S. Nangia - Academia.edu (original) (raw)

Papers by S. Nangia

Maternal & Child Nutrition, 2021

Virtual Collaborative Network of Milk Banks and Associations contributors are listed in Data S2.

Acta Paediatrica, 1993

20. Konturek SJ, Pawlik W, Mysh W. et al. Comparison of organ uptake and disappearance half-time ... more 20. Konturek SJ, Pawlik W, Mysh W. et al. Comparison of organ uptake and disappearance half-time of human epidermal growth factor and insulin. Regul Pept 1990;30:137-48 Callegari C, Laborde NP, Buenaflor G, Nascimento CG, Brasel JA, Fisher DA. The source of urinary epidermal growth factor in humans. Eur J Appl Physiol 1988;58:26-31 Mattila AL, Perheentupa J, Personen K, Viinikka L. Epidermal growth factor in human urine from birth to puberty. J Clin Endocrinol Metab 1985;61:997-1000 Evans NJ, Rutter N, Gregory H. Urinary excretion of epidermal growth factor in the newborn. Early Hun1 Dev 1986;14:277-82 Watanabe K, Ono A, Hirata Y, Fukuda Y, KojimaT, Kobayashi Y. Maturational changes and origin of urinary human epidermal growth factor in the neonatal period. Biol Neonate 1989;56:241-5 21. Scott SM, Guardian CM, Angelus P, Backstrom C. Developmental pattern ofepidermal growth factor in the premature infant and the influence of gender. J Clin Endocrinol Metab 1991;72:588-93 22. Stoll DM, King LE jr, McNeil L, Orth DN. Human urinary epidermal growth factor excretion: age, sex, and race dependence. J Clin Endocrinol Metab 1988;67:361-7 23. Hofmann GE, Abramowicz JS. Epidermal growth factor (EGF) concentrations in amniotic fluid and maternal urine during pregnancy. Acta Obstet Gynecol Scand 1990;69:2 17-2 I 24. Rall LR, Scott J, Bell GI, Crawford RJ, Penschow JD, Niall HD. Coghlan JP. Mouse prepro-epidermal growth factor synthesis by the kidney and other tissues. Nature 1985;313:228 31

Journal of tropical pediatrics, 2019

OBJECTIVE To identify enablers and barriers related to home Kangaroo Mother Care (KMC) adoption a... more OBJECTIVE To identify enablers and barriers related to home Kangaroo Mother Care (KMC) adoption after hospital discharge. STUDY DESIGN An exploratory study, using a mixed methods evaluation, followed 60 mother-infant dyads from the hospital ward to 4 weeks post-hospital discharge. RESULTS Fifty-three of the mothers (88.3%) completed all study visits. The majority of mothers were breastfeeding and practicing skin-to-skin contact 4 weeks post-discharge. Seven mothers (13.2%) discontinued skin-to-skin contact at 4 weeks. KMC was practiced on average 3.3 h/day and 5.1 days/week. The top two enablers reported were significantly related to the amount of time skin-to-skin was practiced, with support for household responsibilities being most significant (U = 195, p = 0.008). Lack of privacy (p = 0.002) and lack of motivation (p = 0.034) were negatively correlated to duration of skin-to-skin contact. CONCLUSION Future programs may increase dissemination and adoption of home KMC by specifical...

Research and Reports in Neonatology, 2017

Meconium aspiration syndrome (MAS) is an important cause of morbidity and mortality among term ne... more Meconium aspiration syndrome (MAS) is an important cause of morbidity and mortality among term newborns. A result of antepartum or postpartum aspiration of meconium stained amniotic fluid (MSAF), MAS causes respiratory distress of varying severity, often complicated by air leaks or persistent pulmonary hypertension (PPHN). There has been a tremendous change in the concepts of pathophysiology and management of MAS over the last few decades. Routine endotracheal suctioning is no longer recommended in both vigorous and nonvigorous neonates with MSAF. Supportive management, along with newer therapies such as surfactant, inhaled nitric oxide, and high-frequency ventilation, has resulted in marked improvement in the overall outcome of MAS. The present review highlights the challenges in understanding the complex pathophysiology and optimal management approach to MAS. Potential future therapies and drugs in trial are also discussed briefly.

JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH, 2014

European Journal of Pediatrics, 2014

The objective of the study was to evaluate the effect of administering prophylactic antibiotics o... more The objective of the study was to evaluate the effect of administering prophylactic antibiotics on the development of neonatal sepsis in term neonates born through meconium-stained amniotic fluid (MSAF). Two hundred and fifty eligible neonates were randomized to study group (Antibiotic group-receiving first-line antibiotics for 3 days) and control group (No Antibiotic group). Both groups were evaluated clinically and by laboratory parameters (sepsis screen and blood cultures) for development of sepsis. All neonates were monitored for respiratory, neurological, and other systemic complications and received supportive treatment according to standard management protocol of the unit. One hundred and twenty one neonates were randomized to 'Antibiotic' group and 129 to 'No Antibiotic' group. The overall incidence of suspect sepsis was 9.6 % in the study population with no significant difference between 'No Antibiotic' and 'Antibiotic' groups (10.8 vs. 8.2 %, p = 0.48, odds ratio (OR) 0.74, 95 % confidence interval (CI) 0.32-1.73). Incidence of culture-proven sepsis was also not significantly different between the two groups (5.42 vs. 4.13 %, p = 0.63, OR 0.75, 95 % CI 0.23-2.43). The incidence of mortality, meconium aspiration syndrome, and other complications was comparable amongst the two groups. Routine antibiotic prophylaxis in neonates born through MSAF did not reduce the incidence of sepsis in this study population. (Clinicaltrials.gov no. - NCT01290003).

Peliosis hepatis (PH) is a rare liver disorder which is characterized by formation of multiple bl... more Peliosis hepatis (PH) is a rare liver disorder which is characterized by formation of multiple blood-filled cysts within the liver parenchyma. These Blood lakes are of various sizes within the liver, and may be continuous It is a usually seen in adults following exogenous steroid intake. Very rarely, it occurs in children. Storage disorders and Congestive Heart Failure are among the common causes of heaptomegaly in a neonate. This case report describes the presence of Peliosis Hepatis in a 16 day old neonate secondary to an adrenal nodular hyperplasia. This is a very rare case report as it describes an uncommon condition, Peliosis Hepatis, presenting as hepatomegaly secondary to endogenous steroid production. Figure 1. 5 Days Old Male Presented with Abdominal Lump CECT axial section non contrast image [A] shows a large hypodense lesion in right lobe of liver without any calcification, arterial phase [B] shows peripheral contrast enhancement with progressive fill in of contrast in po...

Archives of Disease in Childhood, 2012

Conclusions Abnormal aEEG finding in infants with severe hyperbilirubinemia is useful for detecti... more Conclusions Abnormal aEEG finding in infants with severe hyperbilirubinemia is useful for detection of asymptomatic BIND and can be reversible with appropriate treatment.

The Indian Journal of Pediatrics, 1997

End tidal Carbon dioxide monitoring was undertaken prospectively in all Ventilated neonates in ou... more End tidal Carbon dioxide monitoring was undertaken prospectively in all Ventilated neonates in our NICU admitted from March 1995 to August 1995 irrespective of the birth weight, gestational age and indication of ventilation. The aim was to determine the correlation between ETCO2 and PaCO2 in various clinical situations. The arterial blood gases were obtained in all ventilated babies with simultaneous and continuous ETCO2 monitoring and were analysed by AVL 995 Hb blood gas analyser. ETCO2 was analysed by side stream technique by Datex Cardiocap II monitor. A total of 152 samples from in-dwelling radial artery catheters were analysed from babies with birth weight from 900 g to 3400 g, gestation age from 28 to 42 wks and were ventilated for various indications like Severe Birth Asphyxia (SBA), Meconium Aspiration Syndrome (MAS), Recurrent Apnoea and Hyaline Membrane Disease (HMD). Statistical analysis was done in 10 groups to see if the ETCO2 correlated with its corresponding PaCO2 value. The study groups comprised three groups based on birth weight being < 1.5-2.5 kg and > 2.5 kg three groups as per the gestational age being 28-31+6 wks, 32-36+6 wks and 37-41+6 wks and four groups as per the need for ventilation being Severe Birth Asphyxia, Meconium Aspiration Syndrome, Apnoea of Prematurity and Hyaline Membrane Disease. Results of the correlation analysis revealed that the correlation coefficient in the study group ranged from 0.55 to 0.96 and was statistically significant in babies > 2.5 kg and 1.5-2.5 kg, in term and preterms 32-36 wks, and in babies with MAS, SBA and Recurrent Apnoea. The correlation coefficient was lowest in babies with HMD, being 0.55. The study showed that ETCO2 correlates closely with PaCO2 in most clinical situations in neonates and we recommend its use in all level III NICUs in ventilated babies.

