Objectives: This study was undertaken to compare the relation of low birth weight (LBW) categories and level of low-density lipoprotein (LDL) of LBW neonates with maternal postpartum body mass index (BMI). Materials and Methods: This was... more
Objectives: This study was undertaken to compare the relation of low birth weight (LBW) categories and level of low-density lipoprotein (LDL) of LBW neonates with maternal postpartum body mass index (BMI). Materials and Methods: This was a hospital-based observational cross-sectional study conducted in the Department of Neonatology and in the Department of Obstetrics and Gynecology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. Results: A total of 81 LBW neonates and mothers pairs were included in the study. There was no difference in LBW categories with maternal postpartum BMI categories (P = 0.15, post hoc). There was an increase in LDL level in the neonates of the obese mother (P = 0.02), but the difference of LDL level was not significant in the neonates of the normal and overweight mother. Conclusion: LBW categories do not differ with maternal BMI categories, but the LDL level is more in the neonates of obese mother than that of overweight mothers and normal weight mother.
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Background: The incidence of hypospadias with cryptorchidism is about 6-31.6%. Current management recommendations are that undescended testis beyond three months needs surgery between 6-12 months of age. Proximal hypospadias and... more
Background: The incidence of hypospadias with cryptorchidism is about 6-31.6%. Current management recommendations are that undescended testis beyond three months needs surgery between 6-12 months of age. Proximal hypospadias and cryptorchidism overlap with disorders of sex development and endocrine problem. The aim of this study was to assess the outcome of surgical management of hypospadias with cryptorchidism, at selected centers in Dhaka, Bangladesh. Methods: This prospective study was conducted in the Department of Pediatric Surgery of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh during the period from January,2018 to January, 2022. In this study, we included 70 diagnosed cases of hypospadias with cryptorchidism presented as ambiguous genitalia who underwent surgery. Results: Mean age at surgery was 4.6±1.4 years and majority (91.4%) were male. Associated renal anomalies were absent in 81.4% cases, symptomatic renal anomalies were present in 11% cases, severe c...
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Background: Oropharyngeal administration of colostrum has found to play a role in preventing the Necrotizing Enterocolitis (NEC), thus reducing mortality and morbidity in preterm infants. We aimed to determine whether early oropharyngeal... more
Background: Oropharyngeal administration of colostrum has found to play a role in preventing the Necrotizing Enterocolitis (NEC), thus reducing mortality and morbidity in preterm infants. We aimed to determine whether early oropharyngeal administration of mother’s own colostrum can reduce the rates of NEC and/or mortality in preterm infants. Methods: We conducted a randomized, placebo controlled, intervention study in Department of Neonatology, Bangabandhu Sheikh Mujib Medical University, Dhaka from 2019 to 2021. Total 92 infants were enrolled, 52 were randomized to oropharyngeal administration of colostrum group and 40 to placebo group. Oropharyngeal administration of colostrum group received maternal colostrum (0.2 ml), after 24 hours of postnatal life and were given every 3 hour for the next 3 days. Serum IgA was measured at 24 hrs and 7th day of postnatal age. Clinical data during hospitalization were collected. SPSS version 21 was used for statistical analysis. Results: Baselin...
