Pub Date : 2022-01-01DOI: 10.7860/ijnmr/2022/54874.2334
B. Rameshbabu, P. Punitha, E. Manochitra, K. Sasikala, J. Balaji
Introduction: Scorpion envenomation is a life-threatening paediatric emergency. Prazosin-an alpha-1 blocker is the gold standard therapy for scorpion envenomation. Many children with scorpion envenomation were under-treated at Primary Healthcare (PHC) and Secondary Healthcare (SHC) level because of lack of awareness about prazosin therapy. If prazosin is started earlier at PHC and SHC level, complications and mortality can be reduced. Aim: To conduct sensitisation programme for PHC and SHC doctors regarding the management of paediatric emergencies including scorpion envenomation, and to evaluate the effectiveness of sensitisation programme on prazosin therapy for scorpion envenomation at PHC and SHC level. Materials and Methods: This non concurrent clinical trial consisted of training PHC and SHC doctors at the Department of Paediatrics, Government Dharmapuri Medical College Hospital, Tamil Nadu, India for a period of two years (January 2018-December 2019). After the training, children aged 1 month-12 years with features of scorpion envenomation referred from PHC and SHC to this tertiary care centre, during January 2021-September 2021 were evaluated. The data regarding initiation of prazosin therapy at PHC and SHC level and the clinical profile, complications and outcome at tertiary care level were noted. The present study parameters were compared with previous study on scorpion envenomation, done before the sensitisation programme in the same centre, and the data were compared. Results: Training was given to 120 medical officers of PHC and SHC. Sixty-two children, with scorpion envenomation referred from PHC and SHC, were included in the study. A total of 7 (10%) children brought to the tertiary care centre directly were excluded. Prazosin therapy was initiated in 43 (69.3%) children at PHC and SHC level before referral. Initiation of prazosin within four hours of scorpion sting was done in 45 (72.6%). Common symptoms were pain {42 (68%)}, diaphoresis {26 (42%)} and salivation {25 (40%)}. Cold peripheries, myocarditis and pulmonary oedema were noted in 24 (39%), 4 (6%) and 6 (10%) children, respectively. Dobutamine and Non Invasive Ventilation (NIV) were needed in 13 (21%) and 11 (18%) cases, respectively. When compared to the observations pretraining, peripheral circulatory failure (76% to 39%) (p=0.019), pulmonary oedema (27% to 10%) (p=0.010), myocarditis (17% to 6%) (p=0.039), ionotrope support (41% to 21%) (p=0.024), and NIV (39% to 18%) (p<0.003) were significantly reduced. There was no mortality. Conclusion: Following the sensitisation programme, initiation of prazosin for scorpion envenomation at PHC and SHC level significantly improved. Complications like myocarditis, pulmonary oedema, need for inotropes and ventilator support decreased significantly.
{"title":"Effectiveness of Sensitisation Programme on Prazosin Therapy for Scorpion Envenomation at Primary and Secondary Healthcare Level","authors":"B. Rameshbabu, P. Punitha, E. Manochitra, K. Sasikala, J. Balaji","doi":"10.7860/ijnmr/2022/54874.2334","DOIUrl":"https://doi.org/10.7860/ijnmr/2022/54874.2334","url":null,"abstract":"Introduction: Scorpion envenomation is a life-threatening paediatric emergency. Prazosin-an alpha-1 blocker is the gold standard therapy for scorpion envenomation. Many children with scorpion envenomation were under-treated at Primary Healthcare (PHC) and Secondary Healthcare (SHC) level because of lack of awareness about prazosin therapy. If prazosin is started earlier at PHC and SHC level, complications and mortality can be reduced. Aim: To conduct sensitisation programme for PHC and SHC doctors regarding the management of paediatric emergencies including scorpion envenomation, and to evaluate the effectiveness of sensitisation programme on prazosin therapy for scorpion envenomation at PHC and SHC level. Materials and Methods: This non concurrent clinical trial consisted of training PHC and SHC doctors at the Department of Paediatrics, Government Dharmapuri Medical College Hospital, Tamil Nadu, India for a period of two years (January 2018-December 2019). After the training, children aged 1 month-12 years with features of scorpion envenomation referred from PHC and SHC to this tertiary care centre, during January 2021-September 2021 were evaluated. The data regarding initiation of prazosin therapy at PHC and SHC level and the clinical profile, complications and outcome at tertiary care level were noted. The present study parameters were compared with previous study on scorpion envenomation, done before the sensitisation programme in the same centre, and the data were compared. Results: Training was given to 120 medical officers of PHC and SHC. Sixty-two children, with scorpion envenomation referred from PHC and SHC, were included in the study. A total of 7 (10%) children brought to the tertiary care centre directly were excluded. Prazosin therapy was initiated in 43 (69.3%) children at PHC and SHC level before referral. Initiation of prazosin within four hours of scorpion sting was done in 45 (72.6%). Common symptoms were pain {42 (68%)}, diaphoresis {26 (42%)} and salivation {25 (40%)}. Cold peripheries, myocarditis and pulmonary oedema were noted in 24 (39%), 4 (6%) and 6 (10%) children, respectively. Dobutamine and Non Invasive Ventilation (NIV) were needed in 13 (21%) and 11 (18%) cases, respectively. When compared to the observations pretraining, peripheral circulatory failure (76% to 39%) (p=0.019), pulmonary oedema (27% to 10%) (p=0.010), myocarditis (17% to 6%) (p=0.039), ionotrope support (41% to 21%) (p=0.024), and NIV (39% to 18%) (p<0.003) were significantly reduced. There was no mortality. Conclusion: Following the sensitisation programme, initiation of prazosin for scorpion envenomation at PHC and SHC level significantly improved. Complications like myocarditis, pulmonary oedema, need for inotropes and ventilator support decreased significantly.","PeriodicalId":31116,"journal":{"name":"Indian Journal of Neonatal Medicine and Research","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71266288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.7860/ijnmr/2022/49608.2331
