use of parenteral nutrition in sick neonate can facilitate quick recovery & achieve near normal nutritional accretion. Aim To study the incidence, indications, complications of parenteral nutrition & its effect on nutritional accretion in sick neonates . Method: Retrospective hospital based cohort study based on neonatal database of a service referral hospital .The cases were provided PN through peripheral & central vascular access as indicated. Results Out of total 473 admissions, 85 ( babies provided PN, out of which PICC used in 45neonates (Group 1) and Peripheral line (PL) in 40cases (Group 2). PN provided for average of 2 weeks, minimum period 7 days & maximum 36 days. PICC lasted on an average for two weeks. In only 3 of the group 1 cases was a 2nd line used. In group 2 , venous cannula (22G) needed to be changed on an average of 9 times, ie. every 1.5 days.Indications of parenteral nutrition ELBW & VLBW in 28 (32.9%), prolonged ventilation in 23 (27.0%), neonatal necrotizing enterocolitis (sepsis, severe birth asphyxia) in 13 (15.2%), surgical conditions in13 (15.2%) & miscellaneous conditions (inadequate weight gain, gastroesophageal reflux disease etc) in 9 (9.4%) neonates.Complications noted thrombophlebitis in 33 (38.8%), extravasation in 17 (20.0%), local necrosis in 3 (3.5%), hypoglycemia in 15 (17.6%), hyperglycemia in 10 (11.7%), hyperbilirubinemia in 14 (16.4%) & hypertriglyceridemia in 9 (10.5%) cases.Comparing group I vs group II, Weight gain was seen by 3rd day vs 6th day, the maximum calorie concentration reached by 6th day vs 9th day and the average daily weight gain 24 gms vs 17gms. Comparing complications encountered in group I vs group II, Thrombophlebitis in 12 ( 41%) vs 15 ( 38%) (p=0.8), Extravasation in 2 (7 %) vs 10( 25 %) (p=0.012), Hypoglycaemia 6(20%) vs 6(16%) (p=0.104), Hyperglycaemia 5 (18%) vs 2 (5%) (p=0.192), Cholestasis 3 (12%) vs 8 (20%) (p=0.99), Hyperlipidemia 3 (12 %) vs 4 (10 %) (p=0.124). Catheter related sepsis in only 2 neonates in group I. In group II Local Necrosis was seen in 3 (8%) (p=0.5 ). Conclusion Parenteral nutrition is effective management modality in critically ill neonate, hastens recovery & is indicated in variety of clinical situations. It can be provided over prolonged time & enables near normal nutrient accretion.Contrary to popular belief complications associated with this modality are minimal if proper care is taken. Complications were comparable in both groups.

NEO/33(P) CLINICAL PROFILE OF RESPIRATORY DISTRESS IN NEONATES Rajiv KumarE - 03, Housing Complex, Batra Hospital, New Delhi – 110062drrajivkumar@gmail.com

INTRODUCTION: Respiratory disorders are the most frequent cause of admission for special care in both term and preterm infants, within first 48 -72 hrs of life. Respiratory distress is one of the major causes of mortality and morbidity among the newborns. It occurs in 0.96 to 12% of live births and is responsible for about 20% of neonatal mortality. OBJECTIVE: To study the clinical profile of respiratory distress in newborns admitted in Neonatal Intensive Care Unit (NICU). MATERIAL & METHODS: The present prospective study was conducted in NICU of our hospital over a period of one year from January 2006 to December 2006. All neonates presenting with respiratory symptoms were included in the study. The diagnosis of the cause of respiratory distress was based on guidelines recommended by the National Neonatology Forum. All newborns born in our hospital and all those referred from primary and secondary level hospitals or home deliveries for admission with features suggestive of respiratory distress were observed for respiratory problems. Relevant antenatal, intranatal and neonatal data was noted. RESULTS: The overall incidence of respiratory distress was 7.6%. Preterm neonates had the highest incidence (30.0%) followed by post-term (21.0%) and term (4.0%) newborns. Transient tachypnea of newborn (TTN) was found to be the commonest (40.4%) cause of respiratory distress followed by septicemia (16.0%), meconium aspiration syndrome (10.0%), hyaline membrane disease (7.3%) and birth asphyxia (2.1%). TTN was found to be common among both term and preterm neonates. While hyaline membrane disease (HMD) was seen mostly among preterm, and meconium aspiration syndrome (MAS) among term and post-term newborns. CONCLUSION: Respiratory disorders constitute a significant part of neonatal morbidity and mortality. Our results indicate that respiratory distress is a common neonatal problem. TTN accounts for a large proportion of these cases. MAS and septicemia also contribute significantly and are largely preventable. Without adequate ventilatory support HMD and MAS carry high mortality.