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Background: Packed blood cell transfusion in mechanically ventilated neonate is a prime necessity to maintain adequate tissue oxygen supply. Hemoglobin (Hb) is the gold standard for making decision of blood transfusion. Hb estimation is... more
Background: Packed blood cell transfusion in mechanically ventilated neonate is a prime necessity to maintain adequate tissue oxygen supply. Hemoglobin (Hb) is the gold standard for making decision of blood transfusion. Hb estimation is time-consuming in relation to arterial blood gas analysis, total oxygen content (CaO2) is one of the components of the blood gas. In this study, we wanted to predict CaO2as a predictor for blood transfusion in mechanically ventilated baby. Materials and Methods: This is a cross-sectional study conducted to assess the performance of CaO2to detect the indication of packed red blood cell transfusion in mechanically ventilated neonates. CaO2and corresponding venous hemoglobin were measured in normally perfused baby. Test performance of CaO2with different cut-off value was validated by receiver operating curve, sensitivity, specificity and positive predictive value (PPV), and negative predictive value (NPV). Results: Prevalence rate of packed red blood transfusion in mechanically ventilated neonate was 53%. With setting a cut-off value for Hb of 13 g/dl for blood transfusion, the best cut-off value of CaO2for blood transfusion is 18.5 ml/dl and area under curve 0.802, sensitivity is 80% and specificity is 78%, PPV 76%, and NPV 82% and cut value of CaO2off ≤20 ml/dl area under curve 0.97 (95% confidence interval 0.95–1) and specificity 93% and PPV 96% and NPV 95%. Conclusion: Our study concluded that CaO2is an excellent predictor of blood transfusion in a positive-pressure ventilated baby, but actual decision should be taken according to clinical condition of the patient.
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The COVID-19 pandemic had substantial effects on education. As a result, online education has gained popularity among postgraduate medical students. The aim of this study was to explore postgraduate learners’ experiences regarding online... more
The COVID-19 pandemic had substantial effects on education. As a result, online education has gained popularity among postgraduate medical students. The aim of this study was to explore postgraduate learners’ experiences regarding online classes. This study was carried out in the Department of Neonatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh, from March 2020 to September 2020. A questionnaire was sent to neonatology and pediatrics allied residents and students of FCPS paediatrics. Qualitative data were collected and using likert scales to assess satisfaction regarding online learning experience. The study included 79 participants. Of them, 71 (89.9%) responded, 12 (16.9%) attended online classes before the COVID-19 situation. Thirty-four (47.9%) residents opined that online classes provided the right amount of theory. Eighteen (25.4%) disagreed that high-quality learning can be accomplished without face-to-face contact. Twenty-four respondents (33.8%) disa...
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Thrombocytopenia is the commonest hematological abnormality encountered in the neonatal intensive care unit (NICU). This prospective, observational study was conducted among 78 consecutive at-risk neonates admitted in NICU, Bangabandhu... more
Thrombocytopenia is the commonest hematological abnormality encountered in the neonatal intensive care unit (NICU). This prospective, observational study was conducted among 78 consecutive at-risk neonates admitted in NICU, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from September 2016 to August 2017. Platelet count was measured in all at risk neonates at enrollment and less than 1,50,000/cmm was consiered as the cut off point for determining thrombocytopenia. Platelet count was measured every alternate day till discharge or normalisation of platelet count if the initial platelet count was low. If initial platelet count revealed normal, then the babies were followed up clinically if they develop any further risk condition for developing thrombocytopenia. During the period from enrollment to discharge, if any baby develops thrombocytopenia at any time then baby was defined as thrombocytopenic. Overall 39.7%patients found to be thrombocytopenic among 78 at-risk neonate...
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Background: Sepsis is one of the leading causes of neonatal mortality worldwide. Shock is usually accompanied with sepsis. Documentation of presentations and causative organisms is crucial to manage the newborn with septic shock.... more
Background: Sepsis is one of the leading causes of neonatal mortality worldwide. Shock is usually accompanied with sepsis. Documentation of presentations and causative organisms is crucial to manage the newborn with septic shock. Objective: The objective of this study was to describe the clinical profile and outcome of newborns with septic shock. Materials and methods: This retrospective study was conducted in the Department of Neonatology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, from January 2019 to December 2020. A total of144 neonates with septic shock were included in this study. Hospitalized inborn and out born babies were enrolled. Baseline data of selected neonates were retrieved from the registry book. Time of onset of sepsis, presentation of shock with their management and hospital outcome were collected. Data were analyzed in SPSS version 20. Statistical analysis was performed to establish the relationship between neonatal variables and outcomes with septic shock. Results: Among 1086 admitted newborns, 536 (49.4%) developed sepsis, of which 144 (26.86%) newborns developed septic shock. The mean gestational age and birth weight were 34.32±2.88 wk and 1886.50±744.9g respectively. One hundred and eight newborns were premature and 90.3% developed sepsis at >72 hours of age. Newborns with septic shock were presented with tachycardia (100%), prolonged CRT (98.6%), cold peripheries (75%), low pulse volume (44.4%), and 38.9% newborns had low blood pressure. Culture-positive sepsis was 31.2% cases. One hundred newborns recovered from septic shock within 72 hours (69.4%) and 64.6% of newborns survived after septic shock. The predictors of outcome of mortality were male sex, age of onset of sepsis >72 hours, positive blood culture, mechanical ventilation and DIC. No variables were found significant in binary regression analysis. Conclusion: In this study, 26.86% (144/536) septic neonates developed septic shock in the course of NICU stay. The common presentation of shock in newborns were tachycardia, prolonged CRT, cold peripheries, low pulse volume and mottled skin; the incidence of hypotension was 38.9%. Neonatal death after the onset of septic shock was 35.4%. Early recognition and prompt management can improve the survival of neonates.
