History Of Perinatal Asphyxia Research Articles

The prevalence, consequences, and outcome of perinatal asphyxia in term and late preterm live-born neonatesA A case-control study from Iran

Background: Despite several investigations reporting the prevalence of asphyxia in developed and developing countries, very few studies from Iran have demonstrated the rate of neonatal asphyxia and its affecting factors. Objectives: This study aimed to determine the prevalence of asphyxia, its consequences, and neonatal outcomes among Iranian term and late preterm live-born neonates. Methods: A case-control study was conducted in three hospitals; Vali-e-Asr, Yas, and Ziaean from April 2019 to March 2020. The case group included neonates with a history of perinatal asphyxia. Twice gestational age-matched subjects without such a history also entered the study as the control group. All maternal and neonatal data were collected from participants’ medical records. Determining the prevalence of neonatal asphyxia was the primary outcome of the present study. Results: Totally 48 subjects as the case and control groups were included and 16 asphyxiated cases were observed equal to 3.3 per 1000 live-born neonates. Concerning the type of delivery, cesarean section in the control group and vaginal delivery in the case group were the most frequent types of delivery (p=0.041). Comparing neonatal variables, the results showed a significant difference regarding the groups’ genders (p=0.036). Apgar scores in the case group were also significantly lower than the control group (p=0.0001). More cases also required PPV compared to the controls (12 vs. 0; p=0.0001). Hypoxic-ischemic encephalopathy (HIE) grade 1 was also significantly more frequent in the case group than the controls (p=0.0001). The means of pH and base excess in the case group were significantly lower than the control group (p=0.0001). Conclusion: The results showed the prevalence rate of asphyxia among term and late preterm participants was 3.3 cases per 1000 live-born neonates. Apgar scores<5 accompanied with metabolic acidosis, HIE, and requirement of PPV could be predictive variables for perinatal asphyxia. Observing such clinical risk factors may indicate the need of early diagnosis and timely interventions to improve neonatal outcomes.

Transient Neonatal Hypocortisolism in Neonates with Hypoglycemia – Coexistence or Cause?

Abstract Introduction: Infants born preterm, with low birth weight (LBW), or with perinatal stress are at high risk for neonatal hypoglycemia. Low cortisol levels have also been demonstrated in this group of neonates, which is often transient. We report a series of neonates with transient hypocortisolism who had neonatal hypoglycemia. Methods: A descriptive study on clinic-biochemical parameters of a group of five neonates who had persistent neonatal hypoglycemia and had demonstrated low cortisol on critical sample testing. Results: All five neonates had birth weights below normal and four were born preterm. A history of perinatal asphyxia was seen in four cases and neonatal sepsis in two. During critical sample testing (when blood glucose [BG] was <50 mg/dl), hyperinsulinism (Insulin >2 mIU/ml) was seen in three infants whereas insulin was undetectable in two. The median cortisol during critical sample testing was 1.9 mcg/dl (0.88 – 3.7). Critical GH was normal in all, and ACTH ranged from 7.2 pg/ml to 41.3 pg/ml. None of the infants had overt clinical features of panhypopituitarism or primary adrenal insufficiency. USG brain revealed germinal matrix hemorrhage in two infants, which resolved on follow-up. USG adrenals and electrolytes were normal in all. Four of the five babies were started on oral hydrocortisone, to which they responded well with the resolution of hypoglycemia. No adverse events were noted. On follow-up, the median time to recover of serum cortisol to normal was 4 months. Conclusion: The contribution of transient hypocortisolism to hypoglycemia in infants at risk, including preterm, LBW, or those with perinatal stress, in the presence or absence of hyperinsulinism, is not well known. While the non-specific use of glucocorticoids is not advocated, the role of therapeutic glucocorticoids among at-risk neonates with documented hypocortisolism during hypoglycemia should be an area for research. Close follow-up of these neonates for spontaneous recovery of cortisol levels is warranted.

