Introduction: Neonatal mortality contributes to 40% of infant mortality rate (IMR). Over the years, the IMR has reduced worldwide, as well as in India, but neonatal mortality rate has not decreased proportionately. We have taken up this study so as to ascertain the causes of morbidity prevalent in the neonates admitted in Neonatal Intensive Care Unit (NICU) of a teaching hospital. The teaching hospitals cater to a large population, being a referral center and having majority of facilities required for the adequate care of sick newborn babies. Materials and Methods: The study is conducted in NICU of a teaching hospital admitted within 24 h of birth in central India over a period of 1-year. Results: One thousand three hundred and eighty-eight newborns admitted within 24 h of birth were included in the study. About 63.4% were male neonates, (Male:female 1.7:1). The low birth weight babies were 63.5% in our study. Respiratory distress was present in 47.2% of neonates, meconium aspiration syndrome being the most common cause of respiratory distress. Neonatal sepsis accounted for morbidity in 45.10% of neonates, with Klebsiella being the most common organism grown in the blood culture. The incidence of congenital anomalies was 5.4% with cardiac anomalies being most common. The neonatal mortality was found to be 26.6% in our study. Neonatal sepsis and birth asphyxia were the two most common causes of neonatal mortality in the study. Extremely low birth weight neonates had the highest case fatality rate in the study, which indicates the need to develop an efficient group of professionals in teaching hospitals who will provide highly specialized and focused care to this cohort of vulnerable neonates. Conclusion: Our study has shown respiratory distress, perinatal asphyxia, and sepsis as the predominant causes of neonatal morbidity. All three are preventable causes, and our health-care programs should be directed toward addressing the risk factors in the community responsible for the development of these three morbidities. The preterm and low birth weight babies had significantly high mortality even with standard intensive care; therefore a strong and effective antenatal program with extensive coverage of all pregnant females specifically in outreach areas should be developed which will help in decreasing preterm deliveries and also lower the incidence of low birth weight babies.

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Background and Objectives: The objective was to study the correlation of blood culture with the sepsis screen (based on six laboratory parameters) and Takkar and Bhakoo sepsis score (based on six perinatal risk factors) in the diagnosis of early-onset neonatal septicemia. Materials and Methods: In this prospective study, blood samples from 100 clinically suspected early-onset neonatal septicemia cases were selected randomly during the primary observer's study period, i.e., from January 2013 to August 2013, and subjected to blood culture and sepsis screen tests such as C-reactive protein (CRP), micro erythrocyte sedimentation rate (m-ESR), white blood cell count, absolute neutrophil count, I/T ratio, and platelet count. The culture results were correlated with the sepsis score and the sepsis screen tests. Results: Of the 100 cases studied, 63 were blood culture-positive. Higher proportions of septic babies were male (63.4%), preterm (65.1%), low birth weight (76.2%), inborn (52.4%), and those delivered spontaneously (80.9%). Gram-negative organisms (84.13%) were predominant such as Klebsiella (54%), followed by Pseudomonas (15.9%) and Escherichia coli (11.1%). Sepsis screen laboratory parameters such as CRP and m-ESR were significantly associated with culture-proven sepsis. CRP followed by thrombocytopenia and I/T ratio had more sensitivity and high negative predictive value. Leukopenia followed by m-ESR and neutropenia had high specificity and positive predictive value. On applying sepsis risk score, 81.3% were found to be culture-positive in the high-risk category; however, 49% of those with low sepsis risk score were also culture-positive. Conclusion: High-risk newborns identified on the basis of perinatal history by Takkar and Bhakoo sepsis score should be started on antibiotic treatment early. However, the present study illustrates less reliability of this score in low- and moderate-risk categories. A negative septic laboratory screen, in addition to low or moderate sepsis risk score, would be more justifiable in withholding antibiotics in such patients. Blood culture remains the definitive deciding factor.

