Indian Journal of Neonatal Medicine & Research

Status of Transported Neonates and Evaluation of TOPS as a Survival Score

Introduction: To achieve sustainable development goal -3, now we need to focus our attention more towards neonates being transported to higher centre in this very fragile period. We planned this study to assess clinical and demographic characteristics of referred neonates and to evaluate TOPS as a survival score in these babies. Aim: To study the morbidity and mortality pattern in out born neonates admitted in Umaid Hospital. To evaluate TOPS score to predict their outcome. Materials and Methods: This prospective observational study was carried out in a tertiary care teaching hospital. All neonates = 1 kg, born outside of this hospital, and referred here for further management were included. All the data pertaining to clinical and demographic characteristics were recorded. TOPS score was applied at admission and was related with the final outcome; expired or survived. Outcomes were analyzed using chi square test, and ROC curve analysis was done to find out optimum TOPS score to predict mortality. Results: Seventy percent of neonates were referred via ambulance, but condition of these babies at admission was dismal; hypothermic (46.67%), hypoxic (39.23%), hypoglycaemic (21.28%), and poor perfusion (14.61%), the last group being the most fatal (63.16% mortality). TOPS score of =2 with AUC of 0.83 proved to be accurate in predicting mortality among these neonates. Conclusion: Though, condition of neonatal transport is gradually improving in the country, it needs further acceleration for desirable reductions in neonatal mortality. TOPS is a valid survival score.

Thymic Size in Preterm Neonates with RDS and its Relation to Survival: A Prospective Observational Study

Introduction: Thymic size in neonates is represented by the Cardiothymic-Thoracic ratio (CT/T) as measured on chest X-ray. Various pre and post natal factors have been shown to affect thymic size in neonates. Respiratory Distress Syndrome (RDS) is an important cause of mortality in preterm neonates and CT/T ratio in infants with RDS may actually be larger, owing to a decrease in serum cortisol levels in them. We therefore intend to find out the thymic size in infants diagnosed with RDS and whether it is related to survival. Aim: To determine the thymic size in preterm neonates with RDS and their relation to survival and to determine which antenatal and post natal factors have an influence on, or correlation with thymic size. Materials and Methods: The study was conducted in the NICU of Department of Pediatrics, Himalayan Institute of Medical Sciences, Dehradun, India, over a period of nine months. Premature (<37 weeks gestation) neonates admitted in NICU with clinical evidence of RDS, (Silvermann’s score =3) and a chest X-ray suggestive of RDS were included in the study. CT:T ratio was determined on chest X-ray and compared between survivors and non-survivors. Results: Total 42 neonates were enrolled in the study. The mean±SD, CT:T in the study was 0.367±0.026. The CT:T in neonates who survived and those who expired was 0.36 and 0.38 respectively. A neonate with a CT:T of less than 0.403 had a 50% probability of survival. Although, CT:T was higher in the non-survivor group, the result was not statistically significant (p=0.33). Gestational age, sex, mode of delivery, administration of antenatal steroids or presence of birth asphyxia or sepsis did not affect the CT:T ratio. Conclusion: A large CT:T on X-ray chest can be used as a prognostic marker. Preterms with a CT:T of more than 0.40 have a poorer prognosis in terms of survi

Serial Serum C-reactive Protein in the Diagnosis of Neonatal Sepsis: A Cross-sectional Study

Introduction: C-reactive Protein (CRP) is an acute phase reactant secreted in increased amounts in the early hours of acute inflammation. Aim: To evaluate serial CRP levels for the diagnosis of neonatal infection and to do comparative analysis of CRP levels with other parameters of sepsis screen. Materials and Methods: Neonates with birth weight >1500 g and suspected to have sepsis were included. CRP was measured from the serum by quantitative turbidimetric immunoassay. The CRP 1 level was measured at the time of clinical presentation; CRP 2 and CRP 3 were measured at 24 and 48 hours respectively. Results: A total of 100 neonates were included. CRP was positive in 72% cases (CRP 2 in 59% and CRP in 72% cases). On comparative analysis of CRP with symptomatology, culture of the body fluid, WBC count, proven sepsis; serial CRP levels showed increase in sensitivity, decrease in specificity, not much change in Positive Predictive Value (PPV), but increase in Negative Predictive Value (NPV). CRP 3 was significantly associated with culture positivity. Conclusion: Serial CRP measurements are useful in the diagnosis of neonatal sepsis. CRP 3 level may virtually rule out or rule in the diagnosis of neonatal sepsis, and has very good correlation with blood culture.