Desarrollo motor, cognitivo y conductual tras encefalopatía hipóxico-isquémica neonatal

IntroductionThe current neurodevelopmental status of patients with neonatal hypoxic-ischaemic encephalopathy (HIE) in Spain is unknown. Recent European studies highlight a shift of severe pathology towards mild motor disorders and emotional problems. The aim of this study was to analyse neurodevelopmental outcomes in a cohort of neonates with HIE at age 3years. Patients and methodMulticentre observational study of neonates born at 35 or more weeks of gestation with moderate to severe HIE in 2011-2013 in 12 hospitals in a large Spanish region (91,217m2), with the recruitment extended through 2017 in the coordinating hospital. We analysed the findings of neonatal neuroimaging and neurodevelopmental test scores at 3years (Bayley-III, Peabody Picture Vocabulary Test and Child Behavior Checklist). The sample included 79 controls with no history of perinatal asphyxia. ResultsSixty-three patients were recruited, of whom 5 (7.9%) were excluded due to other pathology and 14 (24%) died. Of the 44 survivors, 42 (95.5%) were evaluated. Of these 42, 10 (24%) had adverse outcomes (visual or hearing impairment, epilepsy, cerebral palsy or developmental delay). Other detected problems were minor neurological signs in 6 of the 42 (14%) and a higher incidence of emotional problems compared to controls: introversion (10.5% vs. 1.3%), anxiety (34.2% vs. 11.7%) and depression (28.9% vs. 7.8%) (P<.05). The severity of the lesions on neuroimaging was significantly higher in patients with motor impairment (P=.004) or who died or had an adverse outcome (P=.027). ConclusionIn addition to classical sequelae, the follow-up of patients with neonatal HIE should include the diagnosis and treatment of minor motor disorders and social and emotional problems.

Factors Associated with Speech and Language Disorder in Children Attending Child Development Center of a Tertiary Care Hospital

Background: Speech and language disorders are amongst the most common developmental difficulties. The current study was aimed to identify the factors associated with speech and language disorder in children attending a child development center. Methods: This cross-sectional, observational study was carried out at Saleh Child Development &amp; Disability Management Centre of ICMH, Dhaka from July 2020 to June 2021. Children with speech and language disorder attending the speech clinic were enrolled. According to complaints of parents and confirmed by a multidisciplinary team, cases were selected purposively and after taking consent a pre-tested questionnaire was filled up by a face-to-face interview. Results: Among participating children majority belonged to age group 4-5 years with male predominance. Almost three fourth patients came from nuclear family. History of perinatal asphyxia and neonatal seizure were found in 9(31.0%) and 8(27.6%) cases, respectively. Majority 28(96.6%) mother was primary care giver. Family history of speech delay was seen in 15(51.7%). Most of the children view TV/play computer games &gt; 2 hours/day. Majority had first meaninful word at 23-36 month and parents had identified speech dealy on 25-36 months. 14 children had poor chewing and 2 had drooling. Majority (37.9%) children were delayed receptive, 13(44.8%) were delayed expressive, 9(31.0%) were both delayed receptive and expressive and 5(17.2%) were stammering. Conclusion: Male gender, care giver other than mother, nuclear family, perinatal asphyxia, neonatal complications, family history of speech delay, TV/Computer/Tab watching &gt;2 hrs were associated with speech and language disorder.

Computed Tomographic Findings in Children with Cerebral Palsy in a Developing Country

Background: Cerebral palsy (CP) is one of the most common causes of chronic childhood disability. To know the aetiopathogenesis, severity and prognosis of CP, neuroimaging is an important modality of investigation. Objective: This study was done to observe the findings in CT scan of brain in children with CP. Materials and Methods: This is a cross-sectional descriptive study. One hundred and ten patients who were clinically diagnosed as cerebral palsy were enrolled in the study. After selection of the subjects, demographic and clinical characteristics were recorded. All other comorbidities including visual and hearing impairments were identified. CT scan of brain was done in all children and reporting had been done by a single qualified radiologist. Results: The mean age of the studied children was 2.6±2.2 years (1 to 14 years). Seven types of CP were found in the study group. Among them quadriplegic CP were the most common (39.1%). History of perinatal asphyxia was found in 81.8% children. Cognitive delay was found in 90% children, speech delay was found in 88.2% children, visual impairment was found in 35.5% children and hearing impairment in 31.8% cases. Epilepsy was found in 44.4% among studied subjects. Most common finding on CT scan of brain was cerebral atrophy (62.7%), followed by encephalomalacia (15.5%), calcification (13.6%), and brain malformations (11.8%). Abnormal CT scan findings were found in 88.2% of study population. Conclusion: This study showed that most common type of CP was quadriplegic CP. Maximum children had abnormal CT scan findings. Most common CT scan finding was cerebral atrophy. J Enam Med Col 2021; 11(1): 18-23

