Background: To identify the determinants of mortality in neonates admitted in sncu of tertiary care hospital with respiratory distress. Neonatal intensive care unit in a tertiary level care hospital in central India. Study Design was a prospective observational study. Neonates admitted with respiratory distress over a period of 8 months. Methods: Neonates with respiratory distress i.e. respiratory rate >60/min, chest retraction, grunting, central cyanosis, were included in the study. Surgical problems causing respiratory distress i.e., congenital malformations affecting respiratory tract and congenital heart disease were excluded from the study. All the cases were divided in two groups based on outcome with good outcome defined as those babies who were discharged and poor outcome defined as those babies who expired during the treatment and analyzed. Results: On analysis, Antenatal history of per vaginal bleed, meconium stained liquor, prolonged rupture of membrane, VLBW, prematurity, pre-ductal SpO 2 , shock, apneic attacks, positive sepsis screen were found to be significantly associated with death. Conclusions: India in recent times has made huge improvement in neonatal care with establishing special care new born units. But, still the neonatal mortality rate is in higher range and needs further intense approach to reduce it. The antenatal and neonatal factors discussed above can be used as referral criteria for early referral of a new born with respiratory distress to a tertiary level new born unit for further management. The early identification and referral of a neonate with above risk factors may help in reducing the associated mortality and hence will reduce neonatal mortality.

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BACKGROUND: India houses highest number of malnourished children next to African countries. Malnutrition is lethal in combination with Tuberculosis. Efficacy of BCG vaccination, a part of Universal Immunization Programme in preventing TB infection and utility of TST in detection of TB infection in malnourished children needs to be studied. OBJECTIVE: 1. To obtain the morbidity pattern of tuberculosis. 2. To study the role of BCG vaccination and reliability of TST in under five children with severe acute malnutrition. MATERIAL AND METHODS: DESIGN: A prospective study. SETTING: Severe malnutrition unit in a tertiary level referral hospital in central India. PARTICIPANTS: Under five children with severe acute malnutrition in SMTU. OUTCOME MEASURES: 1. Presence of tuberculosis in SAM children. 2. Morbidity pattern of tuberculosis in SAM children. 3. Presence of BCG scar in diseased children. 4. Reactivity status of TST in diseased children. RESULTS: Tuberculosis was diagnosed in 22% of severe acute malnutrition cases. Seventy eight percent (78.50%) of the pulmonary tuberculosis cases were younger than 1 year. In children of 13-26 months of age, 50% of cases were pulmonary tuberculosis while neuro-tuberculosis and disseminated tuberculosis contributed 25% each. BCG scar was present in 86.6% of malnourished children with pulmonary tuberculosis while only 28.4% of extra pulmonary seriously ill cases had BCG scar. Positive tuberculin reaction was seen in only 8.0% children, 50% of them had 10-15mm induration. CONCLUSION: Tuberculosis is one of the treatable causes of malnutrition and there is high prevalence of tuberculosis infection among SAM children. Identifying adult cases and giving proper treatment as well as screening their malnourished children will help in early identification and preventing spread of pulmonary TB among children.

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