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Aim: Hypothermia (HT) is a common and serious problem during anesthesia. As the ratio of skin surface area to body volume is higher in neonates than in adults, heat loss and ultimately HT are more common in the intraoperative period. This study aimed to determine the incidence and independent risk factors of HT in the neonatal period. Materials and Methods: This retrospective observational cohort study included 63 patients who underwent neonatal surgery within a one-year period. HT was defined as body temperature <36 °C and the patients were divided into two groups: Group I (body temperature <36 °C) and Group II (≥36 °C). Demographic data, ASA score, operative diagnosis, duration of surgery and anesthesia, amount of fluid, inotrope and vasopressor therapy, amount of bleeding, amount of blood transfusion, preoperative and postoperative temperatures, and the heating methods of the patients were recorded. Results: The median age of the patients was 5 days (0-28 days) and their mean weight was 2,792±782 grams. The esophageal method was used for temperature monitoring in 88.9% (56 patients) and the rectal method in 10.1% (7 patients). HT developed in 54% of the patients. Caps and socks were used to prevent HT in 96.8% of the patients, forced-air warming blankets in 95.2%, warming gel mattresses in 27%, and fluid and blood warming devices in 17.5%. In the logistic regression model, the operating room temperature was identified as the only independent risk factor associated with neonatal HT. Conclusion: Despite the use of active and passive warming methods, the incidence of HT in the neonatal period was found to be high. Cold operating rooms were found to be the only independent factor associated with neonatal HT. [ABSTRACT FROM AUTHOR]

Guidelines for screening and management of congenital hypothyroidism in neonates have been recently updated by the American Academy of Pediatrics (AAP). This article compares new AAP guideline with the Indian Society for Pediatric and Adolescent Endocrinology (ISPAE) Guidelines, 2018 and lists the changes in screening, diagnosis, and management of congenital hypothyroidism suggested in the new guidelines, along with clinical utilization in the Indian scenario. [ABSTRACT FROM AUTHOR]

Aim: To investigate the relation between common acid-base parameters and blood lactate concentrations and their prognostic importance in sick, ventilated neonates.Methods: Two hundred and seventy eight serial simultaneous measurements of arterial acid-base status and blood lactate concentrations were carried out in 75 mechanically ventilated neonates with indwelling arterial catheters (gestational age and birthweight, median (range) -29 (23-40) weeks, and 1340 (550-4080) g, respectively).Results: There were no correlations between arterial blood lactate and pH and base excess within subjects (r = 0.07 and r = -0.06, respectively) and only weakly positive but clinically irrelevant positive correlations between subjects (r = 0.28 and r = 0.27) in this group. Even in those infants who had not received any bicarbonate before their initial measurements (n = 48), there were no correlations between initial blood lactate concentrations and pH (r = 0.27), base excess (r = 0.17), or serum bicarbonate concentrations (r = -0.18). There was no relation between peak lactate concentration (PLC) and base excess (r = 0.16), and only a weak correlation between peak lactate concentration (PLC) and pH (r = 0.28). Negative base excess was an insensitive indicator of raised lactate concentrations. Only two out of 33 (6%) instances of hyperlactataemia (lactate > 2.5 mmol/l) would have been identified with a base excess < -10 mmol/l as a cutoff. Lower cutoff values of base excess or pH performed no better. Raised lactate concentrations were associated with increased mortality at all levels. While six of 53 (11%) infants with a PLC < 2.5 mmol/l died, this proportion increased to four of 15 (27%) with a PLC between 2.5-5.0 mmol/l, and four of seven (57%) with a PLC > 5.0 mmol/l. Infants showing little rise or a substantial fall in blood lactate fared better than those with persistently raised values. A clinically important increase in blood lactate preceded the development of clinical markers of deterioration and complications in six infants.Conclusions: Contrary to popular belief, pH or base excess cannot be used as proxy measures for blood lactate concentration, and independent measurement of the latter are needed. Blood lactate concentrations may provide an early warning signal and important prognostic information in ill, ventilated neonates. In this regard, serial measurements of blood lactate are more useful than a single value. [ABSTRACT FROM AUTHOR]

