Vol. 13 • No. 1 ISSN: 0972-2408 Apr–Jun 2012 PerinatologyJournal of Perinatal and Neonatal Care Indexed in EMBASE and CINAHL Vol. 13 • No. 1 Apr–Jun 2012 PerinatologyJournal of Perinatal and Neonatal Care Editor in chief Dr Ranjan Kumar Pejaver Bangalore Managing Editor Dr Jayashree B Keshav Bangalore Editorial Board Dr Kamini A Rao, Bangalore Dr Arvind Shenoi, Bangalore Dr Prathima Radhakrishnan, Bangalore Dr Sulochana Gunasheela, Bangalore Dr Meenakshi Bhat, Bangalore National Advisory Committee Dr DK Guha, Delhi Dr MKC Nair, Trivandrum Dr Uma Ram, Chennai Dr Purnima Satoskar, Mumbai International Advisory Committee Dr Hisham Mirghani, UAE Dr Rajam S Ramamurthy, USA Dr RS Prasad, UK Dr Koravangattu Sankaran, Canada Dr Ravi GP Krishnan, USA Dr Bhavani Sriram, Singapore Dr David Ellwood, Australia Indexed in EMBASE and CINAHL Vol. 13 • No. 1 • Apr–Jun 2012 General Information PerinatologyJournal of Perinatal and Neonatal Care The Journal address of a subscriber on two consecutive Perinatology (ISSN 0972-2408), one of the occasions, names of such members will be few journals dedicated to the emerging deleted from the mailing list of the journal. multidisciplinary field of perinatal medicine, Providing complete, correct, and up-to-date is published and distributed quarterly (in the address is the responsibility of the subscriber. months of January, April, July, and October Information regarding change of address every year) at The Himalaya Drug Company. should be communicated to the publisher at The journal publishes original research articles, [email protected]. review articles, brief reports on clinical and Copyright laboratory observations, case reports, and clinical studies. 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If a copy is received for personal use, one cannot resale Printed at or give away the copy for commercial or M/s Sri Sudhindra Offset Process library use. The copies of the journal are sent #97, DT Street, 8th Cross, Malleswaram, by ordinary post/courier. If a copy returns Bangalore – 560 003 due to incomplete, incorrect, or changed Vol. 13 • No. 1 • Apr–Jun 2012 Contents PerinatologyJournal of Perinatal and Neonatal Care Research Articles Cord Blood Bilirubin Level as an Early Predictor of Neonatal Hyperbilirubinemia— A Hospital-based Prospective Study Singhal V, Kamath N, Baliga BS, Unnikrishnan B 1 Study of Changing Trend in Maternal Mortality Jyothi GS, Umadevi K, Nandakumar BS, Sujani BK 9 Cystic Fibrosis: Are we Missing the Diagnosis in India? Menon PG 16 Fetal Medicine Update Outcome of Isolated Congenital Diaphragmatic Hernia Diagnosed in the Second Trimester Namashivaya A, Radhakrishnan P 20 Picture Quiz 26 Self-assessment Quiz 27 Abstracts from Literature 30 Short Communications Popliteal Pterygium Syndrome Devdas S, Belvadi GB, Premlatha R, Ramya S 32 Sirenomelia with Polycystic Kidneys: A Rare Anomaly Yelamali BC, Pol RR, Kolagi S, Bhagawati M 34 A Simple Approach to Pneumothorax in Newborns Duong HH, Sankaran K 36 Instructions to Authors 39 Vol. 13 • No. 1 • Apr–Jun 2012 Editorial PerinatologyJournal of Perinatal and Neonatal Care Dear friends, It is indeed great that our journal Perinatology, in its new look, released by the new publishers M/s The Himalaya Drug Company, has entered its second year. I am glad to present you the first issue of Volume 13 of the journal. My sincere thanks to the publisher, who has been persistently striving toward raising the academic standard and circulation of Perinatology. I would also like to acknowledge the managing editor and her team for the constant support, cooperation, and help. I would like to bring to your notice that the editorial board, and the national and international advisory committees have been revised. Some of the erstwhile members had to discontinue due to various reasons. I acknowledge their contribution toward the growth of Perinatology since its inception. Active, enthusiastic members who are pioneers in the various disciplines of perinatal medicine have been inducted. The members of the editorial board will be introduced to you in this and subsequent issues. This issue of Perinatology features articles on interesting topics such as changing trend in maternal mortality in India and current scenario of diagnostic services for cystic fibrosis and case reports on rare congenital disorders such as sirenomelia and popliteal pterygium syndrome. The theme page gives you the current scenario on breast feeding practices, particularly in India. I recently had an opportunity to attend the Joint Congress of the Federation of Asian Oceania Perinatal Societies and the Perinatal Society of Australia and New Zealand, held in Sydney, Australia. The conference primarily emphasized on improving the situation of “still births” in various countries of the region. Still births in India is a poorly recorded and reported event. It is estimated that the stillbirth rate in India is between 30 and 35 per 1000 births and perinatal mortality rate is between 60 and 70 per 1000 births. Approximately, 0.8 million stillbirths and 1.7 million perinatal deaths occur every year. It is crucial to improvise perinatal audit, which helps to identify suboptimal care related to perinatal deaths and take appropriate measures for its reduction. I hope you will enjoy reading this issue. Dr Ranjan Kumar Pejaver Editor in chief Email: [email protected] Vol. 13 • No. 1 • Apr–Jun 2012 Know your Editorial Board PerinatologyJournal of Perinatal and Neonatal Care Dr Ranjan Kumar Pejaver is a Senior Consultant Neonatologist at KR Hospital, Honorary Professor of Neonatology at Kempegowda Institute of Medical Sciences, and Head of the Department of Pediatrics at St Philomenas Hospital in Bangalore, India. Dr Pejaver has been associated with various esteemed organizations/committees both at Dr Ranjan Kumar Pejaver the national and international levels. He is the (FRCP, FRCPCH [UK], FIAP, FNNF) president of Federation of Asia Oceania Perinatal Editor in chief Societies; member (International committee) of World Association of Perinatal Medicine; secretary at the Neonatal Chapter of Indian Academy of Pediatrics; Joint National Coordinator of Indian Academy of Pediatrics, Neonatal Resuscitation Program, and First Golden Minute Project; and Fellow of the Royal Society of Tropical Medicine and Hygiene, London. Dr Pejaver has been the founder editor of Perinatology. In addition, he is an associate editor of Journal of Neonatology, member of national advisory board for Indian Pediatrics, and member of the editorial board for Journal of Perinatal Medicine. He has published over 60 scientific papers in national and international journals and delivered more than 75 presentations at various scientific meetings held across the globe. He has also authored and contributed for various medical text books. Dr Pejaver has participated in and guided more than twenty major multicenter research trials. He is a well traveled person, having worked in several places including Africa, United Kingdom, Germany, Middle East, and India. Vol. 13 • No. 1 • Apr–Jun 2012 Theme PerinatologyJournal of Perinatal and Neonatal Care Breast Milk is Best for Newborn Breastfeeding is one of the most effective ways to ensure good health and survival of infants and young children. The World Health Organization recommends exclusive breastfeeding up to 6 months of age and continued breastfeeding along with complementary foods up to 2 years of age or beyond. The American Academy of Pediatrics advises that breastfeeding be continued for at least 1 year, and thereafter for as long as mother and baby desire. Globally, <40% of infants under 6 months of age are exclusively breastfed. Latest statistical reports have shown that breastfeeding