Indian Pediatrics, 1996

Vitamin-D dependent rickets type II (VDDRII) or hereditary 1,25-dihydroxy vitamin D 3 resistant r... more Vitamin-D dependent rickets type II (VDDRII) or hereditary 1,25-dihydroxy vitamin D 3 resistant rickets is an autosomal recessive inheritable disorder, resulting from a failure of target organs to respond to hormonal form of vitamin D i.e. 1,25dihydroxy vitamin D 3 (1,25(OH) 2 D 3)(1). It is characterised by an early onset refractory rickets, hypocalcemia, hypophosphatemia, growth retardation, hyper-parathyroidism, and elevated circulating levels of 1,25-(OH) 2 D 3 and frequent unexplained total scalp and body alopecia(l-5). Since the time, Brooks, et al reported the first case in 1978(2), just about 30 cases have been reported in the world literature. We report one such case without alopecia. Case Report A 3-year-old girl was brought with complaints of widening of wrists and ankles for last 2% years and waddling gait. There was no history suggestive of malabsorption, oliguria, polyuria, jaundice and intake of drugs, or a similar illness in the

Antibiotic treatment in premature infants is often empirically prescribed, and practice varies wi... more Antibiotic treatment in premature infants is often empirically prescribed, and practice varies widely among otherwise comparable neonatal intensive care units. Unnecessary and prolonged antibiotic treatment is documented in numerous studies. Recent research shows serious side effects and suggests long-term adverse health effects in prematurely born infants exposed to antibiotics in early life. One preventive measure to reduce unnecessary antibiotic exposure is implementation of antibiotic stewardship programs. We reviewed the literature on implemented antibiotic stewardship programs focusing on premature infants. Six academic databases were systematically searched and eleven articles met inclusion criteria. Articles were grouped according to common area of stewardship actions; 1) Focus on reducing initiation of antibiotic therapy, 2) Focus on shortening duration of antibiotic therapy, 3) Various infrastructural stewardship implementations. The studies differed in their cohort composition and measured outcomes. We provide an overview of the reduction in antibiotic use achieved. Antibiotic stewardship programs are effective especially when they use a multifactorial approach and are tailored to premature infants. Implementation of antibiotic stewardship programs targeting premature infants should be considered in all neonatal intensive care units. The Norwegian Research Council (project number 273833) and the Olav Thon Foundation supported the study.

The Indian Journal of Pediatrics, 1997

The present prospective, open, controlled, randomised comparative trial was undertaken to evaluat... more The present prospective, open, controlled, randomised comparative trial was undertaken to evaluate the sero response and side effects of PRP-T Conjugate Vaccine (ACT-HIB) in infants and children aged 2 months and 16-24 months. Fifty four babies aged 2 months formed group A, 56 children aged 16-24 months formed group B. Groups A and B were further subdivided into two sub groups each destined to receive either PRP-T vaccine in association with DPT vaccine at different sites (I) or PRP-T and DPT both vaccines at the same site mixed in the same syringe (II). Group A received 3 doses at 2, 3 and 4 months of age and group B received one dose between 16-24 months. The Geometric mean titres of Anti PRP antibodies observed in primary immunisation schedule (A) and single dose vaccination schedule (B) were comparable and significantly higher to prevaccination titres. A serum anti PRP level of > 1.0 mcg/ml after immunisation is believed to correlate with long term protection. Ninety-six percent of infants in Group A and 98% in Group B achieved titres > 1.0 mcg/ml. The side effects were minimal, local and were comparable between the study and control groups, suggesting that PRP-T vaccine is highly immunogenic and well tolerated in Indian infants and children.