NEO/34(P) HEMOGLOBINURIA AND LEUKOERYTHROBLASTOSIS IN A NEWBORN WITH RH ISOIMMUNISATIONKaruna Thapar, Naresh Jindal,Sandeep AggarwalDepartment Of Paediatrics, Government Medical College & Hospital Amritsar kthapar2000@yahoo.com

Leukoerythroblastosis is a poorly defined, uncommon syndrome with leukocytosis, left shift, and nucleated red blood cells (nRBCs) disproportionate to the degree of anemia, which may be associated with leukemia or neoplasia in the bone marrow, acute infection, hemolysis, myelofibrosis, or miscellaneous causes. To our knowledge, Leukoerythroblastosis in association with Rh- isoimmunization had not been diagnosed in a newborn before the case we report. Case report: A full term 10 days old male neonate belonging to Gujjar community was referred to our centre for increasing pallor and cola colored urine since birth. He was 4th in birth order and 2nd live issue. First in birth order was a normal female child. 2nd and 3rd in birth order were male who died of jaundice and anemia with in first 7 days of life. All deliveries were conducted at home by a local dai with no medical attention taken in antenatal, natal and postnatal period. Child was apparently healthy weighing 2550 grams and was on exclusive breast feeding. Physical examination revealed normal vitals, anemia, jaundice and hepatosplenomegaly. Routine laboratory measurements showed anemia (Hb: 6.3 g/dL and Hct: 20.3%), leukocytosis (38,400/mm3) and normal platelet count. The peripheral blood smear suggested leukoerythroblastosis with the presence of nucleated erythrocytes

and 6% blast cells. Blood urea (93.6 mg/dl) and s. creatinine (1.70 mg/dl) were increased. Reticulocyte count (3%) was increased. Coombs Test was positive. Rh incompatibility was seen (Mother B-ve & Baby B+ve). G6PD levels were normal. Urine was dark brown in colour with urobilinogen (2.0 EU/dl) increased. Urine Benzidine test was positive for haemoglobinuria. Case was diagnosed as Rh isoimmunisation with leukoerythroblastosis. Hemoglobinuria and leukoerythroblastosis were thought to have developed secondary to Rh isoimmunisation NEO/35(P) SEPTICEMIC NEONATES WITHOUT FUNGAL CULTURE: WHAT ARE WE MISSING?Karuna Thapar, Naresh JindalDepartment Of Paediatrics, Government Medical College & Hospital Amritsar kthapar2000@yahoo.com

Premature infants in NICU are at particular risk of invasive fungal infections and unfortunately, the incidence of fungal septicemia appears to be increasing. Invasive infections are often associated with significant mortality. The management of candidemia in neonates is difficult since even transient episodes may lead to widespread tissue invasion and multiple secondary complications. Treatment is also controversial and needs high medical expertise. Design: A hospital based study conducted on 565 neonates admitted over a period of 1 year (July 2006 - July 2007). Setting: Tertiary care neonatal unit in northern India. Subjects and interventions: All admitted neonates were evaluated clinically and investigated for presence of infections. Results: Among the 565 neonates, 112(19.82%) were preterm and 176(31.15%) were low-birth weight (LBW) (<2,500 g). Growth of fungus was seen in urine culture of 4 neonates (00.70%). Candida albicans was frequent organism isolated (3/565, 00.53%), following growth of Geotrichium in another sample. All effected neonates were LBW with 2.27 % (4/176) incidence of fungal infections in them. 3 were preterm and 1 was term neonate. In our series of 4 neonates all under 2500 g, we felt that early recognition and aggressive therapy might reduce the mortality from this condition. Our practice is now to take early specimens from potential cases, with a particular focus on those neonates below 37 weeks and below 2500 g. Conclusion: Candidiasis should be considered in the differential diagnosis of sepsis in the LBW neonates. It is likely that a high index of suspicion and vigorous early treatment can improve the prognosis for this vulnerable group.

NEO/36(P) EFFECT OF FOOD FORTIFICATIONS ON THE GROWTH OF VERY LOW BERTH WEIGHT NEWBORNSDevendra Sareen, Ashok Jain, Nishtha Sareen, Dharam Singh, B. Bhandari, Abhishek Ojha 27-F, New Fatehpura, Udaipur-313 001madhusareen@yahoo.co.in

