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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.
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PMID:Neonatal hypoglycemia--clinical profile and glucose requirements. 159 96

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.
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PMID:A four year study on neonatal morbidity in a New Delhi hospital. 193

A marked reduction in neonatal mortality was achieved during 1986, which can be attributed largely to the decline in the incidence of infections as a result of modification of a few of the routine practices in the Intensive Care Nursery of the All India Institute of Medical Sciences (AIIMS) in New Delhi. Over 80% of pregnant women attending the antenatal clinics of AIIMS have 1 or more perinatal high risk factors. All deliveries are performed by obstetricians, and each neonate is managed at birth by 1 or more residents of the neonatology unit. Data on every neonate is recorded on a specially designed case sheet. Cause of neonatal death is classified according to the criteria of Wigglesworth. A monthly report of the census and morbidity mortality data is recorded on a special proforma and discussed in a joint meeting of the staff of the obstetrics and neonatology services. The information presented is based on these monthly reports. A table shows the data on the live births in 1985 and 1986 and their distribution according to birth weight. The total number of live births in the 2 years were nearly the same. There was no significant difference in the neonatal population in different birth weight groups. There were 66 neonatal deaths in 1985 but only 43 in 1986. This significant decline in the neonatal mortality was attributable to reduction in the late neonatal deaths. The neonatal mortality rate (per 1000 live births) dropped from 36.6 in 1985 to 23.9 in 1986. There was a decline in the neonatal mortality rate in birth weight groups from 1001-2500 g. The reduction of deaths in the birth weight group of 1001-1500 g was most pronounced. Neonatal mortality rate (per 1000 live births) dropped from 525.4 in 1985 to 377.7 in 1986 in this group. The overall neonatal mortality rate in infants weighing 2500 g or less declined from 12.3 to 8.5%. The difference in the proportion of deaths in relation to individual causes was significant only in the case of sepsis. The decline in the sepsis-related neonatal mortality was a consequence of 2 factors: the incidence of neonatal sepsis declined from 38.2/1000 live births to 18.8/1000 live births; and a definite though less pronounced improvement occurred in the case fatality rate -- 24.6% versus 17.7% in 1985 and 1986, respectively. The significant decline in late neonatal deaths was largely attributed to the reduction in the sepsis-related late neonatal deaths -- 16 versus 3. Sepsis ranked as number 2 as cause of neonatal mortality in 1985; it ranked as number 4 in 1986.
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PMID:Strategies which reduced sepsis-related neonatal mortality. 323 46

Aortic valve replacement with a pulmonary autograft was performed in 24 patients between October 1993 and October 1994, at the All India Institute of Medical Sciences, New Delhi. There were 20 (83.3%) males and 4 (16.7%) females. Their ages ranged from 10 to 56 years (mean, 21.46 +/- 11.45 years). Associated procedures included 10 mitral valve procedures (4 open commissurotomies, 5 mitral valve repairs, and 1 homograft mitral valve replacement) and 1 tricuspid valve repair. There were 4 (16.7%) early deaths, 3 of which were due to bleeding or its sequelae and 1 due to septicemia. There were no late deaths. Follow-up ranged from 1 to 13 months (mean, 198.3 +/- 111.1 days). Nineteen (95%) patients are in New York Heart Association functional class I, and 1 patient (5%) is in class II, due to poor left ventricular function. Only 1 patient showed grade 2/4 aortic regurgitation on follow-up examinations, and none has shown progression of aortic regurgitation. Our early results with the pulmonary autograft are encouraging; however, long-term evaluation is needed.
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PMID:Pulmonary autograft aortic valve replacement. Early experience with the Ross procedure. 764 2

According to a 3-year collaborative study estimating maternal mortality rates from 41 hospitals affiliated with teaching centers in India, maternal mortality was 721 per 100,000 live births. Community studies in rural areas of Sirur, Pachod, and Ambula reported maternal mortality as 210-253 per 100,000. Cohort studies conducted by the Indian Council of Medical Research reported maternal mortality as 530 per 100,000 based on data from rural areas of Varanasi, 460 per 100,000 in urban Delhi, and 450 per 100,000 in urban Madras. The Ministry of Health gave the rate as 460 per 100,000 in 1984, while UNICEF gave a figure of 400 per 100,000 for 1980-91. India has 1 out of 4 of the world's maternal deaths, or 1 every 6 minutes. The risk of maternal death has been calculated to be one in 64. Risk is unevenly distributed geographically. Risk is low in Kerala compared to Uttar Pradesh or Madya Pradesh. In 1992 maternal mortality was calculated to be 1320 per 100,000 births based on 5 district hospitals. The cause of maternal deaths was anemia in 25% of cases. 75% of cases were accounted for by eclampsia, sepsis, hemorrhage, and abortion. Anemia (pre-existing the pregnancy) is acerbated by the demands of pregnancy and causes congestive heart failure and death. Blood losses of greater than 150 ml (due to hemorrhages of pregnancy and labor) can be fatal. During 1982-89 anemia was responsible for 17-24% of all maternal deaths in rural areas. Morbidity from pregnancy-related causes included obstetric fistulae, pelvic inflammatory disease, anemia, genital prolapse, and urinary incontinence. Quality of maternal care is an important factor in reducing maternal mortality and morbidity. Societal factors such as illiteracy and malnutrition, early marriage, poorly supervised pregnancies, and lack of transportation during emergencies are other determinants of mortality and morbidity. About 10% of maternal deaths are attributed to unsafe abortion. The government aim for the year 2000 of 100% prenatal care and care during delivery will require professional commitment and thousands more midwives in rural areas.
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PMID:How safe motherhood in India is. 765 33