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Objective: To determine the cause and disease pattern of neonatal morbidity and mortality in the secondary care neonatal unit of a district hospital. Study Design: Descriptive prospective study. Setting: Department of Pediatrics, General Hospital, Sec 16, Chandigarh. This hospital is providing optimal neonatal Level 2 care. Participants: All neonates who born in General Hospital Sec 16, Chandigarh, over 1 year were enrolled in the study. Outside born neonates and those who were re-admitted in the neonatal nursery after their discharge from hospital were excluded from the study. Methods: All consecutive live-born babies in the period of 1-year were included in the study. Babies received in labor room or operation theater were assigned Apgar score, and vital parameters were recorded. Sick babies were shifted to neonatal nursery as per admission policy, and rest of the babies were shifted with mother. All the babies were examined within 24 h of birth and daily thereafter till their discharge from the hospital. Main Outcome Measure: Antenatal and postnatal services, maternal education. Results: There were 6509 live births, of which 50 were twin pairs and 6409 were singleton birth. About 4.33% babies were born prematurely (<37 weeks), 21.7% babies were low birth weight (LBW) (<2500 g) including 0.4% very LBW (VLBW) babies (<1500 g), and 0.26% as extra LBW (ELBW) (<1000 g) babies. Five hundred and ninety-two (9.09%) babies were suffered from various morbidities, and 67 (1.03%) died during the hospital stay. Hyperbilirubinemia (7%) was the leading cause of neonatal morbidity followed by sepsis (3.99%) and respiratory distress (3.9%) among the various causes of respiratory distress transient tachypnea of the newborn was the leading cause (33%) followed meconium aspiration syndrome (20.5%) and pneumonia (14.9%). Hyaline membrane disease was seen in 11.8% of cases. Congenital malformations were seen in 1.75% of cases. Limb defects (31.3%) were the most common malformation followed by cardiac 49.9%, neural tube defect (13.9%), and Down syndrome 7.8%. Birth asphyxia (29.85%) and respiratory distress (22.38%) were the leading cause of death followed by extreme prematurity (22.3%) and sepsis (14.9%). Morbidity and mortality among LBW babies (22.3% and 3.53%) and ELBW (100% and 88%) and VLBW (84.6% and 46.2%) were higher as compared to normal birth weights (5.44% and 0.33%). Morbidity and mortality among preterm babies (58.5% and 11.7%) were high as compared to term babies (6.97% and 0.53%). Morbidity was higher among large for date babies (41%) as compared to small for date (SFD) (17.7%) and appropriate for date (AFD) (6.8%) babies higher mortality was seen in SFD babies (1.9%) as compared to 0.8% in AFD babies. Conclusion: Hyperbilirubinemia, sepsis, and respiratory distress were the leading causes of morbidity in our study. Birth asphyxia, prematurity, and neonatal sepsis were the leading causes of neonatal mortality in our study. Interventions to reduce preterm delivery, LBW, and birth asphyxia should be planned and implemented by health-care managers at the community level. Improvements in neonatal care at different levels will definitely reduce the neonatal deaths.

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Objective: To determine a cutoff value for B-type natriuretic peptide (BNP) level above which suggests a hemodynamically significant patent ductus arteriosus (hsPDA) and evaluate whether gestational age influences BNP production. Subjects and Methods: This was a prospective, observational study on infants of 24 0/7-31 6/7 weeks gestation. Up to 5 BNP levels were drawn within the first 2 weeks of life. An echocardiogram was done within the first 5 days in conjunction with the second BNP level. A patent ductus arteriosus (PDA) was graded as no, nonsignificant, or hemodynamically significant. Kruskal-Wallis test and Mann-Whitney U-test were used for statistical analyses. Result: There were 135 BNP-echocardiogram pairs in 95 patients. BNP levels were significantly different between PDA groups, P < 0.0001. Based on our receiver operating characteristic curve, a BNP level of 276 pg/ml or above on the day of life (DOL) 5 was suggestive of an hsPDA. Gestational age had a significant effect on BNP production. Conclusion: A cutoff BNP level of 276 pg/ml on DOL 5 is suggestive of an hsPDA in preterm infants of <32 weeks gestation. Gestational age has a significant impact on the ability of a preterm infant to produce BNP in response to an hsPDA, and therefore, different cutoff values based on gestational age may be appropriate.

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Background: The aim of this study was to find out immediate fetal outcome in meconium-stained amniotic fluid in relation to perinatal asphyxia. Materials and Methods: This retrospective study includes medical records of all neonates admitted to Neonatal Intensive Care Unit (NICU) between September 2014 and July 2015. The variables reviewed are age, sex, weight, mode of delivery, gestational age, presence of meconium aspiration syndrome (MAS) and perinatal asphyxia. Results: Out of 399 total admissions in NICU, 62.4% were male babies and remaining 37.6% were female babies. Of the total 6.8% were cases of MAS, making females (10.7%) more prone compared to male (4.4%) while perinatal asphyxia came out to be 11.5%, making male (12%) more prone than female (10.7%). Postterm (odds ratio [OR] =3.50 [CI: 0.39-31.42]) and term (OR = 2.58 [CI: 1.16, 5.75]) babies were having more risk of developing MAS compared to preterm (P < 0.01). Postterm (OR = 9.15 [CI: 1.91-43.75]) and term (OR = 2.67 [CI: 1.41-5.08]) babies were having more risk of developing perinatal asphyxia compared to preterm (P < 0.01). MAS babies are having 6.62 (CI: 2.85-15.38) times more risk of developing perinatal asphyxia (P < 0.01). Conclusion: The management of MAS, which is a perinatal problem, requires a well concerted and coordinated action by the obstetrician and pediatrician. Prompt and efficient delivery room management can minimize the sequelae of aspirated meconium and decrease the chance of perinatal asphyxia.