SUMMARY: Feeding of VLBW newborns is natural since adequate nutrition is a necessity for their survival. The present study was aimed to assess growth pattern of VLBW newborns whose feeds were fortified with fat in comparison to those whose feeds were not fortified. Total 80 cases were enrolled. 21 served as control group (group IV) whose feeds were not fortified with fat. Group I included 19 cases (food fortified with polyunsaturated fatty acids - sunflower oil), group II (fortified with medium chain triglycerides - coconut oil) and group III (fortification with saturated fatty acid rich butter oil- ghee) included 20 children in each group. Each newborn was weighing between 1.0-1.5 kg., was below 14 days of age & had established enteral feeding and was provided multivitamin drops, calcium supplementation & vit. K (1 mg) at birth. Weight was monitored daily by electronic digital balance and estimation of serum triglycerides was done at time of enrolment and discharge from hospital. We observed that mean weight gain in group I was 12.42±2.09 gm/kg./day and in group II it was 13.21±2.25 gm/kg./day which was significantly higher in

comparison to control group (10.52±1.76 gm/kg/day) p<0.001. However, in group III it was 10.09±1.93 gm/kg/day only, statistically not significant p>0.05.Biochemical assessment also revealed that rise of serum triglycerides in group I (29.77±9.7 mg%) and group-II (35.21±14.82 mg%) was significantly higher than control (23.25±7.01mg%) p<0.001. However in group III, the rise was not significant (25.08±8.89 mg%) p>0.05. This shows that polyunsaturated fatty acids and MCT are better absorbed and assimilated than saturated fatty acids in VLBW newborns. Hence, if VLBW newborns do not show adequate weight gain despite increasing volume of feeds, fortification of mother's feed either with sunflower oil or coconut oil can be recommended.

NEO/37(P) MATERNAL ANTENETAL PROFILE & IMMEDIATE NEONATAL OUTCOME IN LBW BABIESDevendra Sareen, Usha Rani Sharma, Jyoti Jain, Nishtha Sareen, Dharam Singh, Abhishek Ojha27-F, New Fatehpura, Udaipur-313 001 madhusareen@yahoo.co.in

SUMMARY: The birth weight is universally and in all population groups the single most important determinant of the chances of the new born to survive & experience healthy growth & development. Majority of neonatal deaths occur among low birth weights. The present study had been aimed to evaluate antenatal profile of mother contributing to low birth weight babies and to study immediate morbidity & mortality in LBW babies.This retrospective study was conducted in Panna Dhai Zanana Hospital, Udaipur of total of 500 mother delivered between 26 to 36 week gestation and babies weighing less than 2.5 Kg. Demographic and antenatal profile, medical complications during pregnancy, antepartum hemorrhage and delivery outcome were noted. Neonatal profile of babies like Apgar score, sepsis and jaundice etc. were also recorded.We observed that most of the mothers were unbooked (68%), were from rural class (66.6%), teenage (41%), illiterate (58.8%) and were from lower socioeconomic class (56.8%) and multipara (72.6%). 65.2% and 54.6% of mothers with height less than 150 cms. and weight less than 45 Kg. respectively gave birth to LBW babies. Anemia (35.25%), Gestational height (12%), Maternal infections (10.4%) in mothers were major contributing factors for LBW babies. Mortality was highest in ELBW babies and those born before 28 week gestation. Majority of the LBW babies suffered from RDS (10.4%), INN (9.2%) & SBA (6.6%). Hence, need of the hour is a better understanding of maternal antenatal factors & improvement in case of high risk mothers by timely antenatal intervention. Also, there is need of advancement in perinatal and neonatal treatment expertise, provision of efficient NICU facilities to ensure intact newborn survival.

NEO/38(P) NEONATAL CARE: LEVEL OF KNOWLEDGE OF URBAN SCHOOL GOING ADOLESCENT GIRLS OF MEWARSanjay Choudhary, Nishtha Sareen, Dharam Singh27-F, New Fatehpura, Udaipur-313 001 madhusareen@yahoo.co.in

SUMMARY: Because today's adolescent girl is tomorrow's potential mother and todays' infants are tomorrow's citizen, hence it becomes imperative to furnish knowledge about neonatal feeding and rearing practices to the adolescent age group to provide our country the best future.The present study was conducted to determine the knowledge regarding neonatal care practices in urban adolescent school going girls.For this, a cross sectional survey of 475 urban adolescent school going girls between 15-18 years of age was done who had different demographic and socio-cultural background. After a brief introduction of subject, a performa was given to each girl to be filled. Performa contained a series of 22 questions covering various aspects of neonatal care. After compilation of observations, data analysis was done.It was observed that majority (73.05%) of girls

knew that cord should be cut by sterile instrument after birth. 57.88% of them had knowledge of tying the cord with a sterile cotton thread. Only 21% of them were of opinion that nothing should be applied over raw stump of cord.67% of them believed that colostrum protects the baby from illnesses while 57% girls were of opinion in initiation of breast feeding as soon as possible after birth. 27% of adolescent girls were against using pre-lacteal feeds. Majority of them (97%) was aware that new born can not regulate body temperature efficiently. 66.7% of the girls in study group believed that vaccines against various communicable diseases should be provided in new born period. Hence, we must spread the message of proper neonatal care specially to adolescent girls through electronic and press media to enhance their knowledge.

