NEO/1 (P) CARE OF NEWBORN IN SLUM AREAS OF JAMMURitu Gupta, Ravinder K Gupta136 Nai Basti Child Care Clinic, Jammu Cantt. J&K- 180003Email: riturgjammu@indiatimes.com

Background: Despite efforts by government and other agencies, neonatal morbidity and mortality continues to be high in India. Among other reasons, newborn care practices are major contributors for such high rates. AIMS: To find out the newborn care practices including delivery practices, immediate care given after birth and breast-feeding practices in slums of Jammu. Settings And Design: Community based, cross-sectional observational study conducted at Child Care Clinic, Nai Basti Jammu Cantt. Study Period: March 2011 to September 2011. Materials And Methods: About 100 mothers belonging to migrant labor population were considered for the study. A semi-structured, pre-tested schedule was used to interview these 100 mothers of newborns in the study area. Results: About 80% newborns were born at homes , which were mostly conducted by local dais and relatives, while rest deliveries were conducted at government institutions(16) and private nursing homes(4). Bathing the baby immediately after birth was commonly practiced in 62 (77.5%) of home deliveries. The nose and oral cavity in babies delivered at home were cleaned by finger by 54(67.4 %) while cotton swap was used in 34(42.5%) babies for cleaning. A new shaving blade in 36 (45%), knife in 28(35%), old blade in 11(13.7%) and surgical blade in rest of newborns were used to cut the umbilical cord in babies born at home. About 63 (79.8%) of home delivered newborns were not weighed at birth. Rooming in was practiced in majority of the cases. A few of home delivered neonates (12) were given injection tetanus toxoid by unqualified practitioners. Injection Vitamin K was also given to 10 home delivered newborns .Use of clip, band or sterile thread to tie the cord and no application to the cord was seen significantly higher in institutional deliveries. Honey (79%), rose water (13%), water from sacred areas (11%), glucose water (6%), etc. were used as pre lacteal feeds by these mothers. Breast feeding was initiated within 4 hours by about 20% mothers who had delivered at home as compared to 75 % in institutional deliveries. Breast milk as the first feed was significantly more in institutional deliveries. Conclusions: There is an urgent need to reorient health care providers and to educate mothers on clean delivery practices and early neonatal care in slum areas.

NEO/2 (P) EFFECT OF LACTATIONAL TRAINING ON THE WEIGHT PATTERN IN THE NEONATAL PERIODNoella Maria Delia Pereira, Rahul Verma, Nandkishor Kabra Torrefiel, 127, Carter road, opposite Joggers Park, Bandra -west, Mumbai - 400050Email: noella_pereira@yahoo.com

Introduction: Successful breastfeeding during the first few hours to days after delivery is known to be important in securing effective, long, term lactation. It has not been clearly ascertained whether lactational training pre or post partum has any effect on the weight pattern in the neonatal period. Materials & Methods: We assigned 357 mother – infant pairs with gestational ages from 37 – 42 weeks and birth weights more than 2000 grams to receive lactational counseling or no counseling after birth and till discharge from the hospital. The weights of these babies were recorded on Day 1, 3, 7, 14, and 28 and the weight gain from birth to Day 28 of life in both groups were compared. Results: Of the 357

mother – infant pairs, 137 were assigned to the intervention group and lactational counseling was given to these mothers and 128 were assigned to the control group where the usual verbal encouragement was given from the maternity staff. The average weight gain in the neonatal period in the intervention group was 748+/- 349 grams as compared to a weight gain of 649 +/- 398 grams in the control group which is statistically significant (p<0.05). The weight gain per day in the neonatal period in the intervention group was 26.7+/- 12.5 grams per day as compared to a weight gain of 23.3+/-14.2 grams per day in the control group which is significant (p<0.05). The weight gain in grams/kg/day was 9.25+/-4.45 in the intervention group as compared to 8.01+/-5.12 in the control which is significant (p<0.05). Conclusions: This study demonstrates that even postnatal lactational training helps increase the weight gain in infants in the neonatal period. It further hurts that a combination of antenatal and postnatal interaction would bring about a maximal weight gain.

NEO/3 (P) HEALTHY NEWBORN- ASHA WILL BE A REAL ASHA – HOPE Amrit Lal BairwaProfessor & Head, Ped,NMCH, Ashirwad,90-B, Bajrang Nagar,Main Road, Opposite Koushal School, Police Line,Kota-324001 (Raj.)Email: amritbairwa@yahoo.co.in

Globally, 9.7 million children dying every year, about 3.6 million of them during the neonatal period (WHO mortality database). more than two thirds of these neonatal deaths occur in the first week of life.India's Infant Mortality Rate (IMR) remains unbearably high at 58 per 1,000 live births (SRS 2004)with 64%Neonatal Deaths.It is well known fact that majority of neonatal deaths can be prevented with low-technology, low-cost but timely interventions. Lack of specificity of the clinical manifestations of various neonatal morbidities causes difficulty in definite diagnosis, delay in seeking care and resultant high mortality. the Integrated Management of Neonatal and Childhood Illnesses (IMNCI) approach has attempted to provide a standard case definition of various neonatal morbidities, IMNCI approach can be used as an effective tool to screen the high risk and critically ill Newborn. Only Screened Newborns will be seen by the Pediatrician and with effective and timely interventions, Neonatal Mortality can be prevented significantly. About 279 Health Workers (ANMs-82,ASHA-194,LS-3) were evaluated with a set of questionnaires during 11 Training Programs for IMNCI in Kota, Bundi, Jhalawar, Baran & Tonk. All the workers did well. Untrained ASHAs performance was equivocal with the Trained ANMs & LS etc. Surprisingly 5th standard ASHAs also did Well. Level of basic qualification does not affect significantly, only attitude & Interest of Health Worker plays important role. Study concludes that Interested 8th standard Untrained persons after a short (8-10days) training with IMNCI may be used as key person, to screen the Newborns.

NEO/4 (P) INFLUENCE OF GROWTH ON GLYCEMIC STATUS AND INSULIN RESISTANCE AT NINE MONTHS OF AGE IN LBW AND VLBW BABIES Rakesh Jora, Mukesh Gupta, Pramod Sharma, Pradeep Gupta3- Shakti Nagar, 1st Lane, Paota C Road, Paota. Jodhpur (RAJASTHAN), INDIA Email: jorarakesh@gmail.com

Abstract-: Background-: To evaluate the influence of growth on Glycemic status and insulin resistance up to 9 months of age in LBW & VLBW babies. We compared these parameters with normal birth weight babies and these babies served as controls. Methods-: 100 successive low birth weight, (birth weight between 1000-2499 gms) were successively enrolled in the study and 50 neonates with birth weight >2.5 kg included as controls. Of the150 enrolled babies only 101 babies could be followed till 9 months of age (in NBW group-36, in LBW group -35, in VLBW group-30 were followed up to nine months of age). At the time of enrolment anthropometry and routine blood investigation and fasting blood sugar level of neonates (after 2-4 hours fasting) was performed. After discharge, enrolled babies were followed every 3 monthly (+10 days) up to 9 months of age on each follow up anthropometry assessment and fasting blood sugar of neonates (after 2-4 hours fasting) was done. At the age of 9 months venous blood was taken for serum insulin levels (after 2-4 hours fasting). Statistical analyses were performed using t-test. Results-: Mean plasma Glucose and pondral index were at enrolment in NBW babies was higher than LBW and VLBW babies and mean P.Glucose levels at 9 month was higher in VLBW followed by LBW than in NBW (P value<0.01). Maximum S. Insulin level at 9 month found in VLBW babies followed by followed by LBW and NBW but statistically significant in LBW and VLBW in comparison to NBW. Maximum IRI at 9 month occurred in VLBW babies followed by LBW and NBW. When we compared weight gain at 9 month of age in three group these had been maximum weight gain in VLBW babies followed by LBW &NBW. Conclusion-: Low birth weight is an independent risk factor for insulin resistance and this can lead to deleterious effect in their later life in the form of development of diabetes, hypertension, coronary heart disease. Key Words-: Insulin resistance, Plasma Glucose, LBW&VLBW babies

NEO/5 (P) TO STUDY THE EFFECT OF HUMAN MILK FORTIFIER (HMF) IN PRETERM BABIES LESS THAN 1200GM Ajoy Kumar SarmaOil India Hospital AssamEmail: ajoy4781@rediffmail.com

Objective: To study the effect of human milk fortifier on growth in preterm babies less that 1200gm. Materials & methods: Neonate with birth weight <1200gm, gestation less than 30 wks at enrolment. Eligible neonates were randomized to one of the two groups a) only EBM by gavages or spoon feeding b) EBM along with one sachet HMF dally. Weight recorded daily, length and head circumference was measured in the two groups at seven days interval. Outcome variables: primary: weight gain at twenty eight days after enrolment. Result at observation: A total of forty eight neonates were randomized to either group a (n=25) or group b(n-23) mean (SD) weight of the babies in two group are ±266.8 grams in EBM with HMF group and ±229.9gram in only EBM group. At 28 Days weight gain in EBM with HMF group (476.76±49.9gram) was higher compared to only EBM group (334.96±46.4gm) (p<0.05) At seven days less weight loss (7.80±9.8gm) was observed in babies with EBM with HMF group compared to only EBM (21, 52±19.4gm) (p=00.3) Conclusion: EBM with HMF supplementation is a potential to improve weight gain in ELBW babies and cause less weight loss in first seven days in ELBW neonates

NEO/6 (P) UMBILICAL CORD BLOOD TSH- A PREDICTOR OF CONGENITAL HYPOTHYROIDISM

Joseph JohnAssociate Professor, Department of Pediatrics, Sree Narayana Institute of Medical Sciences, Chalakka, North Kuthiyathodu P.O. Ernakulam District 683 594 KeralaEmail: drjj@rediffmail.com

Newborn screening is the most modern public health preventive screening program involving the population at large. Congenital hypothyroidism (CH) is one of the most common causes of preventable mental retardation in children. Incidence reports in India varies from 1:2500 - 2800 to 2.1:1000 live births. Cord TSH is used as a screening tool for patients being discharged early from hospital after delivery. The objective of this study was to study the cord TSH values in newborns delivered at the Sree Narayana Institute of Medical Sciences, Chalakka, Ernakulam as an ICMR STS study. Cord blood was sent for biochemical testing for TSH during the study period. Out of the 113 samples tested 79 (69.9%) were included and 34 (30.1%) had to be excluded as they did not meet the inclusion criteria set. Of the 79 samples included 37 (46.8%) were males and 42 (53.2%) were females. The mean TSH value obtained was 9.47 µU/L (SD 6.37) with a range from 2.24 to 41.32 µU/L. The mean TSH amongst males was 9.05 µU/L (SD 5.42) and that amongst females was 9.06 µU/L (SD 5.20). Of the 79 samples tested 57 (72.2%) were in the normal range (< 10 µU/L) 21 (26.6%) were in the indeterminate range (10 - 40 µU/L) and 1 (1.2%) sample was in the hypothyroid range (>40 µU/L). Screening for CH needs to be a national programme. The financial implications can be reduced by raising the cut off values or at least the high risk newborns should be screened.

NEO/7 (P) ASSESSMENT OF MORTALITY IN NEONATAL SEPTICAEMIA USING SCORE FORNEONATAL ACUTE PHYSIOLOGY-II (SNAP-II)Vinayak Deshmukh, Shreesh V Deshmukh, Sanjay Joshi, Jagdish PakhareBehind Hambarde's House, Raut Wadi Akola- 444001, MaharashtraEmail: coolshreesh@gmail.com

Introduction: -Septicaemia is a leading cause of death in India neonates. Application of severity scores may be useful for prognostication and evaluation of the effectiveness of therapeutic protocols in the Neonatal Intensive Care Unit. Score for Neonatal Acute Physiology-II and its Perinatal Extension is a physiology based score that uses 6 routinely available vital signs and laboratory tests and 3 perinatal characteristics for prediction of neonatal mortality. Aims & Objectives: -To check the sensitivity and specificity of SNAP-II score in predicting mortality in neonatal septicaemia. Materials and Methods: -Prospective cohort type study, undertaken in a level-III NICU in Northern Maharashtra.Neonates with septicaemia were eligible for enrolment. SNAP-II was applied within 24 hrs. of onset of sepsis. Neonates with major congenital malformations and severe birth asphyxia were excluded from the study. Neonates were followed until death or up-to 14 days from enrolment. Results: -Total 100 neonates were included in the study of which 26 died within 14 days. The median SNAP-II and SNAPPE-II scores were significantly higher in babies who died(50 & 56) as compared to those who survived (24 & 38) i.e. p<0.001.A SNAP-II >40 had 93.5% specificity and 69.6% sensitivity and 76.2% positive predictive value.The area under ROC curve was 0.895 for SNAP-II and 0.832 for SNAPPE-II in predicting mortality. When the individual SNAP-II parameters were analysed, it was found that parameters related to perfusion [parameter (ROC): MAP (0.677), acidosis (0.655), hypoxia (0.653) and oliguria (0.706)] were significantly associated with death. Conclusion: -High SNAP-

II and SNAPPE-II scores (>40 and >54) has great sensitivity and specificity for predicting mortality in neonatal septicaemia. Individual SNAP-II parameters do not contribute equally in prediction of mortality.

NEO/8 (P) EFFECTS OF MATERNAL ANEMIA ON NEONATAL OUTCOMESadique MA, Venkatnarayan K, Thapar RKDepartment of Pediatrics, Command Hospital (Eastern Command), Alipore Road, Kolkata-27E mail: rajeevrenuthapar@gmail.com

Background: Anemia is a common problem in resource poor countries. The extent to which maternal anemia affects neonates is largely debatable, though a review of twenty randomized control trials has found no significant association on fetal outcomes with iron supplementation in anemic mothers. Besides, in some Indian studies, higher maternal Hb levels were correlated with better Apgar scores and lower risk of birth asphyxia. Objective: To study the severity of anemia in mothers admitted for delivery and correlate it with hemoglobin status, Apgar scores, anthropometry and period of gestation of neonates born to them. Methods: Design: Prospective Cohort study; Setting: Level-2 neonatal unit in a tertiary care hospital; Duration: Jan 2011 to June 2012; Subjects: Mothers admitted consecutively for delivery were screened for anemia (Hemoglobin (Hb) < 11 mg %) (n=100) or no anemia (Hb > 11mg %) (n=110).The following were the exclusion criteria for mothers: History of any chronic systemic illness; obstetrical complications such as pre eclampsia, eclampsia, ante partum hemorrhage, premature rupture of membranes, diabetes; past history of any major abdominal operations, history of chronic medications and twin pregnancies. The following babies were excluded: Gross congenital malformations, congenital heart disease, hydrops fetalis and circulatory insufficiency. The hemoglobin (Hb) estimations were done by cyanmeth-hemoglobin method in both the groups. Anemia in mothers (Hb<11 mg %) were classified as mild (Hb: 9.9-10.9 mg %), moderate (Hb: 7-9.9 mg %) or severe (Hb<7mg %). For the outcome parameters in neonates, Gestational assessment was done using Expanded New Ballard Score within 24h of delivery; Apgar scores were assigned at 1,5 and 10 minutes of life and anthropometric evaluations were done for birth weight, length, mid arm circumference (MAC) and occipitofrontal circumference(OFC) using standardized tools to the nearest possible accuracy. Results: Of the 100 anemic mothers studied, 63 had mild anemia and 37 had moderate anemia. There were no mothers with severe anemia. On comparing with the mothers with no anemia (Gp I), with those with mild (Gp II) and moderate anemia (Gp III), there were no significant differences in cord Hb (15.2±1.71 gm% (Gp I); 14.8±1.9 gm% (Gp II); 15.5±2 gm% (Gp III); p=0.19). Neither were there any differences in the three respective groups in terms of period of gestations at birth (38 wks (Gp I); 37wks+5days (Gp II); 37wks+4days (Gp III); p= 0.31) or the Apgar scores at 1,5 and 10 minutes (p=0.53, p=0.1 and p=0.16, respectively). The anthropometric parameters were also comparable between the three groups [(Birth weight= 2.83±0.47 Kg (Gp I); 2.89±0.53 Kg (Gp II); 2.69±0.61 Kg (Gp III); p=0.17); (Length= 48.74±2.1 cm (Gp I); 48.79±2.72 cm (Gp II); 48.42±2.79 cm (Gp III); p=0.74); (OFC= 33.63±1.69 cm (Gp I); 33.93±1.81 (Gp II); 33.56±2.31 cm (Gp III); P=0.52); (MAC= 9.86±1.1 cm (Gp I); 9.93±1.26 cm (Gp II); 9.74±1.29 cm (Gp III); p=0.72)]. Conclusion: Mild and moderate anemia in mothers has no significant bearing on neonatal outcomes in terms of cord hemoglobin, Apgar scores, period of gestation or anthropometric parameters. Lack of severe anemia in mothers in our setting was probably due to the healthy

population encountered in our set up. The effect of severe anemia in mother on neonatal outcome needs to be looked in further studies. Key words: Anemia, Maternal, Neonate

NEO/9 (P) NEONATAL SEPSIS: A PROFILE OF A CHANGING SPECTRUMBej PK, Kannan Venkatnarayan, Thapar RKDepartment of Pediatrics, Command Hospital (Eastern Command), Alipore Road, Kolkata- 700027E-mail: rajeevrenuthapar@gmail.com

Abstract: Background: The clinical syndromes of sepsis in neonates are protean. Most of the cases are identified based on the clinical manifestations presenting in early (<72h) or late (>72h) neonatal period [Early Onset Neonatal Sepsis (EONS) and Late Onset Neonatal Sepsis (LONS), respectively]. The bacteriological spectrum along with its relevant lab parameters have not been extensively studied in our setting. Objective: To describe the demographical, bacteriological and laboratory profile of neonates presenting with clinically suspected sepsis based on pre-defined clinical criteria. Methods: Design: Cross-Sectional Study; Setting: Level-2 NICU, Tertiary Care Hospital; Duration: Jan 2011 to Jul 2012. Subjects: 50 consecutive neonates presenting with any of the following symptoms: Refusal to suck, Convulsions, Low/high temp, Diarrhea, vomiting, abdominal distension, Rapid breathing, Superficial infections e.g. umbilical sepsis, pyoderma were included for study and were also assessed for presence of maternal risk factors (PROM>18 hours, foul smelling liquor, maternal fever in 14 days, confirmed maternal urinary tract infection, repeated PV examinations). The following were excluded: Severe Birth Asphyxia, Major Congenital malformations, Respiratory distress caused by pneumothorax, hyaline membrane disease. The included subjects were studied from with respect to: Gestational age, septic screen, classification of sepsis (clinical sepsis, screen positive sepsis, culture positive sepsis); outcomes (Response to first line antibiotic, requirement of inotropes, death); and the type and antibiotic sensitivity of the organisms cultured. Results: Out of the fifty neonates, 38 (76%) were early onset sepsis and of these 11 (29%) were culture positive and 10 were positive only on septic screen (26.3%). Of the 12 (24%) babies presenting with late onset sepsis, 4 (33.3%) were culture positive and 6 (50%) were positive on septic screen. The sepsis screen showed an overall sensitivity of 73%, specificity of 54%; with a positive predictive value of 41% and a negative predictive value of 83%. Of the organisms cultured, the most common organism was Staphylococcus aureus (7 (46.6%)), followed by E Coli (3 (20%)), Pseudomonas (2(13.3%)), Coagulase Negative Staphylococcus (2(13.3%)), Group B Streptococcus (1(6.6%)). GBS and Pseudomonas were cultured only in EOS and the rest of the organisms were found with equal preponderance and distribution between EOS and LOS. Amongst the Gram-positive organisms, Ampicillin fared better than Cefotaxime for all the organisms and all of them were sensitive to Vancomycin. Amongst the Gram-negative organisms, Amikacin fared better than Gentamicin. All the pseudomonas cultures were sensitive to Piperacillin-Tazobactum. Our first line antibiotics were Cefotaxime and Amikacin. In case of requirement of upgradtion, Vancomycin/ Piperacillin-Tazobactum are used. Overall, 37 (74%) responded to first line antibiotics and 11 (22%) required a change of antibiotics. 1 (2%) required addition of inotropes and 2 (4%) of the neonates died. Conclusion: Taking blood culture as gold standard, a clinical diagnosis of sepsis based on predefined clinical criteria along with maternal risk factors, over- treated 27 babies (71%) with EONS and 8 babies (66.6%) with LONS. However, such a clinical diagnosis was supported by a septic screen almost twice as frequently (50% Vs 26.3%) in LONS as compared

with EONS. Staphylococcus aureus was the most common organism isolated in both EONS and LONS. Based on the antibiotic sensitivity pattern, it seems prudent to change the first line of antibiotics to Ampicillin and Amikacin, in our setting.

NEO/10 (P) HOW DOES PREPREGNANCY WEIGHT OF MOTHERS AFFECT THE BIRTH WEIGHT OF NEWBORNS–AN ANALYSISDevendra Sareen, Anuradha Sanadhya, Srishti Sareen, Abhishek Ojha, D.R.Dabi, Nitesh Kumar, Ramesh KumawatProfessor and Unit Head, Dept. of Pediatrics, 27-F, New Fatehpura, Udaipur (Raj.)Email: drsareen@yahoo.com

Summary: - Introduction: Intrauterine growth retardation is multifactorial in etiology. Maternal malnutrition is a very important cause of growth retardation in newborn babies. Amongs various parameters of maternal nutrition, height of mothers, pre pregnancy weight of mothers, mid arm circumference of mothers and Body mass index of mothers are important parameters. These parameters are viewed as predictors of LBW to be used for risk detection and intervention targeting. Aims and objectives- The present study was undertaken to study the effect of pre pregnancy weight of mothers on birth weight of babies. Material and method- The study was a case control study. Study group consisted of 50 mothers of TSGA neonates. Controls were mothers of TAGA newborns. Pre pregnancy weight of mothers was noted from Antenatal record or based on memory of patient if she is intelligent enough . Data for each variable were obtained and compared with each other. Result- Our study revealed that 30% of women in study group and none in control group were having pre pregnancy weight less than 40 kgs which is very low, while weight between 40-45 kg was seen in 52%of study mothers and 48%of controls. Normal weight (45 kg and above) was seen in18%cases and 52%controls was present in 60% of study group and 52% of controls. Mean pre pregnancy weight was 40.94+-3.34 kgs sn46.86+-4.61 kgs respectively, which was highly significant.(p<0.001). Conclusion- Nutritional status of mothers is important determinant of birth weight of babies. As the pre pregnancy weight of the mother increases, the birth weight of the newborn delivered increases correspondingly.

