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Biomedical subjects

V K Paul

Publications and source records attributed to V K Paul.

At least 19 recordsLinked to original sources
PubMed1992

Gastric residuals in preterm babies.

The gastric residual (GR) volume was measured in 50 healthy preterm babies, 38 appropriate-for-dates (AFD), and 12 small-for-dates (SFD) with gestational age of 28-36 weeks. The mean basal 4-hour gastric residual (B4 GR) volume was 2.8 +/- 0.63 ml in parenterally fed babies. There was a marked decrease in the residuals from 20.7 +/- 15.2 per cent (mean +/- SD) on day 4 to 8.6 +/- 4.3 per cent on day 7 (P < 0.001). Of the 27 infants fed with expressed breastmilk (EBM), mean GR was 24.4 +/- 10.2 per cent in supine and 12.8 +/- 4.3 per cent in prone position (P < 0.01). Twenty-one babies nursed in the prone position showed a mean GR volume of 12.8 +/- 4.3 per cent with EBM and 13.6 +/- 2.7 per cent with milk formula. No difference was noted in the gastric residuals of AFD v. SFD babies. No linear correlation was found between increase in abdominal girth and GR. However, if the increase in abdominal girth was at least 2 cm or more, a GR of 23 per cent or more was observed. This should be taken as warnings to reduce or withhold oral feeds.

Gastric Emptying↗
PubMed1992

Effects of maternal labetalol on the newborn infant.

Forty eight neonates, born to mothers suffering from pregnancy induced hypertension and receiving labetalol for control of blood pressure, were studied for the possible adverse effects of the drug. These were compared with eighty one neonates matched for gestation and weight and born to mothers with pregnancy induced hypertension treated with drugs other than labetalol. Incidence of birth asphyxia and intrauterine growth retardation (IUGR) in the study population was 10.4 and 22.9%, respectively and in the control group 5 and 19.7%, the difference between two groups was not statistically significant (p > 0.05). However, the incidence of hypoglycemia was significantly higher (p < 0.01) in the study group (47.9%) as compared to the control group (17.2%). Two-thirds of the hypoglycemic babies in the study population were asymptomatic and they were managed with sugar-fortified milk feeds. In the study population, the symptomatic hypoglycemic babies had hypoglycemia for prolonged duration of 43.3 +/- 23.3 hours as compared to 11.5 +/- 6.3 hours in symptomatic hypoglycemic babies of the control group (p < 0.01). The mothers of the symptomatic babies in the study group received higher doses of labetalol in the range of 287.6 +/- 142.3 mg/day while rest of the mothers in the same group whose babies had either asymptomatic hypoglycemia or normal blood glucose levels, received 239.5 +/- 118.5 mg/day, though the difference was not statistically significant. It is concluded that maternal labetalol therapy is associated with increased risk of neonatal hypoglycemia.

Asphyxia Neonatorum↗
PubMed1992

Prevention of hypoglycemia: a controlled evaluation of sugar fortified milk feeding in small-for-gestational age infants.

The study population included 110 term healthy small-for-gestational age (SGA) infants having a blood sugar of > 30 mg/dl at the age of < 30 minutes. They were randomized into two groups; (a) Group I (study group) received sugar-fortified milk formula and (b) Group II (control group) received standard milk formula. A minimum of 80 ml/kg/24 hour of milk was given. The first feeding was given within 45 minutes of birth and subsequently at 2 hours of age and then every 2 hourly till the age of 24 hours. The blood sugar (initial within 30 minutes of birth) was monitored at the age of 2, 4, 12 and 24 hours by dextrostix. The babies on fortified feeds received significantly (p < 0.001) higher amount of carbohydrate (8.1 mg/kg/min) as compared to those on standard milk (5.1 mg/kg/min). The incidence of hypoglycemia was reduced significantly (p < 0.01) by the sugar-fortified feeds. The mean blood sugar level in babies receiving fortified feeds was significantly higher at all the ages as compared to those receiving standard feeds. Nearly all the babies who subsequently developed hypoglycemia had a preceding blood sugar value of less than 60 mg/dl. The study highlights that sugar-fortified milk feeds are useful in preventing hypoglycemia in SGA infants and should be routinely recommended along with breast feeding in developing countries especially when facilities for monitoring of blood sugar are unsatisfactory or not available.