NEO/39(P) NEONATAL URINARY ASCITES Rajiv KumarE-03, Housing Complex, Batra Hospital, New Delhi - 110062drrajivkumar@gmail.com

INTRODUCTION: Neonatal bladder rupture is a rare cause of urinary ascites. Urinary ascites in a newborn infant is unusual and most commonly indicates a disruption to the integrity of the urinary tract. In some cases, no underlying urological anomaly was discovered in neonates with urinary ascites due to spontaneous rupture of bladder. An early diagnosis and management lower the morbidity and mortality. We report a successfully treated case of neonatal urinary ascites in a preterm neonate who had an intra-peritoneal bladder rupture, presenting with gross abdominal distension and respiratory distress. CASE REPORT: A 1.9 Kg male baby was born at 32 weeks gestation to a 21 years old primigravida who had a history of chickenpox in first trimester and hepatitis E in second trimester. The baby was delivered vaginally and had Apgar scores of 5 and 8 at one and five minutes respectively. The antenatal course prior to the onset of preterm labour was uneventful. He was transferred to our NICU because of respiratory distress. ABG showed a case of hypoxia with severe metabolic acidosis. There were no signs of dehydration. Laboratory investigations showed TLC 8200/cmm, with 73% neutrophils, 24% lymphocytes, 3% monocytes and platelet count 1.64 lacs. PT and PTT were normal He was immediately intubated and ventilated for 4 days. The umbilical vein was catheterized as umbilical artery catheterization was unsuccessful. He was treated with an oxygen, IV antibiotics, sodium bicarbonate, dopamine, dobutamine, surfactant and phototherapy. He was catheterized, but passed only a few drops of urine. He developed anuria and progressive abdominal distension. No organomegaly could be appreciated and the bladder was not palpable. Abdominal ultrasound showed free fluid in abdomen and bilateral mild hydronephrosis with empty bladder. MCU showed extravasation of contrast media from bladder into peritoneum suggestive of intraperitoneal rupture of bladder. Miniexploratory laparotomy was done because of his worsening clinical status. Surgical exploration revealed 2 mm perforation in posterior wall of urinary bladder and confirming that the peritoneal fluid was urine. Urinary bladder repair was done and peritoneal fluid was sent for laboratory examination. Peritoneal fluid contained high levels of potassium, urea and creatinine with a low level of bicarbonate compared with plasma. Blood, urine and peritoneal fluid cultures were sterile. Abdominal distension subsided and urine output improved. The patient improved rapidly and discharged on 12 day of admission. A VCUG repeated after 2 weeks. There was no extravasation of contrast medium from bladder and no vesico-ureteric reflux. CONCLUSION: Neonatal urinary ascites due to bladder perforation, in the absence of any obvious urinary outlet obstruction, is rare. This unusual presentation of neonatal bladder rupture should become familiar to clinicians.

NEO/40(P) EARLY NEONATAL HYPERBILIRUBINEMIA USING CORD BILIRUBIN LEVEL IN NEAR-TERM AND TERM NEWBORNSRajiv KumarE - 03, Housing Complex, Batra Hospital, New Delhi – 110062drrajivkumar@gmail.com

INTRODUCTION: An early neonatal hyperbilirubinemia (NNH) is a cause of concern for the parents as well as for the pediatricians. It is the most common reason for readmission after early hospital discharge. The concept of prediction of jaundice offers an attractive option to pick up babies at risk of NNH. An association between cord bilirubin (CB) levels and the subsequent risk of hyperbilirubinemia has been reported. Infants who are clinically jaundiced in the first few days are more likely to develop hyperbilirubinemia later. OBJECTIVE: To evaluate the predictive value of total CB for the risk of subsequent hyperbilirubinemia in term and near-term newborns. DESIGN: Prospective study. SETTING: Tertiary care hospital. MATERIAL & METHODS: All healthy neonates with gestation >35 weeks, in absence of significant illness or Rh hemolysis were included. The umbilical cord blood samples for bilirubin estimation were taken from 353 inborn newborns from January 2006 to June 2007. The CB was compared with serum bilirubin (SB) at 36 - 48 hours of age. Total SB levels of >=8 mg/dl and >= 12 mg/dl on day 2, >= 12 mg/dl and >= 15 mg/dl on day 3, and >= 14 and >= 17 mg/dl on day 4 and day 5 respectively for birth weight between 2000 – 2500 gms and >2500 gms were defined to have significant hyperbilirubinemia and phototherapy was started. RESULTS: Out of 353 newborns, 125 newborns developed hyperbilirubinemia. Out of 62 near term neonates, 34 (54.84%) and out of 291 term newborns, 91 (31.27%) developed hyperbilirubinemia and required phototherapy. No sex predilection was found. Out of 125 newborns with hyperbilirubinemia, 65 (34.76%) were males and 60 (36.14%) were females. The CB level was statistically increased in babies whose mother received oxytocin (odds ratio 2.285). Babies having birth weight 2500 – 3000 gms had 1.3 times higher risk while babies with birth weight <2500 gms had 3.5 times higher risk as compared to babies with birth weight more than 3000 gms. The requirement of phototherapy was twice in near-term babies as compared to term babies. Those with total CB >= 2.1 mg/dl had 6.8 times chances of NNH and requirement of phototherapy as compared to those with total CB of < 2.1 mg/dl. Newborns with birth weight <2.5 Kg, 2.5 - 3 Kg and >3 Kg had 63.16%, 36.3% and 27.85% chances of developing NNH respectively. CONCLUSION: Cord bilirubin can be taken as predictor for subsequent NNH before discharge from hospital. The total CB level at time of discharge would facilitate safe and cost-effective targeted intervention and follow-up. The timely detection of NNH and optimal management are crucial to prevent brain damage and subsequent neuromotor retardation due to bilirubin encephalopathy.

