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Biomedical subjects

Anil Narang

Publications and source records attributed to Anil Narang.

35 records · Page 2Linked to original sources
PubMed2003

Intravenous immunoglobulins in rhesus hemolytic disease.

OBJECTIVE: To evaluate the role of intravenous immunoglobulins in Rh hemolytic disease of newborn. METHODS: The study included all DCT positive Rh isoimmunized babies admitted in the unit from August 2000 to February 2001. Intravenous immunoglobulins in the dose of 500 mg/kg on day 1 and day 2 of life in addition to the standard therapy. Babies who received IVIG were compared with those who did not receive IVIG for the peak bilirubin levels, duration of phototherapy, number of exchange transfusions, discharge PCV and the need for blood transfusions for late anemia till 1 months of age. RESULTS: A total of 34 babies were eligible for the study. 8 babies received IVIG and 26 babies only standard treatment. The mean maximum bilirubin levels were significantly lower in the IVIG group compared to the group who received NO IVIG (16.52 +/- 2.96 Vs 22.72 +/- 8.84, p=0.004). Five babies in the IVIG group (62.5%) and 23 babies in the NO IVIG group required exchange transfusions (88.5%, p=0.014). 12 of the 26 babies in the NO IVIG group required multiple exchange transfusions while none of the babies in IVIG group required more one exchange transfusion (p=0.03). The mean duration of phototherapy was 165 +/- 109 hours in the IVIG group as against 119 +/- 56 hours in the NO IVIG group (p=0.29). Blood transfusion for anemia was more common in the IVIG group (37.5% Vs 11.5% p=0.126) though the packed cell volumes at discharge were similar in both the groups (39.5 +/- 11 Vs 40 +/- 5.1, P=0.92). CONCLUSION: Intravenous immunoglobulins is effective in decreasing the maximum bilirubin levels and the need for repeated exchange transfusions in Rh hemolytic disease of newborn. There is however an increased need for blood transfusions for late anemia in the babies treated with IVIG.

Erythroblastosis, Fetal↗
PubMed2003

Microcephaly with plate-like cortical calcification.

Congenital malformations of the central nervous system have varied presentations depending on the stage of embryological development when the insult occurred. We report a neonate with microcephaly associated with plate-like cortical calcification, probably secondary to an unidentified insult at around 11-12 weeks post-conceptional age causing an arrest of the proliferative phase. The associated vasculopathy probably caused diffuse cortical calcification.

Brain Diseases↗
PubMed2003

Predictive clinical scores for diagnosis of late onset neonatal septicemia.

There is a paucity of data regarding predictive values and likelihood ratios of clinical signs for the diagnosis of late onset neonatal septicemia. This study aimed to determine these parameters in a prospective fashion, deriving a score by combining the most useful signs and determining the diagnostic utility of the score. All neonates admitted to a neonatal unit over a 1-year period were monitored for the occurrence of 16 pre-defined clinical signs. Symptomatic episodes (105 episodes in 80 neonates) were investigated for sepsis, and diagnosed as definite sepsis (n = 30), most probable sepsis (n = 17), and no sepsis (n = 58). Seven clinical signs (grunting, abdominal distension, increased pre-feed aspirates, tachycardia, hyperthermia, chest retractions, and lethargy) had positive likelihood ratios (PLR) greater than 1, and were combined to make a composite score. When a weighted clinical score (WCS) was used to diagnose definite sepsis, a cut-off score of 2 gave the best positive predictive value (PPV) and PLR (52 per cent and 2.65, respectively), and a cut-off score of 1 gave the best negative predictive value (NPV) and negative likelihood ratio (NLR) (85 per cent and 0.44, respectively). A cut-off score of 2 had a PPV of 65 per cent for definite and/or probable sepsis. In conclusion, physicians who attempt to make a diagnosis of neonatal sepsis on purely clinical grounds can use a seven-item weighted clinical score.

Apnea↗
PubMed2003

Pharmacokinetics of oral ibuprofen in premature infants.

Patent ductus arteriosus (PDA) is a frequent complication in premature infants. So far, intravenous indomethacin is the standard mode of medical therapy in such patients but carries a risk of frequently occurring side effects. Ibuprofen, another nonsteroidal anti-inflammatory drug, has also been shown to be efficacious in closing ductus with lesser adverse effects after parenteral administration. However, limited data are available on the pharmacokinetics of intravenous ibuprofen in this population. Nonavailability of parenteral preparation and lack of information regarding pharmacokinetic disposition of ibuprofen in this subgroup of the population led the authors to conduct this pharmacokinetic study with oral ibuprofen. Twenty premature infants with a gestational age of 30.45 +/- 0.33 weeks and a birth weight of 1262.5 +/- 55.4 g (values given as mean +/- SEM) admitted to the neonatal unit were enrolled in this study. Ibuprofen was administered in a single oral dose of 10 mg/kg between 4 and 72 hours postnatally, and blood samples were collected through an indwelling vascular catheter at time 0 and 1, 2, 4, 8, 12, and 24 hours. Ibuprofen plasma concentrations were assayed by high-performance liquid chromatography. There was a large interindividual variability observed for plasma concentrations, elimination half-life (t1/2) (15.72 +/- 3.76 h), and area under the plasma concentration-time curve (AUC0-infinity) (402.60 +/- 79.67 micrograms.h/mL) in these babies. Variables such as gestational age, birth weight, and sex did not affect ibuprofen pharmacokinetics significantly (p > 0.05). Moreover, no correlation could be found between elimination half-life and gestational age (r = 0.02). Ibuprofen pharmacokinetics showed a wide variability in premature infants. The results of the present study warrant revising the oral dosage schedule to achieve comparable plasma concentrations of ibuprofen associated with successful closure of ductus, as reported in earlier studies.