Incidence of Retinopathy of Prematurity in a Tertiary Care Center of Northeast India

Shubhra Das, Barun Garg

Introduction: Retinopathy of Prematurity (ROP) is a blinding disease of premature and low birth weight babies with abnormal proliferation of the immature blood vessels at the junction of vascular and the avascular retina. Aim: To study incidence of ROP in new born infants and its associated risk factors. Materials and Methods: This was a prospective observational study done at a tertiary care centre after obtaining the ethical clearance and consent of parents. All the babies fulfilling the inclusion criteria were examined using indirect ophthalmoscopy after full mydriasis and subsequently followed up according to the schedule. Treatment was done according to the stages. Results: Out of the total 89 babies, 13 babies (14.61%) had developed ROP in both the eyes during screening. The most important risk factors which were positively correlated were oxygen supplementation, Respiratory Distress Syndrome (RDS), foetal distress. Various other anterior and posterior segment diseases were identified during screening of ROP. Conclusion: ROP is still one of the leading causes of preventable blindness in children. Universal eye screening must be implicated in all centres for all neonates.

A Study on Peripherally Inserted Central Venous Catheter in Infants in Tertiary Care Centre

Jayashree Purkayastha, M Supraja, Leslie Edward Lewis, Ramesh Bhat Y

Introduction: The survival of an increasing number of very low birth weight and critically ill neonates heightens the need for parenteral nutrition to support growth, as well as reliable vascular access for administration of additional intravenous fluids and medications. Aim: To study the use of Peripherally Inserted Central Venous Catheter (PICC) and its complications in infants in a tertiary care centre. Materials and Methods: It is a prospective study done in a tertiary care centre. Study period was from October 2012 to August 2014. Most of the PICC lines were inserted in preterms for Total Parenteral Nutrition (TPN) administration. Single lumen polyurethane catheter (mostly 28G) was used with breakaway needle. Results: Total 124 PICC lines were inserted in 121 neonates. The median gestational age of insertion was 30 weeks (25- 40 weeks). The median birth weight was 1060g (630-3200g). The median age for insertion in our study was 3 days (1-120 days). The most common indication for insertion of PICC line in our study was in preterm neonates for administration of TPN which was 87(70.1%), most of the PICC lines were inserted in two attempts in 75 (60.5%) neonates followed by one attempt in 35 (28.2%) neonates. Most of the PICC lines were inserted by junior residents and in long saphenous vein (91.1%). The median catheter duration in our study was 11 days with a range of 1-35 days. Total of 37 complications were noted during 1467 catheter days with complication rate of 25.2 per 1000 catheter days. The most common complication noted was Catheter Associated Blood Stream Infection (CABSI) in 17 PICC lines (13.7%). PICC lines were electively removed after completion of therapy in 69(55.6%) neonates. Conclusion: PICC lines are easy to insert and safe in neonates and can be safely inserted in extreme preterm neonates also. Long saphenous vein was the best site for PICC line insertion in our study. Proper and standard PICC line care can lead to less major complications.

Roseomonas Gilardi Bacteraemia in a Pediatric Oncology Patient on Chemotherapy: A Rare Case Report

Dhruv Kamlesh Mamtora, Priti Mehta, Pallavi Bhalekar

Roseomonas is a pink-pigmented, non-fermentative, gramnegative coccobacillus bacterium. Human infections caused by Roseomonas are very rare. We describe a rare case report of Roseomonas gilardi bacteraemia in a febrile, neutropenic patient on chemotherapy from oncology unit. The patient responded well to treatment given and was cured of it.

Nutritional Management of Neonatal Chylous Ascites following Congenital Diaphragmatic Hernia Repair

GS Sanghamitra, Sarat Chandra Gullapalli, Prakash Amboiram

Chylous ascites is characterised by accumulation of lymph in the peritoneal cavity and is a recognised complication of congenital diaphragmatic hernia repair. We report a case of neonatal chylous ascites that occurred as a complication of congenital diaphragmatic hernia repair and its successful nutritional management with a cost effective skimmed milk based preparation.

Congenital Pseudoarthrosis of Clavicle: A Rare Diagnosis in Neonate

Tapas Bandyopadhyay, Prathik Bandya, Arvind Saili, Ajay Dudeja, Sandeep Jhajra

Iodine Deficiency in Pregnancy and Challenges to Measure the Level of Deficiency

Himel Mondal, Shaikat Mondal