NEO/41(P) NEONATAL THROMBOCYTOPENIA IN HOSPITALISED SICK NEONATES Rajiv KumarE-03, Housing Complex, Batra Hospital, New Delhi - 110062drrajivkumar@gmail.com

INTRODUCTION: Thrombocytopenia is one of the common hematological problems encountered in the neonatal period particularly in sick newborns, premature babies and neonates admitted in neonatal intensive care units and usually indicate an underlying pathologic process. OBJECTIVE: To determine the number of cases and manifestations of thrombocytopenia in sick neonates. DESIGN: An observational study. SETTING: Tertiary level NICU of Batra Hospital & Medical Research Centre, New Delhi from January 2006 to June 2007. MATERIAL AND METHODS: A total of 365 neonates from 0-28 days of age admitted with different clinical problems irrespective of

birth weight and gestational age were evaluated for thrombocytopenia. These neonates were categorized into five different groups (A, B, C, D, E), which were of neonatal infections, birth asphyxia, preterm and small for gestational age, jaundice and miscellaneous respectively. RESULTS: Out of 365 cases, 88 (24.1%) were found to have thrombocytopenia (platelet counts < 150,000 / mm3). In group A (neonatal infections), out of 152 neonates, 62 ((40.78%)) had thrombocytopenia. In group B (birth asphyxia), out of 90 cases, only 11 (12.2%) had thrombocytopenia. In group C (preterm and small for gestational age), out of 60 cases only 9 (15%) had thrombocytopenia. In group D (jaundice), all 33 cases had normal platelet counts. In group E (miscellaneous), out of 30 cases, only 6 (20%) had thrombocytopenia. The common manifestations in thrombocytopenic babies were petechiae and bruises followed by gastrointestinal hemorrhages and intracranial hemorrhages. The percentage of manifest thrombocytopenia cases was 56.8% and of occult thrombocytopenia 43.1%. CONCLUSION: The leading causes of thrombocytopenia in sick neonates are congenital or acquired viral infections, fungal or bacterial sepsis, necrotizing enterocolitis, birth asphyxia, alloimmune thrombocytopenia, complicated prematurity and small for gestational age. Severe thrombocytopenia may be associated with increased risk of hemorrhage, and increased mortality.

NEO/42(P) STUDY OF NEONATAL THROMBOCYTOPENIA IN HOSPITALISED SICK NEONATES Rajiv KumarE-03, Housing Complex, Batra Hospital, New Delhi - 110062drrajivkumar@gmail.com

