Objectives: The objective was to review the available evidence comparing oral paracetamol versus oral ibuprofen for the closure of patent ductus arteriosus (PDA) in preterm infants. Methods: We searched all the major databases (Medline via Ovid and PubMed) till April 2014. Randomized trials were included. Primary outcome measure was the primary closure rate of PDA after the first course of the drug. Review manager (version 5.2) was used for all the analyses. GRADE criteria were used to rate the quality of evidence. Results: Of 38 full-text articles assessed for eligibility, two trials (n = 240) were included in the final analysis. There was no significant difference between the two groups except for the following parameters, which favored the paracetamol group: Shorter mean days needed for PDA closure (mean difference, −0.49 [95% confidence interval [CI], −0.54 to − 0.44], P < 0.00001), a lower risk of gastro-intestinal bleeding (odds ratio [OR], 0.25 [95% CI, 0.06-1.02], P = 0.05) as well as hyperbilirubinemia (OR, 0.46 (95% CI, 0.23-0.95), P = 0.04). The GRADE evidence was found to be of "low quality." Conclusions: There is not enough evidence to judge about the efficacy or safety of ibuprofen versus paracetamol for treating the PDA in preterm infants. Randomized trials with low risk of bias and adequate sample size including different subgroups of preterm infants are needed before any firm recommendation can be made.

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Background: To study the prevalence and pattern of major congenital malformations of the gastrointestinal tract among the newborns in one of the English Caribbean countries. Materials and Methods: This study includes all newborns with major congenital malformations of the gastrointestinal tract in Barbados from 1993 to 2012. The birth register and the neonatal admission register at the Queen Elizabeth Hospital, where over 90% of all deliveries in this country take place, were the main source of data. Results: The overall prevalence of major congenital malformations of the digestive system in newborns was 7.28 per 10,000 live births. There were 15 (32.6%) cases of congenital absence, atresia, and stenosis of the small intestine giving a prevalence rate of 2.37/10,000 live births and 13 cases (28.3%) of esophageal atresia giving a prevalence rate of 2.06/10,000 live births. The overall prevalence of major congenital malformations of the gastrointestinal tract increased from 4.46/10,000 live births during 1993 - 1997 to 10.50/10,000 live births during 2008 - 2012. The prevalence of the absence, atresia or stenosis of the small intestine increased from 0.64/10,000 live births during 1993 - 1997 to 5.25/10,000 live births during 2008 - 2012. Overall 1.1% of all neonatal deaths were attributed to major malformations of the digestive system. Conclusions: Congenital absence, atresia, and stenosis of the small intestine were the most common malformations, with increasing prevalence over the study period. Tracheoesophageal fistula was the second most prevalent malformation and it had a high case fatality rate.

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Clinical presentation of scabies in neonates is unlike that of adults and older children, resulting in missed or delayed diagnosis. The eruptions are generalized, including involvement of the head, neck, face, palms, and soles, with an early tendency to pustule formation. Other lesions include papules, vesicles, and burrows, which may be obliterated by secondary lesions. A confusing clinical picture resulted in a delay in diagnosing scabies in a 25 day old neonate who was successfully treated with permethrin 5% cream.

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Treacher Collins syndrome is a rare autosomal dominant disorder resulting from malformations of the first and second pharyngeal arches, thus causing marked facial dysmorphism. We herein describe the characteristic facial features of a day old Indian newborn that presented to our outpatient clinic with severe mandibulo-facial dysostosis and diagnosed with Treacher Collins syndrome, that was thought to be of a sporadic origin. This case serves best to promote awareness of this rare entity.

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Objectives: The aim was to determine the selected maternal and fetal risk factor for adverse short-term outcomes in babies with birth asphyxia. Materials and Methods: This was a prospective observational study, including all birth asphyxiated babies born between January 1, 2013 and December 1, 2013 who fulfill the inclusion criteria. Detailed maternal information and progress of babies were noted regularly until the time of death or discharge. Cord blood was collected after delivery for measurement of nucleated red blood cell/100 white blood cells (NRBC/100 WBC) for Katihar Medical College born babies only. Babies were categorized into different stages of hypoxic ischemic encephalopathy according to Sarnat and Sarnat staging. On the basis of outcome, they were divided into two groups, group one who survived and was discharged with stable sign and group two who died. Effects of risk factors on both groups were compared and result were expressed as (P < 0.05 was taken significant), using the Chi-square test. Results : During the study period, out of 5481 neonatal admissions 600 babies (10.94%) were asphyxiated. Of the total asphyxiated babies 60 babies (10%) expired. Maternal factors significantly associated with mortality included antenatal check-up, premature rupture of membranes, meconium stained liquor, parity and place of delivery. Birth injury, hypotension, hypothermia, hypoglycemia, hypoxemia, cord accidents and increased NRBC/100 WBC count were the baby factors. Conclusion : Early identification of high risk mothers and timely referral to tertiary care center can reduce the mortality. Furthermore, there is need to carefully evaluate and monitor the babies with low APGAR scores immediately after birth.