T. Sankar, TV Ramkumar, SarojShekhar Rath, P. Mallik, Bharati Das
Carnitine Acylcarnitine Translocase (CACT) deficiency and Carnitine Palmitoyl Transferase (CPT I and II) deficiency comes under a group of disorders called mitochondrial fatty acid oxidation disorders, due to defects in the carnitine cycle. The CPT and CACT enzymes play a pivotal role in the transfer of Long Chain Fatty Acids (LCFA) from the cytoplasm to the mitochondrial matrix, where β-oxidation take place. In the present case, a male baby presented on day 2 of life with chief complaints of respiratory distress, apnoea, lethargy and seizures. The baby had multiple episodes of hypoglycaemia and seizures after admission. Diagnosis was made with the help of extended newborn screening using Tandem Mass Spectrometry (TMS) showing accumulation of hexadecanoyl carnitine due to CACT/CPT II deficiency. Echocardiography showed features of cardiomyopathy with cardiomegaly. Liver Function Test (LFT) and Prothrombin Time-International Normalisation Ratio (PT-INR) of the child was also deranged, with hypotonia of all muscles. Early detection along with carnitine supplementation and further prevention of fasting episodes resulted in generalised improvement of the baby. So, a high degree of suspicion of Inborn Error of Metabolism (IEM) and timely diagnosis can save the baby
{"title":"Carnitine Cycle Defect in Newborn: A Rare Case Report","authors":"T. Sankar, TV Ramkumar, SarojShekhar Rath, P. Mallik, Bharati Das","doi":"10.7860/ijnmr/2022/49608.2331","DOIUrl":"https://doi.org/10.7860/ijnmr/2022/49608.2331","url":null,"abstract":"Carnitine Acylcarnitine Translocase (CACT) deficiency and Carnitine Palmitoyl Transferase (CPT I and II) deficiency comes under a group of disorders called mitochondrial fatty acid oxidation disorders, due to defects in the carnitine cycle. The CPT and CACT enzymes play a pivotal role in the transfer of Long Chain Fatty Acids (LCFA) from the cytoplasm to the mitochondrial matrix, where β-oxidation take place. In the present case, a male baby presented on day 2 of life with chief complaints of respiratory distress, apnoea, lethargy and seizures. The baby had multiple episodes of hypoglycaemia and seizures after admission. Diagnosis was made with the help of extended newborn screening using Tandem Mass Spectrometry (TMS) showing accumulation of hexadecanoyl carnitine due to CACT/CPT II deficiency. Echocardiography showed features of cardiomyopathy with cardiomegaly. Liver Function Test (LFT) and Prothrombin Time-International Normalisation Ratio (PT-INR) of the child was also deranged, with hypotonia of all muscles. Early detection along with carnitine supplementation and further prevention of fasting episodes resulted in generalised improvement of the baby. So, a high degree of suspicion of Inborn Error of Metabolism (IEM) and timely diagnosis can save the baby","PeriodicalId":31116,"journal":{"name":"Indian Journal of Neonatal Medicine and Research","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71266365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.7860/ijnmr/2022/53354.2330
B. K. Khuntdar, S. Mondal, Umesh Mudi, M. P. Mohanta
Introduction: Neonatal mortality is the most important contributor towards infant mortality. Special Newborn Care Units (SNCUs) are part of the facility based newborn care of National Health Mission (NHM) and cornerstones for reducing neonatal mortality. Aim: To study the mortality and morbidity data of a tertiary care SNCU of rural tribal Eastern India and find out the focus area for improvement. Materials and Methods: This was a retrospective observational study carried out on 19397 babies admitted in the SNCU of Midnapore Medical College, Midnapore, West Bengal, India, from February 2016 to January 2021. Data were collected from the SNCU admission register and computerised reporting data of SNCU. In this study, five years admission and mortality data of the SNCU was analysed. Results: There were 67729 live births during the period between February 2016 and January 2021, out of which 8627 were admitted to the SNCU (inborn). There were 1195 deaths among the inborn babies, thus the mortality rate was13.8%. The number of outborn babies admitted during the study period was 10770, out of which 1357 babies died, thus the mortality rate was 12.6%. There was significantly higher mortality among inborn babies than outborn babies (13.8% vs. 12.6%). The major causes of admissions in the SNCU were prematurity (n=10167, 52.5%), Low Birth Weight (LBW) (n=11519, 59.3%), jaundice (n=4692, 24.19%), Hypoxic Ischaemic Encephalopathy (HIE) (n=4278, 22%) and sepsis (n=2161, 11.14%). The main causes of mortality were HIE (n=766, 30%), and sepsis (n=709, 27.78%), followed by respiratory distress syndrome (n=162, 6.3%), congenital malformations (n=77, 3%), and meconium aspiration syndrome (n=37, 1.45%). Conclusion: Prematurity and LBW were the major causes of morbidity and mortality. Sepsis and HIE were the major direct causes of mortality. Hence to reduce neonatal morbidity and mortality focus should be on preventing the above causes.