Indian Pediatrics, 1998

Oxygen is the most liberally and often used medication in any neonatal unit. Appropriate oxygen t... more Oxygen is the most liberally and often used medication in any neonatal unit. Appropriate oxygen therapy has resulted in improved neonatal survival and a reduction in oxygen-related morbidity over the past 2 decades. However, the degree of arterial oxygenation needs to be continuously and precisely monitored when managing critically ill neonates in order to prevent the adverse effects of both hypoxia and hyperoxia. The authors measured the extent of hyperoxia in spontaneously breathing neonates receiving supplemental oxygen by hood and the utility of pulse oximeters in detecting hyperoxia in newborn infants. The study was conducted during January-April 1996 among 63 preterm and 60 term babies admitted to the Neonatal Unit of Kalawati Saran Children's Hospital, who required supplemental oxygen by hood. All of the infants were independently evaluated by an observer after initial stabilization of temperature and perfusion. 91% of spontaneously breathing infants receiving supplementa...

The Indian Journal of Pediatrics, 2012

Total colonic aganglionosis (TCA) is an unusual variety of aganglionosis. Although appearing to b... more Total colonic aganglionosis (TCA) is an unusual variety of aganglionosis. Although appearing to be an extension of Hirschprung's disease (HD), it may differ from it in many ways and thus is difficult to diagnose on the basis of features applied for HD. The aim of this case report is to discuss the difficulties encountered in recognition of TCA and identification of features which can help in early diagnosis.

Fredet Ramstedt pyloromyotomy first performed in 1911 has long been the standard surgical treatme... more Fredet Ramstedt pyloromyotomy first performed in 1911 has long been the standard surgical treatment for infantile hypertrophic pyloric stenosis (HPS). It is the treatment of choice with excellent results, so much so that conservative medical management is invariably neither considered nor offered. A few reports in early sixties pondered over the issue of medical management (l,2) of HPS utilizing methyl scopolamine, atropine and eumydrin but fell into disrepute because of longer duration of therapy, slower resolution of symptoms, higher mortality, unsuccessful oral medication due to continuing vomiting and recurrence of vomiting after initial success in favour of a seemingly simple surgery with negligible mortality but significant complications.

Paediatrics and International Child Health, 2014

Background: The role of gastric lavage in preventing retching, vomiting and secondary meconium as... more Background: The role of gastric lavage in preventing retching, vomiting and secondary meconium aspiration syndrome in neonates with meconium-stained amniotic fluid is uncertain, and no there are no definitive guidelines. Objective: To evaluate the effect of gastric lavage in preventing retching, vomiting and secondary meconium aspiration syndrome in neonates with meconium-stained amniotic fluid. Methods: This was an open-label, parallel, randomized controlled trial conducted in the labour room, postnatal and neonatal wards of a tertiary-care teaching hospital. Vigorous neonates of §34 weeks gestation with meconium-stained amniotic fluid were randomised into two groups using block randomisation. Infants requiring oxygen, in respiratory distress or with major congenital malformations were excluded. Infants in the study group received elective gastric lavage in the labour room after initial stabilisation. No gastric lavage was done in the control group. The newborns were assessed for retching, vomiting and secondary meconium aspiration syndrome in the first 48 hrs of life or until discharge from the hospital, whichever was later. Results: A total of 267 newborns were randomly assigned to the gastric lavage group and 269 to the no gastric lavage group. There were no statistical differences in overall feeding between the two groups (6.74% vs 10.78%). Feeding of two newborns in the no-lavage group had to be omitted for the initial few hours because of vomiting; this did not happen in any newborn in the lavage group. No newborn in either group developed secondary meconium aspiration syndrome. Conclusion: Gastric lavage in newborns with meconium-stained amniotic fluid does not prevent or reduce the occurrence of feeding problems or secondary meconium aspiration syndrome.

