Milind Ramakant Kulkarni

Abstract

Introduction: Perinatal Asphyxia is a multi-system disorder and its effects are not limited to central Nervous System. Cardiac impairment occurs in about 24-60% of neonates with asphyxia. Myocardial dysfunction secondary to severe birth asphyxia will lead to loss of cerebral auto-regulation with subsequent severe encephalopathy. This study was done to evaluate the usefulness of Creatine Kinase MB (CKMB) in diagnosing myocardial injury in perinatal asphyxia well as prognostic indicator of perinatal asphyxia. Materials and Methods: A Hospital based Prospective Analytical Study performed in 100 asphyxiated term neonates. CKMB was evaluated for sensitivity and specificity in comparison with clinical diagnosis of myocardial injury and were correlated with results from ECG, ECHO, duration of inotrope, severity of shock and outcome. Results: In our study among 100 term asphyxiated neonates, 79% neonates had clinical evidence of myocardial injury. We had large number of neonates (41%) with HIE grade 3 while 35% were stage 1 HIE and 24% were stage 2 HIE. The ROC curve for cardiac dysfunction showed that the value of CKMB for prediction of cardiac dysfunction was 42 IU/L (sensitivity of 79.5% and specificity of 93.3%). The cut off CKMB value for prediction of mortality in our study is 91.1 IU/L with sensitivity of 90.0% and specificity of 83.8% Also the value of CKMB had strong statistical significance with severity of HIE (p Conclusion: CKMB is valuable tool in resource limited settings for early detection of myocardial injury due to perinatal asphyxia. The early detection and prompt treatment of condition will help in improving prognosis of these asphyxiated newborns. Keywords: Perinatal asphyxia, Creatine kinase – MB, Myocardial Injury.

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Abstract

Ectodermal dysplasias are a group of hereditary disorders with improper development of embryonal ectodermal layer. The diagnosis of these disorders is challenging during infancy and it must be considered while investigating infants or neonates with fever without focus and dehydration. In the infants, clinical signs of this condition are subtle and non-specific. The classical signs of the disease become more visible after a few months of life. Paediatricians should have high index of suspicion of anhidrotic ectodermal dysplasia in infants or neonates presenting with fever without focus and dehydration especially in summer season. We report this rare clinical entity and supplicate to consider the diagnosis of anhidrotic ectodermal dysplasia when investigating pyrexia of unknown origin (PUO) or hyperthermia in infants during summer especially in areas of semi arid climate and dry weather. Keywords: External dysplasia, Anhidrotic, Pyrexia of unknown origin.

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