Monday, December 1, 2014

RDS or Hyaline membrane Disease - Classic X ray

A Preterm 33+ weeks male with Perinatal asphyxia presented with Rerpiratory distress at 16 Hour of life. The baby was in respiratory failure so was Intubated immediately and put under mechanical ventilation. The baby required high PIP as lungs were stiff.

Xray was ordered with showed-


Bilateral White out lung field with Air Brochogram.


In Such cases of RDS of Prematurity, best management would have been-
1, Dexamethasone or Betamethasone therapy intrauterine atleast 24 hrs before delivery to provide maturation of lungs.
2. Early CPAP to prevent collapsing of alveoli after delivery if any signs of Distress
3. If feasible , Surfactant therapy within 6 hours with FiO2 requirement increases.



Sunday, November 30, 2014

Newborn Resuscitation Protocol - AHA 2010 changes compared to 2005

Neonatal Resuscitation Guidelines by AHA 2010-

Changes-
1.Introduction of Preductal Saturation cart
2. Removal of Color in assessment
3. MRSOPA - to check if ventilation has been effective
4. CPAP introduced
5. Bagging with Room Air
6. Heart Auscultation over Cord pulsation
7. Medication needed only 3







Saturday, November 8, 2014

Cooperaton For Improvement of oral health of Children in Nepal



Childhood is considered the golden period of life but it is also a phase when diseases are lurking in every nook and corner to attack these tiny buds. Like systemic diseases there are a number of oral health problems that affect children which includes tooth decay, various habits like thumb sucking, gum diseases, oral lesions and early tooth loss. Among these early childhood tooth decay is the number 1 chronic disease affecting young children and is 5 times more common than asthma and 7 times more common than hay fever. Teeth are at risk of dental caries from the time they start to appear in the mouth, putting children from approximately six months of age onwards at risk. Severe form develops very quickly and teeth may be destroyed within six months of its onset. Many of the dental diseases of the childhood can be prevented with proper education of the parents. To achieve this objective, a greater interaction between Pediatricians and Pediatric Dentists are important.


Pediatric Dentistry is the branch of dentistry dealing with children from birth through adolescence including children with special health care needs. Pediatric Dentists are the Pediatricians of Dentistry. Pediatric Dentists promote the dental health of children as well as serve as educational resources for parents. American Academy of Pediatric Dentistry (AAPD) and the American Academy of Pediatrics (AAP) recommend that a dental visit should occur within six months after the presence of the first tooth or by a child's first birthday. A Pediatric dentist has two to three years of specialty training (course) following dental school and limits his/her practice to treating children only. The American Academy of Pediatrics (AAP) recommends a child to visit a pediatrician 6 times in the first year of life and 10 times by 3 years of age. Pediatricians have the opportunity to provide care for children 6 times before the recommended visit to a dentist. In May 2003, the AAP developed a policy statement on oral health risk assessment timing and establishment of the dental home. The policy states “pediatricians and pediatric oral health professionals should develop the knowledge base to perform oral health risk assessments on all patients beginning at 6 months of age to identify high risk children at an early age in order to provide anticipatory guidance, behavior modifications in terms of oral hygiene and diet”.



CONTRIBUTION OF PEDIATRICIANS IN IMPROVING ORAL HEALTH OF CHILDREN:

The importance of dentistry during the early years of child’s life has been well documented. Pediatricians are considered to be in a unique position to contribute to the dental health of their child patients because children often visit their offices at a young age and the parents accept their recommendation well. They can contribute to oral health in the following manner:

EDUCATION: 
Educate parents in many areas such as 
Good oral hygiene: educating the parents about the basics of maintaining oral hygiene.




Prevention  of dental injuries

Prevention of nursing caries by establishing proper feeding habits. Education about the  harmful effects of putting the baby to sleep with a bottle of milk as well as the effects of sugars from juice or milk  on a baby's teeth. The role of feeding habits on development of baby bottle tooth decay. 




Diet counseling demonstrating food guide pyramid and importance of healthy food habit for healthy teeth



Educating parents about the importance of the first dental visit, which is recommended at the time of the eruption of the first tooth and no later than 12 months of age.(AAPD guidelines)




CARIES PREVENTION:  assess whether infants receive optimal fluoride exposure from drinking water or in fluoride-deficient areas by supplementation.

REFERRAL of all children for routine dental care to limit destruction associated with the milder forms of caries as well as referral of infants with cleft lip and palate for fabrication of feeding obturators.

