NEO/01(P) ZINC AND COPPER STATUS OF VERY LOW BIRTH WEIGHT INFANTSAshok Kumar, Sriparna Basu, Meera Gupta, D. Dash, P. N. Singla, J.S. SinghThe Departments of Pediatrics and Biochemistry, Institute of Medical Sciences and Department of Botany, Faculty of Science, Banaras Hindu University, Varanasi

Introduction: Zinc and copper are essential trace elements required for new tissue synthesis and fetal growth. Deficiency is a major concern in very low birth weight (VLBW) infants as they are more susceptible owing to their smaller store at birth, delayed establishment of full enteral feeding and higher growth velocity in the first months of life. Objective: To assess the levels of zinc and copper in maternal and cord blood sera and the impact of these trace elements on the fetal growth. Materials and methods: In this prospective study the concentrations of zinc and copper were estimated by Atomic Absorption Flame Spectrophotometry in blood of expectant mothers during first stage of labor and cord blood. Detailed anthropometry and gestational age was assessed in the newborns. Statistical correlation was sought for between the variables by analyzing arithmetic mean, standard deviation, F test, Kruskal Wallis H test, Multiple Range test (SNK test) and Student’s t test. Results: A total of 87 mother-newborn pairs were selected randomly for the study. Newborns were stratified into four groups according to their birth weight (<1500, 1500-1999, 2000-2499 and >2500 g). Maternal and cord blood zinc and copper levels were found to increase progressively with increase in birth weight and gestational age of the newborns. Conclusion: Zinc and copper levels were significantly lower in the cord blood of VLBW infants indicating poor nutriture. Linear relationship existed between maternal and cord blood levels with birth weight and gestational age indicating significant influence of these elements on fetal growth.

NEO/02(P) AUDITORY BRAINSTEM RESPONSES IN NEONATAL HYPERBILIRUBINEMIA AND RESPONSE TO THERAPYNeelam Grover, Ravi Sharma, Naveen SankhyanDeptt. of Pediatrics,Indira Gandhi Medical College,Shimla,HP,171001

Objectives; To determine the effect of neonatal hyperbilirubinemia on auditory brainstem responses (ABRs) and evaluate responses to lowering of bilirubin levels Methods; This prospective study involving ABR testing in 60 neonates (40 cases & 20 controls). Term appropriate for date neonates with uncomplicated birth history and bilirubin level of ≥ 13 mg/dL were included as cases, those with bilirubin value of < 13 mg/dL were taken as controls. First BERA examination was carried out within 24 hrs of the diagnosis of hyperbilirubinemia and repeat examination was done when total serum bilirubin came down to < 13 mg/dL with treatment. Comparisons were made between cases (before & after therapy) and controls. Results; No abnormality was noted in neonates with bilirubin <18 mg/dL. Abnormal ABRs were observed in 24(60%) of the 40 cases studied, with therapy it reverted back to normal in 15(62%).The commonest abnormality noted was prolonged latency of wave V(42.5%), followed by prolonged latency of wave III(35%) and wave I(22.5%).Latency of wave I was found in only those with bilirubin >20mg/dL. Inter peak latency of wave I-V (Brain stem conduction time) was prolonged in 8 cases; it reverted to normal in all cases. Prolonged inter peak latency of wave I-III was observed in 7 cases, of which it reverted to normal in 6 .Absent waves reappeared in 4 out of 5 cases ,but abnormal amplitude ratios reverted to normal in only one of the 7 cases in which it was abnormal. Conclusions; About 60% of term AFD neonates with serum bilirubin of > 18mg/dL will demonstrate ABR changes. Most of these changes revert to normal early after therapy, indicating need for aggressive therapy in this subgroup of neonates.

NEO/03(O) ASTUDY OF PROGNOSTIC VALUE OF SEPTIC SCREENING TESTS IN NEONATAL SEPTICEMIA D.R. Dabi, Madhu Hans, R.B. SharmaUmaid hospital,Dr SN Medical College,Jodhpur

To find the value of serial septic screening tests in assessing the prognosis of septicemic cases.A total of 83 neonates who had positive septic screening tests were enrolled.The tests were done serially on admission and then on 1st,4th,7th,10th,and 14th daysuntil patient improveResult:- among recovering patients all the laboratory parameter improved with the recovery of newborns C.R.P titers progressively decreased & fall in titer was significant up to day 10. I/T ratio also progressively decreased but improvement was significant up to day 14 Among expired neonates CRP titer was very high (73.9±24.5 µgm/ml) & it remained high till death I/T ratio remained high on day 1st & 2nd of the expired patient On comparing the septic screening test between the N.B. who expired and those who recovered ,no significant difference was found for TLC, A.N.C. & micro E.S.R but a clear cut static significance was observed (p value<0.001) on 1st & 2nd day of expired neonates & day 4th of recovering of neonates Conclusion : serial C.R.P & I.T ratio in septicemic N.B. may be used as prognostic markers also.

NEO/04(P) ANALYSIS OF RISK FACTORS IN NEWBORN DEVELOPING NECROTIZING ENTERCOLITIS IN LEVEL II NEONATAL INTENSIVE CARE UNIT.Rajiv Rathoriya, Virendra Mandloi, Mahendra Mandloi, Manjusha Goel, Rashmi Dwivedi.Department of Paediatrics, Kamla Nehru Hospital, Gandhi Medical College, Bhopal.

Etiology of necrotizing entercolitis is elusive despite decades of research Objectives: Study of necrotizing entercolitis (NEC) in relation to birth weight, gestation age, perinatal and neonatal risk factors. Design: Observation based prospective study. Setting: Level II neonatal intensive care unit (NICU) of department of Pediatric, Gandhi Medical College, Bhopal. Methods: All newborn admitted to NICU during the study period from September 2004 to August 2005 with clinical symptoms of NEC (as per modified Bell’s clinical staging) irrespective of age, sex, gestation period formed the study group. All relevant data, history, physical examination, investigations, feeding records were noted on predesigned proforma. Patient were monitored regularly for abdominal distension, elevated pregavage residual and guaic positive stool & treatment was done as per standard. Result: During the study period 1456 sick newborn were admitted to our NICU, 42 of these developed NEC. 39 (93%) patients were premature (p<0.01), 27 (64%) neonates were below 1500 gm (p<0.01). 16 (38%) were small for gestation age, 17 (47%) had history of perinatal asphyxia, 8 (19%) had shock. Congenital heart disease were diagnosed in 9 (10%). Septicemia (Blood culture positive) was associated with 25 (60%) of cases. Klebsiella was isolated in 11 (28%) cases. The incidence of NEC was 2.88% of total admission. 6.21% of very low birth weight infants developed NEC. Incidence was 10%, 57%, 33% respectively in <28 week, 29-33 week and 34-36 weeks. Incidence of NEC according to birth weight was 13%, 56%, 31% respectively in <1000 gm, 1000-1500 gm, >1500 gm. The over all mortality was 38%. The mortality in stage above Ib was 69%. Conclusion: The overall incidence of NEC in our study was 2.88% of total admission. Major risk factor were prematurity (gestation age below 33 weeks), birth weight <1500 gm, septicemia & perinatal asphyxia.

NEO/05(P) ACUTE TRACHEITIS CAUSING STRIDOR IN A NEW BORN-A CASE REPORTBimbadhar Rath, Abubaker Ibrahim MaheshiB-89 Sector 26, Noida – 201301

Summary: A baby girl born to a primi by vacuum delivery with Apgar score of 1, 4 at 1, 5 minutes was resuscitated in delivery room. At 30 hours she had hyponatremic convulsions (Serum Na 113 millimoles) and hypocalcemia for which she was treated with 3% NaCl and Calcium gluconate. She was intubated at 42 hours due to recurrent apnoea and extubated 2 days later as her condition stabilized. She received Ampicillin and Cefotaxime. Within 2 hours of extubation she had moderate-severe respiratory distress (moderate–severe xiphisternal recession and marked inspiratory as well as expiratory strider) As her condition deteriorated, she was reintubated 6 hours later. Vocal cords had no significant edema and the endotracheal tube could be passed easily. Immediately following intubation the child started coughing and the tube was blocked needing its removal. It was filled with thick tenacious yellowish sputum (plenty of pus cells seen by microscopy). The respiratory distress got relived significantly within a minute or two and mild recession and wheeze that still persisted improved over next 24 hours. Culture of endotracheal tube tip grew Staphylococcus aureus. Child was discharged 3 days later. Laryngeal edema following extubation is well known cause of strider. Acute bacterial tracheitis causing acute strider is described in older infants and toddlers but not reported in newborns. Normal looking vocal cords, sudden and significant improvement after coughing out thick purulent material, persistence of some obstruction after pus came out suggests tracheitis that improved reliving the obstruction. We suggest acute tacheitis be considered in the differential diagnosis of acute strider in the neonatal period.

NEO/06(P) AN UNUSUAL CASE OF OBSTRUCTIVE JAUNDICE IN A NEONATEBimbadhar Rath, Abubaker Ibrahim MaheshiB-89 Sector 26, Noida – 201301

Summary: A preterm baby born after 31-32 weeks of gestation weighing 1800 gms became septicaemic on 5th day of life (Serratia marcescence in blood culture, sensitive to Aztreonam). He had pneumonia too. He received various antibiotics (excluding ceftriaxone), IV immunoglobulin and blood transfusion. Baby had a stormy course and took a long time to respond to Axtreonam. After 8 weeks the child developed jaundice, dark coloured urine and whitish stool. Ultrasound of abdomen revealed a distended gall bladder with thick wall (3.8 mm) and clumps of course echoes filling whole of gall bladder. Common bile duct was 2mm wide. Five days later repeat ultrasound of abdomen revealed the gall bladder partially filled with the debris, a dilated common bile duct (6.8mm) and a hyperechoic mass (5.4 X3.5mm) blocking the distal end of common bile duct. Intrahepatic biliary tree was dilated. Serum bil. 328 mmol (direct 200 mmol), Alk. Phosphatase –292 IU, ALT-178 units. Endoscopic removal of the debris was planed but could not be done due to non-availability of equipment. Parents took the child from hospital for treatment elsewhere. The debris could be either sludge or pus. There was no obvious cause for sludge formation in this baby. Echo density of debris was more in favour of pus. Acute cholecystitis is extremely rare in neonates. Debris should be considered in the differential diagnosis of obstructive jaundice in a neonate.

NEO/07(P) ASSESSMENT OF HEARING IMPAIRMENT IN HIGH RISK INFANTSRadhika Sachdev, Rajiv Kumar, Nomeeta Gupta, Sunil KathuriaDepartment of Pediatrics, Batra Hospital & Medical Research Centre, New Delhi-110062.

Introduction: Hearing loss is the most common birth defect with an estimated incidence of 0.001 – 0.5 % and may be as high as 1 – 5 % in high-risk infants. An early identification of infants with hearing impairment becomes necessary. Objectives: To assess hearing impairment and detect prevalence of hearing loss in the high-risk infants using Brainstem Evoked Response Audiometry (BERA) and Otoacoustic Emissions (OAE). Material & Methods: The present prospective study was conducted on 224 high-risk neonates for hearing loss admitted in our hospital between March 2002 and August 2004. Of these, 24 neonates were excluded from the study because these patients either died or were lost to follow up. Thus, 200 neonates were included in this study. Results: The most common risk factor was the use of ototoxic drugs in 84% of the NICU graduates. The other common risk factors were prematurity and low birth weight (43.5%), and hyperbilirubinemia (26%). 23.5% of the total patients were mechanically ventilated while another 23.5% presented either with septicemia or meningitis as the risk factor. Other risk factors were parental concern (15%), birth asphyxia (13.5%) and congenital infections (3.5%). One male patient with family history of hearing loss was found to be hearing impaired, thereby suggesting that X-linked factor was probably responsible for deafness. One family had shown autosomal recessive inheritance. Out of 52 cases with history of hyperbilirubinemia for which they were given phototherapy, 2 cases shown abnormality on wave 1 on BERA suggesting that bilirubin possibly affects auditory nerve. Six patients with history of prematurity and low birth weight had raised threshold on follow up suggesting that in prematurity a prolonged follow up is required. Seven patients were diagnosed as hearing impaired and were referred to the otolaryngologist for further management. The prevalence rate of hearing impairment in our study was 3.5%. Conclusions: OAE is a very sensitive screening test for hearing impairment while BERA is more specific for confirming the diagnosis and assessing the degree of hearing loss. Most of the neonates and infants at risk for hearing loss presented with multiple risk factors. It is advisable that the patients presenting with hearing loss in the initial screening must be subjected to BERA.

NEO/08(P) BIOTINIDASE DEFICIENCY PRESENTING IN A NEONATE DISCUSSION Kirandeep Sodhi, Uma Raju, NK Biswas, Sheila Mathai, Vishal Sondhi, HRavi RamamurthyCommand Hospital, Wanowrie Road , Pune

Biotin is a water soluble vitamin that acts as a cofactor for the four carboxylase enzymes . Free biotin is generated in the intestine by the action of digestive enzymes and biotinidase . The latter enzyme is also necessary for recycling of biotin in the body .Biotinidase deficiency is an inherited autosomal recessive metabolic disorder of biotin recycling that leads to multiple carboxylase deficiencies .The condition is rare with an incidence of 1 in 60, 000 Objective: To report a rare inborn error of metabolism which although rare is treatable . Case Report : Our patient presented in the early neonatal period with tachypnea , lethargy, hypotonia and a malodorous urine which in the presence of repeated negative septic screen made us suspect an inborn error of metabolism and prompted us to investigate the baby for the same . A metabolic work up revealed a normal blood ammonia , normal pH , and anion gap . The blood sugar was normal, urine ketones were negative as was the ferric chloride test .The propionyl carnitine levels were found raised . Assay of biotinidase demonstrated markedly reduced levels of the enzyme . Replacement with biotin was started titrating the dose according to the response of the patient . The baby was finally discharged on day 30 of life with biotin at a dose of 40 mg / day . The baby is presently two and a half months of age and doing well .

NEO/09(P) BLOOD GLUCOSE LEVELS IN LOW BIRTH WEIGHT NEWBORNSK.K.Locham, Rahul Gandhi, Ravneet Kaur, Seema Rai, Shalini SoiDeptt. of Pediatrics, Govt. Medical College/Rajindra Hospital, Patiala - 147001

Objectives : To evaluate incidence and aetiology of hypoglycemia in low birth weight newborns. Methods : The study period was 5 months from march to july,2005. 100 low birth babies delivered in the department of Obstetrics & Gynaecology and admitted in Neonatology section of Govt. Medical College and Rajindra Hospital Patiala, were the subjects of the study. Sex, mode of delivery, birth weight, gestation, apgar score, biochemical profile, septic-screen, dextrose therapy were recorded in the pretested proforma. Results : Out of 100 low birth weight babies, 13 developed hypoglycemia. Out of these 8 (61.53%) were female babies and 5 (38.47%) were male babies. 7 (53.84%) were born by caesarean section while 6 (46.2%) were born by vaginal delivery. 11 (84.6%) of the babies were preterm while 2 (15.38%) were term. Prenatal record revealed PIH and IUGR in 3 (23.07%) cases each. Premature rupture of membranes was found in 2 (15.38%) babies. Apgar score was more than 7 in 8 (61.53%) and between 5-7 in 5 (38.47%) babies. 3 (23.07%), 8 (61.53%), 1 and 1 babies were in the weight range of 2000- 2499g, 1500-1999g, 1000-1499g and <1000g respectively. 9 (69.33%) babies were AGA while 4 (30.67%) were SGA. Morbidity other than hypoglycemia were septicemia and RDS in 3 (23.07%) cases each. Development of hypoglycemia was observed within 24 hours in all the babies. Response to dextrose therapy was seen with 6 mg/kg/min in 12 ( 91.83%) babies while 1 baby had to be given dextrose at the rate of 8mg/kg/min. Out of 13 babies, 12 (91.83%) responded within 48 hours while 1 responded by 72 hours dextrose therapy. Conclusions : Hypoglycemia is a common occurrence in low birth weight babies.

NEO/10(P) BERA IN HEALTHY TERM NEONATES N.P.Chhangani,Pramod Sharma.Keshram Meena,Rakesh Jora,Ravi Bhatia,Harish KumarUmaid hospital,Dr SN Medical College,Jodhpur

Brainstem Auditory Evoked Responses (BAER) is a simple and objective tool to assess hearing functions. It provides an early means to diagnose hearing impairment in high risk neonates.This study was undertaken to record normal tracings in healthy term non-icteric babies and to draw values of various parameters and determine criteria of an abnormal record. Methods--Thirty healthy term neonates with peak serum bilirubin level less than 12mg% were enrolled as the study group.Babies with birth asphyxia,pyogenic meningitis,severe septicemia,ventilated babies and those with complicated pregnancies were excluded.BAER studies were done between 2-6 days of life using the method described by Taylor. Instrument used was NICHOLAS COMPASS MERIDIAN. Each ear was tested seperately and automatic artifact rejection was obtained. Sweep velocity used was 10m/sec. Click acoustic stimuli with a rate of 10/sec were presented at an intensity of 90db and a masking sound of 40 db given to the non-stimulated ear.An average of 2000 responses were recorded.Latency,interpeak latency and amplitude of waves were measured by placing sensors on the tracings. Results-In the study group male to female ratio was 2.3:1,mean age 3.28+0.69 days,mean weight 3.39+0.44 kg,mean gestational age 38.6+1.01 weeks and mean serum bilirubin 5.30+1.56 mg/dl.Latency of waves ranged from 1.87 msec to 6.25 msecs and inter wave interval ranged from 2.17 msec to 4.09 msec.Criteria for abnormal responses were derived which include Absent response,Prolonged latency of waves and increased threshold from both ears at 30 db. Conclusion-The study has aimed to draw normal values for various components of ABER in healthy term neonates.The values are not affected by infant's sex,presence of CNS depressants and the state of alertness. Abnormalities in records may arise because of brainstem abnormalities or hearing loss and criteria to pick up anomalies need to have normal parameters defined and drawn.