Blood Glucose↗
PubMed1992

A new transport incubator for primary care of low birth weight babies.

A new portable, cheap and indigenous incubator made of polystyrene has been devised for delivery of primary health care services to the newborn babies in the community. Twenty six babies with a mean weight of 1726 g (range 1388-1981g) and gestational age of 35.3 weeks (range 34-38 wks) were continuously evaluated for 2 hours observation period, in naked and clothed conditions. Rectal, abdominal skin, foot, ambient air and nursery temperatures were recorded. The baseline core temperature of the babies was 36.58 (+/- 0.21) degrees C; after incubator care it was recorded s 36.80 (+/- 0.10) degrees C in naked infants. The baseline core temperature of the clothed babies was 36.63 (+/- 0.21) while it was 37.01 (+/- 0.18) after 2 hours of incubator care. An ambient air temperature of 33-34 degrees C in the incubator (thermoneutral temperature range for these babies being 31.0-33.8 degrees C) was achieved within 30-60 minutes of incubator stay (nursery temperature being 28 +/- 0.6 degrees C). No evidence of carbon dioxide narcosis, hypoxia, acidosis, or adverse thermoregulatory behavior was observed. One baby had hypoglycemia (blood sugar less than 35 mg/dl) and another had sweating. There is a scope for providing additional facilities like administration of oxygen, phototherapy, X-rays through the incubator without disturbing the baby.

Body Temperature Regulation↗
PubMed1992

Neonatal hypoglycemia--clinical profile and glucose requirements.

A total of 2248 infants born at All India Institute of Medical Sciences Hospital, New Delhi were selectively screened for hypoglycemia over a period of 15 months. Hypoglycemia (blood glucose less than 30 mg/dl) was diagnosed in 107 cases (4.8%). Preterm babies had three times increased risk (12.8%) as compared to term babies (3.6%). Small-for-dates (SFDs) and large-for-dates (LFDs) infants were at increased risk of manifesting hypoglycemia (7 and 10 times, respectively) as compared to the appropriate-for-dates (AFDs) babies (2.7%). Approximately two-thirds of the hypoglycemic babies (67.3%) had one or more risk factors including birth asphyxia (24.2%), diabetic mothers (23.8%), respiratory distress (13.9%) and septicemia (11.6%). A total of 59.8% cases were asmyptomatic while the rest had one or more symptoms. The most common symptom observed was lethargy (81.4%), followed by jitteriness (67.4%), respiratory abnormalities (41.9%), hypotonia (39.5%) and seizures (30.2%). The amount of glucose (mg/kg/min) needed to maintain a stable blood sugar in various categories of hypoglycemic babies was observed to be in the following decreasing order of amount; symptomatic babies with seizures (Gp IV), IGDM's/IDM's and symptomatic babies with other features (Gp III), SFDs and LFDs (Gp II) and AFDs (Gp I). Such a categorization of hypoglycemic babies will help to treat them more precisely.

Birth Weight↗
PubMed1992

Spectrum of neonatal hyperbilirubinemia: an analysis of 454 cases.