LIFTING THE LIP examination of the child during well baby visits to assess the initiation of decay as well as identify the oral hygiene status and other oral lesions.


STAGES OF  EARLY CHILDHOOD TOOTH DECAY




Initial reverible stage: Chalky, white spots or lines; no pain.





Deep stage : Yellow or brownish discoloration or cavities; pain or sensitivity to hot or cold.









Damaged Stage: Advanced decay with loss of tooth structure. Moderate to severe pain.







Traumatic Stage: severe tooth decay and fractures of one or more carious teeth

Any of the above findings warrants a need to visit the dentist as soon as possible to prevent further progress and complications.


PEDIATRIC DENTISTRY IN NEPAL:

                        Initially in Nepal there was a dearth of Pediatric Dentists but today there are around 15 Pediatric Dentists registered in Nepal, working in various Dental institutions, hospitals and dental clinics. BPKIHS has started Post Graduate degree in PediatricDentistry and the first batch students have already acquired the degree. The only problem with people not seeking care at the proper place is lack of awareness regarding it. The Pediatricians are the first doctors for a child so they can play a major role in being the messiah of oral health by educating and referring the child to the proper channels. The co-operation from their side can help us nurture a child with a positive dental attitude as well. 
               With a little effort and co operation, together we can provide healthy smiles to children all over our nation.


AUTHORS:



Dr. Parajeeta Dikshit is an Assistant Professor, Dept of Pedodontics and Preventive Dentistry (Pediatric Dentistry) at Kantipur Dental College teaching hospital and research center Basundhara , Kathmandu and Consultant Pediatric Dentist at Smile Square Dental Care Center, Maharajgunj, Kathmandu.






Dr. Mamta Dali is an Assistant Professor, Dept of Pedodontics and Preventive Dentistry (Pediatric Dentistry) at BPKIHS, Dharan.


Friday, October 17, 2014

Healthy Food for Growing Children


Children require a steady supply of all the vital nutrients as they grow to facilitate healthy growth and development in general; physically, mentally and socially. In this article you will get to know about the necessary foods for growing kids, their nutrient compositions and their benefits to your child. Here is a detailed look:


Carbohydrates: 

Children spend most of their time playing and consequently utilize most of the energy present in their bodies. As such, it is important that carbohydrates be included in the child's diet so as to provide the body with sufficient energy to not only facilitate playing but also growth of strong and steady muscles, bones and wits.

Foods rich in carbohydrates and which are easy to find include:

Eggs Whole grains and cereals

Potatoes

Green vegetables

Bread

Fruits like citrus, berries, apples and watermelons among others.




Proteins: 

Proteins are among the most vital nutrients for kids as they facilitate body building; directly affecting physical growth. They also help boost the body's immunity against certain illnesses, further ensuring healthy development. As such, you should ensure that your child gets a steady supply of proteins by eating foods like:

Eggs and other poultry products

Dairy products like milk, cheese and yoghurt

Beans and nuts

Lean meat


Vitamins and minerals

Vitamins are necessary for a healthy immune system in growing children. They help to directly improve the body's immune system, helping fight off infections which may be deadly if lest to spread in the body. Other vitamins also help improve the body's general capabilities like eyesight and skin firmness and texture among others. Minerals like calcium on the other hand facilitate growth of strong bones and teeth in the body.

Foods rich in vitamins and minerals include:

Potatoes, carrots and dark green leafy vegetables for vitamin A

Fruits like berries, tomatoes and citrus for vitamin C

Fish oil and cod liver oil for vitamin D to facilitate absorption of other minerals like calcium


Fiber
Albeit it may not seem as important, fibers help keep the body's system clean and running smoothly while also improving digestion and proper body growth and development. They hence help keep your child feeling fit and comfortable.
They are easily obtained from foods like:

Legume like peas, beans and lentils among others

Fruits with peels like apples and peach

Brown rice and pasta made from whole grains

Bread made from whole wheat


Fats
Fats are considered to be generally bad by most people owing to the rising cases of overweight people. However, fats are just as vital as other nutrients. Furthermore, there is a wide range of natural foods with good fats as compared to unhealthy fats and cholesterol found in fast foods. Among other things, fats help store energy in the body for future use They also help give the skin a healthy and supple look and feel; enhancing a healthy and beautiful appearance.
Fats can be easily obtained from foods such as:

Dairy products like cheese, yoghurt and milk

Meat and oily fish

Avocados Margarine and butter


Conclusion. Ensuring that your growing child has a stable supply of these vital nutrients will facilitate strong and healthy body growth. This will consequently ensure that he/she is free of the common illnesses.

