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   Table of Contents - Current issue
Coverpage
January-March 2023
Volume 12 | Issue 1
Page Nos. 1-46

Online since Tuesday, January 3, 2023

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ORIGINAL ARTICLES  

Role of modified sick neonatal score in predicting the neonatal mortality at limited-resource setting of central India p. 1
Rajkumar Motiram Meshram, Roshan A Nimsarkar, Ayushi P Nautiyal
DOI:10.4103/jcn.jcn_83_22  
Background: The targets of Sustainable Development Goals cannot be achieved without reducing mortality of inborn as well as outborn neonates. Objective: The objective was to predict the mortality of neonates by applying Modified Sick Neonatal Score (MSNS). Material and Methods: Parameters of MSNS scoring system were applied to 450 neonates at the time of admission and followed up prospectively till discharge or death. The score and individual parameters were correlated with outcome. A receiver operating curve was plotted to determine the cutoff value for score to predict the mortality. Results: The common clinical diagnoses were respiratory distress (38%), sepsis (26%), and jaundice (14.44%). Sixty-two percent neonates were born at term and 38% were preterm while 55.56% neonates were low birth weight and 44.4% were weighted more than 2500 gms. Neonates who died were older at the time of admission, and duration of hospital stay was shorter compared to alive neonates (P < 0.001) with a mortality rate of 23.11%. The total MSNS for neonates who died was statistically significantly low, (mean ± standard deviation) 7.93 ± 2.70, compared to alive neonates, 12.02 ± 1.84 (P < 0.0001). With optimum cutoff score of ≤10, the sensitivity was 79.80% and the specificity was 82.37% while the positive predictive value and negative predictive value was 57.64% and 93.14% respectively with the area under curve was 0.89 (odds ratio-18.46, 95% confidence interval 10.3-33.64, P < 0.0001). Conclusion: The MSNS of ≤10 has a better sensitivity and specificity in predicting neonatal mortality and is easy to use with minimal resources to both preterm and term neonates.
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Retrospective validation of the Alexandria retinopathy of prematurity model in preterm infants in Saudi Arabia p. 7
Lina H Raffa, Omar M Akeely, Saleh A Alariefy, Faisal A Alharbi, Moussa A Alkhateeb, Mohammad A Khan
DOI:10.4103/jcn.jcn_87_22  
Background: In developing countries, data on the applicability of existing models to predict retinopathy of prematurity (ROP) are scarce. The study aimed to validate the Alexandria ROP (Alex-ROP) and high-grade Alex-ROP (Hg Alex-ROP) models retrospectively to identify treatable ROP in a cohort of preterm infants in Saudi Arabia. Materials and Methods: We reviewed and included the records of 281 infants born prematurely in 2015–2021. We recorded the infants' demographics, gestational age at birth (GA), birth weight (BW), and serial weight measurements (day 7, 14, 21, and 28). We determined whether the included met the Alex-ROP and Hg Alex-ROP detection criteria for treatable or any-stage ROP and calculated the specificity, sensitivity, negative and positive predictive values, and accuracy. Results: The median BW and GA was 1095 g (range: 426–1920 g) and 29 weeks (range: 23–36 weeks), respectively. ROP developed in 112 infants, of which 30 cases were treatable. The Alex-ROP sensitivity for correctly predicting any-stage ROP and treatable ROP was 77.7% and 80.0%, respectively, and its specificity for predicting any-stage ROP and treatable ROP was 49.7% and 41%, respectively. The Hg Alex-ROP had 36.6% and 50.0% sensitivity for detecting any-stage ROP and treatable ROP, respectively, and its specificity for detecting any-stage ROP and treatable ROP was 83.4% and 78.5%, respectively. Conclusion: Previously published accuracy parameters were not reproducible in this cohort and a significant number of children requiring treatment would have been missed if the Alex-ROP or Hg Alex-ROP were applied.
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Impact of a short period of prone versus supine nursing in preterm neonates less than 32 weeks on weight gain: A prospective observational study p. 13
HA Venkatesh, Pankaj Kumar Mohanty
DOI:10.4103/jcn.jcn_89_22  