Maternal & Child Nutrition, 2021

Virtual Collaborative Network of Milk Banks and Associations contributors are listed in Data S2.

Acta Paediatrica, 1993

20. Konturek SJ, Pawlik W, Mysh W. et al. Comparison of organ uptake and disappearance half-time ... more 20. Konturek SJ, Pawlik W, Mysh W. et al. Comparison of organ uptake and disappearance half-time of human epidermal growth factor and insulin. Regul Pept 1990;30:137-48 Callegari C, Laborde NP, Buenaflor G, Nascimento CG, Brasel JA, Fisher DA. The source of urinary epidermal growth factor in humans. Eur J Appl Physiol 1988;58:26-31 Mattila AL, Perheentupa J, Personen K, Viinikka L. Epidermal growth factor in human urine from birth to puberty. J Clin Endocrinol Metab 1985;61:997-1000 Evans NJ, Rutter N, Gregory H. Urinary excretion of epidermal growth factor in the newborn. Early Hun1 Dev 1986;14:277-82 Watanabe K, Ono A, Hirata Y, Fukuda Y, KojimaT, Kobayashi Y. Maturational changes and origin of urinary human epidermal growth factor in the neonatal period. Biol Neonate 1989;56:241-5 21. Scott SM, Guardian CM, Angelus P, Backstrom C. Developmental pattern ofepidermal growth factor in the premature infant and the influence of gender. J Clin Endocrinol Metab 1991;72:588-93 22. Stoll DM, King LE jr, McNeil L, Orth DN. Human urinary epidermal growth factor excretion: age, sex, and race dependence. J Clin Endocrinol Metab 1988;67:361-7 23. Hofmann GE, Abramowicz JS. Epidermal growth factor (EGF) concentrations in amniotic fluid and maternal urine during pregnancy. Acta Obstet Gynecol Scand 1990;69:2 17-2 I 24. Rall LR, Scott J, Bell GI, Crawford RJ, Penschow JD, Niall HD. Coghlan JP. Mouse prepro-epidermal growth factor synthesis by the kidney and other tissues. Nature 1985;313:228 31

Journal of tropical pediatrics, 2019

OBJECTIVE To identify enablers and barriers related to home Kangaroo Mother Care (KMC) adoption a... more OBJECTIVE To identify enablers and barriers related to home Kangaroo Mother Care (KMC) adoption after hospital discharge. STUDY DESIGN An exploratory study, using a mixed methods evaluation, followed 60 mother-infant dyads from the hospital ward to 4 weeks post-hospital discharge. RESULTS Fifty-three of the mothers (88.3%) completed all study visits. The majority of mothers were breastfeeding and practicing skin-to-skin contact 4 weeks post-discharge. Seven mothers (13.2%) discontinued skin-to-skin contact at 4 weeks. KMC was practiced on average 3.3 h/day and 5.1 days/week. The top two enablers reported were significantly related to the amount of time skin-to-skin was practiced, with support for household responsibilities being most significant (U = 195, p = 0.008). Lack of privacy (p = 0.002) and lack of motivation (p = 0.034) were negatively correlated to duration of skin-to-skin contact. CONCLUSION Future programs may increase dissemination and adoption of home KMC by specifical...

Research and Reports in Neonatology, 2017

Meconium aspiration syndrome (MAS) is an important cause of morbidity and mortality among term ne... more Meconium aspiration syndrome (MAS) is an important cause of morbidity and mortality among term newborns. A result of antepartum or postpartum aspiration of meconium stained amniotic fluid (MSAF), MAS causes respiratory distress of varying severity, often complicated by air leaks or persistent pulmonary hypertension (PPHN). There has been a tremendous change in the concepts of pathophysiology and management of MAS over the last few decades. Routine endotracheal suctioning is no longer recommended in both vigorous and nonvigorous neonates with MSAF. Supportive management, along with newer therapies such as surfactant, inhaled nitric oxide, and high-frequency ventilation, has resulted in marked improvement in the overall outcome of MAS. The present review highlights the challenges in understanding the complex pathophysiology and optimal management approach to MAS. Potential future therapies and drugs in trial are also discussed briefly.

JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH, 2014

European Journal of Pediatrics, 2014

The objective of the study was to evaluate the effect of administering prophylactic antibiotics o... more The objective of the study was to evaluate the effect of administering prophylactic antibiotics on the development of neonatal sepsis in term neonates born through meconium-stained amniotic fluid (MSAF). Two hundred and fifty eligible neonates were randomized to study group (Antibiotic group-receiving first-line antibiotics for 3 days) and control group (No Antibiotic group). Both groups were evaluated clinically and by laboratory parameters (sepsis screen and blood cultures) for development of sepsis. All neonates were monitored for respiratory, neurological, and other systemic complications and received supportive treatment according to standard management protocol of the unit. One hundred and twenty one neonates were randomized to 'Antibiotic' group and 129 to 'No Antibiotic' group. The overall incidence of suspect sepsis was 9.6 % in the study population with no significant difference between 'No Antibiotic' and 'Antibiotic' groups (10.8 vs. 8.2 %, p = 0.48, odds ratio (OR) 0.74, 95 % confidence interval (CI) 0.32-1.73). Incidence of culture-proven sepsis was also not significantly different between the two groups (5.42 vs. 4.13 %, p = 0.63, OR 0.75, 95 % CI 0.23-2.43). The incidence of mortality, meconium aspiration syndrome, and other complications was comparable amongst the two groups. Routine antibiotic prophylaxis in neonates born through MSAF did not reduce the incidence of sepsis in this study population. (Clinicaltrials.gov no. - NCT01290003).

Peliosis hepatis (PH) is a rare liver disorder which is characterized by formation of multiple bl... more Peliosis hepatis (PH) is a rare liver disorder which is characterized by formation of multiple blood-filled cysts within the liver parenchyma. These Blood lakes are of various sizes within the liver, and may be continuous It is a usually seen in adults following exogenous steroid intake. Very rarely, it occurs in children. Storage disorders and Congestive Heart Failure are among the common causes of heaptomegaly in a neonate. This case report describes the presence of Peliosis Hepatis in a 16 day old neonate secondary to an adrenal nodular hyperplasia. This is a very rare case report as it describes an uncommon condition, Peliosis Hepatis, presenting as hepatomegaly secondary to endogenous steroid production. Figure 1. 5 Days Old Male Presented with Abdominal Lump CECT axial section non contrast image [A] shows a large hypodense lesion in right lobe of liver without any calcification, arterial phase [B] shows peripheral contrast enhancement with progressive fill in of contrast in po...

Archives of Disease in Childhood, 2012

Conclusions Abnormal aEEG finding in infants with severe hyperbilirubinemia is useful for detecti... more Conclusions Abnormal aEEG finding in infants with severe hyperbilirubinemia is useful for detection of asymptomatic BIND and can be reversible with appropriate treatment.

The Indian Journal of Pediatrics, 1997

End tidal Carbon dioxide monitoring was undertaken prospectively in all Ventilated neonates in ou... more End tidal Carbon dioxide monitoring was undertaken prospectively in all Ventilated neonates in our NICU admitted from March 1995 to August 1995 irrespective of the birth weight, gestational age and indication of ventilation. The aim was to determine the correlation between ETCO2 and PaCO2 in various clinical situations. The arterial blood gases were obtained in all ventilated babies with simultaneous and continuous ETCO2 monitoring and were analysed by AVL 995 Hb blood gas analyser. ETCO2 was analysed by side stream technique by Datex Cardiocap II monitor. A total of 152 samples from in-dwelling radial artery catheters were analysed from babies with birth weight from 900 g to 3400 g, gestation age from 28 to 42 wks and were ventilated for various indications like Severe Birth Asphyxia (SBA), Meconium Aspiration Syndrome (MAS), Recurrent Apnoea and Hyaline Membrane Disease (HMD). Statistical analysis was done in 10 groups to see if the ETCO2 correlated with its corresponding PaCO2 value. The study groups comprised three groups based on birth weight being < 1.5-2.5 kg and > 2.5 kg three groups as per the gestational age being 28-31+6 wks, 32-36+6 wks and 37-41+6 wks and four groups as per the need for ventilation being Severe Birth Asphyxia, Meconium Aspiration Syndrome, Apnoea of Prematurity and Hyaline Membrane Disease. Results of the correlation analysis revealed that the correlation coefficient in the study group ranged from 0.55 to 0.96 and was statistically significant in babies > 2.5 kg and 1.5-2.5 kg, in term and preterms 32-36 wks, and in babies with MAS, SBA and Recurrent Apnoea. The correlation coefficient was lowest in babies with HMD, being 0.55. The study showed that ETCO2 correlates closely with PaCO2 in most clinical situations in neonates and we recommend its use in all level III NICUs in ventilated babies.