NEO/11 (P) CORELATION BETWEEN BIRTH WEIGHT OF THE NEWBORN AND MID ARM CIRCUMFERENCE OF THE MOTHER : A STUDY FROM UDAIPUR DISTRICTDevendra Sareen, Anuradha Sanadhya, Nitin Goyal, Abhishek Ojha, D.R.Dabi, Nitesh Kumar, Harikishan MangalProfessor and Unit Head, Dept. of Pediatrics, 27-F, New Fatehpura, Udaipur (Raj.)Email: drsareen@yahoo.com

Summary: - Introduction: Maternal malnutrition is a very important cause of growth retardation in newborn babies. Among various parameters of maternal nutrition, height, weight ,Body mass index , Mid arm circumference of the mother are very important. They are viewed as predictor of LBW newborns. Aims and objectives- The present study was undertaken to study the effect of Mid arm circumference of mothers on birth weight of newborn delivered. Material and method- The study was a case control study. Study group consisted of 50 mothers of TSGA newborns. Controls were mothers of TAGA newborns. Mid arm circumference of mothers was noted by nonstrechable tape from midway between tip of acromion process and olecranon fossa. Data for

each variable were obtained and compared with each other. Result- Our study revealed that 64% of women in study group and 12% in control group were having mid arm circumference less than 20cms. 36%of mothers in study group and 78% in controls were having mid arm circumference between 21 -24 cm . Mean MAC in both groups was 20.06±1.33cms and 22.34± 1.62cms respectively, which was highly significant(p value <0.001). Conclusion- Mid arm circumference of mothers is important determinant of birth weight of their newborn babies. Besides having predictor of maternal undernutrition it also indicates maternal obesity which is not relevant in our study.

NEO/12 (P) ADVERSE DRUG REACTIONS ASSOCIATED WITH CIPROFLOXACIN IN NEONATESVigil James, N Thomas, Sridhar S, Binu Govind, Manish Kumar, Binu Susan, Manvizhi, Jana AK, K. Anil Kuruvilla Departments of Neonatology & Clinical Pharmacology, CMC, Vellore Email: anilkdj@hotmail.com

Introduction: Ciprofloxacin is used in many nurseries in developing countries. Data on drug concentrations and side effects of ciprofloxacin in neonates is limited. Aims: To study adverse drug reactions (ADR) associated with ciprofloxacin in term and preterm neonates and correlate them with drug levels. Methods: Babies of 3 gestational age(GA) groups were enrolled: 37 (gp1), 32-36 (gp2) and 28-31(gp3) weeks. Ciprofloxacin was administered twice daily at 10mg/kg/dose IV. Lab parameters were done at baseline, day 3 and day 7, including peak and trough drug levels. Using Naranjo algorithm, babies who developed new symptoms after starting ciprofloxacin were classified into definite, probable, possible or doubtful ADR. Drug levels were correlated with ADR. Results: 165 babies receiving ciprofloxacin were enrolled. Predominant ADR were jaundice (79%), rash(23%), hyponatremia(28%), anaemia(15%) and hypokalemia(5%). Using Naranjo algorithm, Probable ADR were cardiac arrhythmia, mucosal ulceration, renal failure and seizures. Possible ADR were rash, elevated liver enzymes, feed intolerance and leucopenia. ADRs were self-limited and treatable. The mean (SD) trough and peak values of ciprofloxacin for the entire study population was 3.57(1.88) and 11.67 (3.66), respectively. Mean (SD) trough drug levels were gp 1 – 2.84 (1.54), gp 2 – 3.80 (1.9), gp 3 – 4.06 (1.98). GA did not seem to play a significant role in pharmacokinetics. Drug levels higher than mean were seen in babies with rash, leucopenia and elevated LFT. Levels were adequate in babies with HIE, high in babies with NEC and lower in those with RDS. Conclusions: Ciprofloxacin can be considered safe for treating newborn infants.

NEO/13 (P) FAMILIAL HYPERTRIGLYCERIDEMIA IN NEONATEAjoy Garg, YK Kiran, Kirandeep SodhiDepartment of Pediatrics, 7Air Force Hospital, KanpurEmail: ajay4248@gmail.com

Case Report: 20 days neonate a product of non-consanguineous marriage admitted with h/o fever, not feeding well, vomiting and lethargic. On examination HR 176/min, RR 64/min, temp 100 F, SPO2 98%, CFT <3sec, wt 3.8kg, pallor +ve, abdomen was distended with hepatosplenomegaly. On investigation Hb 8.6gm%, TLC 4000, Neutrophil 33%, lymphocyte 62%, platelet 1lac, CRP 60 and PBS S/O sepsis, CXR and Transcranial USG were WNL. Baby

was started on broad spectrum antibiotic. After 48hrs of antibiotic, child responded partially but still fever persisting. PBS for MP was positive for plasmodium Vivax. Baby managed with chloroquine. Incidentally the blood sample in plain sterile vacutainer found to be chylous. On investigation cholesterol 202 mg/dl, Triglycerides 1588 mg/dl, HDL 30.46 mg/dl, LDL 97.75 mg/dl, VLDL 73.79 mg/dL, Chylomicron nil , thyroid profile , BSL , S. Amylase were wnl. USG abdomen was s/o of hepatosplenomegaly with no feature s/o pancreatitis. There were no eruptive xanthomas, fundus examination was normal. No family history of dyslipidaemia but Lipid profiles of mother showed increase in triglyceride level .Child was diagnosed as a case of familial hypertriglyceridaemia (FHTG). Baby was managed with low fat milk, Vit ADEK, carnitine supplement and MCT oil. On follow up, baby is thriving well and lipid profiles were within normal limit. Familial hypertriglyceridemia is an autosomal dominant condition occurring in approximately 1% of the population .Familial hypertriglyceridaemia in a neonate is very rare genetic dyslipidaemia .It was incidentally detected in our neonate admitted for late onset neonatal sepsis and malaria and was treated with dietary management. Drug therapy is rarely warranted.

NEO/14 (P) OSTEOARTICULAR INFECTIONS IN NEONATES: A CASE SERIESTamhankar Priti, Malik Sushma, Warke Charusheela, Saboo Ashwin, Shah VivekDivision of Neonatology, Department of Pediatrics, T.N.Medical College & B.Y.L Nair Hospital, Mumbai-8Email- pri13@hotmail.com

Introduction: Osteoarticular infections in neonates are relatively rare but serious infections associated with considerable morbidity and mortality. Acute osteomyelitis (AO) and septic arthritis (SA) in neonates differ from that in older children and often pose diagnostic and therapeutic challenge. Early diagnosis and timely treatment are important to prevent subsequent skeletal deformity and long term sequelae. Materials and Methods: Seven neonates with osteoarticular infection were included in this retrospective study based on a review of cases of osteomyelitis and septic arthritis over a period of one and a half years. Their clinical profile, presenting symptoms, predisposing factors, radiological findings and management were analyzed. Setting-Tertiary care neonatal unit. Results: Amongst our seven cases of AO & SA there were five males and two females. All patients were full term babies and were symptomatic after 1st week of life. Four neonates had antecedent risk factors like previous NICU stay, septicaemia, birth asphyxia and prolonged mechanical ventilation. In three neonates there was significant maternal predisposing factors like ante partum fever, urinary tract infection and one case was a HIV seropositive mother on ART. Presenting features included fever, refusal of feeds, paucity of movements of the involved limb and swelling. Local examination in majority revealed swelling, redness and tenderness at involved site with decreased movement of the affected limb. In our series 3 neonates had OM of humerus, 3 had femur and one case had tibial bone involvement and six patients also had additionally septic arthritis. Besides complete blood counts, blood culture and aspirate cultures, radiography of involved bone/ joint, bone scan and / or CT scan/MRI scans in these patients helped in arriving at the diagnosis. Our subjects were all started on broad spectrum antibiotics and two neonates required surgical intervention. All patients recovered from the acute infection and were discharged. Conclusion: A high index of suspicion is necessary to make an early diagnosis and prompt institution of therapy is crucial to prevent permanent sequelae.

NEO/15 (P) VALIDATING THE AGREEMENT BETWEEN NEWER INFRARED FOREHEAD THERMOMETRY WITH AXILLARY DIGITAL THERMOMETRY IN NEONATESAR Sethi, AS Nimbalkar, DV Patel, AG Phatak, SM NimbalkarNeonatal Unit, Pramukhswami Medical College, Karamsad-Anand-GujaratEmail: somu_somu@yahoo.com

Background: The traditional mercury thermometer has been replaced by the more “user friendly” digital thermometer. As accuracy is comparable with both instruments and mercury remains an environmental hazard they are no longer recommended. New non invasive method of measuring temperature may reduce infection rate as well as intangible pain and suffering of neonate. Methods: The body temperature of patients admitted in Neonatal Intensive Care Unit was measured using axillary digital thermometer as well as a handheld infrared non touch thermometer. Patients placed under radiant warmers were included. Temperature recordings were taken as required routinely for clinical care. Axillary temperature was recorded within 30 seconds and the forehead temperature within 5 seconds. Results: The body temperature measured by Axillary digital thermometer and forehead method do not agree well (95% limits of agreement: -4.2, 2.2). A trend was observed suggesting that agreement depends on the magnitude of the temperature. The agreement slightly improved when patients in warmer were excluded (95% limits of agreement: -4.1, 2.1) with similar trend. The best possible agreement was observed between warmer and axillary temperature but was not clinically acceptable (95% limits of agreement: -0.99, 2.36). Conclusion: Forehead temperature due to the non touch may appear less disturbing to the neonate and also time saving for the nurse but they are misleading. The infrared technology needs further improvement before it can be used in our setting. Although advent of technology is tempting, a scientific validation of new technology under different settings is caveat before adapting it. Keywords: Infrared Thermometry, Digital Thermometry, Forehead, Axillary, Neonates

NEO/16 (P) TRACHEAL AGENESIS WITH TRACHEO-ESOPHAGEAL FISTULASM Nimbalkar, VK Patel, DV Patel, AR SethiNeonatal Unit, Pramukhswami Medical College, Karamsad-Anand-Gujarat Email: somu_somu@yahoo.com

Background: Tracheal agenesis (TA) is a rare congenital defect that presents with respiratory distress soon after birth. Patient: A 1500 gm preterm (32 weeks maturity) female was born by caesarean section to 30 years old fourth gravida mother who had a pregnancy complicated by polyhydramnios. Apgar score was 3 and 5 at 1 and 5 minutes respectively. On performing endotracheal intubation, larynx was visualized clearly up to vocal cord but 3 mm diameter endotracheal tube did not pass beyond the glottis on repeated attempts. PPV by bag and mask ventilation with 100% oxygen was continued with minimum chest expansion and poor air entry over both sides of chest. We passed feeding tube in to the stomach without encountering any difficulty. The baby died at the age of 6 hours. Histopathologic postmortem showed obstructed laryngeal end due to anomalous cricoids cartilage. The part of trachea was absent with short distal trachea communicating to esophagus via tracheo-esophageal fistula. The esophagus showed an elevated opening on the anterior wall which was communicating with the trachea. A

case of abnormal cricoids cartilage with absent upper segment of trachea (tracheal agenesis) and a distal tracheo-esophageal fistula. Comment: Tracheal agenesis should be suspected in newborn with history of polyhydramnios, respiratory distress, and absence of audible cry at birth and failure to intubate beyond the vocal cord. The surgical management of neonates with tracheal agenesis is difficult. Tracheal agenesis is a rare congenital anomaly which should be considered when intubation of a newborn baby is difficult. Keywords: Trachea, Fistula, Esophageal congenital anomalies

NEO/17 (P) KNOWLEDGE AND ATTITUDE REGARDING NEONATAL PAIN AMONGST THE NURSING STAFF OF PEDIATRIC DEPARTMENT AS Nimbalkar, AR Dongara, AG Phatak, SM NimbalkarNeonatal Unit, Pramukhswami Medical College, Karamsad-Anand-GujaratEmail: somu_somu@yahoo.com

Introduction: Neonates receiving care in intensive units are highly likely to experience pain due to investigations or treatments carried out by the health care providers. Unaddressed and mismanaged pain can not only affect the child’s comfort, but may also alter the development, and cognitive abilities of the child in later part of his life. Aim: To assess and compare the knowledge, and attitude regarding neonatal pain amongst the Nurses posted in the various units of pediatric department. Materials and Methodology: An appropriately modified “Knowledge and Attitudes Survey Regarding Pain” questionnaire was consensually validated, pretested and then administered to the nursing Staff of Pediatric Department at our Hospital in Gujarat. Data was entered in Epi-Info and analyzed using SPSS 14.0 after transferring. Result and Discussion: The questionnaire was administered to 41 nurses of pediatric department and response rate was 97.5%. Mean age of the Nurses in the study sample was 25.75 years (SD=5.513). The mean total score of the participants was 8.75 out of 17 (SD=2.549) which was unsatisfactory. The mean correct answer rate was 49.67% among the staff of NICU and 48.67% among the pediatric and PICU staff. It was concluded that the nurses lack knowledge and their attitude was also hindering pain management. One of the barriers which were identified by the nurses was that physicians did not prescribe analgesics. So not only the nursing staff, but all of the caregivers involved in neonatal care, are lacking in knowledge and hold perception and attitudes which hamper neonatal pain management. Keywords: Neonatal Pain, Nurses, Knowledge, Attitude, Perception

NEO/18 (P) CLINICAL PROFILE AND OUTCOME OF NEWBORNS WITH ACUTE KIDNEY INJURY IN A LEVEL 3 NEONATAL UNIT IN WESTERN INDIAA.R. Kungwani, A.S. Nimbalkar, A.R. Sethi, D.V. Patel, S.M. NimbalkarNeonatal Unit, Pramukhswami Medical College, Karamsad-Anand-GujaratEmail: somu_somu@yahoo.com

Background: Our study aims are 1) Study the clinical profile and associated conditions in newborns with Acute Kidney Injury (AKI) in our Level 3 Neonatal ICU. 2) Evaluate the incidence and outcome of newborns with AKI. 3) Study risk factors associated with AKI in our newborns. Methodology: AKI was defined as Serum Creatinine> 1.5mg/dl. Data about neonates admitted over a period of three years were studied from Level 3 Neonatal Intensive Care Unit. Parameters associated with AKI were evaluated and descriptive analysis was done. Results: Out of total 1745 patients, 74 (Male-61, Female-13) patients had AKI. The incidence of AKI was

4.24 % of admitted newborns, and 80% of the babies developed AKI within first week. Incidence of AKI in outborn babies (5.83%) is higher than inborn babies (2.44%) and outborns comprised 72.97% of all AKIs (54/74). Mean Birth weight of neonates was 2.46 ± 0.55 kg with 47.30% being LBWI. Factors associated with AKI were sepsis (91.9%), shock(64.9%), requirement of ventilation(62.2%), Perinatal asphyxia (36.5%), resuscitation (40.5%) and requirement of intubation at birth (23%). Mean Serum Creatinine was 2.87 ± 1.81 mg/dl(1.51 to 10.05). Mean age at diagnosis was 5.76 ± 6.64 days(1 to 41). The mortality was 20% and 51.6% patients went DAMA (Discharge Against Medical Advice). Conclusion: Mortality in patients with AKI is very high. Most AKI occurs in the first week of life and factors associated with AKI are easily recognizable and should prompt early referral of neonates. Keywords: Acute Kidney Injury, Neonates, Clinical Profile, Mortality

NEO/19 (O) MORTALITY AND MORBIDITY OF ELBW BABIES IN TERTIARY CARE CENTRE IN NORTHERN INDIANeha Thakur, ArvindSaili, Ajay Kumar, Vinay KumarDepartment of Neonatal Intensive Care Unit, Lady Hardinge Medical College and associated Kalawati Saran Children Hospital, New Delhi, IndiaEMAIL ID: nehaimsbhu@gmail.com

Abstract: Introduction: Perinatal care has changed dramatically over the past 20 years. Introduction of assisted reproductive technologies has resulted in increase in the number of preterm deliveries. New treatment strategies including antenatal steroid therapy, surfactant administration, and newer modes of ventilation and stringent aseptic measures with better control of nosocomial sepsis have contributed to improved survival of extremely low birth babies (ELBW). Objective: The aim of this study was to evaluate the mortality, and morbidity of ELBW infants delivered in our institute. Methods: The present study was a retrospective analysis of case records of 283 ELBW babies (birth weight <1000 gms) delivered in our institute over a period of twenty four months from April 2010 to March 2012.Gestational age was determined from the date of the last menstrual period and was confirmed by combination of first or early second trimester sonographic examinations and neurological examination of the newborn using New Ballard Scoring. The baby's weight, Apgar scores and details of delivery room resuscitation were also obtained from the delivery records .The neonatal information included duration of hospital stay, respiratory diagnosis (including hyaline membrane disease (HMD)), duration of oxygen therapy, neonatal jaundice, phototherapy, exchange transfusion, patent ductusarteriousus (PDA), necrotizing enterocolitis (NEC), intraventricularhaemorrhage (IVH), culture proven sepsis, retinopathy of prematurity (ROP), bronchopulmonary dysplasia (BPD), congenital anomalies and final outcome (discharge or death). Feeding practices were evaluated and duration of stay in survivors and causes of death in non-survivors were also recorded. Results: The total neonatal mortality rate was 38.7%. The neonatal mortality in boys was 59% and in girls 41%, a significant difference (p< 0.005). Gestational age distribution did not differ between the sexes. None of the infants with a birth weight (BW) below 6OOg survived, Only 2 out of 16 infants with BW 600-700g, 50% with BW 700-800g, 50% with BW 800-900g, 76% with BW 900-1000g survived. Mortality was 100% below 25 weeks, 61% between 25-28 weeks, 28.6% between 28-30 weeks, 36.4% between 30-32 weeks and 15.6% between 32-34 weeks. Of all live-born infants, 21% were twins, triplets or quadruplets. In this group the neonatal mortality was 33.3%. RDS was the main cause of death (27%) of the deaths. Sepsis was the next most common

cause, 24% of deaths was related to IVH, either as the primary cause, or in association with other comorbidities. Asphyxia contributed to 11% of mortality. Prenatal steroids had been given to 150 mothers. The mortality rate among the babies whose mothers have received antenatal steroids was 26%. The mortality rate among infants born alive <28 weeks whose mothers had received prenatal steroids was 32%, compared with 65% among infants of untreated mothers. Conclusion: In view of high costs of NICU care in developing countries where resources are limited continued efforts should be made to prevent preterm deliveries. 10% of our study population comprised of IUGR babies, remaining were preterms. Babies with higher gestational age, higher birth weight and those babies whose mothers had received antenatal steroids had better prognosis.

NEO/20 (P) AN EVALUATION OF BUBBLE-CPAP AS A RESPIRATORY SUPPORT IN ELBW BABIES IN A NEONATAL UNIT IN A DEVELOPING COUNTRY.Neha Thakur, ArvindSaili, Ajay Kumar, Vinay Kumar.

Department of Neonatal Intensive Care Unit, Lady Hardinge Medical College and associated Kalawati Saran Children Hospital, New Delhi, IndiaEMAIL ID: nehaimsbhu@gmail.com

Abstract: Introduction: Continuous Positive Airway Pressure (CPAP) has become a common form of support forrespiratory distress in neonatal intensive care units. Objective: To evaluate the outcome of baby’s weighing less than 1000gm requiring respiratory assistance in the form of Mechanical Ventilation or CPAP. Methods: Subjects included all live-born infants delivered in our institute during April 2010 to March 2012 with birth weight <1000 gms requiring any form of respiratory assistance.We use CPAP predominantly in preterm infants with respiratory distress, apnea of prematurity, delayed adaptation, pneumonia and while weaning from mechanical ventilators in ELBW infants.We studied, in detail, the records of all babies who were initiated in any form of respiratory support (mechanical ventilation or bubble-CPAP). The following data were extracted: birth weight, gestational age, diagnosis, presence of positive bacterial cultures at any time during the admission, duration of hospitalstay and outcome. Results: Of all ELBW infants 75% required some form of respiratory assistance. 47% were mechanically ventilated and 35.6 % received CPAP treatment only Most of the latter were born at gestational ages of ≥27 weeks. Of the live-born infants, < 27 weeks 82% were mechanically ventilated and 88% of them died. Surfactant was given to 106 babies and of these 53 (50%) died. Conclusion: A large percentage of ELBW babies still require some form of respiratory assistance. CPAP alone was helpful in good percentage of these babies.Introduction of bubble-CPAP substantially reduced the need for mechanical ventilation. In models of neonatal care for resource-limited countries, bubble-CPAP may be the first type of ventilatory support that is recommended. Its low cost and safety makes it ideal for this purpose

NEO/21 (P) MATERNAL ANTENATAL PROFILE IN ELBW BABIES BORN IN A TERTIARY CARE CENTRE IN NORTHERN INDIANeha Thakur, ArvindSaili, Ajay Kumar, Vinay Kumar.

Department of Neonatal Intensive Care Unit, Lady Hardinge Medical College and associated Kalawati Saran Children Hospital, New Delhi, IndiaEmail: nehaimsbhu@gmail.com

Abstract: Introduction: Perinatal and neonatal mortality are importantpublic health issues in many developing countries.Birth weightis one of the major determinantsof neonatal survival as well as postnatal morbidity.Preterm delivery is an important cause of extremely low birth weight babies. During the last two decades the survival for premature infants has significantly increased due to advancement in perinatal treatment and improvement in the care of high-risk mothers.A better understanding of maternal antenatal factors contributing to preterm birth and need for improvement of perinatal care are necessary to increase the neonatal survival. Objective: To evaluate the antenatal profile of the mothers and to find out the maternal risk factors for giving rise to ELBW babies. Methods: The present study is a retrospective analysis of case records of mothers of ELBW babies admitted in our NICU during a period of two years from April 2010 to March 2012.Maternal information obtained from the delivery records included age, parity, antenatal care, administration of antenatal steroids, fetal presentation, mode of delivery, incidence of anemia, pregnancy induced hypertension (PIH), antepartum hemorrhage (APH), previous pre-term delivery, drug intake during pregnancy. Results: During the study period 283 babies were admitted in our NICU. Retrospective analysis of their mother’s case records was done. The overall rate of Caesarean section (CS) was 21%, whereas 79% were delivered vaginally.More than half of the mothers (58.4%) were booked. Maternal anemia and multiple births complicated nearly 40% of deliveries. More than 50% of mothers had received antenatal steroids, 44% had PROM >24 hrs. with 40% receiving antibiotics. 9.5% of deliveries were complicated by APH. Amongst the various high risk factors for preterm labor, anemia during pregnancy (41%), previous preterm delivery (34.2%), gestational hypertension (12.7%) and antepartum hemorrhage (9.5%) were common associations. Conclusion: Antenatal profile of extremely low birth weight babies delivered in our institute showed a number of high risk factors. Identification of these risk factors along with timely intervention is important for appropriate prenatal care and better neonatal survival rate.

NEO/22 (P) NEONATAL CHOLESTASISRajesh Rai, Fehmida Najmuddin, Riya George, Keya Lahiri, Anand SudeDepartment Of Paediatrics, Padmashree Dr.D.Y.Patil Medical College, Hospital And Research Centre, Nerul, Navi Mumbai 400706Email: riya_g_john@yahoo.com

Abstract: 2 month old female, born of non-consanguineous marriage, admitted with yellowish discoloration of eyes, skin since day 2 and passage of acholic stools since 1 month. Mother had fever with rashes in the last trimester of pregnancy and she was a case of hypothyroidism on l-thyroxine for 2 years. Child was immunized and had attained milestones. She was exclusively breast fed. On examination, her vital parameters were normal, icterus was seen and the anterior fontanelle was open. Per abdomen examination showed a distended abdomen with dilated veins with splenohepatomegaly; spleen of 8.5 cms and liver of 5.5 cms, both firm in consistency with sharp borders; rest of the systemic examination was normal. Serum transaminases were elevated with indirect hyperbilirubinemia. CMV IgM was positive and HIDA showed partial obstruction of biliary tract with intraparenchymal disease of the liver. Injection Gancyclovir was initiated and continued for 3 weeks, hemogram and renal functions were monitored weekly for thrombocytopenia and creatinine. Child gained weight, was passing yellow stools with reduction of jaundice. HIDA at 3 months showed preserved hepatic function and normal IgM.

