Indication and short term outcome of Mechanical Ventilation in Neonates in a tertiary care hospital

Background: Mechanical ventilation of newborn has been practiced for several years with advances in many ways. As compared to the western world, neonatal ventilation in our country started in recent years.Subjects, Methods and Results: A retrospective chart review was conducted to analyze the common indications and outcome of neonates requiring mechanical ventilation in neonatal intensive care unit at Ad-Din Medical College Hospital from January 2012 to July 2013. Fifty eight neonates were ventilated over a period of 19 months of whom 39 (67.24%) survived. Respiratory distress syndrome was the commonest indication for ventilation (32.75%), followed by Perinatal asphyxia (18.96%), Pneumonia (13.79%), Neonatal Sepsis (13.79%), Meconium aspiration syndrome 6(10.16%) & Pneumothorax 6 (10.16%). Among the babies who survived, 35(89.74%) were managed solely with conventional ventilator and 4 babies required both conventional and High Frequency Oscillatory (HFOV) ventilation. Survival rate was higher where birth weight >2500gm (76.19%) and gestational age 34-37 weeks (88.88%). Survival rates was (69.23%) in <30 weeks and 60% in <1000 g. Prolong ventilator support was needed for Respiratory Distress Syndrome without surfactant (mean 254 hrs), Perinatal asphyxia (mean 187hrs) and Neonatal sepsis (mean 187hrs). Common complications were Pneumonia (12.06%), Pneumothorax (10.34%), sepsis (8.6%) & Pulmonary hemorrhage (3.4%). Survival rate was higher in babies requiring mechanical ventilation for respiratory distress syndrome (84.21%).Conclusion: Use of surfactant could decrease the duration of ventilation and mortality further in babies with respiratory distress syndrome.Bangladesh Journal of Medical Science Vol.16(1) 2017 p.24-28

Granulomatosis with Polyangiitis (Wegener Granulomatosis) with Unusual Presentation

We came across a 32 years old male admitted in our hospital with prolonged low-grade fever, haemoptysis, leg swelling, weight loss, purpuric rashes and malaena. He received anti-TB treatment at another hospital without any improvement. He was pale with bullous and purpuric lesions over legs and feet. He also had features of consolidation over both lung fields. His CRP was 312mg/L, Urine R/M/E showed 40-50 RBC/HPF, Chest X-ray showed features of bilateral consolidation, c-ANCA-10U/L (positive); Tracheal aspirate for AFB was found to be negative. We diagnosed the case as Granulomatosis with Polyangitis (WG) and started treatment with steroid and cyclophosphamide. But the patient could not be saved probably due to delay in starting management.

Neonatal Transport - Experience of a Tertiary Care Hospital of Bangladesh

Safe transportation is mostly an unnoticed neonatal health issue in Bangladesh and no documentation is available regarding the existing practices. So this study was intended to document transport status of the referred newborn to a tertiary care hospital. This observational study included 150 out born neonates over 12 months period transported from various places to NICU, Bangabandhu Sheikh Mujib Medical University (BSMMU) from May 2015 to April 2016. A structured data collection form was used to record information categorized into pre-transport, during transport and at admission. At admission detailed clinical assessment of the baby was done and recorded. Outcome was determined as discharge or death. Of 150 transported neonates, two-third were preterm 115(77%) & LBW 113(75%). Common indications for referral were prematurity and sepsis. Most of the patients were referred from private hospital 107(71%). Majority of newborns (86%) were referred from hospitals of Dhaka city while only 14% were referred from outside Dhaka. Referral notes were supplied in most of the cases 134(89%) but comprehensive information was obtainable only in 3 cases. Although main transport vehicle was ambulance 130(87%), medical personnel accompanied the sick baby only in 6(4%) of cases. The distance traveled was less than 10 kilometers (kms) in 95(63%) and more than 100 km in 10(7%) of enrolled neonates. Transport time was less than 1 hour in 72(48%), 1-6 hours in 66(44%) and more than 6 hours in 12(8%) of cases. Nearly two third of newborn were transported after office period, 107(72%). At admission 21(14%) babies had hypothermia, 8(7.62%) hypoglycemia, 16(11%), poor perfusion 28(19%), low saturation 27(18%). Hyperthermia & hyperglycemia were observed in 8(5%) & 7(5%) cases respectively. Of the total 150 babies referred, 17(11%) died. While comparing with discharged newborn, died newborn were more frequent sufferer of hypothermia (p value 0.007) and low saturation (p value 0.049) at admission. Premature, low birth weight and sick newborns are being transported despite lack of safe transport system.

