Sternocleidomastoid pseudoumor of infancy or congenital torticollis is a self-limiting pseudotumor of infancy presenting with neck mass and restriction of neck movement. It is a benign proliferation of fibrous tissue with in the sternocleidomastoid muscle leading to focal or diffuse enlargement of muscle. Its timely and correct diagnosis can be done by a simple and noninvasive technique of fine-needle aspiration cytology. It's a prompt and reliable diagnostic procedure, more importantly, to differentiate it from other neck lesions of childhood. Here, we represent a case of such tumor with cytological features and spontaneous resolution.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Background: Pulmonary arterial hypertension (PAH) in adults is usually described as mean pulmonary artery pressures of 25 mmHg or more at rest. However, clear cutoff value is not well defined in neonatal age group. Persistent pulmonary hypertension of newborn (PPHN) can be defined as a failure of normal fall in pulmonary vascular resistance at or shortly after birth, leading to shunting of unoxygenated blood into the systemic circulation across foramen ovale or ductus arteriosus. Objective: To study the prevalence and outcome of Pulmonary arterial Hypertension in newborns with perinatal asphyxia. Materials and Methods: This was a prospective observational study in which newborns up to 1 month of age having a history and clinical/laboratorial features of perinatal asphyxia were included in the study. Both inborn and outborn newborns admitted in our Neonatal Intensive Care Unit/neonatal high dependency unit were enrolled in the study. Relevant investigations as and when required for management were done. Echocardiography was done after 48 h of birth, and the findings were noted for the presence of PAH. Second echocardiographic screening was done at 6 weeks of life in all cases. Results: A total number of neonates screened were 41, of which 18 (43.9%) cases had PAH. Out of 18 cases, 8 (44.4%) had a reversal of shunt at the level of patent ductus arteriosus/patent foramen ovale and hence were cases of PPHN. Eleven neonates expired before 6 weeks of age and rest seven cases were screened at 6 weeks. Only one case showed the persistence of PAH at 6 weeks. Conclusion: Perinatal asphyxia was found to have a significant association with the development of PAH, and the mortality was high in neonates with perinatal asphyxia once it is complicated by the development of PAH.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Congenital hernia of the umbilical cord is a less frequent entity in newborns and occasionally associated with other maladies. Sometimes, a large umbilical cord hernia is confused with small omphalocele. We report an unusual case of umbilical cord hernia associated with patent vitello-intestinal duct in a male newborn who underwent surgery and discharged with good general condition.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Background: In India, 18%–20% of newborn deaths are attributed to perinatal asphyxia. Effective resuscitation at birth can prevent neonatal mortality and improve the chances of intact survival. The information about sustainability and retention of gained resuscitation knowledge and skill in India is limited. Objective: The objective of this study is to evaluate the retention of newborn care and resuscitation knowledge and skill of birth attendants at public health facilities after 1 year of clinical practice at the health facilities within Public Health System in India. Methods: In three districts of Uttar Pradesh, knowledge and skill status of 168 birth attendants (54 doctors and 114 nurses) were documented at pre- and posttraining and after 1 year. Results: There was a marked improvement in knowledge scores (doctors: 42%–85% and nurses: 35%–86%) and skill scores (doctors: 15%–89% and nurses: 15%–90%) after training. There was significant retention of knowledge (doctors 58% and nurses 52%) and skill (doctors 82% and nurses 79%) after 1 year, although there was knowledge–skill gap observed after 1 year. Conclusion: The improvement and retention of skill and knowledge among the birth attendants were encouraging. The differential retention of skill and knowledge may be due to the training methodology and opportunity for skill refresher through the skill laboratories.