NEO/23 (P) AN UNUSUAL CASE OF ANTENATAL PUERPERAL BREAST ABSCESSPatil Varsha, Jobanputra Neha, Malik Sushma, Warke Charusheela, Shah DiptiDivision of Neonatology, Department of Pediatrics, T.N.Medical College & B.Y.L Nair Hospital, Mumbai-8Email: drvarsha.a.patil@gmail.com

Introduction: Puerperal or lactational mastitis occurs in approximately 2-3% of lactating women. Breast abscess may develop in 5-11% of women with mastitis. We present an uncommon case of multiple puerperal breast abscesses developed during the antenatal period. Case History: A 24 year old gravida two mother presented in 8th month of gestation with fever, pain and palpable lump in left breast. Local ultrasound revealed abscess in left breast (lower medial quadrant) which was surgically drained by private practitioner and treated with antibiotics and pyridoxine for 7 days. Two weeks later, she developed another abscess in upper medial quadrant of the same breast in addition to persistence of previous abscess. At this time (36 weeks), she was admitted at our hospital where she delivered a 2.6 kg female baby. She had history of copious milk discharge during pregnancy which predominantly occurred from right breast. Her first conception occurred after treatment for primary infertility which terminated as intrauterine fetal demise. There was similar history of copious milk production during previous pregnancy too. There was no history of trauma, wearing tight undergarments, cracked nipple, diabetes mellitus, any drug intake, tobacco chewing or smoking. General examination was normal without any focus of infection. Investigations revealed high leucocyte counts. Both the abscesses in left breast were confirmed by ultrasound and surgically drained twice. The pus grew Staphylococcus aureus. She was treated with injectable antibiotics for 14 days. Her HIV ELISA was negative. X-ray skull, serum prolactin and TSH levels done twice 3 years apart were normal and helped to rule out prolactinoma. Analysis of breast milk from both breasts revealed elevated sodium levels. Baby was breast fed only from right breast due to active pus drainage from left side. Baby had no clinical or laboratory evidence of sepsis, dehydration or hypernatremia. The mother was discharged on oral antibiotics after the breast abscesses reduced. Discussion: Puerperal mastitis and breast abscess occurs most commonly in first 6 weeks of breastfeeding. The breasts are however capable of full lactation from 16 weeks of pregnancy. Abrupt withdrawal of progesterone in presence of high prolactin levels stimulates copious milk production at birth. Antenatal breast abscess is uncommon. Milk stasis is a major predisposing factor for mastitis and breast abscess, which is exemplified in present case. Conclusion: Puerperal breast abscess is uncommon during antenatal period. The goal of treatment for mastitis and breast abscess is to provide prompt and appropriate management to prevent further lactation issues.

NEO/24 (P) REFRACTORY SUPRA VENTRICULAR TACHYCARDIA IN A NEONATE: A TREATMENT CHALLENGE.Ravindra Sharma, Sushma Malik, Bhavesh Rathod, Charusheela Warke, Ashwin Saboo, Sandeep Patil. Division of Neonatology, Dept. of Pediatrics, BYL Nair Ch. Hospital and TN Medical College, Mumbai-8Email: ravindranatural@gmail.com

Introduction- Supraventricular tachycardia (SVT) is the most common sustained arrhythmia to present in the neonatal and infancy age group. Acute management of the neonate / infants who

presents in SVT can be a challenge. The treatment strategy depends upon the clinical presentation and hemodynamic status. Here we present a neonate who had refractory SVT. Case Report- 28 days old, 3 kg FTND male child, with an uneventful antenatal and postnatal history was admitted at peripheral hospital with complaints of respiratory distress, tachycardia (220/min), cardiac failure, normal 2D ECHO and the ECG suggestive of SVT. Patient responded to adenosine and oral propranolol. The neonate was then referred to our NICU for further workup. However, subsequently, baby developed recurrent episodes of SVT, which were refractory to adenosine, amiodarone drip and multiple DC cardioversions. Digoxin was withheld in view of doubt of WPW syndrome. Patient ultimately responded to oral flecainide and amiodarone drip. Discussion- SVT is the most common pathological tachycardia in a neonate that can be a recurrent and persistent condition. Three major subcategories of SVT are re-enterant tachycardia using an accessory pathway, re-enterant tachycardia without using an accessory pathway, and ectopic or automatic tachycardia. Predisposing factors (congenital heart, drug, fever and illness) occur in only 15% of infants. Congestive cardiac failure is more common in infants under 4 months of age (35% incidence). Chronic therapy with beta blocker, flecanide, sotalol and amiodarone has proved effective in controlling recurrent episodes of SVT. Radiofrequency ablation (RFA) is the definitive treatment of refractory SVT, however, interventional therapy poses a high risk of morbidity and mortality in neonatal and infant age group. Conclusion- SVT is successfully terminated in 80 to 90% by adenosine. In refractory SVT, combination of Flecainide & Sotolol effectively controls refractory SVT. Radiofrequency ablation is reserved for drug resistant or life threatening arrhythmias.

NEO/25 (P) CRANIOFACIAL MICROSOMIA - THE NEED FOR EARLY INTERVENTIONNeha Jobanputra, Bhavesh Rathod, Sushma Malik, Charusheela Warke.Division of Neonatology, Department of Pediatrics, T.N.Medical College & B.Y.L Nair Hospital, Mumbai-8Email: smile86in@yahoo.com

Introduction:- Craniofacial microsomia (CFM) includes a spectrum of malformations primarily involving structures derived from the first and second branchial arches. CFM encompasses facial asymmetry, preauricular or facial tags; ear malformations like microtia, anotia or aural atresia, hearing loss, cleft lip / palate and microphthalmia. Non-craniofacial malformations especially vertebral, cardiac or renal can be involved. Here we report a rare case of CFM in our neonate who had anotia, microtia and facial nerve palsy. Case history: - A gravida two mother delivered a full term normal 2.6 kg female baby, who was brought on day 3, for assessment of dysmorphic features and ear anomalies. Antenatally the mother had no fever, rash or diabetes and had not recieved any drugs including retinoic acid or teratogens. An antenatal USG done at 32 weeks was normal. Examination of the neonate showed left anotia, right microtia, facial asymmetry and unilateral left sided LMN facial nerve palsy. X-Ray chest and spine were normal. ECHO revealed small ASD with VSD. Hearing evaluation posed difficulty due to the left anotia and extreme microtia on other side and patient advised for reassessment at 4 weeks for BERA/BOA. USG abdomen showed absence of left kidney with hypertrophied right kidney. Thus the baby was diagnosed as a case of CFM and was discharged with advice of regular follow up especially for hearing and renal assessment and early rehabilitation. Discussion:- Prevalence of CFM has been estimated between 1: 5600 to 1: 26,550 live births. Spectrum of CFM, includes microtia,

anotia, sensorineural hearing loss, cleft lip and/or palate, preauricular skin tags, vertebral anomalies, facial nerve palsy, congenital heart defects and renal anomalies. A systematic approach in these cases including hearing, speech, ophthalmologic evaluation and genetic testing will help in appropriate management to maximize hearing and communication, improve facial symmetry, and optimize cardiac and renal functioning. Conclusion: - Early management is required in cases of CFM, as treatment and interventions are age-dependent and time-sensitive which are done at appropriate stages of craniofacial growth and development.

NEO/26 (P) ROLE OF SILDENAFIL IN PERSISTENT PULMONARY HYPERTENSION IN NEWBORNAsha Mukherjee, Nandita Chatterjee, Somosri Ray, Monomit Halder, Arghya Kusum Pal, Pallavi31 Lake Temple Road, Kolkata- 700029Email: dr.somosri@gmail.com

Abstract: Introduction: We share our experience with 10 newborns, diagnosed to have PPHN in last two years in our hospital RAMAKRISHNA MISSION SEVA PRATISTHAN,KOLKATA.Sildenafil (phosphodiesterase-5 inhibitor )is a unique drug in PPHN which reduces the need of mechanical ventilatior,inhaled nitric oxide and ECMO.We experienced dramatic improvement with this drug. Aims And Objectives: 1) To evaluate the success rate of sildenafil in PPHN. Material And Methods: 10 cases of PPHN were included in the study.Tools used –pulse oximetry,multi channel monitor,serial echocardiography.Response to sildenafil was assessed in terms of decrease in oxygen requirement,respiratory rate,echo criteria-decrease in peak pulmonary pressure and tricuspid regurgitation gradient. Echocardography were performed –one before and another after 5 days of sildenafil. Results: Age of presentation of 10 term babies was between day-1 to day 3 of life.3(30%) out of them were infant of diabetic mother.2(20%) had birth asphyxia ,3 (30%)had sepsis, 2(20%) had meconium aspiration syndrome.All these cases had respiratory distress and diference of oxygen saturation >5% between upper right arm and left lower limb.Echo was done before and ater 5 days of oral sildenafil (2mg/kg/dose four times a day).1 case expired on 3rd day of life,one needed ventilator.8 out of 10 showed 90% decrease in TR gradient,near normalization of peak pulmonary pressure.All 8 cases showed decrease in oxygen requirement from mean 7 litre/min to 1.5 litre/min.Decrease of mean respiratory rate was from 76 to 40/min. Conclusion: Sildenafil is a useful drug in PPHN and its use may avoid mechanical ventilator ,NO and ECMO.

NEO/27 (P) APGAR SCORE: DO WE NEED TWO (HR & RR) OR ALL FIVE COMPONENTSNirmal Kumar, .Sunaina Arora, V. SreenivasSt. Stephens Hospital, Dept. Of Neonatology, Tis-Hazari, Delhi-110054E-mail: nsk9_2000@yahoo.com

Abstract: The Apgar scoring system has been conceptualized as a cycle, linked to cardio respiratory reflexes and metabolically supported by oxygenation .Neonatal resuscitation based mainly on heart rate and respiratory rate. Resuscitative measures directly linked with severity of birth asphyxia. Aim: To see if resuscitative measures are same for two components and all five components of Apgar score. Methods: Data was collected prospectively from the routine Apgar scoring system and resuscitative measures that were done in the delivery room were recorded.

Two components of Apgar scores, heart rate and breathing were assigned as Apgar scores ( heart rate 0 , 1, 2 and breathing 0, 1, 2 ). Total score for two component ranges from 0-4. Use of PPV, chest compression and drug were recorded at 1 and 5 minutes. Results: 1999 babies were studied.Mean weight and gestational age was 2.8 kg and 38 weeks respectively. Apgar score ( 2 component ) was 1 in 9 babies, 2 in 17 babies, 3 in 33 babies and 4 in 1940 babies. Almost all babies with Apgar score ≤ 6 and Apgar score ( 2 component ) of ≤ 3 received bag and mask ventilation at 1 minute . Only Apgar score ≤3 and Apgar score ( 2 component ) of 1 received endotracheal intubation, chest compression and epinephrine. For bag & mask vantilation, sensitivity (82.3% vs. 91.90%), specificity (99.9% vs. 99.9%), positive predictive value (96.2% vs. 96.6%) and negative predictive value (99.4% vs. 99.7%) of Apgar score and two component Apgar were comparable . For chest compression, Apgar score ≤ 3 and two component Apgar score of 1 had sensitivity and specificity of 99%, PPV ( 30.7 Vs 44.4% ) and NPV of 100% were observed. For the use of medication ( Epinephrin ) too the sensitivity and specificity were greater than 99% and PPV ( 22.2% Vs 15.38% ) and NPV 100% were observed. Conclusion :Apgar score ≤ 3 and two component Apgar score of 1 are almost parallel to each other in terms of resuscitative measures that is positive pressure ventilation, chest compression, and epinephrine. Only two components ( HR & RR ) are required for Apgar score.

NEO/28 (P) CONGENITAL SURFACTANT DEFFICIENCYManish K Arya, Payal Shah, A.D. Rathod, S.K. Valinjkar, Kiran M201, Darshan Apt, Opp Sonivadi, Chikan Villa Road, Borivali (W) , Mumbai 92Email: wildbluewind@gmail.com

Introduction: Respiratory Distress Syndrome (RDS) is due to deficiency of surfactant and commonly occurs in preterm babies. We report the case of congenital surfactant deficiency which is a rare but important cause of RDS in term babies. Case report: A 37 week gestation boy with birth weight 3 kg born to registered immunised primi mother developed respiratory distress at four hours of age. baby was shifted on o2 by hood to NICU ,however as baby was not maintaining saturation on the same was put on nasal CPAP. CXR was done which was s/o WHITE OUT LUNG. Subsequently baby was intubated and put on CMV mode. 2 d echo was done to rule out congenital heart disease. Pt was administered surfactant following which pt showed improvement on CXR and ABG and required lesser pressure settings. After 12-16 hour child was requiring higher pressure settings and there was deterioration on CXR and ABG. During 16 days of his life child was given repeated surfactant and each time improvement was seen on CXR, ABG and clinical settings. CBC and septic profile was normal. Renal and liver parameter were within normal limit. Lung biopsy was sent which was s/o surfactant deficiency. Bronchoalveolar lavage was s/o surfactant protein B deficiency. Based on clinical picture and biopsy report case of congenital surfactant deficiency was considered.

NEO/29 (P) ASSOCIATION OF SIGNIFICANT HYPERBILIRUBINEMIA AND TOTAL SERUM BILIRUBIN TSB MEASUREMENT AT 24±6 HOUR OF LIFE LEVEL IN HEALTHY TERM NEONATESSubhash chand Meena, Gaurav Ameta, Suresh GoyalDepartment of Pediatrics, RNT Medical College, UdaipurEmail: gauravameta10dec@yahoo.co.in

Abstract: Back ground: Significant hyperbilirubinemia occurs in 5–10% of healthy term and is most common reason for readmission after early hospital discharge. Aims and Objectives: To evaluate whether the first 24 ± 6 hours TSB value can predict development of significant hyperbilirubinemia; Design: prospective study; Participants and interventions: Intramural healthy neonates with birth weight ≥2500 gm, and gestational age ≥37 weeks born from Dec 2009 to Oct 2011 were included; Exclusion criteria: Rh incompatibility, hydropes fetalis, maternal diabetes, any congenital malformation, any illness requiring NICU admission, Apgar score <5 at 5 min, known viral infection in mother; Intervention: 100 healthy full term neonates participients were subjected TSB estimation at first 24±6 hrs of age and followed clinically (using Kramer’s rule) for the appearance jaundice and total seum Bilirubin estimation was done on fifth day of life or early (if clinical assessment of jaundice >10mg/dl before discharge of baby). Babies were classified into four groups depending on the serum bilirubin levels at first 24 ± 6 hours of life i.e. <4 mg/dl (group-I), 4.0-5.99 mg/dl (group-II), 6.0-7.99 mg/dl (group-III), = 8 mg/dl (group- IV). Results: (mean±SD)TSB beyond 24 hour of life was highest i.e. 15.73±1.44 in group IV and lowest i.e. 10.66±1.43 in group I. Mean TSB level after 24 hour of life increased as the first 24±6 hour TSB level increased from group I to group IV which was highly significant (P<0.001). Conclusions: TSB measurement at 24±6 hour of life predicts significant hyperbilirubinemia during first 5 days of life.

NEO/30 (P) EFFICACY AND SAFETY OF TOTAL PARENTERAL NUTRITION (TPN) IN INFANTS WEIGHING LESS THAN 1250 GRAMS – A CASE CONTROL STUDYSoundaram V, Jayashree P, Ramesh Bhat Y, Leslie E LewisDepartment of Paediatrics, Kasturba Medical College, Manipal University, Manipal-576104, Udupi District, Karnataka, IndiaEmail: drsoundaram@yahoo.co.in

Introduction: VLBW infants are born at a time of rapid intra-uterine growth. Neonates receiving only glucose were found to experience protein loss of 0.5-1g/kg/d. These deficits are difficult to recoup and lead to significant growth and neurodevelopmental delay. Aim: To compare the growth of infants<1250g who received TPN with those not received and assess TPN complications. Materials And Methods: Neonates weighing <1250 g, hemodynamically stable and survived till 7th postnatal day were studied. Cases received TPN and controls did not. Amino acids and lipids were started at 1 g/kg/day on Day 1 and graded up by 1 g/kg/day till 4 g/kg/d of AA and 3 g/kg/d of lipids. Enteral feeds were started within Day2 of life and graded up as per standard protocol. Results: 20 cases and 20 controls were studied. Time to regain birth weight (9.85+/- 3.7 days vs 20.06+/- 7.28 days) and cumulative weight loss (78.75+/- 48.26 vs 130.79+/-54.91grams) were lesser for cases than controls. Cumulative energy intake in 1st week had significant positive correlation with growth velocity (81.35vs37.66 Kcals, p-0.043). Four neonates among cases and two among controls had culture proven sepsis. Asymptomatic hyponatremia(55%) , hypokalemia(45%) ,hyperglycemia(75%), elevated ALP(60%), and elevated urea with normal creatinine(20%) were observed in cases. Duration of hospital stay after controlling for gestational age and discharge weight was shorter for cases(42.68vs54.01 days). Conclusion: Infants who received TPN showed better growth than controls. Careful attention regarding transient metabolic complications and sepsis is required while administering TPN.

NEO/31 (P) STUDY OF THE ROLE OF ZINC IN THE TREATMENT OF NEONATAL SEPSISKayur Mehta45 Flat S1 Chilume Apartment, West Park Road Malleshwaram, Bangalore - 560003Email: kayur.mehta@gmail.com

Abstract: Objective: To study the role of Zinc in the treatment of neonatal sepsis. Design: Double blinded, randomized, placebo controlled trial. Setting: B.P. Koirala Institute of Health Sciences, Dharan, Nepal. (Tertiary Care Hospital) Participants: 614 neonates with Probable Neonatal Sepsis, randomized to receive Zinc (Drug group, n = 307) or Placebo (Placebo group, n =307), in addition to standard antibiotic therapy and supportive care. Intervention: The drug group (n=307) received 1mg/kg/day of elemental zinc, and placebo group (n=307) received the placebo, in addition to antibiotic therapy and supportive care, till the final outcome (discharge/death). Outcome Measures: Decrease in mortality rates (primary outcome), duration of hospital stay and need of higher lines of antibiotic therapy (secondary outcomes) were tested. Results: Baseline characteristics of the two groups were similar. No statistically significant differences in mortality rate (drug group–9.77% vs. placebo group–7.81%; p=0.393), mean duration of hospital stay (drug group-142.85±69.41 hrs, vs. placebo group-147.99±73.13 hrs; p=0.841), and requirement of higher lines of antibiotic therapy (drug group–13.35% vs. placebo group–12.05%, p=0.628) were found after supplementation. Conclusions: This study does not report decrease in mortality rates, duration of hospital stay and requirement of higher lines of antibiotic therapy following zinc supplementation in neonatal sepsis. More trials and subsequently meta-analyses are required to clarify the role of zinc in the treatment of neonatal sepsis.

NEO/32 (P) CORRELATION OF PULSE OXIMETRY AND APGAR SCORING IN THE DELIVERY ROOM

Sandhya Chauhan, Prashant Kumar.69 Silver Estate, Post Rohilkhand University, Pilibhit Bypass Road, Bareilly, 243006, Uttar PradeshEmail: drsandhyapedia@gmail.com

Introduction: Newborn assessment immediately after birth is routinely done by the Apgar score. Newborns are normally desaturated at birth. Pulse oximetry is a non invasive tool which can easily detect this desaturation and help in deciding further intervention. Aim: To detect whether Apgar Score is a sensitive indicator of hypoxemia in normal vigorous babies in the delivery room and to evaluate which component of Apgar Score correlates with the SpO2 levels. Methods: In this prospective cross-sectional observational study ,Apgar Scoring was done in normal vigorous babies at 1 and 5 minutes of birth along with simultaneous recording of the preductal SpO2 values with the help of pulse oximeter. Results: Apgar score at 1 and 5 minutes failed to correlate with the level of hypoxemia at 1 and 5 minutes. Also AS did not show any effect on the time taken to achieve normoxia. Out of the 5 components of Apgar Score , respiratory effort at 1 minute and muscle tone had significant correlation with the level of arterial desaturation persisting in the newborns at 5 minutes. Heart rate, color and reflex activity did not have any significant association with the SpO2 values. Conclusion: Apgar Score is a misleading tool for neonatal evaluation in the delivery room . Respiratory efforts and pulse oximetry readings are the most important factors which determine the level of neonatal hypoxia in the first few minutes of life and the required management .

NEO/33 (P) SLEEP CYCLE IN NEWBORNSJaswir Singh, Manpreet Sodhi, Anil Kumar Poonia, Jaspreet Kaur Deptt. Of Pediatrics, Govt. medical college / Rajindra Hospital, Patiala (Punjab)-147001 Email: dranilkumarpoonia@yahoo.co.in

Introduction: Rapid Eye Movement (REM) sleep patterns first appear between 28 and 30 weeks gestation. Most of the sleep cycle is REM sleep, with little Non Rapid Eye Movement (NREM) sleep. By term at 40 weeks, the sleep cycles are about equal REM and NREM. Aims & objectives: To study pattern of sleep cycle in newborns. Material and methods: The study included 20 healthy, AGA Newborns (10 male & 10 females) admitted to Neonatology section of Level- teaching hospital. All babies were breastfeed. Study was done on 48 th-72th hour of life. There was no antenatal risk factor in these babies. Behaviour variables for this study were body activity, rapid eye movement & respiratory pattern. All variables were studied clinically. Study conducted in a silent and warm room. All babies were taken to study room after adequate breastfeed (average 1 hour 40 min). Results: Babies fell into REM (active) sleep first followed by NREM (quiet) sleep.Sleep Active Quiet Active Quiet Active Quiet

Mean duration(min)

18 10.4 23 12 28.45 11.6

Range 6-26 6-14 14-34 8-17 16-40 8-18

For active sleep, mean duration was 67.15 ± 19.30 minute and for quiet sleep it was 33.2 ± 6.44 minute (p value = 0.0001; statistically significant). While comparing male & female babies, p value for active & quiet sleep was 0.7637 & 0.6398 respectively (not significant). Conclusion: Active sleep is the major part of sleep cycle in newborn.

