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N B Mathur

Publications and source records attributed to N B Mathur.

At least 19 recordsLinked to original sources
PubMed2006

Estimation of rewarming time in transported extramural hypothermic neonates.

OBJECTIVES: To evaluate the time taken for rewarming hypothermic neonates and to correlate the time taken for rewarming with severity of hypothermia (WHO classification), weight, gestational age and associated morbidity. METHODS: 100 extramural neonates transported to the Referral neonatal unit of a teaching hospital, with weight more than 1000 grams and abdominal skin temperature less than 36.5 oC at admission were included in the study. Hypothermia was classified as per WHO recommendations. Clinical features including age, weight, gestational age, clinical diagnosis and vitals were recorded at the time of admission. Rewarming was done under a servo-controlled radiant warmer, in skin mode at set temperature of 37 oC. Skin and air temperatures measured by the thermistor probe were recorded at the time of admission and then at least every 15 minutes till skin temperature reached 36.5 oC. The neonates were monitored for oxygen saturation, blood glucose and capillary filling time and stabilized promptly. RESULTS: The mean abdominal skin temperature was 34.9 +/- 1.4 oC. 72% of babies were moderately or severely hypothermic as per WHO classification. The duration of rewarming was 4.9 +/- 0.8 min, 17.5 +/- 9.5 min and 42+/-7.9 min for mild, moderate and severe hypothermia respectively (p=0.021). The difference in rate of rewarming between various grades of hypothermia was also significant. The duration of rewarming a baby did not differ significantly between the different weight and gestational age groups. When the rate of rewarming was expressed as rise in oC per Kg body weight per hour, it was higher in smaller and more premature babies. The rate of rewarming was slower in asphyxiated babies. CONCLUSIONS: The duration of rewarming depends on the severity of hypothermia. When rewarmed under radiant warmer using servo mode, the duration of rewarming a baby is the same irrespective of weight and gestational age. Asphyxiated babies take longer time to rewarm.

Humans↗
PubMed2006

Acute renal failure in neonatal sepsis.

OBJECTIVE: To evaluate the occurrence of acute renal failure (ARF) and the factors associated with it in cases of neonatal sepsis. METHODS: The case control study was conducted in the referral neonatal intensive care unit of a tertiary teaching hospital. 200 out born neonates with sepsis admitted to the nursery from January to July 2003 were evaluated for presence of ARF (cases) or not (controls). Sepsis was diagnosed on the basis of either a positive sepsis screen (immature: total (I:T) neutrophil ratio > 0.2, micro-ESR > age in days + 2 mm or> 15 mm, CRP> 6 mg/dl, TLC< 5000 cells/mm3; 2 or more positive) or a positive blood culture in symptomatic neonates. ARF was defined as blood urea nitrogen (BUN)> 20mg/dl on two separate occasions at least 24 hours apart. Oliguria was defined as urine output < 1 ml/Kg/hr. RESULTS: 52 out of 200 (26%) neonates with sepsis had ARF; only 15% of ARF was oliguric. The mean gestation of neonates with ARF was similar to those without ARF (36.1+/-4.1 wks vs. 36.6+/-3.5 wk; p = 0.41). A significantly higher number of babies with ARF weighed less than 2500 gm as compared to those without ARF (86.5% vs 67.6%; p = 0.008). The association of meningitis, disseminated intravascular coagulation (DIC) and shock was also significantly higher in neonates with ARF (46.8% vs 26.2%, p = 0.01; 65.4% vs 20.3%, p < 0.001; 71.2% vs 27.0%, p < 0.001 respectively). Mortality in neonates who developed ARF was significantly higher (70.2% vs 25%, p < 0.001). Factors including gestational age, weight, onset of sepsis, culture positivity, associated meningitis, asphyxia, shock, prior administration of nephrotoxic drugs were subjected to univariate analysis for prediction of fatality in neonates with sepsis and ARF; only shock was found to be a significant predictor of fatality (p< 0.001). ARF had recovered in 22 out of 49 neonates in whom data was available; three patients had left against medical advice. The mean duration of recovery in these 22 neonates was 5.5 days (range 1-14 days). Presence of co-existing morbidities (perinatal asphyxia/congestive heart failure (CHF)/ necrotising enterocolitis (NEC)) or nephrotoxic drugs did not alter the frequency of recovery of ARF in septic neonates (45.5% vs 44.4%,p = 0.944; 41% vs 52%, p = 0.308 respectively). CONCLUSION: Renal failure occurred in 26% neonates with sepsis. Although ARF in neonates has been reported to be predominantly oliguric, it was observed that ARF secondary to neonatal sepsis was predominantly non oliguric. Low birth weight was an important risk factor for the development of ARF. The mortality being three times higher in neonates with ARF demands a greater awareness of this entity among practitioners and better management of this condition.