Aetiological Profile and Outcomes of Acute Kidney Injury among Neonates Admitted in a Neonatal Intensive Care Unit at a Tertiary Care Hospital, Northeast India: A Prospective Cohort Study

Introduction: Acute Kidney Injury (AKI) affects approximately 8%-24% of critically ill neonates, with a mortality rate ranging from 10%-61%. Groups of newborns at higher risk for AKI include those with perinatal hypoxia, Respiratory Distress Syndrome (RDS), premature and very low birth weight infants, and newborns with sepsis. AKI is associated with poor short-term and long-term outcomes and has a multifactorial aetiology. Aim: To evaluate the aetiological profile and short-term outcomes of AKI in neonates admitted to the Neonatal Intensive Care Unit (NICU). Materials and Methods: A prospective cohort (descriptive) study was conducted in the NICU at Gauhati Medical College and Hospital, Guwahati, Assam, India, over a period of one year, from September 1, 2021, to August 31, 2022. A total of 100 neonates exhibiting signs and symptoms of AKI according to Acute Kidney Injury Network (AKIN) criteria. Detailed neonatal history, including neonatal resuscitation, history of perinatal asphyxia, signs and symptoms of sepsis, Respiratory Distress Syndrome (RDS), or any other symptoms, were recorded. The course and outcome of the neonates during their NICU stay were noted. Data were presented in terms of frequency (n) and percentages (%). Results: Among the 100 AKI neonates, 58 were males and 42 were females, with a male-to-female ratio of 1.38:1. Out of 100 neonates, birth asphyxia constituted 40 (40%) cases, of cases, followed by sepsis in 30 (30%), RDS 27 (27%), dehydration 2 (2%), and obstructive uropathy in 1 (1%) case. Among the 100 AKI neonates, 64 (64%) cases were discharged, 35 (35%) expired, and 1 (1%) were transferred to the paediatric surgery department. Conclusion: Neonatal AKI is an independent contributor to morbidity and mortality. Therefore, early identification and prompt management are crucial for improving outcomes and prognosis.

Nutritional Status among Children with Cerebral Palsy attended at Medical University Hospital of Bangladesh

Background: Feeding difficulty among children presented with cerebral palsy (CP) is a common problem which ultimately leads to malnutrition.&#x0D; Objective: The purpose of the present study was to assess the nutritional aspect in children with cerebral palsy.&#x0D; Methodology: This cross-sectional study was done in the Pediatric Neurology Unit of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. The children of cerebral palsy aged 1 to 10 years was enrolled in this study. Perinatal, developmental and feeding history was taken meticulously. Nutritional status was assessed by Welcome, Waterlow and WHO classification and on the basis of MUAC and BMI. Neurological assessment was done thoroughly and severity grading was done according to WHO manual 1987.&#x0D; Results: Majority (70.0%) of children were in the age group of 1 to 5 years. Most of the children were male (58.0%), born at term (90.0%) and had history of perinatal asphyxia (82.0%). Among enrolled children, 60.0% took adequate calorie. About 32.0% cases and 26.0% patient had difficulty in chewing and swallowing respectively whereas 54.0% faced drooling. Spastic quadriplegia (48.0%) was the most frequent type of Cerebral Palsy followed by mixed type (22.0%). According to Welcome classification, 32.0% cases had undernutrition and 6.0% cases had marasmus. Among children with marasmus, 66.7% cases had quadriplegia. Undernutrition was most frequent in quadriplegic and mixed type of cerebral palsy.&#x0D; Conclusion: Malnutrition is a common problem among patients with cerebral palsy. However severe malnutrition is less.&#x0D; Journal of Current and Advance Medical Research, January 2022;9(1):42-47

Clinical Profile of Patients Admitted with Seizure Disorder in a Tertiary Care Hospital of Central Nepal