A prospective study of 454 newborn babies with pathological hyperbilirubinemia revealed that in about one-third of cases (34.6%), no cause could be identified despite detailed investigations. Nearly three-fifth of infants (62.5%) had hyperbilirubinemia due to hemolytic causes. On the basis of four variables, i.e., peak serum bilirubin level, age of attaining the peak level, age of starting phototherapy and total duration of phototherapy, the cases of hyperbilirubinemia can be categorized into three groups: (a) Group I (mild) included non-hemolytic hyperbilirubinemia, i.e., idiopathic, bacterial infections, intrauterine infections and others, (b) Group II (moderate) comprised of hemolytic as well as non-hemolytic hyperbilirubinemia due to prematurity, administration of oxytocin, bruising/cephalhematoma, and (c) Group III (severe) comprised of hyperbilirubinemia due to hemolysis as a result of blood group incompatibility between the mother and the neonate and G-6-PD deficiency. Sixty six babies required exchange blood transfusion (EBT) and a total of 100 EBTs were performed. Most of the babies (80.3%) requiring exchange blood transfusion belonged to Group III. The most common cause of hemolytic hyperbilirubinemia needing exchange blood transfusion was Rh isoimmunization followed by G-6-PD deficiency and ABO isoimmunization. There was no death attributable to the procedure of exchange blood transfusion.

Female↗
PubMed1991

A controlled study of sugar-fortified milk feeding for prevention of neonatal hypoglycaemia.

Healthy term, large for gestational age (LGA) infants (130) with blood sugar greater than 30 mg/dl at the age of less than 30 min were randomized into two groups. Group I (study group) babies received sugar-fortified milk formula while group II (control group) received standard milk formula. Milk was fed at a minimum of 80 ml/kg/24 h. The first feed was given within 45 min of birth and subsequently at 2 h of age and then 2 hourly till the age of 24 h. The blood sugar (initial within 30 min of birth) was monitored by dextrostix at the age of 2, 4, 12 and 24 h. The babies on fortified feeds received significantly (P less than 0.001) higher amount of carbohydrate (8.2 mg/kg/min) as compared to those on standard milk (5.2 mg/kg/min). The incidence of hypoglycaemia was reduced significantly (P less than 0.05) by the sugar fortified feeds. The mean blood sugar level in babies receiving fortified feeds was significantly (P less than 0.001) higher at all ages as compared to those receiving standard feeds. Nearly all the babies who subsequently developed hypoglycaemia had an earlier blood sugar level of less than 60 mg/dl. The study shows that sugar-fortified milk feeds are useful in preventing hypoglycaemia in LGA infants and should be routinely recommended in the special care neonatal units of developing countries especially when facilities for monitoring blood sugar are unsatisfactory or unavailable.

Animals↗
PubMed1991

Perinatal outcome of infants born to diabetic mothers.

Two hundred and sixty three pregnant diabetic mothers' perinatal outcome was evaluated. Two hundred and twenty five infants were born to gestational diabetic mothers (IGDM) and 38 infants to mothers with established diabetes mellitus (IDM). In IGDM group, 34 babies (15%) were preterm and 45 (20%) were low birth weight (less than 2500 g). Thirty eight babies (17%) were large-for-dates (LFD) and 14 (6.2%) were small-for-dates (SFD). Among IDM group, 8 (21%) babies were preterm and 8 (21%) were low birth weight (less than 2500 g). Fifteen babies (39.5%) were LFD and 3 (8%) were SFD. Out of all babies, hypoglycemia occurred in 43 (16%), birth asphyxia in 24 (9%) and respiratory distress in 21 (8%). Nearly half of respiratory distress were due to hyaline membrane disease. Perinatal mortality rate was significantly higher (p less than 0.001) in IDM (237/1000 live birth) as compared to IGDM (40/1000 live birth).

Congenital Abnormalities↗
PubMed1991

A four year study on neonatal morbidity in a New Delhi hospital.