INTRODUCTION: Thrombocytopenia is one of the common hematological problems encountered in the neonatal period particularly in sick newborns, premature babies and neonates admitted in neonatal intensive care units and usually indicate an underlying pathologic process. OBJECTIVE: To determine the number of cases and manifestations of thrombocytopenia in sick neonates. DESIGN: An observational study. SETTING: Tertiary level NICU of Batra Hospital & Medical Research Centre, New Delhi from January 2006 to June 2007. MATERIAL AND METHODS: A total of 365 neonates from 0-28 days of age admitted with different clinical problems irrespective of birth weight and gestational age were evaluated for thrombocytopenia. These neonates were categorized into five different groups (A, B, C, D, E), which were of neonatal infections, birth asphyxia, preterm and small for gestational age, jaundice and miscellaneous respectively. RESULTS: Out of 365 cases, 88 (24.1%) were found to have thrombocytopenia (platelet counts < 150,000 / mm3). In group A (neonatal infections), out of 152 neonates, 62 ((40.78%)) had thrombocytopenia. In group B (birth asphyxia), out of 90 cases, only 11 (12.2%) had thrombocytopenia. In group C (preterm and small for gestational age), out of 60 cases only 9 (15%) had thrombocytopenia. In group D (jaundice), all 33 cases had normal platelet counts. In group E (miscellaneous), out of 30 cases, only 6 (20%) had thrombocytopenia. The common manifestations in thrombocytopenic babies were petechiae and bruises followed by gastrointestinal hemorrhages and intracranial hemorrhages. The percentage of manifest thrombocytopenia cases was 56.8% and of occult thrombocytopenia 43.1%. CONCLUSION: The leading causes of thrombocytopenia in sick neonates are congenital or acquired viral infections, fungal or bacterial sepsis, necrotizing enterocolitis, birth asphyxia, alloimmune thrombocytopenia, complicated prematurity and small for gestational age. Severe thrombocytopenia may be associated with increased risk of hemorrhage, and increased mortality.    

NEO/43(P) LATE - HEMORRHAGIC DISEASE OF NEWBORN PRESENTING AS INTRACRANIAL BLEED: TWO CASE REPORTS.Rohit Arora, Premila Paul; Preena UppalE-9/3 Malviya Nagar, New Delhi-110017dr_rohitarora3110@yahoo.co.in

Late HDN is a major source of morbidity and mortality, as intra-cranial bleeds is present in more than 50% of patients. It usually occurs between 2-16 weeks of age. Various studies have suggested the role of Vit-K in prevention of Classical and Late –HDN. Two cases of Late-HDN are presented here both of which presented with intra-cranial bleeds as confirmed by imaging studies. Both cases were about 4 months of age and presented with short history of excessive cry and vomiting after feeds. One case also had two episodes of tonic seizures. Both were on exclusive breast feeds and were not given Vitamin-K prophylaxis at birth. Examination in both cases revealed tense, bulging, non-pulsatile anterior fontanelle. Samples were withdrawn for coagulation profile which revealed markedly deranged PT and PTTK. MRI revealed more-or-less the same picture in both the cases with multiple extra-axial and intra-parenchymal hematomas in left parieto-occipital regions producing marked mass effect. In one case intra-ventricular extension was also present. Both were administered Vitamin-K for three days after which coagulation profile was repeated which then came out to be essentially normal. Both cases are under follow-up and are doing well till now. Although, PIVKA-II levels (protein induced in vitamin –K absence) are considered diagnostic, they are not essential for the diagnosis to be made especially under the circumstances of cost and availability of test, prevailing. NEO/44(O) NEWBORN HEARING SCREENING PROGRAMME – NORTHERN BOARD STATISTICS – NORTHERN IRELAND UNITED KINGDOM.Mugilan Anandarajan, Sanjeev Bali Specialist Registrar Paediatrics, Royal Belfast Hospital for Sick children, United Kingdommugilan@mugilan.org

Background: Targeted hearing screening was initially in place in United Kingdom. With Hall 4 Report – Full screening was introduced. It was an Evidence based approach – Evidence to change practise. National Newborn Hearing Screening Programme Review group concluded that the Screening Programme would benefit from a programme of audit to ensure high standards of care is delivered and develop performance indicators . Objectives: To Evaluate universality and efficacy of Screening programme and Identify cohort of Newborn that had been screened ( non-resident infants who are born in NI & temporary residents in NI during the first 6 months of life ) .To Evaluate screening process and compare local practice to National guideline to identify problems in screening delivery and cost implication. Methods: Retrospective study of all the babies born in Northern Board , Northern Ireland from Newborn Hearing Screening Register book and Child Health record over 6 month period. Results: Among 2019 live births hearing screening was offered to 87.6 % of newborns prior to discharge from hospital and was completed in 86.93 % before discharge from hospital. Screening was completed using Auto Otoacoustic Emission / Automated Auditory Brainstem Response Test in 95.66 % of babies within 4 weeks after birth.Conclusions: The effectiveness of the screening programme is still 95 % and the primary reason for not being 100 % effective had been child being transferred to another hospital or discharged prior to screening offer. Early Identification has significant cost implication in management saving 119 pounds per investigation.