Author Bio:I am Jessica Cranwell, I am a Blogger and Freelancer. I love reading blogs, and writing for them on various themes like Travel, Auto, Lifestyle, Education and Health. As of now I am doing research of Ehic cards.

Tuesday, October 14, 2014

Blood Transfusion Guidelines in Neonates and Children- Red Cell Transfusion

Red Blood Cell transfusion is a common process in Neonatal Intensive care Unit, Pediatric Intensive care and in sick children. A guideline on when to give blood transfusion are provided below. These guidelines are derived from Worldwide accepted textbook - Nelson and Cloherty

Tranfusion Guideleines For Premature Infants- Cloherty

1.  Asymptomatic infants with Hct  less than 21 % and reticulocytes  less than 100, 000/UL (2%)

2. Infants with Hct less than 31% and any of below

  • hood O2 less than 36% or mean airway pressure less than 6 cm H2O by CPAP or IMV  
  • more than 9 apneic and bradycardic episodes per 12 h or 2/24 h requiring bag and mask ventilation while on adequate methylxanthine therapy 
  • HR more than 180/min or RR more then 80/min sustained for 24 h
  • Weight gain of less than 10 g/d for 4 d on 100 Kcal/kg/d 
  • Having surgery


3. Infants with Hct less than 36% and requiring more than 35% O2 or mean airway pressure 6-8 cm H2O by CPAP or IMV


CPAP = continuous positive airway pressure by nasal or endotracheal route; HR = heart rate; Hct = hematocrit; IMV = intermittent mandatory ventilation; RR = respiratory rate. From the multicenter trial of recombinant human erythropoietin for preterm infants.
Source: Data from Straus RG. Erythropoietin and neonatal anemia (Editorial). N Engl J Med 1994;330:1227.



.


 GUIDELINES FOR PEDIATRIC RED BLOOD CELL TRANSFUSIONS [ Nelson Textbook 19th Edition]

CHILDREN AND ADOLESCENTS

   Acute loss of > 25% of circulating blood volume
   Hemoglobin < 8.0 g/dL[†] in the perioperative period
   Hemoglobin < 13.0 g/dL and severe cardiopulmonary disease
   Hemoglobin < 8.0 g/dL and symptomatic chronic anemia
   Hemoglobin < 8.0 g/dL and marrow failure
INFANTS ≤ 4 MO OLD

   Hemoglobin < 13.0 g/dL and severe pulmonary disease
   Hemoglobin < 10.0 g/dL and moderate pulmonary disease
   Hemoglobin < 13.0 g/dL and severe cardiac disease
   Hemoglobin < 10.0 g/dL and major surgery
   Hemoglobin < 8.0 g/dL and symptomatic anemia


Wednesday, September 24, 2014

New Immunization Schedule of Nepal 2014 - IPV, PCV and MR vaccines added

In 2014, September, the National Immunization Schedule was planned for an update with introduction of few new vaccines for prevalent diseases in Nepal. Nepal became the first nation to introduce Injectable Polio Vaccine (IPV) in South East Asia. IPV is recommended in addition to the Oral Polio Vaccine (OPV) and not as it's replacement.

Added Vaccines:

  1. PCV - Pneumococcal Conjugate Vaccine
  2. iPV - Injectable Polio vaccine
  3. MR - Mealsles and Rubella vaccine


The New Immunization Schedule of Nepal:





Thursday, September 4, 2014

Common Cold in children : Concerned Parents

A child may catch cold several times in a year. Common cold is a benign condition but raises a level of anxiety and concern in parents and is pretty much obvious. After all children are as delicate as they look.
Cough is a common symptom that causes a big concern in parents and commonly they are worried about their child having a chest infection - Pneumonia. Another symptom that worries parents is noisy breathing that may be a simple nasal blockade but can be due to Asthma, Croup and other conditions.

The common cold are symptoms caused by a number of different viruses. More than 100 virus cause cold but  rhinovirus, the type of virus responsible for the greatest number of colds. Other are enteroviruses (echovirus and coxsackieviruses) and coronavirus.

Common Cold common symptoms

Children under 6 years get average six to eight colds per year.

Although  colds occur during the fall and winter months,in any geographic location, it can occur though out the year. It is transmitted from person-to-person, either by direct contact or by contact with the virus in the environment. Colds are most contagious during the first two to four days.
Droplets containing viral particles can be exhaled into the air by breathing or coughing. Rhinoviruses are not usually transmitted as a result of contact with infected droplets, although influenza virus and coronavirus can be transmitted via small droplets. Cold viruses are not usually spread through saliva.