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Background: HbA1c is now accepted as a standard measure for diagnosing type 2 diabetes mellitus. Maternal high HbA1c levels have been associated with increased risk of adverse neonatal outcomes. Objective: To find out the relationship... more
Background: HbA1c is now accepted as a standard measure for diagnosing type 2 diabetes mellitus. Maternal high HbA1c levels have been associated with increased risk of adverse neonatal outcomes. Objective: To find out the relationship between maternal HbA1c and neonatal outcomes. Materials & Methods: This prospective observational study was conducted from February 2018 to January 2019 in the Department of Neonatology and Department of Gynecology & Obstetrics, BSMMU, Dhaka. Diabetic mothers with known HbA1c Value and their infants who were born in this study period in BSMMU were enrolled. Neonates were divided into two groups. One group that had maternal HbA1c <6% and the other group >6%. Neonatal weights, routine capillary blood glucose were recorded. Results: Among the total 94 mothers, HbA1c level were <6% in 56 mothers and ³6% in 38 mothers. The mean weight, BMI and previous history of gestational diabetes of mothers were significantly higher in HbA1c ³6% group. Birth we...
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Background: Newborns with intrauterine growth retardation (IUGR) are known to permanently change their physiology and metabolism to adapt to limited supply of nutrients in utero. These programmed changes can later be the cause for the... more
Background: Newborns with intrauterine growth retardation (IUGR) are known to permanently change their physiology and metabolism to adapt to limited supply of nutrients in utero. These programmed changes can later be the cause for the origin of diseases like coronary artery disease, diabetes mellitus and hypertension. If the premature development of cardiovascular risk factors can be anticipated during childhood, future events can be prevented effectively by taking appropriate measures. Objective of the Study: To study serum lipid profile of newborns with IUGR and Appropriate for Gestation Age(AGA) newborns and compare them. Methodology: This cross sectional study was conducted from February 2018 to September 2018 in the department of Neonatology, BSMMU, Dhaka, Bangladesh. Newborn who met the inclusion criteria, information regarding antenatal, natal and postnatal history were recorded in a data collection form after taking consent from the parents/guardians. Weigh...
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Introduction: Early diagnosis of critical congenital heart defects (CCHD) may be missed both during prenatal echocardiography and the short stay in the neonatal nursery, leading to circulatory collapse or death of the newborn before... more
Introduction: Early diagnosis of critical congenital heart defects (CCHD) may be missed both during prenatal echocardiography and the short stay in the neonatal nursery, leading to circulatory collapse or death of the newborn before readmission to hospital. Pulse oximetry screening (POS) has been proposed as an effective, non-invasive, inexpensive tool allowing earlier diagnosis of critical congenital heart disease (CCHD). Objective: This study was conducted to find out the role of pulse oximetry as a screening tool for early detection of critical congenital heart disease in newborn. Methodology: This prospective study was conducted in department of Neonatology and department of Obstetrics & Gynaecology, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, Bangladesh a tertiary care hospital over one year. All inborn and outborn newborns stayed in hospital within 24 hours of age were included in this study. After taking written informed consent from parents, a thorough histo...