NEO/11(O) CORD BLOOD GAS ESTIMATION AND ITS CORRELATION WITH ANTENATAL MONITORING, APGAR SCORE AND NEONATAL OUTCOMESethi M, Kulkarni A, Kaul S, Puri R.K.(Late)Indraprastha Apollo Hospital, Mathura Road, Sarita Vihar, New Delhi

Background: Apgar score is the commonest mode of assessing a newborn but it has limitations. Cord blood acid base (CBAB) analysis is the gold standard for evaluation of fetal well-being at birth. In view of the limited data from our country the present study was conducted. Objectives: This prospective study was conducted from January to December 2004. 1) To assess the feasibility of CBAB estimation. 2) To evaluate the relationship between cord blood gas and antenatal evidence of fetal distress. 3) To evaluate relationship with Apgar score. 4) To assess relationship with immediate neonatal outcome. Material and methods: Sample for CBAB analysis was obtained via a double-clamped segment of umbilical cord in 100 deliveries. CBAB was compared to Apgar score, electronic fetal heart rate recordings (CTG), antenatal ultrasound (USG), antenatal doppler and neurological outcome at 24 hours age. Data was analyzed using the Mann-Whitney test. Results: The mean umbilical artery (UA) pH was 7.24 +/- 0.06. Thirty-one percent (31) of newborns had acidosis (pH < 7.2). Of these 9.7% (3) were respiratory, 35.5% (11) were metabolic and 54.8% (17) were of the mixed type. Of the newborns with acidosis 65.6% (10) had a one minute apgar score of ≤ 7. One-minute Apgar score and UA pH, pO2 and base excess were significantly related (p< .05). No newborn had severe acidosis (pH<7.0). No significant correlation was found on comparing UA acid base status with antenatal CTG, USG and Doppler. All newborns in our study had a normal neurologic status at 24 hours age and at discharge. Conclusions: Correlation between antenatal monitoring parameters and CBAB is poor. Performing CBAB analysis is a reliable way of ruling out perinatal hypoxia. Good outcome is seen even if UA pH is < 7.20, therefore a cut-off of UA pH < 7.0 should be used for defining significant UA acidosis.

NEO/12(O) CLINICAL EVALUATION OF ERROR IN SATURATION-READINGS TAKEN THROUGH A SKIN-PROTECTIVE COVERINGLokesh Tiwari, Jyotsna James, Pramod Upadhyay, Vishnubhatla Sreenivas, Vikas Bhambhani, Jacob M. PuliyelSt Stephens Hospital Tis Hazari, Delhi 110054

INTRODUCTION: In long run adult probes are far cheaper than neonatal clip probes or disposable neonatal sensors. Adult finger-clip-probes of the pulse oximetry oxygen saturation monitors can cause necrosis of the delicate skin of the neonates. Covering the skin under the probe with a Micropore tape or gauze piece can prevents such injuries. AIM: The study was done to see if the protective covering would affect accuracy of the readings. MATERIAL AND METHODS:Fifty neonates were enrolled in the study. The pulse oximetry oxygen saturation monitors readings were taken in random order with the right foot covered with a 3M Micropore tape or covered with two layers of gauze (weight 27gms/sq m +/-5%: Government of India specification) or directly without any covering. The investigator noting the readings was blinded as to how the probe was applied. The readings with micropore and gauze were each compared to the readings taken with the probe applied directly (standard method). Repeatability test was also done – a procedure describes by Bland and Altman. Statistical methods Bland Altman plots were used to study agreement between methods and to test the repeatability of the methods. RESULTS: On plotting the results as Bland Altman Curves when SpO2 readings were taken directly and through micropore, the mean difference was 0.0588 with SD of 1.39. When SpO2 readings taken directly and through gauze, the mean difference was 0.039 with SD 1.3. When test of repeatability plotted with the direct method, the mean difference was 0.215 with SD 0.23 DISCUSSION: Our findings suggest that application of gauze or Micropore-adhesive-tape between the skin and a saturation monitor probe, does not affect the accuracy of the readings to a clinically significant level. As adult probes are far cheaper than neonatal clip probes or disposable neonatal sensors in long run, considerable saving can be achieved using the reusable adult probe. CONCLUSION: Pressure necrosis can be minimized by the use of 3M Micropore or gauze piece wrapped over the area below the clip, without compromising on the accuracy of readings.

NEO/13(P) CONTROL OF VARICELLA OUTBREAK IN A NEWBORN INTENSIVE CARE NURSERYKurien Anil Kuruvilla, Jolly ChandranNeonatology Unit, Christian Medical College & Hospital, Vellore-632004, Tamil Nadu

Introduction: Outbreaks of chickenpox in newborn nurseries are rare due to limited opportunities for exposure and protection by passively acquired immunity. Aims: We report a potential outbreak of chickenpox in a neonatal unit when a physician developed chickenpox. Methods: Description of Outbreak: A paediatric registrar working in the neonatal unit developed chickenpox. She had earlier examined and taken blood samples from babies in the postnatal wards but not in the NICU. Control Measures: The risk to staff and babies in the nursery was discussed with the hospital infection control committee. Babies in the postnatal wards were considered at low risk of contracting varicella zoster (VZ). These mothers were informed of the small risk of VZ to their babies. Preterm infants in the nursery were considered to be at highest risk of VZ infection; a blood sample of these mothers and babies was taken for VZ antibody assay. Staff in the nursery were also screened for VZ antibody. Laboratory Investigations: Serum samples were tested for antibody to VZ virus: an IgG antibody titre above 250 mIU/ml was considered protective. Results: VZ antibody testing of 12 mothers who had delivered preterm babies less than 32 weeks gestation revealed that 84% had protective levels of antibody titres. 13 specimens were obtained from preterm infants in the nursery considered at high risk of infection: 62% were seropositive. They were monitored closely: none developed varicella. Among 60 nursery personnel, 30% were susceptible to VZ infection. They were provided VZ vaccine. Full term babies were reviewed postpartum and none had developed VZ infection. Conclusions: Nursery outbreaks of varicella are unusual: in this potential outbreak, 16% of mothers and 30% of hospital personnel were susceptible to varicella. No infant developed varicella supporting the hypothesis that most neonates are protected by transplacentally acquired antibody to VZ virus.

NEO/14(O) COMPARATIVE ANALYSIS OF RETRIEVED VS SELF TRANSPORTED OUTBORN NEONATES.     Gupta P, Kulkarni A, Kaul S, Gupta V And Balan S.     Division of Neonatology, Apollo Centre for Advanced Pediatrics, Indraprastha Apollo Hospital, New Delhi.

Background: Safe neonatal transport constitutes cornerstone of Specialized Perinatal care at a Tertiary Care Centre. Immediate and long-term outcome of a newborn depends, to a large extent on, clinical condition and stabilization during transport. Objectives: To assess clinical status of out born (retrieved v/s referred) at admission and correlate the mode of transport to immediate morbidity and mortality. Material and methods: This is a retrospective comparative analysis of 500 out born neonates admitted to NICU Apollo Hospital from August 2001 to December 2004. Group A comprised of 157(31.4%) cases retrieved by Apollo transport team including a registrar, a trained nurse equipped with portable incubator, ventilator, monitors, oxygen supply and infusion pumps. These were transferred after coordination with the treating doctor and stabilization of temperature, glucose, perfusion and oxygenation of the baby. Group B comprised of 343(68.7%) self transported babies arriving at triage. Neonatal Characteristics studied at arrival were: rectal temperature, blood sugar, capillary refill time, oxygen saturation, blood gas, and survival at 48 hours. Results: Birth weight and gestational age was comparable in two groups studied. At admission to NICU; In Group A 16(10.1%) had hypothermia, 21(13.3%) had hypoglycemia, 2(1.2%) had cyanosis, 12(7.6%) had CFT>3 sec and 25(15.9%) had acidosis. In Group B 225(65.5%) had hypothermia, 110(32%) had hypoglycemia, 56(16%) had cyanosis, 106(30.9%) had CFT>3 sec and 95(27.6%) had acidosis. Mortality within 48 hours was 20(12.7%) in Group A and 76(22.1%) in Group B. Conclusion: Immediate and long-term outcome varies with the mode of transport, initial stabilization of newborn. Babies transported by NICU team had low incidence of hypothermia, hypoglycemia, cyanosis, poor perfusion, acidosis and lower mortality. Ensuring Safe Neonatal transport is an important prerequisite for establishing a Tertiary Care Referral Center.

NEO/15(P) COGNITIVE ABILITIES OF HIGH RISK NEONATES AT SCHOOL AGE ACCORDING TO INTRAUTERINE GROWTHSudarshan Kumari, Anita Tandon, Sidharth Ramji, Varsha Amin ,Rajni dhingraCenter for newborn care ,Sunder Lall Jain Hospital, Ashok Vihar & Dept of Neonatology, Maulana Azad Medical College, Delhi

Objective: To evaluate psychosocial, intellectual and social maturiy of a cohort of unimpaired high risk neonates at school age according to intrauterine growth Methods: It was a hospital based ,longitudinal follow up at high risk and well baby clinic of a government hospital. Demographic data of these children was recorded and a thorough physical examination was done.Birth weight and gestation were known in all case and their position on intrauterine curves of Ghosh et all(1970)was recoded .Stanford binet test and Raven’s progressive matrices included tests of cognition. Academic achievement was evaluated by Wide RANGE achievement test(WRAT). Visuomotor integration was tested according to Bender Gestault test and Vineland social maturiy test was also performed in all children. Social class was assessedaccording to Kuppuswami’s classification Also soft signs were determined in all study subjects. Results: A total of 172 children were assessed and of these,111 were aga( birth weight between –1 to + 2sd) , 21 were sga (<2sd) and 42 iugr (wt between –1 to –2 sd), ,Mean age at assessment was 8.6-8.9 in the three groups ,While birth weight was significantly lower in two growth retarded groups,.gestational age at birth was 38.6,38.8 and 36.9 weeks for aga, sga &iugr groups respectively .On all tests done it was noted that that while all babies scored within normal range on all tests performed, test scores were significantly lower in sga and iugr groups.School performance was also statistically significantly better in aga group than other two groups. A distinct disadvantage of lower social class was recorded in the study. Conclusions. Cognitive abilities of growth retarded babies ,both iugr and sga are impaired as compared to aga babies indicating persisting handicap at school age As school performance was poorer in iugr babies, some may need to be referred for special education A deviant intrauterine growth is a definite disadvantage for cognitive abilities.

NEO/16(P) CHARGE ASSOCIATION IN NEONATE, A RARE ASSOCIATION WITH DIABETES IN PREGNANCY.K.B. Mahendrappa, Anil, BharathiDept. of Paediatrics, J.S.S. Medical College and hospital, Mysore-570004

Introduction: Currently 3% to 10% of pregnancies are complicated by abnormal glycemic control. Of these 80% are caused by gestational diabetes as opposed to pregestational diabetes. Certain Congenital anomalies due to uncontrolled diabetes during pregnancy are well defined. But rare anomalies like Bilateral choanal atressla and ear anomaly (features of CHARGE association) are is not listed in the known anomalies of an IDM. The most common form of nasal obstruction in neonates is soft tissue edema. But congenital bony nasal anamalies like choanal atressia and nasal stenosis are recognized as an important cause of neonatala airway obstruction. Although the incidence of choanal atresia is one in 8000 live births, Bilateral Choanal atresia is relatively rare. More than 90% of choanal atresia is bony and only 10% are membranous which is noted in our case. We are reporting a case of Bilateral choanal atressla and ear anomalies born to an untreated Gestational diabetes mother. Case Report: A neonate born to non-consanguineous parents presented at birth with respiratory distress and cyanosis. Antenatally mother had no ANC and was diagnosed to have diabetes only four days prior to delivery. It was a preterm LSCS delivery baby cried after oral suction and tactile stimulation. Baby continued to have persistent respiratory distress, severe chest retraction and intermittent cyanosis. We were not able to pass the nasogastric catheter through both the nostrils. Nasoscopic examination revealed block of both posterior nasal apertures. Other associated anomalies were-Bilateral malformed pinna of ears, preauricular skintag, Polydactyly in right hand. Cardia, genitalia and eyes were normal. Routine investigations were with in normal range. CT scan showed billatrial membranous type of choanal atressia. Baby was subjected to transnasal stent insertion and was managed with supportive measures. The stent was removed after one week and the baby is doing well after the removal and after 1year of follow-up. Conclusion: Choanal atressia is a major anomaly in CHARGE association. But the association of untreated gestational diabetes and the features of charge association are not clearly

defined in the standard text except in few studies and in our case. So we would like to report this rare case to emphasize the need for further studies to define this association with gestational diabetes.

NEO/17(P) COURSE AND PREDICTION OF HYPERBILIRUBINEMIA IN NEAR-TERM AND TERM NEWBORNS Nomeeta Gupta, Rajiv Kumar, Leena Soni, Gurdeep AtwalDepartment of Pediatrics,Batra Hospital & Medical Research Centre, New Delhi-110062.

OBJECTIVE: To assess the predictive ability of total cord bilirubin for the risk of subsequent hyperbilirubinemia in term and near-term newborns. DESIGN: An observational prospective study. SETTING: Neonatal Intensive Care Unit of our hospital. MATERIAL & METHODS: The umbilical cord blood samples for bilirubin estimation were taken from 353 inborn newborns from September 2004 to August 2005. The cord bilirubin (CB) was compared with serum bilirubin at 36-48 hours of age. Total serum bilirubin levels of >=8 mg/dl and >= 12 mg/dl on day 2, >= 12 mg/dl and >= 15mg/dl on day 3, and >= 14 and >= 17mg/dl on day 4 and day 5 respectively for birth weight between 2000-2500 grams and >2500 grams 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 2.5 - 3 Kg had 1.3 times higher risk while babies with birth weight <2.5 Kg had 3.5 times higher risk as compared to babies with birth weight more than 3 Kg. 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 neonatal hyperbilirubinemia 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 neonatal hyperbilirubinemia respectively. Total CB level of >= 2.1 mg/dl had sensitivity, specificity, positive and negative predictive values of 69.6%, 72.4%, 58% and 81.3% respectively. False positive and false negative results were 27.6% and 30.4% respectively. CONCLUSION: CB can be taken as predictor for subsequent hyperbilirubinemia before discharge of newborn 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 neonatal hyperbilirubinemia and optimal management are crucial to prevent brain damage and subsequent neuromotor retardation due to bilirubin encephalopathy.     

NEO/18(P) MECKEL - GRUBER SYNDROME WITH LINGUAL CYST: A CAUSE OF RECURRENT NEURAL TUBE DEFECT.Shalu Gupta, B.D. Bhatia, S.Basu, Ashok KumarDepatment of Pediatrics, Institute of Medical Sciences, B.H.U., Varanasi- 221005

Design and setting: a rare case report from Division of Neonatology, Deptt of Pediatrics, IMS, BHU,Varanasi. Meckel Gruber syndrome ,a cause of neural tube defect is an autosomal recessive disorder characterized by a triad of renal cysts, encephalocele and polydactyl. A newborn female born through non consanguineous marriage was admitted in our nursery with multiple congenital anomalies as : solitary occipital encephalocele, micrognathia, microglossia, posterior cleft palate, solitary lingual cyst(1x1 cm), postaxial polydactyl, bilateral renal masses and micropenis.Ultrasonorgraphy of abdomen showed bilateral polycystic, dysplastic kidneys.These findings were consistent with Meckel Gruber syndrome.However, we found Lingual cyst with this syndrome which has not been repoted in literature. It was also found that the mother had an abortion ten years back, which had similar anomalies. This rare syndrome has been reported in the literature as incompatible with life. However, appropriate treatment instituted in our case prevented the mortality. Meckel Gruber syndrome can be evaluated and diagnosed by sonography at the 11th to 14th week. Later in the pregnancy , oligohydramnios makes it difficult to establish a diagnosis Conclusion : Early antenatal diagnosis of this lethal syndrome is essential, so that counselling of the parents with the option of termination be advised.

NEO/19(P) MEROPENEM IN NEONATAL SEPSIS: EXPERIENCE FROM A TERTIARY CARE NICUManish Narang, Dheeraj Shah, M.M.A.FaridiDivision of Neonatology, Department of Pediatrics, University College of Medical Sciences and GTB Hospital, Delhi-110 095.

