Cheluvamba Hospital Research Articles

Neonatal mortality risk assessment using SNAPPE-2 score in a neonatal intensive care unit in moderate-to-late preterm Newborns

Background: In 1993, Richardson et al. introduced the score for neonatal acute physiology (SNAP), a 34-parameter system predicting mortality and morbidity in neonates. To enhance simplicity, it was later refined to nine parameters and renamed SNAP-II. Additionally, a perinatal extension known as SNAP Perinatal Extension, Version II (SNAPPE-II) was developed for broader applicability. Objectives: To determine the validity of SNAPPE-II in predicting the outcome in terms of mortality in premature babies of gestational age between 32 and 36 weeks in a tertiary care neonatal intensive care unit (NICU) of Cheluvamba Hospital, Mysore, Karnataka. Materials and Methods: The diagnostic study was conducted in the NICU of a tertiary care center in Mysore, India. The sample size of 138 subjects was calculated using a formula, and simple random sampling was used. The study included newborns with gestational ages between 32 and 36 weeks, and data was collected within 48 h of birth as per the proforma. The study assessed the correlation between the SNAPPE II score and mortality rate in babies admitted to the NICU. Data were analyzed using various statistical methods. Results: This study finds that the SNAPPE-II score has a moderate ability to distinguish between those newborns who will end up with mortality and those who will survive, as indicated by an area under ROC curve of 0.724, and has moderate diagnostic accuracy as indicated by a Youden index of 0.3974. The associated criterion for the SNAPPE-II score is >57, indicating newborns are more likely to have mortality. Conclusion: The SNAPPE-II score can be used to predict neonatal mortality rates in moderate-to-late preterm babies of gestational age between 32 and 36 weeks.

Base excess as a predictor of neonatal mortality in neonatal sepsis

Background: Neonatal sepsis is responsible for approximately 15% of all neonatal deaths in the world. Despite of availability in advanced medical healthcare facilities for mother and neonates, incidence of mortality secondary to sepsis especially in developing countries like India is more common. Metabolic acidosis is the most common form of acid base imbalance in neonatal sepsis which can be analyzed with increased levels of base excess. Hence early diagnosis of neonatal sepsis can be done by determining base excess. Methods: This is a prospective observational study conducted in NICU at Cheluvamba Hospital, Mysore. 73 term neonates with suspected sepsis were enrolled in the study who were on regular follow-up and treatment till death/discharged from NICU. Base excess value is obtained from the arterial blood gas analysis from each subject and it was compared with survivor and non-survivor group along with other study parameter Results: Out of 73 subjects, incidence of non survivors group with severe increase in base excess is 75%. To predict the mortality, we compared it with standard base excess which showed the prediction of more than 60%, with significant AOC (0.827) of very near to one in ROC curve, with statistically significant (p<0.001) sensitivity of 92.59%, specificity of 63.04%, positive predictive value of 59.5%, negative predictive value of 93.5%. Conclusions: In present study we have proved that base excess is an important parameter for the early diagnosis and for early intervention in neonatal sepsis.

Temperature assessment in newborn: a better method

Background: Accurate temperature assessment is essential in neonatal care as minor temperature changes can have a significant impact on the health and well-being of newborns. The purpose of this study was to compare the performance of three different types of thermometers, including non-contact infrared, digital, and mercury thermometers, for temperature assessment in newborns. Methods: This was a prospective, comparative study conducted between April 2022 and August 2022 in Cheluvamba hospital, Mysuru. A total of 400 healthy newborns were included in the study. Temperature readings were taken from the mid-forehead non-contact infrared thermometer and axilla using digital and mercury thermometers, while maintaining aseptic precautions. Parental oral consent was obtained for participation. Results: The mean temperature recorded with the digital thermometer in the axilla was statistically higher than that recorded with the mercury thermometer. The non-contact infrared thermometer showed a strong positive correlation with the mercury thermometer for the axilla region. Conclusions: The digital thermometer is a useful device for easy and valid measurement of skin temperature in newborns, especially when applied to the axilla. The findings suggest that the use of digital thermometers for axillary temperature measurement in neonates is supported by previous studies, which have reported their accuracy and reliability in comparison to mercury thermometers. The non-contact infrared thermometer may have limitations and its accuracy may vary depending on the site of measurement. The use of digital thermometers for neonatal temperature measurement may be more convenient, less hazardous, and equally reliable compared to traditional mercury thermometers.

