Abstract

Neonatal respiratory distress (NRD) is a main cause of neonatal morbidity and mortality in developing countries. Early detection of its risk factors and early treatment of its causes are major challenges. There are many causes of respiratory distress, among them, transient tachypnea of newborn (TTN), respiratory distress syndrome (RDS) and perinatal asphyxia are commonest causes. Timely and appropriate therapy is essential to prevent ongoing injury and improve outcome. The aim of this study was to determine the risk factors and to identify the causes of respiratory distress in neonatal intensive care unit (NICU) in Combined Military hospital (CMH) Sylhet and to observe the hospital outcome of these babies. Descriptive type of cross- sectional study was conducted in CMH Sylhet over a period of one year from April 2018 to March 2019. During the study period a total of 287 live newborns were found and included as study subjects to observe for development of respiratory distress. The overall prevalence of respiratory distress was 19.2%. There was male predominance (63.6%) and more than two third (71.1%) were born by cesarean section. Prematurity (38.2%), low birth weight (52.7%), male gender (63.6%), APGAR at 1 min <7 (10.9%), caesarean delivery (76.4%), less antenatal care visit (52.7%), more than 4 pervaginal examinations 49.1%, acute fetal distress 43.6% and gestational diabetes mellitus 34.5% were the most common risk factors for development of NRD. The main causes were transient tachypnea of newborn 47.3%, respiratory distress syndrome 29.1% and perinatal asphyxia 10.9%. All babies required high flow oxygen initially, subsequently Bubble Continuous Positive Airway Pressure (CPAP) and mechanical ventilation was required in 14.5% and 1(1.8%) cases respectively. Mortality was 1.8% in neonates with respiratory distress syndrome with pneumothorax with septicaemia requiring mechanical ventilation. NRD is a frequent emergency and causes high morbidity and mortality. Risk factors like prematurity, low birth weight, male gender, APGAR at 1 min <7, caesarean delivery, less antenatal care visit, more than 4 pervaginal examinations, acute fetal distress and gestational diabetes mellitus were associated with respiratory distress in newborns. Majority of cases are due to TTN followed by respiratory distress syndrome and perinatal asphyxia. Mortality was in RDS mainly related to pneumothorax with septicaemia. Better obstetrical care and timely intervention may improve the outcome of newborn respiratory distress. Bangladesh Med J. 2019 Sep; 48 (3): 21-27

Neonatal sepsis is one of the major causes of neonatal morbidity and mortality, particularly in developing countries. Epidemiology and surveillance of neonatal sepsis helps in implementation of rational empirical antibiotic strategy. A cross-sectional prospective study was conducted in the special care baby unit under department of Paediatrics and Neonatology, BIRDEM General Hospital during the period of November 2008 to September 2009 to determine the pattern of bacterial agents causing neonatal sepsis and their susceptibility pattern to various antimicrobial agents. Blood cultures were performed on admitted newborn babies (0-28 days) to rule out sepsis. Antimicrobial susceptibility testing was done for all blood culture isolates according to the criteria of the National Committee for Clinical Laboratory Standards by disk diffusion method. Out of 720 screened blood cultures, 64 (8.9%) reported as positive and the gram positive and gram negative bacteria accounted for 6 (9.4%) and 58 (90.6%) respectively. The most common gram positive organisms were Staphylococcus aureus (6.3%) and Enterococci (3.1%) & gram negative organisms were Klebsiella pneumoniae (37.5%), Serratia (25%), Pseudomonas aeruginosa (10.9%), Citrobacter (10.9%) and Acinetobacter (6.3%). The susceptibilities were remarkably low to Ampicillin (3.12 %) & Cefotaxim (10.9%) for both gram positive & gram negative isolates. Gram positive group had susceptibilities of 66.7% to Ciprofloxacin and Imipenem, 83.3% to Gentamicin, & 100% to Amikacin & Vancomycin. Gram negative isolates showed higher sensitivities to Imipenem (94.8%), Ciprofloxacin (89.7%), Amikacin (72.4%) respectively. Gram-negative bacteria showed high level of resistance to commonly used antibiotics (Ampicillin, Ceftazidim and Cefotaxim). Gentamicin, Amikacin, Imipenem and Ciprofloxacin were the most effective drugs compared to others. Routine bacterial surveillance and their sensitivity patterns must be an essential component of neonatal care. CBMJ 2014 January: Vol. 03 No. 01 P: 35-40

We report the case of a newborn with Down's syndrome associated with transient acute myeloid leukemia (AML). The leukemic presentation resolved spontaneously without treatment just 4 weeks after birth. A 2 days old newborn presented with respiratory distress, lethargy, poor suck and mild hepatosplenomegaly with features of Down's syndrome. Total white cell count was 144,000/cmm with blasts 92%. Other Septic work up was negative. Peripheral blood smear revealed hyper leukocytosis and presence of blast cells. Flow cytometric analysis revealed acute myeloid leukemia. The peripheral blast cells persisted for 4 weeks, after which the hemogram and the differential WBC count returned to normal and a final diagnosis of transient acute myeloid leukemia was made. Only few cases of congenital leukemia with Down's syndrome have been reported in the literature. In Down's syndrome, AML whether transient or not, generally shows cytogenetic and molecular aspects that differ from those of adult acute leukemiasJ Bangladesh Coll Phys Surg 2016; 34(4): 213-217

Background: Neonatal sepsis is one of the major causes of neonatal morbidity and mortality, particularly in developing countries and it is caused by Gram positive bacteria, Gram negative bacteria and fungi. Thrombocytopenia has been used as an early but nonspecific marker for sepsis. About 75% of culture positive neonates have thrombocytopenia. The severity and duration of thrombocytopenia varies in different types of organism. So, the objectives of this study were to examine platelet counts and platelet indices in neonates with culture proven sepsis and to determine if there was an organism specific platelet response.Methods: This cross- sectional prospective study was carried out in the special care baby unit (SCABU) under department of Paediatrics and Neonatology, BIRDEM General Hospital, Dhaka from November 2008 to September 2009.Results: Total 120 newborn babies with culture positive sepsis were included in this study. Gram positive bacteria was found in 06 (5%), Gram negative bacteria was found in 58(48.3%) and fungi was found in 56 (46.7%) neonates. Thrombocytopenia was found in 95% of culture positive neonates. When compared with neonates with Gram positive sepsis, those with Gram-negative or fungal sepsis had a significantly lower platelet count, platelet nadir and prolonged duration of thrombocytopenia (p=<0.05). Fungal sepsis was also associated with prolonged duration of thrombocytopenia when compared with that of Gram negative sepsis (p=0.03).Conclusion: Neonatal sepsis is frequently associated with thrombocytopenia. However, Gram negative and fungal sepsis is associated with a lower platelet count, platelet nadir and prolonged duration of thrombocytopenia compared with that of Gram positive sepsis.Birdem Med J 2014; 4(2): 79-83