Infections with multi-drug resistant gram negative bacteria pose important challenge in treatment of neonates admitted in intensive care units. Meropenem is a new carbapenem with documented in-vivo sensitivity against most of the prevalent gram-negative bacteria. However, the experience with its clinical use and efficacy in neonates is limited. Methods: Fifty neonates with presumed or culture positive sepsis with multi-drug resistant bacteria were included prospectively in the study. Meropenem was administered 12 hourly in the dose of 25 mg/Kg/dose. Baseline information was recorded in a pre-tested proforma. All the babies were monitored for clinical improvement, gastrointestinal intolerance or any adverse effects. Biochemical parameters including blood counts, liver function tests (LFT), renal function tests (RFT) were serially monitored. Results: Fifty neonates (27 males and 23 females) were treated with meropenem during the study period. The mean (+ SD) birth weight and gestation of the babies were 2040 g (+720 g) and 35 weeks (+ 3.4 weeks), respectively. The mean duration of therapy was 10.6 days (+ 3.8 days). The clinical cure was demonstrated in 41 (82 %) babies. Eight (16 %) babies died due to complications of sepsis despite treatment with meropenem. Reversible thrombocytopenia (Platelet count < 0.5 x 109/L) occurred in 36% (18/50) babies with seven (14%) babies having severe thrombocytopenia (Platelet count < 0.2 x 109/L). Eighteen (36%) babies had mild asymptomatic elevation of RFT whereas alteration of LFT or cholestasis occurred in 20 (40%) neonates. Oral candidiasis occurred in 19 (38%) babies which responded to topical treatment with clotrimazole. Feeding intolerance was not common and no baby developed seizures or neurotoxicity after treatment with meropenem. Conclusions: Meropenem is effective in neonatal sepsis with multi-drug resistant bacteria with a high (82%) cure rate. Reversible thrombocytopenia, mild azotemia, cholestasis and oral candidiasis are commonly seen adverse effects of this treatment.

NEO/20(O) NEONATAL SEPSIS & ANTIBIOTIC RESISTANCE IN NEONATAL UNIT OF  INDIRA  GANDHI  GOVERNMENT  MEDICAL  COLLEGE  NAGPUR.Kirtish Balpande, D. N. Balpande, Puja A.Dharmik, Sachin Mule C/o. Dr. D. N. Balpande, Professor of Pediatrics, 14, Jeevanchhayanagar, Ring Road, Nagpur 440022

Introduction: With improving health standard the infant mortality rate has declined markedly but there is no significant change in neonatal mortality. The primary causes of neonatal mortality are sepsis, birth asphyxia, low birth wt., & congenital malformation. Sepsis is at the top of the list, in community as well as in hospital setting. Continued surveillance of neonatal septicaemia is necessary to know the common pathogens & their sensitivity. Aims & Objectives: 1) To identify the organisms, & their sensitivity in neonatal septicaemia. 2) To devise efficacious antibiotic regime as empirical therapy in suspected cases of neonatal septicaemia. Material & Methods: 114 Newborns delivered & admitted in SCNU within 4 hrs. & put on antibiotics were  selected .Their clinical , haematological , microbiological study were done in details. Observation: 1) The incidence of Neonatal septicaemia in our unit was 32.64 %.2) Case fatality rate was 14 %. 3) The most common clinical manifestations were poor cry, tone, activity (C.T.A.), shock, sclerema & poor tolerance of feed. 4) Early onset sepsis (EONS) was more common than Late onset sepsis (LONS). 5) Gram negative organisms were predominant.6) Klebsiella was most common organism causing EONS followed by CONS.  7) CRP would be useful parameter to rule out sepsis & to guide duration of antibioticConclusion:An ideal antibiotic  combination  for  EONS  would  be  Ampicillin + Gentamycin\Amicacin  or Cefotaxime +Amicacin. For LONS it would be  Fluconazole +Cloxacillin.

NEO/21(P) NEONATAL SEPSIS DUE TO VERTICAL TRANSMISSION FROM MATERNAL GENITAL TRACTTaraknath Ghosh, Nabendu Chaudhuri, Sabyasachi Som, Ashok Dutta, Atanu RoyDept. of Pediatrics, Burdwan Medical College, Burdwan

Introduction and Objectives: Neonatal sepsis is one of the commonest causes of morbidity and mortality especially in LBW babies. Early neonatal sepsis (<72 hrs) commonly occurs through vertical transmission from maternal genital tracts. The chance of transmission is more common after PROM, prolonged labour, and repeated intervention during intrapartum period. A prospective semilongitudinal study was under taken in the department of Paediatrics semilongitudinal study was under taken in the department of pediatrics with collaboration of Dept. of G & O, BMCH, Burdwan., to find out a correlation between birth canal flora and occurrence of early onset neonatal sepsis. Methods: High Vaginal Swab (HVS) of 75 expectant mothers were sent for culture at the time of vaginal delivery prior to first vaginal examination. The newborn of these mothers were followed up for development of sepsis. The babies who were suspected sepsis clinically within 72 hrs of delivery, were screened for sepsis which includes complete haemogram, microESR, CRP, blood culture. Results: Bacterial growth was obtained in 44 (58.6%) HVS. Blood cultures were positive 27 (36%) babies. Among the blood culture +ve cases, causative organisms correlated with result of HVS culture in 8 cases (30%), in 13 cases (48%) HVS shows growth of different organism. On the other hand, out of 48 blood culture –ve cases, HVS culture was +ve in 23 (48%) cases. Among total 75 cases, vertical transmission of organism documented in 8 (10.5%) mother – baby dyad. Moreover , sepsis was detected in 62% cases who were risk of developing sepsis (prom>18hrs, repeated vaginal examination, instrumental delivery, chorioamnionitis, birth, wt.<1500gms). Conclusion: The present study shows that not only vaginal flora are responsible for every neonatal sepsis, but also other as a result of repeated vaginal examinations, instrumental delivery play major role in the occurrence of early neonatal sepsis.

NEO/22(P) NEONATAL SHIGELLOSIS: A CASE REPORT      Nomeeta Gupta, Rajiv Kumar      Department of Pediatrics, Batra Hospital & Medical Research Centre, New Delhi-110062.

Shigellosis is extremely rare below the age of six months. The infants are highly resistant to shigellosis before this age, probably due to changes in the intestinal flora of breast-fed babies. This resistance has been believed to be due to the presence of specific antibodies in breast milk or perhaps because of the short transit time that Shigella is carried in an adult's stool. Thus the presence of the organism at delivery is uncommon. Case Report: A 2.8 Kg male baby was born at term gestation to a mother who had a history of diarrhoea with fever for 5 days prior to delivery. The baby was delivered vaginally and had Apgar scores of 6 and 8 at one and five minutes respectively. He was transferred to the NICU because of respiratory distress. He was treated with an oxygen, ampicillin and amikacin. The initial course was excellent. He developed aqueous diarrheal stools containing blood and mucus on third day of life. This was followed by the development of severe septic shock on his sixth day of life. His symptoms included tachycardia (170/min), semiconscious state, pallor, gasping respirations and a central temperature of 38.5°C. On examination, he had hepatosplenomegaly and fresh bleeding was also noted in his nasogastric tube. Arterial blood gases showed a case of hypoxia with severe metabolic acidosis: pH 6.91, PCO2 41 mg/Hg, PO2 41 mm/Hg, bicarbonate 8 mmol/L, and base excess of -27. There were no signs of dehydration. Laboratory investigations showed WBC 8200, platelet count 1.64 lakhs, PT 21 and PTT 82. He was immediately intubated and ventilated. He received albumin, dobutamine (10µg/kg/min) and dopamine (5µg/kg/min) and metabolic acidosis was corrected by intravenous sodium bicarbonate. Ceftriaxone 100 mg/kg/day was added to the previous antibiotics. His general condition improved after several hours of this treatment. Dobutamine and dopamine were discontinued gradually and the baby was extubated after four days. Stool cultures showed Shigella flexneri on the third and seventh days of life, but not on the 12th day and were sensitive to ceftriaxone, amikacin, colistin and trimethoprim-sulfamethoxazole. Blood cultures revealed no growth. Seven days after delivery, the stool culture from the mother was also negative. The baby was discharged in good condition on 15th day of life.     

NEO/23(O) NEURODEVELOPMENTAL OUTCOME OF TERM NEONATES WITH HYPOGLYCEMIAKalra Manas, Kamath NutanKasturba Medical College, Mangalore

AIMS: To study the neurodevelopmental outcome of symptomatic/ asymptomatic, transient/persistent and SGA/LGA /AGA hypoglycemic neonates. METHODS: This longitudinal study was conducted on a group of term neonates who suffered from hypoglycemia (<40 mg/dl) and were compared to a control group with similar risk factors but no documented hypoglycemia. They were classified into Group I - symptomatic hypoglycemia with seizures, Group II - symptomatic without seizures, Group III - asymptomatic hypoglycemia and Group IV – controls. They were followed up for a year with 3 monthly neurological examination, development assessment by “Developmental assessment scales for Indian infants” (Modified Bayley scales), ophthalmological, speech and audiological evaluation. RESULTS: 46 neonates were enrolled in the study and the follow up of 11 of them was inadequate (attrition rate-24%). Group I, II and III accounted for 42.9, 34.2 and 22.9% cases and their mean age at presentation was 49, 26 and 12 hrs respectively. The occurrence of persistent seizures, microcephaly, tone abnormalities, exaggerated reflexes, squint and refractory errors was significantly more in group I babies. There were no major abnormal neurological findings in group III. No relationship was established between hypoglycemia and the incidence of speech and audiologic abnormalities as sequelae. We demonstrated a significant depletion of motor skills in babies with persistent hypoglycemia as compared to transient ones but mental skills remained same. Motor outcome of AGA and SGA babies was significantly affected as compared to the LGA babies. CONCLUSIONS: Symptomatic hypoglycemia with convulsions carries poor prognosis both in motor and mental developmental outcome especially in AGA and SGA babies and those with persistent hypoglycemia.

NEO/24(P) NEONATAL OUTCOME IN MATERNAL ANAEMIAShalini Soi, Ravneet Kaur, Rahul Gandhi, Seema Rai, K.K.LochamDeptt. of Pediatrics, Govt. Medical College/Rajindra Hospital, Patiala - 147001

Objectives : To evaluate effect of maternal anaemia on neonates. Methods : Fifty babies delivered in the department of Obstetrics & Gynaecology, Government Medical College and Rajindra Hospital, Patiala were the subjects of study. Maternal Hb was assessed. On the basis of Hb mothers were categorized as mildly anaemic (Hb 10 to < 12 gm/dl), moderately anaemic (Hb 7 to <10 gm / dl) and severely anaemic (Hb <7 gm / dl). Out of 50 anaemic mothers, 18 (36%) had mild anaemia, 26 (52%) had moderate anaemia, and 6 (12%) had severe anaemia. 15 non anaemic mothers served as control. Neonatal outcome in the form of gestation, birth weight, apgar score or any other abnormality were recorded. Results : Out of 50 newborns, 36 (72%) were males and 17 (34%) were females. 10 (20%) were preterms and 40 (80%) were terms. 8 (16%) were SGA and 32 (84%) were AGA. In mildly anaemic mothers, mean birth weight of newborns was 2938 gm. 17 (94.5%) were terms and 1(5.5%) was preterm. 1 (5.5%)had moderate birth asphyxia. 15 (83%) were AGA and 3 (16.7%) were SGA. In moderately anaemic mothers, mean birth weight was 2618 gm. 23 (88.4%) were terms and 3 (11.5%) were preterms. 1 (3.8%) was having moderate birth asphyxia . 21 (80.8%) were AGA and 5 (19.2%) were SGA. In severely anaemic mothers, mean birth weight was 3133 gm. There was no preterm, SGA or asphyxiated newborn. The mean gestation was 38 weeks. In the control group 7 (46.6%) were males, 8 (53.4%) were females. 12 (80%) were terms and 3 (20 %) were preterms. 14 (93.3%) were AGA and 1 (6.7 %) was SGA. Birth asphyxia was present in 1(6.7%). Conclusions : There was no adverse effect of maternal anaemia on the neonatal outcome.

NEO/25(P) NEONATAL HYPERBILIRUBINEMIA - A PROFILE Pramod Sharma ,Bd Gupta,Ajay Karkara,Sakshi,Jp Soni,Rakesh JoraUmaid hospital, Dr SN Medical College, Jodhpur

Jaundice is seen in the first week of life in 60% of term and 80% preterm babies. Incidence of CNS damage is directly proportional to serum bilirubin levels.It is recommended to follow babies closely and to keep bilirubin levels less than 25mg% This study was undertaken to study clinical and demographic profile of jaundiced babies and to correlate serum bilirubin and CSF bilirubin values. Methods: -Sixty six babies with significant hyperbilirubinemia were enrolled as the study group.76 healthy babies constituted the control group. Bilirubin levels were considered significant -Upto 2 kg >1mg/100 gm body weight,2-3 kg 20-25mg/dl,>3kg >25mg/dl. Babies with birth asphyxia,hypoglycemia,hypothermia and metabolic acidosis were excluded.CSF bilirubin values were recorded at the time of peak serum bilirubin levels. Blood grouping,G6PD levels,day of starting phototherapy,day of performing exchange transfusions were recorded.Management of hyperbilirubinemia was done as per Cockington charts. RESULTS Male female ratio was 1:0.4 and mean weight was 2.13+0.60 kg.Mean gestational age was 36.8+3 weeks.Rh incomatibility,ABO incompatibility,sepsis,breast milk jaundice,exxagarated physiological,G6PD deficiency and Criggler Najjar syndrome were seen in 15%,12%,4.5%,3.03%,3.3%,1.5% and 1.5 % cases respectively. Rest 60% cases were idiopathic.No exchange transfusion was required in 40.9% cases while it was performed once ,twice and more than two times in 25,12 and 2 babies respectively.CSF bilirubin (done in 44 neonates)showed no correlation with birth weight and mean values were CONCLUSION Mean serum bilirubin values in the exchanged babies were 26.29+5.63 mg/dl and 31.4 % neonates had blood levels above the assumed significant levels while in non exchanged babies the corresponding figures were 20.97+4.78mg% and 4.85 % respectively - a statistically significant difference.Intensive double surface phtotherapy and/or exchange transfusion can keep bilirubin levels within a safe range.

NEO/26(O) NEUROBEHAVIORAL STUDY OF ASPHYXIATED NEWBORNS BY USING REWA NEONATAL NEUROBEHAVIORAL SCALE (RENAS)Umesh Pandwar, Mukesh DhankarDepartment of Pediatrics S.S. Medical College and Associated Gandhi Memorial Hospital Rewa

Aims and objectives- The present study has been undertaken to evaluate the neurobehavioral pattern of the newborn having birth asphyxia by using RENAS. This work is ai,ed to evaluate the utility of RENAS in assessing neurobehavioral pattern of asphyxiated newborns, then showing association of Apgar score and other variates associated with birth asphyxia to predict the infant's neurobehavioral outcome. Material and Methods : 40 asphyxiated neonates delivered in the Deptt. of Obst. and Gynae, S.S. Medical College and associated G.M. Hospital Rewa (M.P) were selected in the study. Neontaes having gestatioal age<37 weeks, Apgar scaore >3 at 1 minute or >7 at 5 minutes and associated with any congenital malformation were excluded. The behavioral assessement using RENAS was planned on day 3,7,10 and 14 of life. All planned examination was done on 22 neonates. In rest of neonates the examination could be done only upto 7th day in 9 newborns and up to 10th day in 9 newborns due to parental request to discharge. All the examination were performed in the hospital. RESULTS: Statistical analysis of data shows that there is a significant association between prolonged 2nd state of labour, foetal distress, Apgar score 0-3 at 5 minute and Apgar score < 7 at 10 minute with RENAS score <20. CONCLUSION: We propose that neonates having RENAS score < 20 shall be taken as those who have suffered birth insults/ birth asphyxia if there is suggestive history, and shall be subjected to early stimulation to avoid adverse longterm neurobehavioral ouctome. To simply the study provided a clue to birth asphyxia (apart from other causes of neuronal damage) by RENAS score even for newborns delivered in home setting where there has been no skilled attendant, retrospectively.

NEO/27(P) NEONATAL ORAL CYSTSAnup MohtaGuru Teg Bahadur Hospital and associated University College of Medical Sciences, Dilshad Garden, Delhi

Aim: To present two cases of neonatal oral cysts. Methods: Two cases of large oral cysts causing closing the mouth, difficulty in feeding and feeding are presented. Results and conclusions: Two unusual cases that can present to pediatricians, pediatric surgeons requiring immediate intervention are presented.