Development of Floating-Mucoadhesive Microsphere for Site Specific Release of Metronidazole

PURPOSE

The purpose of this study was to develop and evaluate metronidazole loaded floating-mucoadhesive microsphere for sustained drug release at the gastric mucosa.

METHODS

Alginate gastroretentive microspheres containing metronidazole were prepared by ionic gelation method using sodium bicarbonate as gas forming agent, guar gum as mucoadhesive polymer, and Eudragit L100 as drug release modifier. Carbopol was used for increasing the bead strength. The microspheres were characterized by scanning electron microscopy and evaluated by means of drug entrapment efficiency, in vitro buoyancy, and swelling studies. In vitro mucoadhesion and drug release studies were carried out in order to evaluate site specific sustained drug release.

RESULTS

All formulations showed 100% buoyancy in vitro for a prolonged period of time. Amount of guar gum influenced the properties of different formulations. The formulation containing drug and guar gum at a ratio of 1:0.5 showed the best results with 76.3% drug entrapment efficiency, 61.21% mucoadhesion, and sustained drug release. Carbopol was found to increase surface smoothness of the microspheres.

CONCLUSION

Metronidazole mucoadhesive-floating microspheres can be effectively used for sustained drug release to the gastric mucosa in treatment of upper GIT infection.

A Survey on Current Practice of Management of Early Onset Neonatal Sepsis

It was a survey type of cross sectional study where the participants were from different teaching/referral hospital across the country and was done to gather information regarding current practice of management of neonatal sepsis among paediatricians and neonatologists and was conducted on the spot during a national conference of Bangladesh Perinatal Society in December 2013. Specialists in neonatology, paediatrics, and some other disciplines working in different institutes across the country were requested to respond. Out of 150 physicians, 92 (61.33%) were neonatologists. Physicians suspected early onset neonatal sepsis (EONS) when there is history suggestive of prolonged rupture of membrane (74.77%), prolonged labour (9.33%), chorioamnionitis (7.33%) and maternal fever (2%). Clinical sepsis is found commonly (53.33%) which is later proved by laboratory evidences such as Hb%, TC, DC PBF (peripheral blood film), C-reactive protein, chest X-ray etc. Injection Ampicillin and Gentamycin are still the first choice of antibiotics (61.3%). Preferred route was intravenous (95.3%). Antibiotics were given for 7-10 days by most of the physicians (48.77%). However there is lack of uniformity among the participants in regard to taking decision about antibiotics, the choice of first line and the subsequent options of antibiotics. So, neonatal sepsis is the most important cause of neonatal mortality in the community. Therefore a standard protocolized approach for diagnosis and management of Early Onset Neonatal Sepsis may prove critical which is currently not in practice uniformly.

Neonatal Conjunctivitis Leading to Neonatal Sepsis--A Case Report

Neonatal conjunctivitis is the most common occular disease in neonates. Most infections are acquired during vaginal delivery. In spite most of these cases are benign; some of them may progress to systemic complications like loss of vision if left untreated. The authors present a case of a newborn who developed late onset neonatal sepsis from E. coli positive conjunctivitis. The baby was treated with Injection Meropenem and Injection Amikacin for 10 days. The course was uneventful, after that baby responded well and discharged home on 24th day.

Salt Losing Variety of Congenital Adrenal Hyperplasia--A Case Report

Congenital adrenal hyperplasia is a genetic endocrinologic disorder. The severe classic form occurs in one in 15,000 births worldwide. Twenty-one-hydroxylase deficiency (21-OHD) is the most common cause in this autosomal recessive disease. It can cause virilization, ambiguous genitalia at birth and severe life threatening condition due to salt wasting. In this report we describe the clinical course of a male neonate presenting with lethargy, failure to thrive (FTT), genital pigmentation, electrolytes imbalance and high serum 17-hydroxy-progesterone (17-OHP) level and subsequently diagnosed as Congenital Adrenal Hyperplasia. After the initial crises management, the child was continued on replacement therapy. During the follow up, he was found to grow appropriately and achieving normal milestones for age.

A Case of Organic Acidemia: Are Physicians Aware Enough?

Diversity of clinical presentation of inborn errors of metabolism (IEM) gives a diagnostic challenge to the practicing physicians. In recent years there have been dramatic advances in the diagnosis and treatment of these fatal diseases, which shows improved prognosis of many of these conditions. The need for screening for IEM arises out of the fact that most cases take to irreversible effects as time progresses. Here, the main challenge is to recognize the early signs and symptoms that are also common to sick infants with other diseases. We describe a 32-day-old female infant who was finally diagnosed as a case of IEM (organic acidemia).The baby had a history of multiple neonatal intensive care unit admission. She died during her last hospital admission. The purpose of our case presentation is to provide clues to the true nature of the disease and to make physicians aware about the possibility of IEM.