Introduction: Seizure is one of the common presentation and reason for hospital admission in children. This study aims to address the etiology and clinical characteristics of the patient.&#x0D; Methods: This was a descriptive, cross-sectional study in which children of age 1month to 15 years presenting with seizure were included. The data was analyzed using SPSS 16.0.&#x0D; Results: Out of 192 patients,126 (65.6%) were males and 66(65.6%) were females with the ratio of 1.9:1. Distribution of events in different age groups were 16.1%(n=31) in group of 1month to 1 years, 63%(n=121) in group of 1yrs to 5 years,12.1%(n=24) in group of 5years to 10 years and 8.3%(n=16)in children above 10years.70.3% had febrile seizure, with the highest incidence in age group of 1 to 5 years. Generalised tonic clonic seizure was seen in 94.3% and focal motor seizure in 5.7%. No difference was seen in distribution of the type of seizure across different age groups (p= 0.192).Presenting complaints were fever in 75.5%, loss of consciousness in 26.0%, vomiting in 25.0% , headache in 23.4%, altered sensorium in 8.3% and focal neurological deficits in 8.3%. 33.9% of children had a family history of seizure. Causes of febrile seizures included upper respiratory tract infection in 82.2%, acute gastroenteritis in 12.6%, urinary tract infection in 3% and pneumonia in 2.2%. Afebrile seizure was idiopathic in 38.6% and identifiable causes in the remaining were sequelae of birth asphyxia in 17.6%, hypoglycemia in 8.8%, neuronal migration defects and neurocysticercosis in 5.3%. No relation was observed between the history of perinatal asphyxia and the age of onset of seizure (p=0.250). Of all the patients 57.8% were discharged without antiepileptic, 27.6% were treated with monotherapy whereas 14.5% required polytherapy to achieve seizure control.&#x0D; Conclusions: Seizure is a common problem in children, with the highest incidence in the age group of 1 to 5 years and febrile seizure is the most common type of seizure in children.&#x0D;

Early-onset developmental impairments among infants attending the routine immunization clinic at the University College Hospital, Ibadan, Nigeria.

Developmental disorders are frequently overlooked in the developing countries, particularly in sub-Saharan Africa. Early identification of developmental delays (DDs) is critical to optimal outcomes. This study set out to determine the proportion of children who are at risk of DDs among infants attending immunization clinics at the University College Hospital, Ibadan, Nigeria. Infants 6 weeks to 12 months of age (median age 6 months) who presented for routine immunization were screened for DDs using the Ages and Stages Questionnaire. A total of 587 infants [312 (53.2%) males] were enrolled. A total of 198 (33.7%) children showed signs of DDs. For the domains of communication skills, fine motor skills, gross motor skills, problem solving/cognition skills and personal/social skills, the prevalences of DDs were 7.5%, 15.0%, 10.7%, 14.1% and 14.8%, respectively, and 14.3% had global DDs. Factors that significantly predicted DDs included prematurity (odds ratio [OR] 2.64 [95% confidence interval {CI} 1.45 to 2.05]) and a history of perinatal asphyxia (OR 1.74 [95% CI 1.77 to 2.49]). There is a need to incorporate routine developmental screening into the Nigerian healthcare system for timely recognition of DDs and prompt interventions.

Clinical and Laboratory Profiles of Children with West Syndrome: Experience of 50 Cases in a Tertiary Hospital in Bangladesh

Background: West Syndrome (WS) consists of epileptic spasms, hypsarrhythmia on EEG and psychomotor delay or regression in children.&#x0D; Objective: To observe the clinical and laboratory profiles of children with west syndrome.&#x0D; Materials &amp; Methods: This was a cross sectional study and done from July 2017 to June 2018 in Pediatric Neurology OPD, NINS among total 50 cases of WS (age of &gt; 2 month to 2 years). WS was diagnosed by direct observation or video recording of spasm, along with history of developmental delay or regression and EEG change. Collected data regarding demography, detailed of spasm, clinical examination, radiological and EEG findings were analyzed.&#x0D; Results: Mean age of the patients was 12.61 ± 7.11 months. Males (58.0%) were predominant than females (42.0%). Mean age of onset of spasm was 5.88 ± 3.73 months. Type of spasm: Flexor in 88.0% cases, extensor in 6.0% cases, mixed in 4.0% and asymmetric in 2.0%. Microcephaly was present in 90.0% cases and in 64% cases H/o perinatal asphyxia (PNA) was present. In EEG, Hypsarrhythmia was found in 62.0% cases and modified hypsarrhythmia in 38.0% cases. In CT scan of brain, cerebral atrophy was found in 62.5.0% cases, stroke in 6.0% cases. Out of all WS patients 82% were symptomatic and 18% were either cryptogenic or idiopathic.&#x0D; Conclusion: Flexor type spasm was found more commonly in West syndrome. History of perinatal asphyxia (PNA) was present in majority of cases. In EEG findings, hypsarrhythmia was found more than modified hypsarrhythmia.&#x0D; Bangladesh J Child Health 2020; VOL 44 (3) :139-142