Pulse wave velocity (PWV) has been explored to predict cardiovascular health in adults. Less is known about neonatal PWV. We evaluated the association between arterial stiffness of neonates of mothers (NoM) with diabetes and childhood health. Neonatal brachial-femoral PWV (bfPWV) was measured after birth and neonates followed for a median of 5.2 years [1 month-6.6 years]. 36 pregnant women with pregestational diabetes mellitus PGDM (n = 12), gestational diabetes mellitus (GDM) (n = 13), and controls (n = 11) were enrolled. Neonates were similar in weight, gestational age, and delivery mode. 26 neonates had follow-up data including weight, height and blood pressure. More mothers with PGDM had poor glycemic control compared to mothers with GDM (83% vs. 8%; p = 0.0002). PWV was higher in NoM with PGDM than controls (3.4 ± 0.5 vs. 2.6 ± 0.8 m/s; p = 0.04). At follow-up, children of mothers with diabetes (n = 16) had higher weight percentile (78.5 ± 27.9 vs 49.5 ± 34.6%; p = 0.02) and diastolic blood pressure (DBP) (68 ± 13.6 vs 57.3 ± 4.3 mmHg; p = 0.01) than controls (n = 10). No correlation emerged between neonatal PWV and childhood body mass index (BMI) or maternal HbA1c. Results suggest maternal diabetes affect neonatal arterial stiffness and childhood blood pressure; however, the mechanism is unclear. The long-term implications of these findings warrant further investigation., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Domestic violence (DV) is a serious public health concern, affecting women's health and well-being. An international governance framework, through the United Nations' Sustainable Development Goals and national policies in India have committed the country to attempt elimination of violence against women. Even so, efforts remain starkly inadequate for altering conditions under which women experience DV. This review paper aims to develop an evidence-based, integrated life cycle model to alter conditions that perpetuate DV and related vulnerabilities in society. The analyses identify and determine community-based innovative practices and policies. We propose a collaborative 'R5 model' to incorporate a multi-stage response to break the cycle of gendered vulnerability. The model identifies five stages of vulnerability in the lives of victims of violence: rescue, recovery, rehabilitation, resilience, and reform. This approach can result in promoting a proactive state-society engagement to uphold the rights and the welfare of women. We recommend the 'R5 model' to bridge the global SDG targets, national policies, and local practices. [ABSTRACT FROM AUTHOR]

The article highlights the recommendations to reduce the potential adverse events associated with persistent, prolonged, or symptomatic hypoglycemia. It mentions the clinical signs and symptoms of neonatal hypoglycemia in neonates and also highlights the factor to consider that can affect the accuracy of glucose- level measurement.

The Indian Society for Pediatric and Adolescent Endocrinology has formulated locally relevant Clinical Practice Guidelines for newborn screening, diagnosis and management of primary congenital hypothyroidism (CH).Recommendations: Screening should be done for every newborn using cord blood, or postnatal blood, ideally at 48 to 72 h of age. On this screen sample, neonates with TSH > 20 mIU/L serum units (or >34 mIU/L for samples taken between 24 to 48 h of age) should be recalled for confirmation. For screen TSH > 40 mIU/L, immediate confirmatory venous T4/FT4 and TSH, and for milder elevation of screen TSH, a second screening TSH at 7 to 10 d of age, should be taken. Preterm and low birth weight infants should undergo screening at 48-72 h postnatal age. Sick babies should be screened at least by 7 d of age. Venous confirmatory TSH >20 mIU/L before age 2 wk and >10 mIU/L after age 2 wk, with low T4 (<10 μg/dL) or FT4 (<1.17 ng/dL) indicate primary CH and treatment initiation. Imaging is recommended by radionuclide scintigraphy and ultrasonography after CH is biochemically confirmed but treatment should not be delayed till scans are performed. Levothyroxine is commenced at 10 to 15 μg/kg in the neonatal period. Serum T4/FT4 is measured at 2 wk and TSH and T4/FT4 at 1 mo, then 2 monthly till 6 mo, 3 monthly from 6 mo-3 y and every 3-6 mo thereafter. Babies with the possibility of transient congenital hypothyroidism should be re-evaluated at age 3 y, to assess the need for lifelong therapy. [ABSTRACT FROM AUTHOR]

An introduction to the journal is presented in which the editor discuss the antenatal diagnosis of fetal anomaly.