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Clinical risk index for babies II (CRIB II) score is simple, validated and widely used risk-adjustment instrument for predicting mortality among preterm low birth weight babies. To assess the efficacy of CRIB II score as a tool to predict... more
Clinical risk index for babies II (CRIB II) score is simple, validated and widely used risk-adjustment instrument for predicting mortality among preterm low birth weight babies. To assess the efficacy of CRIB II score as a tool to predict the risk for neonatal death among the preterm and LBW babies admitted in NICU of BSMMU, a tertiary care hospital in Bangladesh. This prospective observational study was conducted in Department of Neonatology in BSMMU from September 2016 to August 2017. Inborn preterm neonates with gestational age ≤34 weeks admitted were enrolled in the study. CRIB-II score was calculated for each infant within 1 hour of birth from birth weight, gestational age, sex, admission temperature and base excess. The primary outcome measured in the study was neonatal death or survival up to 28 days. Total 112 patients were finally analyzed in this study. Mean CRIB II score was significantly higher in the non-survivor group compared to the survivor group (p-value <0.0001)...
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Case Presentation A 10 minutes old boy of a first degree consanguineous parent was admitted in the Neonatal Intensive Care Unit (NICU) of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, for prematurity (31 weeks of... more
Case Presentation A 10 minutes old boy of a first degree consanguineous parent was admitted in the Neonatal Intensive Care Unit (NICU) of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, for prematurity (31 weeks of gestation ), low birth weight (1100 gram) and delayed cry after birth requiring bag and mask ventilation for one minute. There was history of poly hydramnios (amniotic fluid index 38 cm) of the mother, requiring amniocentesis. Mother got 2 doses of antenatal corticosteroid 24 hrs prior to delivery. There was history of sib death in the first week of life due to severe dehydration but cause of death was not confirmed. On arrival, baby was pink in the air, reflex & activity good, SPO2 96% without supplemental 02, normothermic, capillary refill time <3 second, euglycemic, and vital signs were within normal limit. Anthropometric measurements shows weight below 10th centile, length 45 cm and OFC, 29 cm above 10th centile and systemic examination reve...
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Research Interests: Microbiology, Pediatrics, Developing Countries, Sri Lanka, Treatment Outcome, and 13 moreBangladesh, Medicine, India, Humans, Female, Male, Newborn Infant, Public health systems and services research, Randomized Controlled Trial, Neonatal Intensive Care Unit, Brain Diseases, Severity of Illness Index, and Neonatal Encephalopathy
Background : Infantile colic is one of the common pediatric problems that Pediatricians encounter in practice. This condition is associated with excessive crying in healthy thriving infants over a regular period during the day and is... more
Background : Infantile colic is one of the common pediatric problems that Pediatricians encounter in practice. This condition is associated with excessive crying in healthy thriving infants over a regular period during the day and is sustained for the first few months of life. It has been historically described as irritable or compulsive crying or paroxysmal fussing with multifactorial etiology. Although it affects 5-19% of young infants, it remains a frustrating problem for parents and caregivers, because it is difficult to treat and may result in significant psychosocial consequences. Different treatment options are available with no definitive and conclusive benefit. In this metaanalysis, we pooled relevant data regarding the use of probiotics in infantile colic and tried to find out any beneficial effect thereof.Objective : To evaluate the efficacy of probiotics supplementation in the reduction of the duration of crying time in infantile colic.Method : It is a comprehensive meta...