HOW TO CITE THIS ARTICLE

Mosleh T, Dey SK, Mannan MA. A Case of Organic Acidemia: Are Physicians Aware Enough? Euroasian J Hepato-Gastroenterol 2016;6(1):89-90.

Brinjal shoot and fruit borer infestation in relation to plant age and season

Brinjal shoot and fruit borer infestation varied significantly in relation to plant age and season. The peak shoot infestation was 8.56% in the 10th week of transplanting. No infestation of BSFB was found up to 5 weeks of transplanting. The shoot infestation was initiated in the 6th week of transplanting which increased to a little higher level in the next week. Then it showed an exponential increase of shoot infestation up to 10th week after which it declined steadily. Flowering and fruit setting started in the 9th week of transplanting. Infestation of brinjal shoot and fruit borer (BSFB) shifted to fruits from shoots causing a steady declined in the trend of shoot infestation. Plant age had significant effect (r2=0.87) on fruit infestation. The fruit infestation reached the highest level (38.56%) in 14th week of transplanting. However, the level of infestation at different ages of the plant may vary depending on the location, temperature, variety etc. The shoots and fruits of brinjal plant were found to be infested by BSFB throughout the year, although the level of infestation varied. Maximum shoot and fruit infestation was found in the month of September.Bangladesh J. Agril. Res. 40(3): 399-407, September 2015

Osteopenia of Prematurity: Are We at Risk?

The continuous advances in intensive care have led to increased survival of premature infants. As a consequence, the problem of less imminent, slowly progressing disorders such as osteopenia of prematurity has been emerging. Osteopenia of prematurity (OOP) also called metabolic bone disease of prematurity (MBD) or rickets of prematurity is characterized by a reduction in bone mineral content usually manifest between 6th to 12th weeks of corrected gestational age. It occurs in up to 55% of infants born with weight <1000gm and 23% of infants weighing <1500gm. Clinical features of osteopenia of prematurity are mostly non-specific often appears as a late symptoms. Several biochemical markers have frequently been used as screening tools and diagnostic markers, but timing of measurements and the levels at which treatment should be initiated vary widely. Dual energy X-ray absorptiometry (DEXA) and Quantitative ultrasnogram are important diagnostic tool. Standard X-ray, a widely accepted but cannot detect osteopenia unless 20% loss of bone mineralization. The treatment of osteopenia includes provision of adequate mineral supplementation. Monitoring of serum and urinary markers are mandatory. The focus on prevention has largely centered on providing adequate intake of phosphorus and calcium but more research is needed. Till date there are neither enough data regarding clinical risk factors, valid biochemical markers which can detect premature babies at risk of osteopenia nor supplementation as well as appropriate timely management protocol is practicing in Bangladesh.

Identification of bacterial isolates in neonatal sepsis and their antimicrobial susceptibility

A cross-sectional descriptive study was conducted in the Neonatal Intensive Care Unit (NICU) of Ad-din Medical College Hospital during the period of January to December 2011 to determine the pattern of bacterial agents causing neonatal sepsis and their susceptibility pattern to various antimicrobial agents. Blood cultures were performed on admitted newborn babies (0-28 days) to rule out sepsis. Antimicrobial susceptibility testing was done for all blood culture isolates according to the criteria of the National Committee for Clinical Laboratory Standards by disk diffusion method. Out of 1000 screened blood cultures, 87(8.7%) reported as positive and the gram positive and gram negative bacteria accounted for 21(24.1%) and 66(75.9%) respectively. The most common gram positive organisms were Coagulase Negative Staphylococcus Aureus (CONS) (18.4%) and Staphylococcus Aureus (4.6%) and gram negative organisms were Acinetobacter (34.4%), Pseudomonas (21.8%) and Klebsiella spp. (6.9%). The susceptibilities were remarkably low to Ampicillin (20%) and Cefotaxim (29.6%) for both gram positive & gram negative isolates. Gram positive group had susceptibilities of 71.1% to Gentamicin, 85.7% to Imipenem & 100% to Amikacin & Vancomycin. Gram negative isolates showed higher sensitivities to Colistin (96.9%), Piperacillin-Tazobactum (78.7%), Imipenem (74.2%), Levofloxacillin (71.2%), respectively. Gram-negative bacteria showed high level of resistance to commonly used antibiotics (Ampicillin, Ceftazidim and Cefotaxim). Gentamicin, Amikacin, Imipenem and Levofloxacin were the most effective drugs compared to others. Routine bacterial surveillance and their sensitivity patterns must be an essential component of neonatal care.