NEO/34 (P) CLINICAL STUDY OF HYPOXIC ISCHEMIC ENCEPHALOPATHY WITH ECHOCARDIOGRAPHY AND LABORATORY CO-RELATIONMamata.S.Kori, M.M.Karva, L.H.BidariDr.Bidari’s Ashwini Institute Of Child Health And Research, Bijapur, Karnataka.Email: mamtaajay.2008@gmail.com

Introduction:-Hypoxic ischemic encephalopathy(HIE) remains a serious condition in spite of major advances in technology causing significant mortality and long term morbidity. Aims and Objectives: 1. To study clinical profile of neonates with HIE. 2. To study biochemical hematological Echocardiographic and radiological profile of neonates with HIE. 3. To study their outcome and correlate it with relevant clinical and laboratory findings. Materials and Methods: The present study is prospective study carried out on 78 neonates admitted in the NICU Dr BIDARI’S ASHWINI HOSPITAL, BIJAPUR, KARNATAKA from April 2010 to April 2012. All asphyxiated babies with history of fetal distress, state of neurological depression at birth, need for resuscitation efforts and neurological depression afterwards were included. Those with major systemic malformation, <1500g and <32 weeks gestation were excluded.Investigations were done after 12 hours of birth and before 78 hours of life. The data was collected through interviewing,physical examination and investigation techniques. Echocardiography done on all neonates with birth asphyxia by trained ECHO technician with tele – echocardiographic support of cardiologist from “NARAYANA HRUDAYALAYA” Bangalore. Results: There is multiorgan dysfunction in HIE,with CNS most commonly affected,overall mortality 8.97%,HIE III major cause of mortality,metabolic derangements in HIE metabolic acidosis,hypocalcemia,hypoglycemia, and hyponatremia.Tricuspid regurgitation most common finding on echocardiography,symmetrical diffuse periventricular white matter echogenecity most common finding on cranial USG. Conclusion: The results of this study highlights the varied clinical picture of multisystem involvement with special reference to cardiac involvement and importance of bed side echocardiography in predicting the outcome in asphyxiated newborn infant and indicate the need for global management of these infants. Keywords:Birth asphyxia, multiorgan dysfunction, metabolic derangements, Echocardiography, Cranial USG.

NEO/35 (P) EVALUATION OF MYOCARDIAL DYSFUNCTION AND ECHOCARDIOGRAPHIC PROFILE IN NEONATES WITH HYPOXIC ISCHEMIC ENCEPHALOPATHY IN A TERTIARY CARE HOSPITAL Mamata.S.Kori, M.M.Karva, L.H.BidariDr.Bidari’s Ashwini Institute Of Child Health And Research, Bijapur, Karnataka.Email: mamtaajay.2008@gmail.com

Introduction: Perinatal asphyxia leads to multi-organ dysfunction. Virtually any organ system can be affected. Cardiac abnormalities in asphyxiated neonates are often under diagnosed and require a high index of suspicion. Aims and objectives: 1.Assesment of myocardial dysfunction

and Echocardiographic profile of neonates with hypoxic ischemic encephalopathy. Materials and methods: The present study is a prospective study carried out on neonates admitted in the NICU of Dr BIDARI’S ASHWINI HOSPITAL, BIJAPUR, KARNATAKA from April 2010 onwards to April 2012. All asphyxiated babies with history of fetal distress, state of neurological depression at birth, need for resuscitation efforts and neurological depression afterwards were included. Those with major systemic malformation, <1500g and <32 weeks gestation were excluded. The data was collected through interviewing,physical examination and investigation techniques. Echocardiography done on all neonates with birth asphyxia by trained ECHO technician with tele – echocardiographic support of cardiologist from “NARAYANA HRUDAYALAYA” Bangalore. Results:Out of 78 neonates 17(21.79%) neonates had normal study on Echocardiography,28(35.89%) neonates had tricuspid regurgitation(TR),30(38.46%) had Tricuspid Regurgitation with Pulmonary Arterial Hypertension (PAH),03(3.85%) had TR plus PAH plus Left Ventricular Ejection Fraction ( LVEF)<60%. Conclusion: Cardiac abnormalities in birth asphyxia are often underdiagnosed. This study highlights the cardiac involvement in birth asphyxia and importance of bedside Echocardiography in predicting the outcome in asphyxiated newborn babies. Keysword: Birth Asphyxia, Myocardial Dysfunction, Echo-cardiography .

NEO/36 (P) HAIR DISTRIBUTION IN NEWBORNS IN RELATION TO GESTATIONAL AGEJaswir Singh, Manpreet Sodhi, Anil Kumar Poonia, Jaspreet KaurDeptt. Of Pediatrics, Govt. medical college/ Rajindra Hospital, Patiala (Punjab)-147001 Email: dranilkumarpoonia@yahoo.co.in

Aims & objectives: To study hair distribution in relation to gestation. Material and Methods: The study included 50 neonates. Five groups were formed by gestational age as 28-29 wk 1 st group; 30-31 wk 2nd ; 32-33 wk 3rd ; 34-35 wk 4th ;36- 41 wk as 5th group. 10 newborns were in each group. Newborns included were either AGA or SGA. LGA, infants of diabetic mother, newborns with congenital malformation & chromosomal diseases were excluded. All were examined at birth for growth of hair on different body areas, which are- ear pinna; scalp; trunk both side; arm & forearm; dorsum of hand, visually and by magnifying lens. Results:Week Scalp Ear pinna Trunk Arm & forearm Dorsum of hand28-29 P P P = 7

A = 3 P = 8 A = 2

A

30-31 P P P P A32-33 P P P P A34-35 P P P P A = 9

P = 136-41 P P P P P = 8

A = 2 P = present; A = absent.For 28-29 wk gestation, absence of hair on trunk (p = 0.2104) and arm & forearm (p = 0.4561) was statistically insignificant in comparison to later gestation. For hair at dorsum of hand, p value for 36-41 wk in comparison to 34-35 wk was 0.0055 and to rest of other groups was 0.0007(statistically significant). Conclusion: As gestation proceeds, hair growth proceeds from scalp, ear pinna to trunk, arm & forearm. Dorsum of hand is last to show growth.

NEO/37 (P) RETINOPATHY OF PREMATURITY IN PRETERM LOW BIRTH WEIGHT NEONATE AND ITS ASSOCIATION WITH OXYGEN THERAPYAtul K.Gupta, Asha Mukherjee, Arghya K.Pal. Somen SurDept. of Pediatrics Ramakrishna Mission Seva Pratisthan KolkataEmail: docarghya.pal@gmail.com

Objective: To determine the incidence of Retinopathy of Prematurity (ROP) in preterm low birth weight babies admitted to the neonatal unit and to study association with oxygen therapy for its development. Design: Prospective observational study. Setting: Level 2 Neonatal Intensive Care Unit. Subjects: 50 babies admitted to the neonatal unit during a 1½year period who were ≤1500 g or whose gestation was ≤ 34 weeks. Methods: Examination of the eye was done in the neonatal unit or in the neonatal follow up clinic by an Ophthalmologist by indirect Ophthalmoscopy at 4-6 weeks postnatal age. Results: The incidence of ROP was 24%. Of the 50 babies screened, 3 had stage 1, 5 had stage II, 4 had stage III. The incidence of ROP was 83.3% among < 1000 g babies and 18.9% among 1000 - 1500 g babies. The incidence of ROP 75% among < 28 weeks, 37.5% among 29 – 30 weeks and 16.6% among 31 - 32 weeks babies. The maximum stage of ROP developed between 37-42 weeks post conceptional age in 69% subjects. On univariate analysis, gestation < 32 weeks, anemia, blood transfusions, apnea and 7 of the 12 ROP babies received laser photocoagulation. Among ventilated babies 91.6% developed ROP against 8% of CPAP. Conclusion: The incidence of ROP among high risk babies is significant and duration and typeof oxygen therapy predicting the development of ROP. All high risk babies should be screened for ROP. Key words: Retinopathy of prematurity, Prematurity, Low birth weight, Cryotherapy.

NEO/38 (P) MAGNESIUM SULPHATE AS A NEUROPROTECTIVE AGENT FOR PERINATAL ASPHYXIA IN TERM NEONATES Raj Prakash, M.R. SavithaDepartment of Pediatrics, Mysore Medical College and Research Institute, Mysore, KarnatakaEmail: drsavithamr@gmail.com

Introduction:Magnesium antagonizes glutamate excitotoxicity and neuronal injury in perinatal asphyxia and is a promising neuroprotective agent. Aims and objectives:To determine whether magnesium therapy causes early recovery and favorable neurological outcome at discharge for asphyxiated term neonates. Materials and methods: This randomized case control study was done from November 2011 to February 2012 in 120 asphyxiated term neonates (60 cases and 60 controls). Cases received 3 doses of 250 mg/kg magnesium sulphate infusion and controls received 3 doses of 0.5ml/kg normal saline 24 hours apart. Both groups received supportive care according to the NICU protocol. Statistical analysis was done through SPSS for windows(version 16.0).P value < 0.05 was taken as statistically significant. Results:Mild, moderate and severe hypoxic-ischemic encephalopathy were present in 40%, 56.7% and 3.3% cases and 45%, 53.3% and 1.7% controls respectively. Post-intervention mean serum magnesium level of cases was in neuroprotective range of more than 1.2mmol/L. During hospital stay,cases achieved seizure control earlier than controls(36.5 hours vs 55 hours-p=0.026).More cases achieved seizure control in less than 2 days(92% vs 70%-p=0.048) and with single antiepileptic drug(96% vs 74%-p=0.029).Cases recovered early from abnormal neurological findings(3.36 vs 4.96 days-p=0.0001) and more cases recovered within 4 days(84% vs 53%- p=0.0006).Cases

recovered from acute kidney injury early(3.16 vs 4.27 days-p=0.046).At discharge,fewer cases with moderate and severe encephalopathy had abnormal neuroimaging(20% vs 37.5%-p=0.112).Fewer cases had neurological abnormalities(8.6% vs 31.25%-p=0.019) and more cases established breast feeding(91.4% vs 65.6% p=0.009). Conclusions:Magnesium therapy causes early recovery and favorable neurological outcome at discharge for asphyxiated term neonates.

NEO/39 (P) ACQUIRED REVERSIBLE DILATED CARDIOMYOPATHY DUE TO PSEUDOMONAS SEPSIS IN A NEONATEKailash Chandra Patra, Sharik Navrungabade, Vaishali Ghane, Sameer Wankhade, AnjalikalbhandeDepartment of Paediatrics, ESI PGIMSR, Andheri Mumbai 400093Email id: drkailashcp@yahoo.co.in; drsharik123@gmail.com

Introdcution: Neonatal sepsis remains a cause of significant neonatal morbidity and mortality. Impairment of the heart in systemic sepsis is called septic cardiomyopathy. Dilated cardiomyopathy is commonly encountered secondary to viral myocarditis and bacterial infections with diptheria, mycoplasma, listeriosis and streptococci etc. We present a case of Reversible Dilated Cardiomyopathy in a neonate with pseudomonas sepsis. Case history: A preterm SGA, male neonate of 34 weeks of gestation, weighing 1500 grams born by emergency LSCS i/v/o severe maternal PIH. Baby cried immediately but had respiratory distress at birth hence required NICU care. Day three of life baby had gastric aspirates, eye discharge, delayed capillary refill time, poor peripheral pulses indicating sepsis. Baby received oxygen, IV fluids, and emperical antibiotics for the same. Blood culture collected on day three of life isolated pseudomonas aeruginosa sensitive to piperacillin, tazobactum and received the same. Baby clinically responded to the therapy and was feeding well with satisfactory weight gain. On day 30th baby was asymptomatic but had tachycardia, short systolic murmur in 2nd and 3rd left ICS and enlarged liver measuring 2cms. Family history of congenital heart disease or sudden deaths was absent. 2D ECHO detected Dilated cardiomyopathy with left ventricular dilatation and moderately impaired left ventricular function with LVEF of 0.35 to 0.40. A small ASD with left to right shunt was also noted. Baby received Digoxin, Furosemide, Enalapril, Carvedilol for three months. Throughout baby remained asymptomatic, had adequate weight gain. Murmur gradually disappeared and palpable liver regressed by 1cm. 2D ECHO at the end of three months of antifailure therapy showed normal ventricular wall thickness and contractility, with LVEF of 0.6 and intact IAS. Baby is presently continued on Enalapril and Carvedilol, is on regular follow up visits and is clinically doing well. Discussion: Septic cardiomyopathy is impairment of heart in systemic sepsis. Myocardial depression is the most prominent feature of septic cardiomyopathy, resulting in right and left ventricular pump failure and is potentially reversible. Septic cardiomyopathy occurs more often than presently diagnosed. In recent years, the concept of septic cardiomyopathy was proposed, which emphasized alterations of cardiac cellular phenotype as a basis of cardiomyopathy in response to a variety of agents acting on heart cells. In systemic sepsis the detrimental action of endogenous mediators, such as tumour necrosis factor-alpha (TNF-α) , a direct toxicity of the bacterial toxins such as endotoxin , Pseudomonas exotoxin A and lipoteichoic acid are potentially found to cause malfunctioning of various organs, including the heart. Conclusion:Although septic cardiomyopathy is potentially completely reversible also described as myocardial hibernation, still is a condition of high prognostic importance as it accounts for approximately 10% of the fatalities observed in sepsis

and septic shock . In at least approximately 50% of all sepsis patients, a systolic pump failure can be documented by echocardiography.

NEO/40 (P) ‘STUDY OF CORRELATION BETWEEN OAE(OTOACOUSTIC EMISSION) AND ABR(AUDITORY BRAINSTEM RESPONSE) TEST RESULTS FOR ASSESSMENT OF HEARING LOSS IN TERM & PRETERM NEWBORNS IN NICU’Asha Mukherjee, ManomitHaldar, SomosriRay.31 Lake Temple Road, Kolkata- 700029, West BengalEmail: manomit_haldar@yahoo.in; dr.somosri@gmail.com

Introduction: Universal newborn hearing screening with OAE test is now recommended to detect hearing impairment. Sensory-neural hearing loss is detected by ABR test.Any correlation between these 2 tests is very significant,as early detection of hearing impairment helps proper language acquisition. Aims &Objectives: 1. To find out the incidence of hearing impairment in both NICU admitted &normal babies. 2. Any correlation between OAE and ABR tests. Materials & Methods: A prospective observational study was performed on both NICU-admitted (case) and normal post-natal ward (control) babies. Screening OAE was done on day-3 of life,for all babies. 2nd OAE was repeated at 6wks. ABR test was done at 3 months of age for all of them. Results: In the NICU, 17 out of 100 babies had ‘REFER’ result in their screening OAE, out of which 14 had persistent ‘REFER’ in repeat OAE. On ABR testing at 3 months, 5 showed abnormal ABR with deafness. In control group, 10 out of 100 had ‘REFER’ result,6 of them had persistent ‘REFER’ in 2nd OAE; only 1 detected as deaf. Prematurity,Mechanical ventilation, Sepsis , Jaundice& Drugs were significantly associated with abnormal OAE & ABR test. Conclusion: 1.Risks of sensory-neural hearing loss is more in NICU admitted babies. 2. Bothabnormal OAE & ABR test results were having good correlation with deafness. Therefore, a combination of these 2 tests is well suited for use in hearing assessment in newborn & older.

NEO/41 (P) ASSESSMENT OF HEARING LOSS IN NORMAL NEWBORNS& CORRELATION BETWEEN OAE & ABR TEST RESULTS’Asha Mukherjee, ManomitHaldar, SomosriRay.31 Lake Temple Road, Kolkata- 700029, West BengalEmail: manomit_haldar@yahoo.in; dr.somosri@gmail.com

Introduction: Hearing impairment is the most common congenital abnormality in newborns.OAE& ABR are 2 different tests for hearing assessment. OAE detects hearing impairment upto outer hair-cell of cochlea. Sensory-neural hearing loss due to neural dysfunction or auditory brain-stem affection is detected by ABR test. Because of this high incidence of hearing-loss in normal babies, universal newborn hearing screening with OAE & ABR tests should be mandatory. Aims &Objectives: 1. To find out the incidence of hearing impairment in normal newborns. 2. Any correlation between OAE and ABR tests. Materials & Methods: A prospective observational study was performed on normal post-natal ward babies.100 normal newborns above 37wks without any risk-factors were taken as subjects. Screening OAE was done on day-3 of life,for all babies. 2nd OAE was repeated at 6wks. ABR test was done at 3 months of age for all of them. Results: 10 out of 100 normal babies had ‘REFER’ result during screening OAE.6 of the initial 10 abnormal subjects had persistent ‘REFER’ on repeat OAE. 1 baby had abnormal ABR & diagnosed as deaf. Conclusion:

1.Incidence of hearing loss is quite high, even in normal newborns. 2.Both abnormal OAE & ABR test results were having good correlation with deafness.

NEO/42 (P) STUDY ON NEONATAL JAUNDICE WITH SPECIAL REFERENCE TO GLUCOSE 6 PHOSPHATE DEHYDROGENASE (G6PD) DEFICIENCYSabyasachi Das.Junior Resident. R.G.Kar Medical College and Hospital. Kolkata-700001, West BengalEmail: dasbabai83@gmail.com

Introduction: Jaundice is the most common condition that requires medical attention in newborns. G6PD has been reported as an important cause of pathological jaundice. Data on prevalence of G6PD deficiency among jaundiced neonates is lacking from West Bengal. Aims and Objectives: a) Frequency of different causes of pathological jaundice and prevalence of G6Pd deficiency among jaundiced neonates. b) Finding any correlation between the frequency of G6PD deficiency and sex, religion, gestational age, birth weight, peak total serum bilirubin (TSB), significant hyperbilirubinemia, requirement of phototherapy and exchange transfusion of neonates. Materials and method: A cross-sectional study was done for a duration of 4 months among all jaundiced neonates admitted in baby nursery, RGKarMCH. Complete hemogram, CRP, liver function test, direct coombs test, blood grouping of mother and baby and quantitive assay of G6PD was done. The data obtained was analysed by SPSS 17 to find any correlation between them. Results: ● ABO incompatibility (30.99%) was the leading cause followed by G6PD deficiency (6.61%). ● TSB, duration of phototherapy, frequency of exchange transfusion, significant hyperbilirubinemia ( bilirubin > 20mg/dl) was found to be significantly higher in G6PD deficient group than G6PD normal group. No significant difference was found in regards to sex, religion, gestational maturity, birth weight or haemoglobin level. ● The G6PD level of neonates with gestational age 30-32 weeks were significantly higher than neonates of 38-40weeks and 40-42weeks. Conclusion: Newborn screening for G6PD deficiency is a necessity in West Bengal.

NEO/43 (P) SPECTRUM OF RESPIRATORY DISTRESS IN NEWBORN: A STUDY FROM A TERTIARY CARE HOSPITAL IN KOLKATA.Abhijit Dutta, Sibnath Gayen, Sabyasachi Ghosh, Pradip Pakira, M.Basu, S.Ghosh Asst. professor, Dept. of Pediatrics, R.G.Kar Medical collage, 1.No.Khudiram Bose Sarani, Kolkata -700004Email: dr.adutta@yahoo.co.in

Abstract: Introduction: Respiratory distress is a common problem in neonatal problem. It is an important cause of of neonatal mortality. The etiology of respiratory distress in newborn is large, include, transient tachypnea of the newborn, respiratory distress syndrome, meconium aspiration syndrome and other miscellaneous causes. Aims & Objective: To find out the incidence and aetiology of respiratory distress among admitted newborn babies. Materials and Methods: This prospective study was conducted among 2382 inborn newborns admitted in neonatal care unit of R.G. Kar Medical Collage & Hospital between June 2010 to march 2011.The cases were analysed for incidence and aetiology of respiratory distress. Results: In the study population, respiratory distress was detected in 152 newborns, comprising 6.4% of all newborn admission and 14.5% of sick newborns. Transient tachypnea of the newborn was the commonest cause

(32.23%) of respiratory distress followed by pneumonia (24.35%), meconium aspiration syndrome (13.15%), perinatal asphyxia (12.5%), RDS (7.9%), cardiovascular (3.3%) and surgical cause (2.63%). Conclusion: The incidence and etiology of respiratory distress is comparable to other studies except, relative high incidence of MAS and birth asphyxia. The incidence of RDS among ELBW was quite high (41.6%). Besides early onset tachypnea with grunting and subcostal suction along with increasing oxygen demand, frothing from mouth was an important early finding of RDS.

NEO/44 (P) A CASE OF MISOPROSTOL EMBRYOPATHYM.Sabarinath, M. Balasubramaniam, E. Sivakumar, P. Ramasubramaniam, S. Balasankar, M. Nagendran, G.Mathevan Room No-609, Pg Hostel Oasis, Madurai Medical College, Panagal Road, Shenoy Nagar, Madurai-625020.Email-msabari1987@gmail.com

Abstract: Misoprostol is a synthetic prostaglandin E1 analogue that has been used as an abortifacient. If abortion doesn’t occur and the conception continues, the baby delivered may have wide range of defects depending on the time of exposure to misoprostol. Central nervous system and limb defects are the most commonly reported anomalies. Here we report a case of newborn with limb defects with history of prenatal exposure to misoprostol. A female baby was born on 03-03-2012 to a non -consanguineous 33year old father and a 23year old mother. The mother has taken by herself one tablet (200mcg) of misoprostol orally during the first trimester of pregnancy with the intention of aborting the fetus. Mother didn’t seek any medical help, though it didn’t result in abortion and she continued with the pregnancy. Antenatal period was otherwise uneventful. The baby was delivered at term by caesarean section and the birth weight was 2.7 kg. On physical examination, the baby showed absence of all four fingers of right hand and rudimentary thumb. The rest of the physical and neurological examination was normal and there was no other congenital anomaly. The limb defect the child had is most probably due to misoprostol ingestion during the first trimester. A plausible teratogenic mechanism involves uterine contractions induced by misoprostol. Such contractions could potentially create a vascular disruption of the fetal–placental unit, resulting in a range of defects. Hence prenatal exposure of misoprostol should be considered in the setting of congenital anomalies phenotypically similar to amniotic band sequence.

NEO/45 (P) TO STUDY THE INCIDENCE AND OUTCOME OF NEONATE WITH HYPERBILLIRUBINEMIA IN PT.J.N.M.M.C. RAIPUR (CG)Sharja Phuljhele, Akash, KanakDept. of Pediatrics, Administrative Block, Dr.B.R.A.M.Hospital and, Pt.J.N.M.Medical College, Raipur, C.GEmail- akashindoc@yahoo.in

Introduction. Neonatal jaundice is the most common reason for readmission to hospital in the first week of life. About 60% of term and 80% of preterm babies develop jaundice in the first week of life. Objective. Study was done to evaluate the incidence and outcome of Neonatal Hyperbilirubenemia. Material and Method:- All the neonates admitted in NICU during OCT 2011 to 27th SEP 2012 with hyperbilirubinemia were included and were classified as term or

preterm according to the day of presentation and the treatment modalities and outcome. Result. Out of 1466 cases 353 had NNHB.Of these, 38 were Preterm admissions , of which 11 were Inborn and 27 were Outborn.315 term admissions of which 65 were Outborn and 250 were Inborn. 14 preterm and 89 term were ABO incompatible while 2 preterm and 10 term were Rh-incompatable. Total 12 exchange transfusions were done during this period of which 7 were done for incompatibility, of which 5 for ABO and 2 for Rh incompatibility. No death was reported. Conclusion. My study showed that one fourth of all NICU admission were NNHB, most of them were Term, out of which ABO-incompatible were one third and 3% were Rh- incompitable. With interventions (Phototherapy and Exchange transfusion) outcome was excellent and no death was reported.