NEO/45(P) AUDIT OF SURFACTANT ADMINISTRATION IN PRETERM BABIES LESS THAN 31 COMPLETED WEEKS GESTATIONGarg S, Krishnamoorthy SS, Harikumar C15/100, Street No 4, Old Court Colony, Sirsa- 125055, Haryanashalabh77@yahoo.co.in

Summary: Audit of Surfactant Administration in Preterm Babies Less Than 31 Completed Weeks Gestation Introduction: Evidence based guidelines for the use of surfactant in preterm babies babies at high risk of surfactant deficiency should receive surfactant at or soon after birth All babies < 30 weeks completed gestation that are thought to be at high risk of surfactant deficiency, if intubated, should receive surfactant at birth. There is a better outcome with 2 doses of surfactant than with 1 dose Aim : Audit surfactant administration practices against the guidelines. Methods : Retrospective case note review of surfactant administration at North Tees Hospital between July 2005 - June 2006. Results : 40 babies less than 31weeks gestation were admitted in this 1 year period. Of these only 27 case notes could be obtained. Birth Weights ranged from 560g - 1820g. 6 of these 27 babies did not receive surfactant and were not intubated. 13 babies received only one dose of surfactant, 6 received 2 doses, and only 2 babies received more than the recommended 2 doses. All but 2 of these babies received the first dose of surfactant within 30 minutes (90%). No babies received more than 3 doses of surfactant. Conclusions: There is continued improvement and generally good adherence to the guidelines at the North Tees site, and are in top 2 centile for the country. A further audit will be carried out. This audit also highlights the fact that timely audit, implementation of recommendations and re audit leads to continued improvement in performance.

NEO/46(P) COMMUNITY NEONATAL SERVICES Garg, K Quinn, S Garg, C Harikumar and A Tuladhar15/100, Street No 4, Old Court Colony, Sirsa- 125055, Haryanashalabh77@yahoo.co.in

Background: The North Tees Neonatal Unit cares for nearly 275 babies per year, 40 of whom are extremely premature. More than 85% of these babies survive. Since its inception in 1992, the Community Neonatal Service has evolved and has acquired the current configuration. At any given time there are about 30 babies looked after by the service. Aims: To support parents during and beyond the hospital discharge process Facilitate early discharge from hospital Reduce readmission rates Liaison with the multi disciplinary team Follow Up Criteria: < 2300 grams discharge weight/ < 36 weeks gestational age Babies needing high calorific feed supplementation Babies needing home oxygen therapy Babies with Neonatal Abstinence Syndrome Babies born to HIV Positive mothers Cardiac babies The service involves multi agency networking prior to discharge, holding a discharge planning meetings, preparing parents for the discharge home of their premature baby, resuscitation training of parents. The service additionally involves: Running a Nurse led Clinic which allows blood tests to be performed, specific immunisations to be given and for weight monitoring Coordinating the Multi professional High Risk Neonate Follow up Clinic Teaching parents in the care of their babies- i.e.: resuscitation training and in the use of appropriate equipment Teaching other health professionals The North Tees Community Neonatal service has spearheaded the development of the ‘North of England Neonatal Community Interest Group’ which has been set up in January 2006 to address these issues. A Parent Support Group is also being developed in conjunction with the health visitors.

NEO/47(P) NEONATAL ABSTINENCE SERVICE & CLINIC TOWARDS EVIDENCE BASED MANAGEMENT OF NEONATAL ABSTINENCE SYNDROMES Garg, C Harikumar, S Garg, K Quinn, B Harrison, I Verber 15/100, Street No 4, Old Court Colony, Sirsa- 125055, Haryanashalabh77@yahoo.co.in

Background: The focus of maternity services is the health of the mother and the baby and this applies equally to substance misusers. There has been a substantial increase in the admission to the maternity wards of these babies and thus an increase in the burden on services and hence a need to adapt and improve provision of care. Previous management:Not evidence based All babies admitted to neonatal unit Oromorph prescribed for babies with signs of withdrawal Babies remain in the unit until Oromorph completely weaned off, often spending 6-8 weeks in hospital We performed a regional audit of management practices and evolved our own evidence based multi professional treatment pathway. Current Management: At risk mothers identified antenatally by obstetrician and midwife with special interest. Woman screened for communicable diseases, proper antenatal care ensured Multidisciplinary team meeting with social services and action plan put into place Following delivery, baby kept with mother in the postnatal wards whenever possible, ensuring mother-infant bonding; breast feeding encouraged. Infant kept under surveillance with modified Finnigan Score, commenced on Oromorph if showing signs of withdrawal, without separating from the mother.A standardised guideline for introducing and weaning Oromorph therapy introduced A shortened score sheet is used to teach parents to recognise signs of withdrawal. Follow up of the early discharged infant with twice weekly visits by the Community Neonatal Nurse until weaned off all medication Consultant follow up in the outpatient clinic.