Effect of inhaled budesonide therapy in term newborns with meconium aspiration syndrome

Background: Meconium aspiration syndrome is a common cause of respiratory distress in neonates. This study explores the possibility of altering the course of the disease by using anti-inflammatory agents to counter the chemical and inflammatory pneumonitis caused by meconium. The objective is to determine if inhaled budesonide therapy can alter the clinical course of the disease and improve outcome without causing any serious adverse effects. Methods: A comparative study was conducted in NICU of Cheluvamba hospital, Mysore over 12 months. Neonates with MAS were divided into interventional and control groups. Interventional group received budesonide nebulization 12th hourly starting after 6 hours of life, while control group received saline nebulization 12 hourly. Data was analysed by SPSS 20 software and student t test and chi square test were used to assess statistical significance. Results: The patient profile of the two groups was similar, with the interventional group showing early normalization of Downes score compared to controls. The duration of respiratory distress, oxygen dependency, and duration of hospital stay was significantly less in the steroid treated group compared to controls. There was no significant difference in the incidence of sepsis between the two groups, and three patients died during hospital stay due to pneumothorax with overwhelming sepsis with DIC. Conclusions: Nebulized budesonide improves clinical outcome in terms of morbidity and is relatively safe, however long term follow up required to recommend inhalational steroids as safe and effective.

Clinical profile and outcome of Guillain Barre syndrome in a tertiary care hospital

Background: Guillain Barre syndrome (GBS) is a progressive symmetric muscular weakness with absent or depressed deep tendon reflexes. Wide spectrum of disease severity can be seen ranging from a mild disease to quadriparesis, cranial nerve involvement and autonomic instability. Methods: Hospital based observational study is planned for GBS patients admitted to Cheluvamba hospital, a tertiary care hospital in South India, for a period of 2.5 years from Jan 2020 to August 2022.Results: 30 patients (12 males; 18 females; mean age of 7.7 years) were enrolled in this study. Among which 11 were in age group of 0-5 (36%), 10 were in the age group of 6-10 (33%), 7 were in age group of 10-15 (23%), 2 were in age group 16 and above (6.6%). Type of paralysis was paraparesis in 14 (46%) children quadriparesis in 15 (50%) children and one child had no limb involvement. In associated dysfunctions, autonomic dysfunction was seen in 1 (4.5%), bulbar palsy in 3 (13.6%). One child presented with features of Miller Fischer variant of GBS which are ophthalmoplegia and ataxia. Among 30 children 22 were recovered and discharged, 3 children died, and 5 children left against medical advice.Conclusions: The clinical characteristics, subtype of GBS, and outcome vary according to geographic area. This study is directed to find the clinical pattern and outcome of the same in tertiary care hospital in south India.

Study of polyps in female reproductive tract in a tertiary care centre

To study the clinical presentation, management of polyps of female reproductive tract. To know the correlation between ultrasonological finding and Histopathological findings. This was a retrospective hospital based observational study. It was conducted in Cheluvamba hospital, attached to Mysore Medical college and Research Institute, Mysore. Data was collected from hospital registers who underwent surgery for diagnosis of polyp from the year 2018 to 2021 were included in the study. There were 50 cases in the study. They were managed according to their symptoms, age, desire for fertility and type of polyp. Polyps are most common in the age group 31 to 40 years (42%) and in parous women. The most common presenting complaint was heavy menstrual bleeding (82%). Based on USG and HPE the most common type of polyp was leiomyomatous polyp. Heavy menstrual bleeding caused severe anaemia in 44% of women who required blood transfusion for correction anaemia. No cases of malignancy were diagnosed.Polyps are an important cause of AUB. The resulting heavy menstrual bleeding can cause severe anaemia requiring blood transfusion, leading to morbidity. Clinical examination and ultrasound diagnosis correlates with histopathological diagnosis. Using clinical examination and ultrasound one can identify the site and type of polyp and decide on further management.