NEO/46 (P) PATTERN OF DISTRIBUTION OF CONGENITAL ANOMALIES IN THE NEWBORNS IN A TERTIARY CARE HOSPITAL IN EASTERN INDIAAbhijit Dutta, Chaitali Patra, Shatanik Sarkar, Prativa Biswas, Shaon Mitra, S.Ghosh Dept. of Pediatrics., R.G.Kar Medical collage, 1.No.Khudiram Bose Sarani, Kolkata—700004E.Mail: dr.adutta@yahoo.co.in

Abstract: Introduction: Congenital anomalies are important cause of neonatal mortality both in developed and developing countries. It is not only a leading cause of fetal loss, but also contributes significantly to preterm birth, childhood and adult morbidity along with considerable repercussion on the mothers and the families. Aims & Objectives: To determine the incidence and distribution pattern of congenital anomalies in newborns and associated maternal risk factors. Materials And Methods: This prospective study was carried out in the obstetrics and gynaecology department and neonatal care unit of R. G. Kar Medical College and Hospital during the period of August 2011 to July 2012. The newborns were examined and assessed systematically for the presence of congenital anomalies. System wise distribution of anomalies and risk factors were analysed. Results: During the study period,17896 newborns were delivered, of which 286 had congenital malformation, making the incidence of 1.59%. Congenital anomalies were more commonly (66%) seen in the multiparas. Most of the women (57%) belonged to the age group between 21 to 30 years. Prematurity and low birth weight was found to have a higher risk of congenital anomalies. The predominant system involved was musculo-skeletal system followed by central nervous system. Talipes was the commonest one in musculoskeletal group and likewise meningomyelocele in CNS. Conclusion: The commonest associated risk factor was low birth weight, prematurity and multiparity, the frequency of which may be reduced by creating awareness regarding regular antenatal visit and early prenatal diagnosis.

NEO/47 (P) EARLY RECOGNITION AND IMMEDIATE OUTCOME OF NEONATAL SEIZURES Satish Ashtekar, Uday Rajput, S.S.Wagh, Nikhil KadamGovernment Medical College, Miraj, Sangli- 416410, MaharashtraEmail: n07031986@gmail.com

Introduction- Recognition of neonatal seizures is difficult because subtle seizure is the most common type of neonatal seizure. Unrecognised seizure of prolonged duration is associated with poor neurological outcome in future.Hence early recognition of various presentation of neonatal

seizure is useful to reduce the morbidity and mortality associated with it. Aims And Objectives: ● To find out clinical manifestation and various presentation of neonatal seizures. Materials and methods- The present study was conducted at tertiary care NICU at government medical college and hospital, during the period of 2 years. Those babies who have presented with seizures in NICU(witnessed seizures) are included Those who are referred from outside or with history of convulsions are excluded. Study Design: a hospital based prospective observational study. Methodology:neonates presented with seizures are recognized by medical or paramedical staff which are readily acted upon by anticonvulsants and supportive measures.The anticonvulsants used are lorazepam,phenobarbitone,phenytoin,midazolam.neurological outcome in each patient ie evaluated over a period of time. Statistical methods-observations drawn. ● Results- Baseline characteristics- Incidence of Neonatal Seizures is higher in preterm babies(22.98%) than term(6.18%) babies ,There is higher preponderance of male infants(5.72%) in the seizure population. Seizure rate is least found in babies between 30 to < 37 completed weeks of gestation(4.42%) ● Primary outcome measure are; overall Subtle seizures are commonest (48%) seizure type.subtle seizures are commonest (61.9%) in preterm babies. Multi-focal Clonic type of seizures common in term babies. Secondary outcome measured are mortality due to seizures is 22% of neonates. Out of 29 patients died, in 16 pts(55%) died even if using 3 anticonvulsants(loraz+phenobarb+phenytoin/midaz) Conclusions : ● Subtle seizures are commonest seizure type seen.mortality and neurological outcome is poor when more number of anticonvulsant used. ● Early recognition is the key to good outcome in neonatal seizures.

NEO/48 (P) PREDICTING OUTCOME IN TERM NEONATES WITH HYPOXIC ISCHEMIC ENCEPHALOPATHY USING ELECTROENCEPHALOGRAPHY AND MAGNETIC RESONANCE IMAGINGChetan. M, G.S. Sengar, Anil Lahoti, C.K. ChaharDepartment of Pediatrics, S.P Medical College, Bikaner, RajasthanEmail ID: drchetankalkura@gmail.com

Abstract: Introduction: Magnetic Resonance Imaging of the neonatal brain and Electroencephalography have been used either independently or together to assess the prognosis of HIE. Objectives: To evaluate the clinical spectrum, MRI and Electroencephalography profile of neonatal HIE and to correlate these findings with neurodevelopmental outcome. Methods: In all the neonates enrolled in the study, detailed history regarding antenatal events, Apgar scores, resuscitation notes were recorded. The severity of HIE was assessed using Sarnat & Sarnat staging system. All infants had a MRI between 2nd to 8th postnatal days. An EEG was recorded once the baby became stable using the standard 10-20 International system. Neurological examination, anthropometry were performed during admission in the unit. All neonates were followed up at monthly intervals and a neurodevelopmental outcome was assessed at 6 months using Denver Developmental Screening Test II. Results: In a total of 70 term neonates with HIE, 16 neonates had mild HIE (22%), 45 had moderate HIE (65%) and 9 neonates were grouped into severe HIE (13%). Both MRI and EEG were predictive of outcome. A normal MRI was always associated with normal EEG and normal neurodevelopment. Severe changes on MRI (i.e. severe Basal ganglia and thalamus with white matter lesions) were associated with stage 4 EEG changes (abnormal background and presence of epileptiform discharges) and were also associated with poor neurodevelopmental outcome. Conclusion: Both Electroencephalography and MRI are valuable tools that predict the prognosis of infants with HIE thus helping in choosing the best

possible preventive measure and also in counselling parents regarding further development of the infant.

NEO/49 (P) INDICATORS OF MECONIUM STAINED AMNIOTIC FLUID AND NEONATAL OUTCOME IN RELATION TO MATERNAL FACTORSUday Rajput, Nikhil kadam, S.S WaghGovernment Medical College, Miraj, Sangli- 416410, MaharashtraEmail: n07031986@gmail.com

Introduction-Meconium Aspiration Syndrome (MAS)continues to be threat to many newborns throughout world with a case fatality rate of 5%(as much as 40%),in addition to short and long term pulmonary and neurodevelopmental sequale. In resource poor developing countries like India where modern electronic gadgets for foetal monitoring like NST,FETAL DOPLER are not available at every situation, it is difficult to predict the foetal outcome. Therefore, this study is planned to highlight the antenatal,intranatal factors responsible for MSL and markers for prevention of early neonatal mortality and morbidity. With this knowledge,we provide approach to enhance health outcomes among neonates by early enactment. Materials- Setting-Tertiary care NICU. Subjects- Study was conducted on 200 babies born with meconium stained amniotic fluid who are admitted in NICU , born in ANC ward and outborn babies referred for meconium stained liquor. Inclusion criteria-all babies born to mothers who had meconium stained amniotic fluid inclusive of their birth weight and gestational age. Exclusion criteria-Babies with congenital abnormalities were excluded from the study. Methodology. Detail history of babies and mother with MSAF noted with emphasis on antepartum(PIH,Oligohydramnios,anaemia,antepartum haemorrhage) and intrapartum risk factors and factors like need of resuscitation ,need for NICU admission, consistency of meconium(thick,thin and moderate)etc.were taken. Results- During study period of 2 months, there were 1513 livebirths, out of which 200 babies born with MSAF. Thus, making incidence of MSAF to 13.21%.. Primary outcome- Common maternal and fetal risk factors were foetal distress(30%)followed by Oligohydramnios(30%),Pregnancy induced hypertension(24%), anemia(14%),severe anemia(5%), Antepartum hemorrhage(4%) and Antepartum eclampsia(4%).Out of 200,48 babies were admitted to NICU and mean duration of NICU stay was 4 days. Most common indication for NICU admission were birth asphyxia (16%) and MAS (6%) .Total number of deaths were 18 and all these babies had thick meconium with severe birth asphyxia. Secondary outcome-out of 200,78 mothers are between 20-25 yrs of age,122 were >25 years of age.out of 200,136 mother has wt 40-50 kg,54 has 50-60 kg. out of 200,86(43%) were primigravida,114(57%) were multigravida. Out of 200,159(72.5%) were >37 weeks of gestation(post dated),33(16.5%),were 35-36 weeks of gestation,8(4%) were <34 weeks of gestation. There were 110 male babies and 90 females babies . 104(54%) had BW < 2.5 Kg,96(43%) had BW>2.5 kg,. Majority of babies were delivered through thin MSL(44%) followed by thick (35%) and moderate (21%). Out of these 18 babies,4 had septicaemia with DIC and 2 had NIH. 38 babies were non vigorous requiring tracheal suctioning and positive pressure ventilation at birth. Common mode of delivery was emergency Cesarean in 83% patients. Conclusions-Oligohydramnios,PIH,anemia and fetal distress were common antenatal and intranatal factors associated with MSAF. Major morbidity and indication for NICU admission was Birth asphyxia and non vigorous babies.Mortality rate was 9% which is commonly associated with thick meconium and severe birth asphyxia.

NEO/50 (P) ADRENALINE IN REFRACTORY SHOCK IN NEWBORNS WITH BIRTH ASPHYXIASharath Chandra N, Usha B K,Sudha RudrappaDepartment of Pediatrics, Mysore medical College & Research Institute.Email: drnsharathchandra@gmail.com

Introduction: Shock is an important cause of morbidity and mortality in new born.Shock in babies with birth asphyxia is cardiogenic. Ionotropes are used in the management of shock. Adrenaline with its actions on both α and β receptors is used as ionotropes when shock is resistant to dopamine and dobutamine. Aims And Objectives: To evaluate adrenaline as ionotropes in refractory shock in newborn with birth asphyxia. Materials And Methods: Study was conducted from June to Aug 2011.Newborn with Apgar score < 5 at 10 min were admitted. NIBP mean arterial pressure was used as reference to start ionotropes and during treatment. Fluidchallenge 20ml/kg given.Inotropes started in order dobutamine,dopamine and adrenaline.Baby was evaluated for sepsis and for bleeding.When MAP was stable for 24 hrs,ionotropes was tapered and stopped. Results: There were 15 cases with male:female - 2.75:1. 11(73.37%) delivered vaginally.10(66.6%) were term.Total 15 N %MSAF 6 40Wt < 2499 6 40>2500 9 60Resp distress 11 73Resp failure 7 46HIE I 6 40II 7 46 III 1 6.6G I hage 5 33Blood culture 4 26.6Duration of adrenaline <24 hrs Death 6 40

Survived 2 13.3 >24 hrs Survived 7 46.6Dose of adrenaline(µg/kg/min) 0.1 Survived 7 46.6

Death 0 00.2 Death 5 33.3

Survived 2 13.30.3 Death 1 6.6Recovered from shock 9 60Death 6 40Conclusions: 1. Adrenaline is an effective adjunct to ionotopes in refractory shock. Adrenaline when started early even in small doses improves survival of babies

NEO/51 (O) PROBIOTICS HAVE A ROLE IN LATE-ONSET SEPSIS BY CANDIDA SPECIES IN PRETERM NEONATESAmrita Roy, Swapna Chakraborty,

Department of Paediatric Medicine, Medical College, KolkataEmail: preences.amri3107@gmail.com

Introduction: Candidemia in the neonatal intensive care unit (NICU) is steadily increasing, with an incidence of 1.6 to 9% in very-low-birth-weight neonates. The gastrointestinal tract is most frequently implicated site in candida septicaemia. Aims & Objectives:  Probiotics may reduce the colonization of fungal colonies in the gastrointestinal tract, and reduce the risk of bacterial and/or fungal nosocomial infections. Materials & Methods: From May 2009 to July 2010, a prospective randomized trial was conducted in 166 preterms with a birth weight <2500 g and a gestational age <37 weeks consecutively admitted at the NICU & Nursery of Medical College & Hospitals, Kolkata. Inclusion criteria were stable oral feeding within 72 h of birth and an informed parental consent; exclusion criteria were the presence of major congenital malformation or antenatal and perinatal risk factors for sepsis. The newborns were randomized into 2 groups by simple random sampling: group I (n=83) received supplementation with Enterogermina 5 drops daily from the first 72 h after hospitalization for 6 weeks or until they were discharged; group II(control) (n=83) received with no probiotics. Stool samples were cultured for Candida detection & CFU (Colony forming Units) at birth and after 7, 14, 21 and 28 days or till discharge. Statistics: χ2 test and Fisher's exact test was used when applicable. Results: No significant differences at baseline between the 2 groups. The probiotic group presented a significant reduction in gastrointestinal symptoms than the control group. Candida stool colonization was significantly higher (P<0.01) in the control group. The number of invasive Candida infections between 2 groups was not statistically different. All the infants with invasive fungal infection had a gestational age <32 weeks and a birth weight <1500 g. No statistical difference was observed in the duration of antifungal treatment however, neonates with probiotic supplementation resulted in a fast clinical improvement. Conclusion: The use of both probiotics seems to be effective in the prevention of gastrointestinal colonization by Candida, faster clinical improvement in candida septicaemia. However, it could not decrease the incidence of late onset sepsis.

NEO/52 (P) ROP SCREENING BY RET CAMM K Behera, A Parekh, S Kulkarni, P SoniDept of Paediatrics S K N Medical College & Hospital Pune , 411041 Email: manaskumarbehera@yahoo.co.in; manasbehera1952@gmail.com

Introduction: ROP is a fibro vascular proliferative disorder, affect the developing retina of preterm infants and it is an important avoidable cause of blindness in children. RETCAM for ROP screening is very sensitive for early diagnosis and follow up. Aim & Objective: A prospective follow up study was conducted to determine the incidence of ROP and to analyze the associated risk factor. Material & Method: All babies < 34 wks and weight < 1750 gram as well as 34 -37 wks & weight 1750-2000 grm with risk factors were screened for ROP from April 2009 to March 2012 in NICU and High risk follow up clinics in S.K.N. Medical College & Hospital Pune in collaboration with S. V. Desai Eye Hospital Pune by using RETCAM . Expired babies & lost to follow up were excluded from the study. Result: Total Babies screened 83, ROP detected in 21 and incidence of ROP is 25.30 %. Incidences of ROP in babies < 1000 gm - 62% , in < 1200 gm – 48% ,in > 1200 gm 14%, 5 ( 25% )ROP babies are <1000 gm, 13 ( 62% ) are < 1200 gm and 8( 38% ) are > 1200 gm . Male: female ratio of ROP babies 10:11 , Mean wt of ROP babies - 1.19 kg ± 0. 25. Mean age of of ROP babies

29.81 ± 2.13. . ROP Stage I in 3 (14%), stage 2 & stage 3 each in 8 (38%), Plus disease 2 (9.52%) , 5 babies (24%) were treated with laser therapy . Lower birth weight was significantly associated with increased incidences and seventy of ROP. On variant analysis risk factors like oxygen administration, RDS, blood transfusion, apneas, ventilation, and de saturation were significant (p < 0001). Conclusion: ROP screening with RETCAM is an easy procedure avoid stress and expertise of indirect opthalmoscopy, it eliminate inter observer variability. It is very useful for early diagnosis, follow up, documentation and helps in referring the images for opinion of

NEO/53 (P) STUDY OF RETINOPATHY OF PREMATURITY IN A TERTIARY CARE NEONATAL UNITRanjit Kumar Joshi, Anjali KulkarniDept. of Pediatrics, Apollo Hospital, Unit-15, Sainik School Road, Bhubaneswar-751005, OdishaE-mail: ranjitkumarjoshi@yahoo.com

Objective: To study the incidence, risk factors, early diagnosis and treatment of retinopathy of prematurity. Design: Both Retrospective and Prospective study comprises of 145 babies. Settings: Infants admitted to tertiary care neonatal intensive care unit between Apr-2008 to Apr-2012. Methods: Both inborn and outborn with birth weight <1500kgs and gestation<32 weeks and selected infants with birth weight between 1500 to 2000 grams and more than 32 weeks with unstable clinical course were screened for ROP at 6 weeks post-gestational age(for<26 weeks gestation); at 5 weeks(27 to 28 weeks); at 4 weeks (29 to 30 weeks) and at 3 weeks for >30 weeks babies. Infant found to have threshold ROP had laser photocoagulation. Results: The incidence of ROP was 30% and highest in <1000 grams (58%) and <28 weeks(75%).Co-morbidities such as packed red blood cell transfusion (p<0.0001), sepsis (p<0.0001) and prolonged ventilation(p<0.0001) were associated with majority of ROP cases. Duration of ventilation and labile oxygen requirement for prolonged period was also associated with higher stage of ROP and requirement of LASER. Out of 44 infants who had ROP, 20(45%) needed laser photocoagulation. Conclusion: Incidence of ROP is increasing due to increased survival of low birth weight babies. So early diagnosis with reduction of risk factors can prevent serious morbidities.

NEO/54 (P) PROFILE OF NEONATAL MENINGITIS CASES IN A TERTIARY LEVEL HOSPITALKanta Boro, Reeta Bora, Diganta Barman, Ajay kumarDepartment of Paediatrics,Assam Medical College,DibrugarhEmail: digantabarman19@yahoo.com

Introduction: Studies done in late 90s have found neonatal meningitis to be associated with neurological sequele in almost 50%.Neonatal care has improved in recent years. No study is available in our state to find out profile and sequele of neonatal meningitis. Setting: Neonatal unit,AMCH. Objectives: To find 1. Incidence of neonatal meningitis 2. neonatal outcome after meningitis. Materials And Methods: Neonates born in AMCH between September,2011&February,2012 with clinical or culture proven sepsis with meningitis were included. Neonates with CMF & needing surgery were excluded. Enrolment was done if septic

neonates had CSF suggestive of meningitis biochemically/cytologically. Neurological examination& USG cranium was done at discharge. Follow up was at 1,3,6 months . Results: After applying exclusion & inclusion criteria 47 babies were included. 545preterm&3668term were born during study period .Meningitis was present in 17 preterm & 30 term babies.(p<0.01)&in 38/102 culture positive sepsis(37.25%)&9/54 clinical sepsis(16.67%).91.4% had EOS. Respiratory distress was the commonest symptom(53%) followed by HYPOGLYCEMIA(23%) followed by convulsion(14.9%).Predominant organism was GRAM NEGATIVE BACILLI(36.17%). In Csf average value of protein(mg%) was 194(50-400),sugar(mg%) 32(0.5-60)&cells(/cm3)165(5-4500).Csf culture was positive in 2.1%.USG cranium at discharge was abnormal in 21% cases.Neurological examination was abnormal in 15% cases at discharge&in 19.4% cases at 6 month(p<0.01).7.7% babies died during follow up period. Conclusion: Neonatal meningitis was more common in preterms. Neurological sequele with present management is 19%.Longterm neurological follow up is essential.

NEO/55 (O) SEVEN DAYS VERSUS 14-DAYS OF INTRAVENOUS ANTIBIOTICS FOR NEONATAL SEPTICEMIA – A RANDOMIZED TRIAL Saurabh Kataria, Reeta BoraDepartment of Paediatrics, Assam Medical College (AMC), DibrugarhEmail: drskataria@gmail.com

Setting: Neonatal unit AMC, Dibrugarh. Introduction: Studies done to find out ideal duration of antibiotics for neonatal sepsis (NNS), a major cause of neonatal death are few with no acceptable conclusion. A short course of antibiotic for culture proven NNS if proven efficacious, will reduce complications like NEC, microbial resistance etc. Objectives: To find if 1. 7-day antibiotic course is comparable to 14-day course in NNS. 2. Relapse rate varies with causative organism. Materials And Methods: Inborn neonates >30wks gestational age (GA) & birth weight (BW) >1000grams born during study period with blood culture-positive sepsis were included. Neonates with major CMF, deep seated infection, meningitis or needing major surgical treatment were excluded. Enrolment and randomization was done if neonates had culture- positive sepsis &asymptomatic after 5 days of antibiotics. Reappearance of signs of sepsis within15 days of stopping antibiotics with same growth in blood culture was relapse. Neonates were followed for 15 days after stopping antibiotics. For statistical analysis, chi-square was applied for categorical variates. For statistical calculations, SPSS software was used. Results: After applying exclusion & inclusion criteria 39 babies were randomized to 7 days &40 babies to 14 days AB course (n=79). In 7-days group EOS: LOS was 97.5%:2.5% & in 14-days group 90%:10% (P=0.3).In 7-days group symptomatic: asymptomatic was 80:20 and in 14-days gr 85:15(p=0.7). Sepsis screen was positive in 76.92% in 7-day group &in 62.5% in14-days group (P= 0.25). Staphylococcus aureus was predominant organism in both groups (58.97%in 7-days& 50%in 14-days group). No relapse was seen in both groups. Conclusion: 7-days antibiotic course is equally effective as 14-days course for blood culture-positive sepsis.

NEO/56 (P) STUDY TO IDENTIFY NEWBORN AT RISK OF DEVELOPMENT OF HYPERBILIRUBINEMA USING FIRST DAY TOTAL SERUM BILIRUBIN (TSB)Chandan CK, Mounesh P,Chinmay B,N Tago,N MohantyS/O Ca Kumar, Mig-I Door # 30, Housing Board , Kr Nagar, Mysore – 571602, KarnatakaEmail: kauravadoc@gmail.com

Introduction: Jaundice is commonly encountered clinical condition and constitutes major morbidity 50-60% in term and >80% preterm baby within early neonatal period.Neonatal hyperbilirubinemia is considered to be significant when Total Serum Bilirubin (TSB) ≥17mg/dl.Trend of early discharge of newborn has led to significant re-admission for jaundice.Hence there is need for to predict development of jaundice to prevent possible re admission. Aims And Objectives: To evaluate co-relation of first day TSB with occurrence of jaundice in early neonatal period. Materials And Methods: Prospective study was conducted in SNCU of SCB Medical College.250 Healthy term neonates ≥37 weeks with no risk factors were enrolled in study. TSB was measured on D1, D3, D5 of life by modified jendrassik-grof method.TSB ≥6mg/dl on D1 of life was taken as cut off value for risk assessment. Result: With ROC analysis mean TSB of ≥6mg/dl on D1 of life was found to have sensitivity of 94% to predict new born who would have significant jaundice. With this critical mean TSB≥6mg/dl,negative predictive value was very high 98.4% and positive predictive value was 22.3%.Of the 134 newborn who had TSB≥6mg/dl, 35% and 51% developed significant jaundice on D3& D5 of life respectively and only 6% and 10%of newborn with TSB<6mg/dl developed significant jaundice on D1&D5. Conclusion: Mean TSB ≥6mg/dl on D1 of life as cut off can be useful to predict significant hyperbilirubinemia in early neonatal period, but study need to be conducted in large scale and can be established as tool to predict N hyperbilirubinemia.

