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Lead levels were measured by atomic absorption spectrophotometry in umbilical cord blood samples of 205 consecutively born neonates and venous blood in 62 of the mothers. The mean (+/- SD) cord blood lead level was 4.7 +/- 12.1 microg/dL. In the sub sample of 62 mother-baby pairs, the mean (+/- SD) cord blood lead levels were 1.6 +/- 2.5 microg/dL and 2.0 +/- 2.1 microg/dL, respectively. According to CDC risk categories, 92% babies were in Class I of which 87% had lead levels below 5 microg/dL. The mean (+/- SD) birthweight in <5 microg/dL category was 2640 +/- 445 grams as compared to 2617 +/- 408 grams in >5 microg/dL category. The mean (+/- SD) gestational ages were 39.1 +/- 2.0 weeks and 38.1 +/- 2.0 weeks, respectively in the two groups (P=0.014). On multivariate linear analysis, lower gestational age significantly correlated with higher cord blood lead level.

Background: Pneumonia diagnosed using chest radiographs is often used as a study end point in trials and epidemiological studies. We studied whether training of the end-users in 172 standardized chest radiographic features will decrease variability in the interpretation., Methods: Inter-observer variation of 3 observers in recognizing standardized radiographic features for pneumonia was studied in 172 chest radiographs of children with clinical severe pneumonia. (as per WHO definition). The observers were then trained using a software with a repository of normal and abnormal films showing a spectrum of radiological changes in pneumonia. The interobserver variation in recognizing the same standardized radiographic features was recorded after this training. For each radiographic feature, Cohen's kappa statistics to assess the between-observer agreement and Fleiss's multiple rater kappa statistics to assess agreement among all three clinicians was used., Results: The 'uniterpretable' films reduced from 16.6% (95% CI 0%-34.1%) before training to 8.1% (95% CI 0%-17.7%) after training. The 'adequate' films increased from 54.2% (95% CI 12.5%-95.9%) before training to 70% (95% CI 46.5%-93.4%) after training. For all features, agreement between observers 1 with 2 and 1 with 3, the Cohen's kappa improved from poor to moderate agreement. The Fleiss's kappa values before training were 0.1 to 0.2 and after training ranged from 0.37 to 0.52 indicating moderate to good agreement after training., Conclusions: Training of the doctors using standardized features with the help of a software improves agreement substantially in identifying radiological pneumonia.

Objective: To evaluate effects of gastric lavage with mother's milk starting 4 hours after birth, in hospitalized preterm newborns otherwise on exclusive parenteral fluids., Study Design: Randomized controlled trial. Sick preterm babies were assigned to receive in addition to parenteral fluids, either gastric lavage with mother's milk within 4 hours of birth and subsequently every 3 hours till tolerance of nutritive enteral feeds (intervention or BML group, n = 40), or remain nil per orally till tolerance of nutritive enteral feeds (control or NPO group, n = 40). The main outcome was the mean number of days of parenteral fluids till successful tolerance of nutritive enteral feeds. They were also evaluated for mean duration of hospital stay, development of new complications, and mortality., Result: Despite sicker babies in the BML group at baseline, the mean duration of exclusive parenteral fluid was significantly less (P = 0.003) in BML (3.9 +/- 1.5 days as compared to 5.4 +/- 2.6 days in NPO). In the NPO group 60% of the babies stayed longer than 3 weeks in hospital compared to only 30% in the BML group. The risk of development of new complication after randomization was also significantly less in BML group [RR 0.61 (95% CI 0.40-0.95) (P=0.03)]. Incidence of sepsis was 44% less in BML group [30% in BML, 55% in NPO group; RR 0.58; 95% CI 0.35-0.97; P = 0.02]. On multivariate logistic regression, BML group, birth weight and absence of complication at the time of hospitalization were strong predictors of improved outcome. There was no difference in mortality between 2 groups., Conclusion: This study showed that early exposure to even small amounts of mother's milk in sick preterm neonates significantly reduced the days on parenteral fluids, risk of sepsis and the duration of hospital stay without any adverse effect.

Objective: To test the hypothesis that daily supplementation of zinc and copper mixed with the oral rehydration solution (ORS) reduces the duration and the severity of acute diarrhea in children., Methods: In a randomized, double blind, placebo controlled trial children aged 6 months to 59 months in an urban hospital with acute diarrhea, were assigned to receive the intervention of once daily 40 mg of zinc sulfate and 5 mg of copper sulfate dissolved in a liter of standard ORS (n = 102) or placebo (50 mg of standard ORS powder) dissolved in a liter of ORS (n = 98)., Result: The baseline characteristics in the two groups were similar. The mean survival time (days) (SE) with diarrhea was not significantly different in the treatment (4.34 (0.2)) as compared to the placebo group (4.48 (0.2)), nor was there any difference in the median time to cure. Cure was less likely with longer duration of diarrhea prior to enrollment (P < 0.001), if the time taken for rehydration was more (P = 0.001) and if intravenous fluids were used (P = 0.03) regardless of the micronutrient supplementation. The proportion of children with diarrhea > 4 days was 46% in the placebo group with an adjusted odds ratio (OR) (95% CI) of 1.19 (1.58, 0.9; P = 0.2) as compared to 39% in the supplemented group. The most important risk factor for diarrhea > 4 days was diarrheal duration prior to enrollment with OR = 6.25 (3.7, 11.1). The supplemented group however had less severity of diarrhea with a lower proportion of children requiring unscheduled intravenous fluids (OR = 0.4; 95% CI 0.05, 2.2), with weight loss (OR = 0.7; 95% CI; 0.4, 1.3), with complications (OR = 0.15; 0.01, 1.3) and had no deaths as compared to two in the placebo group., Conclusions: This study showed that the most important predictor for duration of diarrhea in children was the severity of the disease at enrollment, and, not the supplementation. There were clinical beneficial effects of supplementation on rate of any complications and mortality. A larger trial is warranted before supplementation of micronutrients mixed with ORS are recommended for management of acute diarrhea.

Antigen A 60 of Mycobacterium bovis is a cell wall antigen with almost complete cross reactivity with antigen A 60 of Mycobacterium tuberculosis. This antigen was used for the ELISA technique for 100 cases suspected of childhood tuberculosis to evaluate the usefulness of the method in the diagnosis. The positivity rate in pulmonary tuberculosis was 65.1%, in central nervous system tuberculosis 50.0% and in the miscellaneous group 76.4%. The overall positivity was 61.0%, proving the utility of the method for diagnosis.