Sociodemographic Profile and Comorbidities of Children with Epilepsy Attending in Child Development Centre (CDC) of Dhaka Shishu Hospital

Background: Epilepsy is the most common conditions encountered in most paediatric neurology clinics in many parts of the developing world. It is important to understand the sociodemographic profile of children with epilepsy and also to recognize the comorbidities associated with themfor planning management and developing wider services within the country.&#x0D; Objectives: The present study aimed at understanding the socio-demographic profileand comorbidities of children with epilepsy, seeking treatment at a tertiary care hospital in Bangladesh.&#x0D; Methods: This retrospective observational study was conducted in an epilepsy clinic of Paediatric Neuroscience Department of Dhaka Shishu Hospital (DSH) over a period of 3 years from January 2013 to December 2015. During this period 1 year follow up record of each patient was analysed. Information on biodemographic data, clinical and developmental assesment made by a multidysciplinary team was analysed.&#x0D; Results: A total 120 children who had epilepsy were included in this study.The median age at presentation was 2.4 years. Male were 69(58%) and female were 51(42%). Most of the children came from rural area (58%, n=70). Middle income families were over presented (58%). 82% had a history of perinatal asphyxia. Motor, speech impairment and malnutrition were found more who had H/O perinatal asphyxia (P value 0.002,0.005 and 0.03 respectively.&#x0D; Conclusion:In conclusion, epilepsy is one of the commonest neurological morbidity in our environment. This study has provided important information about sociodemographic profile and associated comorbidities in children with epilepsy. This information can be used as a guideline for developing services for children with epilepsy and in prevention of some detectable causes in our countries like birth asphyxia which is found large number in this study.&#x0D; DS (Child) H J 2019; 35(1) : 48-54

Epileptic Encephalopathies in Infants and Children: Study of Clinico-Electroencephalographic Spectrum in a Tertiary Hospital in Bangladesh

Background: The epileptic encephalopathies collectively exact an immense personal, medical, and financial toll on the affected children, their families, and the healthcare system. Objective: This study was aimed to delineate the clinical spectrum of patients with Epileptic encephalopathies (EEs) and classify them under various epileptic syndromes. Methods: This was a cross-sectional study that was carried out in the department of Neurophysiology of the National Institute of Neurosciences and Hospital, Bangladesh from July 2016 to June 2019. Children with recurrent seizures which were difficult to control and associated with developmental arrest or regression in absence of a progressive brain pathology were considered to be suffering from EE. Children under 12 years of age fulfilling the inclusion criteria were enrolled in the study. These patients were evaluated clinically and Electroencephalography (EEG) was done in all children at presentation. Based on the clinical profile and EEG findings the patients were categorized under various epileptic syndromes according to International League Against Epilepsy (ILAE) classification 2010. Results: A total of 1256 children under 12 years of age were referred to the Neurophysiology Department. Among them, 162 (12.90%) fulfilled the inclusion criteria. Most of the patients were male (64.2%) and below 1 year (37.7%) of age. The majority (56.8%) were delivered at the hospital and 40.1% had a history of perinatal asphyxia. Development was age-appropriate before the onset of a seizure in 38.9% of cases. Most (53.7%) of the patients had seizure onset within 3 months of age. Categorization of Epileptic syndromes found that majority had West Syndrome (WS) (37.65%) followed by Lennox-Gastaut syndrome (LGS) (22.22%), Otahara syndrome (11.73%), Continuous spike-and-wave during sleep (CSWS) (5.66%), Myoclonic astatic epilepsy (MAE) (4.94%), Early myoclonic encephalopathy (EME) (3.7%), Dravet syndrome (3.7%) and Landau-Kleffner syndrome (LKS) (1.23%). 9.26% of syndromes were unclassified. Conclusion: EEG was found to be a useful tool in the evaluation of Epileptic encephalopathies. The clinico-electroencephalographic features are age-related. Their recognition and appropriate management are critical.

