Objectives: The objective was to study the Incidence and risk factors of early-onset neonatal sepsis in an out born neonatal intensive care unit (NICU) of New Delhi, India. Study Design and Setting: Prospective descriptive study over a period of 1 year. Patients and Methods: All out born neonates admitted within 72 h of life, with clinical features of sepsis with two or more high-risk factors for sepsis were enrolled and samples for sepsis screen and cultures were taken prior to administration of antibiotics in all cases. Standard data collection form was used to collect all demographic data and clinical characteristics of neonates. Bacterial isolates were identified, and their resistance patterns were analyzed using the Vitek 2 C system. Results : Among the 440 admissions to NICU during the study period, 82 neonates (19%) with early onset sepsis were enrolled. The mean (standard deviation) weight and hours of life at admission were 2016 ± 724.04 g and 23.05 ± 2.89 h, respectively. Incidence of early onset sepsis was 18/1000 patient. Twenty-eight (34%) neonates were home delivered. Low birth weight (68%), prematurity (46%), and poor hygiene/cord care (46%) were common risk factors while lethargy/refusal to feed (77%), hypothermia (47.5%), and respiratory distress (44%) were common clinical presentations. Sepsis screen and blood culture were positive in 57% and 18% (n = 15), respectively. Klebsiella pneumonie (36%), Staphylococcus aureus (21%), and Escherichia coli (14%) were common organisms. Case fatality rate was 14% (12/82). Conclusion: Clinical sepsis along with sepsis screen is a good marker of neonatal sepsis: Incidence of early onset sepsis varies in out born neonates and many factors affect it like place of delivery, perinatal risk factors, and immediate practices done in newborn.

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Background: Continuous positive airway pressure (CPAP) as a treatment modality is well established in respiratory distress syndrome. There is still a lot of skepticism for use of CPAP in meconium aspiration syndrome (MAS). We studied the use of CPAP as a primary treatment modality in MAS and tried to identify factors predicting CPAP failure. Objectives: The aim was to identify failure rates of MAS on bubble or ventilator nasal CPAP and potential predictors of CPAP failures in MAS cases. Design: Multicenter observational analytical study. CPAP failures were compared with CPAP success for perinatal and neonatal variables. Methods: From January 2012 to May 2013, 97 babies were admitted with diagnosis of MAS, out of which 66 babies were enrolled in the study. Bubble or ventilator nasal CPAP was started if the SpO ₂ in room air was <90%. CPAP failure was defined as the need for mechanical ventilation (MV). Outcome variables were compared between the MAS infants who failed CPAP and those who were successfully managed with CPAP. Results: Sixteen infants (24%) out of 66 failed to CPAP. Reasons for failure were: 10 infants had increased oxygen requirement (7 had persistent pulmonary hypertension and 3 had sepsis with multiorgan dysfunction). Two infants were ventilated for poor efforts (due to recurrent seizures), 3 (4.5%) for worsening pneumothorax and one infant for severe metabolic acidosis. Baseline variables were compared between the infants who failed CPAP and those who were successfully managed with CPAP alone. On univariate analysis, factors significantly associated with CPAP failure were out-born status, abnormal cardiotocograph, high FiO ₂ at 1 h and high positive end-expiratory pressure at 1 h (P < 0.05) of starting CPAP. On logistic regression analysis, only out-born status was independently associated with CPAP failure (OR = 25, 95% CI: 1.5-300, P < 0.01) and there was a trend toward CPAP failure in infants depressed at birth (OR = 10, 95% CI: 0.9-122). Conclusion: CPAP when applied early may reduce the need for MV in newborns with moderate to severe MAS infants.

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Vertical transmission of Chikungunya has been described in neonates but postnatal chikungunya has rarely been reported. We report a neonate from South India, who presented with apnea, seizures and hypotonia followed by typical visceral and peri-oral skin hyperpigmentation. Chikungunya infection was suspected and confirmed by serology (IgM) which was positive in the baby and negative in mother. It is important to remember viral infections in the differential diagnosis of neonatal seizures and apnea.