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Disseminated neonatal herpes simplex virus (HSV) infection represents the most severe form of neonatal herpes, and is associated with high morbidity and mortality. Early recognition of disseminated HSV disease in the neonate can be difficult, since the clinical presentation often mimics bacterial sepsis with absence of cutaneous vesicles. We describe a 5-day-old male infant with disseminated HSV-2 disease, who initially presented with pneumonia and progressive respiratory failure requiring extracorporeal membrane oxygenation. Laboratory data were significant for leukopenia, thrombocytopenia and disseminated intravascular coagulation. Chest radiograph showed diffuse pulmonary infiltrates. Tracheal aspirate cultures grew HSV-2. The patient was treated with a 3 weeks course of intravenous acyclovir. The key feature in this case is to recognize that HSV can present in neonates with rapidly progressive pneumonitis and sepsis syndrome.

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Mastitis, which is infection of breast tissue, is a rare infection apart from breast feeding period; it is a relatively frequent case at neonatal period. Breast tissue reserves inclination to infections due to early infancy immaturity. Conventionally, as breast tissue, which is hypertrophic and affected by maternal hormones at pregnancy, is squeezed, massaged, or a coin is fastened on it in our country, its being infected due to skin breakdown plays a significant role at neonatal mastitis. In our study, we would like to present a 14-day-old case where mastitis abscess developed after massage on right breast.

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Background: There are many regional variations in the rate and predisposing factors of hearing loss and these could vary over time. The aim of this study was to describe the characteristics and possible etiology of severe to profound bilateral sensorineural hearing loss (SNHL) among Iranian children who were a candidate for cochlear implantation. Materials and Methods: We designed a cross-sectional study to evaluate children with profound SNHL referred to Baqiyatallah Cochlear Implantation Center from all over the country of Iran. Among 471 referred children, 310 cases with diagnosis of bilateral profound SNHL ranging in age from 6 months to 4 years between 2005 and 2011 were enrolled. Results: The mean (±standard deviation) age of individuals and the mean age of diagnosis was 3.50 ± 1.23 and 164 (53%) were male. Considerable risk factors for SNHL in 218 patients (70.3%) were obvious. A total of 103 (33%) children had one or more close relatives with deafness in their family, so they were considered to be hereditary deafness cases, followed by prematurity 32 (10.3%), syndromic etiology 25 (8%), maternal toxoplasmosis, rubella, cytomegalovirus, herpes infection 12 (3.9%), severe hyperbilirubinemia 9 (3%), eruptive infections 9 (3%), meningitis 8 (2.6%), asphyxia 6 (2%), and oto-toxic drug 6 (2%). Our data showed the prevalence of 65% consanguineous marriage among parents of deaf children. Conclusion: This is the first attempt to describe the risk factor of SNHL in Iran. Among the identifiable causes of severe to profound SNHL in Iranian population, the consanguineous marriage was the most common risk factor. Further analytical studies focusing on the relation between etiology and demographic factors were recommended.

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Axial mesodermal dysplasia spectrum (AMDS) is a developmental defect characterized by features of both caudal regression syndrome and oculo-auriculo-vertebral spectrum. This spectrum of anomalies is probably due to a generalized alteration in mesodermal cell migration during the primitive streak period. We report a female newborn with features of the axial mesodermal dysplasia complex presenting with ambiguous genitalia and hematometrocolpos requiring surgical intervention. The present case highlights the clinical spectrum with rare genital features (ambiguous genitalia and hematometrocolpos) in a patient with AMDS from India. To the best of our knowledge, this is the first case of AMDS with such an unusual presentation.