Indian Pediatrics, 1996

Vitamin-D dependent rickets type II (VDDRII) or hereditary 1,25-dihydroxy vitamin D 3 resistant r... more Vitamin-D dependent rickets type II (VDDRII) or hereditary 1,25-dihydroxy vitamin D 3 resistant rickets is an autosomal recessive inheritable disorder, resulting from a failure of target organs to respond to hormonal form of vitamin D i.e. 1,25dihydroxy vitamin D 3 (1,25(OH) 2 D 3)(1). It is characterised by an early onset refractory rickets, hypocalcemia, hypophosphatemia, growth retardation, hyper-parathyroidism, and elevated circulating levels of 1,25-(OH) 2 D 3 and frequent unexplained total scalp and body alopecia(l-5). Since the time, Brooks, et al reported the first case in 1978(2), just about 30 cases have been reported in the world literature. We report one such case without alopecia. Case Report A 3-year-old girl was brought with complaints of widening of wrists and ankles for last 2% years and waddling gait. There was no history suggestive of malabsorption, oliguria, polyuria, jaundice and intake of drugs, or a similar illness in the

Antibiotic treatment in premature infants is often empirically prescribed, and practice varies wi... more Antibiotic treatment in premature infants is often empirically prescribed, and practice varies widely among otherwise comparable neonatal intensive care units. Unnecessary and prolonged antibiotic treatment is documented in numerous studies. Recent research shows serious side effects and suggests long-term adverse health effects in prematurely born infants exposed to antibiotics in early life. One preventive measure to reduce unnecessary antibiotic exposure is implementation of antibiotic stewardship programs. We reviewed the literature on implemented antibiotic stewardship programs focusing on premature infants. Six academic databases were systematically searched and eleven articles met inclusion criteria. Articles were grouped according to common area of stewardship actions; 1) Focus on reducing initiation of antibiotic therapy, 2) Focus on shortening duration of antibiotic therapy, 3) Various infrastructural stewardship implementations. The studies differed in their cohort composition and measured outcomes. We provide an overview of the reduction in antibiotic use achieved. Antibiotic stewardship programs are effective especially when they use a multifactorial approach and are tailored to premature infants. Implementation of antibiotic stewardship programs targeting premature infants should be considered in all neonatal intensive care units. The Norwegian Research Council (project number 273833) and the Olav Thon Foundation supported the study.

The Indian Journal of Pediatrics, 1997

The present prospective, open, controlled, randomised comparative trial was undertaken to evaluat... more The present prospective, open, controlled, randomised comparative trial was undertaken to evaluate the sero response and side effects of PRP-T Conjugate Vaccine (ACT-HIB) in infants and children aged 2 months and 16-24 months. Fifty four babies aged 2 months formed group A, 56 children aged 16-24 months formed group B. Groups A and B were further subdivided into two sub groups each destined to receive either PRP-T vaccine in association with DPT vaccine at different sites (I) or PRP-T and DPT both vaccines at the same site mixed in the same syringe (II). Group A received 3 doses at 2, 3 and 4 months of age and group B received one dose between 16-24 months. The Geometric mean titres of Anti PRP antibodies observed in primary immunisation schedule (A) and single dose vaccination schedule (B) were comparable and significantly higher to prevaccination titres. A serum anti PRP level of > 1.0 mcg/ml after immunisation is believed to correlate with long term protection. Ninety-six percent of infants in Group A and 98% in Group B achieved titres > 1.0 mcg/ml. The side effects were minimal, local and were comparable between the study and control groups, suggesting that PRP-T vaccine is highly immunogenic and well tolerated in Indian infants and children.