What are the Common Cold Symptoms?
In children, nasal congestion is the most prominent symptom.
Children can also have clear, yellow, or green-colored nasal discharge;
Fever (temperature higher than 100.4ºF or 38ºC) is common during the first three days of the illness.
Sore throat
Cough
Irritability
Difficulty
Sleeping
Decreased appetite.
Red and swollen nasal area
Neck lymph nodes may become slightly enlarged.

What are the Complications of Common Cold?
Most children who have colds do not develop complications.
However, parents should be aware of the signs and symptoms of potential complications.
Ear infection — 5 - 15 percent of children with a cold develop a bacterial or viral ear infection.
If a child develops a fever (temperature higher than 100.4ºF or 38ºC) after the first three days of cold symptoms, an ear infection may be to blame.
Asthma - noisy breathing also referred to as wheezing, called Reactive airway disease in smaller children
Sinusitis
Pneumonia- high grade fever, lethargy, fast breathing, cough and child looks toxic.

COMMON COLD TREATMENT 
 Symptomatic treatment —
1. Plenty of fluids - hydration
2. Warm clothing and warm environment.
3. Nasal care- Cleaning and in older children - steam inhalation with soother can be helpful. Steam inhalation in small children should be avoided as it can cause burns.
Saline nasal drops can be used in case of nasal stuffiness and blockade
4. Adequate rest - speciially children in daycare centres and school should be let to stay warm at home.
5. Antipyretics- High fever can cause discomfort and irritability. Dose of Antipyretics can be given for fever exceeding 100.4 F PRN.
6 Children may present with wheezing
   - Such children may require immediate doses of Nebulization with Salbutamol and if improves can be discharged on oral beta2 agonist

Usually Antibiotics are Not needed as Viruses don't respond to antibiotics. So requesting doctor for an antibiotic and administering over the counter antibiotics are not recommended.

When to seek Medical Help?
Refusal to drink or feed
Inconsolability and undue irritability
Lethargy (decreased responsiveness - Sick/toxic looking);
Difficulty breathing,
Fast Breathing
High grade fever greater than 101ºF (38.4ºC) lasts more than three days.
Vomiting
Convulsion

Such children need immediate medical attention regardless of time - night or day


Monday, September 1, 2014

The deadliest disease in today world


Many times we have debated on list of deadliest diseases. But if we look into the root cause, we can easily figure out the cause of most deaths in the world is poverty. More people die of hunger, starvation and poverty than wars and accidents.


In our scenario, newborns are brought in distress into our Neonatal Unit. Almost everytime the problem is same, the parents are economically broke and there isn't much they can do for their newborn, as they cannot afford NICU and medication charges. Many times we arrange Free beds but the problem is not solved with it. Even after the baby is discharged, he needs care and need to be nurtured.

The poverty is such severe that people come to Health Centres for Delivery, just to get Rs 1000 that government provides the mother under Safe Delivery program. Most of the time, we find, the parents are unprepared economically for any unexpected events at the time of delivery. If the newborn or the mother gets sick, the patients are unprepared for it. Only bearing a child is not a solution, the parents should be responsible enough and capable enough to bring up the child under atleast fair condition. A 16 year old father is in crisis after his wife delivers a preterm newborn, and this is the face of real scenario back here.

Most people here are dying of poverty. They are dying of simple diseases like Diarrhea, Pneumonia and treatable conditions like Neonatal sepsis. Malnutrition is omnipresent and is an amplifier of the risk of death and often itself is a cause of death. A small amount of saving for the time of crisis, a little aid from government can save thousand of lives of the future human resource of the nation, the children. Carelessness is even deadlier and unawareness is deadliest. Unaware of simple signs and symptoms of illness, often there is delay in seeking medical attention and such a delay can cost heavily. Health awareness and Education programs will certainly be helpful in poorer communities. A theme of Keeping a backup plan and a saving before delivering a baby should be promoted, as often people are unaware of the scenario that can arise.

Sunday, August 31, 2014

Pediatric OPD is a Challenge: Treating the Child and Meeting Parents expectations


Scenario


" A concerned mother brings her 3 yr child to the Outpatient Clinic, the child has had fever for 1 day, running nose and cough for 2 days. There are no other serious complains and findings on examination are all normal, except for running nose and low grade fever. A case of common cold that is very common in childhood.
The mother is really concerned about the child contracting a Pneumonia , well there were no symptoms as such and pediatrician counsels her on that, but she wants an antibiotic for safe-side. Doctor explains the condition and hazards of erroneous use of Antibiotics, she is convinced.