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Background: In the developing countries, neonatal sepsis (NNS) contributes significantly to neonatal admissions and deaths. Its symptoms are usually nonspecific, and definitive laboratory diagnosis can be challenging in a resource-limited setting. Therefore, early empirical antibiotic therapy antibiotics are important in these localities, and this makes it important to document local organisms and their antibiotic sensitivity pattern. Unfortunately, no previous study in our setting has documented these. Methods: This study involved newborns (inborn and outborn) admitted with sepsis (cases) within the 1^st month of life at the Enugu State University Teaching Hospital (ESUTH), Enugu, Southeast Nigeria. Controls were included for the analysis, and data were collected over a 4-year period from January 2013 to December 2016. Results: In all, 1920 newborns were admitted to the Special Care Baby Unit of ESUTH during the study period. Fifty-seven were managed for culture-proven sepsis, resulting in an in-hospital incidence rate of 29.7 per 1000 admitted newborns (95% confidence interval 21.9–37.4). A total 228 newborns were recruited (57 cases and 171 controls; ratio of 1:3). The most common presenting symptom and sign were fever (84.2%) and depressed primitive reflexes (50.9%), respectively. A case-fatality rate of 7.4% was observed. Newborn's place of birth (P = 0.02) and the final outcome (P = 0.004) were significantly associated with the development of sepsis, while gender (P = 0.12), birth weight (P = 0.33), gestational age (P = 0.53), and mode of delivery (P = 0.74) were not. Nearly 60% of the organisms implicated were coliforms, while one-quarter were Staphylococcus aureus. The most sensitive antibiotics were the fluoroquinolones, particularly ciprofloxacin, while amoxicillin, ampicillin, and clindamycin were generally not effective. Conclusion: NNS in our environment is commonly caused by coliforms and S. aureus and being outborn is a significant determinant. Antibiotic resistance follows recognized patterns, but the quinolones, despite their inconclusive safety profile in children, are most sensitive.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Objectives: The late and moderate preterm (LMPT) babies form a significant proportion of Neonatal Intensive Care Unit (NICU) admissions. The aim of this study is to determine the disease patterns and outcomes of LMPT babies admitted to a tertiary childrens' hospital between January 1, 2017 and July 31, 2017. Material and Methods: This is a retrospective, observational study. Medical records of all neonates admitted during the study period were reviewed. The LMPT infants were analyzed for demographics and outcomes. Results: Of a total of 690 deliveries in the specified period in our hospital, 102 were LMPT neonates (14.8%). Of these, 39 (38.2%) were girls and 63 (61.7%) were boys. In this period, a total of 192 babies were admitted to our NICU of which 82 were LMPT babies (42.7%). 62 of the 82 were inborn (75.6%). Median weight among LMPT babies born in our hospital was 2.27 kg (interquartile range [IQR] 1.95–2.56) and median weight of the LMPT babies at admission to NICU was 2 kg (IQR 1.76–2.32). Preterm care was the most common reason for admission to NICU (67%). Respiratory distress was the main morbidity immediately after admission (28%) to NICU. Jaundice (59.75%) and hypoglycemia (10.9%) formed other main concerns. Median age for discharge was 35 weeks corrected gestational age (IQR 34–36). There was no mortality in the LMPT subgroup in the period specified. Conclusions: Researching and benchmarking our LMPT data have improved the confidence of our unit and will help develop guidelines specific to our population and health practices.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Surgery on an infant with factor VII deficiency is a risky affair, more so when the infant is premature and low birth weight. A 2-month-old infant with factor VII deficiency presented with obstructed right inguinal hernia. He had features suggestive of intestinal obstruction. The hernia was reduced, and the infant was initially managed conservatively. He was operated upon after 72 h under cover of recombinant activated factor VII concentrate to control the bleeding and was closely monitored for bleeding in the postoperative period. After confirming optimal wound healing and no recurrence on 6-month follow-up, contralateral herniotomy for a reducible inguinal hernia was performed at the age of 9 months. Even on thorough literature search, no references have been found on the management of an infant with this rare coagulation disorder undergoing herniotomy during early infancy. Hence, the case is being reported.