NEO/28(O) DESCRIPTIVE ANALYSIS OF BABIES WITH BIRTH ASPHYXIA Maheshwari A, Kulkarni A, Kaul S, Gupta V, Balan S And Kashyap N.      Indraprastha Apollo Hospital, Mathura Road, Sarita Vihar, New Delhi

Background: There is no consensus definition of birth asphyxia. As per the national neonatology forum of India it is defined as “gasping and inadequate breathing or no breathing at 1 min” or APGAR score of 3 or less at 1 min. The incidence may vary depending on various perinatal factors. Objectives: To analyze the characteristics of babies admitted with birth asphyxia and its sequel. Material and methods: This is a retrospective descriptive analysis of neonates admitted to NICU Apollo Hospital from January 2001 to august 2005. Results: During the study period 45 babies were admitted with birth asphyxia. Most (93.3%) of these babies were out born. Preterms (gestation < 37 weeks) comprised 17.7% (8) and 24.5% (11) were low birth weight. The distribution of mode of delivery was evenly distributed (23 were vaginally delivered). APGAR score were documented only in 22 babies and 24.5% of them had scores of 3 or less at 1 min. At admission 95.5% (43) had evidence of hypoxic Ischemic encephalopathy (HIE). HIE stage (sarnat scoring) 1, 2,3 was present in 9.3%. 62.7% and 28% respectively. Neuroimaging was done in 41 babies and 40% (18) did not reveal any abnormality. Seizures were present in 80% babies and 17.7% of them had normal neurological exam at discharge and were sent home without any anticonvulsants. Renal and cardiac involvement was present in 22.2% (10) and 44.4% (20) respectively. Ventilatory support was given in 31.1 % (14) babies. Hypoglycemia and hypocalcaemia were present in 22.5% and 42.2% respectively. Mortality rate in cases of birth asphyxia was 31.1% and cardiac involvement was present in 50% of these cases. Conclusion: The neonatal condition at birth needs better documentation. In the present study mode of delivery was not a significant factor in the causation of birth asphyxia. Majority of the babies had CNS involvement followed by cardiac and renal in that order.

NEO/29(P) AN EVALUATION OF MATERNAL AND SOCIOECONOMIC FACTORS IN RELATION TO PREMATURITY AND IUGR AT BIRTHJaya Agarwal, Abhishek Gupta, S.P. GoelDepartment of Pediatrics, L.L.R.M. Medical College and associated S.B.V.P Hospital, Meerut, 250004

Objective: To study maternal and socioeconomic factors in relation to prematurity and IUGR at birth.Design: Prospective cohort. Setting: All newborns delivered at SVBP Hospital with birth weight <2.5 kg, were included in the study. Method: Maternal particulars regarding age, height, weight, Hb%, parity, interval since last delivery, marital status, period of gestation, antenatal care, any systemic illness during pregnancy, her socio-economic status, education and occupation were recorded. Each newborn baby was examined and his/her birth wet, sex, gestational age using new Ballard Scoring and presence or absence of congenital anomalies were recorded. Result: Of the 468 cases, 139 (29.70%) were low birth weight(LBW) babies of which 51 (36.69%) were preterm and 88 (63.30%) were intrauterine growth retarded (IUGR). Most preterm (49.01%) weighed between 2000–2499 gm. Critical weight of mother was <50 kg, critical level of Hb% was <7.5 gm% for delivery of low birth weight babies. Incidence of premature and IUGR deliveries were more in first born and those delivered after 141 months or more since last delivery. Premature and IUGR deliveries were more common in mothers who were <20 years or >30 years old, in those who belonged to low socioeconomic status (Class IV and V), in those mothers who were illiterate and among housewives and labourers. Antenatal care significantly influenced the incidence of LBW infants. Maternal diseases during antenatal period predisposed to

premature and IUGR births, prematurity more common in mothers with APH and leaking P/V. Mothers with IUCD most often got premature babies, if conceived. Conclusions: The correlation was maximum for mother’s weight, Hb%, education and antenatal care and adverse socioeconomic factors for increased incidence of premature and IUGR.

NEO/30(P) EXTRA - UTERINE GROWTH PATTERN OF PREMATURELY BORN INFANTSJayavardhana.A,Shenoy R,Bhat K, Nutan KamathKasturba Medical College, Mangalore, Karnataka

INTRODUCTION: Impaired postnatal growth is common in premature neonates and has been related to neurodevelopmental delay, ischemic heart disease, diabetes and hypertension. Understanding of postnatal growth and use of growth charts is limited due to scanty data and advances in perinatal care.AIM:To evaluate the postnatal weight changes of neonates who were born between 28 to 34 weeks of gestational age[GA] and analyze the variables that may affect these weight change patterns. METHODS:Weights of 31 premature neonates at birth, hospital discharge and 38th week of estimated GA were compared to a current intra uterine growth reference{FentonTR’BMC`Pediatr`2003}. Excluded were those with Intrauterine growth restriction, major congenital anomalies and twins. Influences of birth characteristics and co-morbid medical conditions on these weight change patterns were also analyzed. RESULTS: 45% and 51% of the infants had weights less than 3rd percentile at discharge and 38th week of estimated GA respectively. Their mean weight was significantly less than the median weight of a fetus of comparable gestational age. Delay in regaining birth weight[mean=17days], maximum weight loss[mean=14.5%] and increased duration of hospital stay[mean=26days] were observed in infants with growth restriction. Factors independently associated with extra uterine growth restriction were gestational age, need of ventilator support, delayed enteral feeds and necrotizing enterocolitis.CONCLUSION:Extra-uterine growth restriction is a significant problem in premature infants which persists during hospitalization and follow-up.Despite the growth deficit, the linear growth of these infants warrant region specific velocity based reference curves for better understanding of growth dynamics.

NEO/31(O) EFFECT OF MATERNAL RISK FACTORS ON BIRTH WEIGHTSJoshi Vaishali; Preethi S.K.; P. D’souza.Department of Pediatrics, Goa medical college, Goa.

Several factors have been found to have an effect on birth weights. Maternal factors constitute a major chunk of causes associated with inadequate growth in utero (IUGR). Some of these factors are easily amenable to treatment and thus would go a long way in reducing the incidence of low birth weights. Goa is a small state with good health parameters on par with western countries as against to rest of the country but has a very high incidence of low birth weights, as high as 30%, which is almost equivalent to most of the other parts of the country. We conducted a hospital-based study to evaluate a few maternal factors and their effect on the birth weights. 150 uncomplicated term low birth weight/IUGR babies born over a period of 1 year were selected at random to form the study group.50 babies weighing >2.5 kgs born during the same period and without any problems at birth constituted the control group. Detail maternal history and examination findings were noted. Various risk factors like anemia, toxemia, and medical diseases as cardiac, renal, diabetes mellitus, drug intake, radiation exposure etc.were recorded in both the study and the control groups. Hemoglobin levels done in mothers who were found to be anemic were recorded. These factors were than analyzed using logistic regression method and calculating ODD’S ratio. In the study group of 150 mothers 31.3% mothers had no known risk factor while in the control group 80% mothers had no risk factor. Maternal anemia and toxemia were found to be most significant (with ODD’S ratio of 5.57 and 3.37 respectively) risk factors contributing to IUGR.Thus interventions to reduce maternal anemia will help reduce the incidence of low birth weights drastically and thereby neonatal mortality and morbidity.

NEO/32(P) EFFECT OF FEEDING ON CARDIO-RESPIRATORY STATUS OF VERY LOW BIRTH WEIGHT (VLBW) NON-ASPHYXIATED NEWBORNSKamaljeet Kaur, Shalini Soi, Puneet Jairath, Manpreet Sodhi, K.K.LochamDepartment of Pediatrics, Govt. Medical College/ Rajindra Hospital , Patiala.- 147001

Objectives : Correlation of heart rate (HR) and respiratory rate (RR) to feeding in very low birth weight (VLBW) non -asphyxiated newborns. Methods : 5 VLBW newborns with no birth asphyxia admitted to Neonatology section of department of Pediatrics, Govt. Medical College , Rajindra Hospital, Patiala were the subjects of study. Sex, gestation, mode of delivery, prenatal risk factors in the form of PIH, eclampsia, gestational diabetes, PROM, prolonged labour, dai handling, foul smelling liquor, MSAF, APH were recorded. Type of feeding given was also noted in the predesigned proforma. Investigations of septic screening ( CRP, B/N ratio , blood culture) and metabolic profile were done wherever required. Slow increment regimen of feeding (started with 15 ml per kg and increased by 15 ml per kg body weight per day) was followed in all the cases. HR and RR before and after feeding were recorded in all cases and results were analysed statistically. Results : There were 2 male and 3 female newborns. 2 newborns were delivered by LSCS and 3 by NVD. 4 newborns were preterm and 1 was term. Prenatal risk factors in the form of PIH was present in one case only. Birth weight of babies ranged from 1000 gms to <1500 gms. Mean HR per minute before feeding in 5 cases was 126.30 +/- 9.9 and after feeding was 131.22 +/- 8.17 with p value > 0.05 which was statistically insignificant. Mean RR per minute before feeding in 5 cases was 35.66 +/- 5.02 and after feeding was 37.72 +/- 3.85 with p value > 0.05 which was statistically insignificant. Conclusions : There is no significant effect of feeding on cardio-respiratory status in non-asphyxiated VLBW babies.

NEO/33(P) EFFECT OF MATERNAL HIV INFECTION OF INTRAUTERINE FETAL GROWTHNegi Surpreet K., Agrawal M., Rathi S.Dept of pediatrics,T.N.Medical college & BYL Nair Hospital, Mumbai.

While perinatal transmission is the well-known consequence of maternal HIV infection, review of literature reveals conflicting reports regarding its effect on growth of un-infected fetus. Aims & objectives: Present study aims to assess the effect of maternal HIV infection of intrauterine fetal growth, irrespective of actual perinatal transmission, using neonatal anthropometric parameters as indicators of fetal growth. Material & methods: Designed as a prospective-controlled study and conducted at a tertiary care hospital during 2002-2003, present analysis includes 124 mother-infant pairs; equally divided into two groups – Group A with seropositive mothers, and Group B with seronegative mothers. Both groups were drawn from the same socioeconomic strata with no significant differences in maternal age, parity and nutritional status. Symptomatic seropositive mothers from group A, as well as preterm deliveries in both groups were excluded. Neonatal weight, length, head circumference were recorded as primary output variables, while Ponderal index was calculated as Wt in Gms / Ht in Cm3 x100. Results: Study reveals that babies born to seropositive mothers had significantly lower mean birth weight (<0.001) as well as head circumference and Ponderal index (both<0.01). However, birth length was comparable in both groups. Incidence of LBW was also significantly higher (<0.05) in Group A than in Group B (28.8% vs. 13.6%). Conclusions: Present study indicates that – a) Maternal seropositivity has significant adverse effect of fetal growth, even in absence of the transmission of infection, and b) such effect appears to be most likely operative in later gestation, as obvious from lower Ponderal index in babies born to seropositive mothers.

NEO/34(O) EVALUATION OF EFFICACY OF NEWBORN HEARING SCREENING PROCEDURES IN CHILDREN WITH HEARING IMPAIRMENTMohd. Shamim Ansari, Rajeev R. Jalvi,Ali Yavar Jung National Institute for Hearing Handicapped, Bandra (W) Mumbai-400050

The article aimed at focusing on the Newborn Hearing Screening Procedures [Auditory brain response (ABR), Otoacoustic emission (OAE), Auditory steady State Response (ASSR), Immitance Audiometry (IA)] used to identify the children with hearing impairments who were referred from various hospitals in our pediatrics hearing evaluation Clinic. The primary investigation reveals that although the recent technological advancement in screening and identification of hearing loss provided the lowest mean identification age for children with hearing impairment, informal hearing procedures (parental suspicion, behavioral observation and referrals) were the procedures of detection of hearing loss for majority of children with hearing loss. It is also inferable from the data that formal screening procedures are not presently identifying the children with Hearing impairment at single evaluation because of various accompanying known medical/nonmedical reasons. Thus professional and parental educations in this area of hearing screening in young children have been advocated.

NEO/35(O) EVALUATION OF EOSINOPHILIA IN HOSPITALIZED SICK NEONATES     Rajiv Kumar, Nomeeta GuptaDepartment of Pediatrics, Batra Hospital & Medical Research Centre, New Delhi-110062.

Introduction: Eosinophilia is defined in neonates as an eosinophil count ≥ 700 cells/mm3. Eosinophilia is common in hospitalized preterm and term neonates, with the reported incidence ranging from 14-76%. However, its causes, pathomechanism and clinical significance are still unknown. It may be associated with establishment of an anabolic state, drug reactions, antibiotic use, transfusion of blood products, hypereosinophilic syndrome, thrombocytopenia with absent radius, response to foreign antigens, chronic lung disease, erythropoietin treatment and infections. Objective: To evaluate the possible association of various clinical conditions associated with eosinophilia and to clarify whether recognition of increase in eosinophil count is of any clinical significance in the management of a sick neonate. Design: An observational study. Setting: Neonatal Intensive Care Unit of Department of Neonatology & Pediatrics, Batra Hospital & Medical Research Centre, New Delhi from January 2004 to June 2005. Material & Methods: Fifty-six neonates with eosinophilia (absolute eosinophil count ≥ 700 cells/mm3) and 55 control neonates matched for gestational age, birth weight and hospitalization days were included in the study. Results: A significant difference between the two groups was found only in blood transfusions, immunoglobulin treatment, specific antibiotic treatment and infectious disease. However, neonates who develop sepsis and are treated with antibiotics and immunoglobulin are more often transfused. Thus, it can be concluded that the main relationship observed is between eosinophilia and infection whereas the other associations are secondary. The relative risk factor for infection when the absolute eosinophil count is ≥ 700/cmm is 1.58, with a confidence interval 1.30-1.91. Conclusions: Eosinophilia seems to be a reliable indicator of sepsis while normal absolute eosinophil count does not exclude infection. Infection should be strongly considered in the evaluation of a sick neonate with eosinophilia.     

NEO/36(O) EVALUATION OF SCORE FOR NEONATAL ACUTE PHYSIOLOGY IN PREDICTING NEONATAL MORTALITYE.Jagadish Venkat Ragavan , J.N.Behera , Aswini.K.Mohanty, S.L.DasS.C.B. Medical College & Hospital, Cuttack, Orissa

Objectives : To evaluate the validity of the Score for Neonatal Acute Physiology as a predictor of neonatal mortality, duration of ICU stay. The study was also undertaken to evolve the best cut-off SNAP scores for predicting neonatal mortality in different gestational ages and birth weights. Methods: 264 newborns admitted to NICU during 2 yrs were evaluated for SNAP. Results: SNAP correlated well with mortality, the best cut-off SNAP value was 13 with 76.5% sensitivity 97.2% specificity, 86% positive predictive value and 94% negative predictive value. Best cut-off value for ELBW infants was 6, VLBW was found to be 9 with 87.5% sensitivity and 100% specificity and in LBW was observed to be 13 with 89% sensitivity and 100% specificity. In infants <32 wks SNAP cut-off value was observed to be 9 with 89% sensitivity and 100% specificity and above 33 wks a cut-off value of 11 was found to have 90% sensitivity and 100% specificity. The median duration of ICU stay among survivors increased as the SNAP increased with values ranging from 4 to 8 days and in dead babies the median duration of ICU stay was 5 days with a SNAP of 6-10 and 4 days above that score. Conclusion: SNAP is a good measure of severity of illness irrespective of differences in the gestational age, birth weight and various morbid conditions. SNAP approach is based on evaluation of function of all organ system in a sick baby rather than the traditional approach of concentrating on the presenting features.

NEO/37(P) INCIDENCE, COURSE AND PREDICTION OF HYPERBILIRUBINEMIA IN NEAR-TERM AND TERM NEWBORNS Leena Soni, Nomeeta Gupta, Rajiv Kumar, Gurdeep AtwalDepartment of Pediatrics, Batra Hospital & Medical Research Centre, New Delhi-110062.

Objective: To assess the predictive ability of total cord bilirubin for the risk of subsequent hyperbilirubinemia in term and near-term newborns. Design: An observational prospective study. Setting: NICU of Batra Hospital & Medical Research Centre, New Delhi. Material & Methods: The umbilical cord blood samples for bilirubin estimation were taken from 353 inborn newborns from September 2004 to August 2005. The cord bilirubin (CB) was compared with serum bilirubin at 36-48 hours of age. Total serum bilirubin levels of >=8 mg/dl and >= 12 mg/dl on day 2, >= 12 mg/dl and >= 15mg/dl on day 3, and >= 14 and >= 17mg/dl on day 4 and day 5 respectively for birth weight between 2000-2500 grams and >2500 grams 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 2.5 - 3 Kg had 1.3 times higher risk while babies with birth weight <2.5 Kg had 3.5 times higher risk as compared to babies with birth weight more than 3 Kg. 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 neonatal hyperbilirubinemia 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 neonatal hyperbilirubinemia respectively. Total CB level of >= 2.1 mg/dl had sensitivity, specificity, positive and negative predictive values of 69.6%, 72.4%, 58% and 81.3% respectively. False positive and false negative results were 27.6% and 30.4% respectively. Conclusion: CB can be taken as predictor for subsequent hyperbilirubinemia before discharge of newborn 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 neonatal hyperbilirubinemia and optimal management are crucial to prevent brain damage and subsequent neuromotor retardation due to bilirubin encephalopathy.      

