Razieh Sangsari, K. Mirnia, M. Saeedi, N. Asl, A. Kajbafzadeh
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.
{"title":"Prognostic value of carbohydrate antigen 19-9 in the urine of mothers with fetal hydronephrosis to the severity and cause of neonatal renal involvement","authors":"Razieh Sangsari, K. Mirnia, M. Saeedi, N. Asl, A. Kajbafzadeh","doi":"10.4103/jcn.jcn_6_22","DOIUrl":"https://doi.org/10.4103/jcn.jcn_6_22","url":null,"abstract":"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.","PeriodicalId":45332,"journal":{"name":"Journal of Clinical Neonatology","volume":"11 1","pages":"143 - 149"},"PeriodicalIF":0.2,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45995186","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}
Emmanuel Ogbe, E. Anigilaje, E. Olateju, Uduak Offiong, U. Sanni, K. Airede
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.
{"title":"Cordblood vitamin A levels and intraventricular hemorrhage outcomes in preterm infants","authors":"Emmanuel Ogbe, E. Anigilaje, E. Olateju, Uduak Offiong, U. Sanni, K. Airede","doi":"10.4103/jcn.jcn_54_22","DOIUrl":"https://doi.org/10.4103/jcn.jcn_54_22","url":null,"abstract":"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.","PeriodicalId":45332,"journal":{"name":"Journal of Clinical Neonatology","volume":"11 1","pages":"165 - 171"},"PeriodicalIF":0.2,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47998634","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}
Sudhir Malwade, M. Nayak, Anand Gangadharan, S. Agarkhedkar
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.
{"title":"Fulminant late-onset sepsis due to elizabethkingia meningoseptica in term newborns","authors":"Sudhir Malwade, M. Nayak, Anand Gangadharan, S. Agarkhedkar","doi":"10.4103/jcn.jcn_8_22","DOIUrl":"https://doi.org/10.4103/jcn.jcn_8_22","url":null,"abstract":"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.","PeriodicalId":45332,"journal":{"name":"Journal of Clinical Neonatology","volume":"11 1","pages":"182 - 186"},"PeriodicalIF":0.2,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47527332","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}
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.
{"title":"Difference in the nucleated red blood cell counts among donor and receipt twins affected by Twin‒Twin transfusion syndrome","authors":"S. Manzar","doi":"10.4103/jcn.jcn_47_22","DOIUrl":"https://doi.org/10.4103/jcn.jcn_47_22","url":null,"abstract":"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.","PeriodicalId":45332,"journal":{"name":"Journal of Clinical Neonatology","volume":"11 1","pages":"192 - 194"},"PeriodicalIF":0.2,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48522758","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}
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.
{"title":"Neonatal outcome of twins and singleton neonates: An experience from tertiary care teaching center of Eastern Maharashtra, India","authors":"R. Meshram, Arya James","doi":"10.4103/jcn.jcn_50_22","DOIUrl":"https://doi.org/10.4103/jcn.jcn_50_22","url":null,"abstract":"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.","PeriodicalId":45332,"journal":{"name":"Journal of Clinical Neonatology","volume":"11 1","pages":"159 - 164"},"PeriodicalIF":0.2,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46869884","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}
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.
{"title":"Occurrence of vesicoureteral reflux among the antenatally detected urinary tract dilation/antenatal hydronephrosis","authors":"I. Ahmed, M. Ashraf, N. Mir, S. Andrabi","doi":"10.4103/jcn.jcn_14_22","DOIUrl":"https://doi.org/10.4103/jcn.jcn_14_22","url":null,"abstract":"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.","PeriodicalId":45332,"journal":{"name":"Journal of Clinical Neonatology","volume":"11 1","pages":"150 - 153"},"PeriodicalIF":0.2,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48952350","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}
Sudhir Malwade, M. Nayak, Anand Gangadharan, S. Agarkhedkar
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.
