1668 babies (10 twins) of 1658 mothers, who elected to undergo puerperal sterilization out of 5873 mothers delivering vaginally were studied. There were 29 instances of previous sibling death in infancy among these 1658 and 6 of these deaths happened in the neonatal period. 210 of the 1668 babies weighed less than 2.5kg (low birth weight) and within them 17 (16 small for date and one preterm) weighed less than 2 kg. Overall, certificates were refused in 27 (1.6%) of 1668 babies and deferred (for less than a week) in 88 (5.3%). 1553 were issued well baby certificates on their first visit and 88 were cleared in the second examination within a week. The reasons for refusal were low birth weight (7), malformations like Down’s syndrome (1), microcephaly (1), ventricular septal defects (4), hypospadiasis (2), cleft lip and palate (1), rectovaginal fistula (1), undescended testes (3), chordee (1), dystrophic talipes equinovarus (2), icthyosis (2), and dislocated hip (2). The reasons for deferral were umbilical sepsis (14), conjunctivitis (12), pyoderma (32), jaundice (22), hypothermia (1), pyrexia (2), wide anterior fontanelle for thyroid test (2), umbilical bleeding (1) and candida rash (2). Two of the babies whose mothers had undergone PS on the strength of our well baby certificates presented to us later in the infancy with congestive cardiac failure due to ventricular septal defects.

Ideally, certifying baby’s well being for maternal PS should be as rigorous as the process of issuing a pediatrician’s certificate for adoption of infants that is followed in many countries [5]. These include, apart from a detailed clinical examination, a normal inborn error of metabolism (IEM) screening report, negative serology for HIV, hepatitis B and hepatitis C as well as a normal cardiac echocardiography and abdominal ultrasound in selected cases. The prevalence of hypothyroidism in a recent Indian neonatal screening program is 1 in 1700 and many inborn error of metabolisms have a prevalence rate of less than 1:2000 [6]. Targeted IEM screening would have been in order for those babies whose mothers had previous sib deaths in infancy. This certification process can be made more foolproof if cardiac imaging is done by pediatricians trained in basic echocardiography [7]. In an increasingly litigious environment that exists in India today, it is in our interest that an informed written consent is taken explaining the above facts to the parents.

Contributors: GK: conceptualized the study, collected data, analyzed and wrote the paper; TLR: contributed to critical appraisal of the data, revised the draft paper and both authors have approved the final version of the paper submitted. GK: will be the guarantor of the paper.

Funding: None; Competing interests: None stated.

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