NEO/57 (P) A PROSPECTIVE STUDY ON IMPACT OF KANGAROO MOTHER CARE IN REDUCING MORBIDITY AND MORTALITY AMONG LOW BIRTH WEIGHT BABIES IN A TERTIARY CARE HOSPITALNandini Naskar, Leena Das, Pravakar Mishra, Niranjan MohantyDepartment of Pediatrics, SCB Medical College & Hospital, Cuttack-753007, OdishaEmail: nnbrishti@gmail.com

Introduction: Worldwide more than 20 million babies are born each year with low birth weight either because of preterm birth or impaired prenatal growth.These babies require intensive neonatal nursing & care from often limited resources at a vast expence.Kangaroo mother care ( KMC) is defined as skin to skin contact between mother and baby,early initiation of frequent and exclusive breast feeding and early discharge from hospital so as to continue such care at home. Aims & Objectives: To determine whether there is evidence to support the use of KMC in low birth weight infants as an alternative to conventional neonatal care. Materials & Methods: Place of study: Newborn ward of SCB Medical College & Hospital and SVP PGIP,Cuttack. Study design: Prospective Cohort study. Duration of study: 1 year study from October 2011 to September 2012. Study subjects: 240 low birth weight newborns (<1800g) with mothers complying with our study, started KMC after stabilisation of the newborn for at least 6 hr/day. Study instrument: Pre designed proforma, electronic weight machine and measuring tape. Data thus obtained was tabulated and analysed using percentage, relative risk (RR), mean difference and chi square test. Results: At discharge or 40 week post menstrual age KMC was found to be associated with a significant reduction in the risk of mortality(RR 0.7), nosocomial sepsis(RR 0.55), hypothermia(RR 0.32)length of hospital stay ( mean difference 3 .1 days). KMC has significant positive impact on initiation and sustaining breast feeding, growth parameters and mother infant bonding. Conclusion: This study supports the use of KMC in low birth weight babies as an alternative to conventional neonatal care mainly in resource limited settings.

NEO/58 (P) NEWBORN SCREENING FOR CONGENITAL HYPOTHYROIDISM (CH) IN UTTAR PRADESH UP)Bhatia V, Joshi K, Gopalakrishnan V, Dabadghao P, Phadke SR, Das V, Agarwal M. Additional Professor, Department Of Endocrinology, Sgpgims, Post Box- 375, Lucknow -226001, Uttar PradeshEmail: bhatiaviji@gmail.com

Introduction – Newborn screening (NBS) in India is still in its nascent stages due to poor infrastructure and economic constraints. Aims and Objectives- To evaluate feasibility and recall rates in a thyroidNBS program in underprivileged population in UP.Methods- Post natal heel prick samples were collected on Whatman 903 filter papers at 24 to 96 hours of life for TSH assayby immunofluorescence. Babies with screen TSH20 - 40miu/L were recalled for repeat filter paper sample at10 days.Those with screen TSH>40miu/L were immediately recalled for serum TSH and T4. After the first 5000 babies,in view of high recall rates, age related cut offs were used:TSH >34miu/l during 24-48 hours of life and >20miu/L after 48 hours. Results- 11,700 newborns were screened. 5% mothers refused screening and 11% of those recalled refused to come for confirmatory sample. Using 20miu/l cutoff,recall rate was 1.47%.With age related cutoffs,recall was lowered to 0.88%, though still high.Nine babies with CH were identified. Three (screen TSH 96 to 331miu/L)have transient CHand are off therapy. Three have permanent CH (imaging and follow up findings).Three are possibly transient, on tapering doses of levothyroxine at 4 to 6 months of age. Conclusions - NBS can be successfully implemented in underprivileged regions of India. Age related cutoffs may be necessary to deal with the high recall rate resulting from early discharge and neonatal TSH surge. Follow up is important to distinguish transient and permanent CH.

NEO/59 (P) EVALUATION OF NEONATAL JAUNDICE BY TRANSCUTANEOUS BILIRUBIN MEASUREMENT DEVICE (BILICHECK)Devdeep Mukherjee, Rafiqul Hassan,.Apurba GhoshInstitute Of Child Health, Kolkata 17Email – devdeep_dm@rediffmail.com.

Introduction: Levels of transcutaneous bilirubin (TcB) can be determined with a device that non invasively estimates total serum bilirubin levels by measuring light transmission through the skin of neonates. Materials And Methods: 120 neonates were studied during September 2011 to August 2012 at NICU of ICH, Kolkata. All neonates having clinical jaundice, requiring estimation of serum bilirubin were included in the study. Babies who had received phototherapy or had an exchange transfusion were excluded. BILICHECK (transcutaneous bilirubinometer) and Laboratory method (Diazo Reaction) were used for the study. Neonates were investigated for total serum bilirubin by a single standard laboratory method and simultaneously with transcutaneous measurement of bilirubin by BILICHECK. Results: 60 neonates were male. The study group was divided into term (83 neonates) and preterm (37 neonates).Mean gestational age was 37.9 weeks and mean birth weight was 2583.3 grams. Mean age when measurements were taken was 74.3 hours. The overall correlation of TcB and TSB for the whole population is linear and statistically significant. Pearson”s correlation co-efficient: r=0-79, P = <0.001 and r2 = 0.61.Similar correlation existed between TcB and TSB in term population as was in whole

population. Pearson”s correlation co-efficient r= 0.79, P= <0.001 and r2= 0.62.Corelation between TcB and TSB was linear and statistically significant for pre-term population. Pearson”s correlation co-efficient r=0.78, r2 =.602, P<0.001.The average error in evaluating hyperbilirubinemia with TcB compared with evaluation with TSB was 0.3mg/dl (95% CI = -5.9 to 6.4). This finding means that TcB measurement slightly underestimated in comparison with TSB. The agreement between TcB and TSB was poor with increasing bilirubin level. Only 6 data point (5%) fall outside 2SD of the difference, indicating that the difference were normally distributed. Conclusion: According to our results,TcB level was correlated well with the laboratory measurement of TSB. It also demonstrated that using TcB level of above the 75 th

percentile for age was 100% sensitive in identifying infants who may be at risk for clinically significant hyperbilirubinemia.

NEO/60 (P) COMPARATIVE ANALYSIS OF EFFICACY OF IBUPROFEN AND INDOMETHACIN FOR PDA CLOSURER. Kishore Kumar, Abhay B Mahindre, Mir Dilshad Ali, Ashwini Kawale, Nandini Nagar, S.V. Girish.Neonatal Department, Cloudnine Hospital, 1533, 9th Main, 3rd Block Jayanagar, Bangalore – 560011, INDIAEmail: drkishore@cloudninecare.com

Background: PDA is a common cause of morbidity in preterm newborn. Ibuprofen & indomethacin are both prostaglandin synthesis inhibitors that facilitate contraction & closure of the duct but has varying side effects. Objective: To compare the efficacy of ibuprofen & indomethacin for preterm ductal closure. Methods: This retrospective study was conducted from August 2007 to July 2012. A total 35 cases of PDA were identified. PDA was suspected clinically based on signs & symptoms. Echocardigraphic confirmation was done in all cases. Of 35 newborn newborns 19 (54.28%) were male and 16 (45.72%) were female. Birth weight varied from 710 gm -3860 gm (mean 2000 gm) & gestation age varied from 27 wks - 36 wks. Age at presentation varied from 1 to 6 days. Ibuprofen was administered to 22 (62.85%) babies IV Indomethacin was administered to 13 (37.14%) babies of which 8 (61.58%) received at the rate of 0.2 mg/kg/dose for 3 days & remaining 5 ( 38.46%) received at the rate of 0.1 mg/kg/dose for 6 days. Results: Ductal closure was observed in 21 (95.45%) with ibuprofen and 12 (92.30%) with indomethacin. Babies who failed to respond to one mode of medical treatment was switched to other modality but no closure occurred & failure babies required surgical ligation. Side effect profile was comparable in both the groups. Conclusion: Treatment with ibuprofen & indomethacin is equally effective and the babies do not respond to one mode is unlikely to respond to other & requires surgical ligation. Key words: PDA; Ibuprofen; indomethacin; efficacy.

NEO/61 (P) OSTEOPENIA OF PREMATURITY: EXPERIENCE OF TERTIARY LEVEL NICU OF SOUTH INDIAAbhay B Mahindre, R. Kishore Kumar, Mir Dilshad Ali, S.V. Girish, Nandini Nagar, Syed Tejamul.Neonatal Department, Cloudnine Hospital, 1533, 9th Main, 3rd Block Jayanagar, Bangalore – 560011, INDIA.Email: drkishore@cloudninecare.com

Background: Osteopenia of prematurity (OPP) is a metabolic bone disease referred to as hypomineralized skeleton of the premature infants due to decreased amount of bone matrix (scarcity of bone) & can be caused by either insufficient synthesis &/or increased resorption of organic bone matrix. In growing VLBW infants(Birth weight < 1500 grams; GA < 32 weeks) OPP is very common. Serum alkaline phosphate is often correlated with disease severity. Objective: To see the incidence & prevalence of osteopenia of prematurity in VLBW newborns admittied at tertiary level NICU of Cloudnine hospital Bangalore. Methods: This retrospective study was conducted between August 2007 to July 2012. All VLBW newborns admitted in NICU over the study period were subjected to screening for ostepenia based on standard protocol. Results: During the study period there were 158 VLBW babies admitted in NICU. Out of these 13 babies had serum alkaline phosphate value > 500 IU/L with the incidence of 8.2% among VLBW newborns. Mean gestational age of these newborn is 28.6 weeks & mean birth weight is 1140 grams, mean age of diagnosis is 20.8 days. Two babies had alkaline phosphate value > 1000IU/L with radiological evidence of rickets. Conclusion: Incidence of osteopenia of prematurity is significantly lower in our NICU compared to present available data. This low incidence can be correlated with antenatal screening of mothers for calcium & vitamin D deficiency with adequate supplementation and early enteral feeding. Key words: Osteopenia, alkaline phosphate, VLBW

NEO/62 (P) NON HEREDITARY SPHEROCYTOSIS IN NEWBORN - A RARE CASE REPORTAbhay B Mahindre, R. Kishore Kumar, Syed Tajamul, Ravi SahotaNeonatal Department, Cloudnine Hospital, 1533, 9th Main, 3rd Block Jayanagar, Bangalore – 560011, INDIAEmail: drkishore@cloudninecare.com

Introduction: Hereditary spherocytosis is a common hemolytic anemia. But non hereditary spherocytosis is rare in newborn population. Case report: 3 day old male baby first born to non consanguinous married couple, delivered by LSCS presented with yellowish discoloration of skin. There was no other risk factor; breast-feeding well, no significant weight loss & no family H/O neonatal jaundice Examination: had pallor, deep icterus, no hepatospenomegaly. Other systems were normal. With a provisional diagnosis of Neonatal hyperbilirubinemia started on phototherapy and investigated. Initial Investigations: i) Hemoglobin 16.3g/dl. ii) Peripheral smear- Marked anisopoikilocytosis, spherocytes, polychromasia, 2 nucleated RBCs/100 WBCs. WBCs and platelets were normal. iii) MCHC- 39.3 % MCV -75.3 fl. iv) Reticulocyte count – 8% v) Osmotic fragility – Markedly increased vi) Hemoglobin Electrophoresis (SDS PAGE) - normal Spectrin & Ankyrin vii) Direct coomb’s test- negative viii) Liver function tests- S. bilirubin- total 15.3 mg/dl and indirect 0.5 mg/dl. Diagnosis and further course of management. Diagnosis of non hereditary spherocytosis was confirmed. Baby readmitted on day 8 of life with severe unconjugated hyperbilirubinemia requiring exchange transfusion. At 6 weeks check baby was found to have severe pallor with mild icterus. Investigation reveled severe anemia, mild jaundice with high retic count & peripheral smear showing few spherocytes, mild polychromasia. USG abdomen reveled moderate splenomegaly, parents were evaluated for hereditary sphereocytosis, were normal. As child had severe anemia, he was given one unit of blood

transfusion. He was put on folic acid supplement 1 mg daily. Key words: Non hereditary spherocytosis, Osmotic fragility, Gall stones, Splenectomy.

NEO/63 (O) ROUTINE NEWBORN SCREENING PROGRAMME – WHAT ARE WE WAITING FOR? AND WHAT ARE THE IMPLICATIONS FOR THE REST OF THE WORLD?R. Kishore Kumar, Nandini Nagar, Arvind Shenoi, Girish.S.V., Suma, Prince Dinakar, Abhay MahindreNeonatal Department, Cloudnine Hospital, 1533, 9th Main, 3rd Block Jayanagar, Bangalore – 560011, INDIA.Email: drkishore@cloudninecare.com

Objectives: Routine newborn screening programme – is it worth the effort and money? Subjects and interventions: Newborn screening (NS) was performed on samples between 26.01.2007 and 31.08.2012. Dried blood samples from either heel prick or vene-puncture were collected from babies at 36 hours of age, on special filter papers, dried & sent in for analysis. Results: A total of 10,651 samples were tested. Abnormal results were detected in 453 (4.21%). One hundred twenty nine needed to be repeated – majority because of abnormal results (79) -) - galactosaemia (1), congenital hypothyroidism (CHT)(11), Congenital adrenal hyperplasia (CAH) (5), transient tyrosinaemia (8), abnormal acylcarnitine profile (10), hyper-phenylalaninaemia (8) and glucose 6 phosphate dehydrogenase deficiency [G6PD] (319) - and rest were for poor sampling (40) & prior transfusion (10The baby with galactosaemia had a variant type as the Galactose-1-phosphate uridyl transferase enzyme activity was measured at 25 % of normal. G6PD ranged from 0 to 20 % of normal activity. 80 cases of “pseudo-methylmalonic acidaemia (MMA)” were detected due to maternal vitamin B12 deficiency. Conclusions: 1) The incidence of hypothyroidism – in our study was less than 1:1000. 2) G6PD - The results of the ongoing programme clearly indicate that it is beneficial as we would have missed these cases, which could have caused significant morbidity. 3) We have enough data that India needs to screen for CHT, CAH, G6PD and MMA. Commercialisation and poor reporting can destroy the programme. We give a cautious welcome to this programme, with proper analysis and reporting being in place. Keywords: Newborn screening, inborn errors of metabolism

NEO/64 CASE PROFILE IN HIGH RISK CLINIC (HRC) IN A TERTIARY CARE HOSPITALPravakar Mishra, N. Gupta, Sandeep Ku Tripathy, Dolamani TandiSVP PG Institute of Pediatrics & SCB Medical College, Cuttack – 753002, Odisha, IndiaEmail- drpmishra61@gmail.com

Introduction:- As a large number of ELBW & VLBW babies are surviving by improved neonatal care including NICU, they are followed up in HRC for better outcome. Our Institute started HRC from February 2012. Babies surviving from NICU and Newborn wards satisfying criteria for High Risk babies are included in this study. They are followed up on Wed and Monday 9AM to 12 Noon at specified intervals as per NNF guidelines. We followed up 192 babies. Results:- 1) Hie- 45.8%. 2) Neonatal sepsis-20.8%. 3) Preterm- 28 to 35 wks- 22.6%. 4) -<28 wks- 2.2%. 5) LBW- 12.5% VLBW- 16.6% ELBW- 6.8%. 6) Neonatal seizure- 9.4%. 7) Neonatal meningitis- 4.6%. 8) Congenital malformations- 16.6%. 9 Nicu(ventilated)- 3.4%. 10) TTT-

1.04%. 11) Neonatal bilirubinimia encephalopathy- 9.4%. 12) Abnormal neurological exam- 4.7%. Interventions in HRC:-1) Feeding councelling- 87%. 2) Immunisation-87%. 3) Physiotherapy-32.4%. 4) Speech therapy-7.3%. 5) EEG - 34.6%. 6) AED- 13.8%. 7) BERA- 18.6%. 8) CT/MRI brain-9.3% abnormal in- 7.3%. 9) Echo study with cardiology consultation- 10.1%. 10) Malformation with surgical consultation- 4.1%. Conclusion:- High Risk babies have significant single or multiple morbidities, which need timely intervention and longterm follow up for better outcome.

NEO/65 (P) NEONATAL MORTALITY – RETROSPECTIVE ANALYSISJhancy.M, Madhavi.N, A.Satyavani,.Giridhar, D.ManikyambaRangaraya Medical College, Kakinada, A.P.Email:jhansimalay@yahoo.com

Introduction: The Neonatal period is a highly vulnerable time for an infant. The Neonatal Mortality is highest during first 24 hours and accounts for about 65% of all infant deaths.The leading causes of Neonatal deaths in India are infection (sepsis), birth anoxia and prematurity. India, with about 1.2 million deaths of neonates each year, accounts for over one quarter of all neonatal deaths in the world. Aims & Objectives: To study major causes of inborn neonatal mortality in single teaching hospital. Materials And Methods: Retrospective analysis of causes of inborn newborn mortality. The data collected every month from the neonatal case sheets from NICU, GGH, Kakinada during January 2012 to June 2012. Results: Total institutional deliveries were 5472, Inborn admissions 562 (10.27%). The total number of deaths were 131 with neonatal mortality of 23.31%. 63(48.10%) neonatal deaths were due to birth asphyxia including MAS with more incidence around May , June. 34 ( 25.95%) were due to sepsis. The parturient to Obstetrician ratio is 10:1. Newborn to paediatrician ratio 25:1 Nurse to newborn ratio 10:1. Conclusions: Our analysis showed major neonatal deaths were due to birth asphyxia. Few other contributing factors are delayed Referrals from outside. Lack of newborn care corners in delivery rooms, trained staff who continuously changes to various other departments. Lack of qualified lab technicians with 24 hrs laboratory facilities, sufficient disposables and quality equipment with annual maintenance. Preventable deaths from our analysis were 97 out of 131 with NMR 6.05% provided many practical difficulties are rectified.

NEO/66 (P) SHORT RIB POLYDACTYLY SYNDROME: REPORT OF TWO CASES OF TWO DIFFERENT SUB-TYPESKausik Mandal, Swarupananda MaitiDepartment Of Neonatology; IPGME&R and SSKM Hospital; Kolkata; India. E mail: mandal.kausik@gmail.com

Introduction: Short rib polydactyly syndrome (SRPS) is a group of rare lethal skeletal dysplasia manifested with short limb, short ribs and polydactyly. There are four major sub-types. Here we report 2 cases of SRPS. Case 1: A macerated still born was born vaginally at term to a 20 year old gravid2 para1 woman. The couple was nonconsanguinous. 1st pregnancy resulted in a spontaneous abortion at 4months. Antenatal USG at around 30 weeks revealed fetal ascites, shortened limbs and macrocephaly with mega cysterna magna. External examination showed a hydropic and dysmorphic fetus weighing 3000grams. The thorax was short and narrow. External genitalia was ambiguous; phallus was small with penoscrotal hypospadias; small gonads in

genital folds were noted. All four limbs were short and revealed postaxial polydactyly on both hands with overlapping of 4th toe over 3rd toe on both feet. Postmortem radiograph showed short horizontal ribs (there were 11 pair of ribs;12th rib was absent), small scapula, high positioned clavicles, relatively normal tibia and smooth pointed femoral ends with no spur. Radiograph was suggestive of SRPS Type I. Autopsy examination revealed dysplastic left kidney. Case 2: A 2125 gram female baby was delivered vaginally at 34weeks. She expired within 30 minutes of birth due to pulmonary hypoplasia. The parents were nonconsanguinous. Mother was a 3rd gravida. Prior to this pregnancy, a term male baby died similarly within 1hour of birth. Exact details of that baby were not available. There was no history of infection or drug intake or radiation exposure during current pregnancy. Antenatal USG at 28 weeks revealed mild ascites, small ribs, pulmonary hypoplasia, large echogenic kidneys, small limbs and polydactyly. There was central cleft lip, natal teeth and bifurcated tongue. The thorax was short and narrow. External genitalia was normal female. All four limbs were short and revealed postaxial polydactyly along with bilateral bifid thumbs and toes. Postmortem radiograph showed narrow long thorax with short horizontal ribs with bilateral short ovoid tibia suggestive of SRPS Type II. Discussion: Short rib polydactyly syndrome is a heterogenous group of skeletal dysplasia presenting with hypoplastic thorax, short horizontal ribs, polydactyly and a variety of nonskeletal defects. According to the international osteochondrodysplasia classification, there are at least four types of SRPS: Type I (Saldino-Noonan), Type II (Majewski), Type III (Verma-Naumoff) and Type IV (Beemer-Langer). All the types are inherited as autosomal recessive trait and all are lethal in the newborn period. The molecular basis of different varieties of SRPS has not been very clearly elucidated and subtyping of SRPS is often difficult because of considerable overlap of the characteristic features. Our first case has most features of type I and the second that of type II.

NEO/67 (P) NEONATAL AIRWAY COMPROMISE BY AN EXTENSIVE VENOUS HEMANGIOMA –SURGICALLY MANAGEDShenoy J, Coutinho A, Kamath Sowmini P, Pai S, Anchuri Swapna, Malayil ShareefKasturba Medical College, Mangalore, Manipal UniversityEmail: kamathsowmini@yahoo.com

Abstract: Background: Hemangiomas may appear at birth as cutaneous (surface) or subcutaneous (deep) lesions affecting any part of the body. Diagnosis may be missed, if it is deeply situated. Case report: Third trimester antenatal scan revealed cystic lesion (63 X 55 mm) with multiple septations - ? Cystic hygroma neck. Outborn 34-36 wks preterm female AGA (Birth Wt - 2.54 Kg) delivered by caesarean section. Resuscitation and immediate ventillatory support required due to mass obstructing the airway.Clinical examination revealed an ill defined lobulated, non pulsatile, compressible, nonreducible mass (6x5 cm) over the anterior aspect of neck extending between the bilateral anterior borders of sternocleidomastoid muscles with the lower border inappreciable along with absence of bruit. Systemic examination was unremarkable. USG neck revealed large mutli septated cystic lesion with vascularity noted and extending into the retrosternal area, features suggestive of vascular malformation. CECT NECK was conclusive of vascular malformation extending inferiorly till the superior mediastinum. As there was no clinical response with inj dexamethasone and propranolol, the mass was surgically removed on day 25 of life. Histopathology of the lesion was suggestive of venous hemangioma. Baby is off ventilator and is maintaining saturations on tracheostomy with T piece. She is tolerating feeds well.Thyroid and parathyroid hormone assays were done to rule out deficiency states. She is on

oral thyroxine for the associated hypothyroidism. Conclusions: Extensive and deeply situated hemangiomas can be life threatening and requires early identification and intervention.

NEO/68 (P) OUTCOME OF VLBW BABIES AT 1 YEAR OF AGE IN A TERTIARY CARE CENTREJeena Annie Philip, Soumya S.P, Shanavas.A, Sobha Kumar.SNeonatology Unit, Dept of Pediatrics, SAT Hospital, TrivandrumEmail: jeenaanniephilip@gmail.com

Abstract: Objectives: To study the growth and neuro-developmental outcome of VLBW babies (<1500g) in the 1st year of life. Design: Hospital based prospective descriptive study. Study setting: Neonatal ICU and Outpatient clinic of newborn division of a tertiary level teaching centre at Trivandrum. Study Period: 1 Year. Participants: 50 consecutive Very Low Birth Weight newborn babies discharged during the study period. Exclusion criteria: Babies with major congenital anomalies, evidence of Intrauterine infections and hypoplastic babies. Methods: Gestational age was determined by NBS score, LMP and 1st trimester antenatal USG. Babies discharged From NICU were asked to attend the follow up clinic. ROP screening was started at 1 month of age. Assessment of growth was done by 3 monthly measurements and interpreted using IAP growth charts. Developmental evaluation was done by DDST II. Hearing was evaluated using OAE/BERA. Assessment for intermittent illnesses/ rehospitalisation were also done. Results: Mean Gestational age of study group was 31.1 weeks and mean birth weight was 1.297kg. On follow up at 1 year, 59.6% of babies had weight less than 3 rd centile, 38.2% had length less than 3rd centile and 6.3% had head circumference less than 3rd centile. 16% developed ROP of which 14% underwent laser therapy. Of them 62.5% had myopia and 58% had strabismus at 1 year follow up. 18% had developmental delay at 1 year of age , of which 4% had spastic diplegia. On Neurosonogram, 4% babies had evidence of periventricular leucomalacia. No babies with hearing impairment were identified. Rate of hospital readmissions was 19%. Bronchiolitis was the major morbidity. Conclusions: VLBW babies are at a high risk for postnatal growth retardation. Follow up for visual morbidities is necessary for all VLBW babies.