Augmented post-induction therapy for children with high-risk acute lymphoblastic leukemia and a slow response to initial therapy

BACKGROUND

Children with high-risk acute lymphoblastic leukemia (ALL) who have a slow response to initial chemotherapy (more than 25 percent blasts in the bone marrow on day 7) have a poor outcome despite intensive therapy. We conducted a randomized trial in which such patients were treated with either an augmented intensive regimen of post-induction chemotherapy or a standard regimen of intensive post-induction chemotherapy.

OBJECTIVE

To compare the effect of augmented therapy with standard intensive post induction therapy in children with high-risk ALL who entered remission after a slow response to initial therapy.

METHODS

Between January 2005 and December 2011, 311 children with newly diagnosed ALL who were either 1 to 9 years of age with white cell counts of at least 50,000 per cubic millimeter or 10 years of age or older, had a slow response to initial therapy, and entered remission at the end of induction chemotherapy were randomly assigned to receive standard therapy (156 children) or augmented therapy (155). Those with lymphomatous features were excluded. Event-free survival and overall survival were assessed from the end of induction treatment.

RESULTS

The outcome at five years was significantly better in the augmented-therapy group than in the standard-therapy group. The difference between treatments was most pronounced among patients one to nine years of age, all of whom had white-cell counts of at least 50,000 per cubic millimeter (P<0.001). Risk factors for an adverse event in the entire cohort included a white-cell count of 200,000 per cubic millimeter or higher (P=0.004). The toxic effects of augmented therapy were considerable but manageable.

CONCLUSION

Augmented post-induction chemotherapy results in an excellent outcome for most patients with high-risk ALL and a slow response to initial therapy.

Newborn hearing screening: what are we missing?

The objectives of the study were to demonstrate hearing status in newborns at first screening by Transient Evoked Otoacoustic Emissions and to find out the relationship between abnormal hearing screening and known risk factors. This study was conducted in the department of neonatology of Bangabandhu Sheikh Mujib Medical University in collaboration with department of otolaryngology and department of obstetrics and gynaecology. This prospective observational study included a cohort of 168 neonates from Neonatal Intensive Care Unit and neonatal Nursery (Minimal care unit). All were screened for hearing impairment using Transient Evoked Otoacoustic Emissions in out-patient department of otolaryngology by a trained audiologist before discharge from hospital. Risk factors analysed were according to the criteria of American Academy of Pediatrics. Of the total neonates screened, Refer rate was 32.7% irrespective of presence or absence of risk factors. Small for gestational age, in-utero infections, ototoxic medications, birth weight < 1500, sepsis/meningitis, hyperbilirubinemia were found to be significant risk factors (p < 0.0001). It can be recommended that hearing screening should be universally done for all newborns.

Clinical experience with BIAsp 30: Results from the Bangladesh cohort of the global A1chieve study

The aim of A1chieve was to remedy the deficit of data on the efficacy and safety of insulin analogues in routine clinical care in less well-resourced developed countries. To present results from the Bangladesh cohort of the A1chieve study receiving BIAsp 30 ± oral anti diabetic drugs. A1chieve was a 6-month, observational study of 66,726 people with type 2 diabetes, started on insulin detemir, insulin aspart or biphasic insulin aspart (BIAsp 30) in 28 countries across four continents. A total of 1,093 subjects were recruited from 49 sites in Bangladesh and 580 subjects initiated on BIAsp 30 were studied. In the entire cohort, treatment with BIAsp 30 for 24 weeks significantly reduced mean HbA(1c) (2.8%, p < 0.001), fasting plasma glucose (4.0 mmol/L, p < 0.001) and post prandial plasma glucose (6.6 mmol/L, p < 0.001) levels from baseline. The rate of overall hypoglycaemic events in the entire cohort also reduced significantly at 24 weeks (1.86 to 0.02 events/person year, p < 0.0001). BIAsp 30 can be considered as a safe and effective option for initiating as well as intensifying insulin therapy for type 2 diabetes.