NEO/38(O) INITIATION OF RELACTATION: AN ARMY HOSPITAL BASED STUDY OF 381 CASESR P S Tomar, N Singh, P L N G Rao, S BushanInstitutional Address     Military Hospital, Amritsar Cant (Punjab) 143001

Exclusive breast feeding continues to deteriorate in our country which increases these infants to devastating illnesses inherent to top feeding. Relactation is an effective intervention to promote exclusive breast feeding and can successfully be established in most mothers with motivation and support. Design: A prospective hospital based study.Setting & Methods: Mothers with their less than 6 month old infants admitted for various illnesses associated with lactational failure were studied over a three year period. Structured maternal interview was conducted for demography, family information and basic reasons for introduction of supplementary feeds. Detailed examination of infants and mothers were done and treated for their medical ailments. Relactation supported by skilled hospital staff was initiated in all infants, as and when their condition permitted. All bottles were immediately discarded. No lactagogoues were used.  Results: There were 381 mother and 387 infants (4 mothers had twins & one had triplets). 239 (62.7%) were primipara, 64% belonged to rural areas and only 7% were working. 272 (71.2%) had delivered in the hospital and 246 (64.6%) had given prelacteal feeds. Commonest cause was insignificant milk (53.1%). Many mothers wanted to habituate the baby which would make subsequent top feeding easier. 88% of the infants were bottlefed and majority was on animal milk. Relactation was attempted in all cases and was successful in 327 (85.8%) but failed in 54 (14.2%) cases. Establishing of lactation ranged from 5 to 28 days. Incidence of failure increased with lactational gap & age of infant.Conclusion: Relactation is an effective intervention to promote exclusive breast feeding requiring persistent and supportive care to the mother by the health staff. This may rarely be necessary if mothers continue to receive this support and motivation in the beginning of her antenatal care and through the first few crucial postpartum weeks.

NEO/39(P) HAEMATOLOGICAL PROFILE IN VERY LOW BIRTH WEIGHT AND NORMAL BIRTH WEIGHT BABIES IN HOSPITAL DELIVERYSabyasachi Som, A. K. Dutta, K. Nayek, Taraknath Ghosh, N. ChoudhuryBurdwan Medical College, Burdwan

Introduction: Haematological profile varies with gestational age and factors like sepsis also modify it. Aim & Objective: To compare the change in blood profile of Term and V.L.B.W. babies, suffering from clinical sepsis. Methodology: Babies less then 1500gms, with no malformation, divided into three groups: Group I: less than 1000 gms. Group II: (1001-1250gms) Group III: (1251-1500 gms). Investigations done: Hemoglobin (Hb%). Total Leucocyte Count (TLC), Differential Leucocyte Count (DLC), Toxic Granules, and Band cell, MicroESR. Blood culture, 10 cases of (TERM) with clinical sepsis taken. Dubowitz score for gestational age. Result: 32 V.L.B.W. babies and 10 term babies taken. Male and female ratio 1:1.2 in V.L.B.W. but in Term is 3:2. 34.4% of V.L.B.W. & 40% term found to be culture positive. Hb% was more in group – I (14.8+/-4.32in gm%). Than in group – II & III. Maximum value of HB% in Group – I is 16.8gm% but in Term (15.09+/2.06gm%) TLC more in group – III (9875+/-1573) than in group – I & II. TLC in term even more. Neutrophil in group – II (61.78+/-25.12) & III greater than in I but less in Term. Lymphocyte in group – I (46.33+/-11.54) more than in group II & III and term babies. Band cell more in group – I (4.67+/-4.62) than in – II & III but less in term. Babies with E coli infection (in V.L.B.W. group) had Hb% less than in no-growth group but same in Staph. Aureus group, and in V.L.B.W group, less than term group. In V.L.B.W. group, Hb% was less than that in term babies. Conclusion: Blood profile varies with weight in neonate studies can standardize the value for term and preterm.

NEO/40(P) HYPOXIC ISCHAEMIC ENCEPHALOPATHY (HIE) IN BIRTH ASPHYXIAK.K.Locham, Manpreet Sodhi, Kamaljeet Kaur, Shalini Soi, Puneet JairathDeptt. of Pediatrics, Govt. Medical College/Rajindra Hospital, Patiala – 147001

Objectives : To know the prevalence of HIE in birth asphyxia. Methods : 20 newborns with birth asphyxia admitted to Neonatology section of department of Pediatrics, Govt. Medical College, Rajindra Hospital Patiala were subjects of study. Sex, gestation, mode of delivery, prenatal risk factors, apgar score, method of resuscitation were recorded in predesigned proforma. Investigations of septic screen (CRP, B/N ratio, blood culture) , metabolic profile, Chest X-ray, S.Bil, CT scan were done. HIE was graded according to modified Sarnat and Sarnat staging on 1st and 3rd day of life. All the babies were followed up for neurological status till 7 days of life. Results : There were equal number of male and female babies (10 each). 70% newborns were delivered by LSCS and 30% by NVD. 7 (35%) newborns were preterm and 13 (65%) were term. Prenatal risk factor in the form of PIH was present in 40%. Prolonged labour and dai handling was present in 20% babies whereas 10% babies had meconium stained amniotic fluid. 65% of babies had mild birth asphyxia (apgar score 5-7 at 1 min), 25% had moderate birth asphyxia (apgar score 3, 4 at 1 min) and 10% had severe birth asphyxia (apgar score 0-2 at 1 min). 11 babies were resuscitated with bag and mask while 7 babies were intubated. 40% of babies had respiratory distress syndrome, 10% had septicaemia and 15% had neonatal hyperbilirubinemia. HIE was diagnosed in 4(20%) babies, out of which 1 had HIE stage I while the 3 had HIE stage II. One of the babies of HIE stage II progressed to HIE stage III. Prenatal risk factors were present in all the babies with HIE. Conclusions : 20% of asphyxiated babies had HIE. Stage II HIE was the most common.

NEO/41(P) FEEDING IN VERY LOW BIRTH WEIGHT (VLBW) ASPHYXIATED NEWBORNSKamaljeet Kaur, Puneet Jairath, Shalini Soi, K.K.LochamDeptt. of Pediatrics, Govt. Medical College/Rajindra Hospital, Patiala - 147001

Objectives : To study the tolerance and complications of feeding in VLBW asphyxiated newborns. Methods : 8 VLBW asphyxiated newborns delivered in department of Obstetrics and Gynaecology and admitted to Neonatology section of department of Pediatrics, Rajindra Hospital Patiala were the subjects of study. Sex, mode of delivery, apgar score, birth weight, prenatal risk factors, feeding pattern in the form of day of initiation of trophic feeding, increments per day, day of establishment of full enteral feed and complications were recorded in the pretested proforma. Follow up was done till the day of discharge. Results : 5 newborns were male and 3 were females. 4 newborns were delivered by LSCS and 4 were born by vaginal delivery. Prenatal risk factors in the form of PIH was present in 3 babies, prolonged labour in 1 and 1 baby had cord around neck. 5 (62.5%) babies had mild birth asphyxia and 3 (37.5%) had moderate birth asphyxia. 5 (62.5%) babies were SGA and 3 (37.5%) were AGA. Trophic feeding was initiated on day 1 in 1 baby, on day 2-3 in 3 babies, on day 4-5 in 3 babies and on day 5-7 in 1 baby. Slow increment regimen of feeding (started with 15 ml per kg and increased by 15 ml per kg body weight per day) was followed in all the cases. 2 babies developed complication in the form of abdominal distension. Feeding was withheld in both the cases. Both were investigated for NEC and one was found to be suffering from NEC. Feeding was resumed in the baby not having NEC. Conclusions : Trophic feeding with slow increments is tolerated well by majority of asphyxiated VLBW newborns.

NEO/42(P) FEEDING PRACTICES IN ASPHYXIATED NEWBORNSKamaljeet Kaur, Ravneet Kaur, Rahul Gandhi, Seema Rai, K.K.LochamDeptt. of Pediatrics, Govt. Medical College/Rajindra Hospital, Patiala - 147001

Objectives :To evaluate feeding practices in asphyxiated babies. Methods : 25 babies delivered in department of Obstetrics & Gynaecology, Government Medical College and Rajindra Hospital, Patiala were subjects of study. Gestation, sex, birth weight, apgar score were recorded. Feeding pattern was observed with regards to time of initiation, type, mode and any complications during feeding, days for which feeding was withheld and day of life when breast feeding was started. Results : Of 25 cases with asphyxia, 18 (72 %) were males and 7 (28%) were females. 15 (60 %) babies were terms and 10 (40%) were preterms. 17 (68%), 2 (8%) and 6 (24%) had mild, moderate and severe birth asphyxia respectively. Mean time for starting feeding was 24, 48 and 48 to 72 hours in mild, moderate and severe birth asphyxia respectively. Respiratory distress following birth asphyxia was responsible for delay in initiation of feeding in some newborns . In mild birth asphyxia cases, mean age of starting breast feeding was 48 hours. 1 (5.9%) case who was started with trophic feed on 4th day and tube feed on 6th day of life developed NEC on the same day and breast feeding was delayed till 14th day of life. Of 2 cases with moderate birth asphyxia, in one trophic feed was started on 4th day and tube feed on 6th day of life. To the other baby tube feed was started on 5th day. This baby developed NEC and hence breast feeding was delayed till 21st day of life. In severe birth asphyxia mean age of starting breast feed was 3 days. Conclusions : Feeding was well tolerated by majority of asphyxiated newborns. Respiratory distress following birth asphyxia was responsible for late initiation of feeding while NEC prolonged the duration to achieve full feeding.

NEO/43(O) RETINOPATHY OF PREMATURITY (ROP) - A COMPREHENSIVE REVIEW OF EPIDEMIOLOGY AND RISK FACTORS AT A LEVEL II NURSERYAllawadhi M, Sharma M, Aggarwal R,Khilnani K, Kothari ASPMCHI, SMS Medical College and Hospitals, JLN Marg, Jaipur

Objective: Improved survival of premature babies has led to an increased incidence of ROP. Western guidelines for screening have been found inadequate in our country. However no guidelines exist for our setup. This study evaluates the epidemiology and risk factors associated with ROP and proposes screening criteria for our setting. Materials and methods: Prospective hospital based study. Intramural babies born during study period fulfilling expanded screening criteria (birth weight BW ≤ 1500gm or gestational age GA ≤ 34 weeks or GA between 34 – 37 weeks/BW between 1500 – 2000 gm with oxygen exposure>72 hours, septicemia, blood transfusions, ³ 1 apneic spells, respiratory distress syndrome, intraventricular hemorrhage, acidosis, seizures or necrotizing enterocolitis) were registered. Screening was done at 3-4 weeks postnatal age. Data were collected for 7 maternal, 25 neonatal and 9 therapeutic risk factors. Outcome measures: Progression to ROP or retinal maturity. Statistical software was used for analysis. Results: The incidence of ROP was 32.8 %( 16.4% stage I, 8.2% stage II, 8.2% stage III). The incidence of ROP among babies with GA 29-31 weeks, 32-34 weeks and 35-38 weeks was 37.7%, 34.7% and 18.8%, respectively. The incidence of ROP for < 1000 g, 1000-1250 and 1250-1500 weight categories was 60%, 38.8% and 30.4% respectively. Advanced ROP was not observed in babies with GA >32 weeks and BW > 1500. Oxygen supplementation (p=0.05), mechanical ventilation (p=0.007), respiratory distress syndrome (p=0.039), apnea (p=0.05), anemia (p=0.022) and packed red cell transfusion (p=0.028) were significant risk factors. Conclusion: ROP is common with prematurity, LBW, oxygen supplementation, mechanical ventilation, respiratory distress syndrome, apnea, anemia and packed red cell transfusion. Modified screening criteria are proposed for our setup.

NEO/44(P) REBOUND IN SERUM BILIRUBIN AFTER EXCHANGE TRANSFUSIONKamaljeet Kaur, Rahul Gandhi, Ravneet Kaur, Seema Rai, Rajeev Tandon, K.K.LochamDeptt. of Pediatrics, Govt. Medical College/Rajindra Hospital, Patiala - 147001

Objectives : To assess the rebound in bilirubin after exchange transfusion. Methods : 10 babies with neonatal hyperbilirubinemia requiring exchange transfusion admitted in teaching hospital were the subjects of study. Sex, mode of delivery, gestational age, birth weight, agar score, blood group of the mother, laboratory investigations like septic screening (CRP, B/N ratio, blood culture), blood group of the baby and serum bilirubin were recorded in pretested proforma. Rebound of bilirubin was related to the need for further exchange transfusion. Exchange transfusion was done depending upon the weight of baby and bilirubin levels as per Cashore and Stern charts. Bilirubin level was assessed immediately, after 1 hour and after 12 hours of exchange transfusion. Data so obtained was analysed statistically. Results : In the study group 5 babies were male and 5 were female. 9 babies were born by normal vaginal delivery. 6, 1, 2, 1 babies had weight > 2000g , 1500-1999g , < 1500g , < 1000 g respectively. The mean pre-exchange serum bilirubin level was 18.60 ± 5.09 mg/dl, The mean value of serum bilirubin immediately after, after 1 hour and after 12 hour was 7.25 ± 2.54 mg/dl, 11 ± 3.50 mg/dl and 14.62 ± 2.63 mg/dl respectively. The values rose to 39.1%, 59.3%, 78.4% of preexchange value immediately after, 1 hour and 12 hours after exchange respectively. 1 baby had post exchange value 16.6 mg/dl after 12 hours, which was equal to preexchange value. Repeat exchange transfusion was done in this case. There was significant rise in bilirubin level from immediately after exchange to 1 hour and also from 1 hour to 12 hours after exchange with p value <0.01 and p value <0.001 respectively. Conclusions : Rebound rise in serum bilirubin was significant though level requiring exchange transfusion could not be reached.

NEO/45(O) RETROSPECTIVE STUDY OF INTRACRANIAL HAEMORRHAGE IN PRETERMSJain P., Kulkarni A., Kaul S., Gupta V., Balan SIndraprastha Apollo Hospital, Mathura Road, Sarita Vihar, New Delhi

Introduction -Intraventricular haemorrhage (IVH) is the most common type of Intracranial haemorrhage (ICH) in the neonate primarily in preterm infants but is occasionally seen in near term and term infants. It can lead to adverse neurodevelopment outcome. Objective-To find out the incidence of ICH in preterm population and correlate with various obstetric and perinatal variables. Methods-A retrospective study was conducted from January 2000 to January 2005. Diagnosis of ICH was made by clinical assessment and ultrasound evaluation. Our ultrasound cranium protocol for preterm is day1, day 3 and thereafter as required. Results: Of a total of 707 preterm admissions, 45 (6%) had IVH, of these 28 were out born and 17 were inborn. The birth weight ranged from 860-3665 gm and gestational age between 27 to < 37 weeks. The incidence of IVH by weight was 34%, 11%, 4% and 2% in babies weighing <1000 gm, 1000-1499 gm, 1500-1999 gm and >2000 gm respectively. Incidence by gestational age was 25%, 8%, 8% and 3% in <28 weeks, 28-30 weeks, 31-34 weeks and 35 to <37 weeks gestation respectively. Incidence as per mode of delivery was 7%, 8% and 3% in emergency LSCS, vaginal delivery and elective LSCS respectively. Associated co-morbid conditions were HMD-35%, Asphyxia-29%, and HMD and Asphyxia-23%. Incidence of IVH was 6 % (45/707) in our preterm population as compared to higher incidence in other studies and 75% of these were transferred from other centers. Of these 18 (40%) had > grade II IVH. Of the IVH cases- 24 (53%) babies expired, 11 (24%) were discharged and 10 (22%) went LAMA.Conclusions: (A) Risk factors for IVH are multiple and include obstetric and perinatal variables. (B) Elective LSCS as a mode of delivery may have some protection against IVH. (C) HMD is the most common associated co-morbid condition. (D) Delivery in a Perinatal Centre is desirable to decrease the incidence of IVH.

NEO/46(O) RELATIONSHIP BETWEEN DURATION OF KMC AND PHYSIOLOGICAL PARAMETERS OF LBW INFANTSVeena R.Parmar, Ajay Kumar, Srikanta BasuDepartment of Pediatrics, Govt. Medical College, Chandigarh

Objective: To study the influence of duration of KMC on the physiological parameters of LBWI. Setting: Postnatal ward of dept. of Pediatrics, GMCH-32, Chandigarh. Method: This prospective study was conducted in department of Pediatrics from June 2002 to December 2003. Inborn stable low birth weight babies (wt.<2000gms) were included in the study. 50 mother-baby dyads who completed KMC for >4 hours per day with a minimum of 1 hour in each sitting were analyzed. Physiological parameters such as heart rate, respiratory rate, and temperature and oxygen saturation were recorded before and ½ hourly during KMC to ensure safety and 30 minutes after stopping KMC. Total of 483 sittings were recorded and were grouped according to the duration of KMC. Group-A, KMC for 60 minutes at a stretch (n=148); group-B, KMC up to 90 minutes (n=146) ; group-C, KMC up to 120 minutes (n=131) and group-D, KMC up to 150 minutes (n=58). Result: In relation to pre-KMC parameters, no significant variation was observed in the heart rate in any of the groups but in group-D stabilization was observed at 150 minutes and it was maintained even at half hour after KMC. Similarly, no significant variation in respiratory rates was observed in group-A, B and C but in Group D, it stabilized significantly from 45.39 + 4.36 (mean + SD) at 120 minutes to 44.71+4.67 (mean + SD) at 150 minutes (p-value=0.03), and persisted till half hour after KMC. A highly significant (p<0.0001) increase in body temperature in relation to baseline was observed within half hour of commencement of KMC in all the four groups. The temperature continued to rise progressively and stabilized at 37-37.20C till 90 minutes of KMC, p<0.001 and thereafter remained so during the later period in Group ‘C’ & ‘D’ and for ½ hour post KMC period. Improvement in oxygen saturation too was significantly observed within half hour of KMC in all groups and remained so throughout the KMC (p-value=0.03). This effect was also observed for ½ hour at post KMC. Conclusion: KMC starts exerting its stabilizing effects on the vital parameters as early as within 30 minutes. Temperature and oxygen saturation are first to improve followed by significant stabilization of respiratory rate and heart rate. Physiological benefits of KMC start early but most and maximum benefits are achieved when given for more than 2 hours at a stretch in each sitting.