She is equally concerned about the cough. She has been giving the child Anti-tussive from Over-the-counter prescription that is pandemic in our country. Doctor advice her to stop the drug as current research does not recommend its use in below four years children. She is not convinced this time, in-spite of counselling"
In such a Scenario either doctor keeps trying to convince her, either he loses the follow-up or he has to go with the flow an prescribe Anti-tussives and Vitamins as the trend is in Private practice.




Pediatrics is a bit different subject to doctors in many sense. Specially in Pediatric out patient department or in private clinics, doctors will often find a mildly ill child but more skeptical parents who might constantly test you with their queries and doubts.
Pediatrics is different in that , not just treatment of the sick child is important but also meeting of the parents expectations, counselling them well and taking them in confidence. Often doctors meet lot of patient who are already on Antibiotics for Viral URTI , so the dilemma sets in- to continue or to stop the medication. The trend in the private practice is so wide-spread that antibiotics are prescribed for cases without any indications. The fault is not just in doctors here but in parents as well who often switch doctors when doctor prescribes less drugs. However it is what the nature of care-taker is, they always want to be on the safe side, while unknowingly they may be harming the child.

Erroneous and Erratic use of Antibiotics have led to Antibiotic resistance.There was a time when Penicillin was Jack of All, a shot of it could treat almost everything,today plain Penicillin rarely can treat any condition. These are the outcomes.

Meeting the Expectations of Parents-
What parents generally expect is that their child should be well with a day of treatment, which is rarely a possibility, because most antibiotics take at-least 24-48 hours to get working.  Counselling about the need and expected time of resolution can convince the parents to be more patient.
They want all their Queries fulfilled and all their doubt cleared. Because they are on behalf of a child patient who cannot express many things and they are guardian to such delicate human beings. Show then the empathy and that you care equally for the welfare of the child. Be patient and answer all the queries they have. Doctors should put themselves in the place of parents and try to fulfill their queries.

They may search for your qualifications and experience , face them confidently and without hesitations. Getting angry at it will not mask the thing, but will cause you to lose a rapport and trust.
They always want best among the pediatrician to treat the child, so they may test you with several questions, doctor must let them know that you are equally good and take them in confidence.
And last of all, ethically don't give up and prescribe medications to satisfy the parents, do it only when you know it is required. And the question is " Is this a possibility?"

I may not be totally right as I have a long journey to go, if you have a different opinion, I welcome your feedback.

Friday, August 29, 2014

What the child feels about Doctor ?


What child feels about Medical books and Medical Education



What child thinks about being Sick



What shocks the child most



How child feels when the doctor is on Leave



What child really hates



Some Parents are more Childish



Thursday, August 28, 2014

Pavilizumab Prophylaxis for RSV Bronchiolitis: Recommendation

Palivizumab is a humanized monoclonal antibody directed to an epitope in the A antigenic site of the F protein of RSV. It is a composite of primarily human antibody sequences (95%) and murine antibody sequences (5%). Palivizumab provides both neutralizing and fusion-inhibitory activity against RSV, resulting in inhibition of RSV replication. Although resistant RSV strains have been isolated in laboratory experiments, no resistant clinical isolates have been identified at this time.

Her are some updates- UPDATE on RSV prophylaxis



The updated policy recommends that RSV prophylaxis be considered in:
  • infants and children younger than 2 years of age who have required medical therapy for CLD within the 6 months prior to the start of RSV season; patients with severe CLD may benefit from prophylaxis with palivizumab through 2 RSV seasons
  • infants born at or prior to 32 weeks gestation
  • infants born between 32 and 35 weeks gestation with known risk factors, such as birth within 6 months of RSV season, child care attendance, school-age siblings, exposure to environmental pollutants, airway abnormalities, or severe neuromuscular disease
  • infants and children younger than 2 years of age with hemodynamically significant CHD, particularly patients with pulmonary hypertension or cyanotic heart disease, and those who require medication for congestive heart failure.
Source - AAP through Medscape 



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)


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.


References
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 

Monday, July 7, 2014

List of Thesis and Dissertation topics for Neonatology

List of thesis and dissertation topics for Pediatric MD and Neonatologist.