{"title":"Analysis of Five Years Data of Special Newborn Care Unit in a Rural Medical College: Scope for Improvement in Neonatal Mortality and Morbidity","authors":"B. K. Khuntdar, S. Mondal, Umesh Mudi, M. P. Mohanta","doi":"10.7860/ijnmr/2022/53354.2330","DOIUrl":"https://doi.org/10.7860/ijnmr/2022/53354.2330","url":null,"abstract":"Introduction: Neonatal mortality is the most important contributor towards infant mortality. Special Newborn Care Units (SNCUs) are part of the facility based newborn care of National Health Mission (NHM) and cornerstones for reducing neonatal mortality. Aim: To study the mortality and morbidity data of a tertiary care SNCU of rural tribal Eastern India and find out the focus area for improvement. Materials and Methods: This was a retrospective observational study carried out on 19397 babies admitted in the SNCU of Midnapore Medical College, Midnapore, West Bengal, India, from February 2016 to January 2021. Data were collected from the SNCU admission register and computerised reporting data of SNCU. In this study, five years admission and mortality data of the SNCU was analysed. Results: There were 67729 live births during the period between February 2016 and January 2021, out of which 8627 were admitted to the SNCU (inborn). There were 1195 deaths among the inborn babies, thus the mortality rate was13.8%. The number of outborn babies admitted during the study period was 10770, out of which 1357 babies died, thus the mortality rate was 12.6%. There was significantly higher mortality among inborn babies than outborn babies (13.8% vs. 12.6%). The major causes of admissions in the SNCU were prematurity (n=10167, 52.5%), Low Birth Weight (LBW) (n=11519, 59.3%), jaundice (n=4692, 24.19%), Hypoxic Ischaemic Encephalopathy (HIE) (n=4278, 22%) and sepsis (n=2161, 11.14%). The main causes of mortality were HIE (n=766, 30%), and sepsis (n=709, 27.78%), followed by respiratory distress syndrome (n=162, 6.3%), congenital malformations (n=77, 3%), and meconium aspiration syndrome (n=37, 1.45%). Conclusion: Prematurity and LBW were the major causes of morbidity and mortality. Sepsis and HIE were the major direct causes of mortality. Hence to reduce neonatal morbidity and mortality focus should be on preventing the above causes.","PeriodicalId":31116,"journal":{"name":"Indian Journal of Neonatal Medicine and Research","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71266389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.7860/ijnmr/2022/55647.2351
RK Shwetabh, Manas R Upadhyay, R. Upadhyay
Introduction: Nosocomial infections are a major problem for hospitalised neonates due to increase in morbidity, mortality, duration of hospitalisation and costs of treatment. The magnitude of this problem varies from place to place and is unique to each place as per the organisms and their resistance pattern is concerned. There is need to develop local level surveillance data on incidence of nosocomial sepsis, causative organisms, their sensitivity pattern and periodically review antibiotic policy based on this information. Aim: To determine the aetiological agents of nosocomial sepsis and their antibiotic sensitivity and resistance pattern. Materials and Methods: This was a cross-sectional study in which the cases of nosocomial infections in neonates of > 35 weeks were studied from November 2018-October 2019 at Sriram Chandra Bhanja Medical College and Hospital (S.C.B.M.C.H) and Sardar Vallabh Bhai Patel Postgraduate Institute of Paediatrics (S.V.P.P.G.I.P) based on clinical findings, sepsis screen and blood culture. Blood culture is considered as gold standard for diagnosis of sepsis. Blood sample (1 mL) was collected under strict asepsis in Becton Dickinson and Company (BACTEC) and was sent for performing blood culture. The data was processed and arranged into distribution tables and cross tables using Statistical Package for the Social Sciences (SPSS) version 21.0. Results: Out of total 100 suspected cases of nosocomial sepsis, blood culture was positive in 46 (46%) of cases. Candida spp. was the most common obtained organism 9 (19.5%) followed by Klebsiella pneumoniae 8 (17.3%) and Staphylococcus aureus 8 (17.3%) each respectively. There was increased incidence of bacterial resistance to commonly used antibiotics and combinations of it, like ampicillin, gentamicin, cefotaxime, amikacin and piperacillin+ tazobactam among these bacterial isolates. Among the possible new combinations deduced from the observation, the combination of vancomycin+amikacin had sensitivity of 67.6% and can be considered as initial antibiotic combination of choice while combination with colistin and tigecycline should be reserved only for culture proven resistant cases or babies who continue to be deteriorating and critically sick while on previous combination. Conclusion: Candida spp. is the leading cause of nosocomial sepsis. Among bacterial organisms, Klebsiella pneumoniae and Staphylococcus aureus are most common. Most isolates are resistant to traditional antibiotics, hence new combination like vancomycin+amikacin are more appropriate empiric choice in present context and combination with colistin and tigecycline are reserved only for culture proven resistant sepsis.
由于发病率、死亡率、住院时间和治疗费用的增加，医院感染是住院新生儿面临的一个主要问题。这个问题的严重程度因地而异，每个地方都是独一无二的，因为生物体和它们的抗性模式是有关的。有必要建立关于医院败血症发生率、病原生物及其敏感性模式的地方监测数据，并根据这些信息定期审查抗生素政策。目的:了解院内败血症的病因及其抗生素敏感性和耐药模式。材料与方法:本研究是一项横断面研究，基于临床表现、败血症筛查和血培养，研究了2018年11月至2019年10月在斯利拉姆·钱德拉·巴贾医学院和医院(S.C.B.M.C.H)和萨达尔·瓦拉巴·巴伊·帕特尔儿科研究生研究所(S.V.P.P.G.I.P)进行的bb0 - 35周新生儿医院感染病例。血培养被认为是诊断败血症的金标准。在Becton Dickinson and Company (BACTEC)严格无菌条件下采集血样(1ml)，送血培养。使用SPSS 21.0版对数据进行处理并整理成分布表和交叉表。结果:100例院内败血症疑似病例中，46例(46%)血培养阳性。最常见的病原菌是念珠菌9(19.5%)，其次是肺炎克雷伯菌8(17.3%)和金黄色葡萄球菌8(17.3%)。这些细菌分离株对氨苄西林、庆大霉素、头孢噻肟、阿米卡星和哌拉西林+他唑巴坦等常用抗生素及其组合的耐药发生率增加。在观察推断的可能的新组合中，万古霉素+阿米卡星联合的敏感性为67.6%，可考虑作为初始抗生素组合的选择，而粘菌素和替加环素联合应仅用于培养证实耐药的病例或既往联合后病情继续恶化和危重的婴儿。结论:念珠菌是院内败血症的主要原因。在细菌有机体中，肺炎克雷伯菌和金黄色葡萄球菌是最常见的。大多数分离株对传统抗生素具有耐药性，因此万古霉素+阿米卡星等新组合是目前情况下更合适的经验选择，而粘菌素和替加环素的组合仅用于培养证实具有耐药性的败血症。
{"title":"Aetiological Agents in Neonatal Nosocomial Sepsis and their Sensitivity Pattern from a Tertiary Care Hospital, Odisha, India: A Cross-sectional Study","authors":"RK Shwetabh, Manas R Upadhyay, R. Upadhyay","doi":"10.7860/ijnmr/2022/55647.2351","DOIUrl":"https://doi.org/10.7860/ijnmr/2022/55647.2351","url":null,"abstract":"Introduction: Nosocomial infections are a major problem for hospitalised neonates due to increase in morbidity, mortality, duration of hospitalisation and costs of treatment. The magnitude of this problem varies from place to place and is unique to each place as per the organisms and their resistance pattern is concerned. There is need to develop local level surveillance data on incidence of nosocomial sepsis, causative organisms, their sensitivity pattern and periodically review antibiotic policy based on this information. Aim: To determine the aetiological agents of nosocomial sepsis and their antibiotic sensitivity and resistance pattern. Materials and Methods: This was a cross-sectional study in which the cases of nosocomial infections in neonates of > 35 weeks were studied from November 2018-October 2019 at Sriram Chandra Bhanja Medical College and