Evaluation of serum vitamin D levels in diabetic children and the effect of vitamin D supplementation on glycemic control (Hba1C) in vitamin D deficient diabetic children

Background: It has been estimated that around 96,000 children under 15 years are found to develop type 1 diabetes annually all over the world. Vitamin D deficiency is more common in paediatric diabetic population and vitamin D supplementation is known to improve glycemic control in Diabetic children. The objectives of the study being, to compare serum vitamin D levels of diabetic children aged less than 18 years with non-diabetic children aged <18 years and to study the effect of oral vitamin D supplementation on glycemic control in vitamin D deficient diabetic children.Methods: Present study was a cross sectional study conducted in Cheluvamba hospital, Mysuru. 60 diabetic children and 60 healthy (control) children were enrolled for the study. Serum 25(OH)D was assessed by ELISA in both groups. HbA1c levels were assessed by HPLC among vitamin D deficient diabetic children before and after supplementation of Vitamin D.Results: In current study, study group (diabetic children) mean vitamin D levels were found to be 21.667±7.9 ng/ml which were statistically significant compared to control group that is 25.90±10.06 ng/ml (p=0.012) but there was no clinical significance. Among diabetic children the mean HbA1c before and after supplementation of vitamin D among vitamin D insufficient children was 11.78±2.22% vs. 11.73±0.141% (p=0.141) respectively and in vitamin D deficient children was 11.74±1.18% vs 11.72±1.17% (p=0.662). Conclusions: Mean serum vitamin D levels were comparable among diabetic children and control group. The mean HbA1c levels were comparable before and after supplementation of vitamin D among vitamin D deficient diabetic children thus indicating that there is no role of vitamin D in glycemic control among diabetic children.

Study of changes in serum sodium and potassium levels in term and preterm neonates following phototherapy

Background: Neonatal hyperbilirubinemia is a common physical finding in the first week of life. It is a common cause of hospital readmission during neonatal period. Phototherapy is an important treatment modality. However, it has some complications; amongst them serum electrolyte changes are a common complication. Objective of this study is to determine the changes in serum sodium and potassium in neonates before and after phototherapy and compare the occurrence of these changes in relation to gestational age and birth weight.Methods: In a prospective hospital based comparative study both term and preterm neonates admitted in neonatal intensive care unit receiving phototherapy at Cheluvamba hospital Mysore from July 2021 to April 2022 (10 months) were studied. A predesigned proforma aided the enrolment of new-borns into the study. Serum bilirubin and electrolytes and a comparative study was made between before and after phototherapy groups to determine the incidence of electrolyte imbalance.Results: The study group included 100 neonates. Incidence of low-birth-weight babies was 28% and preterm 22%. Mean birth weight and gestational age was 2.91±0.65 kg and 38.43±1.96 week respectively. The incidence of hyponatremia post phototherapy was found to be 9% which was more in low birth weight and preterm neonates (p<0.001) and was statistically significant. The incidence of potassium changes was found to be non-significant.Conclusions: The study shows that neonates under phototherapy are at higher risk of hyponatremia. This risk is greater in premature and low birth weight babies and hence this group of babies should be closely monitored for electrolyte changes and managed accordingly.

Comparing Clonidine and Fentanyl as Adjuvants to Intrathecal Hyperbaric Ropivacaine in Elective Infraumbilical Surgeries- A Randomised Clinical Study