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Neonatal hemochromatosis, (NH) is a rare congenital disorder of liver associated with a poor prognosis and characterized by extrahepatic siderosis. Often rarely discusses in this disorder is the presence of siderosis in the minor salivary glands of lips. One of the most clinically accessible and consistently involved extrahepatic sites in NH is the labial minor salivary glands. Thus, biopsy of the labial minor salivary glands can help in establishing the diagnosis and initiating early care in such patients. As NH is often diagnosed after the exclusion of other common neonatal causes of liver failure, there is always a delay in diagnosing these patients. Rarely mentioned in the literature, is the role of lip biopsy as an adjunct to the clinical findings for early diagnosis of NH. This paper reports a case of NH for which lip biopsy emphasized on the diagnosis. The histological features seen in NH have also been described.

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Background: The emergence of carbapenem resistant organism (CRO) in the health care setting has been well-documented recently. CRO is an increasing cause of neonatal infections all over the world especially in developing countries. Objective: The aim was to study pattern, incidence, and antimicrobial sensitivity of CROs in neonatal Intensive Care Unit (NICU). Materials and Methods: We conducted a retrospective observational study between January 2011 and June 2012. The study was conducted at a tertiary level NICU. Blood cultures were done in BACTEC 9120 or brain heart agar. Culture isolates were identified by automated identification or conventional biochemical tests. Microscan 96 and/or disk diffusion method performed antibiotic susceptibility. We studied the entire Gram-negative blood culture positive isolates and also studied their antibiotic sensitivity pattern. CRO was defined by any Gram-negative isolates showing resistant to meropenem and imipenem. Results: One hundred and thirty-four babies had grown microorganisms in their blood culture. Of the 134, 77.6% (n = 104/134) was due to Gram-negative organism infection. Among culture positive Gram-negative organisms, 14.4% (n = 15/104) babies had carbapenem resistant Gram-negative organisms infections. Among the CRO, most common was Acinetobacter species (n = 9), followed by Klebsiella pneumoniae (n = 4), Escherichia coli (n = 1), Serratia (n = 1). CRO showed resistance to our first line, second line drugs and carbapenems. Mortality among CRO babies was 33% (n = 5/15). Babies with nonCRO infection had 10% mortality (n = 9/89). All CROs were sensitive to Polymyxin and colistin. Conclusion: The incidence of CRO was surprising. Polymyxin B and E (colistin) is the drug of choice for CRO. Mortality among these CROs was greater than nonCRO. Mortality caused by CRO is knocking and shocking data, indicating the emergence to check the use of antimicrobials in NICUs.

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Congenital pouch colon (CPC) is a rare variant of anorectal malformation seen predominantly in Indian subcontinent. It has been classified into various forms as per length of colon involved. Type 5 is the rarest form of CPC, which has segmental dilatations and only one case has been reported so far. We present a 1-day-old male child with type 5 CPC with colovesical fistula and management.

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Congenital epulis, a rare benign soft tissue tumour from the alveolar crest is smooth-surfaced, pedunculated and lobulated. It is almost always located on the gingiva and is found predominantly on the maxilla. It can obstruct the oral passage by its size and induce airway obstruction and feeding problems. Spontaneous involution after birth is rare. Newborns with a diagnosis of congenital epulis should be immediately subjected to the simple conservative surgical excision to restore vital functions, improve quality-of-life and decrease parental anxiety. Wide radical excision is not recommended as no recurrences have been described even after incomplete excision. The parents of the newborn with congenital epulis should be assured of this benign pathology and the simple treatment. This report documents the presentation and management of a congenital epulis of the maxillary alveolar ridge found in a newborn female and treated with simple conservative surgical excision.

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Arhinia is the congenital partial or complete absence of the soft tissue of the nose and nasal structures. It is an extremely rare defect of embryogenesis and is generally associated with other craniofacial anomalies like arachnoid cysts and also midline defects such as cleft palate, absence of paranasal sinuses, and other palatal and ocular abnormalities. Less than 40 patients with arhinia have been reported so far in the history of modern medicine. We report herein a patient with congenital partial arhinia with intracranial arachnoid cyst and discuss the embryology and review of literature of such a rare disease

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Harlequin ichthyosis is an extremely rare autosomal recessive disorder and is the most severe form of congenital ichthyosis. We present here a classical case of Harlequin ichthyosis.

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