NEO/69 (P) TO STUDY THE PATTERN OF MORBIDITY AND MORTALITY IN NEONATES ADMITTED TO TERTIARY CARE NEONATAL UNIT IN CENTRAL INDIAKhan I.A., Dwivedi R.,Malik S., Bhargava S.,Tiwari A.D3, Bda Colony, Kohe Fiza ,BhopalEmail: khan_iraj8f@yahoo.co.in

Introduction: To achieve millennium developmental goals, specific focus on neonatal mortality and morbidity is required. Knowledge about spectrum of neonatal diseases and proper management of common neonatal problems will lead to better outcome and improved quality of life among survivors. Aims And Objectives: to study the pattern of morbidity and mortality in neonates in tertiary care neonatal unit in Central India. Material And Methods: A hospital based prospective study was conducted during period between October 2010 to September 2011. All neonates admitted at age of less than 24 hours were included in the study. Data was prospectively recorded on pre-tested proforma developed with references of standard definitions developed by National Neonatal Forum, India. Results : out of 1388 patients, most of patients

were males(63.5%).Nearly two-third were low birth weight (63.5%) and nearly half were preterm(44.5%). Highest mortality rate was for septicaemia (47.57%) followed by perinatal asphyxia (25.95%), extremely low birth weight (21.08%), pneumonia (13.24%), hyaline membrane disease (12.97%), congenital malformation(6.21%), intraventricular haemorrhage (5.40%).Systemic infections ( 45.1%), birth asphyxia (43.94%), neonatal seizures in (22.48%), hyperbilirubinemia ( 14.9%), meconium aspiration ( 12.54%), congenital pneumonia (11.31%), hyaline membrane disease (5.12%) were common morbidities involved. Conclusion: the study helps in developing appropriate facilities and management protocol to improve neonatal survival. Pattern of mortality and morbidity is different as compared to National Perinatal Neonatal Database so there is compelling need to obtain and analyse reliable data on uniform format from all regions of the country. Keywords: neonates, mortality, morbidity

NEO/70 (P) TO STUDY THE CORRELATION OF C REACTIVE PROTEIN AND LOW TOTAL LEUCOCYTE COUNTS TO CULTURE POSITIVE SEPSIS IN NICU.S.Phuljhele, K.Ramnani, Sanjeev, V.KurreyAdministrative block department of pediatrics, Dr B R Ambedkar Memorial Hospital, Pt JNM Medical College, Raipur Email:-dr.sharjaphuljhele@gmail.com

Introduction: NICU neonates are very prone to sepsis which is a major cause of mortality. Cultures requires 72 hrs, till then CRP and low TLC can be used as indicators. Objectives – To study the efficacy of CRP, leucocytopenia and thrombocytopenia as predictors in neonatal sepsis. Materials And Mathod: total 580 neonates included in study admitted in the NICU of PT.J.N.M.M.C from September 2011 to august 2012 with propable sepsis. Their CRP, CBC and blood culture were sent from same sample. Results were collected and positive and negative predictive value calculated. Result: Of 580 patient studied,360 had positive CRP, of these, 195 had culture positive sepsis and 165 culture negative sepsis. So the positive predictability value of CRP is 54% whereas in the CRP negative group only one neonate had culture positive sepsis so the negative predictability value of CRP is 99%. Of 195 neonates with CRP and bood culture positive sepsis, 64( 32.8%) had leucopenia and thrombocytopenia, 70(36%) had only thrombocytopenia and 53(27% )had normal leucocyte and platelet counts.In the CRP positive, culture negative group 54 (33%) had leucopenia and thrombocytopenia; 37(22.5%) had only thrombocytopenia. 1 neonate who presented with CRP negative, culture positive sepsis had both leucopenia and thrombocytopenia. Conclusion: CRP is a good indicator of sepsis in NICU. Its specificity is 99% , hence a negative CRP level is a good predictor to rule out sepsis in a neonate. Similarly a patient with thrombocytopenia with or without leucopenia should be worked up for sepsis.

NEO/71 (P) NEONATAL SPONTANEOUS PLEURAL EFFUSION - A RARE CASE REPORTP. Nagasree, Manas Ranjan Sahoo,P.Sudarsini,G.ChaitanyaDepartment of Pediatrics , Alluri Sitarama Raju Academy of Medical Sciences, Eluru, APEmail: drmrsahoo@gmail.com; Pydinagasree @hotmail.com

Introduction: Congenital isolated pleural effusion is a rare condition with an incidence of about 1 in 12,000 to 1 in 15,000 pregnancies.  It is usually chylous.  Herein, we report a rare case of

nonchylous congenital pleural effusion managed successfully. Case report: A baby boy weighing 2520 grams was delivered by LSCS to an unbooked, immunized, full-term, primigravida mother,aged 20 with breech presentation with polyhydramnios. The baby had no h/o birth asphyxia & developed respiratory distress since birth & shifted to our NICU at 4hrs of life. There were signs of severe respiratory distress and the breath sounds were poorly audible in the both hemithorax. Baby was neither dysmorphic nor hydropic. Rest of the systemic examination was normal. ABG revealed respiratory alkalosis. A chest radiograph obtained at 4 hours of birth, revealed bilateral hydrothorax (figure 1).Intercostal needle drainage revealed straw coloured fluid which was sent for analysis.USG chest & abdomen revealed bilateral pleural effusion & b/l hydronephrosis..2-D echo was normal.. Following pleural fluid drainage also respiratory distress continued so was put on CPAP for36 hrs. Two 10 Fr size intercostal tube were put in left & right hemithorax which drained straw coloured fluid & drained clear fluid later(figure 2).Then he developed distress and hypoxia ,so ventilated at 36 hrs of life with assist control mode On day 3 child developed left hydropneumothorax and another 10 Fr catheter was inserted in left 2nd

intercostal space .The baby passed urine and meconium within 24 hrs of life. A total 150ml of clear fluid was over the next 7 days .Chest tubes were removed after chest xray showing significant resolution of hydrothorax & hydropneumothorax.(Figure 3)Then he was extubated on day 9 ,followed by on oxygen for 4 days. Baby was started on tube feeding on day 10 of life and over 7 days full feed established. The pleural aspirate was found to be a transudate , with proteins 2.3 g /dl and normal sugars, triglycerides, cholesterol, lactate dehydrogenase and culture. The,karyotype ,TORCH, LFT, RFT,Haemogram sepsis screen were normal. No Rh incompatibility noted .The baby was finally discharged on day 40, with a weight of 2.745 kilograms and the mother was advised breast feeding -

Figure 1: bilateral pleural effusion at 4 hrs of life

Figure 2: left & right ICDs

Figure 3: Resolution

NEO/72 (P) UMBILICAL CORD BLOOD GLYCOSYLATED HEMOGLOBINAND C-PEPTIDE IN INFANTS OF DIABETIC MOTHERS AND ITS CORRELATION WITH NEONATAL HYPOGLYCEMIAGirish M, Dandge V, Mujawar N, Punia S, Bhattad S. C/o Dr Vithalrao P Dandge Asha' Plot # V-42, Narendranagar, Ring Road, Nagpur- 440015, MaharashtraEmail:sameerpunia@gmail.com;dandge_vp@yahoo.com;vithalrao.dandge.dahigaon@gmail.com We hypothesise that cord blood HbA1c would be a good marker to determine the risk of neonatal hypoglycemia in IDM. If this is confirmed we can very easily identify the group which needs close monitoring and probably early supplemental feeding to decrease the risk of hypoglycemia. Such a prediction would not only help avoid the short and long term consequences of neonatal hypoglycemia but also obviate the need to start artificial feeds in all babies. Objectives- 1. To study the relationship between maternal glycated hemoglobin and cord blood HbA1c in Infants of Diabetic mothers (IDMs). 2. To evaluate whether there is an association between maternal glycated haemoglobin, cord blood insulin,C-peptide. 3. To study the relationship of cord blood insulin,with birth weight in offspring of diabetic mothers. 4. To test the hypothesis that cord blood glycosylated hemoglobin can predict occurrence of postnatal hypoglycemia in IDMs. 5. To investigate long-term effects of maternal glcemia on their offsprings. Methodology – All mothers with diabetes mellitus and their newly born delivered in any hospital in Nagpur in a period of one year, between the period of July 2011 and July 2012 will be recruited for the study. Babies with sepsis or birth asphyxia, meconium aspiration, respiratory distress syndrome etc. and babies with major congenital anomalies not attributed to maternal diabetes were excluded. Cord blood was collected for analysis of HbA1C, C-peptide, maternal blood for HbA1c and postnatal blodd sugars done as per current consensus protocol. Study Design- Observational Longitudinal Study. Statistical Analysis- Chi square and t test by NCSS and EPI info.

NEO/73 (O) TO ASSESS AND COMPARE THE NEONATAL MORTALITY AND MORBIDITY IN LATE – PRETERMS AND TERM NEONATESParveen Mittal, Ravneet KaurHouse no. 37, Khalsa college colony, Near saket hospital, PatialaEmail: doc_parveen@yahoo.co.in

Introduction: Pre term birth rate has been on a rise throughout the world mainly at the expense of late – preterm births (defined as births between 34 weeks and 36 weeks 6 days gestation). Late – preterm newborns often termed as “near – terms” have been historically managed as terms because of their relatively large size and seemingly larger appearance, these late – preterms are considered to have significantly more mortalities and morbidities because of less physiological maturity and limited compensatory responses compared to term neonates. Late – preterm newborns are the fastest growing subgroup of neonates and constitute approximately 70 % of preterm births. In recent years, the absolute number of late – preterms being admitted to NICUs has been rising, only few studies have been conducted regarding their morbidities and mortalities. The present study was an attempt to obtain data regarding the morbities and mortalities in late – preterms as compared to their term counterparts. Aims And Objectives: To assess the mortality and morbidity in late – preterm newborns and to compare it with term newborns born in Rajindra Hospital, Patiala. Materials And Methods: The study was conducted on 200 newborns born in Rajindra Hospital, Patiala, comprising of 100 late – preterms and 100 term neonates. Their mortality rates were assessed

and compared in terms of total deaths in neonatal periodin late – preterms and terms. Their morbidities were assessed and compared in terms of incidence of hypoglycaemia (that was managed by i/v infusions), respiratory distress syndrome (neonates who were given oxygen in 1st 24 hrs of life), hyperbilirubinemia (requiring phototherapy) and septicaemia (requiring antibiotic therapy). The data obtained was statistically analysed. Results: following results were obtained:

No. Of Late preterms (out of 100)

No. Of Terms (out or 100)

P value (significance value)

Mortality in neonatal period

5 2 P=0.4448(fischers exact test,two tailed p value)

hypoglycemia 22 6 P=0.0018 fischers exact test,two tailed p value

hyperbilirubinemia 68 46 P=0.0026( fischers exact test, two tailed p value)

septicemia 56 21 P < 0.001RDS 72 23 P < 0.001Conclusions: Our study showed a significantly higher risk of overall morbidity but not mortality in late – preterms as compared to terms. As the late preterm subgroup comprises approximately 10 % of all the births, even a modest increase in the morbidity may have a profound impact on health care resources, thus explaining the need to consider these seemingly mature late preterm newborns as physiologically immature and to be carefully evaluated, monitored and followed up.

NEO/74 (P) RETINOPATHY OF PREMATURITY IN INFANTS WITH BIRTH WEIGHT BETWEEN 1501-1800 GRAMSRohit Kapoor, Harish Chellani, B.P.Guliani, Sugandha Arya, Rakesh Yadav.Institute-Vardhman Mahavir Medical College & Safdarjang Hospital New Delhi-110029Email ID-rohitvmmc@gmail.com,rkkapoor57@yahoo.co.in

Introduction:According to American academy of pediatrics screening criteria adopted for Indian infants may miss Retinopathy of premaurity in infants with larger weight Abstract:Aims and objectives: To determine the incidence and associated risk factors of ROP among new born infants between 1501-1800 grams in a tertiary care hospital. To compare the possible risk factors associated with Retinopathy of Prematurity in infants with birth weight between 1501-1800 grams and with birth weight <1500 grams.To suggest recommendations for ROP screening of infants with birth weight between 1501-1800 gram babies in developing countries if any. Materials and Methods:278 infants with birth weight <1800 grams were longitudinally followed in uptil complete vascularization of Retina the surviving neonates born were divided in 3 sets depending on the birth weight viz.less than 1800 grams and between 1501 to 1800 grams and <1500 grams , the comparision of the incidence and associated risk factors for ROP in both of these groups was done .Qualitative data was analysed using Pearson’s Chi Square test with Yates correction of Ficher’s exact test ,Multiple logistic regression analysis was performed to determine independent risk factors for the Disease in each of the 3 groups.Results:Out of 278 babies 203 completed the follow up,and data was analysed from the 1st contact of the infant with the ROP team.The incidence of ROP was found to be 13.67% of which 11.87% had stage I ,Stage II was present

in 1.44% and Stage III 0.36%,Risk Factors which came out to be significant on univariate analysis were low birth weight,Low gestational age,Respiratory distress syndrome, prolonged oxygen exposure, acidosis, mechanical ventilation, blood transfusions, exchange transfusions,anemia,Intraventricular hemorrhage,Sepsis,NNH,Multiple Gestation, Resuscitation, Low APGAR score, vasopressor use, pneumothorax ,IUGR,PIH, APH, Patent ductus arteriosus. Risk factors which independently came out to be significant were Multiple Gestation ,mechanical ventilation ,low APGAR score at 1 min,blood transfusions Pregnancy induced hypertension and antepartum hemorrhage. Incidence of ROP in Babies weighting greater than 1501 grams ,Stage I was found to be 10.27%,Stage II to be 1.37% and no cases of stage III,IV and V were found , Univariate analysis showed low birth weight, Low gestational age ,respiratory distress syndrome, prolonged oxygen exposure , acidosis,mechanical ventilation,blood transfusions,exchange transfusions, anemia, Intraventricular hemorrhage, Sepsis,Resuscitation,Low APGAR score, vasopressor use,pneumothorax,PIH,APH,Patent ductus arteriosus came out to be significant. Independent risk factors were Blood transfusion and anemia. Incidence In infants weighing less than 1500 grams incidence was 15.9% ,The univariate analysis revealed were low birth weight, Respiratory distress syndrome, prolonged oxygen exposure, acidosis, mechanical ventilation, blood transfusions, exchange transfusions, anemia, Intraventricular hemorrhage, Sepsis, Multiple Gestation, Resuscitation, Low APGAR score, vasopressor use, pneumothorax, IUGR, Patent ductus arteriosus. independent risk factors for ROP in this set was found to be Mechanical ventilation, APGAR score <3 at 5 min. Conclusion: Thus ROP in larger babies as seen greater in developing countries may be a upcoming problem in coming years.

NEO/75 (P) SUBCUTANEOUS FAT NECROSIS OF THE NEWBORN AND HYPERCALCEMIC ENCEPHALOPATHYSK Patnaik, SS Dalal, Arvind, V VenkateshwarDept of Pediatrics, Command Hospital Air Force, Bangalore 560007Email: drskp@yahoo.com

Introduction Subcutaneous fat necrosis of the newborn (ScFN) is an uncommon condition caused by hypoperfusion associated with perinatal asphyxia, shock and hypothermia. Only 3 cases have been reported from India till date. Aims & Objectives To present our experience with ScFN at a tertiary care level Armed Forces hospital Materials & Methods Retrospective case review amongst 234 infants who received neonatal intensive care during Oct 2010 to Sep 2012 Results ScFN was noted in 2 male term neonates with history of perinatal asphyxia leading to a prevalence of 4.2 per 1000. Subcutaneous panniculitis was notable by first 2 weeks in both cases. While one baby remained asymptomatic with regression of lesions over 08 weeks without any metabolic complications, PTH independent hypercalcemic encephalopathy (Serum calcium 14.2 mg/dl phosphate 4.1 mg/dl creatinine 0.6 mg/dl 25OH Vit D 20.9 ng/ml 1,25 (OH)2 Vit D 131.5 pmol/l PTH 1.54 pg/ml) occurred in the other baby by 6 weeks age. Hepatosplenomegaly. hypertriglyceridemia, hyperferritinemia, subcutaneous fat granulomas with cholesterol crystals, periventricular calcification on CT head and nephrocalcinosis were also observed. Bone marrow examination ruled out hemophagocytosis. Liver biopsy showed intracellular cholestasis. Infant was managed with steroids and alendronate with normalization of calcium levels within 2 weeks. Hypertriglyceridemia persisted till 3 months age. At 09 months followup, child has mild developmental delay and normocalcemia but has persistent firm hepatosplenomegaly, nephrocalcinosis and sporadic calcinosis cutis. Conclusions ScFN is an underrecognized entity. Longterm surveillance must be in place to detect late onset life-threatening hypercalcemia. Oral alendronate is an effective therapy.

NEO/76 (P) AUDIT OF NEONATAL ADMISSIONS AND DEATHS AT A TEACHING HOSPITAL INParihar Mahendrasingh Y, More P W, Savaskar S V Department of Pediatrics, Government Medical College, Latur, MaharashtraEmail: dr_mahen_parihar@hotmail.com

Objective: - To know the disease pattern and causes of deaths among newborns admitted to the neonatal intensive care unit of tertiary care teaching hospital, Latur, Maharashtra. Methods:- It was descriptive study conducted from 1st March 2011 to 29th February 2012. Data of all the babies admitted to the NICU was recorded in prefixed format. The records were studied statistically for sex, weight, age, gestational age, place of delivery and mode of delivery. The causes of admissions and deaths were determined on the basis prefixed working definition. The reasons for referral were also recorded and studied. Results:- A total 929 neonates were admitted during the study period. Among them 536 (57.69 %) were male and 393(42.30 %) were female. Majority of babies i.e. 625 (67.72%) were admitted in first 24 hours of life. Low birth weight (< 2.5 kg) admitted were 585(62.97%). The inborn delivered babies were 559(60.17%) and outborn were 370(39.83%). 833(89.66%) were delivered at hospital and 91 (9.75%) were home delivered. Birth asphyxia (29.58%), sepsis (25.72%) and preterm with low birth weight (13.82%) were the main causes for referral to the hospital. Among the 403(43.38%) preterm babies, preterm with LBW were 279(69.23%), preterm with sepsis were 106(26.30%), only preterm were 60 (14.88%), preterm with RDS were 44 (10.91%) and other were 5(1.24%). Among 526(56.62%) full term babies diagnoses were birth asphyxia (29.65%), sepsis including meningitis and pneumonia (23.57%) and meconium aspiration syndrome (13.68%), neonatal jaundice (7.6%), congenital heart disease (6.27%), intrauterine growth retardation (8.74%), transient tachypnea of newborn (3.04%), surgical conditions(8.93%), antibiotics prophylaxis(11.78%) and other(2.85%). 552(59.41%) were completely cured and discharged, 238(25.61 %) died, 29(3.12%) were referred out, 63(6.78%) left against medical advice and 47(5.05%) were discharged on request. Prematurity (72.26%), hypoxic ischemic encephalopathy (15.81%) sepses (14.43%) were the main causes of the deaths in neonatal intensive care unit. Conclusions:- Prematurity, low birth weight, birth asphyxia and sepsis are main causes of admission to the neonatal intensive care unit. The main causes of deaths are prematurity, hypoxic ischemic encephalopathy and sepsis. There increased need for awareness for in time referral to the tertiary level hospital is mandatory to increase the neonatal survival. Mortality in NICU in high and suggests need to identify and reduced the risk factors with emphasis on prematurity, low birth weight, birth asphyxia and sepsis.

NEO/77 (P) IS KANGAROO MOTHER CARE (KMC) INCREASES BONDING WITH MOTHERS. Nath, Arya suchismita, R.SharanDepartment Of Paediatrics, Tata Motors Hospital, JamshedpurEmail- smritin@tatamotors.com

Introduction- Kangaroo mother care (KMC) is a cost effective method to promote health & wellbeing of preterm low birth weight (LBW) babies. In our NICU acceptability of KMC by mother was a great concern. Although benefits of KMC are well established but there is insufficient data in our country regarding its acceptability by mothers. Aim & Objective- To determine the effectiveness of KMC in LBW babies and to analyse the bonding effect of

KMC. Material & Method- prospective comparative study. Setting- Level II NICU in Tata Motors Hospital Jamshedpur. Period- Nov 2010-Feb 2012. Study group- Neonate weighing <2kg admitted in NICU were initiated KMC as soon as they were stable. Intervention KMC was conducted and bonding was assessed by infant maternal attachment scale and weight was recorded daily. Result – The KMC babies documented a significantly better average wt gain 22.6+ 9.4 gm/day vs 13.9+3.2 gm/day in conventional method of care (CMC) gr p value < .01. The confidence level of mother increasing for their LBW infant was significantly higher in KMC group (P<0.0001). Bonding between mother and baby was more in the KMC group when compared to CMC group. Conclusion: KMC has immense benefits on growth & reduction of morbidities in LBW babies. It also increases bonding between mother & babies.

NEO/78 (P) TO EVALUATE THE TOLERANCE OF RAPID ADVANCEMENT OF ENTERAL FEED IN LBW BABIES Anand Jain, Kailash Meena, Prashant Agrawal, Shiv Kumar Vishnoi, Pankaj Jain 798 Ram Nagar Colony, Shastri Nagar, JaipurE-mail- dranandjain76@gmail.com Abstract: Introduction: Paediatricians are very much concerned about GI intolerance & risk of NEC in LBW babies and hesitates in rapid advancement of feeding so enteral nutrition has generally been slowly advanced at most of centres. Recent studies have shown that rapid advancement of feed is well tolerated in LBW babies without any risk of gut intolerance, NEC & shown faster weight gain. Aims & Objective: To evaluate the tolerance of rapid advancement of enteral feed in lbw babies (1000-1800gms). Method: Stable newborns weighing between 1000-1800 gms randomized in two groups, Group A- slow advancement group-feed increased by 20 ml/kg/day & Group B-rapid advancement group-feed increased by 40 ml/kg/day till maximum 180 ml/kg day in both groups. Outcome measured were rate of weight gain/day, regaining of birth weight, time achieving full feed, hospital stay, incidence of NEC, & other feeding related complications. Results: In slow advancement of feed (group-A) time of attainment of full feed was mean 9.4 days & in rapid advancement (group-B) was 6.6 days(p<0.001), mean time of regaining birth weight was 10.32 days in group-A & 9.13 days in group-B (p<0.001),Feeding was interrupted in 8(13.33%) cases in group-A & 12(20.34%) cases in group B(P>0.05), Gastric residue found in 5(8.33%) cases in group-A & 8(13.56%) cases in group-B(P>0.05),abdominal distension found in 7(11.67%) cases in group-A & 11(18.64%) cases in group-B(P>0.05). Conclusion: The adverse events related to rapid advancement of feed as gastric residuals, abdominal distension, and feeding interruption were found equal in both groups with benefits of rapid advancement of feed were early regaining of birth weight, less hospital stay, & early achievement of full feed. So it can be concluded that in LBW babies rapid advancement of feeding up to 40 ml/kg/day is a safe & well tolerated& reduces nosocomial infections, parental stress and extra work load on hospitals.