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Background: Neonatal jaundice is a cause for anxiety in parents as well as physicians due to its complications and prolonged hospital stay with increased cost. With early discharge practice, neonatal hyperbilirubinemia has become an important cause for readmission. Aim: The aim of this study is to evaluate the efficacy of oral fenofibrate in the treatment of neonatal hyperbilirubinemia in full term (FT) neonates due to ABO or Rh incompatibility. Design: The type of the study is prospective case control study. Patients and Methods: This study was carried out on 60 FT newborns suffering from neonatal hyperbilirubinemia due to ABO or Rh incompatibility and exaggerated physiological jaundice divided into two groups. Group A (control group): This group included 30 FT neonates with neonatal hyperbilirubinemia 19 males and 11 females. Their duration of stay ranged from 4 to 7 days. All the neonates in this group received phototherapy only. Group B (fenofibrate group): This group included 30 FT neonates with neonatal hyperbilirubinemia 20 males and 10 females. Their postnatal age ranged from day 1 to day 6. Their duration of stay ranged from 4 to 7 days. All the neonates in this group received one single oral dose of fenofibrate suspension with a dose 10 mg/kg beside phototherapy. Results: In our study, there was a statistically significant difference between the two groups (fenofibrate group vs. control group) as regard the response of babies to decrease the level of total serum bilirubin (TSB) and the duration of stay on phototherapy in hospital "lower in fenofibrate group". We found that babies in fenofibrate group showed lower values in successive TSB levels and lower duration of stay in comparison to the control group. We studied the highest level of TSB reached during treatment and found that mean TSB of fenofibrate group was 15.797 mg/dl while mean TSB of the control group was 16.593 mg/dl. In our study, we found that the mean duration of stay at the hospital of fenofibrate group was 4.366 days, while mean duration of stay at the hospital of the control group was 5.633 days (P = 0.0058*). Conclusion: The use of a single oral dose of fenofibrate (with a dose 10 mg/kg) with phototherapy accelerates bilirubin conjugation and excretion via induction of glucuronyl transferase activity hence reduces the duration of stay in hospital.

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Purpose: Due to appearing serious a complication following repeated blood products transfusion in premature neonates, beneficial protective effects of recombinant human erythropoietin (rhEpo) is being widely investigated. The present study evaluated the effectiveness of rhEpo in preventing anemia of prematurity by assessment of the changes in serum erythropoiesis parameters in very low birth weight (VLBW) neonates. Materials and Methods: In a single-center randomized, double-blinded, placebo-controlled trial, 60 premature infants with birth weight <1500g who were born between 24 and 31 weeks of gestation admitted to the neonatal intensive care unit of Fatemieh Hospital in Hamadan were enrolled. The study medication (rhEpo or placebo) was randomly assigned to each patient. The rhEpo (250 U rhEpo/kg body weight at birth, equal to 1 mL solution/kg birth weight) and placebo drug solutions were indistinguishable. The study drug was administered 3 times weekly for 3 weeks. Results: Monitoring hemoglobin, hematocrit and reticulocyte count showed no relevant deviation from baseline to the 2 ^nd week of the study. However, there was relevant difference for these parameters between investigated patients who received rhEpo and the patients who received placebo during the 3 ^rd week of the medication. 16 (53.3%) in the intervention group and 20 (66.7%) in the control group required blood transfusion with an insignificant difference. No serious side-effects were observed in either the rhEpo or placebo group. Conclusion: Our study suggested that rhEpo is an effective drug for improving erythropoiesis parameters after 3 weeks of administration in VLBW infants regardless its effect on the need for blood transfusions.

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Preterm births, defined as a birth before 37.0 weeks gestation, are a main worldwide health problem. In the world, every year, about 15 million babies are born preterm, and their incidence is rising. Broadly outcomes improve with increasing gestational age; however, health care needs for preterm survivors can be extensive, both in terms of immediate postnatal support for infants and their families and in terms of lifelong support. The effect on the lifespan for the survivors especially in terms of mental health and cardiometabolic status need more attention and researches. A deeper awareness by pediatricians to the impact of preterm birth on the developing of adult diseases and pathological conditions could be of help in preserving and maintaining health once the child become an adult and in optimizing his/her impact on society.

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Germ cell tumors rarely originate from the kidney. We here present a case of primary intrarenal mature teratoma with renal dysplasia associated with mid penile hypospadias in 26-day-old child. Our case is unusual due to the younger age of child and association of renal dysplasia with primary renal teratoma.