Hospital (S.C.B.M.C.H) and Sardar Vallabh Bhai Patel Postgraduate Institute of Paediatrics (S.V.P.P.G.I.P) based on clinical findings, sepsis screen and blood culture. Blood culture is considered as gold standard for diagnosis of sepsis. Blood sample (1 mL) was collected under strict asepsis in Becton Dickinson and Company (BACTEC) and was sent for performing blood culture. The data was processed and arranged into distribution tables and cross tables using Statistical Package for the Social Sciences (SPSS) version 21.0. Results: Out of total 100 suspected cases of nosocomial sepsis, blood culture was positive in 46 (46%) of cases. Candida spp. was the most common obtained organism 9 (19.5%) followed by Klebsiella pneumoniae 8 (17.3%) and Staphylococcus aureus 8 (17.3%) each respectively. There was increased incidence of bacterial resistance to commonly used antibiotics and combinations of it, like ampicillin, gentamicin, cefotaxime, amikacin and piperacillin+ tazobactam among these bacterial isolates. Among the possible new combinations deduced from the observation, the combination of vancomycin+amikacin had sensitivity of 67.6% and can be considered as initial antibiotic combination of choice while combination with colistin and tigecycline should be reserved only for culture proven resistant cases or babies who continue to be deteriorating and critically sick while on previous combination. Conclusion: Candida spp. is the leading cause of nosocomial sepsis. Among bacterial organisms, Klebsiella pneumoniae and Staphylococcus aureus are most common. Most isolates are resistant to traditional antibiotics, hence new combination like vancomycin+amikacin are more appropriate empiric choice in present context and combination with colistin and tigecycline are reserved only for culture proven resistant sepsis.","PeriodicalId":31116,"journal":{"name":"Indian Journal of Neonatal Medicine and Research","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71266417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.7860/ijnmr/2022/50253.2324
N. Agarwal, Alpa Gupta, R. Dhasmana, A. Mehta, N. Agrawal
Systemic Pseudohypoaldosteronism type I (PHA I) is an uncommon and an often missed cause of salt wasting crisis in the neonatal period. In addition to dyselectrolytemia, cutaneous findings in the form of miliaria rubra, and ophthalmic findings secondary to abnormal sebum accumulation in the eye may also be present in patients with systemic PHA I. This article is about systemic PHA in a female neonate (birth weight 2.040 Kg, delivered at 34 weeks of gestation), who presented with life-threatening hyperkalemia, along with characteristic cutaneous and ophthalmic manifestations. Normal female genitalia, history of hyperkalemia with similar cutaneous and ophthalmic manifestations leading to death in the previous sibling, provided clue to the diagnosis. All relevant investigations were performed. Blood chemistry in this neonate revealed hyponatremia and hyperkalemia with metabolic acidosis. Plasma renin and serum aldosterone levels were reportedly high. Neonate was followed and electrolytes were monitored twice weekly on outpatient basis. But the life-threatening hyperkalemia led to multiple episodes of vomiting and, refusal to feed for few hours and the baby succumbed to death at age of 2.5 months. Hence, it was concluded that systemic PHA I should be considered in the differential diagnosis of neonates presenting with hyponatremic dehydration, hyperkalemia, and metabolic acidosis. Timely and appropriate electrolyte correction is pivotal for favourable outcome.
{"title":"Cutaneous and Ocular Findings in Systemic Pseudohypoaldosteronism I: Early Clinical Pointers","authors":"N. Agarwal, Alpa Gupta, R. Dhasmana, A. Mehta, N. Agrawal","doi":"10.7860/ijnmr/2022/50253.2324","DOIUrl":"https://doi.org/10.7860/ijnmr/2022/50253.2324","url":null,"abstract":"Systemic Pseudohypoaldosteronism type I (PHA I) is an uncommon and an often missed cause of salt wasting crisis in the neonatal period. In addition to dyselectrolytemia, cutaneous findings in the form of miliaria rubra, and ophthalmic findings secondary to abnormal sebum accumulation in the eye may also be present in patients with systemic PHA I. This article is about systemic PHA in a female neonate (birth weight 2.040 Kg, delivered at 34 weeks of gestation), who presented with life-threatening hyperkalemia, along with characteristic cutaneous and ophthalmic manifestations. Normal female genitalia, history of hyperkalemia with similar cutaneous and ophthalmic manifestations leading to death in the previous sibling, provided clue to the diagnosis. All relevant investigations were performed. Blood chemistry in this neonate revealed hyponatremia and hyperkalemia with metabolic acidosis. Plasma renin and serum aldosterone levels were reportedly high. Neonate was followed and electrolytes were monitored twice weekly on outpatient basis. But the life-threatening hyperkalemia led to multiple episodes of vomiting and, refusal to feed for few hours and the baby succumbed to death at age of 2.5 months. Hence, it was concluded that systemic PHA I should be considered in the differential diagnosis of neonates presenting with hyponatremic dehydration, hyperkalemia, and metabolic acidosis. Timely and appropriate electrolyte correction is pivotal for favourable outcome.","PeriodicalId":31116,"journal":{"name":"Indian Journal of Neonatal Medicine and Research","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71266437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.7860/ijnmr/2022/53265.2340
A. Dalal, A. Dhingra, D. Jakhar, .. Janshruti, .. Vaibhav, Ritambhara Lohan, Jyoti Sangwan
Introduction: Novel Coronavirus Disease-2019 (COVID-19) is caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). Besides the systemic manifestations, muco- cutaneous involvement has also been reported with COVID-19. Reports suggest that the mucocutaneous manifestations may differ in children and adult patients. Aim: To describe the prevalence and characteristics of cutaneous manifestations among COVID-19 infected Children. Materials and Methods: This descriptive cross-sectional study was undertaken in Shaheed Hasan Khan Mewati, Government Medical College and Hospital, Nuh, Haryana, India. Fifty SARS- CoV-2 positive children, admitted during the study period (between July, 2020 to December, 2020) and fulfilling inclusion criteria were screened for muco-cutaneous manifestations. Findings were recorded on a predesigned proforma. The data was statistically analysed and significant association between findings was recorded. Results: Total 50 (4.56%) children out of 1095 were positive for SARS-CoV-2 Reverse Transcription Polymerase Chain Reaction (RT-PCR) test and were admitted in Isolation Ward. Male to female ratio was 3:2 in present study. Four children had cutaneous manifestation: maculopapular rash (3/50) and urticarial lesions (1/50). All four patients had mild to moderate severity of disease. None of the patient had mucosal involvement. Conclusion: Appearance of dermatological findings among 8% of COVID-19 positive children warrants that all COVID-19 positive children should be screened for cutaneous findings.