Acute Kidney Injury↗
PubMed2006

Newborn care practices in an urban slum of Delhi.

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 an urban slum of Delhi. SETTINGS AND DESIGN: Community based, cross-sectional survey in a resettlement colony (a type of urban slum). MATERIALS AND METHODS: Semi-structured, pre-tested schedule was used to interview 82 mothers of newborns in the study area. STATISTICAL ANALYSIS: Data was analyzed using Epi - info version 6.04. Fischer exact test and chi2 test were applied. A P value of less than 0.05 was considered significant. RESULTS AND CONCLUSION: More than half i.e. 26 (56.1%) of home deliveries, which were mostly conducted by dais (24, 91.3%) or relatives in 4 (8.7%) of home deliveries. Bathing the baby immediately after birth was commonly practiced in 38 (82.6%) of home deliveries. Finger was used to clean the air passage in most of the home deliveries (29, 63%). About 61% (28) 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. Use of clip, band or sterile thread to tie the cord and no application to the cord was significantly higher in institutional deliveries. Breast milk as the first feed was significantly more in institutional deliveries. There is an urgent need to reorient health care providers and to educate mothers on clean delivery practices and early neonatal care.

Cross-Sectional Studies↗
PubMed2005

Evaluation of WHO classification of hypothermia in sick extramural neonates as predictor of fatality.

The objective of this study is to correlate the severity of hypothermia in sick extramural neonates with fatality and physiological derangements. This is a prospective observational study carried out at the referral neonatal unit of a teaching hospital admitting extramural neonates. The subjects comprised of 100 extramural hypothermic neonates transported to the Referral neonatal unit. Neonates weighing more than 1000 g, with abdominal skin temperature less than 36.5 degrees C at admission were included in the study. Hypothermia was classified as per WHO recommendations. Clinical features including age, weight, gestational age, clinical diagnosis, vitals, place of delivery, details of transportation and capillary filling time were recorded at the time of admission. Oxygen saturation was recorded by a pulse oximeter. Samples for sepsis screen, blood culture and blood glucose were taken at admission. During the study it was observed that fatality was 39.3% in mildly hypothermic babies, 51.6% in moderately hypothermic babies and 80% in severely hypothermic babies. However, the presence of associated illness (birth asphyxia, neonatal sepsis and respiratory distress), physiological derangements (hypoxia, hypoglycemia and shock) and weight less than 2000 g were associated with more than 50% fatality even in mildly hypothermic babies. When moderate hypothermia was associated with hypoxia or shock, the fatality was 83.3% and 90.9% respectively. Similarly, mild hypothermia with hypoglycemia was associated with 71.4% fatality. The conclusion drawn from this study is that the WHO classification of severity of hypothermia correlates with the risk of fatality. However, it considers only body temperature to classify severity of hypothermia. The presence of associated illness (birth asphyxia, neonatal sepsis and respiratory distress), physiological derangements (hypoxia, hypoglycemia and shock) and weight less than 2000 g should be considered adverse factors in hypothermic neonates. Their presence should classify hypothermia in the next higher category of severity in WHO classification.

Asphyxia Neonatorum↗
PubMed2005

Infant feeding - an evaluation of text and taught.

OBJECTIVE: Study was conducted to 1) assess knowledge of doctors, medical interns and nurses/ANMs regarding exclusive breast-feeding, management of common problems related to breast feeding and appropriate complementary foods 2) review the above aspects in books commonly read by medical and nursing students. METHODS: Cross-sectional study conducted in the department of Community Medicine, Maulana Azad Medical College, New Delhi during a seven-month period on 93 interns, 58 medical officers and 44 nurses/ Auxillary Nurse Midwives (ANMs) with the help of a pre-tested structured multiple choice questionnaire and review of some commonly read books of Pediatrics, Community Medicine and Nursing. RESULTS: The concept of 'exclusive breast-feeding' was clear to most health personnel but the fact that water should also not be given was not clear in the books reviewed. The books also lacked emphasis on management of common lactation problems and this was also seen in the knowledge of the health personnel. CONCLUSION: As inappropriate feeding practices are widely prevalent, knowledge of large proportion of health personnel is incorrect and commonly read books are inadequate on this issue, there is need for greater emphasis on this in books and training sessions.