Introduction: Ropivacaine is popular as a safe intrathecal anaesthetic drug due to its higher safety profile over bupivacaine. Intrathecal additives are known to increase the quality of anaesthesia and analgesic duration. Aim: To compare the effects of clonidine and fentanyl as intrathecal adjuvants to hyperbaric ropivacaine in elective infraumbilical surgeries. Materials and Methods: This randomized, double-blinded, clinical study was undertaken at Krishnarajendra hospital and Cheluvamba hospital, attached to Mysore Medical College and Research Institute, Mysuru, Karnataka, India, from January 2018 to June 2018. Total 60 adult patients aged between 18-60 years of age, American Society of Anesthesiologists (ASA) I and II status, and posted for infraumbilical surgeries, were randomized to two groups of 30 patients each i.e., group C patients receiving 2.5 mL of hyperbaric 0.42% ropivacaine and clonidine 15 mcg, and group F patients receiving 2.5 mL of hyperbaric 0.42% ropivacaine and fentanyl 25 mcg. The onset, extent and duration of sensory and motor blockade, heart rate, mean arterial pressure, prolongation of analgesia in the post operative period, and any complications were observed. Statistical analysis was done using student’s t-test, and Chi-square test to test significance of variables. The p-value <0.05 was taken as statistically significant. Results: Demographic characteristics were comparable in both the groups. The onset of sensory blockade and the maximum height of sensory blockade attained were similar in both groups i.e., group C-2.12±0.22 min vs group F-2.24±0.66 min, group C-4.94±0.91 min vs group F-5.12±1.38 min, respectively. The duration of sensory blockade was prolonged in group C (148.5±10.84 min vs 109.37±14.5 min), resulting in delayed demand for analgesic after surgery in this group. The onset of motor block and the complete motor blockade was prolonged in group C patients (3.22±1.01 min vs 1.16±0.3 min, 6.8±1.49 min vs 3.72±1.31min). The recovery from motor blockade was also significantly delayed in Group C (125.17±13.29 min vs 95.47±13.08 min). The incidence of hypotension was similar in both the groups. Conclusion: Clonidine, and fentanyl both provide early and adequate spinal anaesthesia, but the former (clonidine 15 mcg), prolongs the duration of spinal anaesthesia with Ropivacaine 0.42% hyperbaric solution, and significantly increases the time for the demand for analgesia in the recovery period, compared to fentanyl

Central Line Associated Blood Stream Infections and Effectiveness of Care Bundle Approach: A Prospective Cohort Study

Introduction: Insertion and maintenance of Central Venous Catheters (CVC) are integral components for the supportive care of critically ill neonates. Their use is often associated with the unavoidable risk of acquiring Healthcare Associated Infections (HAI) like Central Line Associated Blood Stream Infections (CLABSI) especially in resource limited public sector Neonatal Intensive Care Units (NICU). Adopting a care bundle approach to decrease CLABSI rates in such NICUs still remains a challenge. Aim: To determine the baseline CLABSI rate, identify the risk factors associated with it and also to determine the effectiveness of care bundle approach in decreasing CLABSI. Materials and Methods: An analytical prospective cohort study was conducted in Cheluvamba Hospital, attached to Mysore Medical College and Research Institute, Mysuru, Karnataka, India, from June 2018 to June 2020. In the preintervention phase (June 2018 to May 2019), the data of 307 neonates in whom Central Line (CL) was inserted were analysed to determine the baseline CLABSI rate and risk factors. CLABSI bundle involves a group of evidence-based practices which when implemented reliably and consistently have shown to significantly reduce CLABSI rates. CLABSI bundle was implemented in June 2019 and in the postintervention phase (July 2019 to June 2020), the data of 283 neonates were analysed and compared to those in the preintervention group in order to assess the effectiveness of the care bundle approach. Chi-square test was used to compare categorical variables whereas a two sample t-test was used to compare continuous variables. Results: A total of 41 CLABSI episodes were documented in the preintervention phase (Group 1) as compared to 12 in the postintervention phase (Group 2). Mean birth weight and gestational age was significantly lower in neonates with CLABSI as compared to neonates without CLABSI in both the groups. The incidence of CLABSI was significantly higher in neonates with a catheter dwell time of more than eight days and in those who received Total Parenteral Nutrition (TPN). Implementation of the CLABSI bundle resulted in the reduction of the baseline CLABSI rate from 16.25 to 8.3/1000 CL days; a significant reduction in the catheter dwell time and duration of NICU stay was also noted in group 2. Duration of NICU stay and death rate among neonates who developed CLABSI did not differ significantly between both the groups. Conclusion: Despite incorporating the care bundle approach, CLABSI rate remained to be high. Very preterm neonates with birth weight of <1500 grams and NICU stay of more than 25 days were more likely to develop CLABSI. Significant reduction in CLABSI rates can be achieved with widespread implementation of the CLABSI bundle in resource limited NICUs across India.

