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   Table of Contents - Current issue
Coverpage
October-December 2021
Volume 10 | Issue 4
Page Nos. 209-256

Online since Friday, September 24, 2021

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ORIGINAL ARTICLES  

Worse outcomes of early targeted ibuprofen treatment compared to expectant management of patent ductus arteriosus in extremely premature infants p. 209
Jana Termerova, Aleš Antonín Kuběna, Ráchel Paslerová, Karel Liška
DOI:10.4103/jcn.jcn_73_21  
Aims: The aim of the study is to evaluate two different patent ductus arteriosus (PDA) management approaches and their impact on neonatal mortality and/or bronchopulmonary dysplasia (BPD) and 2-year outcomes. Subjects and Methods: For two consecutive periods, data on early mortality and morbidity were obtained retrospectively, while long-term morbidity data in children born before 28 weeks of gestation were collected prospectively. In the early targeted treatment period (TTP), ibuprofen was early indicated on patients with high clinical risk and PDA diameter of more than two millimeters in the first 3 days. In the expectant treatment period (EXP), the expectant approach was used. Results: A total of 201 eligible infants were screened. Of these, 99 were managed in the TTP and 102 in the EXP. From 99 infants in the TTP, 24 patients were treated early and 17 later. From 102 infants in the EXP, 17 infants with symptomatic PDA were treated. Severe BPD and/or death were more frequent in the TTP as compared to EXP (28 and 16 infants, respectively; P = 0.007; odds ratio = 2.12; confidence interval = 1.06–4.23; c = 0.216). Moreover, infants who underwent the expectant approach did not need further cardiological interventions after discharge. Conclusions: Early targeted treatment of large PDAs was associated with an increased risk of severe BPD and/or death. We must pay attention to the side effects of early ibuprofen treatment because these may outweigh the benefits of ductus closure, especially in the vulnerable population of extremely preterm infants.
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Oxygen saturation nomogram by pulse oximetry in the first 24 h of life p. 216
Lina Hussain M. Habboub, Khalil Mohd Khalil Salameh, Sarfrazul Abedin, Anvar Paraparambil Vellamgot, Rajesh Pattu Valappil, Sajid Thyvilayil Salim, Naser Abulgasim Mohamed Elkabir
DOI:10.4103/jcn.jcn_41_21  
Aims: The aim of this study is to plot a nomogram of oxygen saturation (SpO2) in healthy newborns during the first 24 h of life and study the possible relationship to birth weight, mode of delivery, parity, and gender. Materials and Methods: This was a retrospective study done on a healthy newborn population. The primary purpose of the study was to see preductal saturation during the first 24 h of life and to plot a nomogram of the 5th and 95th percentile for the first 24 h of life. Results: From 5252 babies born in our hospital during 2016, 4139 (78.8%) were included in the study. Mean SpO2 was 98.82%, with a standard deviation of 1.21%. Saturation nomogram of 5th and 95th percentile of preductal saturation during the first 24 h of life was between 96% and 100%. There was no significant difference in gender and mode of delivery. Conclusion: Baseline arterial SpO2 was relatively stable during the first 24 h of life. Moreover, it was similar to the other studies reported earlier.
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The effect of antenatal betamethasone on prevention of neonatal respiratory distress syndrome before elective cesarean section at term p. 220
Farnaz Sahaf, Nahideh Afshar Zakariya
DOI:10.4103/jcn.jcn_53_21  
Background: Respiratory distress syndrome (RDS) is an important respiratory disease possibly caused by surfactant deficiency in infants and has a heavy financial burden on the country's health system. The purpose of the present study was to evaluate the relationship between RDS in neonates who were born by elective cesarean at term with and without corticosteroids. Materials and Methods: This randomized clinical trial study was performed on all mothers who delivered by elective cesarean section at Alzahra and Taleghani Hospital with a Pregnancy age of more than 37 weeks. After considering exclusion criteria, the patients were randomly divided into either betamethasone (IM injection of 12 mg daily for two doses) or the control group. The comparison of these two groups was in RDS, hospitalization in the neonatal ward, or admission to newborn intensive care unit (NICU). Results: One hundred and sixty patients participated in the study. Fifty percentage (n = 80) of them received betamethasone and 50% did not. Of all, 160 neonates, 73.8% in Group 1 and 82.5 of the Group 2 had a 1st-min Apgar score of 9.9–9.10. Significant differences were observed in neonatal Apgar score in two groups (P < 0.05). RDS was found in 11 (6.87%) neonates born from both groups. The hospitalization of neonatal in intensive care units and the time of hospitalization of infants in the betamethasone group were less than the control group and statistically significant (P < 0.05). No cases of necrotizing enterocolitis and neonatal sepsis were observed. Conclusion: The results of the present study represented that giving betamethasone to mothers with programmed elective cesarean at term beseem to have a beneficial effect on RDS, NICU admission, and hospitalization. More studies with a larger sample size including the effects of other steroids are recommended.