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Background: While there is currently much emphasis on the developmental origins of diseases associated with deranged metabolism in developed societies, there is a paucity of data on this subject in developing countries. Insulin resistance (IR) at birth is known to be the earliest detectable abnormality in the natural history of diabetes. It is also a precursor of obesity and cardiovascular diseases. Objective: The objective of the study was to determine IR profile in apparently healthy term neonates. Methods: The cross-sectional study involved 33 small for gestational age (SGA), 29 appropriate for gestational age (AGA), and 38 large for gestational age (LGA) healthy neonates <48 h of age. Glucose and insulin samples taken after a shortened fasting time were measured with glucose oxidase and Enzyme-linked immunosorbent assay methods, respectively. Homeostatic model assessment of IR (HOMA-IR) was calculated. Results: The mean fasting glucose, fasting insulin, and HOMA-IR were 2.66 ± 0.7 mmol/L, 8.68 ± 3.63 μU/mL, and 1.01 ± 0.46, respectively. Fasting glucose levels in LGA, AGA, and SGA neonates were 2.92 ± 0.76 mmol/L, 2.58 ± 0.53 mmol/L, and 2.45 ± 0.68 mmol/L, respectively (p = 0.012). Insulin levels of LGA, AGA, and SGA were 9.47 ± 4.77 μU/mL, 8.44 ± 2.03 μU/mL, and 7.98 ± 3.08 μU/mL, respectively (p = 0.207). HOMA-IR of LGA, AGA, and SGA was 1.18 ± 0.54, 0.97 ± 0.32, and 0.86 ± 0.40, respectively (p = 0.01). The correlation coefficient, r, between HOMA-IR and birth weight was 0.72 (p < 0.001) and the correlation coefficient between HOMA-IR of neonates and maternal body mass index (BMI) was 0.51 (p = 0.001). Conclusions: LGA and infants delivered to mothers with higher BMI are at a higher risk of IR and should be screened at birth.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Aim: We aimed to determine if a structured neonatal resuscitation program, advanced NeoResus, can effectively improve the confidence level of the nonpediatric-trained medical and nursing staff in the emergency department (ED) for providing neonatal resuscitation in the face of sudden, unexpected delivery. Materials and Methods: A self-reported questionnaire powered by Likert scale and open-ended questions, was used to evaluate the impact of the program on the ED staff in gaining confidence after completing the online and face-to-face parts of the program. Results: A total of 45 nonpediatric-trained multidisciplinary health-care professionals attended the program; out of those 24 were nurses/midwives. Before the course, 97% candidates had reviewed the online learning modules and 91% of them found them good or excellent. All ED staff agreed that the time allocated for practicing the use of airway adjuncts, manual ventilation devices, chest compressions, and umbilical venous line and the quality of information provided was adequate. All ED staff, again, either agreed or strongly agreed that participating in neonatal resuscitation scenarios had improved their confidence level in managing the neonatal emergencies. Conclusion: There was a very good compliance and acceptability of the course by the nonpediatric trained staff. All attendee felt more confident about acquiring the necessary knowledge and skill needed for neonatal resuscitation in emergent situation. A further follow-up study will be required to assess objectively about the knowledge acquisition and retention by the ED staff for ongoing provision of emergency neonatal resuscitation.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

A term male baby weighing 3000 g was delivered by elective cesarean section with antenatal diagnosis of mass in the oral cavity. The ex utero intrapartum treatment was performed. The magnetic resonance imaging of head and neck delineated the mass. The mass was excised and histopathology of the specimen suggested sublingual cyst. Postoperatively, he did well and got discharged home safe on full feeds.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Osteopetrosis is a rare, heterogeneous group of inherited diseases characterized by increased bone mass and density due to defective osteoclasts, leading to failure in bone resorption. Pathological features are related to increase in bone mass density and altered craniofacial morphology. Cranial nerve compression due to narrowing of cranial foramina can lead to progressive blindness and deafness. Bone marrow failure can lead to pancytopenia and life-threatening infections. Early diagnosis is crucial due to a short window of opportunity for curative treatment and to prevent complications such as visual impairment. We present the case of a late-preterm infant who had recurrent hypocalcemic seizures and visual impairment. Genetic testing confirmed the diagnosis of autosomal recessive osteopetrosis.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]