Attitude of Health Personnel↗
PubMed2005

Predictors of fatality in neonates requiring mechanical ventilation.

OBJECTIVE: To evaluate initial arterial blood gas, pulmonary pressures, pulmonary mechanics (compliance and resistance), pulmonary volumes, oxygenation indices and serum carotenoid levels as predictors of fatality in mechanically ventilated neonates. DESIGN: Cross Sectional. SETTING: Referral neonatal unit of a teaching hospital. SUBJECTS: 83 mechanically ventilated outborn neonates. METHODS: 83 neonates consecutively put on mechanical ventilator from March to December 2001 were enrolled in the study. The mechanical ventilator used was pressure limited time cycled ventilator with facility for online measurement of volumes and pulmonary mechanics. Arterial blood gas after half an hour of initiation of mechanical ventilation and initial pulmonary pressures, pulmonary compliance, resistance and duration of mechanical ventilation were recorded in a pre structured proforma. Initial serum carotenoid levels were also measured using spectrophotometric method. The neonates were regularly followed up for outcome. Multiple logistic regression analysis was done to find out the predictors of fatality for those variables that were significantly associated with outcome on univariate analysis. RESULTS: On univariate analysis weight ( < 2000 g), gestational age <34 weeks, pH <7.3, duration of mechanical ventilation <72 hours, a/A <0.25, compliance <1 mL/cmH2O, fraction of inspired oxygen (FiO2) >60%, oxygenation index >10, AaDO2 >250 and serum carotenoid levels < 100 microg/dL were significantly associated with fatality in neonates requiring mechanical ventilation. However, on multiple regression analysis only FiO2, gestational age and serum carotenoids < 100 microg/dL were found to be independent predictors of fatality. CONCLUSIONS: Initial FiO2 > 60%, gestational age <34 weeks and initial serum carotenoid levels < 100 microg/dL were independent predictors of fatality in neonatal mechanical ventilation. Even in a setting with high fatality rates, high risk of mortality in mechanically ventilated neonates can be identified.

Carotenoids↗
PubMed2004

Effect of stepwise reduction in minute ventilation on PaCO2 in ventilated newborns.

OBJECTIVE: To study the effect of step reduction of expired minute ventilation (MV) on PaCO2 in ventilated newborns and to determine whether MV within a defined range can predict PaCO2. DESIGN: Prospective descriptive. SETTING: Referral neonatal unit of a teaching hospital. METHODS: Forty neonates stable on mechanical ventilation receiving minute ventilation in the range of 150-210 ml/kg/min. were studied. The spectrum of disorders for which the babies were ventilated included apnea of prematurity in 16, pneumonia in 14, meconium aspiration syndrome in 6 and hyaline membrane disease in 4. Median age at study was 6 days and median weight at study was 2.1 kgs. The MV was reduced from 210 to 150 mL/kg/min in three steps and concomitant PaCO2 was measured. Reductions were not done if PaCO2 was more than 50 mmHg. MVs were plotted against PaCO2 and a regression equation to predict PaCO2 from MV was calculated. RESULTS: A stepwise increase was seen in CO2 with reduction of MV over the range studied. The median MV and median PaCO2 achieved in the three steps were 201 mL/kg/min and 36.7 mm of Hg, 180 mL/kg/min and 41.7 mm of Hg, 160 mL/kg/min, and 44.3 mm of Hg. The regression equation to predict PaCO2 was PaCO2 = 70 - 0.17 x MV in mL/kg/min, r = -0.45, r2 = 0.20, residual variance (s2) = 39.37; gave a predicted PaCO2 within 12.5 mmHg. for a given MV. CONCLUSION: Reducing minute ventilation led to an increase in the levels of PaCO2. Minute volumes of 160 ml/kg/min correlated with PaCO2 value of 44.3 mm of Hg. MV as low as 160 mL/kg/min are well tolerated by newborns.

Blood Gas Analysis↗
PubMed2003

Portal vein thrombosis complicating neonatal hepatic abscess.

Hepatic abscess in a neonate is a rare but serious disorder. Diagnosis of hepatic abscess requires a high index of suspicion in any septic neonate. CT scan and ultrasound of liver are the most sensitive diagnostic tests in detection of hepatic abscess. Portal vein thrombosis and portal cavernoma formation is hitherto unreported complication of neonatal hepatic abscess in English literature. Present case report highlights the difficulty in diagnosis of neonatal hepatic abscess and describes the development of portal vein thrombosis and cavernoma during its treatment.

Female↗
PubMed2002

Respiratory distress in neonates with special reference to pneumonia.