简介:新型冠状病毒病-2019 (COVID-19)是由严重急性呼吸综合征冠状病毒-2 (SARS-CoV-2)引起的。除了全身性表现外，也有报道称COVID-19累及皮肤粘膜。报告显示，儿童和成人患者的粘膜皮肤表现可能不同。目的:了解新冠肺炎(COVID-19)患儿皮肤表现的流行情况及特点。材料和方法:本描述性横断面研究在印度哈里亚纳邦努赫政府医学院和医院的Shaheed Hasan Khan Mewati进行。在研究期间(2020年7月至2020年12月)入院的50名符合纳入标准的SARS- CoV-2阳性儿童进行了皮肤粘膜表现筛查。结果记录在预先设计的表格上。对数据进行统计分析，并记录结果之间的显著关联。结果:1095例患儿中，SARS-CoV-2逆转录聚合酶链式反应(RT-PCR)阳性50例(4.56%)，进入隔离病房。本研究中男女比例为3:2。4名儿童有皮肤表现:斑疹(3/50)和荨麻疹(1/50)。所有四名患者均有轻度至中度的疾病严重程度。所有患者均无粘膜受累。结论:在8%的COVID-19阳性儿童中出现皮肤学表现，证明所有COVID-19阳性儿童都应进行皮肤检查。
{"title":"Cutaneous Manifestations Among Hospitalised COVID-19 Infected Children from Northern India: A Cross-sectional Study","authors":"A. Dalal, A. Dhingra, D. Jakhar, .. Janshruti, .. Vaibhav, Ritambhara Lohan, Jyoti Sangwan","doi":"10.7860/ijnmr/2022/53265.2340","DOIUrl":"https://doi.org/10.7860/ijnmr/2022/53265.2340","url":null,"abstract":"Introduction: Novel Coronavirus Disease-2019 (COVID-19) is caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). Besides the systemic manifestations, muco- cutaneous involvement has also been reported with COVID-19. Reports suggest that the mucocutaneous manifestations may differ in children and adult patients. Aim: To describe the prevalence and characteristics of cutaneous manifestations among COVID-19 infected Children. Materials and Methods: This descriptive cross-sectional study was undertaken in Shaheed Hasan Khan Mewati, Government Medical College and Hospital, Nuh, Haryana, India. Fifty SARS- CoV-2 positive children, admitted during the study period (between July, 2020 to December, 2020) and fulfilling inclusion criteria were screened for muco-cutaneous manifestations. Findings were recorded on a predesigned proforma. The data was statistically analysed and significant association between findings was recorded. Results: Total 50 (4.56%) children out of 1095 were positive for SARS-CoV-2 Reverse Transcription Polymerase Chain Reaction (RT-PCR) test and were admitted in Isolation Ward. Male to female ratio was 3:2 in present study. Four children had cutaneous manifestation: maculopapular rash (3/50) and urticarial lesions (1/50). All four patients had mild to moderate severity of disease. None of the patient had mucosal involvement. Conclusion: Appearance of dermatological findings among 8% of COVID-19 positive children warrants that all COVID-19 positive children should be screened for cutaneous findings.","PeriodicalId":31116,"journal":{"name":"Indian Journal of Neonatal Medicine and Research","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71266491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.7860/ijnmr/2022/56704.2348
V. Mandala, Siddhartha Gangadhari, Muralikrishna Thummakomma, Rakesh Kotha
Introduction: Exclusive breastfeeding practices for six months and its continuity, including supplementary foods, is recommended to the child for a particular duration. In addition, antenatal counselling on early breastfeeding practices ensures optimum nutrition for the neonates, thereby reducing mortality. Aim: To evaluate the positive effects of antenatal counselling on breastfeeding outcomes in primigravida women. Materials and Methods: This quasi-experimental study was conducted over 18 months on the mothers who attended the Obstetrics Department at Niloufer Hospital in Hyderabad, India. Participants were allocated either to a study group (n=100) (volunteered for antenatal counselling) or a control group (n=100) (did not volunteer for antenatal counselling). The study group received 1-3 breastfeeding counselling sessions during different months of gestation, whereas the control group merely received routine antenatal counselling. A breastfeeding performance checklist was finished, and the outcome of the counselling sessions was observed among the subjects. The procured data was analysed using the Statistical Package for the Social Sciences (SPSS) software version 22.0 for the t-test, odds ratio and Chi- square values, p<0.05 was considered statistically significant. Results: This study monitored the breastfeeding practice of mothers in the first 48 hours and defined corrective timely breastfeeding practice for the following infantile period based on their reflexively formed habits under the impact of counselling improving awareness. Statistically, significant difference was observed in the counselled group concerning duration of breastfeeding, importance, and the benefits of breastfeeding to the mothers and families when compared to the control group (p<0.0001**). In addition, the questionnaire and the breastfeeding assessment scores were statistically significant in the counselled group compared to the control group (p<0.001** and p=0.002*, respectively). Conclusion: The statistically significant results of the study showed that antenatal counselling during pregnancy increases the frequency and duration of exclusive breastfeeding in mothers. Various aspects of counselling sessions on breastfeeding practices cleared the myths and misconceptions that mothers previously had in this study.