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Background: Jaundice is a significant problem in the early neonatal period due to excessive destruction of red blood cells or immature liver enzymes detoxifying bilirubin which may lead to neurotoxicity and brain damage in severe cases. Patients and Methods: A prospective clinical trial study was conducted on 120 neonates in neonatal Intensive Care Unit at Tanta University Hospital from May 2014 to August 2015. All of them suffering from neonatal jaundice. All of them received phototherapy, sixty of them (Group I) received phenobarbitone, and sixty of them (Group II) received fenofibrate. Results: There was no statistically significant difference between the two studied groups as regard total serum bilirubin (TSB) at time of admission (peak of TSB) P = 0.8, while there was a high statistical significant difference between both groups as regard TSB after 24 h P = 0.000, TSB after 48 h P = 0.000, and TSB at time of discharge (TSBD) P = 0.000, mean of TSB at time of admission is 17.9 ± 2.2 mg/dl in Group I and 18 ± 2.3 mg/dl in Group II, mean of TSB after 24 h is 16.3 ± 0.9 mg/dl in Group I and 11.5 ± 2.4 mg/dl in Group II, mean of TSB after 48 h is 12.8 ± 3 mg/dl in Group I and 6.7 ± 1.7 mg/dl in Group II, and finally mean of TSBD is 9.2 ± 0.6 mg/dl in Group I and 6.5 ± 1.4 md/dl in Group II. Conclusion: We concluded that oral fenofibrate in a dose of (10 mg/kg single dose) with phototherapy is more effective than oral phenobarbitone in a dose of (3 mg/kg/day for 3 days) with phototherapy in neonatal jaundice, so oral fenofibrate in this dose-treated neonatal jaundice more effective than oral phenobarbitone with avoidance of most of its side effects.

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Objective: The objective of this study was to compare the effects of triggered pressure assist (TrPA) to nasal continuous positive airway pressure (nCPAP) on cerebral and splanchnic regional blood flow and tissue oxygenation. Methods: Stable preterm neonates (<32 weeks gestation) receiving nCPAP had echocardiographic determination of hemodynamics and cerebral and splanchnic regional tissue oxygenation monitoring using near-infrared spectroscopy before and 3 h after switching to TrPA. Results: Ten neonates (birth weight; 1120 ± 450 g, gestation; 27.6 ± 1.5 weeks) were studied at 13.3 ± 12.4 days (mean ± standard deviation). The end-expiratory pressure was 5 ± 1 cm H ₂ O in both modes. There were no significant differences in any of the hemodynamic measurements between nCPAP and TrPA. Cerebral regional tissue oxygen saturation (CrSO ₂ ; 74.5 ± 6.9 vs. 73.1 ± 5.8; P < 0.001) and splanchnic rSO ₂ (72.4 ± 10.4 vs. 68.0 ± 10.8; P < 0.001) were greater during TrPA compared to nCPAP. In addition, the splanchnic/CrSO ₂ ratio was higher on TrPA (0.97 ± 0.15 vs. 0.92 ± 0.15; P < 0.001). The measurements of splanchnic and CrSO ₂ were not affected by feedings. Conclusions: Switching from nCPAP to TrPA did not result in significant changes in cardiac output or hemodynamics when the end-expiratory pressure was held constant. TrPA was associated with a small increase in CrSO ₂ and a larger increase in splanchnic rSO ₂ . These changes were independent of feeding. The clinical significance of these small magnitude changes is uncertain.

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Prolonged neonatal jaundice has been previously reported in neonates with congenital hypothyroidism. Isolated central hypothyroidism is a rare disease which may be missed by newborn screening programs. Here, we report a case of isolated central hypothyroidism presenting with neonatal hyperbilirubinemia, anemia, and hepatosplenomegaly, which showed marked improvement with levothyroxine supplementation.