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Background: Patent ductus arteriosus (PDA) is a common cause of neonatal morbidity. We aimed to do this meta-analysis to compare the efficacy of oral paracetamol/acetaminophen and intravenous (IV) paracetamol for the closure of... more
Background: Patent ductus arteriosus (PDA) is a common cause of neonatal morbidity. We aimed to do this meta-analysis to compare the efficacy of oral paracetamol/acetaminophen and intravenous (IV) paracetamol for the closure of hemodynamically significant PDA (hsPDA) in preterm infants. Methodology: Medline, Embase, and Google Scholar databases were searched for citations. We included 14 studies with significant PDA and used either oral or IV paracetamol for PDA treatment. Pooled proportion of PDA closured was analyzed. Results: We included 14 studies with 454 premature infants having PDA. Pooled proportion of PDA closure with oral paracetamol was 77.79% (95% confidential interval [CI] 72.92—82.15) in fixed effect and 75.77% (95% 65.48—84.74) in random effect model. In case of IV paracetamol group, pooled portion of PDA closure was 81.52% (95% 74.00—87.64) and 81.52 (95% CI 74.62—87.55) in fixed and random model, respectively. The difference of proportion in the fixed effect model was 3.75% (95% CI, −5.08—11.64) (P = 0.37), and in the random effect model, it was 5.75 (95% CI, 3.14—13.74) (P = 0.181). Conclusion: Our study concluded that pooled proportion of PDA closure is comparable with oral versus IV route of paracetamol use.
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Background: Seizure occurs more frequently in neonatal period and incidence of seizure is 50%-68% in perinatal asphyxia. At present phenobarbital is the drug of choice for treating neonatal seizure, which has some adverse effects on... more
Background: Seizure occurs more frequently in neonatal period and incidence of seizure is 50%-68% in perinatal asphyxia. At present phenobarbital is the drug of choice for treating neonatal seizure, which has some adverse effects on neurodevelopment status. Levetiracetam is a novel antiepileptic agent well-tolerated and effective in focal, generalized and neonatal seizure as well and lacks the adverse effects like phenobarbital. The present study was undertaken to compare the safety and efficacy of levetiracetam to phenobarbital in the treatment of neonatal seizure due to perinatal asphyxia.Methodology: This interventional study (Randomized Controlled Trial) was conducted in Department of Neonatology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka and Dhaka Medical College Hospital, Dhaka, Bangladesh from 1st January’ 2014 to 30th June’ 2015. Intravenous levetiracetam injection, 50 mg/kg loading followed by 10 mg/kg 8 hourly maintenance was used and phenobarbital intrave...
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Background: Emergence of multidrug-resistant (MDR) neonatal sepsis is a potential threat to the survival of newborn babies. Hence, periodic evaluation of the drug resistance organisms responsible for neonatal sepsis is essential for... more
Background: Emergence of multidrug-resistant (MDR) neonatal sepsis is a potential threat to the survival of newborn babies. Hence, periodic evaluation of the drug resistance organisms responsible for neonatal sepsis is essential for appropriate management and prevention. Objective: This study was conducted to determine the antibiotic-resistant pattern of isolates from blood culture in neonates and their outcome in terms of death. Materials and Methods: This retrospective study was conducted in the neonatal intensive care unit (NICU) of Bangabandhu Sheikh Mujib Medical University from October 2014 to December 2017 for a period of 38 months. During the study period, of 1829 records of admitted patients, 559 cases were found to be suggestive of sepsis. Only blood cultures positive cases were analyzed in this study. Results: Culture-proven sepsis was documented in 124 cases among 559 (22.2%). Majority were late-onset sepsis (LOS), i.e., 113/124 (91.1%); remaining were early onset sepsis (EOS). Acinetobacter (46%) was found to be the most common organism in both early and LOS. Most of the organisms were resistant to 1st- and 2nd-line antibiotics. Colistin exhibited the highest sensitivity (91% in EOS and 94% in LOS). The prevalence of MDR and extended drug-resistant (XDR) organisms were 77.4% and 51.6%, respectively. When outcome was compared between nondrug resistance and MDR group, no death was documented among nondrug resistance (P < 0.001). Similarly, death was significantly higher among XDR when compared with nondrug resistance counterpart (P < 0.001). Conclusion: Acinetobacter, Klebsiella, and Escherichia coli are the leading causes of drug-resistant bacterial sepsis in NICU. There is high prevalence of MDR and XDR organisms. Death was significantly higher among MDR and XDR sepsis when outcome was compared with nondrug resistance counterpart.