Miscellanous from Different colleges

  1. Neonatal Cord blood pH as indicator of Perinatal Asphyxia
  2. Plastic bag wrapping to prevent hypothermia in preterm babies- Randomized control trial
  3. Comparison of Neonatal cord blood and venous blood for screening of Early onset sepsis
  4. Use of Transcutaneous bilirubinometer in screening of jaundice in neonates in Nepal
  5. Serial CRP in guiding antiobiotic duration in neonatal sepsis.
  6. Single dose of Clofibrate in neonatal jaundice
  7. Weight growth in KMC vs non-KMC babies


From Rajiv Gandhi University- Visit RGU website for details-


Issue DateTitleAuthor(s)
2009A Clinical Study of Neonatal Sepsis in Term and Preterm Neonates with Special Reference to C-Reactive ProteinAshok, M V
2014Correlation between cord blood nucleated rbc's And outcome in early neonatal period in term small For date neonatesDilip Kumar.S
2011CRANIAL ULTRASOUND IN HIGH RISK NEONATESZaidi, Fauzia
2008Study Of Comparison Of Procalcitonin And C-Reactive Protein Concentrations As Early Marker Of Neonatal SepsisRajeev, D
2014To study the effectiveness of cord Blood albumin as a predictor of Neonatal jaundiceMurali s m
Sep-2006Assessment of Biochemical Abnormalities in Neonatal SeizuresMohammed Libab, K A
2009Outcome of neonates born to mothers with premature rupture of membranesReddy N, Chowda
May-2012Comparative study of cord blood lipid profile in term and preterm sga and aga neonatesEluri, Venkateshawara Reddy
2006Aetiological Profile, Clinical Course, Immediate Outcome And A Short Term Follow Up Study Of Babies With Neonatal ThrombocytopeniaKannan, B
2009Congenital Heart Disease In Neonates – Clinical Profile, Diagnosis, Immediate Outcome, And Short Term Follow Up StudyKuriakose, Vinod Jacob
2010A Study of Correlation of Foot Lenth and Gestational Maturity in NeonatesDeepa, S
2011Study of neonatal convulsions with special Reference to levels of magnesium and Incidence of hypomagnesemia in Hypocalcaemic neonatesRohini, Patil K
2011A comparative study of serum creatine kinase muscle-brain fraction (ck-mb) and lactate dehydrogenase (ldh) levels amongaphyxiated and non-asphyxiated term neonatesKrishna, Masaraddi Sanjay
2010Immediate outcome and a short term follow up study of neonates with neonatal thrombocytopeniaChakraborty, Amit
2010Neonatal PneumoniaSunitha, N
2010Role of procalcitonin in theDiwakar, Prasad B. M.
2005A Study Of Etiology, Onset And Clinical Manifestations Of Neonatal SeizuresUpadhya, Sripadh
Apr-2008Usefulness of CRP in Differentiating Infected From Uninfected Neonates Among Those At Risk of InfectionKalyan Rao, Cheeti Srinivas
2013Epidemilogical and clinicobacteriological study of neonatal sepsisJomily, U V
2010Surrogate Markers For Small For Gestational Age TermJaya, Joseph P.
2009Etiological Profile, Clinical Course, Immediate outcome and short team Follow upof Anemia In New BornHegade, Sudhakar
2012CEREBELLAR DIMENSIONS IN THE ASSESSMENT OF GESTATIONAL AGE IN NEONATESMascarenhas, Vanessa
2011“Faecal Calprotectin as a Marker of Gut inflammation in Preterm neonates Admitted to the Neonatal Intensive Care UnitT Shenoy, Mohan
Apr-2011Frequency and necessity of thyroid function tests in screening for congenital hypothyroidism in neonates in a rural medical collegeBabu M, Dilshad
Apr-2011Frequency And Necessity Of Thyroid Function Tests In Screening For Congenital Hypothyroidism In Neonates In A Rural Medical CollegeDilshad babu., M
2007Study of effect of fluid restriction on mortality & morbidity pattern in full term neonates with birth asphyxia.Haresh Babu, G A
2007Stusy of the relationship between gestational age, placental pathology and neonatal outcome in preterm birthsMurthy, Anjana K
2006Study of Clinical Presentation, Aetiological Profile, Immediate Outcome And Shrt Term Follow up Of Bleeding NeonatesVani, H N
2007Clinical study of birth asphyxia with hypoxic ischemic encephalopathyRajeswari M