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Objectives: To measure D-dimer levels in neonatal sepsis and compare D-dimer as a marker of sepsis with the gold standard that is, blood culture and other established marker of sepsis like C-reactive protein, micro-erythrocyte sedimentation rate and total leucocyte count (TLC) in predicting sepsis. Study Design: Prospective observational hospital based study. Setting: Tertiary care hospital. Subjects: From November 2010 to October 2011, 936 neonates were admitted to the neonatal unit of Indira Gandhi Medical College, Shimla, Himachal Pradesh. Out of these, 355 neonates were admitted with suspected sepsis. Out of these, only 101 term neonates were without asphyxia and blood culture positive and were enrolled as cases, and 96 term neonates without the asphyxia admitted for neonatal jaundice without sepsis were enrolled as controls. Methods: All neonates, cases and control were investigated as per the protocol at admission and simultaneously the D-dimer levels were measured. D-dimer levels were evaluated in predicting neonatal sepsis and were compared with other established markers of sepsis in predicting sepsis. Results: In the study group, age ranged from 0 to 22 days with an average of 5.58 days. In the control group, age ranged from 0 to 23 days with an average of 5.62 days. Sex distribution was almost equal in both groups. The mean value of D-dimer in the cases and control group were 1.832 mg% and 1.365 mg% respectively. The study group had significantly higher values of D-dimer (P - 0.04). Sensitivity and negative predictive value of D-dimer in predicting sepsis were 90.0% and 84.4% respectively, the highest amongst all the markers studied in sepsis. Positive predictive value and specificity of TLC in sepsis was highest in all the marker studied. Negative predictive value of various markers was comparable in sepsis. Conclusion: D-dimer is a sensitive predictor of sepsis in neonates with a high sensitivity and negative predictive value. Hence, it should be included in the septic screening of newborns.

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Localized pulmonary interstitial emphysema (PIE) is a known complication of mechanical ventilation. Recently, we encounter two cases of localized PIE, which developed on the course of mechanical ventilation using high-frequency oscillatory ventilation, followed by conventional intermittent positive pressure ventilation. We then switched the ventilator mode to neurally adjusted ventilatory assist (NAVA). We observed that on switching to NAVA, there was a decrease in peak inspiratory pressure (PIP) in case 1 and case 2, and decrease in tidal volume in case 2. Localized PIE resolved in 6-9 days' time. Since high PIP and high tidal volume are risk factors for PIE, NAVA could lead to resolution of localized PIE by achieving lower PIP and lower, but optimal tidal volume. We suggest that NAVA is a treatment of choice in localized PIE.

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The treatment of multidrug-resistant Acinetobacter baumannii infections is a serious problem in neonatal Intensive Care Units. Colistin has been used successfully in the treatment of these infections. Due to the limited penetration of colistin into the cerebrospinal fluid, central nervous system infection due to A. baumannii necessitates intrathecal or intraventricular application. Here, we describe our experience with intravenous and intraventricular colistin administration in a premature infant (33 gestational weeks) with shunt infection and brain abscess. No side-effects related to the drug were observed. To the best of our knowledge, our patient is the first premature infant to undergo intraventricular colistin administration. Although the central nervous system infection in our patient was treated successfully, it is obvious that detailed prospective studies are required regarding colistin usage in neonates and especially in premature infants.

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Intracardiac tumors are very rarely seen in newborn infants. Rhabdomyoma is the most common primary cardiac tumor in infants. Rhabdomyoma is generally intramural and rarely causes cardiac outflow tract obstruction. Herewith we report an unusual presentation of cardiac rhabdomyoma arising from the free wall of the right ventricle.

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Intestinal obstruction in newborns can be life threatening. Congenital internal hernias comprise a very rare cause of the blockage and are thought to arise from a defect in the formation of the mesentery of the small intestine. We describe two cases of neonatal internal hernias and review the current literature. Both infants had clinical signs of obstruction shortly after birth, but the cause of the obstruction was not found until surgical intervention took place. Intestinal necrosis due to segmental twisting of the intestine through a mesenteric defect was found requiring resection and temporary enterostomies. At outpatient follow-up, both children are doing well with normal intestinal function. Our two cases along with the current literature review, illustrate the rare nature of this condition, but one that should be considered in any neonate presenting with intestinal obstruction.

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Epigastric heteropagus twin is a rare form of parasitic twins. Though heart defects may be found in 28% of these babies, an association with situs inversus and dextrocardia is extremely uncommon. We present a rare case of epigastric heteropagus twinning with dextrocardia and situs inversus.