The neonatal morbidity was studied in 7015 neonates born at the All India Institute of Medical Sciences Hospital, New Delhi. The incidence of low birth weight babies was 26.7 per cent; one seventh (13.5%) of the series were preterm (less than 37 wk), while 6.6 per cent were 'small-for-dates'. Birth asphyxia of varying severity developed in 5.9 per cent infants. Respiratory distress syndrome was diagnosed in 5.7 per 100 live-births; most being due to hyaline membrane disease (33.5%), which affected 14.1 per cent of preterm babies. Neonatal hyperbilirubinemia occurred in 5.9 per cent, most of whom were premature. In nearly one-fifth, the cause of jaundice could not be identified after detailed investigations. Minor bacterial infections (conjunctivitis, pyoderma, oral thrush, umbilical sepsis) were observed in 1.8 per cent while major infections (septicemia, meningitis, diarrhoea) in 3.0 per cent. The overall incidence of major malformations was 2.3 per cent. Reasons for low incidence of bacterial infections and common occurrence of hyaline membrane disease in premature infants, are highlighted.

Asphyxia Neonatorum↗
PubMed1991

Perinatal & neonatal mortality in a hospital.

A total of 7109 consecutive births were studied over four years to assess perinatal and neonatal mortality. The extended perinatal mortality rate was 57 while conventional perinatal mortality rate (PNMR) was 41 per 1000 total births. Perinatal hypoxia (28.7%), immaturity (24.8%), congenital malformations (14.6%) and infections (5.6%) accounted for most perinatal deaths. The ranking of causes of neonatal deaths was immaturity, birth asphyxia, bacterial infections and congenital malformations. Neonatal mortality rate was 31 per 1000 live births and nearly 90 per cent mortality occurred in low birth weight (LBW) neonates. Hyaline membrane disease accounted for 13.4 per cent of early neonatal deaths. The case fatality rate among LBW babies and preterm babies was 10 per cent and 20 per cent respectively. There is a need to identify strategies to reduce the incidence of prematurity and LBW babies. Comprehensive antenatal coverage and adequate care followed by optimal management of infants at birth is likely to reduce PNMR and improve quality of life among the survivors.

Cause of Death↗
PubMed1991

Neurodevelopmental outcome of asymptomatic & symptomatic babies with neonatal hypoglycaemia.

A total of 107 babies with hypoglycaemia were studied over a period of 15 months. Symptomatic hypoglycaemia was found in 43 while it was asymptomatic in the others. Asymptomatic hypoglycaemia occurred at a relatively earlier post-natal age (4.5 +/- 2.2 h), as compared to symptomatic hypoglycemia (18.5 +/- 5.4 h, P less than 0.001). The mean blood glucose in hypoglycaemic babies with seizures was found to be significantly lower (P less than 0.001) when compared to those with other features as well as asymptomatic ones. Hypoglycaemia lasted for a significantly longer duration in symptomatic babies as compared to those without symptoms (P less than 0.001). On neurodevelopment follow up the mental developmental index (MDI) and the psychomotor developmental index (PDI) of symptomatic babies with seizures were significantly lower (P less than 0.001) as compared to those with other features of hypoglycaemia as well as asymptomatic babies. The neurodevelopmental status of babies with symptoms other than seizures was also significantly poorer (P less than 0.001), when compared to asymptomatic hypoglycaemic babies. The duration of hypoglycaemia was directly related to the MDI (r = -0.74, y = 102.5 - 0.69x) and PDI (r = -0.81, y = 105.6 - 0.86x). This study indicates that there is a need to identify babies vulnerable to symptomatic hypoglycaemia more precisely.

Humans↗
PubMed1990

Primary causes of neonatal deaths in a tertiary care hospital in Delhi: an autopsy study of 331 cases.

Of a total of 755 neonates who died between 1972 and 1988, 331 (43.9%) were subjected to necropsy examination. The ranking of major primary causes of neonatal death was as follows: infections 27.2%, hyaline membrane disease 20.2%, congenital malformations 19.6%, perinatal anoxia 14.5%, immaturity 5.1% and birth trauma 2.7%. Over the years, the prevalence of infections as the cause of death has consistently declined. Compared with that in other contemporary Indian studies, the prevalence of hyaline membrane disease is higher and that of infections and perinatal anoxia relatively lower.

Asphyxia Neonatorum↗