Characteristics of Paediatric Patients Transported by Emergency Care Personnel in a Government Tertiary Care Centre, Mysuru, India: A Cross-sectional Study

Introduction: Emergency Medical Service (EMS) systems have been well established and designed largely to cater to the needs of the cardiac and trauma related emergencies in adult patients. Paediatric emergencies are different; the benefits and outcomes of paediatric EMS have been assumed but without much evidence. With the emergence of paediatric and neonatal Advanced Life Support (ALS); it is imperative to have data that define the problems encountered in the prehospital care setting and also their outcome. This analysis may also provide insights into any modifications that may be required in the EMS system that exists to transport sick children. Aim: To characterise the paediatric prehospital care with emphasis on demography, presenting symptoms, treatment given, prehospital times, vitals monitoring and interventions done during EMS transport affiliated to Emergency Medical Service Agency. Materials and Methods: This descriptive cross-sectional study was conducted from July 2018 to June 2019 in Cheluvamba Hospital, a tertiary care referral teaching hospital attached to Mysore Medical College and Research Institute, Mysuru, India. The study included 147 children who were provided EMS by the 108 ambulance affiliated to the state/central government. Data pertaining to demography, presenting symptoms, vital sign monitoring, treatment given, various prehospital times, and interventions done during transport was obtained and analysed. Inpatient diagnosis with the duration of hospital stay and outcome in these childrens were also described. Results: Among the 147 children included; 3 were brought dead, hence the studied population comprised of 144 children. Amongst them, 42 were neonates and the remaining 102 belonged to the general paediatric population (older children). Overall, 61.8% were males and 57.64% hailed from a rural background. Mean ‘on- scene’ time was 12.12±2.34 minutes and 5.50±5.01 minutes, and ‘transport time’ was 33.79±16.78 minutes, and 26.11±14.2 minutes for neonates and older children, respectively. Respiratory distress was the most common presenting symptom. The mean Heart Rate (HR, beats/min), Respiratory Rate (RR, cycles/min) and temperature (°C) in neonates was 129.86±27.91, 59.90±15.40 and 36.14±0.84 whereas in older children it was 112.81±28.39, 34.87±14.86, and 37.40±0.96, respectively. Mean systolic blood pressure (SBP mmHg) in children aged more than 10 years was 116.67±8.61. Of the 39 children aged more than 6 years, 36 (92.30%) had a Glasgow Coma Scale (GCS) between 13-15. The most common intervention done was administering oxygen in 84.02% (121/144) of children; 34.02% (49/144) of children were unstable at admission; 127 (88.2%) were discharged; remaining 17 (11.8%) succumbed to their illness. On- scene time of more than 15 minutes, transport time of more than 30 minutes and factors such as hypoxia, respiratory failure and shock at admission were significantly associated with mortality (p<0.001). Conclusion: Majority of the EMS transports were related to medical conditions. Basic Life Support (BLS) interventions were done albeit mostly in older children. Emergency Medical Technicians (EMT)/paramedics delivering EMS need special training to orient themselves to the special needs of critically ill children and to improve their outcome.

Clinical and laboratory profile of multisystem inflammatory syndrome in children: A cross-sectional study in a tertiary care hospital, Mysuru

Background: Multisystem inflammatory syndrome in children (MIS-C) is considered to be a rare, yet serious complication of coronavirus disease 2019, where there is immune dysregulation related to past infection with the virus. It is an inflammatory syndrome affecting multiple systems with varied manifestations including gastrointestinal, cardiovascular, respiratory, neurological, renal, hepatobiliary, and dermatological symptoms. Aim: Current study aimed to investigate the clinical and laboratory profile of MIS-C. Materials and Methods: A cross-sectional study of 40 hospitalized children who were diagnosed as MIS-C and studied over a 12-month period from June 2020 to May 2021 at Cheluvamba Hospital in a tertiary care center attached to Mysore Medical College and Research Institute Mysuru, Karnataka. Results: Out of the 40 children studied, all fulfilled the diagnostic criteria of MIS-C. The most common symptom was fever (100%), followed by gastrointestinal symptoms (90%). The next most common system involved in our study was cardiovascular system (52.5%). The most common laboratory findings included elevated inflammatory markers (100%). Furthermore, there was high incidence of hematological alterations, in the form of anemia (62.5%), thrombocytopenia (57.5%), and neutrophilia (27.5%). About 33.3% cases had echocardiography abnormalities. All patients received intravenous methylprednisolone and intravenous immunoglobulin. There were six deaths (15%) in our study and the remaining cases had good immediate outcome. Conclusion: Early recognition and prompt medical attention are necessary for a favorable outcome in MIS-C. However, there is scarcity of data regarding its long-term outcome.