Short-term outcome of magnesium sulfate infusion in perinatal asphyxia

This randomized, single blind, controlled, clinical trial was done to see the effect of magnesium sulfate infusion in perinatal asphyxia. This study was conducted in the Department of Neonatology, Bangabandhu Sheikh Mujib Medical University and Dhaka Medical College Hospital from January, 2010 to October, 2010. Total 50 term neonates having postnatal age less than 12 hours with history of perinatal asphyxia and had history of hypoxic ischemic encephalopathy (moderate or severe) were included in this study. Patients were assigned randomly to receive either 3 doses of magnesium sulfate infusion at 250mg/kg per dose (0.5ml/kg per dose) 24 hours apart (experimental group) or 3 doses of normal saline infusion 24 hours apart (placebo-controlled group). Both groups also received supportive care according to the unit protocol for perinatal asphyxia. Baseline characteristics of 50 neonates had no differences in gestational age, birth weight, gender, mode and place of delivery, parity, ANC, liquor colour and hypoxic-ischemic encephalopathy (HIE) staging and mean age of intervention between the experimental and controlled groups. The mean serum magnesium at admission was 1.6±0.3mg/dl and 1.8±0.4mg/dl and after 48 hours was 3.9±0.6mg/dl and 1.9±0.2mg/dl in experimental group and in controlled group respectively. There was no significant difference or alteration in colour, heart rate, respiration, capillary filling time/blood pressure and oxygen saturation between the experimental and control groups. At discharge, 26% (5 of 19) of infants in the experimental group had neurological abnormalities, compared with 61% (11 of 18) of infants in the control group. At discharge experimental group were received more (78% vs. 44%) oral feedings by sucking compared with the controlled group. There is no significant difference in Electroencephalographic (EEG) abnormalities between groups. Good short-term outcomes at discharge were seen more (60% vs. 32%) in the experimental group, compared with the placebo-controlled group. The overall mortality rate in our study was 26%. Postnatal magnesium sulfate infusion is effective in improving short-term outcomes in neonate with perinatal asphyxia.

Neonatal Sepsis – A Review

DOI: http://dx.doi.org/10.3329/bjch.v36i2.13084 Bangladesh J Child Health 2012; Vol 36 (2): 82-89

Prevalence and Pregnancy Outcome of Gestational Diabetes Mellitus Among Bangladeshi Urban Pregnant Women

Objective: To assess the prevalence of gestational diabetes mellitus (GDM) among the pregnant women of Dhaka city and to find out the consequences or effects of GDM on pregnancy outcome. Materials and methods: This was a descriptive type of cross sectional study followed by cohort type of study, conducted in different hospitals in Dhaka city. Initially 960 pregnant women of 24th to 28th weeks were selected purposively; plasma glucose was measured at fasting and two hours after taking 75g oral glucose load. Modified method of Carpenter and Coustan criteria was followed to diagnose GDM. For each GDM case diagnosed, one non-GDM pregnant women was taken as control after matching age and parity. Both groups were followed up to 4 wks after delivery to find out maternal and neonatal mortality and morbidities. Results: Out of 960 pregnant women 72 were GDM positive (7.5%).There was no maternal mortality but morbidities like hydramnions (p<0.001)), pre-eclampsia (p<0.001)), urinary tract infection (p<0.05), puerperial sepsis (p<0.05)) and surgical interventions (p<0.001) were more prevalent in GDM compared to non-GDM groups. The prevalence of antipartum haemorrhage, post partum haemorrhage, and eclampsia did not vary between the groups. There was one still birth, one perinatal mortality (due to respiratory distress syndrome) and one congenital anomaly observed in neonates of GDM mothers. More pre-term (p<0.01), post-term (p<0.01), low birth weight (p<0.001) and macrosomic (p<0.001) babies were found among the babies of GDM mothers than non-GDM mothers. More babies also suffered from neonatal jaundice (p<0.05) and respiratory distress syndrome (p<0.05) in GDM groups than non GDM groups. Conclusion: The prevalence of GDM in urban Bangladeshi population is about 7.5%. Maternal morbidities like hydramnios, pre-eclampsia, infections and operative interventions were observed more in GDM mothers. Pre-term, post-term and LBW babies alone with perinatal morbidities like respiratory distress syndrome, macrosomia and neonatal jaundice were more common in babies of GDM mothers. DOI: http://dx.doi.org/10.3329/jom.v13i2.12749 J Medicine 2012; 13 : 147-151