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Background: Birth defect is one of the most important causes of neonatal mortality worldwide. In a developing country like Bangladesh many possible factors for birth defects are present which should be identified. This study was performed... more
Background: Birth defect is one of the most important causes of neonatal mortality worldwide. In a developing country like Bangladesh many possible factors for birth defects are present which should be identified. This study was performed to determine those risk factors of birth defect and complications associated with it. Materials and Methods: A hospital based matched case-control study was conducted from August 2015 to July 2016 in department of Neonatology along with Obstetrics and Gynecology at BSMMU. A total of 98 mother-infant pair (49 babies with birth defect as cases and 49 healthy babies without any birth defects as controls) was included in the study. For each case, a gestational age, sex and post-natal age matched control was taken. Data was collected by face to face interview. Univariate and multivariate conditional logistic regression models were computed to examine the effect of independent variables on outcome variable using SPSS 23.0. Variables with p-value <0.05...
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Birth defects are one of the leading causes of neonatal mortality worldwide. Every year more than 8.14 million children are born with a serious birth defect. The risk factors predictive of birth defects in babies vary from country to... more
Birth defects are one of the leading causes of neonatal mortality worldwide. Every year more than 8.14 million children are born with a serious birth defect. The risk factors predictive of birth defects in babies vary from country to country even from region to region. About 60% of the causes of birth defect in humans are still unknown. However, in about 25% cases, the causes seem to be “multifactorial”, indicating a complex interaction between genetic and environmental risk factors. Many studies have been conducted to determine the association of various risk factors with the incidence of birth defects. Most of them found significant association with maternal age, parity, consanguinity, poor nutrition, life style factors, low socioeconomic condition and many more. But still there is debate in certain issues like common type of birth defect, specific age of mother for having birth defect babies, role of drugs during pregnancy etc. With advancement of diagnostic tools, birth defects ...
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Gentamicin is commonly used as first line drug in neonatal sepsis. It is usually used in combination with other drugs. It is a nephrotoxic and an ototoxic drug. Long term use causes renal failure and hearing impairment. Its efficacy... more
Gentamicin is commonly used as first line drug in neonatal sepsis. It is usually used in combination with other drugs. It is a nephrotoxic and an ototoxic drug. Long term use causes renal failure and hearing impairment. Its efficacy depends on the peak concentration, and its toxicity is related to the trough concentration. There is no set protocol of using gentamicin in neonate in Bangladesh, whether it should be used once daily or twice, it is till debatable in this perspective. In daily practice, it is not followed up trough and peak concentration of gentamicin, so it is not known the renal and hearing status of the baby treated with aminoglycosides. In this regard, primary objectives were to measure the peak level (to observe efficacy) and trough (to observe toxicity) level of gentamicin in once-daily dose (ODD) and in twice-daily dose (TDD) of gentamicin in neonates treated for suspected or culture proven sepsis and finally to assess the renal status and hearing status. This was...
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Expectant reduction of neonatal mortality and formulation of preventive strategies can only be achieved by analysis of risk factors in a particular setting. This study aimed to document incidence of neonatal death and to analyze the risk... more
Expectant reduction of neonatal mortality and formulation of preventive strategies can only be achieved by analysis of risk factors in a particular setting. This study aimed to document incidence of neonatal death and to analyze the risk factors associated with neonatal death. This retrospective study was carried out in department of Neonatology, Bangabandhu Sheikh Mujib Medical University (BSMMU) over a 12-month period from January to December 2015. The newborns that died within 28 d of life were defined as "Cases" and "Control" were the surviving newborn discharged to home as healthy. Two birth weight and gestational age matched controls were taken for each case. Maternal, obstetric, and newborn characteristics were analyzed between both the groups. Data analysis was performed using SPSS version 20.0 (SPSS Inc., Chicago, IL). A probability of < .05 was considered statistically significant. The strength of association was determined by calculating odds ratio ...