2010Study Of Correlation Between Umbilical Artery Blood Gas Parameters And Neonatal OutcomePinto Merlin, Reshma
2013A study of renal parameters and serum calcium levels in birth asphyxiaJames, Daniel S
Sep-2005Clinical Study Of Neonatal Septicemia With Reference To Early Indicators Of SepsisJose, Santhosh
Mar-2011Clinical Study of Respiratory Distress in NewbornMohamad, Jassim
2008Correlation study of crp and blood culture in eavluation of neonatal sepsis.Kyadigeeri, Ravi
2010Incidence Of Acute Renal Failure In Birth Asphyxia And Its Correlation With Hypoxic Ischemic Encephalopathy (Hie) StagingGanavi, R
Apr-2010Comparison Of Clinical Assessment Of Nutritional Status Score With Other Methods In The Assessment Of Fetal MalnutritionChaitra, D
2006Prediction of significant neonatal hyperbilirubinemia in healthy term newborns using cord bilirubin and 24th hour serum bilirubinChawla, Gautam
2012Study of glucose levels in newborns with Specific reference to hypoglycaemia in and Around sullia.Gada, Sandeep
Apr-2010A study of brainstem evoked response audiometry changes in neonates with unconjugated hyperbilirubinemia before and after therapyNayak, Nayana
Mar-2006A Study Of Neonatal Polycythemia In J.S.S Hospital, MysoreMohan, B K
Sep-2006A Study On Validity Of C – Reactive Protein In Deciding The Duration Of Antibiotic Therapy In Suspected Neonatal Bacterial InfectionPrashanth, S
2011Role of oral probiotics in the prevention Of necrotizing enterocolitis In preterm neonatesPuthukkara, sheby
2011PREDICTIVE VALUE OF LABORATORY INVESTIGATIONS IN THE DIAGNOSIS OF PERINATAL ASPHYXIAC G, Shylaja
2006Evaluation Of Screening Of Neonatal SepsisKartik, R
2009Use Of Early Nasal Continuous Positive Airway Pressure In Preterm Neonates With Hyaline Membrane Disease (Neonatal Respiratory Distress Syndrome)Ahmad, Nazeer
2007Screening for retinopathy of prematurity one year hospital based prosective clinical studyAshoka H N
2011Correlation of cord blood bilirubin with neonatal hyperbilirubinemiaAhamed A, Habeeb
2010Do we need to redefine physiological jaundice?Xavier, Rose
2013“PREDICTION OF HIE BY NUCLEATED RBC’S IN CORD BLOOD, SERUM CREATINE KINASE AND ASSESMENT OF OUTCOME BY FOLLOW UP UPTO 6 MONTHSNIGAM, GAURAV
2012Study of urinary uric acid and creatinine ratio as a marker of nenonal asphyxiaShashidhara, Shetty Yuvaraja
2011Neonatal outcome in infant of diabetic mothersTarangini, D
2013CLINICAL STUDY OF PERINATAL ASPHYXIA IN TERM NEONATES WITH SPECIAL REFERENCE TO THE ROLE OF MAGNESIUM SULPHATE THERAPYRAJ PRAKASH
2012Study of electrolyte status glucose and uric acid levels in perinatal asphyxiaJayaprakash, K
Apr-2008Study of the complications in infants of diabetic mothersKavya
2011Universal hearing screening in newborn feasibility and referenceAnil Kumar, Y C
2011Effect of prophylactic theophylline to prevent the renal dysfunction in term newborns with perinatal asphyxia a randomized controlled studyAngappan, K
2012ROLE OF ERYTHROPOIETIN IN FULL TERM NEWBORNS WITH MODERATE HYPOXIC ISCHEMIC ENCEPHALOPATHYB, PRADEEP KUMAR
2011Cord blood bilirubin can be used As an early predictor of neonatal HyperbilirubinemiaBharath, A.P
2010Multiorgan Dysfunction In Neonates With Perinatal AsphyxiaDambalkar, Geetanjali
2010A clinical study of infants of diabetic mother with special reference to blood glucose levelsShashidhar, A
2012Study of cutaneous lesions during early neonatal Period in a rural teaching hospital and its socioclinical implications at m.v.j. Medical college and research hospital, HoskoteShilpa, C
2011A comparative study of calf circumference with other anthropometric measurements as a measure of low birth weightSunil Kumar, P
2012CORRELATION OF CORD BLOOD BILIRUBIN AND NEONATAL HYPERBILIRUBINEMIA IN NEWBORNS WITH A SETTING OF ABO INCOMPATIBILITYC H, SAJJAD SANEEQ
Sep-2006Retinopathy Of Prematurity – One Year Hospital Based Prospective Clinical StudyDinesh, N