{"title":"Effect of Antenatal Counselling by Healthcare Professionals in Initiating Precise Early Breastfeeding Practices in Primigravida Mothers: A Quasi-experimental Study","authors":"V. Mandala, Siddhartha Gangadhari, Muralikrishna Thummakomma, Rakesh Kotha","doi":"10.7860/ijnmr/2022/56704.2348","DOIUrl":"https://doi.org/10.7860/ijnmr/2022/56704.2348","url":null,"abstract":"Introduction: Exclusive breastfeeding practices for six months and its continuity, including supplementary foods, is recommended to the child for a particular duration. In addition, antenatal counselling on early breastfeeding practices ensures optimum nutrition for the neonates, thereby reducing mortality. Aim: To evaluate the positive effects of antenatal counselling on breastfeeding outcomes in primigravida women. Materials and Methods: This quasi-experimental study was conducted over 18 months on the mothers who attended the Obstetrics Department at Niloufer Hospital in Hyderabad, India. Participants were allocated either to a study group (n=100) (volunteered for antenatal counselling) or a control group (n=100) (did not volunteer for antenatal counselling). The study group received 1-3 breastfeeding counselling sessions during different months of gestation, whereas the control group merely received routine antenatal counselling. A breastfeeding performance checklist was finished, and the outcome of the counselling sessions was observed among the subjects. The procured data was analysed using the Statistical Package for the Social Sciences (SPSS) software version 22.0 for the t-test, odds ratio and Chi- square values, p<0.05 was considered statistically significant. Results: This study monitored the breastfeeding practice of mothers in the first 48 hours and defined corrective timely breastfeeding practice for the following infantile period based on their reflexively formed habits under the impact of counselling improving awareness. Statistically, significant difference was observed in the counselled group concerning duration of breastfeeding, importance, and the benefits of breastfeeding to the mothers and families when compared to the control group (p<0.0001**). In addition, the questionnaire and the breastfeeding assessment scores were statistically significant in the counselled group compared to the control group (p<0.001** and p=0.002*, respectively). Conclusion: The statistically significant results of the study showed that antenatal counselling during pregnancy increases the frequency and duration of exclusive breastfeeding in mothers. Various aspects of counselling sessions on breastfeeding practices cleared the myths and misconceptions that mothers previously had in this study.","PeriodicalId":31116,"journal":{"name":"Indian Journal of Neonatal Medicine and Research","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71266594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.7860/ijnmr/2022/53588.2322
P. Subramanian, Jayalakshmi Pabbati, Mahesh Renikuntla, S. R. Chitgupikar
Introduction: Pregnancy Induced Hypertension (PIH) can lead to intrauterine growth restriction resulting in Low Birth Weight (LBW) neonates. LBW remains a significant cause of under-five mortality in India and Asia. Aim: To calculate the prevalence of PIH and to study the correlation between Birth Weight (BW) of neonates and severity of maternal hypertension; and compare the incidence of neonatal morbidities across varying severity of maternal hypertension. Materials and Methods: A longitudinal study was conducted among 153 pregnant mothers, diagnosed with PIH. They were classified into mild {Systolic Blood Pressure (SBP) ≥140- 149 mmHg or Diastolic Blood Pressure (DBP) ≥90-99 mmHg}, moderate (SBP ≥150-159 mmHg or DBP ≥100-109 mmHg) and severe (SBP ≥160 mmHg or DBP ≥110 mmHg) hypertension. A total of 142 neonates, born to PIH mothers, were included. The neonates were followed-up for seven days to check for early neonatal outcomes and deaths. Correlation between maternal blood pressure (systolic and diastolic) and BW of the neonates was assessed using Pearson’s correlation coefficient (r). Binary Logistic Regression (BLR) was performed to analyse the impact of confounders on BW. Results: The prevalence of PIH was 7.76% (153/1972). The mean BW of neonates born to mothers with moderate (2.435 kg) and severe hypertension (2.342 kg) was significantly lower than that of neonates born to mothers with mild hypertension (2.828 kg) (p<0.00001). 1SD increase in SBP resulted in 0.245 kg decrease in BW, while an 1SD increase in DBP resulted in 0.312 kg decrease in BW. After accounting for confounders using BLR, maternal DBP still had a significant negative correlation with BW (r=-0.663; p<0.001). The incidence of prematurity (p<0.0001), small for Gestational Age (GA) (p=0.0283), Respiratory Distress (RD) (p=0.002), Neonatal Hyperbilirubinemia (NNH) (p=0.033) and Neonatal Intensive Care Unit (NICU) admissions (p=0.003) were significantly higher among neonates born to mothers with moderate and severe hypertension than those born to mothers with mild hypertension. Three neonatal deaths (all due to perinatal asphyxia) were observed in this study and there was no statistical significance with respect to deaths across neonates of the three groups (p=0.219). Conclusion: Maternal DBP had a significant negative correlation with BW. The mean BW of neonates born to mothers with severe hypertension was significantly lower compared to those born to mild hypertension.
{"title":"Correlation of Severity of Maternal Hypertension and Birth Weight of Neonates- A Longitudinal Study","authors":"P. Subramanian, Jayalakshmi Pabbati, Mahesh Renikuntla, S. R. Chitgupikar","doi":"10.7860/ijnmr/2022/53588.2322","DOIUrl":"https://doi.org/10.7860/ijnmr/2022/53588.2322","url":null,"abstract":"Introduction: Pregnancy Induced Hypertension (PIH) can lead to intrauterine growth restriction resulting in Low Birth Weight (LBW) neonates. LBW remains a significant cause of under-five mortality in India and Asia. Aim: To calculate the prevalence of PIH and to study the correlation between Birth Weight (BW) of neonates and severity of maternal hypertension; and compare the incidence of neonatal morbidities across varying severity of maternal hypertension. Materials and Methods: A longitudinal study was conducted among 153 pregnant mothers, diagnosed with PIH. They were classified into mild {Systolic Blood Pressure (SBP) ≥140- 149 mmHg or Diastolic Blood Pressure (DBP) ≥90-99 mmHg}, moderate (SBP ≥150-159 mmHg or DBP ≥100-109 mmHg) and severe (SBP ≥160 mmHg or DBP ≥110 mmHg) hypertension. A total of 142 neonates, born to PIH mothers, were included. The neonates were followed-up for seven days to check for early neonatal outcomes and deaths. Correlation between maternal blood pressure (systolic and diastolic) and BW of the neonates was assessed using Pearson’s correlation coefficient (r). Binary Logistic Regression (BLR) was performed to analyse the impact of confounders on BW. Results: The prevalence of PIH was 7.76% (153/1972). The mean BW of neonates born to mothers with moderate (2.435 kg) and severe hypertension (2.342 kg) was significantly lower than that of neonates born to mothers with mild hypertension (2.828 kg) (p<0.00001). 