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Objective: To find out prevalence, risk factors, severity and outcome of neonatal thrombocytopenia (TCP). Study Design: Prospective Observational study. Setting: Neonatal Intensive Care Unit (NICU) of Children Hospital Complex Multan. Period: January 2020 to January 2021. Material & Methods: A total of 191 neonates admitted to NICU during the study period were enrolled. A special proforma was designed to record all study information while SPSS version 26.0 was utilized for data analysis. Prevalence of TCP was noted among neonates admitted in NICU during the study period. Maternal risk factors, neonatal risk factors, severity of TCP and outcome were recorded. Results: In a total of 191 neonates, 110 (57.6%) were male while overall mean age was recorded to be 2.98+2.46 days. The prevalence of TCP was recorded to be 47.1% (90/191). Pregnancy induced hypertension (p=0.0003), premature rupture of membrane (p=0.0105) and eclampsia (0.0215) were found to have significant association with the presence of TCP. Preterm neonates (p<0.0001), small for gestational age (p<0.0001), sepsis (p<0.0001) and nectrozing enterocolitis (p=0.0014) were found to have significant association with TCP. A total of 13 (6.8%) neonates died, out of which, 5 (38.5%) were having severe TCP. Conclusion: Prevalence of neonatal thrombocytopenia at neonatal intensive care unit was found to be high (47.1%). Pregnancy induced hypertension, premature rupture of membrane and eclampsia were found to have significant association with neonatal thrombocytopenia. Preterm, small for gestational age, sepsis and necrotizing enterocolitis were noted to be significantly associated with neonatal thrombocytopenia. Severe thrombocytopenia was noted to be a significant predictor of poor outcomes. [ABSTRACT FROM AUTHOR]

Objective: To identify the types and risk factors associated with birth injuries. Study Design: Observational study. Setting: Department of Neonatology, The Children's Hospital and the Institute of Child Health, Multan Pakistan. Period: November 2019 to July 2020. Material & Methods: A total of 52 neonates admitted in neonatology unit with birth injuries were included. Clinical examination was done to note possible birth injuries. Characteristics of neonates like gender, gestational age, body weight, maternal age and mode of delivery were calculated. Risk factors like difficult labour and instrumentation were described. Pattern and types of birth injuries were highlighted. Results: In a total of 52 neonates with birth injuries, there were 39 (75.0%) male and 13 (25.0%) female representing a male to female of 3:1. Majority of the babies were term born 43 (82.7%). There were 27 (51.9%) babies weighing > 3000 grams. The highest incidence of birth injuries were recorded in normal vaginal deliveries and least in forceps deliveries. Difficult labour was the most common risk factor observed in 30 (57.7%) cases. Extracranial bleeds were seen in 23 (44.2%) neonates while soft tissue injuries were noted in 15 (28.8%) cases, Erb's paralysis was noted in 5 (9.61%) babies and fractures in 9 (17.3%) babies. Conclusion: Extracranial bleeds were the most common type of birth injuries, followed by soft tissue injuries, fractures and nerve injuries. Difficult labour was the most common risk factor associated with birth injuries. [ABSTRACT FROM AUTHOR]

Objective: To compare the effectiveness of Levetiracetam and Phenobarbital for treating neonatal seizures associated with hypoxic-ischemic encephalopathy. Study Design: Quasi-experimental study. Place and Duration of the Study: Department of Neonatology, The Children's Hospital and Institute of Child Health, Multan Pakistan, from Mar to Nov 2021. Methodology: A total of 132 term neonates of both genders, with birth weight above 1800 grams, presenting within 24 hours of life, with clinical or electric seizures onset secondary to perinatal hypoxia and requiring resuscitation at birth, were included. The neonates were allocated to either Phenobarbital or LEV Group. The efficacy was labelled "yes" if a neonate showed cessation of seizures after the 1st or 2nd dose of the drug and remained seizure-free for the next 24 hours. Results: Out of 132 neonates, 77(58.3%) were male. The mean age was 8.92±4.22 hours. The mean birth weight was 2.29±0.28 kg, ranging between 1.9 and 3 kg. The mean gestational age was 37.67±0.91 weeks. Cessation of seizures occurred among 43(65.2%) neonates in the PB-Group in comparison to 54(81.8%) in the LEV-Group (p=0.030). Mortality was reported in 7(5.3%) neonates (4 in the PB-Group and 3 in the LEV-Group). Conclusion: The LEV was found to be more effective than PB as a first-line treatment agent for neonatal seizure associated with hypoxic-ischemic encephalopathy. Therefore, the LEV can be considered a good and safe alternative to PB for treating NS. [ABSTRACT FROM AUTHOR]

