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There is sufficient evidence at present to support early enteral feeding of low birth weight (LBW) neonates, including those who are sick or very preterm (< 30 weeks). Trophic feeding with human milk initiated within 48 hours of birth at 10-15 ml/kg/day improves later tolerance to graded increment of enteral feeding volumes without increased risk of necrotizing enterocolitis. Trophic feeding supports increments of feeding volumes by 30 ml/kg/day by intermittent gavage feeding. Non-nutritive sucking and spoon-feeding aid earlier transition to exclusive breast-feeding. Human milk promotes adequate growth of most preterm neonates, though many need multivitamin and mineral supplementation. The role of human milk fortifiers to promote growth appears controversial.

Objective : The purpose of the study is to report a unique association of clinical and pathological findings in a neonate. Foregut enteric duplication cysts-rare developmental anomalies that are associated with midline vertebral fusion anomalies.Methods : We had a neonate with foregut duplication cyst who presented at birth with respiratory distress. The child also had associated communicating hydrocephalus. The patient underwent excision of the duplication cyst alongwith a ventriculo-peritoneal shunt.Result : The excised specimen revealed a duplication cyst lined by aberrant pancreatic tissue.Conclusion : The present case demonstrates histologically the presence of both pancreatic and gastric tissue.

To test the hypothesis that room air is superior to 100% oxygen when asphyxiated newborns are resuscitated, 84 neonates (birth weight > 999 g) with heart rate < 80 and/or apnea at birth were allocated to be resuscitated with either room air (n = 42) or 100% oxygen (n = 42). Serial, unblinded observations of heart rates at 1, 3, 5, and 10 min and Apgar scores at 1 min revealed no significant differences between the two groups. At 5 min, median (25th and 75th percentile) Apgar scores were higher in the room air than in the oxygen group [8 (7-9) versus 7 (6-8), p = 0.03]. After the initial resuscitation, arterial partial pressure of oxygen, pH, and base excess were comparable in the two groups. Assisted ventilation was necessary for 2.4 (1.5-3.4) min in the room air group and 3.0 (2.0-4.0) min in the oxygen group (p = 0.14). The median time to first breath was 1.5 (1.0-2.0) min in both the room air and oxygen groups (p = 0.59), and the time to first cry was 3.0 (2.0-4.0) min and 3.5 (2.5-5.5) min in the room air and oxygen groups, respectively (p = 0.19). Three neonates in the room air group and four in the oxygen group died in the neonatal period. At 28 d, 72 of the 77 surviving neonates were available for follow-up (36 in each group), and none had any neurologic sequelae.(ABSTRACT TRUNCATED AT 250 WORDS)

To study the short term effects of resuscitation of hypoxic newborn babies with room air, a randomized multicenter study was initiated. Here the data from one center is reported. Entry criteria were: birth weight > 1000 gram, heart rate at birth < 80 per min and or apnoe justifying resuscitation. This was performed with bag and mask or after endotracheal intubation when needed. Babies were enrolled into a group treated with room air (RA, N=36) or 100% oxygen (O2, N=42). Babies in RA group who did not respond within 90 seconds were treated with supplementary oxygen. Heart rate from birth to 10 minutes and Apgar scores from 1 to 20 minutes were identical in both groups as well as pH, BE, paO2 and paCO2 at 10 and 30 minutes post partum. Neonatal mortality was 2/36 in RA and 4/42 in O2 groups (NS) respectively. The study shows that judged by short term follow up hypoxic newborn infants may be resuscitated with room air just as well as with 100% O2.

At the time of independence 340 million lived in urban areas in India, and currently 200 million of an estimated population of 800 million live in 3000 cities and towns with inhabitants over 10.000. There are 90.000 government-employed doctors in urban areas: 1 doctor per 2200 residents. Another 180.000 are practicing in such areas providing a ratio of 1 doctor for every 800 urban people. In Delhi in 1986 there were 63 allopathic hospitals with 15.000 beds and 561 dispensaries. Government employees receive preferential treatment, while the public waits long hours. In frustration the poor often turn to private practitioners even if their qualifications are dubious. Despite 35 years of socialistic planning, only 10-15% of children living in a Delhi colony received adequate vaccination. To rectify this inequality a system is recommended guaranteeing public access to dispensaries on the same fee-basis as that accorded to government employees. A health card could prevent misuse, and it would ensure optimal utilization of existing health facilities. Future development of 50-100 bed hospitals within 2-3 km of clients' homes and the attachment of 5-10 of them to a large hospital or medical school is proposed. A central health board could oversee and coordinate area-based health services.

The goals of the "Health for All" (HFA) by the year 2000 remain unfulfilled, as preschool child mortality is almost 10 to 20 times higher than developed countries. 75% of the population of Indian still lives in villages and 70% of farmers are landless. The Community Health Volunteer (CHV) scheme was launched in 1977 to implement the health policy formulated by the Bhore Committee calling for extension of primary health centers and rural hospitals with 50 beds. Although CHV was changed to community health worker (CHW), and later to village health guide (VHG), this Indian version of the Chinese barefoot doctor scheme never took root. The population coverage of primary health centers was reduced from 100,000 to 30,000 and that of a subcenters to just 3,000 to 5,000. The Bhore panel proposed to set up 7,200, 30-bed community health centers (CHC's) in the rural areas by 2000 calling for 90% of all beds to be at the village, taluk or district levels with 40% set aside for maternal and child health. In 40 years of health planning, the government has been able to create only 30,000 medical jobs to serve 600 million people living in the rural areas, while there are more 90,000 jobs for 200 million urban people. Only 750 (20%) of about 3800 posts of specialists have been sanctioned for the CHC's established in the rural areas by March 1987. It is necessary to provide primary care through a network of specially trained voluntary workers. It is incumbent on the government to establish more than 3 lakh hospital beds in the next 13 years to meet the target of 1 bed for 1,000 people in concordance with the objectives of the Bhore Committee. In addition, it is advisable to implement the recommendations of the National Workshop on Child HealthManpower: 2000 A.D.