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Association of cord blood insulin-like growth factor-1 and leptin levels and changes in fetal weight gain in the third trimester of pregnancy p. 227
Maria Mexitalia, Agustini Utari, Rina Pratiwi, Julian Dewantiningrum
DOI:10.4103/jcn.jcn_32_21  
Context: Insulin-like growth factor-1 (IGF-1) and leptin are hormones impacting somatic growth regulation and organ development in early fetal life. Aims: The study aimed to investigate the correlation between IGF-1 and leptin levels with birth weight and fetal weight gain during pregnancy third trimester. Settings and Design: A cohort study included 52 newborns from Semarang, Indonesia. Subjects and Methods: Serum IGF-1 and leptin were taken from the umbilical cord, and the estimated fetal weight in the third trimester was measured by ultrasound. Anthropometric data were plotted to the World Health Organization Fetal Growth Chart 2017. We divided three categories, i.e., weight gain faltering, if the infant decreased of two major percentiles (G1), normal weight gain (G2), and accelerated weight gain, whose increased more than two major percentiles (G3). Statistical Analysis Used: Fetal growth and other parameters were analyzed using Pearson's or Spearman's rho correlation. The comparison of IGF-1 and leptin levels among G1, G2, and G3 was analyzed by one-way ANOVA, least significant difference post hoc test, Kruskal–Wallis, and Mann–Whitney tests. Results: The mean IGF-1 level in G1 was 82.9 (25.9) ng/mL, G2 was 86.2 (28.9), and G3 was 134.8 (33.9), and there were significant differences between G1–G3 and G2–G3. Meanwhile, the levels of leptin among groups were not different. Birth weight was correlated with the level of IGF-1 (r = 0.456, P = 0.001) and leptin (r = 0.39, P = 0.004), and maternal body mass index was correlated with cord blood leptin. Conclusions: This study indicated that a higher IGF-1 and leptin cord blood level is correlated with larger birth weight.
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Neonatal hospital readmissions: Rate and associated causes p. 233
Manal Bawazeer, Raghad K Alsalamah, Dalal Raed Almazrooa, Shaden Khalaf Alanazi, Nada Saif Alsaif, Reem Saud Alsubayyil, Alaa Althubaiti, Aly Farouk Mahmoud
DOI:10.4103/jcn.jcn_64_21  
Background: The neonatal period is important for establishing a strong healthy foundation and is also associated with high mortality and morbidity rates. This study aimed to determine the rate of neonatal hospital readmission and to identify the associations between the neonatal age at readmission and the length of stay (LOS) during readmission, the outcome of readmission, and the associated maternal and neonatal factors. Methods: A cross-sectional study was performed by reviewing the medical records of 570 neonates who were born in and readmitted to King Abdulaziz Medical City, Riyadh, Saudi Arabia, through emergency and outpatient clinics from January 2016 to December 2018. Results: The neonatal readmission rate during the study period was 2.11%. The most common causes for readmission were respiratory diseases (24.9%), jaundice (22.1%), and fever to rule out sepsis (16.7%). Sex and breastfeeding were significantly associated with neonatal age at readmission (P = 0.025 and P = 0.017, respectively), but only breastfeeding was a significant predictor of age at readmission. Males were more likely to be admitted at the age >7 days, and exclusively formula-fed neonates were approximately three times the risk compared to exclusively breastfed neonates to be admitted at age >7 days (adjusted risk ratio 2.9, 95% confidence interval). Neonates readmitted at ages >7 days had double the LOS as those readmitted at ages ≤7 days (P < 0.001). The outcomes (discharge or pediatric intensive care unit admission) had no significant association with neonatal age at readmission. Conclusion: The readmission rate was 2.11% and was most commonly due to respiratory diseases. Age at readmission was significantly associated with sex, breastfeeding, and LOS. Assessment of the factors associated with readmission before discharge may reduce the rate of readmission.
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CASE REPORTS Top