Objective: To find out the frequency of hypoglycemia among infants of diabetic mothers (IDMs) and factors affecting it. Study Design: Descriptive Cross Sectional study. Setting: Department of Neonatology, The Children's Hospital and Institute of Child Health, Multan, Pakistan. Period: September 2019 t0 June 2020. Material & Methods: A total of 186 IDMs admitted to department of neonatology during the study period were enrolled. Bed side blood glucose (BG) was measured using "Accu Chek Performa Blood Glucose Meter" at 0, 2, 4, 6, 8, 12, 18 and 24 hours of life. All IDMs (Infants of Diabetic Mothers) were labeled either gestational diabetes mellitus (GDM) or pre GDM (pre-GDM). IDMs noted to have hypoglycemia during 1st 24 hours of life were described as hypoglycemic and others were labeled as normoglycemic IDMs. Results: Hypoglycemia was noted among 77 (41.4%) IDMs. Duration of disease was significantly more among mothers of hypoglycemic infants (27.62+28.8months vs. 19.69+24.41 months, p=0.0444). Significantly more large for gestational age (LGA) IDMs were found to be hypoglycemic in comparison to normoglycaemic ones (32.5% vs. 16.5%, p=0.0110). Among a total of 77 IDMs noted to have hypoglycemia, 34 (44.1%) were born to mothers who had GDM while remaining 43 (55.9%) were born to pre-GDM mothers. Significantly more IDMs were preterm among pre-GDM mothers when compared to GDM mothers (53.5% vs. 23.5%, p=0.0077). Conclusion: Hypoglycemia is frequent problem among IDMs. Increased duration of diabetes among mothers, LGA as well as preterm IDMs are found to have significantly increased risk of developing hypoglycemia. [ABSTRACT FROM AUTHOR]

Objective: To assess the effectiveness of early nasal Continuous Positive Airway Pressure (nCPAP) in preterm neonates with respiratory distress syndrome (RDS). Study Design: Cohort study. Setting: Department of Neonatology, The Children’s Hospital and Institute of Child Health, Multan. Period: September 2018 to June 2020. Material & Methods: A total of 172 neonates admitted to neonatal intensive care unit (NICU), having RDS with gestational age as 28 to 34 weeks were enrolled. All study participants were administered early nCPAP (within 6 hours of onset of RDS). All babies with RDS were evaluated using Silverman–Anderson (SA) score, blood gas analysis and pulse oximetry. Results: Out of a total of 172 neonates, most, 91 (52.9%) were mal, nourished 89 (51.7%) had gestational age between 31 to 32 weeks and 97 (56.4%) with birth-weight between 1000 to 1500 grams. Majority of the neonates, 97 (56.4%) were found to have radiological grading of RDS as moderate. Successful outcome of early nCPAP was observed in 143 (83.1%) neonates. There was no statistical difference in terms of nCPAP outcome among study participants with respect to gender (p=0.4990). Gestational age, birth weight and severity of radiological grading of RDS were significantly associated with outcome of nCPAP (p <0.00001). Arterial blood gas parameters as PO2, PCO2 and HCO3 were also significantly associated with nCPAP outcome among study participants (p<0.0001). Conclusion: Early Nasal CPAP is safe, inexpensive and effective means of respiratory support in neonates with RDS. Early nasal CPAP is useful especially in mild to moderate grade RDS. [ABSTRACT FROM AUTHOR]