Caldwel-Luc operation without intranasal antrostomy

Introduction: Sub-labial antrostomy also known as Caldwel-Luc operation is a well-accepted procedure to remove any diseased mass, organic tissue or non-organic foreign body from maxillary antrum. The proceedings of this operation are though complex but not complicated if done by an expert hand. In addition to sub-labial approach this procedure is followed by an intranasal antrostomy to facilitate future drainage and through which the antral pack is introduced and removed post-operatively.Methods: In our series of 30 patients, we performed the same procedure through sub-labial approach only. No intranasal antrostomy were done. Also we opened the antrum by a small hole made over antero-lateral wall of the antrum.Results: The adopted method decreased the post-operative morbidity and also reduced the period of healing. No patient developed any major complication like oro-antral fistula either on immediate or long term follow-up up to one year. Only one (3.33%) patient had a temporary obstruction in drainage of collection in antrum even after not performing the intranasal antrostomy.Conclusion: Thus we conclude that this modification of Caldwel-Luc operation only through sub-labial approach without performing intranasal antrostomy could be accepted as an innovative procedure for better outcome of the patients as well as its cost-effectiveness DOI: http://dx.doi.org/10.3329/bjo.v18i2.12007 Bangladesh J Otorhinolaryngol 2012; 18(2): 156-160

Maternal and foetal risk factor and complication with immediate outcome during hospital stay of very low birth weight babies

This prospective study was done to find out the maternal and foetal risk factors and complications during hospital stay. It was conducted in Special Care Neonatal Unit (SCANU), Department of Child Health, Bangabandhu Memorial Hospital (BBMH), University of Science and Technology Chittagong (USTC) from1st October 2001 to 30th March 2002 and cases were 35 very low birth weight (VLBW) newborns. Common complications of VLBW babies of this series were frequent apnea (40%), Septicemia (25.71%), Hypothermia (17.14%), NEC (14.28%), Convulsion (11.43%), Hyper-bilirubinaemia (8.57%), Anemia (5.71%), IVH (5.71%), RDS (2.86%), HDN (2.86%), CCF (2.86%), ARF (2.86%), either alone or in combination with other clinical conditions. Newborns 62.86% male, 37.14% female & their mortality rate were 40.91% & 38.46% respectively; Preterm 88.57% & their mortality (41.93%) were higher than term babies (25.00%); AGA 62.86%, SGA 37.14% & mortality rate of AGA babies (45.46%) were higher than of SGA (30.77%) babies. The mortality rate of VLBW infants of teen age (≤ 18 years) mothers (57.14%) & high (≥ 30 years) aged mothers (50.00%) were higher than average (19-26 yrs) maternal age mothers (33.33%). Mortality rate was higher among the babies of primi (41.67%) than multiparous (36.36%), poor socioeconomic group (53.33%) than middle class (30.00%) & mothers on irregular ANC (47.83%) than regular ANC (25.00%). It has been also noted the mortality rate of home delivered babies (50.00%) higher than institutional delivered (34.78%) babies; higher in LUCS babies (46.15%) than normal vaginal delivered babies (31.58%); higher in the babies who had antenatal maternal problem (48.15%) than no maternal problems babies (12.50%); higher in the babies who had fetal distress (50.00%) and twin (46.67%) than no foetal risk factors (28.57%) during intrauterine life; higher in the babies who had problems at admission (46.67%) than no problems (35.00%); and mortality higher in twin (46.67%) than singleton babies (35.00%). Maximum VLBW babies who died during hospital stay had multiple problems and mortality was varied from ?60-100%. The babies who had frequent apnea have been carried relative better outcome (mortality rate 35.72%). In this study out of total 35 studied baby 21(60.00%) survived and 14(40.00%) died. Frequent apnea, sepsis, hypothermia, NEC, convulsion, jaundice, anemia, IVH, and RDS are common complications in VLBW babies. Male sex, prematurity, primiparity, average (middle) socio-economic status, irregular ANC, preterm labor, toxemia of pregnancy, prolonged rupture of membrane, malnutrition, multiple gestations and foetal distress are risk factor for VLBW delivery. Clinical outcome depends on maturity, birth weight, centile for weight, maternal age, parity, maternal nutrition & socio-economic status, ANC, place & mode of delivery, maternal problems during antenatal & perinatal period, number of gestation, fetal condition, presentation at admission, postnatal problems, time of start of management & referral and level of care.

