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   2022| July-September  | Volume 11 | Issue 3  
    Online since July 6, 2022

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Enhancing the quality of neonatal care by improving mothers' knowledge, attitude, and practice through checklist intervention
Sanmithra Patavardhan Koppa Arunakumar, Sujatha Ramabhatta, SR Lakshmipathy, BG Raghunandan, K Rashmi, Dudala Kumaraswamy, P Priya Mol, C Anushree
July-September 2022, 11(3):154-158
Objectives: The objective of this study is to improve the newborn and self-care practices among postnatal mothers through quality improvement techniques and to create awareness about newborn and perinatal care practices in the Mother and Child Protection (MCP) Card. Materials and Methods: The barriers to low newborn and self-care practices were identified and evaluated using fishbone analysis. An operational team was formed, and a checklist was created. A total of four Plan-Do-Study-Act (PDSA) cycles were carried out. Baseline knowledge was collected using the questionnaire from the checklist. Appropriate education and counseling regarding newborns and self-care practices were taught. A variety of measures were used during counseling. The educated mothers were recalled after 5–7 days to assess their knowledge. Results: A total of 102 postnatal mothers were enrolled in the study, and 78 were available for follow-up after 5–7 days. During all study cycles, median checklist scores increased from 38 to 57 (PDSA 1), 37 to 58 (PDSA 2), 37 to 57 (PDSA 3), and 32.5 to 56 (PDSA 4). The increase in median checklist scores in all the PDSA cycles was statistically significant (P < 0.05). The median difference in checklist score from baseline in the chronological order of PDSA cycles was 19, 21.5, 22, and 23. After educating the mothers about the MCP Card, the percentage of mothers who read the information in the MCP Card increased from <5% to 38%. Conclusion: Quality Improvement principles such as the introduction of a checklist can be successfully implemented to improve the quality of newborns and self-care practices among postnatal mothers.
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Occurrence of vesicoureteral reflux among the antenatally detected urinary tract dilation/antenatal hydronephrosis
Ibrar Ahmed, Mohd Ashraf, Naseer Yousuf Mir, Syed Ashiq Nisar Andrabi
July-September 2022, 11(3):150-153
Background: Approximately 1% of pregnancies on obstetric ultrasound (US) are associated with structural fetal anomalies, among whom 20% are of the genitourinary system. Objective: The objective of this study was to determine the occurrence of vesicoureteral reflux (VUR) among the antenatally detected urinary tract dilation (UTD)/antenatal hydronephrosis (ANH) on postnatal follow-up. Methods: The study was a prospective observational study where the presence of anterior-posterior renal pelvis diameter (APRPD) of the fetal kidneys on obstetric ultrasound of >4 mm in the second trimester or >7 mm in the third trimester was taken to diagnose UTD/ANH were enrolled for the follow-up of successive US scans postnatally on the 7th, 30th, and 45th day of life. Patients with APRPD >4 mm postnatally, were subjected to micturating cystourethrogram (MCUG) at or after 45 days of life. Results: A total of 61,587 pregnant women visited the outpatient department, among whom 10,800 pregnant women underwent US scanning for fetal well-being during the second trimester, where 119/10,800 (1.1%) had UTD/ANH. A total of 21 patients were excluded from the study for various reasons and 98 patients were on follow-up. Postnatally on the 7th day of life, UTD/hydronephrosis (HDN) was detected in 41/98 (41.8%), as 57/98 (58.2%) neonates had no UTD/HDN. VUR was detected in 21/98 (21.4%) on MCUG. Conclusion: Around three-fifth of fetal UTD/ANH had a spontaneous resolution, whereas 2/5th has persistent UTD/HDN. Moderate and severe UTD/ANH infants possess a high risk of VUR as was observed in the present study and mandates a careful follow-up, to avoid any medical/surgical eventuality.
