Background: Better understanding of the clinical characteristics of ABO hemolytic disease in neonates helps optimize care. Objective: To assess the morbidity associated with ABO incompatibility. Materials and Methods: Neonates with blood groups A or B born to mothers with blood group O were studied. Need for phototherapy (PT), intensive PT, intravenous immunoglobulin (IVIG) therapy, and packed red blood cell (PRBC) transfusions was studied. Results: The O–A group accounted for 57.2% and the O–B group 42.8%. Three-hundred and seventy-nine (46%) were Direct Coomb's test (DCT) positive. Need for PT and intensive PT was significantly higher in DCT-positive infants compared to DCT-negative infants (P < 0.001). DCT-positive infants required more PRBC transfusions (5.3% vs. 0.9%, P < 0.001) and IVIG therapy (6% vs. 0.2%, P < 0.001) compared to DCT-negative infants. Sixty percent of the blood group B infants were DCT positive compared to 35% of blood group A infants (P < 0.001). Need for PT (62% vs. 39%, P < 0.001), intensive PT (17% vs. 4%, P < 0.001), and IVIG therapy (5.4% vs. 0.8%, P < 0.001) was higher in infants with blood group B. TcB measured at median age of 12 h was predictive of the need for PT (area under the receiver operator characteristic [AUROC] =0.867) and intensive PT (AUROC = 0.917). The maximum reticulocyte percentage was predictive for both the need for IVIG therapy (AUROC = 0.978) and PRBC transfusion (AUROC = 0.863). Conclusions: DCT-positive infants and infants with blood group B suffered significantly higher adverse outcomes. TcB measured at 12 h is predictive of the need for PT and intensive PT. Maximum reticulocytes count is predictive of the severity of ABO incompatibility as evidenced by the need for PRBC transfusions and IVIG therapy.

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Background: Hypothermia on admission in neonatal units is a well-recognized contributor of neonatal mortality and morbidity. This study aimed to identify risk factors for hypothermia on admission in a resource-poor setting which will help provide targeted preventive interventions. Methods: A retrospective cross-sectional descriptive study was conducted from July 1, 2020 to January 31, 2022. A total of 567 neonates were included in the study, data were collected from the unit electronic database. The axillary temperature of each neonate was measured using a digital thermometer at the point of admission. Bivariate and multiple logistic regressions were used to assess associated risk factors. Results: The prevalence of admission hypothermia (AH) in the study population was 42.4% with mild and moderate hypothermia accounting for 46.3% and 53.7%, respectively. Maternal ages 20–29 years (adjusted odds ratio [aOR] 0.28, 95% confidence interval [CI] 0.09–0.93) and 30–39 years (aOR 0.27, 95% CI 0.08–0.88) and primary education (aOR 0.44, 95% CI 0.21–0.92) were associated with reduced risk of AH. Age <24 h (aOR 3.61, 95% CI 1.70–7.66), gestational age 28–32 weeks (aOR 3.90, 95% CI 1.41–10.79) and 33–36 weeks (aOR 2.835, 95% CI 1.52–5.28), admission weight <2.5 kg (aOR 2.01, 95% CI 1.18–3.43), and cold season (aOR 1.85, 95% CI 1.06–3.14) were associated with increased risk of AH. Mortality in those with AH was 3 folds (crude odds ratio 3.38, 95% CI 1.6–6.82). Conclusion: Hypothermia on admission is common in neonates in resource-poor settings. Training of newborn care-providers in maintaining thermoneutral environment and temperature at delivery and postnatal periods will be a cost-effective intervention in reducing neonatal mortality.

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Background: The Corniche Hospital, Abu Dhabi, is the largest and most advanced perinatal center in the United Arab Emirate (UAE), providing care in line with international standards within its 64-cot NICU, serving a mainly Muslim population. We share our experience on outcomes of babies born in our center at 22 weeks' gestation, below the threshold of viability. At this gestation, a senior neonatologist attends each delivery to assess the baby, offer stabilization whilst assessing the baby's response. We then looked simply at the outcomes of these births. Methods: Retrospective data was collected from June 2011 to Dec 2020 using electronic hospital records and our in-house neonatal database – a nine-and-a-half-year period. Information on all babies born between 22 + 0 to 22 + 6 weeks gestation was sought; Gestational age was calculated from last menstrual period (LMP). Results: Over a nearly 10-year period, just over 67,000 live births occurred at our center, of which 134 babies were between 22 + 0- and 22 + 6-week gestation at birth. Complete data was available in 114 babies who were assessed as alive at the onset of labor. Thirty-seven were still born and there were 77 live births, their average weight was 486 gm. Twenty-eight babies were offered comfort care, the other 49 babies were offered stabilization/resuscitation from which 20 babies were admitted to the NICU. Four babies, whose average weight was 536gms, survived to discharge. All four survivors have varying degrees of neuro-disability and chronic lung disease. Conclusion: This information may feed into the development of a framework, that supports parents and clinicians. This framework should reflect cultural, religious, and legal aspects applicable to the Middle East whilst providing direction on the care of babies born below the current definitions of viability within the region.