Out come of induction of remission in undernourished children with acute lymphoblastic leukaemia

Acute lymphoblastic leukaemia (ALL) is the most common childhood leukaemia. On the other hand under-nutrition is a common problem in our country. This prospective study was conducted to see the outcome of induction of remission in undernourished children with acute lymphoblastic leukaemia. This study was carried out in the department of Paediatric hematology and oncology of Bangabandhu Sheikh Mujib Medical University (BSMMU) during the period from November 2002 to October 2004. A total of sixty (60) children who were diagnosed as acute lymphoblastic leukaemia in 1 to 15 years of age were included in this study. But the children with previous history of congenital disease and that of chemotherapy or steroid were excluded from this study. Patients were divided into two groups on the basis of Z score of weight for age. Thirty (30) children those with Z score- 2 or less were classified as undernourished and was labeled as Group A and another thirty (30) patient those Z score above-2 were classified as well nourished and was placed in Group B, After inclusion into the study, completion of induction of remission was monitored by physical examination and laboratory investigations. The result showed that mean age in Group A was 77.16 ± 7.07 months and that in Group B was 74.13 ± 5.09 months with male preponderance in both the groups. Mean body weight in Group A was 14.55 ± 0.76 Kg and that in Group B was 21.40 ± 1.05 kg (p<0.001). Children in Group A required 39.06 ± 0.72 days to complete induction but in Group B it required 31.63 ± 0.17 days (p<0.04). Hospital stay in Group A children was 52.10 ± 1.08 days and in Group B 42.37 ± 0.50 (p<0.002). The result suggested that under nutrition has an influence on the out come of induction of remission in undernourished children with acute lymphoblastic leukaemia. So appropriate measures are essential to improve nutritional status of children for successful management of ALL in children.

Nutritional parameters in children with cancer

The study was conducted in the Departments of Pediatric Haemato-Oncology, Bangabandhu Sheikh Mujib Medical University, Shahbagh, Dhaka, Bangladesh from January 2007 to May 2009. Total 44 children (34 males and 10 females) aged between 10 months and 12 years with newly diagnosed malignancy. Nutritional status of 44 children with newly diagnosed malignancy was evaluated by anthropometric, hematological results and biochemical parameters before initiating therapy and response to therapy was assessed during follow up. Malnutrition was seen in 56.8% children by weight for age criteria (WFA <-2z). Low hemoglobin was found in 82% children, 25% had low total proteins (<5.7g/dL), 20.5% low serum albumin (<3.2g/dL), 27.3% low serum transferrin (<210mg/dL) and 16.3% low serum iron (<60μg/dL). Mean anthropometric and biochemical parameters were higher among the survivors compared to non-survivors. Significant difference between the well nourished and the malnourished group was detected in the achievement of remission/response (69.5% vs. 38.1%), delays in therapy (8.7% vs. 38.1%) and mortality (30.5% vs. 61.9%). Complications like febrile neutropenia and bleeding were more in the malnourished group. A statistically significant higher incidence of infection was seen in children with serum iron <60μg/dL than those with higher values of serum iron (42.8% vs. 8%).

Effect of recombinant human granulocyte colony stimulating factor (rhG-CSF) for the treatment of neonates in presumed sepsis with neutropenia

Bacterial sepsis continues to be an important cause of morbidity and mortality in neonates. In newborn with presumed sepsis, short-term treatment with rhG-CSF increased the neutrophil count and more importantly improved survival. The objective of the study was to evaluate the effect of rhG-CSF for the treatment of neonates in presumed sepsis with neutropenia. This interventional study was conducted in the Department of Neonatology, BSMMU, Dhaka during July 2009 to May 2010. Total 30 neonates of presumed sepsis with absolute neutrophil count ≤5000/cumm, age<28 days and birth weight 1000-2000g were included in the study. A subcutaneous injection of rhG-CSF (10μgm/kg/day) was administered to 15 neonates for 5 consecutive days (study group) and 15 neonates did not receive it (control group) in addition to standard antibiotic protocol for neonatal sepsis. Baseline characteristics of 30 neonates shows male/female ratio, weight on admission, gestational age were similar in both groups. Among 30 neonates of clinically presumed sepsis 7(23%) were culture proven. E. coli was the most common organism. After 24 hours of treatment mean ANC was increased more in study group (p<0.05) compared to control group. Mean ANC after 72 hours of treatment was increased significantly in study group than control group: 5940.00 versus 5706.00 (p=0.01). At the end of treatment, the mean ANC was higher than that of control (p=0.001). Twelve neonates in study group and ten neonates in control group survived to hospital discharge. The mortality rate in the study group 3/15(20%) and in control group 5/15(33%) were not significant. Duration of hospital stay was less in study group but not significant. The study concluded that before routine use of rhG-CSF in neonatal sepsis with neutropenia further large scale, multi-centre, randomized, placebo controlled trial are needed to validate the beneficial effect.