Case 2: Multiple Cranial Nerve Palsies in a Neonate with a History of Perinatal Asphyxia

A singleton term male neonate is born of a nonconsanguineous marriage with no significant antenatal history and a birthweight of 2,600 g via cesarean section. He does not cry immediately after birth and is resuscitated with positive pressure ventilation for 2 minutes. The Apgar scores are 3 at 1 minute and 7 at 5 and 10 minutes. The extramurally delivered newborn is brought to the NICU for postresuscitation care. On initial examination, the neonate is encephalopathic with altered sensorium, hypotonia, and poor respiratory efforts. The heart rate is 110 beats/min with good volume pulses and a capillary refilling time of less than 3 seconds. Features of multiple right-sided lower motor neuron type of cranial nerve palsies (cranial nerves V, VII, IX, X) are seen on clinical examination. These include deviation of the angle of mouth to the left side, obliteration of nasolabial fold and failure to close the eyelid on the right side, abnormal gag reflex, and pooling of secretions. In view of poor breathing efforts, the newborn undergoes intubation and is started on conventional mechanical ventilation. Cord arterial blood gas reveals a pH of 7.25 and a base deficit of −5 mmol/L, which is normal. Routine supplementation with intravenous vitamin K is given. A provisional diagnosis of perinatal asphyxia with hypoxic-ischemic encephalopathy (HIE) with brainstem involvement is made. ### Day 1 to Day 10 The respiratory …

Tratamiento médico exitoso de una osteomielitis multifocal neonatal producida por la bacteria Staphylococcus aureus meticilina resistente (SAMR). Revisión de caso

La osteomielitis (OM) en el periodo neonatal es una condición rara y trascendental. Su incidencia estimada corresponde al 0,1 de casos por cada 100 admisiones hospitalarias. El subdiagnóstico es frecuente dada la presentación paucisintomática de este grupo etario, que lleva a demoras en el inicio del tratamiento y puedeconducir a secuelas permanentes. Presentamos un caso de osteomielitis multifocal con fracturas asociadas, causada por la bacteria Staphylococcus aureus meticilina resistente (SAMR), secundaria a una infección asociada a catéter en un neonato nacido a las 37 semanas de gestación, con antecedente de asfixia perinatal y encefalopatía hipóxica isquémica. El caso debutó con sepsis, edema y artritis, pero el diagnóstico fue confirmado con ultrasonografía y radiografías que evidenciaron múltiples fracturas patológicas. Al no ser candidato para el manejo quirúrgico, se concertó una adecuación del esfuerzo terapéutico dirigiendo el manejo a la terapia antibiótica de amplio espectro y al control del dolor con adecuada respuesta clínica.

Encephalopathy due to mutation in mitochondrial fission factor gene

Mitochondrial fission factor (MFF) is a part of the protein complex that promotes mitochondrial and peroxisome fission. Mitochondria and peroxisome fission are complex processes of vital importance for cell growth and survival. Here, we are presenting a case of 5-year-old boy with spastic diplegic cerebral palsy, global developmental delay, and intellectual disability with a history of perinatal asphyxia and encephalopathy. MRI brain was suggestive of symmetrical hyper-intensities in bilateral thalami. Whole-genome sequencing indicates homozygous MFF gene mutation at exon 3 of c.19_20delAGinsTT; p.Ser7Phe variant.

Structural changes in the brain on cranial magnetic resonance imaging in severely malnourished children before and after treatment.

The aim of this study was to examine the structural changes in brain on magnetic resonance imaging (MRI) in severely malnourished children before and after treatment. This was a prospective study conducted at a Severe Malnutrition Treatment Unit (SMTU) at a tertiary care center. The study was carried out with 52 severely malnourished children 0 to 5 y of age admitted to the SMTU. The cases with neurologic diseases such as epilepsy, cerebral palsy, meningitis, tumor, or hydrocephalus; or history of perinatal asphyxia were excluded to enable us to detect central nervous system changes attributable to malnutrition only. MRI brain without contrast was performed on all 52 cases at admission and after 6 mo of treatment and were reported by an experienced radiologist. The common MRI findings in the study included cerebral atrophy, dilated ventricles, periventricular white matter changes, widened cortical sulci, enlarged basal cisterns, and widened interhemispheric fissure. Development assessment using the Denver Developmental Screening Test II was also performed to infer correlation with MRI findings. Of the 52 children who were severely malnourished, 10 (i.e., 19.2%) had abnormal MRI findings. Development assessment revealed that of the 10 abnormal MRI cases, 80% had delayed developmental milestones as well. These changes are reversible in most cases after nutritional rehabilitation. The present study revealed that malnutrition per se has a significant effect on the structure of the developing brain and also affects neurologic development. These changes are reversible after treatment so early stimulation and nutritional rehabilitation can help to prevent permanent neurologic derangements.