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Cordblood vitamin A levels and intraventricular hemorrhage outcomes in preterm infants
Emmanuel Augustine Ogbe, Emmanuel Ademola Anigilaje, Eyinade Kudirat Olateju, Uduak Mayen Offiong, Usman Abiola Sanni, Kaareem Iwunmole Airede
July-September 2022, 11(3):165-171
Background and Aims: Intraventricular hemorrhage (IVH) is a major complication of preterm birth and large haemorrhages may yield significant future disability. Although multifactorial, prematurity and low birth weight are the most important risk factors for IVH. Furthermore, being “born too soon” affects the accretion of Vitamin A (VA) which is essential for normal brain development. We sought out to estimate VA nutrient levels among preterm newborn infants at birth and establish any relationship with IVH occurrence and grade severity. Methods: Ninety infants were recruited over a 6-month period. VA levels were determined by the enzyme-linked immunosorbent assay using cord blood and IVH was assessed by transcranial ultrasound scan done on the 7th day of life. Data analysis was by the Statistical Package for the Social Sciences IBM (SPSS) version 21. P < 0.05 was considered statistically significant. Results: The infants' median interquartile ranges for gestational age, birth weight, and cord blood VA levels were 32 weeks (4.25 weeks), 1580 g (650 g), and 0.31 μmol/L (0.19 μmol/L), respectively. The prevalence of VA deficiency, low VA, and sufficient VA was 67.8%, 25.5%, and 6.7%, respectively. IVH was found in 8 (9.20%) infants, with incidence rates of 5.70%, 2.30%, and 1.10% for Grades I, II, and III, respectively. Although statistically insignificant, the occurrence of IVH was only among infants with abnormal VA status at birth (P = 0.65). Conclusions: Despite low median cord blood VA level of preterm infants in this study, there is no impact on IVH occurrence or grade severity. Further study with larger sample size is warranted.
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Prognostic value of carbohydrate antigen 19-9 in the urine of mothers with fetal hydronephrosis to the severity and cause of neonatal renal involvement
Razieh Sangsari, Kayvan Mirnia, Maryam Saeedi, Nina Gozali Asl, Abdol-Mohammad Kajbafzadeh
July-September 2022, 11(3):143-149
Background: Hydronephrosis is the most common problem in prenatal sonography, which early detection decreases its complication and increases the survival rate of infants. Increased carbohydrate antigen 19-9 (CA19-9) tumor marker has been observed in nonmalignant conditions including hydronephrosis secondary to ureteral stones. This study aimed to determine the relationship between urinary CA19-9 in mothers with hydronephrosis fetuses with prognosis, severity, and cause of neonatal renal insufficiency. Materials and Methods: The present study is a retrospective/prospective cohort study. The CA19-9 was measured in 63 pregnant women who had a fetus with hydronephrosis in the third trimester of pregnancy. The relationship between CA19-9 and the following parameters was evaluated: causes of hydronephrosis, need for hospitalization after birth, need for surgery, treatment status, and survival. Results: In the present study, high values of CA19-9 (more than 27.8%) were able to predict severe hydronephrosis in neonates with a sensitivity of 80.6% and a specificity of 59.6%. An increase in this marker also could determine the pathological cause of hydronephrosis such as posterior urethral valves, the need for hydronephrosis surgery (P < 0.001), the need for hospitalization (P < 0.001), and the need to assisted ventilation (P = 0.001). Conclusion: The level of CA19-9 biomarker in the urine of pregnant mothers with hydronephrosis fetuses can be predictive value. Even urinary CA19-9 of mothers during the pregnancy can predict the need for the neonatal intensive care unit after delivery.
