Online ISSN: 2515-8260

Keywords : NICU


To compare clinical profile and outcome of pediatric patients with sepsis admitted in pediatric and neonatal intensive care unit in a tertiary care hospital of central India

Jyotsna Mishra, Shashikant Patidar, Chayan Chakma, Naresh Bajaj

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 517-524

Background: Sepsis and septic shock cases in the Neonatal intensive care unit (NICU)
and Pediatric intensive care unit (PICU) remain one of the most significant causes of
morbidity and mortality in pediatric patients. Therefore, studying and comparing the
clinical features and outcomes of pediatric patients with sepsis in ICUs are important,
especially in developing countries.
Methods: From 1st July 2021 to 31st December 2021, we have collected data from both of
our pediatric ICU and neonatal ICU of Shyam Shah Medical College using a preformed
proforma. Complete blood count, C - reactive protein and culture sensitivity reports
were used to diagnose or screen sepsis. We compared clinical features, laboratory data,
microbiologic results, and final outcome for patients with sepsis in both NICU and
PICU.
Results: A total 1509 and 236 cases with sepsis from both NICU and PICU respectively
are included in the study (mean duration of stay in NICU 8.9 days±4.3; in PICU 12.5
days±5.3). Among these cases, culture positive cases with sepsis were 66% and 28% in
NICU and PICU respectively. Common pathogens isolated from blood cultures were E.
coli and pseudomonas in NICU and E.coli and S. aureus in PICU. Mortality, discharges,
refers and Left against medical advice cases were compared as outcomes in our study.
Comparing with NICU (n=24, 10.1%), mortality due to sepsis in PICU (n=111, 7.3%)
was less.
Conclusion: Sepsis in children both in NICU and PICU is associated with high mortality
despite aggressive treatment strategies, but more in NICU. Early recognition and
prompt treatment is the key to improve outcome of sepsis.

Fetomaternal Outcome in Women Undergoing Caesarean Section in First Stage Vs Second Stage of Labour

Kesavachandra Gunakala, P.M.Rekha Rao, Mude Vennela, P.Harika

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 6052-6060

Background:Second stage caesarean is technically more difficult due to deep
engagement of fetal head, and this is associated with increased risk of maternal
morbidity such as surgical injuries and intra operative excessive haemorrhage as well as
fetal morbidity such as asphyxia and fetal injury. A Prospective study was done to
compare the maternal and neonatal complications of caesarean sections performed in
second stage compared to first stage of labour. Objective: To determine the maternal
and perinatal outcome associated with caesarean sections performed in second stage
versus first stage of labour.
Materials and Methods: It is an observational cross-sectional study where 7033 women
were enrolled in the study, out of them 1272underwent C- section in first stage of labour
where as rest152 underwent caesarean section in second stage of labour for various
indications.
Results: It was found that the women who underwent caesarean section in second stage
of labour had a higher risk of maternal morbidity than those who underwent caesarean
in first stage of labour The rate of intraoperative bleeding is>1000ml,uterineatony,
longer duration of surgery,adhesions, fetalhypoxia, neonatal admissions toNICU,
neonatal sepsis and early neonatal death were more common in second stage of labour
as compared to first stage.
Conclusion: In conclusion, Present study suggests that women undergoing c-section in
second stage of labour have increased chance of Uterineatony, rate of excessive
bleeding, postoperative fever, wound infection, fetal hypoxia compared to first stage of
labour and therefore require special care and should be handled and operated by
experienced obstetricians’ The rate of complications can be avoided by proper antenatal
care, proper usage of partograph, pelvic assessment in early labour and timely
intervention.

Study of Hypertensive Disorders of Pregnancy by Comparision of Spot Urine Protein/Creatinine Ratio and 24hours Urinary Protein toDiagnose Proteinuria

Ch. Sunita, Nilofer. Gayathri KB

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 10022-10032

Background:The aim is to compare the spot urine protein/creatinine ratio with 24hour
urinary protein in hypertensive disorders of pregnancy.
Materials and Methods: A prospective correlational study was conducted on 100
hypertensive pregnantwomen during the study period. The objective of the study was to
know if a spot protein/creatinine ratio would provide an accurate quantification of
proteinuria and whether it can replace the use of the 24 hours urine protein in
preeclamptic women. Ethical clearance and informed consent were obtained. Urine
samples were collected for visual dipstick, spot urine P/C ratio and 24hours urinary
protein estimation.
Results: A fair degree of correlation existed between the two variables with r =
0.842with a highly significant p value <0.01 when all the observations were considered.
The correlation at lower level of proteinuria was less r = 0.72 compared to higher levels
of proteinuria,but is statistically significant. The area under the ROC curve - 0.739
(95% CI: 0.628, 0.849) with p value < 0.01 (significant). The optimal cut off point was
0.5, which yielded a sensitivity of 92% and specificity - 66%. Even though the results
were known to clinicians the values were not taken for clinical decision, only by the
ratio alone. However the 24 hour urine protein values were considered for the patient
management. The perinatal outcome in women with higher levels of proteinuria were
poor with increased incidences of IUGR, prematurity, low birth weight and the need for
NICU care was increased in such babies.
Conclusion: The present study indicates that this method for quantification of
proteinuria, when properly interpreted, can provide valuable information, that for
clinical purposes is a satisfactory substitute for the determination of protein excretion in
a 24 hour collection.