During 1992, 53 women were admitted to Lady Hardinge Medical College and Smt Sucheta Kriplani Hospital in New Delhi, India, for septic induced abortion and 1855 were admitted for medical termination of pregnancy (MTP). Most septic induced abortion cases lived in semi-urban/urban slums (64.15%), were Hindus (98.11%) and married (94.34%), and had a parity of less than 2 (56.6%). The leading reason for abortion was unwanted pregnancy among septic abortion cases (81%) and contraceptive failure among MTP cases (98.3%). No septic abortion case had used contraception. Among septic abortion cases, termination methods included instrumentation by untrained midwives (62%), foreign body insertion (7.5%), and dilatation and curettage or suction by unqualified personnel (7.5%). About 33% of septic abortion cases presented with generalized peritonitis, septicemia, septic shock, acute renal failure, or disseminated intravascular coagulation (DIC). All septic abortion cases had pelvic inflammatory disease compared to 3.55% among MTP cases. 94.35% had anemia. About 34% needed a blood transfusion compared to 0.16% among MTP cases. MTP cases were significantly less likely to suffer uterine perforation than septic abortion cases. None of the MTP cases had septicemia. The need for laparotomy was more common among septic abortion cases than MTP cases (26.4% vs. 0.43%). A hospital stay of more than one week was also more common (72% vs. 0.43%). On discharge, MTP cases were more likely to be in satisfactory condition than septic abortion cases (100% vs. 75.7%). No one in the MTP group died, while 13.2% died in the septic abortion group. The causes of death were septic shock (7 cases), hepato-renal failure (2 cases), and DIC (1 case). The abortion ratio was 312/1000 births. The abortion mortality ratio was 1.7/1000 abortions. Illegally induced abortions were responsible for 20% of all maternal deaths at this institution in 1992. These findings suggest that family planning education, contraceptive use, and safe pregnancy termination facilities would prevent abortion-related morbidity and mortality.
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PMID:Maternal mortality and morbidity associated with clandestine abortions. 765 45

A household survey of neonatal mortality was conducted during 1991 in Meerut District, about 70 km from Delhi in Uttar Pradesh, India. The sample included 2211 infants from 30 clusters, which included 111 deaths in the first year of life for data collected during November 12-19, 1991. The estimate of infant mortality rate was 50.1/1000 live births. There were 42 neonatal deaths--a neonatal rate of 19.0/1000 live births. 90.5% of neonates were home deliveries. 45.3% were delivered by an untrained birth attendant and 30.9% were delivered by a trained birth attendant. 11.9% were delivered by a family member. 42.8% of neonates who died did not receive treatment for an illness before their death. 11.9% of neonates, who died but received some treatment, were treated in hospitals. 66.7% of mothers had knowledge about prenatal immunization against tetanus, but only 30.9% received complete immunization, and 23.8% had one dose of tetanus toxoid vaccine. The most common causes of death were attributed to septicemia and neonatal tetanus infections (21.4% of neonatal deaths). Other causes of neonatal death were infantile diarrhea (11.9%), prematurity (9.5%), congenital anomalies (9.5%), pneumonia (7.2%), and birth asphyxia, meningitis, burn injury, and Rh incompatibility (2.4% each). This study in 1991 shows that neonatal mortality declined over the prior 10 years. However, outreach of qualified medical staff into this rural community was still limited. Knowledge of some health practices, such as immunization, was evident, but the service component was inadequate. This study confirms that exogenous factors contributed to at least 66% of neonatal deaths. These deaths could have been averted with proper and timely maternal and child health care services.
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PMID:Neonatal mortality in Meerut district. 811 86