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Term male baby was born by normal vaginal delivery. The mother was followed-up in fetomaternal unit. Ultrasound report showed a huge mass arising externally from left ventricle free wall with multiple intracardiac masses with moderate pericardial effusion. A possibility of rhabdomyoma was considered. Baby was born with poor respiratory effort needed resuscitation and mechanical ventilation. Immediate postnatal echocardiography confirmed the presence of the extra and intra cardiac masses. Baby remained hemodynamically stable, developed one attack of supraventricular tachycardia and heart failure for which medical treatment given. Investigations confirmed the presence of tuberous sclerosis complex in this baby including magnetic resonance imaging and computed tomography (CT) scan that showed multiple subcortical and periventricular tubers'. CT abdomen showed angiomyolipoma of the left kidney, which disappeared completely after that. Baby remained free from neurological symptoms, discharged home on oral propranolol with multidisciplinary outpatient follow-up. His cardiac masses regressed significantly over his 2 years of life

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Sirenomelia is a rare congenital malformation and is characterized by complete fusion of the lower limbs, commonly associated with lethal urogenital and gastrointestinal malformations. Here, we are presenting a case of sirenomelia diagnosed at birth.

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Purpose: There are multiple orthopedic conditions that plague a newborn. However, identification of many conditions is difficult and requires strict vigilance. Keeping the idea in mind, a retrospective analysis of various orthopedic problems was done in a tertiary care setting in India. Materials and Methods: A 10 years retrospective analysis done at a tertiary care setting to identify various orthopedic conditions in a newborn. Results: The overall prevalence of musculoskeletal abnormalities in the study group was 2.03% (20/1000). Foot abnormalities composed the highest group with 43.3% (8.8/1000), followed by hand abnormalities 23.50% (4.78/1000), spinal abnormalities 15.20% (3.09/1000), trauma 5.5% (1.12/1000) and paralytic conditions 5.06% (1.03/1000). The rest of the conditions had a combined prevalence of 1.5/1000 (7.37%). Low birth weight, nonvaginal delivery, maternal age more than 30 years and multiparity were significantly associated with an increased incidence of congenital malformations. Conclusion: Musculoskeletal abnormalities are commonly seen in newborns and early identification, and prompt intervention can lead to a bright future for the child.

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Epignathus is a rare congenital head and neck tumor (1 in 35,000-200,000 live births) with many associated complications. We report a rare association of giant epignathus associated with disseminated intravascular coagulation. To our knowledge, only one case of this association has been reported so far. A review of different clinical presentations of epignathus, classification, its reported associations and available management strategies is included.

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We are reporting a case of rhizomelic chondrodysplasia punctata, which is a rare form of peroxisomal disorder. It is an autosomal recessive disorder with distinct clinical phenotype of dwarfism due to symmetrical shortening of the proximal long bones (rhizomelia), cataracts and specific radiological abnormality like punctate epiphyseal calcification. ^[1] A Hindu male baby, born at term (40 weeks) by vaginal delivery, had a weak cry at birth referred to Neonatal Intensive Care Unit for fast breathing. Baby had proximal shortening of upper limbs and lower limbs. Other dysmorphic features included depressed nasal bridge, broad nose, coarse facial features, long philtrum, and macrostomia. Baby had contractures at thigh and elbow. On ophthalmological examination, there was bilateral megalocornea and near mature cataract.

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Background: Oxidative and nitrosative stress are known to be associated with the transition from fetal to neonatal life at birth, when newborns having a compromised antioxidant defense system are suddenly exposed to a normoxic environment (from a hypoxic state). The current study explores the levels of antioxidants, markers of oxidative and nitrosative stress, in the cord blood samples of neonates born by cesarean section (CS) and normal delivery (ND), to assess the effect that the mode of delivery has on neonates, as far as oxidative and nitrosative stress are concerned. Aims: The main purpose of this study was to compare the levels of oxidative stress, nitrosative stress, and the antioxidant status in the cord blood of neonates delivered by ND, versus neonates delivered by CS. Materials and Methods: Cord blood was collected from 80 full-term, mature neonates of both sexes; 40 born via ND and 40 delivered by elective CS under regional (spinal) anesthesia. The samples were tested for the percent of methemoglobin as a marker of oxidative stress, as well as the antioxidants red blood cell (RBC) glucose-6-phosphate dehydrogenase (G6PD), RBC reduced glutathione (GSH), and serum nitrate and nitrite as markers of nitrosative stress. The statistical evaluation of the data obtained was done using SPSS 17 software, taking the significance level as P < 0.05. Results: The comparison of the analytes between the two groups revealed that the percent of methemoglobin (P < 0.001) was significantly higher, and both RBC G6PD (P < 0.001) and RBC reduced GSH (P = 0.003) were significantly lower in CS neonates than in ND neonates. There were no significant differences in the serum nitrate (P = 0.273) and serum nitrite (P = 0.060) between the two groups of neonates. Conclusion: The CS neonates were deficient in antioxidants and had higher levels of oxidative stress than the ND neonates, but no significant difference existed in the nitrosative stress between the groups.

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