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Introduction: Neonatal jaundice is a common cause of hospital admission among neonates in the 1^st week of life. The condition results from an imbalance between oxidative stress and antioxidant mechanisms. Considering the fact that the metabolism of both bilirubin and 25-hydroxy Vitamin D occurs in the liver and 25-hydroxy Vitamin D being a potent antioxidant, we hypothesized that there exists an association between 25-hydroxy Vitamin D and serum bilirubin levels. Methods: A total of 174 neonates were enrolled in the study and were further subclassified into 4 groups: Group A (no clinical jaundice), Group B (clinical jaundice with the value of serum bilirubin <10 mg/dl), Group C (clinical jaundice with the value of serum bilirubin >10 mg/dl but not in phototherapy range), and Group D (clinical jaundice with serum bilirubin value requiring initiation of phototherapy). 25-hydroxy Vitamin D and serum bilirubin levels along with parathyroid hormone, calcium, phosphorus, and alkaline phosphatase levels were estimated. Results: The mean 25-hydroxy Vitamin D levels were highest in Group A and lowest in Group D (21.92 ± 20.85 vs. 14.38 ± 8.52, P = 0.020) and vice versa for serum bilirubin levels (15.08 ± 0.93 vs. 4.28 ± 0.97, P < 0.001). There was a nonsignificant negative correlation between serum 25-hydroxy Vitamin D and bilirubin levels (correlation coefficient: −0.113 [−0.257–0.0364], P = 0.138). Conclusion: The present study suggests a lack of association between serum 25-hydroxy Vitamin D and bilirubin levels. However, the results need to be confirmed by further prospective studies to conclude that 25-hydroxy Vitamin D has no role in the pathogenesis of neonatal hyperbilirubinemia.

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Fungal sepsis is a sinister infection in the neonatal intensive care unit associated with significant mortality and neurodevelopment sequelae. Very low birth weight and very preterm neonates are often predisposed and manifestations range from mucocutaneous to invasive organ involvement. Prompt recognition and treatment with appropriate antifungal improve survival and neurodevelopmental outcomes. In this report, we describe a neonate with rare dermatological manifestation in the form of a cutaneous fungal abscess with urinary tract involvement. The diagnosis was based on budding yeast cells seen on pus smear examination and culture suggestive of Candida albicans. Risk factors included birth weight <1500 g, placement of central vascular catheter, endotracheal tube, parenteral nutrition, surgical intervention, and use of broad-spectrum antibiotics. Amphotericin B deoxycholate and incision and drainage of the abscess were done to manage the abscess successfully. This report highlights the consideration of Candida as an etiological agent for cutaneous abscesses, in case of preterms with risk factors for fungal infection. Evaluation for systemic dissemination is mandatory and management with appropriate antifungal agents is critical for survival.

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Neonatal seizures are prevalent in premature babies and can be the earliest sign of neurological abnormalities. Seizures in newborns are clinically significant and further inquiry leading to a solid identification of the underlying disease can aid with prognosis and treatment options. We report a male neonate born at 27 + 6 weeks of gestation. An intractable seizure developed at 9 days of age. The diagnosis is confirmed based on genetic testing.

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Aphallia, or penile agenesis, is an extremely rare congenital anomaly, resulting from the failure of the genital tubercle to develop normally during the early period of embryogenesis. We present the case of a baby born at term by normal vaginal delivery to a primi mother with an uneventful antenatal history, except for oligohydramnios detected in the third trimester. Examination of the baby revealed an absence of phallus and external urethral meatus, normally descended testes, a normal scrotum, and a normally positioned patent anal orifice. Subsequent workup of the baby by radiological studies revealed a malrotated right kidney in the midline, multicystic renal dysplasia of the left kidney, and urethral atresia.

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Congenital thrombotic thrombocytopenic purpura (cTTP) is a thrombotic microangiopathic caused by severely reduced activity of the von Willebrand factor-cleaving protease A Disintegrin And Metalloproteinase with a Thrombospondin type 1 Motif, member 13 (ADAMTS-13), which leads to small-vessel platelet-rich thrombi, thrombocytopenia, and microangiopathic hemolytic anemia (MHA) in the absence of neutralizing antibodies. We describe a case of cTTP in a female neonate presenting initially on the 1^st day of life with asymptomatic thrombocytopenia thought to be alloimmune thrombocytopenia, then progressed to severe neonatal jaundice, pallor, and MHA, in whom ADAMTS-13 levels <5%, and the anti-ADAMTS-13 antibody titer was negative confirming the diagnosis of cTTP. The patient initially received intravenous immunoglobulin infusion before documenting MHA. She received fresh frozen plasma infusions which successfully reversed the MHA (by supplying ADAMTS-13) and prevented organ damage in this patient.

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We describe a preterm infant with a peripherally inserted central catheter (PICC) placement. The PICC line was suspected to be in the persistent left superior vena cava (PLSVC), confirmed by echocardiogram. PLSVC is a rare anomaly. On routine screening, the infant was noted to have an ipsilateral intraventricular hemorrhage (IVH) postulated to be secondary to the altered retrograde blood flow through the PLSVC. No such association has been reported previously. The case presentation is followed by evidence supporting the postulated mechanism. Although the association between PLSVC and IVH could be coincidental, clinicians should be aware of the blood flow-related problem associated with PLSVC in preterm infants.

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