Cardiovascular manifestations and echocardiographic findings in pediatric multisystem inflammatory syndrome associated with COVID-19 (MIS-C): A retrospective study

Background: The multisystem inflammatory syndrome in children (MIS-C) has been described recently during COVID-19 pandemic. It is a delayed post-infectious response with a lag time of 4–6 weeks following the exposure to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), involving multiple systems which is being increasingly reported worldwide. Aim: The study aims to investigate and report the cardiovascular manifestation and echocardiographic findings in pediatric patients diagnosed with MIS-C. Materials and Methods: The present study is a retrospective analysis of clinical data gathered from 40 admitted children diagnosed with MIS-C. The study was conducted for 1 year (from 1st June 2020 to 30th May 2021) at Cheluvamba Hospital, a tertiary care center attached to Mysore Medical College And Research Institute, Mysore, Karnataka. Results: Out of 40 children, 21 (52.5%) had manifestation of cardiovascular system in the form of shock, requiring ionotropic support and care at the Intensive Care Unit. Among them, 90% patients show elevated cardiac biomarker (Troponin T), 33.3% had two-dimensional echocardiographic (2D echo) findings in which 9.5% show coronary artery dilatation and 23.8% show left ventricular hypertrophy. Conclusion: MIS-C is a hyperinflammatory syndrome related to SARS-CoV-2 infection. Cardiac involvement is evidenced by perturbation of cardiac chamber size, function, coronary artery abnormalities, and elevated cardiac biomarker. Though, most of the patients responded to the initial treatment and recovered, there is scarcity of data regarding long-term cardiovascular complication.

A study on the predictive value of red blood cell distribution width as a biomarker of outcome in paediatric critical illness

Background: Red blood cell distribution width (RDW) is a simple, low cost measure, which is routinely reported as a standard component of complete hemogram. Several recent studies have found a positive association between RDW and risk of both morbidity and mortality in several diseases, particularly in critically ill adults.But, data regarding the outcome predictive utility of RDW in critically ill paediatric population is limited. The objective of the study was to determine the association between RDW and mortality and morbidity in paediatric critical illness.Methods: A cross sectional observational study was conducted from February 2019-May 2019 at Cheluvamba Hospital, Mysuru. 97 subjects admitted to Paediatric intensive care unit (PICU) were included in the study. Data regarding subject demographics, hospitalization characteristics, laboratory values and outcomes were collected.Results: A significant positive correlation was found between mortality among critically ill children and RDW measured within 24 hours of PICU admission (p=0.01) and peak RDW during the first 7 days of PICU stay (p=0.01). The relative change in RDW correlated significantly (p=0.01) with the number of intensive care unit (ICU) free days. Our subjects were divided into quartiles based on the admission RDW, subjects in the fourth quartile were found to have the highest mean Paediatric risk of mortality (PRISM III) score, Paediatric index of mortality (PIM 2) score and the least number of ICU free days. Area under the receiver operator curve (AUROC) for incidence of death was 0.706 for admission RDW,0.71 for peak RDW and 0.882 for PIM 2 score.Conclusions: Our data demonstrates that RDW at the time of PICU admission could serve as a cost-effective marker for early identification of critically ill paediatric population who are at risk for adverse outcomes.