头皮先天性AV畸形是一种罕见的先天性血管畸形，常被误诊为血管瘤。迄今为止，只有3例新生儿头皮动静脉畸形的报告。我们报告了一例罕见的新生儿头皮AV自退化畸形。一个小时大的足月女婴，出现一个柔软的搏动性大病变（5cm x 4cm），边界抬高，左侧顶枕区有硬皮，听诊有瘀伤。婴儿有轻微的心脏杂音。USG颅骨可能提示AV畸形或脑血肿。MR脑静脉造影显示颅骨外多个扩张的弯曲静脉网络流入左横窦、乙状窦和IJV。CT脑和CT颈动脉造影显示，左侧ECA及其分支、脑膜中动脉和左侧椎动脉有多条动脉馈线，多条静脉通道流入左侧横窦、乙状窦、IJV和EJV，可能是动静脉畸形，不太可能是婴儿血管瘤。超声心动图显示中肌小VSD。计划进行血管内栓塞，但没有立即进行，因为婴儿没有表现出任何心力衰竭的迹象。婴儿正在定期随访，生长良好，病变正在自行消退。到目前为止，婴儿没有任何心力衰竭的迹象，因此只给予支持性护理。AVM的早期发现和综合管理可产生积极的结果。只有当获益大于风险时，才建议进行栓塞治疗。
{"title":"Self-regressing scalp arteriovenous malformation in a neonate","authors":"Sudhir Malwade, M. Nayak, Anand Gangadharan, S. Agarkhedkar","doi":"10.4103/jcn.jcn_32_22","DOIUrl":"https://doi.org/10.4103/jcn.jcn_32_22","url":null,"abstract":"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.","PeriodicalId":45332,"journal":{"name":"Journal of Clinical Neonatology","volume":"11 1","pages":"187 - 191"},"PeriodicalIF":0.2,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47661185","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}
Premkumar Segaran, CN Kamalarathnam, A. Murugesan, Vaideeswaran Mariappan
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.
{"title":"Long QT syndrome: Presenting as fetal bradycardia","authors":"Premkumar Segaran, CN Kamalarathnam, A. Murugesan, Vaideeswaran Mariappan","doi":"10.4103/jcn.jcn_147_21","DOIUrl":"https://doi.org/10.4103/jcn.jcn_147_21","url":null,"abstract":"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.","PeriodicalId":45332,"journal":{"name":"Journal of Clinical Neonatology","volume":"11 1","pages":"179 - 181"},"PeriodicalIF":0.2,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47114721","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}
T. Natarajan, Ramesh Srinivasan, S. Raju, Suvetha Kannapan
Objective: To compare the diagnostic accuracy of various transcutaneous bilirubin (TcB) nomograms for predischarge screening. Methods: The paired total serum bilirubin (TSB) and TcB measurements collected in neonates ≥35 weeks and ≥2000 g birth weight were analyzed. BiliCare™ bilirubinometer was used for TcB measurement. We chose the following nomograms for the study: Bhutani nomogram, Maisel's nomogram, Agarwal nomogram, Thakkar nomogram, American Academy of Pediatrics (AAP) nomogram within 3 mg/dl of phototherapy cutoff, AAP nomogram >70% of phototherapy cutoff and if TcB value is above 13 mg/dl. The diagnostic accuracy of these nomograms for TcB was compared with TSB plotted in the Bhutani nomogram. Results: TcB showed a positive correlation with TSB (Pearson correlation coefficient = 0.783). Bhutani nomogram, Maisel's nomogram and AAP (using within 3 mg/dL cutoff) nomogram showed good sensitivity and low false-negative rate while avoiding blood draws in most neonates. Conclusion: Bhutani nomogram, Maisel's nomogram, and AAP (using within 3 mg/dL of phototherapy cutoff) nomograms have comparable diagnostic accuracy for predischarge bilirubin screening in neonates.