NEO/47(P) KANGAROO MOTHER CARE: A FEASIBILITY AND ACCEPTABILITY STUDY IN AN URBAN HOSPITALVeena R. Parmar, Ajay Kumar, Srikanta Basu, Sunny Narula and Siddharth ParmarDepartment of Pediatrics, Government Medical College and hospital, Chandigarh, India.

Background: World over, Kangaroo Mother Care (KMC) is an established, safe, effective and widely accepted method of care for the low birth weight infants (LBWI). Objectives: To study the acceptability and feasibility of KMC in the care of LBWI by the hospital staff (nurses and doctors) and care givers (Mothers, fathers and other family members). Methods: KMC is a routine practice in our neonatal unit since June 2002. Every hemo dynamically stable LBWI, is put on KMC in the specified KMC cubicle in the postnatal ward and in the NICU even when on minimal life support. Mothers are encouraged to give KMC for as long as possible (minimum 1 hr in each sitting & at least 4 times/day). All the mothers, 39 relatives and 26 health professionals (doctors and nurses working in these areas) were assessed on Likart’s scale for acceptability of KMC on day three. of its commencement. Results: In all 112 babies {62 in NICU (group I) and 50 in the Post-natal ward 50 (group II) were analyzed. The mean duration of KMC in- Group I was 7 days (range 3 to 48) and in-group II 4.11+0.2days (3-43 days). In group-I, 19(31%) babies were below 1000 gm, 32(52%) between 1001-1500 G & 11(%) between 1501-2500 gm smallest being 500G.The mean birth weight in Group II was1420+ 315 G. Heart rate, Respiratory rate O2 saturation and temperature remained stable in all the babies during KMC. Acceptability: All mothers understood the method very well and 8% opined no need for special demo, as it is a natural instinct to hold babies close to ones bosoms. 50 % mothers were apprehensive in first sitting. All but one was able to maintain baby in comfortable position, 90% wished to continue it at home and teach to other mothers as well. 95 % mothers said that KMC elevated their mood, improved their confidence in handling the tiny babies and improved their milk flow. 6% mothers expressed a concern about privacy and and18% interference in routine activities. In all, 34% mothers confronted

minor problems such as; tiredness12%, excessive heat 2%, pain in stitches 10% and mess on account of urine and stool passed by baby 2%. 76% husbands, 84%motherinlaws, 66% father in-laws and85% of other relatives expressed that KMC is a very useful method of care. In fact quite a few fathers (n=5), mother-in-law’s (n=6), other relatives (n=10) and siblings (n=2) gave the KMC in the ward as well as NICU. Attitude of health personals: All the nurses have accepted it as a baby & mother friendly practice. They observed that babies getting KMC improved faster, had lesser risk of infections and falling sick & moved out of NICU earlier. Mother’s lactation & the EBM yield improved. The need for using additional heat convectors to keep the babies warm too declined significantly. 58% said it neither increased their workload nor interfered with care of other sick neonates. 85% opined that KMC surely saved human resource and need for expensive equipment to keep babies warm.35%nurses opined that KMC improved the over all behavior of babies. All said it should be introduced in all health care facilities. 11% nurses found it difficult to convince the mothers initially and 31% nurses in NICU initially felt that during KMC, the babies would require more frequent monitoring hence, it would be more time consuming. Feasibility: KMC was feasible in our setup as we have been able to make it operational successfully and sustain the program till date. It is now an obsession with the nurses & doctors. Some times in NICU the mothers of seriously sick babies too express their desire to do so for their babies. Conclusions: KMC is a feasible and well-accepted technique for the care of LBWI by mothers, family members and health personals.

NEO/48(O) TRENDS IN HYALINE MEMBRANE DISEASE Preeti Bindra, Sandhaya ,K D Gupta, Aruna Behl, Neerja Dayal ,Sudarshan Kumari.Center for newborn care and dept of obstetric & gynecology,

Introduction .During last decade,there has been increasing use of antenatal steroids for anticicpated or elective preterm birth.This has resulted in decreased incidence of hyaline membrane disease in preterm babies .Although incidence of respiratory distress in our NICU admissions remains at about 70% over last 8 years, it appeared that the incidence of hyaline membrane disease has decreased. This has been attributed to liberal use of antenatal stroids. What is the exact decrease has not been reported except nnf data base. Aims & objective This study was undertaken to find out incidence of hyaline membrane disease (hmd) in a level 3 NICU during last 8 years. Material and methods and results The study includes all case of hmd admitted to our nicu from 1997-2005 .Diagnosis of hmd was based on clinical and radiological finding based according to national neonatology forum criteria .All cases were scrutinised by first author and followed till hospital discharge or otherwise. During all these years proportion of preterm neonates has been between 40-45%. Two third of babies were outborn.The incidence of hmd decreased from 8.% during 1997 to 2.6% in 2005. Although the frequency of hmd decreasd remarkably birth weight was no different over the study period and mean gestation was between 30-32 weeks. During the same period it was noted that neonates whose mothers had received steroid ,mean duration of hospital stay was shorter. Frequency for use of steroids also increased over the years There was a significant differnce in birth weight of neonates who survived and those who had a fatal outcome;during 1998,mean birth weight of survivors and death was2027gm and 1499gm respectively,this was noted to be 1672 and 1037 gm respectively. Further data on other causes of respiratory distress will be presented. The study will also highlight the contribution of maternal factors. Conclusion: Our study highlights the decresing incidence of hmd,attributed to increasing use of antenatal steroids coupled with postnatal surfactant . Also obstetric interventions of prolonging pregnancy and availability of neonatal intensive care services are partally responsible for improved neonatal survival. Still about 50 % of babies who developed hmd need ventilatory support . during this study we noted that antenatal steroids reduced the duration of respiratory distress from 8.4 days to 5.3 days even when the diagnosis was not hmd. Often a question of safety of steroids for neurodevelopmental outcome has been debated , a recent report by Stuchfield & colleagues in a ranomnised control trial of women undergoing elective cesarian have shown decreased duration of respiratory distress with two doses of betamethasone before delivery. Our study documents the decreasing incidence of hmd ,a trend of success of obstetric intervention.

NEO/49(P) TOTAL ANTIOXIDANT LEVEL ASSAY IN NEONATES: EVALUATION OF ANTIOXIDANT STATUS OF LOW BIRTH WEIGHT AND PRETERM NEONATES AT BIRTHR. AdhikariOpp. Petrol Pump, Near Bus Stand, Sagwara (Raj.) – 314025

Objective: The study, total antioxidant level [TAO] in newborn of various gestational age and birth weight was conducted to know antioxidant status of neonates at birth. It is of concern whether LBW and preterm neonates are deficient of antioxidant status at birth. Design: Cross sectional study, consist of physical and biochemical assay. Setting: secondary level center in south Rajasthan, India. Methods: The study sample included 100 neonates of gestational age 26-41 wk. And birth weight 0.55-3.85 kg. Cord blood sample were processed and TAO level assay of plasma done by standard method. Gestational age and birth weights were recorded as per standard norms. The neonates were classified into various categories in reference to maturity, gest.age, birth wt., sex, dietary habit of mother etc. Result: In our study the mean TAO level [mmol/L] in different categories was found to be as; in TAGA 1.37±0.12, inTSGA 1.34±0.14, in PreAGA 1.20±0.12, in PreSGA 1.09±0.13, in group 26-36 wk. 1.15±0.14, in 37-41 wk. 1.36±0.13, in 0.50-1.45 kg. 1.05±0.10, in 1.50-2.45 kg. 1.31±0.11, in 2.50-3.75 kg. 1.37±0.12, in veg 1.24±0.18, in nonveg 1.26±0.17, in male 1.25±0.18, in female 1.26±0.17 mmol/L. We observed TAO level higher in term neonates than preterm, higher in AGA neonates than SGA neonates, nearly equal in veg and nonveg groups, nearly equal in male and female neonates groups, increasing from lower to higher gestational ages and birth weights showing positive correlation, having ’P’ value < 0.001,highly significant among these groups. Male v/s female, veg v/s nonveg groups have nonsignificant difference [P>0.05]. Gestational age has more positive correlation[ r = 0.877] than birth weight [ r = 0.814] respectively. Gestational age and birth weight each has highly significant contribution [p<0.001] individually for TAO level in plasma. Conclusion: We conclude that preterm and LBW neonates have low TAO levels, which indicates lower antioxidants status. The chances of pathogenesis of various diseases due to free radicals and oxidative stress are more in preterm neonates as compared to term neonates. Early supplementation of exogenous antioxidants to the preterm and LBW neonates should be considered at priority to reduce morbidity and mortality. Total Antioxidant Level Assay in Neonates: Evaluation of Antioxidant Status of Low Birth Weight and Preterm Neonates at Birth.

NEO/50(P) TROPHIC FEEDING INDUCED NECROTIZING ENTEROCOLITIS ( NEC )Puneet Jairath, Kamaljeet Kaur, Shalini Soi, Manpreet Sodhi, K.K.LochamDeptt. of Pediatrics, Govt. Medical College/Rajindra Hospital, Patiala - 147001

Trophic feeding induces gut secretions which help in the maturation of gut. It does not cause NEC. We report a case where trophic feeding was responsible for NEC. Case Report : A preterm (AGA) baby of 32 weeks gestation weighing 1500 grams was delivered vaginally. Mother was on MgSO4 regimen due to severe PIH. Baby was resuscitated with endotracheal intubation. Apgar score was 4/10 and 8/10 at 1 min and 5 min respectively. Respiration of the baby was shallow. Baby was put on treatment with IV fluids, oxygen and antibiotics. Meconium was passed on 1st day of life. Trophic feeding was started on 4th day of life with LBW formula 1ml 4 hourly. Baby developed abdominal distension on 5th day of life. Bowel sounds were absent. Trophic feed was stopped. Baby was continued with IV fluids, nasogastric decompression and antibiotics. Plain X-Ray abdomen on 5th day of life was normal. Abdominal girth of baby continued to rise. On 8th day of life, X-ray abdomen showed free air under the right dome of diaphragm. Septic screen was negative on day 1 and day 5 and blood culture showed no growth. Metabolic screen, renal function tests and serum electrolytes were normal. Baby was managed conservatively. Discussion : NEC can be presenting feature of cystic fibrosis, Hirschprung’s disease, ileal/ duodenal atresia. Our baby had none of such causes. Baby was preterm, borderline VLBW and had perinatal asphyxia. The baby developed NEC due to trophic feeding started on 4th day of life. Conclusion : Trophic feeding should be used cautiously in babies with multiple risk factors to avoid the risk of NEC.

NEO/51(O) PLATELET COUNT IN NEONATES WITH HYPOXIC ISCHAEMIC ENCEPHALOPATHY – CORRELATION WITH SEVERITY.Piyush Chandel, Navaneetha S., Ashwini Deshmankar., Jyotsna Shrivastava. Rashmi Dwivedi.Department of Paediatrics, Kamla Nehru Hospital, Gandhi Medical College, Bhopal.

In the bone marrow, megakaryocytes are the most sensitive cells to hypoxia. Objective and Design : In this prospective study conducted from July 2004 to July 2005, we evaluated the effect of hypoxia on platelet count and its correlation with the severity of HIE. Setting : Tertiary care neonatal unit in Central India. Subjects and Interventions : 100 asphyxiated neonates were included in the study and were classified according to the sarnat and sarnat staging. Within 24 hours of age; 1 ml of venous blood was taken in an EDTA vial, mixed gently and immediately sent for platelet count. All neonates with early onset septicaemia, congenital anomalies, hepatosplenomegaly, IUGR and maternal history of PIH were excluded from the study. Results : Out of the 100 cases, 37, 52 and 11 were in HIE stages I, II and III respectively. 4 out of the 37 cases (10.8%) in stage I, 15 out of the 52 cases (28.84%) in stage II and 7 out of the 11 cases in stage III (63.6%) showed thromboctopenia. The mean platelet count in stage I was 2,20,000+62,000, stage II 1,96,000+58,000 and stage III 1,82,000+76,000. Conclusions : Thrombocytopenia is more significantly associated with the severer stages of HIE (p <0.05) but the severity of thrombocytopenia as measured by mean platelet count is not significantly different in the three stages.

NEO/52(O) PREDICTING NEONATAL HYPERBILIRUBINEMIA USING FIRST DAY SERUM BILIRUBIN LEVELSShivani Randev, Neelam Grover, V.K. SharmaDepartment of Pediatrics, Indira Gandhi Medical College, Shimla-171001

Hyperbilirubinemia is the major cause of readmission of neonates discharged early from the hospital. Here comes the need for predicting at-risk neonates on the first day of life so that they can be retained in the hospital for observation and early management of hyperbilirubinemia if the need arises. Objective: To determine the first day total serum bilirubin (TSB) value which will predict with reasonable accuracy, neonates likely to develop subsequent hyperbilirubinemia. Design: Prospective. Subjects and Setting: Healthy term neonates born at a tertiary care hospital. Methods: Serum bilirubin was estimated for all enrolled cases within 18 to 30 hours of life by microcapillary. The babies were then followed up clinically by 2 observers for the appearance and progression of jaundice every 12 hours till discharge and then daily upto 5th day of life. TSB estimation was repeated if the clinical assessment of serum bilirubin was more than 10 mg/dl by any observer using Kramers rule. Hyperbilirubinemia was defined as TSB level >12mg/dl between 24 to 48 hours of life, >15 mg/dl between 48 to 72 hours of life and >17 mg/dl beyond 72 hours of life. Results: A total of 200 neonates were enrolled in the study. Of these 24 neonates (i.e.12%) developed hyperbilirubinemia. The mean first day TSB value in the neonates who subsequently developed hyperbilirubinemia was 7.716 mg/dl as compared to a value of 5.154 mg/dl in those who did not. The difference was significant (p=0.000). Using Receiver Operating Characteristic (ROC) Curve analysis, a value of 6.4 mg/dl (First Day TSB) was determined to have the best predictive ability for subsequent hyperbilirubinemia, with a sensitivity of 87.5%, Specificity of 80.11%, Positive Predictive Value of 37.5% and Negative Predictive Value of 97.92%. Conclusion: First day TSB estimation can serve as a reliable screening test for neonates at risk for subsequent hyperbilirubinemia. Neonates with a first day serum bilirubin level of less than 6.4 mg/dl have minimum risk of subsequent significant hyperbilirubinemia.

NEO/53(O) PERIPHERALLY INSERTED CENTRAL CATHETER - IS IT AN EFFICACIOUS REPLACEMENT TO THE PERIPHERAL VENOUS LINEUma Raju, H Ravi Ramamurthy, S C Shaw, N K Biswas , Kiran Sodhi, Sheila Mathai,M SharmaCommand Hospital, Wanowrie Road, Pune

Introduction: There is an increasing trend towards the usage of Peripherally Inserted Central Catheter (PICC) in the Neonatal Intensive Care Unit (NICU). However little data exists regarding their indications of usage and complications. Objective: To evaluate the usage, complications and expense factor of PICC with the peripheral venous lines (PL). Design: The data of 106 babies at a tertiary level NICU over one year were retrospectively studied. The PICCs were used when IV alimentation beyond 10 days was envisaged; imminent lack of venous access anticipated or concentrated solutions needed to be provided. 46 babies were managed with PICC (Group I) and 60 babies with PL (Group II). The data was analyzed by Chi square test (EPI 6) to determine the statistical significance. Results: The indications for prolonged venous access in Group I(PICC) vs Group II(PL) were ELBW & VLBW’s in 13(28%) vs 15(25%),Ventilation 17(37%) vs 17( 28%), Surgical Conditions 5(10%) vs 12(20%), Others 11(23%) vs 16(26%). The complications of PICC vs PL were Extravasation in 2 vs 16(p<0.05), Thrombophlebitis in 19 vs 24 (p>0.05). Local Necrosis was exclusively in 5(8%) of the PL group. Complications exclusively in PICC group were, blockage 6(13%), catheter related sepsis 3(7%) and breakage 2(4%). A PICC lasted an average of two weeks (Maximum 25 days). In six of the group I a 2nd PICC used. In group II, the PL (22G) required change on an average of 9 times (every 1.5 days). The single PICC (Rs900) was marginally more expensive than the PL (Rs 65/-each) of which nine were required. Conclusions: PICC is a safe option to the PL in babies who require prolonged IV alimentation. PICC is unassociated with a significantly greater risk of complications. The cost was not much different and PICC consumed less time in securing a venous access.

NEO/54(P) PREDICTION OF NEONATAL HYPERBILIRUBINEMIA IN ABO INCOMPATIBILITYDeepak Bhat, Mira Purohit, BK Jain, HS BainsDepartment of pediatrics, Dayanand Medical College & Hospital, Ludhiana.