Effect of oral 25% dextrose on pain relief in newborn infants undergoing venepuncture

Background: Aim of this study was to study effect of oral 25% dextrose for pain relief in newborns undergoing venepuncture.Methods: This is a case control study conducted in NICU, Cheluvamba hospital attached to Mysore medical college and research institute during the period between September 2018 to November 2018. Babies with gestational age between 34 to 40 weeks of gestation who had clinical indication for blood sampling were included in the study. Neonates who are critically ill, suffered perinatal asphyxia and having congenital anomalies were excluded from the study. Hundred newborn babies admitted to NICU who had clinical indication for blood sampling were enrolled in the study. Study population were divided into 2 groups, dextrose (cases) and non-dextrose group (controls). The data analysis included gestational age, postnatal age, weight, sex, heart rate, oxygen saturation, crying time and behavioural pain assessment.Results: Mean pain score, crying time and heart rate at 5 minutes of venepuncture were studied in both the groups. Mean pain score in dextrose group was 2.68 and in non-dextrose group was 7.18 with significant p value of 0.0062. Mean crying time in dextrose group was 8.98 minutes and in non-dextrose group was 42 minutes with significant p value of 0.001. Mean heart rate in dextrose group was 142 beats/minute and in non-dextrose group was 146bpm with p value of 0.08.Conclusions: Pain in the newborns should be recognised and adequately treated. Lingual 25% dextrose can be used as safe and effective analgesia in neonates undergoing minor invasive procedures like venepuncture.

Referral pattern of pregnant women coming to Cheluvamba Hospital, Mysuru, Karnataka

Background: Maternal morbidity and mortality remains a major challenge. At present pregnant women can visit any level of health care irrespective of severity of their health condition. Most of the burden of these pregnant women is on tertiary centers, hence depriving the seriously ill of the expert care. Most of the pregnancies can be managed at primary level itself. This study was therefore conducted in order to describe the referral pattern of pregnant women coming to Cheluvamba Hospital, Mysuru.Methods: It was a cross sectional study conducted during September 2018 with sample size of 100. All the pregnant women who were referred in the second week of September 2018 were included in the study without using any sampling technique and data was collected by interview using the semistructured questionnaire.Results: Mean distance travelled by study participants from their residence to Cheluvamba hospital was 42.1±29.8 kilometers. Main obstetric and logistic reason for referral was because of hypertensive disorders and non-availability of doctors respectively. Average number of ANC visits and mean gestational age upon arrival at Cheluvamba hospital was 6.71±2.3 visits and 37.4±3.6 weeks respectively.Conclusions: Most common obstetric reason for referral was hypertensive disorders. A structured referral system would help both the patient and the doctor in providing necessary obstetric care.

Evaluation and histopathological correlation of abnormal uterine bleeding in menopausal transition in a tertiary care centre at Cheluvamba hospital, Mysore

Introduction: AUB at menopausal transition is alarming and needs thorough evaluation, as it could be the only clinical manifestation of cancer. Methodology: This prostective study was done to evaluate the gynaecological causes of AUB in menopausal transition in OBG Department, MMC&RI, Mysore. These women were evaluated; clinical, ultrasound and histopathological findings were correlated. Results: In the present study, heavy menstrual bleeding (66.7%) was the commonest type of bleeding pattern. Leiomyoma, DUB and Adenomyosis were the principle causes of AUB. Leiomyoma accounts for the 60.6% of cases, DUB accounts for 15.9%, Adenomyosis accounts for 9.09% and Leiomyoma with Adenomyosis accounts for the 14.39% of cases. Conclusion: Endometrial biopsy and its interpretation play a pivotal role in the management of AUB cases in menopausal transition. It emphasizes the role of health care professionals to encourage teaching and implementation of alternative procedures to ensure that women receive the maximum benefits with least morbidity.