OBJECTIVE: (i) To find causes of respiratory distress in neonates brought to a referral neonatal unit with symptoms suggestive of respiratory disorder; (ii) to evaluate clinical signs for diagnosis of neonatal pneumonia; (iii) To determine bacterial etiology of neonatal pneumonia; and (iv) To determine indicators of fatality in neonatal pneumonia. DESIGN: Prospective descriptive. SETTING: Referral neonatal unit of a teaching hospital. SUBJECTS: 150 neonates admitted with respiratory symptoms consecutively. METHODS: All neonates presenting with respiratory symptoms were included in the study. The diagnosis of the cause of respiratory distress was based on guidelines recommended by the National Neonatology Forum. Clinical features, FiO2 requirement, sepsis screen, X-ray chest, blood culture and antibiotic sensitivity, arterial blood gases and other relevant investigations were documented in a structured proforma. The neonates were regularly followed up for outcome. Multivariate unweighted logistic regression was done to find out the indicators of fatality in neonatal pneumonia for those variables which were significantly associated with outcome on univariate analysis. RESULTS: Pneumonia was found to be the most common cause (68.6%) of respiratory distress in neonates. Other conditions included hydline membrane disease (HMD), transient tachypneia of new born (TTNB), birth asphyxia with hypoxic ischemic encephalopathy (HIE) and meconium aspiration syndrome (MAS). Clinical signs and symptoms were non specific and did not differentiate between pneumonia and other causes of respiratory distress. Respiratory rate was less than 60 per minute in 11.6% neonates with pneumonia. The most common organism responsible for neonatal pneumonia was Klebsiella pneumoniae. Chest X-ray was clear in 15% of neonates with pneumonia. On univariate analysis weight < 2000 g, gestation age < 34 weeks, age at presentation < 72 hours, lethargy, absent neonatal reflexes, shock, positive C-reactive protein, positive ventilatory support, blood culture positivity, Silverman Score >3, FiO2 >40%, pH < 7.2, alveolar arterial gradient (AaDO2) > 250 mmHg and arterial alveolar tension ratio (a/A) of < 0.25 were significantly associated with mortality in neonates with pneumonia. However, on multivariate analysis, only AaDO2 of > 250 mmHg was found to be independent predictor of fatality in neonatal pneumonia. CONCLUSION: Pneumonia was the most common cause of respiratory distress in neonates. Clinical features and X-ray chest missed the diagnosis of pneumonia in 15 cases and had to be corroborated with sepsis screen and blood culture. AaDO2 > 250 mmHg was an independent predictor of fatality in neonatal pneumonia

Analysis of Variance↗
PubMed2000

Physical growth and biochemical indicators of protein adequacy in exclusively breastfed neonates weighing less than 1500 g.

The objective of our study was to evaluate biochemical indicators of protein adequacy and the growth pattern in very low birthweight infants, weighing less than 1500 g, who were exclusively breastfed by their mother in the first 4 months of infancy in a tertiary level referral neonatal unit. The study design was descriptive. The study population comprised neonates admitted to the referral neonatal unit by 48 h of age, weighing less than 1500 g, whose mothers were willing to breastfeed and in whom enteral feeds could be given by day 6 of life. Detailed history, clinical evaluation and anthropometry were recorded and blood samples drawn for serum total proteins, serum albumin and blood urea nitrogen (BUN). All infants were given feeds as per the Unit policy. Infants were discharged when they were exclusively suckling and showed a positive trend in weight gain. Follow-up longitudinally for 4 months included clinical evaluation, growth velocity, biochemical indicators of protein adequacy, and occurrence of any morbidity. Growth parameters were compared with available postnatal growth standards. The mean velocity of weight gain for all neonates for the first 4 months was 19.78 g/day or 14.78 g/kg/day. The mean velocity of gain after regaining birthweight was 23.2 g/day. Mean velocity of gain in length and head circumference was 0.84 cm/week and 0.71 cm/week, respectively. Serum total proteins, albumin and BUN were within the normal range. No infant developed hypoproteinemia or hypoalbuminemia at any time during the study period. All infants obtained sufficient volume of milk from their mothers and could be successfully breastfed until 4 months of age. The velocity of growth of the neonates was comparable to the available reference standards. Indicators of protein metabolism were within normal limits. Thus, exclusive feeding of mother's own milk can be strongly recommended for very low birthweight babies particularly in the weight group 1251-1500 g.

Biomarkers↗
PubMed2000

Tracheal agenesis.

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Anus, Imperforate↗