NEO/48(P) NEONATAL IRON STORAGE DISEASEPiyush Shah, Manish Arya , Senthilkumar, Vidyanand Patil, M.Malkanidrprashant1981@rediffmail.com NISD a rare fulminant liver disease of unknown cause characterized by iron deposition in Liver , Pancreas ,Heart and Endocrine organs. Some are Autosomal Recessive . It has rapidly fatal progression characterized by hepatomegaly , hypoglycaemia, hypoprothombinemia ,hypoalbuminemia . and hyperbilirubinemia. Chelating agents are ineffective . LIVER Transplant could be considered. CASE : 7 days old , female ,BONCM,with complaints of severe Jaundice ,ecchymotic patches ,haematuria, malena ,On investigation. Blood Sugar-10 mg%,Sr.Bilirubin:32mg% with Prothromin time of 60 sec for control 12sec, Septic workup being negative, Sr.Albumin-1.2 with LFT deranged. Was started on glucose maintenance drip But succumbed in three hours of admission. POST-MORTEM Liver Biopsy was suggestive of stainable IRON seen as granules in haepatocytes with extramedullary haematopoesis S/O NEONATAL HAEMOCHROMATOSIS. NEO/49(P) SERUM BILIRUBIN WITHIN 24 HRS OF LIFE: RISK OF NEONATAL HYBERBILIRUBINEMIAChanchal Kr Kundu ,Jayant Kr Ghosh ,Subhashis Bhattacharya, Malay Kr Sinha ,Sukanta ChatterjeeNeonatology unit,Dept of Pediatric Medicine, Medical College, Kolkata drjayantkg@yahoo.co.uk

Objective: To determine the risk of developing hyperbilirubinemia in neonates based on their serum bilirubin value within 24 hrs of life. Method: This is a prospective study on term appropriate for

gestational age babies followed upto 7 days of post natal age with estimation of serum bilirubin within 24 hrs of life and on day 5.Exclusion Criteria: Newborn with low birth weight; sick neonates; newborn who have undergone any kind of resuscitative procedure or got any medication; babies with ABO/Rh incompatibility, red cell enzyme defect or any surgical cause of jaundice. Cases were defined as those who were born by LUCS having birth weight of ≥2500gm.Total 50 cases were taken and 5 cases were lost to follow up. Results: Babies born with serum ≥2.5mg/dl within 24hrs of life were found to have day 5 bilirubin around 18 mg/dl or more with development of clinical jaundice and they required intervention. Conclusion: Neonates with serum bilirubin ≥2.5 mg/dl within 24 hrs of life should be frequently followed up if discharged early.

NEO/50(P) NEONATAL NONKETOTIC HYPERGLYCINEMIA: A CASE REPORTRahul P. Bhamkar, Prisca ColacoDepartment of Pediatrics, MGM Medical College and Hospital, Navi Mumbai

Introduction: Nonketotic hyperglycinemia (NKH) is a rare inborn error of glycine metabolism (1 in 2,00,000) with autosomal recessive inheritance, classified as neonatal, infantile, late-onset and transient types.CASE REPORT: A full-term male baby (Wt 2.3 Kg) was born to a healthy, consanguineous couple by emergency caesarean section. Previously the couple had had one intrauterine male fetal death.The baby cried immediately after birth but started convulsing within a few minutes thereafter. The convulsions were myoclonic in nature occurring at 30-45seconds intervals. The baby was severely hypotonic and the seizures were refractory. His routine investigations were normal. Urine chromatogram showed excessive excretion of glycine and no organic aciduria or ketonuria. Sodium benzoate (500 mg/kg/day) and dextromethorphan (3.5 mg/kg/day) were started, but his seizures remained uncontrolled. The baby succumbed on the 14 th

day of life. His plasma glycine level was 944 μmoles /L (N 232-745 μmoles/L) and CSF glycine was 356 μmoles /L (N 2.3-14.2 μmoles/L). Glycine index was 0.38 (>0.08 is diagnostic of hyperglycinemia). DISSCUSSION: NKH is caused by a defect in the glycine cleavage system (GCS) which leads to accumulation of large quantities of glycine in the CNS. This allosterically activates N-methyl-D-aspartate (NMDA) receptors, located in the hippocampus, cerebral cortex, olfactory bulb and cerebellum to produce excitoneurtoxicity leading to intractable seizures. In the brainstem and spinal cord however it acts as an inhibitory neurotransmitter explaining the apnea, hiccups and hypotonia. Most patients of neonatal NKH are normal at birth but within 6 hours to 8 days develop progressive encephalopathy. Most of them die in the neonatal period. NKH is diagnosed by elevated levels of glycine in urine, serum and CSF in the absence of any organic aciduria and ketoacidosis. Disease severity has been directly linked with the glycine index. Enzymatic confirmation of NKH requires estimation of the GCS activity in liver samples. Glycine decreasing agents i.e. sodium benzoate and NMDA antagonists ketamine and dextromethorphan have been tried. The outcome is usually poor. Antenatal diagnosis is possible by estimation of GCS activity in chorionic villous sampling at 8-16 weeks of gestation.