Background: Neonatal outcome is a sensitive indicator of availability, utilization and effectiveness of obstetrics and neonatal health care in the community. Review of hospital based mortality and morbidity pattern is critical to improve the quality of health care delivery system in that hospital. Objectives: To study the morbidity and mortality pattern of neonates admitted to neonatal intensive care unit (NICU) of a rural medical college hospital. Material and methods: All the neonates admitted to NICU from July 2013 to June 2015 were retrospectively analysed for demographic profile, short term morbidity and outcome. Results: 1580 neonates were admitted in the study period. 59.5% were Males, 63% were inborn, 75% were term babies and 59.5% had normal birth weight. 89.8% were admitted in early neonatal period. Important causes for admission were sepsis (24%)), birth asphyxia (23.6%), prematurity and low birth weight care (18.5%), Respiratory problems (13.9%) and hyperbilirubinemia (10.3%). The outcome of the admitted babies showed 83% discharges, 3.7% deaths, 12.2% discharge against medical advice and 1.96% referred to another centre. The major causes of mortality were birth asphyxia including hypoxic ischemic encephalopathy (45%), sepsis (27.5%) and respiratory problems (27.5%). The survival of term as well as inborn babies was better than that of preterm and out born neonates respectively. Conclusion: Birth asphyxia, neonatal sepsis, prematurity and respiratory problems were major causes of both mortality and morbidity. There is need to strengthen services to address these problems more effectively.

Background: Sepsis is an important cause of neonatal mortality and morbidity. Nonspecific and subtle clinical features coupled with expensive, time consuming and unavailable definite laboratory tests challenges its accurate diagnosis in clinical practice. Sepsis is traditionally suspected in neonates based on clinical features, maternal and neonatal risk factors and is treated by empirical antibiotics. These risk factors and clinical features are variable depending on geographical, cultural and socio-economic background. We studied the clinical and bacteriological profile of high risk neonates for sepsis development in our Neonatal Intensive Care Unit (NICU), to make the precise clinical diagnosis and prevent inadvertent use of antibiotics.Methods: A prospective observational study was conducted on 200 neonates with suspected sepsis either by high risk factors and /or clinical features admitted to NICU for a period of nine months. After clinical examination, septic screen including blood culture was done and antibiotics were started as per the NICU protocol.Results: Of the 200 neonates studied, 20.5% had positive blood culture with Coagulase negative staphylococci (CoNS) and contaminants. 89.5% had early onset of sepsis (EOS). Neonatal profile showed 60.5% males, 55% inborn, 37.5% premature, 49.5% low birth weight babies. Maternal profile showed 49.5% Primigravida, 73% aged above 20 years at delivery and 97.5% literates. Outcome of admitted neonates showed, 72% were discharged after improvement, 10.5% died and 17.5% discharged against medical advice. Death due to respiratory distress syndrome was common in preterm and male neonates.Conclusions: EOS was common in our NICU. Blood culture showed more CoNS and contaminants necessitating the need for better blood sampling and hand wash technique.

BACKGROUND: Acute respiratory infections are a leading cause of morbidity and mortality in under-five children in developing countries. Hence, the present study was undertaken to study the various risk factors, clinical profile and outcome of acute lower respiratory tract infections (ALRI) in children aged 2 month to 5 years. OBJECTIVE: clinical features, laboratory assessment and morbidity and mortality pattern associated with acute lower respiratory tract infections in children aged 2 months to 5 years. METHODS: 100 ALRI cases fulfilling WHO criteria for pneumonia, in the age group of 2 month to 5 years were evaluated for clinical profile as per a predesigned proforma in a rural medical college. RESULTS: Of cases 61% were infants and remaining 39%12-60 months age group, males outnumbered females with sex ratio of 1.3;1. Elevated total leukocyte counts for age were observed in only 22% of cases, of these 3% were having pneumonia, 9% severe pneumonia and 10% very severe pneumonia. Significant association was found between leukocytosis and ALRI severity (p=0.0001) Positive blood culture was obtained in 8% of cases and was significantly associated with ALRI severity (p=.0.027). Among the ALRI cases, 84% required oxygen supplementation at any time during the hospital stay and 8% required mechanical ventilation. The mortality rate was 1%; with 99% of cases recovering and getting discharged uneventfully. CONCLUSION: Among the clinical variables, the signs and symptoms of ALRI as per the WHO ARI Control Programme were found in almost all cases. Regarding the laboratory profile, leukocytosis and blood culture positivity were observed in a small percentage, but significant association with ALRI severity was observed for both. Thus, clinical signs, and not invasive blood tests are a better diagnostic tools, though the latter may provide additional therapeutic and prognostic information in severe disease.

Background: Acute respiratory infections are a leading cause of morbidity and mortality in under-five children in developing countries. Hence, the present study was undertaken to study the various demographic risk factors which predispose to acute lower respiratory tract infections (ALRI) in children aged 2 month to 5 year. Objective; Demographic factors associated with acute lower respiratory tract infections in children aged 2 months to 5 years. Methods: 100 ALRI cases fulfilling WHO criteria for pneumonia, in the age group of 2 month to 5 years were evaluated for demographic risk factors and clinical profile as per a predesigned proforma in a rural medical college. Results: Sociodemographic risk factors like parental illiteracy, overcrowding, partial immunisation and low socioeconomic status were potential risk factors; similarly nutritional risk factors like early and late weaning, anaemia and malnutrition were associated with ALRI. Significant environmental risk factors were use of biomass fuels, inadequate ventilation at home, and lack of separate kitchen. Conclusion: The present study has identified various socio-demographic, nutritional and environmental risk factors for ALRI which can be tackled by effective health education of the community and effective training of peripheral health personnel.

Background: Compulsory Rotating Residential Internship (CRRI) is an important learning period for medical graduates to become competent registered medical practitioners. Exclusive teaching programs for interns are scarce. During short pediatric CRRI postings, it is difficult to disseminate the necessary knowledge and skills to manage the common pediatric problems seen in the community by traditional teaching methods. We explored innovative teaching techniques to train the interns in a short time to acquire such basic skills. One minute preceptor (OMP) is a five micro skills clinical teaching, tailored to the learner’s needs by motivating them to learn. Objective: To implement OMP in our busy pediatric outpatient department (OPD) to train the interns andto know if it is an effective teaching technique. Methods: The study group included 15 interns who were posted to pediatric OPD on rotation for a month and never had earlier OMP teaching module. Their learning experience with traditional teaching method was gathered by a validated pre-project questionnaire graded on Likert scale. After 3 OMP sessions with a trained faculty, their learning experience was again collected by a post-project questionnaire. The data were compared and analyzed statistically using stata14 version software. p<0.05 was considered as statistically significant. Results: The average scores of questions went up from 1.3 and3.1 in pre-project questionnaire to average scores of 2.3 and 4.1 in post-project questionnaire on a 5-point Likert scale. This shows OMP as an effective teaching method over traditional teaching method for interns at pediatric OPD. Preceptor experienced OMP as simple, individualized and focused teaching method to the interns. Conclusion: OMP should be implemented in pediatric OPD to train the interns on common pediatric problems.