Relationship of maternal serum ferritin with foetal serum ferritin, birth weight and gestation

Haemoglobin and ferritin estimations employing the micro-ELISA technique were done in 308 random selected mothers in labour and their newborns. The values of haemoglobin and serum ferritin as well as birth weight and gestation of babies born to iron depleted, and mildly and moderately anaemic mothers were no different from those of newborns of non-anaemic women. However, the values of serum ferritin per se in all these newborns were much lower than what are generally reported from the western countries. Babies born to severely anaemic women, on the other hand, showed elevated levels of haemoglobin and serum ferritin, and lower birth weights and gestation. Thus, mild to moderate iron deficiency in the mother does contribute to lower iron reserves in the foetus, if not frank iron depletion, and severe iron deficiency anaemia to lower birth weight and gestation.     

A clinical analysis of hysteria and psychalgia

A retrospective study of children presenting with pain to the Child Guidance Clinic, during 1984-85 revealed 101 cases of hysteria and 22 of psychalgia. Children in these two groups did not differ significantly with respect to sex, age, education or occupation of parent. Children with psychalgia presented significantly later, and more frequently complained of headaches and abdominal pain. Children with hysteria presented with seizures, abdominal pain and anxiety symptoms. Pain can be of psychological origin also. Early diagnosis is essential to avoid unnecessary investigations and reinforcement of the "sick role".     

Hypothyroidism Complicating Pregnancy

In this report we describe 26 pregnancies complicated by hypothyroidism cared for over 6.5 years at AIIMS, New Delhi. In 2 women hypothyroidism was diagnosed during pregnancy; others were diagnosed before pregnancy and continued to receive thyroxine replacement therapy throughout pregnancy. The thyroxine treatment needed readjustment in 7 (26.9%) pregnancies to maintain euthyroidism. Maternal complications included anaemia (23.0%), pregnancy induced hypertension (26.9%), postpartum haemorrhage (7.7%), intrauterine growth retardation (15.4%), postdatism (30.8%), and deficient lactation (19.2%). Perinatal mortality was 3.9%. No case of stillbirth occurred probably because of intensive fetal monitoring and timely termination of pregnancies on evidence of intrauterine fetal compromise. One neonatal death occurred due to fetal thyrotoxicosis. In these cases close surveillance during pregnancy is needed to maintain optimum thyroid hormone concentration, and intensive fetal monitoring is required to achieve a good perinatal outcome.     

Pharmacokinetics of a single dose of morphine in preterm infants during the first week of life

We studied morphine pharmacokinetics after a single intravenous dose of 0.1 mg/kg in 20 newborn infants, who were born at 26 to 40 weeks of gestation and were less than 5 days of age. In the 10 infants whose gestational age was less than or equal to 30 weeks, the mean (+/- SD) distribution half-life was 50 +/- 35 minutes, elimination half-life was 10 +/- 3.7 hours, and clearance was 3.39 +/- 3.28 ml/kg/min; the corresponding values for the three term infants were 19 +/- 8 minutes, 6.7 +/- 4.6 hours, and 15.5 +/- 10 ml/kg/min, respectively. The data suggested a trend of decreasing values for distribution and elimination half-lives with increasing gestation, but a considerable degree of variation was seen. The morphine clearance rate increased as a function of gestational age at a rate of 0.9 ml/kg/min per week of gestation. Between 18% and 22% of the drug was found to be protein bound. Four hours after the dose, the drug level remained greater than or equal to 12 ng/ml in 8 of 10 infants born at greater than or equal to 31 weeks of gestation. In 8 of 10 infants born at less than or equal to 30 weeks of gestation, similar levels were maintained at 8 hours after the initial dose. We conclude that (1) there is a marked degree of variation in morphine pharmacokinetics during the neonatal period, (2) nearly 80% of the intravenously infused drug remains free, which might explain the high sensitivity to morphine in this age group, and (3) during the first week of age, adequate blood levels can be maintained by administration of morphine at 4- to 6-hour intervals in term infants and at less frequent intervals in very premature infants (less than or equal to 30 weeks of gestation).     