1SD increase in SBP resulted in 0.245 kg decrease in BW, while an 1SD increase in DBP resulted in 0.312 kg decrease in BW. After accounting for confounders using BLR, maternal DBP still had a significant negative correlation with BW (r=-0.663; p<0.001). The incidence of prematurity (p<0.0001), small for Gestational Age (GA) (p=0.0283), Respiratory Distress (RD) (p=0.002), Neonatal Hyperbilirubinemia (NNH) (p=0.033) and Neonatal Intensive Care Unit (NICU) admissions (p=0.003) were significantly higher among neonates born to mothers with moderate and severe hypertension than those born to mothers with mild hypertension. Three neonatal deaths (all due to perinatal asphyxia) were observed in this study and there was no statistical significance with respect to deaths across neonates of the three groups (p=0.219). Conclusion: Maternal DBP had a significant negative correlation with BW. The mean BW of neonates born to mothers with severe hypertension was significantly lower compared to those born to mild hypertension.","PeriodicalId":31116,"journal":{"name":"Indian Journal of Neonatal Medicine and Research","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71266123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.7860/ijnmr/2022/52509.2332
S. Aiyer, A. Datar
Introduction: Retinopathy Of Prematurity (ROP) is a vasoproliferative disorder that affects premature infants with multiple risk factors. Timely screening and treatment can help decrease this preventable cause of blindness. Aim: To assess the risk factors for development of ROP, and to study its association with postnatal weight gain. Materials and Methods: This was an observational study with both prospective and retrospective arms. In the retrospective component, the case files and ROP screening records of the infants were screened, in the duration of July 2019 to February 2020. The prospective data was collected from the ongoing screening sessions, during March 2020 to November 2020. The risk factors for ROP, and postnatal weight gain was observed during the ROP screening programme conducted at the intramural Neonatal Intensive Care Unit (NICU) of Sir Sayajirao Hospital, Vadodara, Gujarat, India. Infants with Birth Weight (BW) <2000 g and Gestational Age (GA) <34 weeks and those with high risk factors {prolonged oxygen exposure, mechanical ventilation, anaemia requiring blood transfusion, Intraventricular Haemorrhage (IVH), Respiratory Distress Syndrome (RDS), Bronchopulmonary Dysplasia (BPD), recurrent apnea, hypotension requiring inotropes, surgery during first week of life, sepsis and hypoglycaemia} were included in the study. Subjects were followed-up till 44 weeks Post-Menstrual Age (PMA), or till complete vascularisation of retina or regression of ROP on retinal examination whichever was earlier. Risk factors were studied using univariate analysis and multivariate regression. Weight gain was studied using independent sample t-test. Results: A total of 486 neonates were enrolled, who underwent serial ophthalmological examinations. Out of these, 375 infants (198 (52.8%) male and 177 (42.7%) females) underwent examinations until 44 weeks of PMA or till complete retinal vascularisation, or till complete regression of ROP with or without treatment. Out of these, 173 patients had no ROP, 120 patients developed ROP which got spontaneously regressed over time and 82 patients developed severe ROP which required treatment. Mean Gestational Age (GA) in the study population was 34.35 week (±2.64 wk), and mean Birth Weight (BW) was 1.67 kg (±0.45 kg). In the group of severe ROP, mean GA was 32.03 week (±1.33 wk) and mean BW was 1.33 kg (±0.35 kg); and the mean number of positive risk factors were 5.93 (±1.77). Poor postnatal weight gain was associated with more risk of severe ROP. GA <34 week (p-value <0.0001), BW <1750 g (p-value <0.0001), oxygen exposure (p-value <0.0001), IVH (p-value <0.0001), RDS (p-value=0.0111), BPD (p-value=0.0058), hypotension requiring inotropes (p-value=0.0001) and sepsis (p-value <0.0001) were significant risk factors. On multivariate logistic regression, BW <1750 g, GA <34 week, sepsis and hypotension requiring inotropes were most important risk factors for ROP, along with poor postnatal weight gain. Conclusion: Poor pos
{"title":"Risk Factors for Retinopathy of Prematurity with Specific Emphasis on Postnatal Weight Gain: An Observational Study","authors":"S. Aiyer, A. Datar","doi":"10.7860/ijnmr/2022/52509.2332","DOIUrl":"https://doi.org/10.7860/ijnmr/2022/52509.2332","url":null,"abstract":"Introduction: Retinopathy Of Prematurity (ROP) is a vasoproliferative disorder that affects premature infants with multiple risk factors. Timely screening and treatment can help decrease this preventable cause of blindness. Aim: To assess the risk factors for development of ROP, and to study its association with postnatal weight gain. Materials and Methods: This was an observational study with both prospective and retrospective arms. In the retrospective component, the case files and ROP screening records of the infants were screened, in the duration of July 2019 to February 2020. The prospective data was collected from the ongoing screening sessions, during March 2020 to November 2020. The risk factors for ROP, and postnatal weight gain was observed during the ROP screening programme conducted at the intramural Neonatal Intensive Care Unit (NICU) of Sir Sayajirao Hospital, Vadodara, Gujarat, India. Infants with Birth Weight (BW) <2000 g and Gestational Age (GA) <34 weeks and those with high risk factors {prolonged oxygen exposure, mechanical ventilation, anaemia requiring blood transfusion, Intraventricular Haemorrhage (IVH), Respiratory Distress Syndrome (RDS), Bronchopulmonary Dysplasia (BPD), recurrent apnea, hypotension requiring inotropes, surgery during first week of life, sepsis and hypoglycaemia} were included in the study. Subjects were followed-up till 44 weeks Post-Menstrual Age (PMA), or till complete vascularisation of retina or regression of ROP on retinal examination whichever was earlier. Risk factors were studied using univariate analysis and multivariate regression. Weight gain was studied using independent sample t-test. Results: A total of 486 neonates were enrolled, who underwent serial ophthalmological examinations. Out of these, 375 infants (198 (52.8%) male and 177 (42.7%) females) underwent examinations until 44 weeks of PMA or till complete retinal vascularisation, or till complete regression of ROP with or without treatment. Out of these, 173 patients had no ROP, 120 patients developed ROP which got spontaneously regressed over time and 82 patients developed severe ROP which required treatment. Mean Gestational Age (GA) in the study population was 34.35 week (±2.64 wk), and mean Birth Weight (BW) was 1.67 kg (±0.45 kg). In the group of severe ROP, mean GA was 32.03 week (±1.33 wk) and mean BW was 1.33 kg (±0.35 kg); and the mean number of positive risk factors were 5.93 (±1.77). Poor postnatal weight gain was associated with more risk of severe ROP. GA <34 week (p-value <0.0001), BW <1750 g (p-value <0.0001), oxygen exposure (p-value <0.0001), IVH (p-value <0.0001), RDS (p-value=0.0111), BPD (p-value=0.0058), hypotension requiring inotropes (p-value=0.0001) and sepsis (p-value <0.0001) were significant risk factors. On multivariate logistic regression, BW <1750 g, GA <34 week, sepsis and hypotension requiring inotropes were most important risk factors for ROP, along with poor postnatal weight gain. Conclusion: Poor pos","PeriodicalId":31116,"journal":{"name":"Indian Journal of Neonatal Medicine and Research","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71266321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.7860/ijnmr/2022/57793.2356