Objectives: The objective of this study was to identify the microorganisms and antimicrobial susceptibility pattern of neonatal septicemia in NICU, Children Hospital and Institute of Child Health, Multan. Study Design: Descriptive study. Setting: Neonatal Intensive Care Unit of NICU, Children Hospital and Institute of Child Health, Multan. Period: 6 months from October 2017-March 2018. Material and Methods: In this study a total of 173 specimen were cultured including peripheral samples 160 (92.5%), tips of endotracheal tubes 8 (4.6%) and tracheal aspirates 5 (2.8%). Our patients were newborns age ranging from 5 - 19 days who were admitted due to suspected septicemia. Specimens were sent to Shaukat Khanam Memorial Hospital Lahore and Aga Khan University Hospital, Karachi where they were cultured by using standard microbiological methods. The necessary information's regarding age of the neonates, weight, gestational age, mode of delivery, prior use of antibiotics and outcome were recorded on predesigned data collection sheet. Results were analyzed by using statistical tools. Results: The outcome of 173 specimens, microbial testing showed that 91 (53%) isolates were found to be positive. Out of these 91, 77 (85%) were Bacterial and 14 (15%) were fungal species. The incidence of Gram Negative and Gram Positive bacteria was found to be 62 (68%) and 15 (16%) respectively. The most common gram negative specie was Klebsiella Pneumonia 20 (32%). Among gram positive bacteria staphylococcus epidermidis 15 (67%) was the most common species. Among fungal species Candida sepsis was the most common, 13 (14%) of all the samples. Most of the gram negative organisms were sensitive to Aminoglycosides, Imipenem and Ciprofloxacin. Gram positive species were sensitive to Linezolid and Vancomycin. All the fungal species were sensitive to Fluconazole and Voriconazole. Conclusion: There is a variety of organisms causing neonatal septicemia in Tertiary Care hospitals with variable susceptibility pattern, which reflects the need to evaluate the incidence of different microbial species after every quarter and study there susceptibility patterns. [ABSTRACT FROM AUTHOR]

Introduction: The need for neonatal resuscitation is usually unexpected and approximately 10% infants require some assistance at birth to begin breathing. We conducted a study to know the facilities and practice of neonatal resuscitation among healthcare providers at different healthcare centers of Multan. Study Design: A cross sectional descriptive epidemiological study. Setting: Different Health Care Centers providing Gynecological and Obstetrical Care in different areas of Urban Multan. Period: 15-08-2016 to 30-08-2016. Method: A questionnaire-type survey on neonatal resuscitation was performed at 69 different health care facilities of Multan. Data were analyzed using SPSS version 17.0 for windows. The results are presented using tables. Results: Out of 69 healthcare facilities, 50 (72.5%) were private hospitals. Majority of the center were run by doctors (52.2%). Ambu-bags were present in 83% centers, bulb sucker 68%, foot sucker 62% and electric sucker in 75% of healthcare centers. Routine delivery room care like drying, warmth and wrap were given in 70%, 74% and 48% centers respectively. Most common way of resuscitating the baby was suction 74%. Post resuscitation referrals in cases needing special care to other facility were made by 88% centers. New born resuscitation courses had been attended by only 36% of healthcare providers. Conclusion: Basic neonatal resuscitation facilities were available at most of the health facilities. There is increased need of new born resuscitation courses attended by the healthcare providers. [ABSTRACT FROM AUTHOR]

Background: Persistent pulmonary hypertension is a serious disease among new-borns. Inhaled nitric oxide is first line of therapy along with extracorporeal membrane oxygenation. Pulmonary vasodilators such as sildenafil, bosentan and milrinone are also used to treat persistent pulmonary hypertension especially in resource limited centres where inhaled nitric oxide is not available. The objective of this study was to compare the effect of sildenafil alone and sildenafil with bosentan on severity of tricuspid regurgitation and duration of hospitalization in new-borns with persistent pulmonary hypertension., Methods: This was single blinded clinical trial conducted at The Children's Hospital & the Institute of Child Health, Multan, Pakistan, from July 2016 to December 2016. New-borns with pulmonary hypertension were admitted and divided into two groups. Group A was treated with sildenafil (2mg per kg per dose three times a day) and group B with both sildenafil (2 mg per kg per dose three times a day) and bosentan (1 mg per kg per dose twice a day)., Results: There were 50 new-borns in each group. The mean age, sex distribution and baseline TR measurement (mmHg) at the time of admission was similar in both the groups. Measurement of TR (mmHg) after 72 hours admission was significantly less in Group B as compared to group A (11±4.62 versus 23±4.78), p-value<0.0001. The mean duration of hospital stays (days) was 10.12±5.20 in group A and 7.56±3.77 in group B (p-value <0.0001). There was no mortality in any group and no case of hypotension in both groups., Conclusions: The combined use of sildenafil and bosentan is more effective than sildenafil alone for control of pulmonary hypertension in resource limited centres.