2012COMPARATIVE STUDY OF NUCLEATED RED BLOOD CELLS IN CORD BLOOD OF NEONATES WITH MECONIUM STAINED AMNIOTIC FLUID AND CLEAR AMNIOTIC FLUIDS.M, Babu
Apr-2011Assessment of role of anemia in the development of retinopathy of prematurityMuttappa, Bistagond Shailashree
2013Study on the spectrum and predisposing factors for birth injuriesSuresh, Gundapalli
2013A clinical study on correlation of retinopathy of prematurity changes in preterm infants with respect to gestational ageSneha, R
2014Clinical study of perinatal Asphyxia and its outcome with Reference to nucleated rbc count In venous blood of term newborns Sujata s alawanialawani, Sujata s
2014The study of incidence and risk factors of Retinopathy of prematurity in a Government tertiary care centreprabhakaran, Deepthi k
2006Clinical study of birth injuries in the new born in a rural medical collegeKumar, Avinash
Sep-2009Evaluation of safety of magnesium of sulphate therapy in neonates with birth asphyxiaAhmed F K, Riyaz
2012A STUDY ON CLINICAL PROFILE OF MECONIUM ASPIRATION SYNDROME IN RELATION TO GESTATIONAL AGE AND BIRTH WEIGHT AND THEIR IMMEDIATE OUTCOMEKaur, Rupender
2012NUTRITIONAL ASSESS OF HIV INFECTED MOTHERSS, Hemalatha
2014Study of preterm babies with reference to maternal risk factors and their immediate outcome in a rural teaching hospitalLakshmi .S, Kavitha
2013A Study Of Hearing Evaluation For Neonates With Hyperbilirubinemia Using Otoacoustic Emission And Brain Stem Auditory Evoked ResponseManjunath, V C
Apr-2012Determinants of various anthropometric measurements of new born at birthLohitha, M N
2012Study of acute phase reactants in children with sepsis with special reference to serum crp procalcitonin and ferritinKumar, Vinaya
2006Randomised Control Study Of Umbilical Cord Care At Birth Using Different MethodsSqn Ldr (Dr) Multani, K S
Apr-2008Antenatal Ultrasonographic Predictions Of Gestational Age, Fetal Weight And Congenital Anomalies With Actual Immediate Post-Natal Clinical Outcomea Corroborative StudySandesh, Ganesh
2009Developmental Outcome Of Nicu Graduate Weighing Less Than 2500 Grams In A Tertiary Care HospitalSinha, Rahul
2012Surfactant therapy in meconium aspiration syndromeNanditha, G
2013RETINOPATHY OF PREMATURITY IN A TERTIARYCARE HOSPITAL: INCIDENCE AND RISK FACTORSREDDY, G. BHARATH
2014To study the effect of beta-2 agonist Salbutamol in the treatment of transient Tachypnea of the newbornReddy, Hemachandra
Mar-2006Spectrum Of Multi-Organ Systemic Involvement In Perinatal AsphyxiaKhan, Fazeelath Ali
2006A Prospective Observational Study On Proportion And Risk Factors Of Retinopathy Of Prematurity In Preterm BabiesLakshmipathy, S R
Mar-2005Study of pattern of lower respiratory tract infection in children below 12 years of age admitted to govt. General hospital, gulbargaChandrashekhar, Bilagundi
2006Randomised Controlled Trial Of Prophylactic Oral Erythromycin In Preventing Necrotising Enterocolitis And As A Prokinetic Agent In Preterm And Low Birth Weight InfantsNarayana Swamy, S
2010Serum Adenosine Deaminase Estimation After Bcg Vaccination As A Marker Of Cell Mediated Immunity And Its Correlation With Tuberculin Skin TestNaren Sandeep, D
2011A study of knowledge attitude and Practices of breastfeeding among mothers In sulliaKumar, Brajesh
2006Clinical Profile Of Congenital Heart Disease In Children With Special Reference To Echo CorrelationHyder, Abbas
2006Relationship Of Anthropometric Parameters Of Newborn With Varying Period Of Gestational AgeNarendra, K S
2009Comparison Of Maternal Serum And Neonatal Cord Blood Levels Of Zinc In Relation To Birth Weight And Period Of GestationVinayak, M
2013STUDY OF THE CLINICAL SPECTRUM OF CEREBRAL PALSY WITH REFERENCE TO ETIOLOGIESK H, ANIL KUMAR
2011Study On The Clinical Profile Of Patients With Cerebral PalsyMallick, Swagata

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