LBW Babies Research Articles

Nasojejunal feeding in high risk infants: recent trends.

Nasojejunal feeding is one of the methods of feeding sick and/or LBW babies. It does not require expensive new technology save for the appropriate feeder tubes. The importance of maintaining adequate nutrition in growing premies using this simple technique cannot be overemphasised. There are advantages of NJ feeding such as decreased risk of aspiration and provision of adequate calories early with less initial weight loss. But there are disadvantages like it requires trained medical and nursing personnel for insertion. It carries increased risk for complications of NEC, intestinal perforation and intussusception. However, NJ feeding may be of value when intravenous supplementation is not possible or when the risks of gastric feeding are increased, e.g., tbabies on nasal CPAP or babies with severe RDS and esophageal chalassia.

484 CLINICAL DISAGREEMENT IN THE ASSESSMENT OF BPD IN A CLINICAL TRIAL

Disagreement between clinicians in interpreting clinical signs is ubiquitous in medicine. In the interpretation of endpoints in clinical trials, this can be crucial. A randomised clinical trial to test the effectiveness of Vitamin E in LBW babies in the prevention of BPD required the assessment of BPD to be as objective as possible. Three radiologists agreed to interpret the X-rays, independently and blindly. One was a pediatric radiologist; one, a general radiologist, regularly reviews neonatal films; and one was interested in pulmonary disease. The criteria used were those of Northway. X-rays, taken at days 1, 10, 21, 28 and 42 were coded and read. The results of the first batch of 268 films indicated that there was complete agreement in 28% (usually the normal films); agreement between 2 of the 3 in 36% and no agreement in 35%. Possible sources of disagreement included the quality of the films and the comorbidity of the babies as well as reviewing out of context. The decoded films were placed back in order. Agreement was reached on 35% of babies; two agreed on 17% and all 3 agreed on a further 13% but not on the severity of the disease. 35% still had questionable conclusions. Strategies to resolve these differences included adding the complete series of baby films; checking autopsy reports if insufficient films were available and bringing the 3 radiologists together with a neonatologist to resolve interpretative differences.

GROWTH AND DEVELOPMENT OF THE CHILD

Deaths of infants and of their mothers may be the most dramatic consequence of ill health, but there are other serious consequences which affect the child and, indeed, may follow it throughout adult life. The damage done by infections and associated malnutrition to a young child in its formative years is manifested in retarded physical growth and mental development, which it may never be able to catch up on, thus impairing the potential for a full and active adult life. Poverty, ignorance, and ill health thus create a vicious cycle spanning from one generation to the next, and from which the individual has little chance of escape. A striking expression of this generation link is the frequency of "low birth weight" (LBW) babies, ie, babies weighing less than 2500 gm at birth. It is now known that this frequency is closely determined by the same adverse maternal and environmental factors which determine the nutritional status of the mother. It has also been observed in developed countries that the frequency is higher among mothers who smoke during pregnancy. About 21 million LBW (small for date) babies are born each year, the greatest majority of them in developing countries. The observed incidence rate ranges from about 4% in the most developed countries to over 30% in some poor rural populations. It is also known that LBW is the single most important factor determining the survival chances of the child. The infant mortality rate is about 20 times greater for all LBW babies than for other babies, and the lower the birth weight the lower is the survival chance.

1016 DEVELOPMENT OF LOW BIRTH WEIGHT (LBW) INFANTS

Evaluations were done at 21 months post-conceptual age on 134 LBW infants discharged from the Regional Neonatal Intensive Care Center between 1974-1976. A 60% return of those assigned for evaluation (all infants with birth weights less than 1500 grams and 20% of infants with birth weights between 1500 and 2500 grams) was achieved. The evaluation tools were the Bayley Scales of Infant Development with mental and physical developmental quotients (MDQ;PDQ), neurological and general evaluations. The only group that was significantly different from the other groups was those less than 1000 grams, where 6 of 16 in this group were estimated to be mentally defective. Three of the 6 defective babies had birth weights less than 750 grams. No differences were evident due to race and sex. It would appear that the babies at major risk for serious handicap are the very LBW babies and they continue to provide a perplexing problem for those involved with the care of small infants.