Objective: To determine the clinical manifestations of hypoglycemic neonates presenting at a tertiary care facility. Method: This was a cross sectional study conducted at neonatal unit, National Institute of Child Health, Karachi from 10th December 2013 to 9th December 2014. All hypoglycemic neonates of either gender and term gestation were enrolled. Detailed relevant history and clinical examination was considered i.e. Refusal to feed, jitteriness, seizures, lethargy, respiratory distress and hypothermia. Blood sample for glucose level was sent to the institutional laboratory. Blood glucose values less than 40 mg/ dl (2.8mm0l/1) was considered as hypoglycemia. Data was analysed in SPSS version 17. P value < 0.05 level as taken as significant. Results: Mean age, weight and gestational age of the neonates were 14.69 ± 10.23 days, 3.16 ± 0.46 kg and 3.16 ± 0.46 weeks respectively. There were 65 (59.10%) female and 45 (40.90%) male patients. Frequent clinical manifestation were refusal to feed (43%), jitteriness (35%), respiratory distress (33%), lethargy (27%), seizures (11%) and hypothermia (11%). Conclusion: Refusal to feed was the commonest clinical expression in hypoglycemic neonates. It builds our threshold for management and prevention strategies towards hypoglycemic neonates with diverse clinical picture. [ABSTRACT FROM AUTHOR]

Aim: Infant feeding can be the reason for presentation and/or admission to hospital. The aim of this study was to identify if infant feeding history was documented in charts of infants presenting and/or admitted to a paediatric hospital. Methods: A systematic random sample of hospital charts of infants who had presented to the emergency department between 1 July 2011 and 30 June 2012 was audited for presence of documentation of feeding. Results: In total, 465 charts were audited, representing 12.5% of infants who presented to the emergency department in the year. Frequency of documentation for feeding measures was as follows: feeding mode, 263 (57%); feeding type, 228 (49%); feeding frequency, 119 (26%); and with changes 89 (19%) since birth. Increasing infant agewas significantly associated with less frequent recording of feeding mode, type, frequency and changes. Conclusion: A comprehensive feeding history is not recorded on many occasions of infant presentation and/or admission to hospital. The recording of feeding mode, type, frequency and changes is needed in order to explore the existence, or otherwise, of a relationship between feeding and the reason for presentation and/or admission. [ABSTRACT FROM AUTHOR]

The article focuses on the study conducted to evaluate the effectiveness of four dried blood spot testing protocols screening for congenital hypothyroidism (CH) of new born that are transferred to the neonatal intensive care unit. It mentions that population-based retrospective cohort study and logistic regression methods are used in the study. It concludes that primary testing programmes do not incorporate and serial screening may fail to identify approximately half of newborns with CH.

Objective To explore the maternal demographic factors associated with operative births (instrumental vaginal births or caesarean section), after adjustment for health, interpersonal, pregnancy, labour and infant covariates. Design Nationally representative cohort study. Setting Women giving birth in the UK, during the period 2000-2002. Sample A total of 18 239 mother-infant pairs. Methods Multinomial logistic regression models were estimated to explore the relationship between demographic characteristics and mode of birth, stratified by parity. Main outcome measures Self-reported mode of birth, defined as unassisted vaginal birth, instrumental vaginal birth, emergency caesarean section and planned caesarean section. Results For primiparous women, operative births rose steeply with increasing maternal age. Women from lower occupational status households were at an increased risk of planned caesarean section. Mode of birth differed significantly by ethnicity. For multiparous women, a younger age at first birth was protective of a later caesarean section or instrumental vaginal birth at the cohort birth. Women with qualifications normally taken at the age 18 years were at an increased risk of planned caesarean section compared with women with degree-level qualifications. Mode of birth differed significantly by ethnicity, and non- UK born women were at an increased risk of emergency caesarean section. Conclusions The sociodemographic characteristics of UK women independently predict mode of birth. Further research is needed to establish to what extent sociodemographic differences in mode of birth are a reflection of the attitudes and behaviours of women, or health professionals, and are therefore amenable to change. [ABSTRACT FROM AUTHOR]

Objective: To examine the inter-rater reliability of The King's Outcome Scale for Childhood Head Injury (KOSCHI) with clinicians of varying experience in paediatric traumatic brain injury (TBI); and to examine change in outcome during long-term follow-up of children following traumatic brain injury (TBI) using KOSCHI. Method: Retrospective assessment of detailed clinic reports of 97 children followed-up by a tertiary specialist paediatric brain injury service. Investigators were blinded to each other's scores. Results: Inter-rater reliability was substantial (weighted kappa 0.71) and similar for investigators of varying experience. KOSCHI outcome was strongly associated with markers of injury severity ( p = 0.028). In longitudinal follow-up, KOSCHI score worsened in 7 (23%) children who were injured under 8 years but in no older children ( p = 0.02). Conclusion: KOSCHI has high inter-rater reliability for investigators of different experience. Long-term KOSCHI outcome is associated with injury severity. Some young children may develop worse disability over time. [ABSTRACT FROM AUTHOR]