Non-thyroid Disease Syndrome and Other Thyroid Function Anomalies in Ecuadorian Newborns with Early and Late Neonatal Sepsis

The aim of this study is to assess thyroid function in newborns with early and late neonatal sepsis by measuring T3, T4, and TSH. This study included 80 newborns with a diagnosis of neonatal sepsis divided into two groups: early neonatal sepsis and late neonatal sepsis, which during the clinical and laboratory manifestations of sepsis showed changes in thyroid hormones, particularly low T3 syndrome and low T3-T4. It excluded newborn children of mothers with thyroid disease and those with a history of perinatal asphyxia, congenital defects, and previous major surgeries. Development of the non-thyroid disease syndrome was confirmed in both study groups, with a prevalence of 54.2% for neonates with early neonatal sepsis and 80.95% for neonates with late neonatal sepsis. It also found low T3 in neonates with early neonatal sepsis and low T4 syndrome in neonates with late sepsis. Low levels of thyroid hormones are associated with a worse prognosis and a poor evolution in severely ill neonates. In Ecuadorian preterm infants with a mean gestational age of 32 weeks, the non-thyroid disease syndrome was found in 54.24% of the patients with early neonatal sepsis and in 80.95% with late neonatal sepsis. TSH levels are decreased in 11.86% of neonates with early neonatal sepsis and 10% in patients with late neonatal sepsis. All cases were children born of adolescent mothers with or without ruptured membranes, from urban areas of Quito.

Neurological Sequalae in Survivors of Perinatal Asphyxia

Perinatal asphyxia is the most common cause of either death or severely handicapped survivors. Perinatal asphyxia can be identified by one, five, ten minutes APGAR scores less than 7. Prolonged asphyxia produce hypoxemia, acidosis, hypercapnia, thus diminishing cerebral blood flow, which in turn results in clinical patterns of Hypoxic - Ischemic Encephalopathy (HIE). The atm of this study was to evaluate the accuracy of clinical observation on newborn asphyxia to predict the presence of neurological deficits connected with blood gas analysts investigation. Thirty eight newborn babies who bad APGAR scores of less than 7 as an asphyctic newborn baby group compared with an equal number of normal babies as control group. Physical and neurological examinations were performed immediately after birth and at six months of age. Two of the 38 infants who bad perinatal asphyxia died several hours after birth. Two of the 31 of the surviving infants with a historical of perinatal asphyxia bad cerebral palsy. One of the two babies with cerebral palsy bad epilepsy. Twenty nine of the 31 of the surviving infants with a history of perinatal asphyxia with or without mild HIE showed normal neurological outcomes. All of the normal newborn babies as control showed normal neurological outcome. One infant with cerebral palsy and one infant who bad cerebral palsy with epilepsy bad a history of a severe degree of HIE and moderate degree of Hm with neonatal convulsion respectively. One of the 2 infants with cerebral palsy bad severe hypoxia and none on the infants with normal neurological outcome exhibited Pa02 less than 50 mmHg. There were no significant differences ( p &gt; 0.05) of the Pa02 PH and base deficit between the infants with a history of asphyxia and with a history of a vigorous baby, who bad a normal outcome.&#x0D; We concluded that postasphyxia encephalopathy was more accurate than a low APGAR score in predicting an adverse outcome, and the value of the Pa02 very important in predicting an encephalopathy.