NEO/79 (O) STUDY OF TOTAL SERUM CALCIUM LEVEL IN ICTERIC NEWBORN RECEIVING PHOTOTHERAPY Anand Jain, Kailash Meena, Surendra Meenal, Nishant dangi, Pankaj Jain, Prashant agarwal798 Ram Nagar Colony, Shastri Nagar, JaipurE-mail- dranandjain76@gmail.com Abstract: Introduction- Jaundice is the most common abnormal physical finding during early days of life in newborn Presently phototherapy is the most effective and widely accepted method for management of neonatal jaundice but phototherapy is not free from its side effects

i.e. hyperthermia, diarrhoea, dehydration, rashes and hypocalcemia etc. Among these hypocalcemia is one of the potential side effect but commonly neglected and lesser studied earlier. So we have conducted this study to determine the effect of phototherapy on total serum calcium level with comparison between full-term and pre term icteric neonates. Aim & Objective- Effect of phototherapy on total serum calcium level in preterm (≥32 to <37wks) and full term (≥37wks) newborn receiving phototherapy. Methods- This comparative study was carried out in NICU, Zenana Hospital, Jaipur. A total number of 120 icteric neonates were enrolled for the study on consecutive basis and divided in two group, group A included full term babies and group B included pre-term babies each group consisting of 60 neonates including 20 neonates as control. All neonates of study group were fulfilling the criteria for indication of phototherapy and neonates in control group were icteric but not in phototherapy range. Measurement of total serum calcium level was done before and after 48 hr of institution of phototherapy. Result- In group A 15% of study group showing hypocalcemia after phototherapy with mean fall in total serum calcium level of 0.99mg/dl which was statistically significant (p<0.001). In group B 32.5% of study group showing hypocalcemia after phototherapy with mean fall in total serum calcium level 1.057mg/dl which was statistically significant (p<0.001).While fall in serum calcium level of control in both group was statistically insignificant. Conclusion- This study concluded that hypocalcemia is benign but a significant adverse effect of phototherapy in newborn particularly in preterm neonates therefore during the period of phototherapy serum calcium level should be monitored.

NEO/80 (O) OVER-HYDRATION IN LABOUR CAN BE DANGEROUS FOR MOTHER AND BABYSiba Prosad Paul, Alexander Department of Paediatrics, Yeovil District Hospital, Yeovil BA21 4AT (UK);Email: siba@doctors.org.uk

Introduction: Women in labour are encouraged to drink plenty of fluids. Some may receive intravenous fluids. While intravenous fluids are documented, oral fluids may be administered without being recorded leading to dilutional hyponatraemia both in the mother and newborn baby. Case studies: The first case was a neonate born by C-section following a prolonged rupture-of-membrane of 20hours. He underwent blood investigations and antibiotics were started. Serum sodium was 126mmol/L. Review of documented records and speaking to the mother, it was found that a total of 3litres of oral fluids and 1litre of intravenous fluids were received. The infant was managed with fluid restriction and observation. The second case was of a septic lady in labour where intravenous fluid was administered before C-section. She was transferred to NNU, suffered convulsions secondary to hyponatraemia. Managed by fluid restriction and administration of 3%NaCl bolus. Discussion: 1) Dilutional hyponatraemia remains undetected in most cases. 2) Oral fluids remain underestimated and often not documented. 3) Moen et al. (BJOG, 2009) highlighted total volume of >2.5litre in labour is associated with increased risk of hyponatraemia. 4) Eclampsia-like presentation can occur in expectant mothers who received plenty of hypotic fluids e.g. water. 5) Neonates may suffer from irritability, poor feeding and rarely convulsions secondary to dilutional hyponatraemia. Conclusion: Dilutional hyponatraemia is avoidable in most cases by careful monitoring and clear documentation of fluid received in labour. Unexpectedly low sodium in neonate (after birth) should raise suspicion of dilutional hyponatraemia secondary to over-hydration in labour.

NEO/81 (P) PROFILE OF TWIN BIRTH BABIES IN OUR SET UP Jaswir Singh, Baljinder kaur, Jaspreet, Anil

197 Sewak Colony, Patiala, PunjabEmail: banga.baljinder@yahoo.com

Aims & Objectives: To study profile of twin babies in our set up. Design:A Prospective study. Material&Methods: 54 babies born as Twin & Triplet deliveries in Department of obstetrics & gynaecology Government Medical college& Rajindra Hospital were the subjects of study.Study was conducted for a period of one year.Name &Address of Parents,Antenatal Record,Mode of delivery,APGAR,Complete examination of Newborn,Postnatal events were recorded on Pretested,Predesigned Proforma & data so obtained was analysed. Results: Incidence of Twin deliveries were found to be 2.7%.Out of 54 multiple births 48 were found to be Twins 2 were Triplets.90% were born by caesarian section while10% were born by vaginal deliveries.6[12%] babies were born between 25 to 30weeks while26[50%]were born between 30to35 weeks while 20 were born between35 to 37 weeks; None of the Pregnancy was carried to Full Term.Respiratory distress developed in 18 [21%]Twin one babies 24[48%] Twin two babies.Birth Asphyxia was observed in 8[15%] babies 4 each in 1st & 2nd

Twin.Neonatal hyperbilirubinemia was observed in 44[81%] babies;20Twin one babies,22Twin two babies & 2 Twin three babies.Polycythemia developed in 3 babies. 3 babies were weighing less than 1000 grams,11 babies weighed between1001to1500 grams;29 weighed between1501 to 2500 grams .9 babies were born with weight more than 2500 grams

NEO/82 (P) IV FLUIDS SURVEY ACROSS NEONATAL UNITS IN UKKishore Yerur Vrajananda, Pravin DesaiConsultant Neonatologist and Paediatrician, Cloudnine Hospital, Bangalore, IndiaEmail: kishoreyv17@yahoo.co.in

Introduction: Newborn babies vary in the requirement of IV fluids and serious morbidity can result from fluid imbalance. Aims & Objectives: To survey practices of IV fluid administration in term and preterm neonates across the neonatal units in the UK. Material & Methods: We emailed questionnaires to neonatologists working at the neonatal units across the UK. Results: Response was obtained from 120 neonatal units in the UKIV fluids in term babies (mean)

in ml/kg/day DAY 1 DAY 2 DAY 3 DAY 4 DAY 5

Level 1 neonatal units

Term babies 59 85 110 137 146

Preterm babies 65 94 121 144 152

Level 2 Term babies 58 85 112 139 148

Preterm babies 68 95 122 145 152

Level 3 Term babies 62 86 110 134 146

Preterm babies 76 101 121 143 150

Number of units (%)

Extra fluids for babies less than 1kg

Extra fluids for babies on phototherapy

Restricting fluids for babies at risk of HIE

Level 1 neonatal units 6/18 (33.3%) 11/18 (61.1%) 16/18 (88.9%)

Level 2 neonatal units 28/62 (44.2%) 27/62 (43.5%) 58/62 (93.5%)

Level 3 neonatal units 17/40 (42.5%) 8/40 (40%) 33/40 (82.5%)

Conclusions: The practice of fluid administration varies across the UK. The level 3 units are more liberal with their fluids. Most units restrict IVfluids for babies at risk of HIE. There is a variation in practice in terms of liberalizing fluids for extreme preterm babies and babies on phototherapy. This study highlights the dilemma faced by neonatologists in the fluid management, mainly due to multiple variables influencing fluid balance in the newborn. We are not aware of similar studies in India, which will be helpful in managing preterm babies in NICU.

NEO/83 (P) PRETERM INFANT WITH SEMILOBAR HOLOPROSENCEPHALY AND HYDROCEPHALUS (A CASE- REPORT)Namita Agrawal, J.P.Singh, Sunil GuptaDepartment Of Pediatrics, Tirath Ram Shah Hospital, DelhiEmail: namita_shini06@yahoo.co.in

Holoprosencephaly (HPE) is the most common structural anomaly of developing forebrain, and affects 1 in 8-16,000 live births. It refers to incomplete cleavage of pros encephalon into two halves and is associated with facial dysmorphism and neurological impairment. We present A preterm infant with gestational age of 35 weeks 3 days delivered to a primi 29 yr old Bengali mother who presented to the emergency in active labor, an urgent USG done at that time was s/o hydrocephalus with H.C of 443.6 mm and bpd of 138.9 mm, since the head was very large ante natal decompression was done and 550 ml of CSF drained out. After birth baby cried immediately APGAR of 8, 9 at 1 and 5 minutes, was moving all the four limbs and had no obvious congenital anomaly. Baby was shifted to NICU and started on antibiotics i/v/o CSF leak. Ballard’s scoring was consistent with maturity of 35 weeks, vital signs were within normal limits, physical examination revealed widely separated sutures, evidence of CSF leak, H.C of 33 cm and neurologically baby was normal. The maternal history was unremarkable for prenatal infections, trauma, drug abuse and chronic disease. No significant obstetric or family history could be elicited. Iron and folic acid was taken regularly, AN – USG done in first trimester was normal and further USG was done in our hospital only when patient went into labor at 8 mo. Daily monitoring of H.C showed gradual increase in head size and CT scan was planned –that was s/o semilobar type of HPE with intra parenchymal bleed (due to needle trauma), there was no associated congenital malformation, karyotype and USG abdomen were normal. MRI was not done as it would not have changed the diagnosis and management. At discharge the H.C was 41 cm which was increasing on follow up, so V-P shunt placed at 3 mo of age. On f/u child was developmentally delayed and was having seizures requiring two anti-convulsant for control. Discussion –HPE is the insult to developing forebrain and by rule presents with microcephaly, if the H.C at birth is normal or increased it is s/o hydrocephalus (an atypical feature in our case). It is classified into four types depending on degree of non- separation of fore-brain and has varied prognosis. Also it

is important to diagnose and classify HPE as it has prognostic implications for future pregnancies.

NEO/84 (P) NEONATAL REFERRAL PATTERNS IN DAKSHINA KANNADA DISTRICT- A PROSPECTIVE OBSERVATIONAL STUDYK. Dileep Kumar, Suchetha Rao, B. Shantaram Baliga C/o Dr B. Shantaram Baliga  Kshitij, Blue Berry Hills, Yeyyadi, Mangalore, Dakshina, Kannada-575008, KarnatakaEmail: dilipzing@yahoo.co.in Introduction: A referral can be defined as a process in which health worker at one level of the health system, having insufficient resources (drugs, equipment, skills) to manage a clinical condition, seeks the assistance of a better or differently resourced facility at the same or higher level to assist in, or take over the management of the clients case. Aim: To study referral patterns to neonatal intensive care unit in Dakshina Kannada district of Karnataka state. Objectives: 1. To study referral patterns 2. To study outcome measures. Study design: prospective observational study. Inclusion criteria: all neonates referred to neonatal intensive care unit of:  1. RAPCC  2. Lady Goschen hospital. Study design: prospective observational study. Statistical analysis: proportions. Results: Out of 267 patients referred, 158 are males and 109 are females. Majority of patients are of term babies. Most of the referrals are for medical causes. Out of 267 patients, 45 cases expired.

NEO/85 (P) INCIDENCE OF RETINOPATHY OF PREMATURITY (ROP) IN PRETERM VERY LOW BIRTH WEIGHT BABIES AND ITS CORRELATION WITH NEONATAL AND MATERNAL RISK FACTORS.Jyoti Bagla, Sonia Baidya, Anita Arora, M C AgarwalDepartment of pediatrics, ESI PGIMSR Basaidarapur, New Delhi, IndiaEmail: jyotibagla@yahoo.co.in

Objective:– Incidence of ROP in preterm, VLBW babies and its correlation with maternal and neonatal risk factors. Design: Prospective Observational Cohort Study. Setting: NICU of a tertiary care hospital. Participants: 100 preterm < 32 wks and < 1500 gm babies. Methods: 100 Intramural premmies enrolled after consent and managed with standard NICU protocol. Gestation assigned by LMP/New Ballards Score. First screening done at 4 weeks postnatal age by Retina specialist with expertisation in neonatal ROP screening. Detected ROP were further followed up weekly till threshold ROP or regression of the disease. For threshold ROP laser therapy was done and and followed up till regression of the disease. Babies with no ROP on first screening followed up every 2 week for partially vascularised retina and no follow up for fully vascularised retina. Data analysed by SPSS. Result: Overall Incidence of ROP was 30% with more in 1001 – 1250 gm weight (58%) and 28-30 wks gestation (47%). 20% had stage 1, 6% stage 2, 4% stage 3 and none had stage 4 and 5 disease. All the 4 infants with stage 3 ROP underwent successful laser surgery. On univariate analysis birth weight, gestation, oxygen and total days on oxygen & blood transfusion were found to be significant risk factors while gender, multiple births, sepsis, ventilation, shock, IVH, NNH, exchange transfusion, acidosis & NEC were not. Maternal risk factors- Leaking PV, Pregnancy Induced Hypertension (PIH), Antepartum hemorrhage (APH), Diabetes & Maternal fever were not correlating for development of ROP. Conclusion: Screening of babies below 31 wks gestation or 1300 gms with risk factors will save valuable resources and not miss any baby who required therapy for ROP.

NEO/86 (O) A STUDY OF HYPOXIC ISCHEMIC ENCEPHALOPATHY IN NEWBORNS WITH ITS RELATION WITH LEVELS OF SUPEROXIDE DISMUTASE AND REDUCED GLUTATHIONE IN CEREBROSPINAL FLUIDArvind Kumar Singh, Taraknath Ghos, Snehansu Chakraborti, Kanailal Barik.Senior Resident, Kalawati Saran Children Hospital, Lady Hardinge Medical College, New DelhiEmail: drarvind.bmch@gmail.com

Abstract: Objective: To find out the relationship between severity of hypoxic ischemic encephalopathy and levels of superoxide dismutase and reduced glutathione in cerebrospinal fluid (CSF). Design: Cross sectional hospital based study. Setting: Burdwan medical college and hospital. Subjects: Intramural newborns suffering from birth asphyxia and admitted in Department of Pediatrics of Burdwan medical college and hospital. Result: The values of superoxide dismutase (SOD) were found to be 84.45±11.56, 54.32±19.02, 32.53±13.82 SOD U/ml of CSF respectively in 3 stages of HIE (P<0.001, r=-0.8) and significantly low in newborns who expired when compared to survived newborns, the values being 62.26±23.14 and 23.42±7.94 U/ml respectively (P<0.001).The obtained values of reduced glutathione(GSH) for 3 stages of HIE being 1361.54±272.84, 1045.56±289.78, 693.68±187.49 ng/ml of CSF respectively(P<0.001,r=-0.722) and were found to be significantly low in newborns who expired when compared to survived newborns, the values being 1107.58±336.86 and 585.32±116.62 ng/ml of CSF respectively (P<0.001). Conclusion: Oxidative stress is an important factor in deciding the extent of damage due to hypoxic ischemic injury. Biochemical parameters like superoxide dismutase and reduced glutathione levels in cerebrospinal fluid not only get altered significantly but also the levels may suggest the extent of free radical injury during the process.

NEO/87 (P) TO STUDY THE EFFECT OF MATERNAL NUTRITIONAL STATUS ON THE BIRTH WEIGHT OF THE NEW BORNKhushbu Verma, Veenu AggarwalC/O Dr Veenu Agarwal, W/O Dr Amit Kumar, R-2/156 Raj Nagar, Ghaziabad, Uttar PradeshEmail: khushbuverma@gmail.com

Objective: 1. To study the proportion of low birth weight babies in our setup. 2. To study and prioritize the effect of various maternal dietary and anthropometric parameters on the birth weight of the new born. Study design: A hospital based retrospective study. Material and methods: A total of 365 mothers were enrolled. Mothers with significant illness, pregnancy related complication, multiple pregnancy were excluded. Newborns with any chromosomal anomaly, syndrome or pre term gestation were excluded. Outcome variable was birth weight of the baby. Predictor variables were diet , anthropometry and haemoglobin of the mother. Dietary data was collected by recall method. Bivariate analysis followed by multivariate analysis was done. Results ●Incidence of LBW was more in females as compared to males. ● LBW was more common in mothers with BMI <19 kg/m2. ● 53% of all the LBW occurrences were found in mothers having a caloric intake of less than 1500 kcal. ● 58% of the mothers having a daily protein intake of less than 40 gm delivered LBW babies. ● Consumption of milk and egg during pregnancy resulted in better birth weight. Conclusions: It was concluded that maternal anthropometry and dietary intake have a significant role to play in determining the birth weight of the new born and are important predictors of low birth weight. It is therefore necessary to take care of the health of the females as it is closely linked to the health of the progeny as well.

NEO/88 (P) CEREBRAL BLOOD FLOW VELOCITY IN NEONATAL HYPERBILIRUBINEMIASriparna Basu, Dibyajyoti De, RC Shukla, Ashok KumarDepartment of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, VaranasiEmail: drdibyajyotide1@gmail.com

Abstract: Introduction: Neonatal hyperbilirubinemia (NNH) with high bilirubin load is well known for its potential neurotoxicity. Till date several studies have documented increased cerebral blood flow velocity (CBFV) after phototherapy in NNH, but no study has ever assessed CBFV in NNH before phototherapy. Objective: To assess CBFV changes in NNH. Methods: In this prospective observational study, 60 healthy newborns with NNH requiring phototherapy (AAP guidelines) were compared with 60 age-and weight-matched neonates without NNH. Neonates with perinatal asphyxia, systemic or metabolic disorders, shock, and hypoalbuminemia were excluded. Resistance index (RI), pulsatility index (PI), peak systolic velocity (PSV) and vascular diameter were measured in internal carotid, vertebral and middle cerebral arteries by transcranial color-doppler at the beginning of phototherapy, after 48 hours of starting phototherapy and again at 48 hours after stoppage of phototherapy. In controls CBFV was assessed once at inclusion. Data were analyzed by SPSS 16.0 Results: Decreased RI, PI with increased PSV and diameter of cerebral arteries were observed in NNH even before starting phototherapy compared to controls. After 48 hours of phototherapy, CBFV increased further. After 48 hours of stoppage of phototherapy, CBFV came down to baseline and became comparable to controls. There was linear correlation between total serum bilirubin (TSB) concentrations and CBFV. ROC curve analysis showed high predictive accuracy of CBFV parameters in moderate-to-severe hyperbilirubinemia with TSB above 16 mg/dL. Conclusions: CBFV is increased in NNH, which has further been potentiated by phototherapy. Increased CBFV is directly correlated with TSB with high predictive accuracy. Key words: Cerebral blood flow velocity, phototherapy, neonatal hyperbilirubinemia

NEO/89 (P) TO STUDY THE EFFECT OF EARLY NASAL CPAP FOR PREVENTING MORBIDITY AND MORTALITY IN VLBW BABIESS. Nath, Debjani Bose Department Of Paediatrics, Tata Motors Hospital, JamshedpurEmail- smritin@tatamotors.com

Introduction: CPAP is a non-invasive method that prevents collapse of lung alveoli and provides respiratory support to immature lungs of preterm babies. Aims And Objectives:To determine if ENCPAP in preterm VLBW babies reduces the need for mechanical ventilation and its associated morbidities. Material And Methods: Design – Randomized Control Trial ●SETTING – Level II NICU, Tata Motors Hospital, Jamshedpur. ● PERIOD – Sep 2011 to Aug 2012 ● INCLUSION CRITERIA –spontaneously breathing neonates with birth weight <1.5 kg & gestational age < 34 week ● EXCLUSION CRITERIA: i. No spontaneous breathing ii. Congenital anomaly iii. Complete dose of antenatal steroids received ● METHOD- Neonates were randomized into 2 groups. GROUP 1- Early nasal CPAP within 10-15 min after birth. GROUP 2- Conventional method of care. Neonates followed for 30 days and intubated if required, at specified conditions. ● OUTCOME – 1) Percentage developing RDS requiring rescue surfactant& ventilator 2) Percentage developing adverse effects - air leaks, sepsis, ROP. 3) Mortality 4) Results. 40 neonates were randomized into 2 groups. In Group 2, 55% developed RDS, required intubation & rescue surfactant, compared to 20% in Group1. which is significant( p value=.02). Difference of incidence of sepsis in gr2

was significant as compared to Gr1( P VALUE=.04). The incidence of air leaks, sepsis, ROP, mortality & Mean duration on ventilator were not significant ( P >.05) . Conclusion: There is less incidence of RDS, requirement of intubation and associated morbidities in neonates who received ENCPAP.

NEO/90 (P) PRUNE BELLY SYNDROME(EAGLE-BARRETT SYNDROME) Ashok Rathod, Spoorthi Jagadish, Chetan PatilProf Of Pediatrics, Bldg # 1, Flat # 15, Sir JJ Hospital Campus, Byculla Mumbai-400008, MaharashtraEmail: spoojagadish@gmail.com

Prune Belly Syndrome affects 1/40,000 live births. It is characterised by deficient abdominal muscles,undescended testes, urinary tract abnormalities resulting from severe urethral obstruction in foetal life. Other features are oligohydramnios, pulmonary hypoplasia, dysplastic kidneys, malrotation of bowel, musculoskeletal system-limb abnormalities and scoliosis. It overlaps closely with type 4 subtype of Potter’s syndrome. Prognosis depends on degree of pulmonary hypoplasia and renal dysplasia. 1/3 are stillborn or die within first few months of life. 30% survivors develop end stage kidney disease requiring renal transplant. Our patient was a full term, male child of birth weight 2.4 kg born to a primi by vaginal delivery with breech presentation, baby did not cry after birth and had severe bradycardia and was resuscitated and shifted to NICU. Antenatal USG in late 2nd trimester showed single live fetus with gestational age 25 weeks with breech presentation along with grossly distended bladder with dilated proximal urethra with backpressure hydroureters bilaterally causing intra-abdominal mass effect with anhydramnios likely suggestive of posterior urethral valve. Patient had syndromic facies with low set ears,depressed nasal bridge, receding chin, hypertelorism,external abdominal wall laxity,epispadias, bilateral undescended testis,right CTEV.Chest X ray showed left pneumothorax,right lung hypoplasia,liver on left, stomach bubble on right(malrotation of gut),floating ribs and scoliosis.Cardia was normal. Patient was managed with Ventilatory support,fluids, IV antibiotics, IV adrenaline and dopamine infusion, but succumbed to death after 5 hours of birth due to lethal anomalies incompatible with life.