Organism specific platelet response in neonatal sepsis in neonates weighing ≤1800 gm

Background: Thrombocytopenia is an important but non-specific marker of severity of neonatal sepsis. Few studies have observed organism-specific response in platelet count, however this finding in not consistently seen in various studies. We carried out this study to look for organism-specific response of platelet count and indices in neonatal sepsis in our setup.Methods: A prospective analytical study was conducted during December, 2019 to November, 2020 at tertiary care centre of central Gujarat. Neonates weighing ≤1800 gm (n=100) were enrolled according to eligibility criteria. Sepsis screen including TLC, ANC, platelet count, platelet indices, micro ESR, CRP, and blood culture was done. Patients with culture-proven sepsis were divided according to organisms isolated from blood or CSF. Patients were followed up to the final outcome of their hospital stay. Appropriate analytical tests were used for the results.Results: Out of 100 patients, 69 had culture-proven sepsis, of which 40 (58%) were gram-negative, 21 (30%) were gram-positive and 8 (12%) had fungal sepsis. Of these 48/69 (70%) patients had thrombocytopenia. Of these patients with thrombocytopenia 60%, 30% and 10% in the first sample while 48%, 38% and 16% in the second sample had gram positive, gram negative and fungal sepsis respectively. Commonest organisms isolated were Enterococcus and MRCONS, and thrombocytopenia was not having specific correlation with any particular organism. There was no significant difference between mean and median platelet count of gram-positive, gram-negative, and fungal sepsis.Conclusions: Thrombocytopenia is significantly associated with neonatal sepsis. The effects of sepsis on platelet count are not organism-specific.</jats:p

Clinical profile, outcome and clinical indicators for poor prognosis in full term babies born with severe birth asphyxia: study from tertiary care hospital from western India

Background: The World Health Organization describes birth asphyxia as failure to initiate and sustain default breathing at birth. The aim of the study was to study the clinical profile and outcome at 3 months of age of full term babies born with severe birth asphyxia and to analyze risk factors associated with adverse outcome.Methods: This was a prospective observational study carried out over period of 12 months in year 2015-16. All full term babies born with severe birth asphyxia (n = 45) during four months period were enrolled and were followed up for 3 months. Severe birth asphyxia was defined as APGAR score 3 or less at 1 minute. Baseline characteristics, clinical profile and outcome were noted. HIE was graded as per Sarnat and Sarnat staging. Neurological Assessment at 7th day and on discharge was done and were assessed by Amiel Tison Scale at 3 months. Multivariate analysis by linear regression was done to find risk factors associated with adverse outcome. Results: Of total 45 babies with SBA, 35 developed HIE, of which 13 (28.8%) were in HIE grade II and 13 (28.8%) were in HIE III. Mortality found was 20% while 28.5% of survivors had abnormal neurological outcome at 3 months. Multivariate analysis of risk factors shows that abnormal neurological finding on 7th day of life, APGAR ≤ 6 at 10 minute and HIE grade II or more where associated with abnormal outcome(p = 0.01). The risk factors associated with mortality were multiorgan dysfunction, difficult to control seizures, APGAR ≤4 at 10 minute (p = 007).Conclusions: Full term neonates with severe birth asphyxia has significant mortality and significant number of survivors has abnormal neurological outcome at 3 months of age. Presence of certain clinical indicators is associated with increased risk of adverse outcome.</jats:p

Effect of specific physiotherapy interventions in comparison with multisensory stimulation on neurobehavioral outcome and weight gain in preterm infants: a randomized control trial

Background: A premature infant is deprived of in-utero sensory experiences which are essential for normal brain development and rather is exposed to unusual sensory stimuli in the Neonatal Intensive Care Units (NICU) that pose risk to the developing brain in terms of adverse neurodevelopmental outcomes. The objective of this study was to study and compare the effect of specific physiotherapy intervention with multisensory stimulation on neurobehavioral outcome and weight gain in preterm infants. Inclusion criteria was preterm infants appropriate for gestational age more than 32 weeks, babies who were hemodynamically stable and babies receiving full enteral feeds. Exclusion criteria were major congenital anomalies, inability to undergo intervention (any fracture) or perinatal asphyxia. Methods: Eligible infants were randomly allocated into one of the two groups. Group A was offered multisensory stimulation: Auditory, Tactile, Visual and Vestibular (ATVV). Group B received Specific Physiotherapy Intervention (SPI) in form of kinesthetic exercises, oil massage and oral stimulation. The outcome was studied before and after intervention. Appropriate statistical tests were applied. Results: Both the groups had better suck co-ordination and improvement on neurobehavioral scale following intervention when compared to pre-intervention status (P&lt;0.0001). When both groups were compared, SPI group had better sucking coordination than ATVV group, improvement in neurobehavioral scale was similar in either group.Conclusions: In preterm infants, Specific Physiotherapy Interventions are more effective in improving suck co-ordination, has better weight gain and are equally effective in improving neurobehavioral outcome compared to multisensory stimulation. </jats:p