Postnatal development of renal function in preterm and term neonates

The study was done to determine the renal function in preterm and term newborn infants in the neonatology unit of the Department of Paediatrics and Labour Ward of the Department of Obstetrics and Gynaecology, Bangabandhu Sheikh Mujib Medical University (BSMMU) during the period of February 2002 to February 2003. Sixty physiologically stable newborn infants were enrolled in this study, 40 of those were preterm and 20 were term. The gestational ages of preterm and term babies were 35.6±4.7 and 39.10±1.41 weeks respectively. Mean weight of preterm babies was 1840±410 gm and term babies was 3150±340 gm respectively. Male to female ratio was1.6:1. The concentration of serum creatinine was high during the first week of life in both the term and preterm babies. The concentration decreased in both the groups during the subsequent 3 weeks. Although creatinine values were significantly high in preterm babies than the term babies at first week (p<0.001), the values reach to almost similar at 3rd week of life. A negative correlation was found between serum creatinine and gestational age (r=0.86, p<0.001). Creatinine clearance was found low at birth, the lowest values being observed in the most premature infants (p<0.0001) and was increased in the subsequent 3 weeks of the study period. Creatinine clearance showed a positive correlation to gestational age from the first week onwards (r=0.87, p<0.001). Fifteen percent preterm babies were hyponatraemic and in all term babies serum level of sodium was within normal limit. Fractional excretion of sodium was high in preterm neonate than the term neonate especially in early weeks of life (p<0.001). The value correlated negatively to gestational age (r=0.67, p<0.001). It was evident from the present study that the renal function is significantly lower in preterm neonates than term neonates. The study also indicates that the maturation of renal function occurs earlier in the term babies than the preterm babies.

17β-hydroxysteroid dehydrogenase-3 deficiency in disorder of sex development

A 29 years old patient, claimed to be a male, presented to us with pubertal gender swing from female to male. Since birth he was reared as a female child. His breasts, axillary hairs and pubic hairs developed at about 11-12 years of age. At that time he also observed the mental and physical changes towards a male. He began to feel sexual attraction towards females due to enlargement of his phallus and he preferred to behave as a male. The patient further noticed deepening of voice as well as appearance of facial hairs at about 15 years of age. He never experienced menstruation. His parents are first degree cousins. On examination, there was facial hairs in upper lip and chin (G3), breasts were in mature stage (B5), pubic hairs were darker, coarser and curlier and spreading sparsely (P3), and stretched dorsal phallic length was 6cm. In perineoscrotal area, there was hypospadias with blind vaginal pouch, partially fused, pigmented & ruggated bilateral labio-scrotal folds and soft palpable ellipsoid gonads measuring about 8 ml (each) in volume within labio-scrotal folds. Ultrasound examination revealed no uterus and karyotyping test found 46XY. Provisionally, he was diagnosed as a case of 46,XY Disorders of Sex Development (DSD). On further investigations, serum testosterone was low, serum LH and DHEA were raised and serum electrolytes were normal. From history, physical examination and investigations we diagnosed the case as 46,XY DSD due to 17β-hydroxysteroid dehydrogenase-3 deficiency.

Role of serum procalcitonin and C-reactive protein in the diagnosis of neonatal sepsis

This cross sectional observational study was done in the division of neonatology, department of pediatrics, Bangabandhu Sheikh Mujib Medical University (BSMMU) in the year 2007. The study population was 50 newborns in total who needed evaluation of sepsis on clinical suspicion. The main objective of this study was to assess serum procalcitonin (PCT) as a better diagnostic marker than C-Reactive Protein (CRP) in neonatal sepsis. The total study populations were classified into 4 groups like highly probable, probable, and possible and no sepsis group according to the clinical and blood parameters. PCT and CRP were assessed and compared by statistical analysis. For the estimation of PCT and CRP, venous blood was drawn and centrifuged and stored at - 20 degrees C in the refrigerator. Later on PCT was measured by rapid semi quantitative immunochromatographic test. Level of CRP was determined by semi quantitative method (latex). All data were analyzed by SPSS version 10 windows. For statistical analysis appropriate tests were done. In all observations sepsis was found to be more common in male newborns and in those who were delivered by caesarean section. In low birth weight and preterm newborns sepsis was more prevalent. Premature rupture of membrane (PROM) was found to be the commonest maternal clinical condition as a risk factor of sepsis. There was positive correlation between serum PCT and CRP and values of serum PCT as well as CRP differed significantly in the different categories of sepsis indicating relation to the severity of sepsis. PCT is a useful, sensitive and independent biomarker of neonatal sepsis. CRP measurement along with PCT measurement may increase the specificity. Though PCT measurement is comparatively expensive but an easy bed side promt convenient procedure for sick neonates in addition to CRP for rapid evaluation of neonatal sepsis rather than waiting for the report of blood culture.