In the expanding list of conditions causing neonatal icterus gravis, blood group incompatibility still remains most common and important cause of icterus of potential severity. Heterospecificity of mother and child with respect to blood group-A,B & O, is common. Because of the relative infrequency of severe ABO disease, the urgency for predictive criteria in this disease have been slow in forthcoming. Hence this study was taken up. Objective: To establish a correlation between cord blood bilirubin levels and the development of subsequent hyperbilirubinemia in healthy term newborn ABO incompatible infants of blood group “O” mothers. Subject & Methods: One hundred consecutive healthy full term offsprings of ABO incompatible pregnancies and 30 controls resulting from O-O pregnancies were studied. Blood group and serum bilirubin estimations were carried out on cord blood and bilirubin estimation were done at 12,24,36 and 48 hours of life. Results: Out of 100 cases in study group 33 (33%)developed hyperbilirubinemia whereas only 1(3.3%)out of 30 cases in control group developed hyperbilirubinemia. Majority of cases with hyperbilirubinemia i.e. 20 (60.6%) out of 33 cases, had cord blood bilirubin values between 2.5 to 2.99 mg/dl. Mean cord blood bilirubin values were significantly higher (2.27+ 0.76) in study group as compared to control group (1.55 + 0.33). Conclusion: It is concluded that in ABO incompatibility the cord blood bilirubin value > 2.5 mg/dl can serve as a useful cutoff limit for the later development of hyperbilirubinemia.

NEO/55(P) PRUNE BELLY SYNDROME with d-TGA; A RARE ASSOCIATIONP.M.C Nair, Laxmi Venugopal, Kiron . S Dept of Paediatrics, Institution Medical College , Trivandrum

Prune Belly syndrome constitutes a triad of deficiency or absence of anterior abdominal wall musculature, urinary tract anomalies and bilateral cryptorchidism. We report a case of a newborn with Prune Belly syndrome who died on 3rd postnatal day and fetal autopsy showed an associated d-TGA. INTRODUCTION: Prune Belly syndrome constitutes a triad of deficiency or absence of anterior abdominal wall musculature , urinary tract anomalies and bilateral cryptorchidism. Associated cardiovascular anomalies are found in 10% of cases and include ASD ,VSD , PDA and TOF. It is extremely rare in clinical practice to get an associated d-TGA. CASE REPORT: We report the case of a term AGA baby born of a non consanguineous marriage admitted in our newborn nursery on 1 st

postnatal day. The mother is a 4th gravida with history of 2 abortions and 1 live child. She had PIH and was on methyldopa for treatment. Antenatal USG done at 8 th month of gestation revealed oligohydramnios, fetal hydronephrosis and dilated ureters.Baby was delivered on completing 37 weeks by elective LSCS. The umbilical cord had only single umbilical artery. The baby was transferred to our newborn ICU. On examination there was no facial dysmorphism. Baby had respiratory distress, grossly distended abdomen with wrinkling of anterior abdominal skin and large mass palpable on left lumbar region. There was a fistulous track with continuous drainage of urine below umbilicus. External genitalia were normal. Bilateral CTEV was present.CVS examination was normal. Baby expired on 3 rd

postnatal day . The body was sent for fetal autopsy. Fetal autopsy done revealed hypoplastic abdominal musculature , bilateral hydronephrosis with dilated pelvis , pulmonary hypoplasia and d-TGA with small PDA . DISCUSSION: Prune Belly syndrome or Triad syndrome or Eagle Barrett syndrome constitutes a triad of deficiency or absence of anterior abdominal wall musculature , urinary tract anomalies and bilateral cryptorchidism. Prune belly syndrome is a rare anomaly seen in 1 in 35,000-50,000 live births. Prune belly syndrome occurs almost exclusively in males, with less than 3% occurring in female patients and occurs in individuals of all races. Diagnosis is made in utero using ultrasound (US) or in the neonate with characteristic clinical findings. In the 1970s, half of the patients with prune belly syndrome died in early infancy. Currently, the survival rate has improved markedly. The following defects are seen: Abdominal wall The abdominal wall defect varies from a complete absence of musculature and scanty subcutaneous tissue to an apparently normal appearance of the abdomen. The lower portion of the abdomen usually is involved and the flanks bulge. The margins of the liver and spleen, as well as bowel loops, are visible. The chest appears small with flaring of the lower ribs. The wrinkled appearance of the dystrophic abdominal wall is responsible for the prune like appearance of the abdomen. Urethra The urethra may be normal or portions of the corpus spongiosum may be absent and associated with megalourethra of the anterior urethra. The posterior urethra is elongated and dilated with a funnel-shaped appearance that resembles a posterior urethral valve. A persistent prostatic utricle usually is present in the posterior urethra. Underdevelopment of the posterior lobe of the prostate gland results in a diverticulum like posterior projection of the posterior portion of the urethra. Bladder and urachus The bladder is large, vertical in orientation, and often thick-walled. In some patients, a bulging conical dome of the bladder represents persistent urachus. Vesicoureteral reflux often occurs, and large post void residual is frequent. Ureters The ureters are markedly tortuous and dilated, with the distal ureter more affected than the proximal ureter. The wall of the ureter is fibrous, with deletion of the muscular layer. Kidneys Dilatation of the renal pelves with clubbing of the renal calyces and a diminished number of calyces is characteristic. The kidneys are hypodysplastic, often with diffuse parenchymal cysts. Progressive renal failure occurs with repeated infection. Testes All male patients have cryptorchidism. The testes are present and usually are small and intra-abdominal in location. Sperm usually are absent, and neoplasia has been reported to occur in the testes. GI Tract In the GI tract, anomalies include malrotation with mesenteric defect, imperforate anus, gastroschisis, Hirschsprung disease, and constipation. Cardiac Anomalies include VSD ,ASD , TOF and PDA and have been reported in 10% of patients. Pulmonary Pulmonary anomalies include hypoplasia resulting from the oligohydramnios, compression from the large abdomen, and Potter syndrome. Respiratory compromise secondary to abdominal muscular deficiency may be seen. Extremities Skin dimples over the patient's joints ,clubfoot and developmental dysplasia of the hip from fetal crowding by oligohydramnios. Investigations X ray chest and abdomen USG abdomen For urinary tract evaluation,

perform renal US and voiding cystourethrography. Some diagnosticians assess renal function by performing a technetium Tc 99m dimethylsuccinic acid (DMSA) renal scan that shows both the appearance and function of the kidneys. Intervention Careful observation of urinary output and electrolytes is essential in the early newborn. A rise in BUN and creatinine associated with decreased urine output is an indicator of obstruction. Radiologic studies should be obtained in the newborn period, regardless of whether obstruction is present or not. Undescended testis can be brought down using laparoscopic techniques. Abdominal wall reconstruction is performed in most boys to improve respiratory function as well as for cosmetic reasons. If the child is stable a standard pyeloplasty can be performed as another means of managing the obstructed UPJ. The patient with urethral obstruction can be managed by several means. The simplest and best is the use of a Blocksom vesicostomy in the early newborn period. A patent urachus can be frequently found in patients with urethral obstruction, . In these patients ligate the urachus at the time of vesicostomy. Posterior urethral valves are best managed by transurethral resection. For patients with megaureters and megacystis, reconstruction of the urinary tract with tapering and reimplantation of the ureters and reduction cystoplasty is undertaken in the more severely affected infants or as a staged procedure in children.

NEO/56(O) SERUM CALCIUM ON 1ST DAY OF LIFE AS PREDICTOR OF SHORT TERM MORTALITY IN PRETERMSSamiuddin Shaikhsamiuddin.shaikh@rediffmail.com

Introduction:Maternal malnutrition, poor antenatal care and small for gestational age babies with prematurity predispose to micronutrient deficiency especially of calcium, which can effect mortality and morbidity. Aims & objective: To determine the following : 1) serum total and ionic calcium in preterm newborns on 1st day of life; 2) the effect of different neonatal conditions on serum total and ionic calcium; 3) the relationship between serum calcium and subsequent mortality of preterm babies. Method: Venous blood sample were obtained within 4 hours of hospitalization of a total of 120 preterm (gestational age < 36 weeks) admitted to special care neonatal unit of a tertiary care hospital. Total calcium was estimated using photometric method and ionic calcium with selective electrode analyzer. Base line data was obtained and all neonates were followed up till discharge or death. All babies received standard care for their underlying condition including parenteral calcium if warranted. Results: The mean gestational was 33.95 (+ 2.11) weeks. Pregnancy induced hypertension was commonest maternal complication observed in 65 (54.16%) babies. Respiratory distress syndrome, sepsis, hyperbilirubinemia, seizures and apnea was present in 59 (49.16%). Mean serum total and ionic calcium were 8.43 (+ 1.44)mg/dl and 0.87 (+0.17) mg/dl respectively. There was no significant statistical relationship between serum total and ionic calcium and any one neonatal complication or maternal risk factors. On logistic regression low serum total calcium was strong predictor of in hospital mortality [adjusted OR 2 ( 1.17, 3.3 ) ] Conclusion: The role of hypocalcemia on 1 st day of life as cause for mortality in preterm neonates and its management to reduce mortality needs to be further investigated. It has the potential to be adopted in a scoring scale to predict mortality in sick preterm neonates.

NEO/57(P) SEGMENTAL RATIO AND SPAN IN NEWBORNSK.K.Locham, Ravneet Kaur, Seema Rai, Rahul Gandhi, Puneet JairathDepartment of Pediatrics, Govt. Medical College/ Rajindra Hospital , Patiala

Objectives : To correlate the segmental ratio and span to gestation, birth weight, mode of delivery and presentation, parity and sex of newborns. Methods : 100 newborns delivered in the department of Obstetrics and Gynaecology, Govt. Medical College and Rajindra Hospital, Patiala were the subjects of study. Maternal parity, mode of delivery, presenting part, period of gestation, sex, weight, length, upper and lower segment, segmental ratio and span of newborns were recorded. Results : Out of 100 newborns, 52% were males, 48% were females. 32% were preterms and 68% were terms. 42%, 55% and 3% had birth weight between 1501-2500 gm, 2501-3500 gm and more than 3500 gm respectively. The mean segmental ratio was 1.68 ± 0.19, 1.68 ± 0.18 and 1.57 ± 0.06 in newborns with birth weight 1501-2500gm, 2501-3500 gm and more than 3500 gm respectively. The mean span was 43.47 ± 2.45, 45.77 ± 2.14 and 49.5 ± 1.73 cm in newborns with birth weight 1501-2500 gm, 2501-3500 gm and more

than 3500 gm respectively. The mean segmental ratio was 1.67 ± 0.2 and 1.68 ± 1.18 in newborns born between 32-36 week and 37 week or more respectively. The mean span was 43.43 ± 2.58 and 45.52 ± 2.43 cm in newborns born between 32-36 week and 37 week or more of gestation respectively. The variation of segmental ratio according to birth weight and period of gestation was not statistically significant (p>0.005), whereas the span increased progressively both with increase in birth weight and gestation, and was statistically significant (p<0.01). However, segmental ratio and span did not show any significant difference in relation to mode of delivery, type of presentation, parity and sex of newborn (p>0.05). Conclusions : Segmental ratio and span was having significant relation to gestation and birth weight.

NEO/58(P) SEPTICEMIA DUE TO MULTIDRUG RESISTANT KLEBSIELLA PNEUMONIAE IN A TERTIARY CARE NEONATAL UNITL. H. Bidari, Nitin Tikare, Anand Kanakaraddi, Vinayak Revankar, Sachin Admuthe, B. G. ManturBidari’s Ashwini Institute of Child Health & Research Centre, Bijapur.

Background: In recent years, there has been an increase in the incidence of outbreaks caused by multidrug resistance K. pneumoniae organisms or the extended spectrum beta-lactamase (ESBL)-producing K. pneumoniae. The problems associated with extended spectrum beta-lactamase-producing organisms include limited treatment options and increased morbidity and perhaps mortality. Objective: To study profile of neonatal septicemia caused by multiresistant Klebsiella pneumoniae. Design:Retrospective study.Setting: Dr. Bidari’s Ashwini Institute of Child Health & Research Centre, Neonatal Tertiary Care Centre at Bijapur Methodology:Records of neonates with blood culture proved Klebsiella pneumoniae sepsis admitted to NICU from July 2004 to August 2005 were studied with respect to age at onset, sex, weight, sensitivity pattern & outcome. Results: There were 726 admissions in the NICU during August 2004 to July 2005 (1 year). 134 neonates had blood culture proven sepsis of which 27 (20.15%) were due to klebsiella pneumoniae. Mean weight at the time of presentation was 2.085 kg, out of these 18.51% babies were ≤ 1.5kg, 59.26% were 1.5 - 2.5kg and 22.22% were >2.5kg. Male babies were predominant (77.78%).Early onset (<3 days) sepsis was seen in 55.56% cases, intermediate (3 – 8 days) onset in 25.93% and late (>8 days) was observed in 18.5% of cases. All the 27 isolates were found to be resistant to a minimum of 3 antibiotics, hence these were considered multidrug resistant. Klebsiella were the most sensitive to Imepenen & meropenem (100%) and amikacin (51.85%). The sensitivity to other antibiotics were gentamycin (29.63%), ciprofloxacin & ofloxacin (11.1%) and ceftzidime, cefuroxime, ceftriaxone, netromycin (3.7%). None of the isolates were sensitive to cefotaxime and ampicillin. Overall mortality was 14.8%. Conclusion: Neonatal septicemia still bears disastrous consequences if not treated optimally. Emergence of MDR organisms particularly Klebsiella in NICUs is worrisome and warrant special attention to the choices of antibiotics.

NEO/59(P) SERUM MAGNESIUM IN PRETERM NEWBORNSHajare A. A., Sheikh S, Patel Ab, Balpande DnIndira gandhi government medical college, Nagpur

Objective: To determine serum magnesium(Sr Mg) levels in preterm infants its clinical correlates, the serum calcium (Sr Ca) (total and ionic) and mortality. Design: Observational, cross sectional, at the premature baby unit. . Methods: Venous samples of all 120 preterm babies within 4 hours of hospitalization. Sr Mg and total Sr Ca was estimated using photometric methods. Ion selective electrode was used for ionic calcium. Results: Mean gestational age was 33.95 (+2.11) weeks. The mean serum magnesium level was 1.293 (+0.24) mg/dl. Hypomagnesemia (serum magnesium <1.5mg/dl) was in 105 (87.5%) of newborns. The mean total Sr Ca and ionic Ca were 8.42 + 1.44 mg/dl and 0.87 + 0.17 mmol/L respectively. Sr Mg level tended to increase with gestational age and birth weight but was not statistically significant. Sr Mg was significantly low in small for gestational age newborns(SGA) (1.280 + 0.248 mg/dl) as compared to appropriate for gestational age(AGA) newborns (1.370 ± 0.233 mg/dl) (P<0.05). There was no statistical significance between Sr Mg levels with history of maternal risk factors or presence of birth complications in the baby. Also there was no significant statistical correlation between Sr Mg, total and ionic Ca levels. On multivariate regression, presence of SGA was most predictive of hypomagnesemia (coefficient of regression = -1.284, p= 0.0358). Gestational age and total Sr Ca were strong predictors of subsequent mortality. (Gestational age:

coefficient of regression = – 0.862, p = 0.000; Total serum calcium: Coefficient of regression = –0.694, p = 0.0109). Serum magnesium level was not significantly associated with risk of mortality (coefficient of regression = -0.526, p = 0.676). Conclusion: SGA in preterms was most predictive of neonatal hypomagnesemia.

NEO/60(P) STUDY OF THROMBOCYTOPENIA IN SICK NEONATESRajiv Kumar, Nomeeta GuptaDepartment of Pediatrics, Batra Hospital & Medical Research Centre, New Delhi-110062.

Thrombocytopenia is one of the most common hematological problems in the neonatal intensive care unit (NICU). OBJECTIVE: To determine the number of cases and manifestations of thrombocytopenia in sick neonates. DESIGN: An observational study. SETTING: NICU of Department of Neonatology & Pediatrics, Batra Hospital & Medical Research Centre, New Delhi from January 2004 to June 2005. 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-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. 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/61(O) A STUDY OF PERINATAL MORTALITY IN HYPERTENSIVE DISORDERS OF PREGNANCY IN A RURAL MEDICAL COLLEGE AND HOSPITAL.Pankaj C Vaidya, Amar Taksande, Krishna Y Vilhekar, Pushpa Chaturvedi.Department of Pediatrics, Mahatma Gandhi Institute of Medical Sciences and Kasturba Hospital , Sevagram, 442102, Dist-Wardha

Hypertensive Disorders of Pregnancy (HDP) represent greatest danger for the fetus due to compromised uteroplacental circulation and unfavorable uterine environment and are associated with high Perinatal Mortality (PNM) and morbidity, because of susceptibility to ante partum & intra partum asphyxia, IUGR, prematurity (PT), Low Birth Weight (LBW) and numerous perinatal complications. Objectives: To study the PNM in HDP in rural set ups in relation to Maternal Characteristics, Birth Weight, Gestational Age and causes of Early Neonatal Deaths(ENND). Methods: All the intramurally delivered mothers during the study period of 2 years were classified as HDP [further classified as Gestational Hypertension (GHT), Preeclampsia (PE), Eclampsia (E), Superimposed Preeclampsia on Chronic Hypertension (Sup. PE on CHT) and CHT] and Non-HDP. Cross-sectional study of all the 432 consecutive PNM was done and they were analyzed statistically. PNM whose mothers had HDP were labeled as GROUP I and PNM whose mothers were normotensive (non-HDP) as GROUP II and both were compared. Results: Proportion of HDP was high (14.73%). In GROUP I, PNM were significantly high (p<0.05), PNMR almost thrice, proportion of FSB significantly higher (p<0.05), mothers from the rural area proportionately more, emergencies proportionately higher, primigravidae proportionately more and LSCS deliveries significantly more (p<0.05). Among PNM the SB were proportionately highest among PE, followed by E, GHT and ENND proportionately highest among E, followed by PE, GHT. PNMR (/1000 live births) highest among PE-470, followed by E-461, GHT-75 GHT and nil-both Sup.PE on CHT and CHT. LBW and PT were proportionately highest among E and lowest among GHT. Common primary causes of ENND in GROUP I were Prematurity (27.66%) with or without RDS (14.89%), Birth Asphyxia (25.53%) and Sepsis (14.89%). Conclusions: Proportion of HDP is high even

in the rural areas and HDP is a major contributor to PNM. Timely antenatal intervention & management in HDP can help improve pregnancy outcome. There is a need for an increased awareness and education in mothers, better health care, and transport and referral facilities in rural areas.

