Indian journal of pediatrics
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Comparative Study Clinical Trial
Neonatal effects of anesthesia for caesarean section.
Seventy eight parturient mothers undergoing elective caesarean section were studied with regard to the immediate neonatal outcome in those receiving general and spinal anesthesia. All mothers were of grade I anesthesia risk, were term and had singleton appropriate for gestational age fetuses. There was no difference in fetal acid base chemistry in the two groups. ⋯ Induction delivery intervals were longer in the spinal group but it was not associated with more morbidity. Uterine incision delivery intervals were very small in both groups and no meaningful conclusion could be drawn as regards effect on the newborn. A plea is made for more frequent use of spinal anesthesia considering its many postnatal advantages.
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Review Comparative Study
BCG vaccination in India and tuberculosis in children: newer facets.
With the extended programme of immunisation and since 1985 the universal programme of immunisation and the coverage status of BCG vaccination in India has been very good, although it is still unsatisfactory in the eastern states. It is emphasized that BCG vaccination cannot prevent natural tuberculous infection of the lungs and its local complications, although it reduces the haematogenous complications of primary infection. However, this is not true for malnourished children who, inspite of BCG vaccination, develop serious, and often fatal types of tuberculosis such as miliary, meningitic and disseminated tuberculosis. ⋯ Similarly, vaccinated children may present with hepatomegaly, splenomegaly or isolated organ disease. It is important to relearn the new patterns of tuberculosis disease seen in vaccinated, non-malnourished children, and to a lesser extent in children with grade 1 to 2 protein energy malnutrition (PEM). With these limitations of BCG vaccination, other strategies like chemoprophylaxis need multicentric trials in high risk children, in different parts of the country.
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The neonate with circulatory failure and cardiogenic shock is a difficult management problem. However, the initial approach is that of resuscitation with exact diagnosis of secondary concern. Once the infant has been stabilized and septic and hypovolemic shock have been excluded, attention should be directed to the four most likely causes of cardiogenic shock: structural heart disease with left heart obstruction being the most common, cardiac muscle disorders, cardiac dysrhythmias, and cardiac metabolic disorders.