Unusual presentation of cow's milk protein allergy in a neonate p. 239
Sudhakar Palanisamy, Ramesh Srinivasan, Thirumal Perumal
DOI:10.4103/jcn.jcn_55_21  
Cow's milk protein allergy is the most common food protein allergy in children. We report a neonate on breast feeds and formula feeds presenting on day 9 of life with blood in stools, anemia, shock, respiratory failure with multiorgan dysfunction, and recovered with intensive care. Colonoscopy and biopsy confirmed the diagnosis as allergic colitis. Neonate improved with cow's milk protein-eliminated diet. Food protein allergy can present with protean signs and symptoms; high index of suspicion is needed for the prompt early diagnosis.
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Twin pregnancy with fetus papyraceus – vanishing twin p. 242
Bibi Quratulain, Haleema Khalid, Vikram Kumar, Azeem Khan, Syed Rehan Ali
DOI:10.4103/jcn.jcn_7_21  
Fetus papyraceus is a mummified fetus, which is related to multiple gestations.[1] In this rare condition, one fetus expires and becomes compressed between the uterine wall and membrane of the other fetus. Surviving infant is at high risk of developing complications secondary to the release of thrombi and other factors from the dead fetus; including prematurity, intrauterine growth retardation, gastroschisis, intestinal atresia, aplasia cutis, congenital heart abnormalities, and even death. We have reported consecutive case series in dichorionic diamniotic twins and monochorionic diamniotic twins successively. In our case reports, both pregnancies resulted in preterm deliveries and were managed successfully without any complications.
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A gershoni-baruch syndrome variant or a new association p. 245
Mustafa Kaplanoglu, Muhammer Ozgur Cevik, Mehmet Bulbul, Dilek Kaya Kaplanoğlu, Haydar Bagıs
DOI:10.4103/jcn.jcn_71_21  
A pregnant woman with no previous routine pregnancy follow-up referred to our obstetrics clinic. Ultrasonography revealed the presence of a fetal heartbeat 26 weeks and 4 days old. Polyhydramnios, omphalocele, a diaphragmatic hernia, left ventricular hypoplasia, an occipital bone defect, a fetal head in severe retroflexion, and exaggerated cervicothoracic lordosis were detected in the fetus. After obtaining parental consent, the board decided to terminate the pregnancy. An examination performed after the termination revealed that the fetus was female and weighed 780 g. The first phalanx of the left thumb was hypoplastic. An X-ray examination showed coat hanger–shaped costal fusions and cranial structures consistent with iniencephaly. Fetus karyotyping revealed a normal 46, XX female karyotype. We speculate that this case represents a variant of Gershoni-Baruch syndrome.
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An unusual case of multisystem inflammatory syndrome in children in newborn due to covid-19 – presenting with stage 11 b necrotizing enterocolitis p. 248
Neha Thakur, Narendra Rai
DOI:10.4103/jcn.jcn_78_21  
Neonatal enterocolitis is the most common gastrointestinal emergency reported in preterm babies. The most common infective organism involved in the pathogenesis includes bacteria such as Escherichia coli and Klebsiella. Until now, severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) as a causative agent of necrotizing enterocolitis (NEC) has not been reported. We report a unique case of multisystem inflammatory syndrome in children (MIS-C) and adolescents in newborn who presented with NEC. A 34-week-old male baby born to COVID-19-positive mother by normal vaginal delivery was admitted since birth in the special care newborn unit due to respiratory distress. Baby was COVID positive within 24 h of birth. He developed NEC at day 8 of life. He developed signs and symptoms of MIS-C. He responded to intravenous immunoglobulin and was discharged on day 16 of life. This is the first case report of MIS-C in newborn in India. Baby had NEC due to SARS-CoV2 which has not been reported until now. This case highlights the possibility of surge in newborn MIS-C postsecond wave of COVID-19 pandemic in India.
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Severe feeding intolerance in extremely preterm neonates successfully treated with human milk derived human milk fortifier: A case series p. 251
Patricia Lofiego, Veronica Samedi, Stientje Esther Rai
DOI:10.4103/jcn.jcn_210_20  
Feeding intolerance in preterm infants can be severe and can lead to clinical suspicion and diagnostic testing for other acute abdominal surgical pathologies and hence delay achievement of full enteral feeds. We present two cases of extremely premature infants who presented with recurrent severe feeding intolerance following fortification of human milk with a bovine human milk fortifier (HMF). Subsequently, both infants had an extensive workup for their symptoms. Each infant was eventually tried on a human HMF which led to the complete resolution of symptoms in each case. This case series highlights that clinicians should consider the use of human HMF for preterm infants with severe feeding intolerance secondary to the use of bovine HMF.
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LETTER TO EDITOR Top

Considerations for intravenous immunoglobulin infusion in neonates p. 255
Majid Malaki
DOI:10.4103/jcn.jcn_95_21  
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