A comprehensive study on maternal mortality at a tertiary care hospital

Introduction: Maternal mortality, according to WHO is defined as “the death of women while being pregnant or within 42 days of termination of pregnancy, irrespective of duration and site of pregnancy, from any cause related or aggravated by the pregnancy but not from accidental or incidental cause”. Maternal death is classified as Direct and Indirect maternal death. About 99% ofMMRoccur in developing countries. Hence the present study has been taken up to analyze cause of maternal mortality in tertiary hospital. Aim: Our study aims to analyze the cause and incidence of maternal mortality in a tertiary care hospital Materials and Methods: Present Study is a, Retrospective study conducted in Cheluvamba hospital, MMC&RI which is a tertiary care hospital. We have analyzed all maternal deaths, which were reported in the institute during the study period starting from 1st January 2015 to 31st May 2019 (4 years 5 months). Results: There were 52,896 deliveries in our institute during the study period. 60 maternal deaths were reported. Maternal mortality rises with high degree of parity as noted in the study, multigravida (56.7%). 55% cases were unbooked. The major cause of death was attributed to Hypertensive disorders of pregnancy (45%) and second major cause is anemia (41.7%). Conclusion: Enhancing women’s access to basic health care facilities, regular Antenatal care, high risk pregnancy detection and its management and basic health education helps in reducing maternal mortality. Keywords: High risk pregnancy, Maternal mortality.

Maternal and fetal outcome in HIV infected pregnant women-A two year study at tertiary hospital

Introduction: At present scenario Acquired immunodeficiency syndrome is currently one of the worst global health concerns. HIV has a dramatic impact on the health of women and their children. Objective: To find out the prevalence of HIV status among pregnant women in a tertiary care hospital to determine maternal and fetal outcome in HIV infected pregnant women. Materials and Methods: A retrospective study conducted in Cheluvamba Hospital a tertiary care hospital attached to MMCRI during January 2014 to December 2016. The case records of pregnant women with HIV positive status were selected from hospital records. Follow up details of both mother and babies were obtained from ICTC Centre. Results: Total deliveries during the study period were 19641. Of these the incidence of HIV Status was 80, the Incidence being 0.4%. primigravidas were found to be 43.75%. HIV seropositivity rate was more between 21 to 25years of age group, contributing to 56.25% of the total cases. CD4 count of >200 was found in 37.5% of cases, of which 25% were primigravida. Among all cases 31.25% were not put on Antiretroviral Therapy (ART). Vaginal deliveries were 83.5% and caesarean sections were 16.5%. Birth weight of >2.5 kg were seen in more than 50% of cases. Breast feeding was opted by 81.75 %. 93.8% neonates received nevirapine of the babies admitted in NICU 4 babies died (11.2%). 2 babies were found to be positive. Conclusion: Adverse outcomes were associated with untreated maternal HIV infection in pregnancy. PMTCT services were utilized sub optimally by the women with low level of education. Awareness and information is important for programs designed to increase access to PMTCT services including HAART from early pregnancy. Keywords: Antiretroviral Therapy (ART), Pregnancy with HIV.

Study of eosinophil count in nasal smear and peripheral blood smear in children with allergic rhinitis

Background: Allergic respiratory disorders are the common cases seen in Pediatrics OPD. With an appropriate history and detailed examination, the diagnosis usually may not be problematic and routine investigations may not contribute much for the final diagnosis but may help in ruling other possibilities. The objectives of this study were done to know the eosinophil counts in nasal and blood smear and to assess the feasibility of nasal cytogram which is simple, economical and reliable investigation in patients of allergic respiratory disorders.Methods: A prospective clinical correlation study conducted in outpatient visiting Mysore Medical College and Research Institute, Cheluvamba hospital Department of Pediatrics and ENT Department KR hospital. 60 children of age group between 2 to 18 years were selected to estimate the eosinophil count in nasal and peripheral smear in allergic rhinitis. All allergic rhinitis cases based on clinical signs and symptoms were selected and investigated for nasal and blood eosinophilia. The nasal and blood eosinophilia were compared with each other and the clinical findings of allergic rhinitis were studied.Results: In this study peak age incidence is between 6-10 years and there is equal gender distribution. Seasonal variation and pollen allergens were the most common risk factors for allergic rhinitis. Running nose and the nasal obstruction were the most common symptoms in children with allergic rhinitis followed by sneezing and itching. One tenth of the children with allergic rhinitis had bronchial asthma. Nasal eosinophilia contributes to the diagnosis of allergic rhinitis as compared blood eosinophilia. Mild intermittent variety of allergic rhinitis was the most common form of allergic rhinitis.Conclusions: Among various risk factors for allergic rhinitis, seasonal variation and pollen allergens have significant association with the severity of allergic rhinitis. Among various symptomology, only itching had a significant relation to the severity of allergic rhinitis.