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Objective: To study the outcomes after starting therapeutic hypothermia in our unit. Primary Outcomes: Mortality in Neonatal Intensive Care Unit, neurological examination at discharge, seizures, encephalopathy duration, and mortality up to 18 months were the primary outcomes. Secondary Outcomes: Number of anti-epileptic drugs (AED) at discharge, duration of mechanical ventilation, hospital cost, feeding patterns, duration of hospital stay, and neurodevelopmental outcome at 18 months were the secondary outcomes. Setting: The study was conducted at the NICU, Dr. Mehta's Children Hospital, Chennai. Study Period: October 2013 to December 2015. Conclusion: Therapeutic hypothermia resulted in better survival and neurodevelopmental outcomes though there was no significant reduction in MRI and EEG abnormalities.

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Objective: To evaluate the efficacy of light-emitting diode (LED) over conventional phototherapy in near-term and term Rh-compatible otherwise healthy neonates in resource-constrained settings. Design: This was a 3-year prospective observational study. Setting: The study was conducted in the neonatal unit of a teaching hospital. Patients: Near-term and term (≥35 weeks of gestation) Rh-compatible, otherwise healthy, newborns were included in the study. Interventions: Single surface LED or conventional phototherapy was performed. Main Outcome Measures: The primary outcome variable was the duration of phototherapy, and the secondary outcome variables were a rate of fall in the total serum bilirubin (TSB) and need for exchange transfusion. Results: A total of 406 patients constituted the study population. Two hundred and thirty patients received LED phototherapy, and 176 patients received conventional phototherapy. The birth weight, gestational age, gender, mean TSB, and other baseline laboratory parameters were similar in both groups. The median duration of phototherapy in the LED group (22.0 h [95% confidence interval: 20.47, 23.53]) was significantly less than that in the conventional phototherapy group (32.0 h [95% confidence interval: 29.8, 34.1]). Similarly, the rate of fall of TSB at 6, 12, and 18 h was significantly higher in LED group than in the conventional group. Fifteen patients (6.5%) received double volume exchange transfusion in LED group and twenty patients (11.4%) in the conventional group. Conclusions: LED phototherapy was found more efficacious than conventional phototherapy in resource-constrained settings, where the majority of jaundiced patients are managed with latter one and because of limited resources irradiance is never checked or checked inappropriately, which can be a source of serious error.

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Objective: Auscultation is one of the most important procedures in routine examination of neonates for congenital heart disease (CHD). Differentiating between innocent and pathologic murmurs during auscultation is very hard and usually unfeasible. The aim of this study was to assess the ability of clinical examination in comparison to echocardiographic examination to differentiate innocent from pathological murmurs and also to define the prevalence of heart murmurs in neonates. Materials and Methods: In the current cross-sectional study, 7113 neonates were examined in a period of 1 year by two neonatologists. If heart murmurs or unnatural sounds were auscultated during the examination, the observations were categorized as "probably pathologic" or "probably innocent" and the neonates were then referred to a pediatric cardiologist for echocardiography. Results: Prevalence of heart murmurs was found to be 19.26 for every thousand live births. According to the clinical examinations, 55% of murmurs were categorized as innocent and 45% as pathologic. Echocardiographic results revealed that in fact 50.8% of cases were either normal or had physiological defects and 49.2% were pathologic. Sensitivity, specificity, positive predictive value, and negative predictive value of clinical examination in differentiating between innocent and pathologic murmurs were found to be 79.7%, 88.5%, 87%, and 81.8%, respectively, and the false-positive and false-negative rates were found to be 11.5% and 20.3%, respectively. Conclusion: Although these numbers show that clinical examination is adequate for differentiating between innocent murmurs and CHD, however the false-positive and false-negative rates in clinical examination, stress that echocardiography must be performed for a better CHD diagnosis.

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Congenital herpes simplex virus (HSV) Type-2 infection is a rare but life-threatening condition that usually results from vertical transmission from mother to her fetus. This case report presents a rare case of a preterm born with congenital HSV with the classical triad of cutaneous, central nervous system (CNS), and ophthalmologic disease. The infant had mild respiratory distress at the time of birth but otherwise appeared normal. On day 3 of birth, the child presented with classical symptoms of HSV. The child was given antiviral therapy for HSV infection; however, the infection was progressive and adversely affected the CNS, eyes, and overall development of the child. This paper highlights the importance of prenatal screening in women at risk to reduce the incidence of congenital HSV. Since most of the congenital HSV cases camouflage as other congenital, infectious, or developmental disorders of neonates, proper antenatal and postnatal screening is required to identify such cases.