Indian Pediatrics, 1998

Oxygen is the most liberally and often used medication in any neonatal unit. Appropriate oxygen t... more Oxygen is the most liberally and often used medication in any neonatal unit. Appropriate oxygen therapy has resulted in improved neonatal survival and a reduction in oxygen-related morbidity over the past 2 decades. However, the degree of arterial oxygenation needs to be continuously and precisely monitored when managing critically ill neonates in order to prevent the adverse effects of both hypoxia and hyperoxia. The authors measured the extent of hyperoxia in spontaneously breathing neonates receiving supplemental oxygen by hood and the utility of pulse oximeters in detecting hyperoxia in newborn infants. The study was conducted during January-April 1996 among 63 preterm and 60 term babies admitted to the Neonatal Unit of Kalawati Saran Children's Hospital, who required supplemental oxygen by hood. All of the infants were independently evaluated by an observer after initial stabilization of temperature and perfusion. 91% of spontaneously breathing infants receiving supplementa...

The Indian Journal of Pediatrics, 2012

Total colonic aganglionosis (TCA) is an unusual variety of aganglionosis. Although appearing to b... more Total colonic aganglionosis (TCA) is an unusual variety of aganglionosis. Although appearing to be an extension of Hirschprung's disease (HD), it may differ from it in many ways and thus is difficult to diagnose on the basis of features applied for HD. The aim of this case report is to discuss the difficulties encountered in recognition of TCA and identification of features which can help in early diagnosis.

Fredet Ramstedt pyloromyotomy first performed in 1911 has long been the standard surgical treatme... more Fredet Ramstedt pyloromyotomy first performed in 1911 has long been the standard surgical treatment for infantile hypertrophic pyloric stenosis (HPS). It is the treatment of choice with excellent results, so much so that conservative medical management is invariably neither considered nor offered. A few reports in early sixties pondered over the issue of medical management (l,2) of HPS utilizing methyl scopolamine, atropine and eumydrin but fell into disrepute because of longer duration of therapy, slower resolution of symptoms, higher mortality, unsuccessful oral medication due to continuing vomiting and recurrence of vomiting after initial success in favour of a seemingly simple surgery with negligible mortality but significant complications.

Paediatrics and International Child Health, 2014

Background: The role of gastric lavage in preventing retching, vomiting and secondary meconium as... more Background: The role of gastric lavage in preventing retching, vomiting and secondary meconium aspiration syndrome in neonates with meconium-stained amniotic fluid is uncertain, and no there are no definitive guidelines. Objective: To evaluate the effect of gastric lavage in preventing retching, vomiting and secondary meconium aspiration syndrome in neonates with meconium-stained amniotic fluid. Methods: This was an open-label, parallel, randomized controlled trial conducted in the labour room, postnatal and neonatal wards of a tertiary-care teaching hospital. Vigorous neonates of §34 weeks gestation with meconium-stained amniotic fluid were randomised into two groups using block randomisation. Infants requiring oxygen, in respiratory distress or with major congenital malformations were excluded. Infants in the study group received elective gastric lavage in the labour room after initial stabilisation. No gastric lavage was done in the control group. The newborns were assessed for retching, vomiting and secondary meconium aspiration syndrome in the first 48 hrs of life or until discharge from the hospital, whichever was later. Results: A total of 267 newborns were randomly assigned to the gastric lavage group and 269 to the no gastric lavage group. There were no statistical differences in overall feeding between the two groups (6.74% vs 10.78%). Feeding of two newborns in the no-lavage group had to be omitted for the initial few hours because of vomiting; this did not happen in any newborn in the lavage group. No newborn in either group developed secondary meconium aspiration syndrome. Conclusion: Gastric lavage in newborns with meconium-stained amniotic fluid does not prevent or reduce the occurrence of feeding problems or secondary meconium aspiration syndrome.