{"title":"Predischarge screening of neonates with transcutaneous bilirubinometer: Comparison of various nomograms","authors":"T. Natarajan, Ramesh Srinivasan, S. Raju, Suvetha Kannapan","doi":"10.4103/jcn.jcn_129_21","DOIUrl":"https://doi.org/10.4103/jcn.jcn_129_21","url":null,"abstract":"Objective: To compare the diagnostic accuracy of various transcutaneous bilirubin (TcB) nomograms for predischarge screening. Methods: The paired total serum bilirubin (TSB) and TcB measurements collected in neonates ≥35 weeks and ≥2000 g birth weight were analyzed. BiliCare™ bilirubinometer was used for TcB measurement. We chose the following nomograms for the study: Bhutani nomogram, Maisel's nomogram, Agarwal nomogram, Thakkar nomogram, American Academy of Pediatrics (AAP) nomogram within 3 mg/dl of phototherapy cutoff, AAP nomogram >70% of phototherapy cutoff and if TcB value is above 13 mg/dl. The diagnostic accuracy of these nomograms for TcB was compared with TSB plotted in the Bhutani nomogram. Results: TcB showed a positive correlation with TSB (Pearson correlation coefficient = 0.783). Bhutani nomogram, Maisel's nomogram and AAP (using within 3 mg/dL cutoff) nomogram showed good sensitivity and low false-negative rate while avoiding blood draws in most neonates. Conclusion: Bhutani nomogram, Maisel's nomogram, and AAP (using within 3 mg/dL of phototherapy cutoff) nomograms have comparable diagnostic accuracy for predischarge bilirubin screening in neonates.","PeriodicalId":45332,"journal":{"name":"Journal of Clinical Neonatology","volume":"11 1","pages":"86 - 89"},"PeriodicalIF":0.2,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47753830","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}
Hamidreza Shatabi, Negin Moghadam, A. Shafa, Mohamadreza Habibzade
Background: Nowadays, with or without sugar, balanced electrolyte solutions are used to prevent hyponatremia, hypoglycemia, and hyperglycemia for neonatal fluid therapy. Objectives: This study aimed to compare the effects of two types of fluid therapy with normal saline and 5% dextrose in half amount of normal saline (DW5% NaCl 0.45%) solution on plasma electrolytes and blood glucose during and after surgery in neonates. Methods: The research population consisted of 1-day to 30-day-old infants who were candidates for surgery under general anesthesia; 70 infants were selected and assigned by block randomization in two groups of 35. Patients in Group A received fluid therapy with normal saline 0.9% (10 cc/kg/h) and DW 5% NaCl 0.45% solution in Group B (10 cc/kg/h). Results: There was no significant difference in the mean value of bicarbonate level (HCO3), base excess and blood acidity (pH) in the study groups (P > 0.05). In Group A, there was no significant difference in sodium (Na) and mean arterial pressure (MAP) over time (P > 0.123), while in Group B, Na level decreased and MAP increased significantly (P < 0.05) with time. Blood sugar levels increased significantly in both groups over time, although this increase was greater in Group B. Conclusion: In general, the results of the study showed that both fluid therapy with normal saline and DW5% NaCl 0.45% solutions can be used in neonatal surgery, but based on the studied variables in this work, normal saline has a lower risk of hyperglycemia than DW5% NaCl 0.45% solution and therefore it is preferred.
{"title":"Comparison the effects of using two methods of fluid therapy with normal saline or 5% dextrose in half amount of normal saline solution on blood glucose and plasma electrolytes during and after neonatal surgeries: A randomized controlled trial","authors":"Hamidreza Shatabi, Negin Moghadam, A. Shafa, Mohamadreza Habibzade","doi":"10.4103/jcn.jcn_131_21","DOIUrl":"https://doi.org/10.4103/jcn.jcn_131_21","url":null,"abstract":"Background: Nowadays, with or without sugar, balanced electrolyte solutions are used to prevent hyponatremia, hypoglycemia, and hyperglycemia for neonatal fluid therapy. Objectives: This study aimed to compare the effects of two types of fluid therapy with normal saline and 5% dextrose in half amount of normal saline (DW5% NaCl 0.45%) solution on plasma electrolytes and blood glucose during and after surgery in neonates. Methods: The research population consisted of 1-day to 30-day-old infants who were candidates for surgery under general anesthesia; 70 infants were selected and assigned by block randomization in two groups of 35. Patients in Group A received fluid therapy with normal saline 0.9% (10 cc/kg/h) and DW 5% NaCl 0.45% solution in Group B (10 cc/kg/h). Results: There was no significant difference in the mean value of bicarbonate level (HCO3), base excess and blood acidity (pH) in the study groups (P > 0.05). In Group A, there was no significant difference in sodium (Na) and mean arterial pressure (MAP) over time (P > 0.123), while in Group B, Na level decreased and MAP increased significantly (P < 0.05) with time. Blood sugar levels increased significantly in both groups over time, although this increase was greater in Group B. Conclusion: In general, the results of the study showed that both fluid therapy with normal saline and DW5% NaCl 0.45% solutions can be used in neonatal surgery, but based on the studied variables in this work, normal saline has a lower risk of hyperglycemia than DW5% NaCl 0.45% solution and therefore it is preferred.","PeriodicalId":45332,"journal":{"name":"Journal of Clinical Neonatology","volume":"11 1","pages":"79 - 85"},"PeriodicalIF":0.2,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48252197","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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