Background: Postnatal growth depends on multiple factors such as gestational age, associated morbidities, and the nutrition and varies from one newborn to another. Preterm babies in neonatal intensive care unit are very much susceptible to growth faltering even after adequate nutrition and supplements. The positioning of preterm infants in neonatal intensive care has an impact on their survival and neurological outcome. Prone positioning is known to improve oxygenation, minute ventilation, and functional residual capacity. Quiet undisturbed sleep in preterms has helped them to conserve energy for growth. Objective: To determine the effect of prone versus supine position on weight gain in infants less than 32 weeks of gestational age. Design: Prospective observational study. Participants: Twenty-two neonates were recruited. Results: On day 1, in the prone position, 63.6% gained weight vs. 59.1% in the supine position (P = 0.425). On day 2, in prone, 72.7% has gained vs. 63.6% in supine (P = 0.359). On day 3, in prone, 68.2% gained weight vs. 63.6% in supine position (P = 0.426). Conclusion: Nursing a baby in a prone position has demonstrated weight gain over nursing in a supine position though not statistically significant.
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Novel cord blood and urinary phytoestrogens levels in male neonates with normal external genitalia p. 16
Che Che Ahmad Muttaqin Salim, Azrina Shahrizat Khutubul Zaman, Hana Azhari, Suzana Makpol, Shareena Ishak, Zarina Abdul Latiff, Dayang Anita Abdul Aziz
DOI:10.4103/jcn.jcn_95_22  
Objective: This was a new prospective study to determine the association between phytoestrogen levels in the cord blood and urine with normal and abnormal external genitalia in male newborns. Materials and Methods: One hundred and fifty-one term male newborns were enrolled. Cord blood and urine and medical photos of their external genitalia were obtained. Prematurity and multiple congenital anomalies or syndromic characteristics were excluded. Serum and urine levels of phytoestrogens (daidzein and genistein) were calculated using liquid chromatography/mass spectrometry. The normality of the appearance of the external genitalia of the males was determined by a consensus review by experts. Results: A total of 146 cord blood and 96 newborn urine samples were obtained; only two newborns had abnormal external genitalia. In the 144 babies with normal external genitalia, mean levels were determined to be as follows; serum daidzein 10.82 ng/ml, serum genistein 42.17 ng/ml, urine daidzein 69.91 ng/ml, and urine genistein 126.09 ng/ml. In the two babies with abnormal external genitalia, mean levels of each of the measured phytoestrogen were lower; however, there was no statistical significance between the two groups (P > 0.05). Conclusions: We successfully determined and developed a novel database on the levels of measurable phytoestrogens in serum and urine from male newborns with normal external genitalia. In the normal group, a higher concentration of serum and urinary phytoestrogens was correlated with the extension of the scrotal pigmentation above and proximal to the base of the penis. These data are useful to better understand the role of phytoestrogens in the development of male genitalia and for future research on newborns with abnormal external genitalia.
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Knowledge, attitudes, and perceptions of health-care workers about human milk banking in Singapore p. 22
Natalie Yi Ting Koh, Chua Mei Chien, Seyed Ehsan Saffari, Rajadurai Victor Samuel
DOI:10.4103/jcn.jcn_99_22  
Background: The use of human milk provides substantial short- and long-term benefits. With the establishment of the first donor human milk bank in Singapore, high-risk preterm and critically ill infants whose mothers have an inadequate milk supply can have access to pasteurized donor human milk. Materials and Methods: A self-administered anonymous questionnaire was conducted among doctors and nurses working in the special care unit and neonatal intensive care unit of KK Women's and Children's Hospital. The questionnaire was divided into three main sections, namely, demographics, knowledge assessment, and opinion. The aims of the survey were to assess the knowledge, attitudes, and perceptions of health-care workers on breast milk donation and milk bank, and to identify any differing perceptions among different racial and ethnic groups. Results: A total of 38 doctors and 140 nurses from various racial and religious backgrounds participated in this survey. More than 50% of respondents know the benefits of breast milk over formula milk; however, knowledge of the milk donation process and the effect of pasteurization on donated breast milk can be improved on. In the opinion section, 78.7% of survey respondents were supportive of the human milk bank. Sixty-eight (38.2%) respondents felt that recipients should receive milk from donors of the same race and ethnicity, whereas 56 (31.5%) disagreed and 53 (30%) were neutral. Conclusion: Donor human milk banking is well received and supported by health-care workers. Knowledge of milk donation, screening, pasteurization, and storage can be improved on. Further evaluation is required to determine the underlying concerns that different ethnic groups may have.
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REVIEW ARTICLE Top