A Study of Early Neonatal Deaths at Kathmandu Medical College Teaching Hospital

Over 9 million deaths occur each year in the perinatal and neonatal periods globally. 98% of these deaths take place in the developing world. Nepal has a high neonatal mortality rate (NMR) of 38.6 per 1000 live births (2001). Two thirds of the newborn deaths usually occur in the first week of life (early neonatal death). Newborn survival has become an important issue to improve the overall health status and for achieving the millennium developmental goals of a developing country like Nepal. Aims and Objectives: This study was carried out to determine the causes of early neonatal deaths (ENND) at KMCTH in the two-year period from November 2003 to October2005 (Kartik 2060 B.S. to Ashoj 2062). Methodology: This is a prospective study of all the early neonatal deaths in KMCTH during the two-year study period. Details of each early neonatal death were filled in the standard perinatal death audit forms of the Department. Results: Out of the 1517 total births in the two-year period, there were 10 early neonatal deaths (ENND). Early neonatal death rate during the study period was 6.7 per 1000 live births and early neonatal death rate (excluding less than 1 kg) was 6.1 per 1000 live births The important causes of early neonatal deaths were extreme prematurity, birth asphyxia, congenital anomalies and septicaemia. During the study period, there was no survival of babies with a birth weight of less than 1 kg. Among the maternal characteristics, 80% of the mothers of early neonatal deaths were aged between 20-35 years. 50% of the mothers were primigravida. 50% of the mothers of ENNDs had delivered their babies by caesarean section.Discussion: Most of the early neonatal deaths were due to extreme prematurity. Birth asphyxia was the second most important cause of early neonatal deaths. 70% of ENNDs were among LBW babies. Prevention of premature delivery, proper management of very low birth weight babies and early detection and appropriate management of perinatal hypoxia have become important interventional strategies in reducing early neonatal deaths in KMCTH.Conclusion: Early neonatal mortality at KMCTH is fairly low. Good care during pregnancy, labour and after the birth of the baby has helped to achieve these results. Low cost locally made equipments were used to manage the sick newborns. Reduction of early neonatal deaths require more intensive care including use of ventilators, surfactant and parenteral nutrition and prevention of preterm births Key words: Early neonatal death (ENND), neonatal mortality doi:10.3126/jnps.v27i2.1584 J. Nepal Paediatr. Soc. Vol 27(2), p.79-82

Clinico-Laboratory Profile and Immediate Outcomes of Hyperbilirubinemic Babies Admitted in Kanti Children Hospital

Introduction: Jaundice is an important problem in the neonatal period especially in the first week of life. Our objective of the study is to find out the immediate outcome of hyperbilirubinemic babies admitted in Kanti Children Hospital. Methodology: This is a retrospective study and carried out in tertiary care paediatric hospital. Results: Altogether 73 babies were enrolled in the study. Male babies outnumbered the female (72.6% vs. 27.4%).Only 2.4% babies were near-term. LBW babies constitute 19.2% of the study population.86.3% of babies also have clinical sepses as defined by WHO criteria. Almost half of the babies have mild hyperbilirubinemia (15-19.9 mg/dl). Most of the babies (94.5%) improved and the mortality was 5.5%. Conclusion: Healthy term babies with a serum bilirubin <17mg/dl should not be admitted for routinely as they do not need phototherapy. Phototherapy is effective in most of the time, but exchange transfusion should also be carried out when phototherapy fails. Causes of hyperbilirubinemia should be searched extensively especially to rule out haemolysis. Key words: hyperbilirubinemia, kernicterus, neonates, phototherapy DOI: 10.3126/jnps.v30i1.2457 Journal of Nepal Paediatric Society Vol.30(1) 2010 31-36

GROWTH AND DEVELOPMENT OF THE CHILD

Deaths of infants and of their mothers may be the most dramatic consequence of ill health, but there are other serious consequences which affect the child and, indeed, may follow it throughout adult life. The damage done by infections and associated malnutrition to a young child in its formative years is manifested in retarded physical growth and mental development, which it may never be able to catch up on, thus impairing the potential for a full and active adult life. Poverty, ignorance, and ill health thus create a vicious cycle spanning from one generation to the next, and from which the individual has little chance of escape. A striking expression of this generation link is the frequency of low birth (LBW) babies, ie, babies weighing less than 2500 gm at birth. It is now known that this frequency is closely determined by the same adverse maternal and environmental factors which determine the nutritional status of the mother. It has also been observed in developed countries that the frequency is higher among mothers who smoke during pregnancy. About 21 million LBW (small for date) babies are born each year, the greatest majority of them in developing countries. The observed incidence rate ranges from about 4% in the most developed countries to over 30% in some poor rural populations. It is also known that LBW is the single most important factor determining the survival chances of the child. The infant mortality rate is about 20 times greater for all LBW babies than for other babies, and the lower the birth weight the lower is the survival chance.