Objective To determine the relationship between nearpatient-test (NPT) lactate, white blood cell count (WBC) and C-reactive protein (CRP) and severe bacterial infection (SBI) in children presenting to the emergency department (ED) with infection.Methods An observational cohort study was undertaken in a paediatric emergency department of a large urban teaching hospital. Data were collected from January 2007 until December 2007. Inclusion criteria were age <16 years, blood test including NPT lactate obtained in the ED and infection-related ED diagnosis. Patients were pre-assigned to risk groups according to their NPT lactate, WBC and CRP. Results 506 children were included in the study, of which 42 (8.3%) had SBI. NPT lactate, WBC and CRP were significantly higher in the SBI cohort. High-risk NPT lactate (⩾4 mmol/l) had a sensitivity of 38.1% (95% CI 23.6% to 54.4%) and a specificity of 89.7% (95% CI 86.5% to 92.3%); high-risk WBC (<5 or ⩾15x109/l) had a sensitivity of 51.2% (95% CI 35.1% to 67.1%) and a specificity of 73.8% (95% CI 69.4% to 77.8%); and high-risk CRP (⩾50 mg/l) had a sensitivity of 36.8% (95% CI 21.8% to 54.1%) and a specificity of 83.6% (95% CI 79.4% to 87.2%) for SBI. All three high-risk markers combined yielded a sensitivity of 5.3% (95% CI 1.5% to 17.3%) and a specificity of 99.2% (95% CI 97.6% to 99.7%) for SBI. Conclusion The data from our study suggest that NPT lactate provides early diagnostic information about the risk of SBI in children presenting to the ED with a suspected infection. Combining NPT lactate with WBC and CRP resulted in a promising rule-in-tool for SBI in children in the ED which, with prospective validation, has the potential to aid early identification of SBI in children. [ABSTRACT FROM AUTHOR]

BACKGROUND Early pregnancy obesity (body mass index, BMI, ≥30 kg/m2) carries significant health implications. This cohort study investigates the association between early pregnancy BMI and the risk of fetal and infant death in pregnancies not affected by congenital anomalies or pre-gestational diabetes. METHODS Data on singleton pregnancies delivered during 2003–2005 at five hospitals were linked with data from three regional registers: the Northern Perinatal Mortality Survey, the Northern Diabetes in Pregnancy Survey and the Northern Congenital Abnormality Survey. Logistic regression models were used to determine the crude and adjusted odds ratios (aOR) of a spontaneous fetal death (≥20 weeks gestation) and infant death (aged up to 1 year), among underweight (BMI <18.5 kg/m2), overweight (BMI 25–29.9 kg/m2) and obese women compared with women of recommended BMI (18.5–24.9 kg/m2). RESULTS Obese women were at significantly increased risks of both fetal death [aOR = 2.32 (95% confidence interval: 1.64–3.28), P< 0.001] and infant death [aOR = 1.97 (1.13–3.45), P= 0.02]. Continuous analyses revealed a V-shaped relationship between BMI and the risk of fetal and infant death, with a minimum risk at 23 kg/m2, and significantly increased risk thereafter for both fetal death [aOR, per unit = 1.07 (1.05–1.10), P< 0.001] and infant death [aOR, per unit = 1.06 (1.02–1.10), P= 0.007]. No significant excess risks, however, were identified for either maternal underweight [fetal death: aOR = 0.98 (0.42–2.25), P= 0.96; infant death: aOR = 1.89 (0.73–4.88), P= 0.19] or maternal overweight [fetal death: aOR = 1.34 (0.94–1.89), P= 0.10; infant death: aOR = 1.35 (0.79–2.32), P= 0.27] as categories. Except for higher rates of pre-eclampsia among stillbirths, no specific cause of death could explain the increased odds of fetal and infant death among the obese. CONCLUSIONS Early pregnancy obesity is significantly associated with fetal and infant death, independent of the known relationships with congenital anomalies and maternal pre-gestational diabetes. [ABSTRACT FROM PUBLISHER]

