Prematurity comprises a series of disadvantages that render adaptation to extra-uterine life extremely difficult. Among these, establishing an adult type of cardiorespiratory circulation including closing of the fetal shunts, resorption of the fluid, which fills the lungs and achieving functional residual capacity, to change to oxygen enriched milieu, and keeping an adequate body temperature are altogether challenges that without the aid of heavily skilled caregivers in the delivery room (DR) are practically insurmountable for the very preterm infant. In recent years, there is an unequivocal tendency toward gentle management of preterm babies in the DR to avoid long-term consequences. Caregivers' aim should be to achieve a satisfactory stabilization of the patient without causing harm to his/her feeble organs during the so-called first golden minutes. The last International Liaison Committee on Resuscitation Guidelines were published in 2010. Since then, new information has rendered available. The aim of this review is to provide the reader with updated information regarding newly performed interventions in the DR hoping that it will be useful for their everyday clinical practice.

Context: Platelet indices are useful markers of platelet maturity and function and can be used for the early diagnosis of thromboembolic disorders. Prematurity, birth asphyxia (BA) and small for gestational age (SGA) babies have been associated with increased risk of hemostatic abnormalities. Aims: The aim was to study the platelet indices in prematuriy, SGA, and BA newborns. Settings and Design: The type of this study is Prospective study. Materials and Methods: Blood samples from 253 newborns were collected in K2EDTA (Becton Dickenson, USA) tubes within 24 h of birth. The following parameters were studied - platelet count, mean platelet volume (MPV), plateletcrit (PCT) and platelet distribution width (PDW). Data regarding the neonatal physiological status with respect to prematurity, gestational age and BA were collected. Statistical Analysis Used: The statistical analysis was performed on the entire sample used was mean, standard deviation and one-way ANOVA. P <0.05 was considered as significant. Results: The average platelet count in preterm, SGA, and BA newborn was significantly lower than the average platelet count in controls. MPV averaged 8.29 fL, 8.16 fL, and 8.35 fL in preterm, SGA and BA neonate, respectively and was significantly increased. PCT was 0.18% in preterm, SGA and in BA. Though, the difference was not statistically significant. PDW was significantly increased in preterm, SGA, and BA newborns when compared with controls. Conclusions: MPV, PDW was significantly increased in SGA, premature and BA newborns, which may be due to platelet activation. Platelet indices may provide to be a useful marker of thromboembolic status in newborns.

Objective: This study aimed to compare the cost and effectiveness of Kangaroo mother care (KMC) and conventional methods of care in low birth weight (LBW) neonates. Materials and Methods: A retrospective economic evaluation conducted in Al-Zahra Teaching Maternity Hospital of Tabriz, Iran by participating 45 LBW and preterm neonate in each therapeutic groups (90 neonates). Convenience sampling used to select participants from KMC and conventional care method (CCM) (incubator) groups in 2010-2011. Baseline characteristics, therapeutic interventions, resources utilization data and clinical events during the initial hospitalization and at 2-month follow-up were collected according a detailed case report forms. Data are described as mean (standard deviation) and no (percentage) and were compared with Student's t-test, χ² and Fisher exact test between groups. P ≤ 0.05 were considered to be statistically significant. Data were analyzed using the SPSS-16 statistical package. Result: The mean birth weight (BW) of the patients in KMC group was 1240.89 (5.98) g and in CCM was 1133.78 (139.06) g, hence differences in BW was statistically significant ( P < 0.001). Greatest cause of problem in groups was icter and after that preterm birth and House Dust Mite (HDM) with icter were the most frequent problem between neonates. In 2 months follow-up period, 3.7% of infants cared with KMC and conventional methods died respectively ( P = 0.078). Daily weight gain was 12.28 g in KMC group and 9.65 g in conventional group ( P = 0.011). The mean cost of hospitalization per individual infant for KMC was 3539.47$, whereas for Conventional group was 2907.27$. Conclusion: KMC promoted weight gain in LBW infants better than conventional care. Although KMC's unit cost is a little higher than Conventional method, but comparing its positive outcomes on breastfeeding's and mortality it can be considered as cost effective method.