Risk factors for developing pressure ulcers in neonates and novel ideas for developing neonatal antipressure ulcers solutions p. 27
Adarsha Narayan Mallick, Meghana Bhandari, Bijit Basumatary, Shivani Gupta, Kamaldeep Arora, Ashish Kumar Sahani
DOI:10.4103/jcn.jcn_84_22  
Pressure Ulcers (PU) are highly prevalent iatrogenic occurrences among hospitalized adults and neonatal patients. These decubitus ulcers are progressive in nature and are mostly seen in patients that are immobile for prolonged periods, either by virtue of being bedridden or chair bound. The continual pressure on the skin surfaces disrupts blood supply from the subcutaneous regions and leads to the development of PUs. Several treatment and prevention protocols have been defined for adult patients. However, there is a dearth of literature available for critically ill pediatrics or neonates and often adult practices are used to treat pressure injuries in them. There is a significant physiological and anatomical difference between the skin of newborns and adults or even older children. The dermal layer of a preterm neonate is <60% of the thickness of an adult and has a much higher susceptibility for developing pressure ulcers. The immune system of premature infants lacks an efficient antigenic specificity, diversity or immunologic memory, making them prone to lethal infections. The study was performed using search engines like PubMed, EMBASE and Google Scholar, with the focus of the search strategy being the breadth rather than the details of the study. Selected keywords were used alone or in combination with each other to retrieve relevant articles. This review focuses on the risk of developing PUs in neonates, explains the currently available solutions of PU prevention in adults, emphasizes the need for neonatal specific solutions and presents novel ideas for developing antisore bed for neonates.
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CASE REPORTS Top

An unusual course of pneumonia in a term neonate with suspected multisystem inflammatory syndrome secondary to severe acute respiratory syndrome coronavirus 2 infection p. 34
Ashish Ragireddy, Ratan Kumar Das, Bhabagrahi Mallick, Debasish Nanda
DOI:10.4103/jcn.jcn_96_22  
Neonatal multisystem inflammatory syndrome secondary to severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection is a relatively new entity with only a few cases being reported in the literature. We report the case of a 25-day-old term neonate who presented with severe respiratory distress, required respiratory support, and systemic antibiotics at admission. Two-dimensional echocardiography revealed the features of pulmonary arterial hypertension. Computed tomography scan of the chest was suggestive of features of organizing pneumonia. In view of multisystem involvement, raised inflammatory markers, and high anti-SARS-CoV2 antibody, intravenous immunoglobulin was administered, following which the baby improved and weaned off to room air and eventually discharged.
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Invasive fungal infection presenting as early-onset neonatal sepsis: A case report from Northern Nigeria p. 38
Usman Abiola Sanni, Taslim Olatunde Lawal, Aliyu Mamman Na'uzo, Lamidi Isah Audu
DOI:10.4103/jcn.jcn_98_22  
In neonatal intensive units, invasive fungal infection remains a significant cause of morbidity and mortality, although an unusual cause of early-onset neonatal sepsis. In this report, we present a case of Candida parapsilosis infection presenting as early-onset bacterial sepsis. The patient was a 6-day-old male preterm neonate (estimated gestational age of 32 weeks) admitted to our neonatal unit on account of fever, refusal to feed, and vomiting which started during the first 24 h of life. Initially, he was managed for early-onset neonatal sepsis. However, his clinical state deteriorated within the 1st week of admission and his blood culture yielded C. parapsilosis. His clinical condition subsequently improved significantly following the administration of intravenous amphotericin. He spent a total of 25 days on admission before discharge. Our report reiterates the need to raise the index of suspicion for invasive fungal infection in cases of early-onset neonatal sepsis with poor response to appropriate and potent antibiotics.
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Down syndrome with umbilical cord hematoma: Case report and review of literature p. 42
Ammara Naeem, Sajjad Rahman, Muhammad Hassan Abdulghani, Yahya Almalki
DOI:10.4103/jcn.jcn_103_22  
Umbilical cord hematoma (UCH) is the extravasation of blood in the umbilical cord. The condition is rare and asymptomatic but very important to recognize because it can potentially compromise fetal blood flow. Hence, UCH increases the chances of fetal mortality and morbidity. We are presenting the case report of a large but asymptomatic UCH in a newborn baby with Down syndrome. To the best of our knowledge, the association between Down syndrome and UCH has not been reported in medical literature till the time of writing of this manuscript.
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