N. Adalarasan, S. Stalin, Seenivasan Venkatasamy, S. Sridevi, S. Padmanaban, P. Chinnaiyan
Introduction: Neonatal sepsis is a leading cause of mortality and morbidity. Inspite of using appropriate antibiotics, those who are bacterial culture-negative, still succumb to fungal infection. Fungal sepsis is common in the neonatal Intensive Care Unit (ICU), especially with invasive procedures and prolonged empirical use of antibiotics. The incidence of fungal infection varies widely across centers, likely due to differences in practice related to modifiable risk factors such as exposure to empiric antibiotics and length of parenteral nutrition. Neonates are at high risk for acquiring infections due to their specific Central Nervous System (CNS) structure as well as functionally immature immune system causing central nervous system infection or intracranial haemorrhage due to sepsis induced coagulopathy. Being Intracranial Haemorrhage (ICH) in neonates often results in devastating neurodevelopment outcome and also having significant mortality in the neonatal period. Aim: To find the association and outcome of intracranial haemorrhage in newborn with fungal sepsis. Materials and Methods: This study was a prospective cohort study conducted at Department of Pediatrics, Government Kilpauk Medical College, Chennai, Tamil Nadu, India, on neonates admitted in newborn ward of the hospital ICU during the period January 2018 to December 2020. Neonates with the diagnosis of fungal sepsis were identified from blood cultures. They were also subjected to Complete Blood Count (CBC), Capillary Refilling Time (CRT), Prothrombin Time (PT), activated Partial Thromboblastin clotting time (aPTT) and cranial ultrasound. Chi-square analysis for descriptive data and Cox Proportional Hazard Regression for survival and non survival neonates and Kaplan-Meier curve analysis was done. Results: Out of total 80 neonates, nine had intracerebral haemorrhage, 21 neonates had intraventricular haemorrhage and no haemorrahge in 50 neonates. More the gestational age, lesser were the chances of intracranial haemorrhage and the difference was statistically significant (p-value<0.001). A total of 50 babies died, majority (42%) were in the gestational age between 37-40 weeks. All the babies diagnosed with C. albicans sepsis succumbed to infection. Conclusion: The present study highlights the fact that the lesser of the gestational age, the more or the chances of intracranial haemorrhage. A close monitoring of the coagulation profile PT and aPTT will help us to identify the babies for more prone for intracranial haemorrhage. Expert cranial ultrasound will pick up the haemorrhage early. Timely treatment measures instituted will help in preventing mortality due to bleeding manifestions in fungal sepsis. The Cox regression analysis reveals that both PT& aPTT and intracranial haemorrhage are the associated risk factors for non survival in fungal sepsis neonates.
{"title":"Association and Outcome of Intracranial Haemorrhage in Newborn with Fungal Sepsis- A Prospective Cohort Study","authors":"N. Adalarasan, S. Stalin, Seenivasan Venkatasamy, S. Sridevi, S. Padmanaban, P. Chinnaiyan","doi":"10.7860/ijnmr/2022/57793.2356","DOIUrl":"https://doi.org/10.7860/ijnmr/2022/57793.2356","url":null,"abstract":"Introduction: Neonatal sepsis is a leading cause of mortality and morbidity. Inspite of using appropriate antibiotics, those who are bacterial culture-negative, still succumb to fungal infection. Fungal sepsis is common in the neonatal Intensive Care Unit (ICU), especially with invasive procedures and prolonged empirical use of antibiotics. The incidence of fungal infection varies widely across centers, likely due to differences in practice related to modifiable risk factors such as exposure to empiric antibiotics and length of parenteral nutrition. Neonates are at high risk for acquiring infections due to their specific Central Nervous System (CNS) structure as well as functionally immature immune system causing central nervous system infection or intracranial haemorrhage due to sepsis induced coagulopathy. Being Intracranial Haemorrhage (ICH) in neonates often results in devastating neurodevelopment outcome and also having significant mortality in the neonatal period. Aim: To find the association and outcome of intracranial haemorrhage in newborn with fungal sepsis. Materials and Methods: This study was a prospective cohort study conducted at Department of Pediatrics, Government Kilpauk Medical College, Chennai, Tamil Nadu, India, on neonates admitted in newborn ward of the hospital ICU during the period January 2018 to December 2020. Neonates with the diagnosis of fungal sepsis were identified from blood cultures. They were also subjected to Complete Blood Count (CBC), Capillary Refilling Time (CRT), Prothrombin Time (PT), activated Partial Thromboblastin clotting time (aPTT) and cranial ultrasound. Chi-square analysis for descriptive data and Cox Proportional Hazard Regression for survival and non survival neonates and Kaplan-Meier curve analysis was done. Results: Out of total 80 neonates, nine had intracerebral haemorrhage, 21 neonates had intraventricular haemorrhage and no haemorrahge in 50 neonates. More the gestational age, lesser were the chances of intracranial haemorrhage and the difference was statistically significant (p-value<0.001). A total of 50 babies died, majority (42%) were in the gestational age between 37-40 weeks. All the babies diagnosed with C. albicans sepsis succumbed to infection. Conclusion: The present study highlights the fact that the lesser of the gestational age, the more or the chances of intracranial haemorrhage. A close monitoring of the coagulation profile PT and aPTT will help us to identify the babies for more prone for intracranial haemorrhage. Expert cranial ultrasound will pick up the haemorrhage early. Timely treatment measures instituted will help in preventing mortality due to bleeding manifestions in fungal sepsis. The Cox regression analysis reveals that both PT& aPTT and intracranial haemorrhage are the associated risk factors for non survival in fungal sepsis neonates.","PeriodicalId":31116,"journal":{"name":"Indian Journal of Neonatal Medicine and Research","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71266797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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