Objective: The aim was to assess the incidence, presenting features, and complications of breastfeeding associated hypernatremic dehydration among hospitalized neonates. Materials and Methods: A retrospective study over a period of 18 months to identify term and near term (≥35 weeks of gestation) breastfed neonates, who were admitted with serum sodium concentration of ≥150 mEq/l and no apparent explanation for their hypernatremia other than inadequate breastmilk intake. Results: The incidence of breastfeeding associated hypernatremic dehydration among 2100 term and near term neonates was 1.38%. The median serum sodium at presentation was 164 mEq/l (range: 151-191 mEq/l). The mean weight loss in these patients was 10.16% ±6.6%. The reasons for seeking medical attention were refusal of feeds (72.41%), lethargy (68.96%), decreased urine output (44.82%), jaundice (27.58%) and fever (24.13%). Five patients (17.24%) had seizures and three (10.34%) had coagulopathy. Other complications included hypoglycemia, hypocalcemia, acute kidney injury (AKI) (37.93%) and intraventricular hemorrhage. The mean serum creatinine was 1.82 ± 2.5 mg/dl (range: 0.19-9.6). A statistically significant association was seen between serum sodium concentration at presentation and AKI. It was also found that those patients who had AKI had a higher weight loss and had presented later to the hospital than those without AKI. One patient died within 12 h of admission. This child had disseminated intravascular coagulopathy, AKI, and hypoglycemia. Conclusions: Breastfeeding associated hypernatremic dehydration is a serious condition with many serious complications and even results in death if detected late. Health care providers have increasing responsibilities of promoting proper breastfeeding techniques and taking measures for early diagnosis and treatment of this problem.

Umbilical vein catheters (UVC) are widely used in neonatal medicine. Serious complications from UVC placement are uncommon but do exist, including infection, thrombosis, arrhythmias, and hemorrhage. Although rare, hepatic complications, in particular, have been associated with significant morbidity and mortality. Correct positioning of the catheter prior to starting infusion of hyperosmolar solutions and early recognition of UVC-related complications are crucial in minimizing iatrogenic injury. We report the case of a neonate who was found at 10 days of age to have large pleural and peritoneal effusions and a massive fluid collection in the liver due to malposition of a UVC.

Isolated right ventricular hypertrophy (RVH) is a rare form of hypertrophic cardiomyopathy and premature closure of the patent ductus arteriosus in utero is a probable etiologic factor. We reported transient isolated RVH in three neonates and ventricular hypertrophy resolved within 8-10 weeks period without any specific therapy in all cases.

A 2-month-old female infant presented with subacute intestinal obstruction of 1½ month duration. Investigations revealed a cystic intra-abdominal lesion. On exploration, a large multicystic mass was noted in the ileal mesentery with induration and inflammatory interbowel adhesions. It had resulted in bowel volvulus. It was completely excised along with the involved bowel. Histopathologic examination diagnosed the tumor to be a cystic lymphangioma. It is the youngest patient with mesenteric cystic lymphangioma ever reported in the literature.

A full-term female baby presented at birth with a swollen left labia and atrophic lesions affecting the sacrum and left buttocks. A diagnosis of focal dermal hypoplasia was made from the histopathology of the labial lesion. Patient presented at the age of 2 years with urinary incontinence and constipation and imaging of the neuro-spinal axis showed lipomyelomeningocele with tethered cord.

Sepsis in neonatal intensive care units throws formidable challenges in homoeostasis, be in metabolic, nutritional or hematological. Newborn sepsis results in considerable morbidity and mortality among neonates. Due to inability on part of the neonate to develop adequate inflammatory response to localize the infection they commonly develop disseminated systemic infection, pneumonia and/or meningitis. We have described 4 cases of neonatal sepsis with localization at unusual sites. Our first case presented as a Fournier's gangrene, an infective necrotizing fasciitis of the perineal, genital or perianal regions. We also present a very rare entity of acute digital gangrene in a newborn baby as a sole manifestation of neonatal septicemia.

Aplasia cutis congenita is defined as congenital localized absence of skin. This absence of skin most commonly affects the scalp, but any location of the body surface can be affected. Most patients with aplasia cutis congenita have no other anomalies. Aplasia cutis involving trunk and extremities in association with Epidermolysis bullosa is extremely rare. We describe a neonate with this rare disease having multiple other anomalies.

A sixteen days old newborn was admitted with exfoliating erythematous lesions over the trunk, face, back and extremities for two days. A diagnosis of Staphylococcal Scalded Skin Syndrome (SSSS) also known as Ritter disease was made clinically. The child responded to Injection amoxycillin-clavulinic acid (Augmentin) and topical fusidic acid. Lesions gradually resolved over 72 hours and child was discharged after ten days of hospitalization. SSSS represents a rare dermatology emergency in neonate which if untreated can be life threatening.

Anomalies during growth and development do occur. Cyclopia is an unusual anomaly in which the anterior brain and the midline mesodermal structures develop anomalously. Cyclopia is seen in severe form of holopresencephaly with abnormal position of nose. This case report presents with a rare case of synopthalmia with proboscis.