Hot caloric test in patients with peripheral vertigo

The Present study was carried out in order to evaluate the efficacy of warm monothermal test in patients of peripheral vertigo. Thirty patients were diagnosed to have peripheral vertigo based on clinical, audiometric and vestibular evaluations. The vestibular evaluation was done using clinical bithermal caloric test (Fitzgerald & Hallpike), ice cold caloric (Kobark) and bithermal test with ENG recordings. The data of clinical evaluations were compared with the normative one, obtained, from a control population consisting of 15 subjects. The sensitivity of warm monothermal test following clinical evaluation and with ENG was 84% and 79% respectively. The sensitivity of the ice cold caloric test was 71% thus suggesting a greater sensitivity of warm monothermal test. Warm monothermal test is a cost effective screening procedure for patients of peripheral vertigo.     

Prevalence of behaviour problems in Ajmer school children

In a questionnaire survey of 10,000 primary school children, parents and teachers reported behaviour problems in 38% of 6199 children on whom complete information was made available. Categorization of 3572 behaviour problems according to a modified APA-DSM II classification showed aggressive reactions to be the commonest (22.7%). This was followed by disorders of sleep (17.1%), unsocial aggressive reactions (15.5%), aggressive-regressive reactions (13.5%), regressive reactions (10.7%), school grade problems (8.7%) and others. Significant influence of sex, age and socio-economic class was noted on the overall prevalence, and prevalence of specific behaviour problems. A general lack of awareness among the parents about the childhood behavioural problems was noticeable from the pattern of utilization of the pediatric outpatient services in the study area. There is a need to educate parents on behaviour of children and the significance of behavioural deviations.     

Growth pattern of intrauterine growth retarded (IUGR) babies in first nine months of life

Forty-one full term intrauterine growth retarded (IUGR) babies of different maternal etiologies viz. maternal undernutrition (12), small maternal size (12), toxaemia of pregnancy (9) and idiopathic (8) were studied for growth pattern during first 9 months of life. Eighteen fullterm and 11 preterm who were appropriate for gestational age served as controls. These mothers were comparable for age, parity, socioeconomic status, weight and height (except in small size mothers), haemoglobin and plasma albumin (except in undernourished group). The various anthropometric parameters studied were weight, crown-heel length, head circumference, their velocities and ponderal index. The IUGR babies of undernourished mothers had lowest means for weight, crown-heel length and skull circumference. The babies of small sized mothers suffered most in crown-heel length followed by weight. The head growth was not affected in these babies. The IUGR babies of mothers with toxaemia of pregnancy demonstrated a catch up growth for all three parameters. The IUGR babies of idiopathic group showed a spurt in weight gain around 3 to 6 months and a similar spurt for crown heel length and head circumference was observed between 6 to 9 months of age. These babies were close to IUGR babies of mothers with toxaemia of pregnancy at 9 months. The preterm AGA babies also demonstrated a catch up growth for the weight, crown heel length and circumference.     

Integrated approach to maternal and child health and family planning

India has been emphasizing the interrelationship between primary health care, maternal and child health, and family planning as the major problem for family welfare. Family welfare has been adopted at the national level by the government. Integration of these 2 components of family welfare maternal and child health (MCH) and family planning has been recognized as a feasible proposition for improving the effectiveness and efficiency of the related services. An integration of these 2 services can lead to an improved acceptance of the family planning, give it credibility, and improve cost effectiveness. India follows a policy of simultaneous and concurrent focus on MCH and family planning which are being treated as the 2 arms of family welfare department. The integration of family planning and MCH can be effected in 2 ways: the structural integration, where a common administrative agency runs the program but the services are delivered through different category of workers; and the process integration where the administration and the lower formations take care of both the components of the family welfare services. The integrated approach raises 2 fundamental issues: how to achieve the integration; and the stage at which a particular component should be emphasized. To analyze the problem, a conceptual model was developed. It consists of 4 elements arranged in a sequential manner, indicating the process, the objectives leading to activities which produce certain results, and these results are reflected by the indicators. A newly married couple wants to have children. The pattern of the family in accordance with the small family norm can be developed by the following objectives: to bring about wanted conceptions; the wanted conceptions to develop into healthy newborns; the wanted newborns to be reared to healthy children; to avoid unwanted births; to regulate the interval between the pregnancies; and to adopt a small family norm. Each of the objectives lead to a series of respective activities which produce specific results. The health outcomes of such an integrated program of family planning and MCH can be considered in 3 categories, namely, effects on: mother's health as illustrated by low maternal mortality and morbidity, an improved nutritional status, and a low incidence of preventible complications of pregnancy; fetal health, a low fetal mortality and stillbirth rate, proper care of the newborn, prevention, and early detection of abnormalities of development; and child health, as shown by reduction in perinatal, neonatal, infant and child mortality, a better health of the infant at birth, and a decreased vulnerability to disease by the children.