Background: The development of a country is defined by its healthcare status especially the maternal and child health. Neonatal Mortality Rate in India has always been an area of concern again due to logistic issues in implementation of preventive and curative programs in a large and diverse country as ours but has shown a slow but steady fall in the last 2 decades. The current NMR of Gujarat is 25.4/ 1000 live births (2016) which is similar to the national NMR. The goal is to bring down NMR to single digit. Several measures are being taken to address these goals. The objective is to study the morbidity and mortality profile of newborns admitted to the Special Newborn Care Unit at GMERS Medical College and Hospital, Gotri, Vadodara between January 2017 and December 2017.Methods: Retrospective study was carried out at the Special Newborn Care Unit (SNCU), Department of Pediatrics, GMERS Medical College admitted in the period between January 2017 to December 2017. Both inborn and out born admissions were included. Newborns admitted in SCNU were analyzed for causes of morbidity and mortality.Results: 1039 neonates were admitted over a period of 1 year. The gender distribution was 1.5:1 (M: F). 54% admissions were out born. 62% were Low Birth Weight out of which 14% were term SFD vs.86% were premature. Majority of admission in SNCU were Neonatal hyperbilirubinemia 38%, followed by Sepsis in 23%, RDS in 16%, Perinatal asphyxia 15%. Congenital anomalies were reported in 3% newborns. The outcome rates for Survival, LAMA and death were 75%, 06% and 19%. The most common cause for mortality was sepsis (40%) followed by birth asphyxia (21.4%) and RDS (12.2%).Conclusions: The leading cause of morbidity were Sepsis, Birth asphyxia, Respiratory Distress Syndrome and prematurity. Sepsis was the leading causes of mortality in present study followed by Birth asphyxia and RDS. Leading causes of mortality in the study are preventable and curable. Therefore, surveillance and training interventions aimed at management of these causes should be established and strengthened.

Background: Multiple parameters have been developed to prognosticate the outcomes of critically ill newborns admitted in NICUs. The objective of this study is to predict the outcome of newborns admitted in NICU using a simple but efficient score, TOPS score, involving alteration of physiological parameters. Aim of this study was to evaluate role of TOPS score in predicting mortality in sick neonates.Methods: The variables assessed under TOPS score on arrival for all subjects were: Temperature, Oxygen Saturation, Perfusion and blood glucose reading <45 mg/dl. All affected neonates were given treatment as per NICU protocol and outcome was assessed in terms of mortality or discharge using TOPS score. It was prospective study conducted at NICU, Department of Pediatrics, GMERS medical college and general hospital, Gotri, Vadodara. Study population was all admitted neonates aged <28 days at NICU.Results: Mean age of presentation of all cases was 2.8±3.58 days. Hypothermia on admission was observed in 63.3% cases. 40.8% cases had hypoxia. 26.5% neonates recorded poor perfusion. Mortality observed in hypoxic group was 51.7% followed by hypothermic group (46.9%). Highest strength of association was found for poor perfusion, mortality (87.5%) and OR-33.406.  TOPS score was observed to be statistically significant (X2 value is 63.27, p < 0.05) as predictor of mortality. Thus, mortality rate increased with increasing no. of altered TOPS parameters. Regression analysis showed three factors (hypothermia, hypoxia, prolonged CRT) which are consistently associated with p value ≤ 0.05 for each variable and can be used to predict mortality.Conclusions: All parameters in TOPS score are physiologically important and each parameter carries an independent risk associated with mortality. It is important to note that multiple parameters affected increases the risk. TOPS score is a simple, basic and effective tool to guide about the condition of new born at admission and outcome. of neonatal mortality.