NEO/62(P) A STUDY ON THE EFFECT OF MATERNAL PASSIVE SMOKING VERSUS TOBACCO CHEWING ON NEONATAL OUTCOMERaghu Raman B, Avyact Agrawal, Pawan GanghoriyaDepartment of Pediatrics, NSCB Medical College, Jabalpur, M.P.

Objectives: 1. To study the effect of tobacco chewing/passive smoking by pregnant mothers on the newborns. 2. To compare the present study with 2 previous studies to study the temporal trend of the adverse effect of tobacco chewing on newborn babies. Material and methods: 202 mothers and their babies were studied during a one year period from June 2004 to July 2005. 52 mothers consumed oral tobacco, 50 mothers were exposed to various levels of passive smoke and 100 mothers who were non-consumers and non-exposed constituted the ‘control group’. Detailed maternal data and newborn details were collected. The perceptions of mothers regarding tobacco chewing and passive smoking and the effect on the fetus were studied as per a structured questionnaire. Results: All three groups were homogenous with respect with respect to maternal variables. The mean birth weight of babies in the tobacco chewers and passive smokers were 176.31 grams and 184 grams less respectively [P<0.05]. The mean length in both the study groups were 0.95 cm and 0.98 cm less than in the control group [P<0.05]. There was no increase in incidence of preterm births, congenital malformations. The mothers neither knew about the difference between active and passive smoking and the harmful effects of chewing tobacco/passive smoke on the fetus. Conclusion: This study clearly demonstrates that the tobacco consumption orally too affects the neonatal growth adversely. The poor awareness among mothers regarding its harmful effects should be addressed by proper counseling during antenatal visits so that a preventable cause of Low birth weight babies can be dealt with.

NEO/63(O) A STUDY OF NEONATAL SKINFOLD THICKNESS AND ITS CORRELATION TO THE GESTATIONAL AGE, BIRTH WEIGHT,AND SEX OF THE BABYLokesh Sharma, Ashok K Singh, Vivek Singh. S.P. GoelDepartment of Pediatrics, L.L.R.M. Medical College and associated S.B.V.P Hospital,Meerut, 250004

Objective: To study the correlation of neonatal skinfold thickness to the birth weight, gestational age and sex of the baby. Design: Cohort study Setting: Neonatology unit of tertiary level hospital Method: A total of 258 appropriate for gestational age, full term newborns delivered at department of Obstetrics and Gynaecology, LLRM Medical College, Meerut, were included in the study. Detailed maternal history and a detailed neonatal examination, including modified Ballard scoring and anthropometry were performed within 48 hours of birth. They were divided into three birth weight groups and correlation of skinfold thickness with sex, birth weight and gestational age of baby was observed. Result: The difference in mean skinfold thickness among females and males of all birth weight groups was statistically significant (p < 0.01 for subscapular skinfold and p <0.001) for triceps skinfold).The difference in mean skinfold thickness among different birth weight groups was statistically significant for skinfold at both sites [p < 0.001 (except for triceps in comparison between 1501-2000 gms vs 2001-2500 gms birth weight groups, p < 0.05)].On comparison of skinfold thickness among different gestational age groups, the difference was statistically significant but for that near post term end. Conclusions: The mean skinfold thickness was found to be more in males than females in the present study and that it increases with increase in birth weight and gestational age, correlation being more constant with birth weight. The use of skinfold thickness alone for estimation of gestational age, therefore needs further evaluation.

NEO/64(P) LEFT ADRENAL HEMATOMA, A RARE CAUSE OF ABDOMINAL MASS AND AN UNEXPLAIND HYPERBILRUBINEMIA IN NEONATES.Mahendrappa K.B, Nagaraj Murthy, Libab,Dept. of Paediatrics, J.S.S. Medical College and hospital, Mysore-570004

Introduction: As in the facets of birthtrauma hamill first described adrenal hemorrhage. In newborn following a spontaneous delivery in 1892. The incidence of adrenalhemorrhage Is about 3 per 1,00,0000 live births and it is relatively highin difficult breechdeliveries. Due to the anatomical position, the right adrenal hemorrhage is more common upto78% compare to left 14% and bilateral 8%.WE are reporting here a very very rare case with the left adrenal hematoma presenting with a mass per with out features of hypoadrenalism. CaseReport: A 5 –day –old baby brought with history of difficult labor, birth asphyxia and progressive increase in jaundice of 2 days duration. On examiantion baby weighing 4 Kg. Had deep jaundice and lethargic with a high pitched cry. Vital signs were stable and abdomen examination revealed an irregular, firm mas ofabour 8x6 cm in the left lumbar and left hypochondriac region. Investigation like blood routine including coagulation profile were within the normal range. The ultra sound and cT abdomen showed large hematoma in the left adrenal gland.Baby improved well with exchange transfusion and other supportive measures. Follow up and repeat ultrasound revealed regressionof the hematoma. Conclusion:- Adenal hematoma is a rare consequence of birth trauma especially in difficult labour. Hematoma preseting as a mas per abdomen and in an unexplained cause of hyperbillirubinemia in neonate has been a rare clinical situation oberved in our case.

NEO/65(P) LIVER ABSCESS, PORTAL VEIN THROMBOSIS AND CAVERNOMA FORMATION FOLLOWING UMBLICAL VEIN CATHERIZATION IN A NEONATE.Sidharth Kumar Sethi, Anju Aggarwal, L.Upreti, M.M.A Faridi. Department of Pediatrics and Radiology, University College of Medical Sciences and Guru Tegh Bahadur Hospital, Delhi-110095

Hepatic abscess is a rare condition in neonates and its diagnosis requires a high index of suspicion. A male child who had undergone umbilical vein catheterisation on day 3 of life for exchange transfusion presented at 2 months with fever of one month duration, inadequate weight gain and generalized oedema. On examination the child was lethargic, pale, had a tense abdomen and generalized oedema. Liver was enlarged 4 cm below the costal margin and the spleen was enlarged 5 cm below the costal margin. Investigations revealed abnormal liver function tests with hypoproteinemia and a haemoglobin of 6 gm%. An ultrasound (USG) of the abdomen revealed multiple abscesses in the right lobe liver with subcapsular collections. Doppler USG and contrast enhanced computed tomography abdomen revealed thrombosis and cavernous transformation of portal vein. Serial USG revealed resolution of abscess. The child was treated with intravenous antibiotics. However, the child expired on follow up, most probably due to sepsis. CONCLUSION: Hepatic abscess should be considered in any infant with a history of umbilical vein catheterisation and signs of sepsis. Portal vein thrombosis and cavernoma formation are rare complications of umbilical vein catheterisation and sepsis in a neonate. These children are at risk of developing portal hypertension due to cavernoma formation. Early and prompt treatment improves prognosis.

NEO/66(P) LIPID PEROXIDATION AND ANTIOXIDANT STATUS IN NEONATAL SEPTICEMIAKapil Kapoor, B.K.Das, B.D.Bhatia, Department of Pediatrics, Institute of Medical Sciences, BHU, Varanasi-221 005.

Introduction: Free radicals have been implicated in the pathogenesis of neonatal septicemia, which is a major cause of morbidity and mortality despite availability of potent antibiotics and intensive supportive care. The present study was done to estimate the lipid peroxidation and antioxidant status in neonatal septicemia. Objectives : The study was done to evaluate the status of lipid peroxidation, enzymatic and non-enzymatic antioxidants in septicemic neonates with a view to suggest antioxidant therapy. Design : Prospective Study in Neonatalogy Unit, Deptt. of Pediatrics, Institute of Medical Sciences, BHU. Materials and methods : 44 septicemia neonates, irrespective of gestational

age, birth weight and postnatal age and 30 healthy neonates were taken for study. Malondialdehyde (MDA), Superoxide dismutase (SOD), Catalase (Cat) Glutathione Peroxidase (GTPx), Uric acid (UA) and albumin (Alb) were estimated in serum of all cases and controls. Statistical analysis was done by SPSS-version-10 software. Results : Neonates with septicemia had significantly higher levels of MDA, SOD, GTPx, and Cat,while the levels of UA and Alb were significantly lower as compared to controls (p<0.001).Significantly elevated levels of MDA (p<0.05) and depressed levels of UA (p<0.001) were found in babies with late onset sepsis. Neonates who ultimately succumbed had significantly elevated levels of MDA, SOD, GTPx and Cat, whereas levels of UA and Alb were significantly depressed (p<0.001). Conclusions : Neonates with sepsis are handicapped in terms of their defense mechanism against free radicals. Hence utility of supplementation of antioxidants in neonates with septicemia need further evaluation.

NEO/67(O) VALUE OF ECHOCARDIOGRAPHY IN A TERTIARY CARE NEONATAL INTENSIVE CARE UNIT.   Chopra A, Kulkarni A, Kaul S, Gupta V, Balan S, Kohli V     Indraprastha Apollo Hospital, Mathura Road, Sarita Vihar, New Delhi

Background : It may be difficult to rule out congenital heart disease in a sick newborn on clinical grounds alone. In addition persistent pulmonary hypertension can complicate RDS and diagnosis can only be confirmed by echocardiography. Objectives: a)To evaluate the indications of echocardiography, b) Co-relate the clinical signs with echo findings, c) Evaluate response to specific management. Methods: A retrospective analysis was carried out on all the echocardiograms performed in the neonatal ICU between Jan 2000 and Dec 2004. Results: The total no. of neonates admitted during the study period was 1580. The no. of echocardiograms performed were 410 of which 280 (68%) were done on outborns and 130 (32%) on inborns. The commonest indication for an echo was birth asphyxia followed by respiratory distress with shock, suspicion of congenital heart disease and sepsis. Persistent pulmonary hypertension (PPHN) was the commonest finding (34 %) followed by acyanotic heart disease (17 %), cyanotic heart disease (8 %) and cardiomyopathy (6 %). Patent ductus arteriosus (PDA) was the commonest acyanotic heart disease needing pharmacological closure in 93% cases and ligation in 7 % cases. d-TGA was the commonest among the cyanotics. The echocardiogram was normal in 35 % of the neonates done for pre-anesthetic check up to rule out cardiac malformation, in very low birth weight babies and for family history of congenital heart disease and high risk pregnancies. Conclusion: Echocardiography certainly helps in diagnosis of congenital heart disease, assessment of cardiac function and timely management. Echo forms an integral part of NICU management especially in preterms with an open ductus and in terms with high pulmonary pressures.

NEO/68(O) UTILITY OF ECHOCARDIOGRAPHY IN NICUSudarshan Kumari, Rakesh Gupta, Preeti bindra, A P.Mehta, J. P Dadhich,S K BhargavaCenter for newborn care and echocardiography unit,Sunder Lal Jain Hospital, Ashok Vihar,Phase 3, Delhi 11—52 Introduction .Routine echocardiography (echo) as an integral part of neonatal intensive care(nicu) has been viewed by neonatologists in affluent countries .How ever in India due to lack of this facility at most centers .Often a therapeutic intervention is delayed till a cardiac murmur appears, or there is poor perfusion despite inotopes as for patent ductus arteriosus(pda) . As problems in sick neonates are most frequent in first few days of life when they can not be moved to cardiac centers for echo ,the most severe problems may be missed for intervention before a fatal outcome occurs or a sudden deterioration with multiorgan failure. Objective . This study was undertaken to find out the cardiac problems in a nicu and appropriate diagnosis & management of problems(eg-pda,inotopes,or referral to a higher cardiac center). There is paucity of reports in this topic from India so far. Material and methods and results: We have a 24 hrs facility for echocardiography in our unit by cardiologistwith expertise in neonatal echo over the last decade. All neonates who had echocardiography done in our nicu over a four year period were prospectively studied .Systemic morbidity in the study groups was also prospectively recorded for all significant events. .A total of 246 neonates formed the study group. Nearly a quarter of babies each had birth weight <2000gm and >3000gm.45.9% of the study group had echo within 72 hr of life Systemic morbidity was mainly respiratory, cardiac, and neurological. 91 5 of neonates had repiratory

problems .pneumonias occurred in a third of all infants..Cardiovascular problems were in term of shock,cardiac nurmur ,congestive cardiac failure .and evedence of myocardial ischemia on ecg. Neurological morbidity occurred in 51% of case with delayed cry at birth in (71% ) Among study group ,8.7 % had a fatal outcome, of these only 3 had normal echo while 43 neonatal deaths had an abnormal echo .Ten babies were transferred to higher cardiac center for management. Results of echo showed any abnormality in 84% of infants..Congenital structural cardiac malformations were noted in 17.4% of cases, patent ductus arteriosus was excluded from this category as most shunts closed later. Reduced left ventricular ejection fraction and hypokinesia occurred in 21% of infants;most of these were asphyxiated babies..Transitory shunts at atrium,and ductsu level were found in 101 and 44 cases respectively.pericardial effusion was noted in 7 neonates,3 had septal hypertrophy . Conclusions. Our study highlights the usefulness of echo in nicu as this is a need based in neonatal units for proper management of problems in sick neonates . In a zeal to focus on brain,lungs, gut and kidneys etc heart has been a forgotton organ by neonatologists. The future need of nicu’s is some basic knowledge and training in echo for nicu residents and young neonatologists.

NEO/69(P) UMBILICAL CORD HAEMATOCRIT IN NORMAL NEONATESPuneet Jairath, Rahul Gandhi, Ravneet Kaur, Seema Rai, K.K.LochamDeptt. of Pediatrics, Govt. Medical College/Rajindra Hospital, Patiala - 147001

Objectives : To assess the umbilical cord haematocrit in newborns. Methods : 21 babies delivered in department of Obstetrics and Gynaecology and admitted in the Neonatology section of department of Pediatrics, Govt. Medical College and Rajindra hospital, Patiala were the subjects of study. The babies having perinatal risk factors like PIH, eclampsia, maternal fever within 2 weeks prior to delivery, gestational diabetes mellitus, premature rupture of membranes, foul smelling liquor, preterms, small for gestational age, large for gestational age, birth asphyxia, respiratory distress syndrome (HMD, TTN, MAS, congenital pneumonia ), HIE and cyanotic heart disease were excluded from the study. Sex, birth weight, gestation, mode of delivery were recorded in a pretested proforma. 2ml of cord blood was taken in EDTA vial. PCV was measured by macro method which was performed in Wintrobe’s tube. The blood was mixed carefully in Wintrobe’s tube and centrifuged for 30 minutes. The height of column was taken as the PCV. Results : All the newborns were term (AGA). Birth weight range was between 2200-3600 gm. 3 newborns were males (61.9%) and 8 females (38.1%). 14 (66.7%) were delivered by lower segment caesarean section and 7 (33.3%) by normal vaginal delivery. PCV ranged from 46% - 56% in babies delivered by caesarean section while PCV ranged from 45.5% - 58% in babies born by vaginal delivery. Overall range of PCV was 45.5% - 58% and mean PCV was 49.77 ± 3.62%. Conclusion : Mean haematocrit in normal babies in our study was 49.77± 3.62%.

NEO/70(O) INTRMURAL ECHOCARDIOGRAMS IN A TERTIARY LEVEL NICUH K Palaha, S S Prabhu, S Rao, Sumitra Venkatesh, Ruchira Pahare B.J. Wadia Hospital for Children, A D Road, Parel, Mumbai-400012

Objectives: (a) To define indications of neonatal echocardiograms(b) to establish yield and range of cardiac defects in neonates (c) to document changes in existing clinical management Methods: 264 neonates admitted in a tertiary care NICU in a seven month study period were evaluated for need for echocardiography. A complete anatomical and hemodynamic evaluation was done on a intramural HP Sonos 2000 Echocardiography / Color Doppler machine. Results: 80 babies requires echocardiocardiographic evaluation out of 264 admissions. Definitive cardiac lesions were found in 43 babies ( 98% Confidence Interval 30- 33%) of which , 36 babies had anatomical defects and 7 babies had functional cardiac defects. 30 babies required change in the existing management( 98% Confidence Interval is 46-50%). These changes included cardiac decongestant therapy , ductal manipulation , inotropic support and pulmonary vasodilators. The results were compared with a sister tertiary level NICU without in house echocardiographic facility . Conclusion : Echocardiogram is an important diagnostic tool in NICU. It has a higher yield of positive results in terms of diagnosing the underlying cardiac defects and also has an impact in the management of sick neonates with cardiac problems.