Lactic acidosis is a common finding in critically ill patients. It has been used as a prognostic marker of the outcome in Pediatric Intensive Care Unit patients. Lactic acid is produced as a product of anaerobic glycolysis and is reversibly converted to pyruvate in the presence of favorable metabolic environment. All the body tissues can produce and consume lactate with few having predominant function of production and others of consumption. Liver is a major organ for lactate consumption and it is the liver, which metabolizes the increased lactic acid produced in regional tissue beds. The lactate levels can be done on arterial, venous, or mixed venous blood and can be measured by various methods. Serial lactate concentrations and the difference in arterial and mixed venous lactate levels or between the arterial and regional blood lactate levels like jugular venous lactate levels have been shown to have better correlation with the outcome. High initial blood lactate levels and persistently high lactate levels have been correlated with poor outcome. There are various causes of lactic acid overproduction, which may produce either hyperlactatemia or lactic acidosis. High blood lactate levels are found in critically ill patients with shock of any etiology and sepsis due to various reasons, which include increased catecholamine induced glucose flux apart from the tissue hypoperfusion and hypoxia. Various other illnesses can cause an increase in blood lactate levels like acute lung/liver injury, severe asthma, poisoning, post cardiac surgery etc. Treating the underlying disease leading to lactic acidosis is the best measure to control lactic acidosis. Some therapeutic choices are available to neutralize the effect of lactic acid on cell function, but none has stood the test of time and are tried only in desperate situations. [ABSTRACT FROM AUTHOR]

Our aim was to compare the respective values of base deficit and lactate in birth asphyxia. Methods: Base deficit and lactate levels were measured from radial artery blood samples taken at 30 min of life in 115 term newborns suspected as having been asphyxiated during labour. Both base deficit and lactate levels were compared between patients who further developed moderate or severe encephalopathy and those who experienced no or only mild encephalopathy. Receiver operating characteristics curves and clinical values of both indicators were computed. Results: The correlation between base deficit and lactate was significant (r[sup 2] = 0.51, p < 0.0001). Both indicators were significantly associated with neonatal outcome. Lactacidaemia lower than 5 mmol/l and/or base deficit level lower than 10 mEq/l were not followed by neurological complications. Plasma lactate concentration greater than 9 mmol/l was associated with moderate or severe encephalopathy with a sensitivity of 84% and a specificity of 67%. Base deficit and lactate had similar clinical values. Conclusions: Base deficit and lactate measurements in arterial blood at 30 min of life are equally valuable in assessing the severity of birth asphyxia. [ABSTRACT FROM AUTHOR]

Chronic pain often is assumed to have so many psychologic attachments that a “simple” approach to treatment, while not uncommonly tried, is expected to resuit in failure (a not uncommon result). Chronic pain that “fails” drug management then often is considered to be “psychologically” based ( ie, “not real”), and referral is made to a mental health specialist. Thus, “mind” and “body” are treated as separate entities. This article emphasizes a more integrated approach, with increased recognition of the meanings of behavior by the anesthesiologist, enhanced involvement of the generalist ( eg, pediatrician), and a closer collaboration between the mental health and pain specialists. [ABSTRACT FROM AUTHOR]

To assess the accuracy and reliability of reflectance photometers in estimating blood glucose concentrations, two were assessed: the Ames Glucometer 3 (Bayer Diagnostics) with Glucofilm Test strips; and the Reflolux S (Boehringer Mannheim) with BM Test Glycemia 20-800 strips. These were compared with laboratory blood glucose estimations in 100 assays (50 comparisons for each machine, measuring the difference (d) between the glucose reading and the mean of the reflectance photometer and the laboratory value). The Ames Glucometer 3 (mean d = + 0.7 mmol/l, (SD 1.1) mmol/l) was less accurate than the Boehringer Reflolux S (mean d = 0.2 mmol/l, (SD (0.7) mmol/l). The range of error of both machines is wide (Ames 2 SD range + 2.9 mmol/l to -1.5 mmol/l true readings; Boehringer + 1.8 mmol/l to -1.2 mmol/l of true readings). Because of this, any reflectance photometer readings that are even slightly low should be checked with laboratory estimations. The clinical value of such machines is limited in infants with low blood glucose concentrations. [ABSTRACT FROM AUTHOR]

The authors discuss the sustainable development goals (SDGs) which will guide global health development from 2015 to 2030. They argue on the promises of the SDGs. The authors relate that SDGs include 17 goals and 169 targets to address people, planet, prosperity, peace and partnership. They also examine the Goal 3 which comprises of 13 targets that explicitly identify quantitative and qualitative health targets.

Byline: Samir. Suri, Michael. Parr The landmark publication of the recent SAFE study provides some answers on fluid resuscitation and demonstrates large pragmatic studies are possible in Intensive Care. The [...]