Background: Nephrotic syndrome is a significant cause of chronic renal disease in children. The objective of the study was to analyze demographic profile, response to steroids and associated complications, in children with Nephrotic syndrome.Methods: A retrospective study of all patients referred to Renal diseases clinic at GMERS Medical College Gotri Vadodara was done. Period of study was from year 2014 to June 2017. Variables assessed were sex distribution, age at presentation for first attack, occurrence of complications, steroid responsiveness and use of steroid sparing agents. Study was done from special clinic cards used for documentation of visits of patients in Nephrotic disease special clinic.Results: 59 patients were studied. Mean age at presentation of was 4.08 years. Sex distribution ratio was 1.18:1. 88% of cases were infrequent relapsers. Steroid dependence was observed in 8.4% of cases. Complications were noted in 38% children. UTI was the commonest complication 13.5%. Associated renal conditions were present in 5% of children.Conclusions: In the present study clinical profile of children with Nephrotic syndrome was concordant with typical nephrotic syndrome in children. Pattern of nephrotic syndrome and response to treatment did not differ significantly from other studies.

Background: Acute kidney injury (AKI) is defined as an acute deterioration in ability of the kidneys to maintain homeostasis of body fluids and electrolytes leading to retention of wasted and toxic metabolic end products. It is fairly common in newborn population and is a major contributor of neonatal mortality and morbidity. The aim was to study the incidence of renal failure in high risk neonates and risk factors for renal failure.Methods: A prospective observational study was done to evaluate renal profile in high risk neonates admitted to neonatal intensive care unit, GMERS Medical College and General Hospital, Gotri, Vadodara, Gujarat, India over a 1-year period. nRifle criteria was used for classification of acute kidney injury.Results: The incidence of AKI in high risk newborns admitted in this study was 52 (37.14%). The male to female ratio in current study was 2.46:1. Majority of neonates with AKI were out born 44 (84.6%). The incidence of AKI was higher in term newborns. Mean weight in AKI group was 2048 grams. The highest incidence of AKI was found in AFD newborns (57.69%). nRifle criteria was used to diagnose AKI in this study. Out of 52 neonates who had AKI, 27 (51.9%) were in risk category, 21 (40.4%) were in injury group and 4 (7.7%) were in failure group. Mortality in these groups were 5 (18.51%), 7 (33.33%) and 3 (75%) respectively. Highest correlation of risk factors for AKI was found with birth asphyxia 18 (34.9%) followed by sepsis 12 (23.1%) and shock 15 (28.5%). 29 (55.76%) neonates had non oliguric AKI. 28 (53.8%) neonates with AKI developed dyselectrolytemia.Conclusions: Early recognition and management of risk factors can help in reducing the occurrence and improve outcomes in them.

Background: Neonatal hypernatremia is less common but significant  metabolic problem  with acute morbidity as well as long term consequences. Many causative  factors have been identified such  as inadequate breastfeeding, hot  weather with high  evaporative losses ,  infections etc. It is important to identify, anticipate and correct the condition before it leads to damaging consequences. The objective of the present study was evaluation of clinical profile, renal parameters and causative factors associated with hypernatremia in exclusively breast-fed infants.Methods: A retrospective review of  30 new-borns less than 28 days of age admitted in  GMERS General hospital for hypernatremia was conducted. The study group included inborn and out born admissions. Records were reviewed, feeding history, severity of hypernatremia and altered renal parameters were analysed. The study period was from April 2018to June2018i.e summer months.Results: Total NICU admissions were 303 during these months  out of which 30 were diagnosed  with hypernatremia completely and discharged. Mean age of presentation was 8.4 days. Sodium levels ranged from 146-179 mmol/l. Mild hypernatremia was most common (56.7%), followed by moderate hypernatremia in 40%. All neonates were on  exclusive breast feeding. Majority of the affected neonates were term SGA followed by term AGA and preterm AGA. Renal parameters were altered in quarter of affected  infants.  Most common clinical feature noted was lethargy(70%), followed  by fever(53.3%),significant weight loss ,jaundice and dehydration. 29 patients were successfully discharged on breast milk feeding.Conclusions: Hypernatremia though rare, is common in young infants in summer months. It is preventable and treatable condition. It is important to anticipate, identify and treat such patients at the earliest. Treating physicians and nursing staff should be more vigilant for establishment of breast feeding in low birth weight infants. Exclusive breast feeding for first six months of life should always be promoted.