During January 1989-September 1991, in India, neonatologists prescribed assisted ventilation (intermittent positive pressure ventilation [IPPV] and continuous positive airway pressure [CPAP]) for 90 neonates born and treated at a tertiary hospital in Delhi. All neonates requiring more than 168 hours of ventilation received IPPV. The smallest surviving neonate weighed 830 g at birth and was born at 26 weeks' gestation. This neonate received 510 hours of ventilation. One neonate received 48 days of ventilation (gestational age at birth, 28 weeks; birth weight, 800 g). This neonate eventually died due to necrotizing enterocolitis (NEC), bronchopulmonary dysplasia (BPD), and sepsis. This infant was the only infant to develop NEC. A total of two newborns developed BPD. One infant developed retinopathy of prematurity (ROP). Indications for ventilation were hyaline membrane disease (HMD) (45/90), apnea (13/90), and transient tachypnea of the newborn (TTNB) (11/90). Almost all HMD cases who weighed more than 1.5 kg at birth on CPAP survived. CPAP successfully treated all TTNB cases. Nine neonates developed pneumothorax. Three of them survived. 34 neonates developed sepsis, the most common complication. 20 sepsis cases also had underlying pneumonia. Sepsis was responsible for 35% of deaths (14/40). Five infants on IPPV developed persistent pulmonary hypertension (persistent fetal circulation). 35 infants developed infection during ventilation, 34 of whom had a nosocomial infection. The nosocomial infection rate was 37.7%. Nosocomial infection was responsible for 35% of deaths. 12 babies (13%) developed pulmonary air leaks, 50% of whom died. 25 of the 33 infants on CPAP survived. Few CPAP cases developed pulmonary air leak, BPD, and ROP. Six of 22 very low birth weight (VLBW) infants (1 kg) survived. These findings led the researchers to recommend that medical centers with basic facilities for level II care should provide neonatal ventilation. They proposed that ventilation may not be cost effective for VLBW newborns, however.
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PMID:Three-year experience with neonatal ventilation from a tertiary care hospital in Delhi. 788 27

The incidence and risk factors for neonatal nosocomial infection were investigated in a cohort study of 134 hospital-born infants transferred to a neonatal unit in New Delhi, India, after birth and observed for up to 72 hours. 22 of the 134 infants developed nosocomial infections. The median age at diagnosis was 184 hours. In 16 of these infants, both sepsis screen and blood culture were positive. Septicemia was diagnosed in 21 neonates; 11 had associated pneumonia and four had soft tissue infection. Multiresistant Klebsiella species was the infectious agent in 68% of cases. The overall nosocomial infection rate was 16.8/1000 patient-days and the device-associated infection rate was 11.9/1000 device-days. Factors significantly associated with neonatal nosocomial infection in the univariate analysis were low birth weight, prematurity, vaginal delivery, hyaline membrane disease, assisted ventilation, and use of peripheral venous and umbilical vascular catheters. In the final multivariate analysis, only birth weight under 1500 g (odds ratio, 3.3) and assisted ventilation for more than 72 hours (odds ratio, 14.2) remained significant risk factors. It was observed in 122 random observations in this hospital that 15-18% of nurses and residents failed to adhere to adequate hand-washing techniques. Strict adherence to aseptic protocols in neonatal units is essential to keep infection rates under control.
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PMID:Neonatal nosocomial infection: profile and risk factors. 933 94

The study aimed at obtaining insights into the processes underlying infant deaths to help identify preventive interventions which may bring down infant mortality rates further. Verbal autopsies were performed on 162 deaths of liveborn infants that occurred in a birth cohort in two urban slums of Delhi, India, between February 1995 and August 1996. A structured verbal autopsy form was used for ascertaining the cause of death. The narratives of caretakers on seeking of care and treatment received for illness were reviewed to identify the actions and behaviours that might have contributed to death. Seeking of care was less common (57%) for illnesses that led to death in the first week of life than at later ages. The first-week deaths commonly (61%) occurred within 24 hours of recognition of illness which might have been too a short time for effective interventions by care providers. Only six of 45 neonates who had features of sepsis, pneumonia or meningitis, major congenital malformations, birth asphyxia, or prematurity were advised by primary care providers for hospitalization. Similarly, only 25 (41%) of 61 older infants who had severe malnutrition and sepsis or meningitis, diarrhoea or pneumonia, or other illnesses were referred to hospital. Parenteral antibiotics were prescribed less often than warranted. Only two of 16 neonates with serious bacterial infections and eight of 19 postneonates with features of sepsis or meningitis received parenteral antibiotics. Inappropriate healthcare practices were common among the practitioners of modern and indigenous systems of medicine and registered medical practitioners. Forty percent of the neonates and a little over half of the older infants, advised for hospitalization, were taken to hospital. Fifteen percent of the infants taken to hospital were refused admission. Of 21 hospitalized infants discharged alive, five (23%) died within 48 hours and 13 (62%) within a week of returning home. A major effort is required to improve skills of healthcare providers of the biomedical and indigenous systems of medicine in caring for neonates and infants. Development of home-based treatment regimens for young infants and objective criteria for their hospitalization and discharge should receive a high priority.
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PMID:Pathways to infant mortality in urban slums of Delhi, India: implications for improving the quality of community- and hospital-based programmes. 1218 95


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