Case 3: Refractory Seizures Continuing into Infancy in a Term Neonate with Definite History of Perinatal Asphyxia

A 7-day-old neonate presents to our NICU with multiple jerky movements of both upper and lower limbs and floppiness. He is the product of a third-degree consanguineous marriage and is born in a peripheral institution. He has a sister who is 6 years old and is healthy. ### Birth to 7 Days after Birth The neonate is born vaginally and requires bag and mask ventilation for 5 minutes. He is transferred to a level II NICU, where he stays for 5 days. He exhibits features of encephalopathy and also has a multifocal clonic seizure 2 hours after birth; he receives a single loading dose of phenobarbital. He is diagnosed as having hypoxic-ischemic encephalopathy (HIE) grade 2. Subsequently, his sensorium improves and he is discharged while breastfeeding exclusively. Since day 6, he has been having multiple episodes of multifocal clonic seizures and is brought to our NICU on day 7. ### Day 7 to Day 23 A strong suspicion of neurometabolic disorder arises in view of consanguinity and refractory seizures. He is nil per os. He requires full loading doses of antiepileptic drugs (AEDs) phenytoin and phenobarbital, after which his seizures stop. Testing for blood glucose, arterial lactate, pH, serum ammonia, urine ketones, and urine-reducing substances and tandem mass spectroscopy …

Neurodevelopmental disorders in children aged 2-9 years: Population-based burden estimates across five regions in India.

BackgroundNeurodevelopmental disorders (NDDs) compromise the development and attainment of full social and economic potential at individual, family, community, and country levels. Paucity of data on NDDs slows down policy and programmatic action in most developing countries despite perceived high burden.Methods and findingsWe assessed 3,964 children (with almost equal number of boys and girls distributed in 2–<6 and 6–9 year age categories) identified from five geographically diverse populations in India using cluster sampling technique (probability proportionate to population size). These were from the North-Central, i.e., Palwal (N = 998; all rural, 16.4% non-Hindu, 25.3% from scheduled caste/tribe [SC-ST] [these are considered underserved communities who are eligible for affirmative action]); North, i.e., Kangra (N = 997; 91.6% rural, 3.7% non-Hindu, 25.3% SC-ST); East, i.e., Dhenkanal (N = 981; 89.8% rural, 1.2% non-Hindu, 38.0% SC-ST); South, i.e., Hyderabad (N = 495; all urban, 25.7% non-Hindu, 27.3% SC-ST) and West, i.e., North Goa (N = 493; 68.0% rural, 11.4% non-Hindu, 18.5% SC-ST). All children were assessed for vision impairment (VI), epilepsy (Epi), neuromotor impairments including cerebral palsy (NMI-CP), hearing impairment (HI), speech and language disorders, autism spectrum disorders (ASDs), and intellectual disability (ID). Furthermore, 6–9-year-old children were also assessed for attention deficit hyperactivity disorder (ADHD) and learning disorders (LDs). We standardized sample characteristics as per Census of India 2011 to arrive at district level and all-sites-pooled estimates. Site-specific prevalence of any of seven NDDs in 2–<6 year olds ranged from 2.9% (95% CI 1.6–5.5) to 18.7% (95% CI 14.7–23.6), and for any of nine NDDs in the 6–9-year-old children, from 6.5% (95% CI 4.6–9.1) to 18.5% (95% CI 15.3–22.3). Two or more NDDs were present in 0.4% (95% CI 0.1–1.7) to 4.3% (95% CI 2.2–8.2) in the younger age category and 0.7% (95% CI 0.2–2.0) to 5.3% (95% CI 3.3–8.2) in the older age category. All-site-pooled estimates for NDDs were 9.2% (95% CI 7.5–11.2) and 13.6% (95% CI 11.3–16.2) in children of 2–<6 and 6–9 year age categories, respectively, without significant difference according to gender, rural/urban residence, or religion; almost one-fifth of these children had more than one NDD. The pooled estimates for prevalence increased by up to three percentage points when these were adjusted for national rates of stunting or low birth weight (LBW). HI, ID, speech and language disorders, Epi, and LDs were the common NDDs across sites. Upon risk modelling, noninstitutional delivery, history of perinatal asphyxia, neonatal illness, postnatal neurological/brain infections, stunting, LBW/prematurity, and older age category (6–9 year) were significantly associated with NDDs. The study sample was underrepresentative of stunting and LBW and had a 15.6% refusal. These factors could be contributing to underestimation of the true NDD burden in our population.ConclusionsThe study identifies NDDs in children aged 2–9 years as a significant public health burden for India. HI was higher than and ASD prevalence comparable to the published global literature. Most risk factors of NDDs were modifiable and amenable to public health interventions.