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Spondylocostal dysostosis (SCD) is a rare anomaly of axial skeleton due to flawed embryological development characterized by malformed ribs, fused ribs, and hemivertebra. Case one: A newborn baby boy with right-sided polythelia, meningocele, fan-like configuration of 3 ^rd and 4 ^th rib, fused 5 ^th and 6 ^th rib, and 3 ^rd thoracic hemivertebra was delivered to a second gravid mother by elective cesarean section. Based on clinical examination and radiological picture, a diagnosis of SCD with meningocele with right-sided polythelia was made. Case two: Baby girl born to primigravida mother by cesarean section had hemivertebrae with multiple right-sided rib defects, short neck, preauricular ear tags, imperforate anus, and rectovaginal fistula. Very few cases of SCD have been reported in literature with neural tube defects (NTDs) with supernumerary nipple, none from developing country. Till now, there is limited literature regarding the associations of SCD none showing its association with the genitourinary system without NTDs. We need to study the causal associations of SCD with detailed genetic work up as it is not so uncommon as presumed.

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Septicemia, pneumonia, meningitis are common problems in neonatal age group in developing countries. Epidemiology of meningitis differs in developed and developing countries with Group B streptococci, being more common in developed countries and Klebsiella pneumoniae in developing countries. In some of the cases, meningitis can lead to complications such as abscess, ventriculitis, and communication with ventricles. Proteus is the most common organism reported for brain abscess in neonatal age group in western literature. We found more cases of K. pneumoniae from the Indian subcontinent. Hence, we collected data from all published cases of Indian origin to highlight the etiology, any risk factor, most common site, complication, and outcome. We concluded that: K. pneumoniae is the most common organisms for neonatal brain abscess with fatal outcome in cases with ventricular perforation. Frontal lobe was the most common site of abscess. Minimum 6 weeks of antibiotic therapy was mentioned in 7 of 15 cases. Survival and discharge were reported in 13 of 15 cases, suggesting good immediate outcome in such cases.

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The patient was a 38 week female infant who was prenatally detected to have left sided diaphragmatic hernia which has not been previously described in literature. Diaphragmatic hernia is associated with chromosomal disorders. Multiple case reports have described Mosaic Trisomy 14 with distinctive characteristics. The patient shared few of the reported clinical features and had some novel phenotypic features. The patient was a term female infant who was prenatally detected to have left-sided diaphragmatic hernia at 34 weeks along with polyhydramnios, clover-shaped skull, and shortening of long bones. On delivery, the patient was noted to have multiple distinct features. The patient received maximal cardiorespiratory support but succumbed to the disease process after 6 days. Amniocentesis was performed on mother, and fluorescence in situ hybridization revealed duplication 14q24.2.2q32.33 and deletion 14q32.33. Karyotype on peripheral blood of the patient revealed partial Trisomy 14, by virtue of extra 14q32 region.

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Introduction: Recent progress in medical sciences approved phototherapy (PT) as a standard method of treatment and care for hyperbilirubinemia in the neonatal period. Previous studies which assessed the effect of PT on serum cytokines levels and white blood cells' (WBCs) count in infants mentioned different results. The aim of this study was to investigate the effect of neonatal PT on serum level of interleukin-6 (IL) and WBCs' count in healthy neonates with hyperbilirubinemia. Materials and Methods: This is a cross-sectional analytic study, which was conducted on 97 term newborns admitted to 17 ^th Shahrivar Hospital, Rasht (Northern part of Iran), with the chief complaint of indirect hyperbilirubinemia. Data were gathered by a form, which consisted of demographic characteristics and laboratory results. Four lamps with a wavelength of 400-500 nm were used at a distance of 30 cm for PT. Blood samples were taken to measure WBCs' count and IL-6 level before and 48 h after PT. Data were analyzed by t-test and Pearson's correlation coefficient in SPSS 19 software. Results: The mean age of the infants was 6.82 ± 2.16 days and 62.9% were males. The mean amount of WBCs before and after PT was 9235 ± 2215 and 9700 ± 2163, respectively (P = 0.001). The mean level of IL-6 before and after PT was 1.14 ± 0.98 and 1.42 ± 1.17, respectively (P = 0.004). There was a positive correlation between WBCs' count and IL-6 levels before and after PT (P < 0.001). Conclusions: Our findings demonstrated that an increased level of serum IL-6 and WBCs' count in healthy term neonates after PT could be indicated as its complications. Therefore, it seems that PT can change the function of the neonatal immune system.

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