Friday, August 15, 2014

10 Danger signs of illness in babies every parents should know

Neonatal period is a period of great delicacy and concern to born the newborn as well as parents. After more than 9 months of all the preparation and hope, a baby is born and soon it becomes the entire attention of the family. Even normal behaviors of newborn may seem strange to the parents, as often the physiology and phenomenon of the infants are unknown to many parents.
In this sensitive period, newborn might acquire an illness and parents should know the danger signs that an infected neonate may show. Early detection is very important as delay can compromise the outcome in the baby.

Here are list of Danger sign's listed by WHO- IMCI ( 0 to 2 months )

Possible serious Bacterial infections

1. Convulsions - uprolling of eyes, paddling movement of limbs (involuntary), vancant staring, sudden bluish discoloration with cessation of respiration, head drops, sucking like movement, flickering of eyes.
Convulsion may be sign of hypoglycemia, meningitis, sepsis or bleeding inside the cranium.

2.Fast breathing - More than 60 breaths per minute is cut off point for fast breathing in < 2 months baby. Fast breathing is seen in Pneumonia, Sepsis and metabolic acidosis.

3. Severe chest indrawing- Indrawing of lower chest and upper abdomen with respiration is a sign of respiratory problem most commonly Pneumonia and Metabolic acidosis.

4. Nasal flaring- is a sign of respiratory difficulty.

5. Grunting- sound produced during breathing typically is seen in lower respiratory tract infection including pneumonia.

6. Bulging Anterior frontanel- Frontanels are the open areas on the cranium covered only by skin and soft tissue. It is present in anterior portion of scalp as well as posterior. Bulging and tight anterior frontanel is a danger sign and may indicate meningitis, or intracranial bleed in sick infant.

7. Skin pustules- 10 or more skin pustules over the body or single boil 1cm , indicates need of medical attention.

8. Fever and hypothemia- Fever is less common in infants even when they have infection, more likely that they develop hypothermia ( cold clammy temperature ). It may be sign of hypoglycemia, sepsis or shock.

9. Lethargic or unconscious.

10.Less activity than normal.

Local Bacterial infection- 3 signs

1. Umbilical redness or draining pus

2. Pus discharge from ears

3.Less than 10 skin pustules.

One very remarkable sign both the parents and doctors have noticed in sick infant is, poor sucking of breast milk or cessation to feed on breast milk. Sometimes they may get irritable and difficult to console with excessive crying and recurrent vomiting.
Know these signs and be a Informed and Responsible parent. Only loving your child is not enough, you need to protect and know about them as well.

- Author- 
Dr  Sujit Kumar Shrestha, MD Pediatrics ( IOM, TUTH)

Sunday, August 3, 2014

Severe defect caused by side effect of Computer technology

These children were normal at birth. With the advancement of computer technology, some body took their photo and created one of the defects world has never seen. This is probably the photoshopped image of a girl and a baby circulating through the internet in name of rare severe birth defect. After going through several websites related to this image, it proved to be nothing more than photoshop effect. Nonetheless it has the power you give you a good Scare.

This is just a humor article :) Side effects of Photoshop are numerous.

Photo found on internet while scrolling through rare birth defects. A fake one indeed.

Severe rare birth defects - Congenital malformations

Birth defects are often encountered by a Pediatrician. Sometimes the defects are so profound that it might astonish even the doctors. Here are few severe birth defects leading to physical malformations.

Craniopagus parasiticus - Conjoined twin where one twin has no developed body and depends on other for survival.

Profound fusion of Conjoined twin. The fusion of two twins are so profound that it gives shape of another creature. The twin is smeared to back of other twin.

Cyclopia- condition where the eyes fuse into one eye, giving appearance of a mythical creature "Cyclops"

Progeria " Hutchison-Gillford Disease" a condition where there is quick ageing process causing child to look like an old man by late childhood.

"Collodian Baby" often referred to as Snake baby, is a condition where there is over growth of layer of skin " Lamellar Icthyosis. The skin is shed off .

Mermaid Syndrome or Syrinomelia where the lower limb poorly develop or fuse with each other causing appearance of a Mermaid.

Proteus Syndrome -a rare condition characterized by overgrowth of the bones, skin, and other tissues. 

Thursday, July 24, 2014

Flat assymetric head in babies or Plagiocephaly : What to do ?

               Baby's head is built of soft cranial bones and sutures, that are liable to get deformed on pressure. When a baby sleeps on supine or on back for long duration, there is continued pressure on the back of head, occiput area, causing flattening. This is caused by babies head weight. Sometimes even sores can develop if positions are not changed. This condition where the baby develops positional asymmetry and flattening of the head is called Plagiocephaly.

Although the plagiocephaly has been linked to learning problems as children grow [1] as well as Visual defects [2] , the studies have shown conflicting results. Nevertheless , the problem is sometimes a big concern to the parents.

Here is one video addressing the issue, Since the "Back to Sleep" Campaign was launched in USA against Sudden Infant Death Syndrome, the deaths decreased significantly but with it increased the incidence of flat head syndrome by 5 folds.

Pediatricians suggest frequent positioning of the baby to avoid pressure on same spot, increase on-stomach play time ( Tummy time ) while child is under supervision and even helmets have been introduced.

When to really get concerned has been a question for parents.
If the flattening is severe, immediate consultation is required. Severe cases may require Cranial orthotic therapy.
In mild cases, get advice from your doctor. Frequent positioning and adequate tummy time may be sufficient.

1.  PEDIATRICS Vol. 105 No. 2 February 1, 2000 , Long-Term Developmental Outcomes in Patients With Deformational Plagiocephaly Robert I
2. Visual Field Defects in Deformational Posterior Plagiocephaly R. Michael Siatkowski, MD
JPO Journal of Prosthetics & Orthotics:

Sunday, July 20, 2014

APGAR score in practice and its implications

A baby is born. Pediatrician receives the delivery, fetal bradycardia with maternal hypertension was the scenario. Baby is efficiently resuscitated. By the time everything is settled its around 7-8 minutes of babies life. In such a rush scenario, APGAR now has to be awarded retrospectively. A skilled pediatrician or neonatologist can do good but still it has a drawback. 

The Apgar scoring system was intended as an evaluative measure of a newborn's condition at birth and of the need for immediate attention.

In practice
We often use mnemonic form APGAR, for our convenience. But in fact the mnemonic does not represent the initials for true parameters we use for evaluation.
Example Pulse is not used in newborn for assessment, instead Heart rate is used, but P in APGAR stands for pulse rate.

The real parameters are given Below-

What we use in practice for convenience-

Though the assessment may not be much different in practice, it makes a big difference when using such parameters in exams.

Importance of APGAR
1.Despite the advent of modern technology, the Apgar score remains the best tool for the identification of newly born infants in need for cardiopulmonary resuscitation.
2. Data suggest that serial Apgar ratings in infants with early low scores detect clinically important recovery of lack thereof.

Drawbacks of APGAR 
1. Subjective assessment
2. Retrospective assessment - usually done after resuscitation so health workers usually recall after the event.

Few Interesting Readings-
The Apgar scoring system was intended as an evaluative measure of a newborn's condition at birth and of the need for immediate attention. In the most recent past, individuals have unsuccessfully attempted to link Apgar scores with long-term developmental outcomes. This practice is not appropriate, as the Apgar score is currently defined. Expectant parents need to be aware of the limitations of the Apgar score and its appropriate uses
J Perinat Educ. 2000 Summer; 9(3): 5 Apgar Scores: Examining the Long-term Significance Kristen S. Montgomery, PhD, RNC, IBCLC