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Neonatal outcome of twins and singleton neonates: An experience from tertiary care teaching center of Eastern Maharashtra, India
Rajkumar Motiram Meshram, Arya James
July-September 2022, 11(3):159-164
Introduction: It is impossible to achieve the target of Sustainable Developmental Goal without focusing on care of twins' neonates as they are more prone for death and higher chance of long-term morbidity and neurodevelopmental handicap in survivors. Aim: To estimate the outcome among twin and singleton neonates at a tertiary care teaching center of Eastern Maharashtra. Materials and Methods: Prospective observational study was conducted on neonatal intensive care unit graduates of twin birth and simultaneously admitted singletons at Government Medical College and Hospital Nagpur from June 2020 to February 2021 (9 months). Outcome among twin and singleton neonates, and their morbidity and mortality pattern were studied. Results: A total of 210 neonates of twin birth and 870 singleton neonates were recruited. Male were dominant in both groups. Preterm and low birth weight neonates were significantly more in twins compared to singleton neonates. Twin neonates were significantly more hypothermic (P < 0.001) and hypoxic (P = 0.001) compared to singleton. Jaundice (37.62%) and respiratory distress syndrome (36.67%) were the most common diagnosis in twin neonates while sepsis (34.71%) was predominant in singleton. Sepsis (33.9%) was the most common cause of death in singleton neonates while respiratory distress syndrome (35.38%) in twin births. Length of hospital stay (P < 0.0001) and neonatal mortality were significantly higher in twin neonates compared to singleton neonates (P = 0.001). Conclusion: Sepsis is the leading cause of admission and death in singleton neonates while respiratory distress syndrome in twins. Twin neonates have significantly higher mortality and longer hospital stay because of prematurity and low birth weight.
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Fulminant late-onset sepsis due to elizabethkingia meningoseptica in term newborns
Sudhir Malwade, Manas Nayak, Anand Gangadharan, Sharad R Agarkhedkar
July-September 2022, 11(3):182-186
Elizabethkingia meningosepticum is not usually found in the human body. Just a few cases have been reported in neonates in India to date. We provide a series of two different cases of Elizabethkingia meningoseptica encephalitis that were admitted to our newborn intensive care unit (NICU). At our NICU we observed two cases of Elizabethkingia meningoseptica, during a period of 1 month. Both the babies presented with refractory status epilepticus and decreased feeding. The organism was isolated from cerebrospinal fluid (CSF) and blood in the first baby whereas it was isolated from postmortem CSF sample in the second case. In both the cases, the organism was resistant to multiple antibiotics. The first baby was found to have ventriculitis and hydrocephalus and was discharged after complete recovery although had neurological deficits. The second baby presented at 2nd day of life and succumbed to death at 8th day of life. A difficult treatment, poor associated prognosis, and its multidrug resistance warrants a better understanding of the organism.
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Long QT syndrome: Presenting as fetal bradycardia
Premkumar Segaran, CN Kamalarathnam, Anitha Murugesan, Vaideeswaran Mariappan
July-September 2022, 11(3):179-181
Long QT syndromes (LQTSs) are inherited disorders of abnormal myocardial repolarization. It is characterized by prolonged QT interval, T wave abnormalities, and tachyarrhythmias such as Torsade de Pointes. Previous literature on congenital LQTS in neonates had reported presentations of cardiac arrhythmias leading to sudden death in the postnatal period. We present here a case of a neonate who presented initially with fetal bradycardia; postnatally developed ventricular tachyarrhythmias which after stabilization showed prolonged QT interval in electrocardiography leading to the diagnosis of LQTS due to a rare mutation in the ankyrin B gene. Acute ventricular tachyarrhythmia was managed with lidocaine and magnesium infusion. We used propranolol to sustain the reduction in QT interval to prevent tachyarrhythmias and Torsades de Pointes and thereby sudden death. On follow-up, the infant showed normal growth and neurodevelopment with QT interval maintained below 500 ms on propranolol prophylaxis. Fetal bradycardia can also be one of the initial manifestations of LQTS due to rare genetic mutations involving the ankyrin B gene.