Administration, Oral↗
PubMed2003

Counting respiratory rate in infants under 2 months: comparison between observation and auscultation.

The World Health Organization's global programme for the control of acute respiratory infections relies on counting respiratory rate (RR) by observing abdominal and chest movements in order to diagnose pneumonia. However, few studies on the reliability of the observation method have been published. We counted RR simultaneously by observation and auscultation in 100 healthy infants at 1, 2, 4, 6 and 8 weeks of age for 15, 30 and 60 sec, and compared RRs obtained by the two methods. In all the age groups studied, the co-efficients of variation for the RRs recorded by observation or auscultation were similar. The mean RR by observation was higher by 1-3 breaths/min than mean RR by auscultation (p < 0.001). The 95% confidence interval (+/-2 SD) for the difference between RR by the two methods ranged from +5 to -8 breaths/min for RR counted for 1 full minute. Our data support the assumption that observation is as reliable as auscultation for counting RR.

Age Factors↗
PubMed2003

Unusual manifestations of VACTERL association.

We report a case of VACTERL association along with unusual manifestations of pseudo-exostrophy of bladder, hemifacial microsomia and an urachal cyst communicating with the bladder.

Abnormalities, Multiple↗
PubMed2003

Drug resistant neonatal Candida tropicalis septicemia. Did it cause diaphragmatic hernia?

A full-term, 3 kg baby girl developed early onset Candida tropicalis septicemia. The fungus was resistant to amphotericin B, fluconazole and itraconazole. She developed an acquired diaphragmatic hernia during the course of the infection. The possible association of the hernia with the fungal sepsis is discussed. She improved on treatment with 4-flucytosine and after being operated for the hernia.

Candida tropicalis↗
PubMed2002

Bilateral congenital choanal atresia.

Our experience with the diagnosis and management of bilateral choanal atresia is presented. Four patients were treated by endoscopic transnasal approach followed by stenting with portex endotracheal tube for four to six weeks. Meticulous postoperative care particularly stent management is crucial for successful treatment of choanal atresia.

Choanal Atresia↗
PubMed2002

Phenobarbitone prophylaxis for neonatal jaundice in babies with birth weight 1000-1499 grams.

Management of neonatal jaundice is simple but in sick, very low birth weight babies poses additional hemodynamic insult. Role of prophylactic postnatal phenobarbitone (two different dosage regimens) was evaluated prospectively on occurrence of neonatal jaundice and the need for therapy in 150 babies with birth weight 1000-1499 grams. Phenobarbitone in the dose of 10mg/kg given within 6 hours of life followed by 5mg/kg/day till day 5 of life intravenously significantly decreased the need for exchange transfusion and duration of phototherapy in babies with birth weight of 1000-1499 grams. This dosage schedule was better than dose of 5mg/kg for 5 days in significantly reducing the duration of phototherapy

Exchange Transfusion, Whole Blood↗
PubMedDate not supplied

Chorangiopagus parasiticus twins.

Chorangiopagus parasiticus twins (CAPP) occur due to asymmetric abnormality of monozygous, twinning. It is the commonest form of asymmetric twinning, occurring in 1% of monozygous twins. The asymmetric twin survives by parasitizing the more normally developed co-twin by connecting with the chorionic circulation, hence, chorangiopagus parasiticus. CAPP twin is a markedly edematous foetus with relatively well-developed legs, incomplete pelvis and lower spine. The body cavity contains some incomplete abdominal viscera but usually no thoracic organs. The upper portion of the twin consists of edematous cystic tissue. This parasitic perfused twin has no placental vascular connection and its cord vessels are conjoint with those of the parasitized pump twin on the surface of the placenta or somewhere along the cord. This malformation can be identified by ultrasound as early as 12 weeks gestation.

Abnormalities, Severe Teratoid↗
PubMedDate not supplied

Pathology teach and tell: neonatal hemochromatosis with massive hepatic necrosis.

Neonatal hemochromatosis (NH) is an uncommon disorder clinicopathologically defined by severe liver disease of intrauterine onset associated with extrahepatic siderosis that spares reticuloendothelial elements. NH phenotypically is a similar disorder to hereditary hemochromatosis. However, its extremely early onset of liver failure makes it notably unique. Massive liver necrosis in the newborn is a rare occurrence, but whenever present hemochromatosis should be considered in the differential diagnosis. Herein, we report a case of neonatal hemochromatosis that had massive hepatic necrosis with sparing only little parenchyma. The outcome was fatal within the first month of life.

Diagnosis, Differential↗