  370 50 -
A neonate with peromelia: congenital transverse deficiency of an upper limb
Rakesh Kumar, Sanober Wasim, Girish Gupta, Mansi Naithani
July-September 2022, 11(3):176-178
Peromelia is a rare condition leading to the absence of limb. Birth of such a baby is an unexpected and emotionally disturbing event for the parents, if it was not diagnosed antenatally. Family members and especially the mother at such time need proper counseling from the health-care workers during the initial days. The management aspects including prosthesis and timing of intervention need to be informed to the parents. Here, we describe a case of peromelia with emphasis on the psychological aspect of management.
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A case of neonatal alloimmune neutropenia with an uncommon presentation
Marta Ribeiro Silva, Vasco Carvalho, Filipa Raposo, Margarida Lima, Miguel Costa
July-September 2022, 11(3):172-175
Neonatal alloimmune neutropenia (NAN) is a rare condition in neonates, with an incidence of <0.1%. It occurs when maternal antibodies against neutrophil antigens inherited from the father cross the placenta, destroying the neutrophils of the fetus and/or the newborn. We report a case of a female neonate who started exhibiting scattered petechiae over the trunk and lower limbs, a day after birth. The blood count revealed severe neutropenia and mild thrombocytopenia. Infections were excluded. Flow cytometry analysis confirmed the presence of antineutrophil immunoglobulin G antibodies in the newborn's neutrophil membrane and in the mother's serum. When screened for polymorphisms in the genes encoding for human neutrophil antigens (HNA), we identified HNA-1b and/or HNA-3a as potential causes of the mother/daughter incompatibility. Even though neutropenia is usually self-limiting, neonates with NAN are at risk of developing severe infections. Therefore, early identification of these patients can prevent serious complications.
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Self-regressing scalp arteriovenous malformation in a neonate
Sudhir Malwade, Manas Nayak, Anand Gangadharan, Sharad Agarkhedkar
July-September 2022, 11(3):187-191
Congenital AV malformations of scalp are rare congenital vascular malformations and often misdiagnosed as hemangiomas. Only 3 cases of neonatal scalp AVM have been reported till date. We report a rare case of self regressing scalp AV malformation in a neonate. An hour old full term female baby, presented with a soft, pulsatile large lesion (5cm x 4cm) with elevated borders and crusting over left parieto-occipital area, with bruit on auscultation. The infant had a soft cardiac murmur. USG cranium was likely suggestive of AV malformation or cephalhematoma. MR brain venography showed extra-calvarial network of multiple dilated tortuous veins draining into the left transverse sinus, sigmoid sinus and IJV. CT brain with CT carotid angiography revealed multiple arterial feeders from the left ECA and its branches, middle meningeal artery and left vertebral artery with multiple venous channels seen draining into the left transverse sinus, sigmoid sinus, IJV and EJV, the possibilities were arteriovenous malformation and less likely infantile hemangioma. Echocardiography showed small midmuscular VSD. Endovascular embolization was planned but didn't do immediately as the baby didn't show any signs of cardiac failure. The baby is on regular follow up and is growing well, with the lesion being regressing on its own. The baby doesn't have any signs of cardiac failure till now, hence only supportive care is being given. Early detection and comprehensive management of AVM result in a positive outcome. Embolization is only recommended if benefit outweighs the risk.
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Difference in the nucleated red blood cell counts among donor and receipt twins affected by Twin‒Twin transfusion syndrome
Shabih Manzar
July-September 2022, 11(3):192-194
A high nucleated red blood cell (NRBC) count at birth is taken as a biomarker of fetal hypoxia. In twin-to-twin transfusion syndrome (TTTS), the communication of placental vessels between the donor and recipient twin creates an imbalance of blood flow resulting in anemia in the donor and polycythemia in the recipient. The anemia in donors results in hypoxia. The NRBC count could be used as a biomarker of chronic hypoxia in donor twins. A literature search shows no previous report on the NRBC count at birth comparing donor and recipient twins in TTTS. We present a case of TTTS with a discussion on the pathophysiology of elevated NRBC at birth in donor twins.
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