Indian Journal of Neonatal Medicine & Research

Collodion Baby: A Clinical Enigma

Sonam Singh, Sumita Mehta, Tarun K Ravi, Anshuja Singla, Ankita Mann

Collodion baby is a term used for neonates in whom the body surface is covered by thick skin sheets, appearing like a translucent, tight parchment paper. This membrane is formed due to dysfunction of epidermal development resulting in epidermal hyperkeratosis. It is a rare condition with an incidence of 1 in 50,000-100,000 deliveries. The early neonatal period of a collodion baby can be complicated by hypernatremic dehydration, electrolyte imbalance, hypothermia and skin infections, resulting in high morbidity and mortality. Early diagnosis helps in optimal initial management and prevention of complications and thereby improves prognosis. Here, the present authors report a case of a collodion baby born and managed successfully in the institute.

A Study on Prevalence and Association of Anaemia and Hyponatremia in Simple Febrile Seizures in Children

Introduction: Febrile seizures are common type of seizures in children which occurs between 6 months to 60 months of life, usually single episode within 24 hours of onset of fever. It lasts for less than 15 minutes with a brief period of post-ictal drowsiness without any neuroinfection. Aim: To find the prevalence of anaemia and hyponatremia in simple febrile seizures and also the association of anaemia and hyponatremia in children with simple febrile seizures. Materials and Methods: The cross-sectional study was conducted from November 2013 to November 2015 .The sample constituted 120 children belonging to the age group of 6 months to 5 years presenting with simple febrile seizures in the Pediatrics department of Sri Chamarajendra Hospital(SCH), Hassan Institute of Medical Sciences, Hassan. The following data were collected-duration of fever, time of onset of seizures, type of seizures, duration of seizures, medical and family history of seizures in first degree relatives, consanguinity and history on trigger for febrile episode. Anaemia was evaluated by complete blood count analysis with manual peripheral smear examination while hyponatremia was assessed by doing electrolyte analysis using Transasia automated analyser by ion selective electrode method. The data was analysed by using chi-square test. Results: In total 120 children with simple febrile seizures were studied and majority of them belonged to 6months to 2years of age (61.6%).The study showed a significant association between anaemia and febrile seizures (p<0.02), a significant association between Hyponatremia and febrile seizures (p<0.05) and a significant association between anaemia and hyponatremia in simple febrile seizures (p<0.001). Prevalence of anaemia was 50% where as hyponatremia was 35.8%; as a risk factor for febrile seizure. Conclusion: Anaemia is a common problem in children so treating or preventing anaemia may decrease the prevalence of febrile seizure and also treating hyponatremia may further bring down the episodes of febrile seizures.

Safety and Outcome of High Dose Parenteral Amino Acid Supplementation for VLBW Neonates on Partial Parenteral Nutrition: A Randomised Controlled Study

Rakesh Gami, Manisha Bhandankar

Introduction: Total Parenteral Nutrition (TPN) is prescribed to meet a neonate’s requirement for growth and development when his/her condition and/or gestation prevents complete enteral feeding. In India Partial Parenteral Nutrition (PPN) is used in neonatal units with inadequate facilities to prepare TPN. Aim: To evaluate the effect of supplementation of high dose parenteral Amino Acid (AA) on growth and biochemical parameters of Very Low Birth Weight (VLBW) neonates receiving PPN in first week of life. Materials and Methods: This was a Randomised controlled study, conducted in a tertiary care medical center. Sixty VLBW newborns with birth weight of <1500 gm admitted to level III NICU within 24 hour of life were included and Randomised into two groups of AA supplementation: One group received 1 g/kg/day of parenteral AA (Aminoven) on day 1, which was increased by 1g/kg/day till 4 gm/kg/day. The other group received 3 g/kg/day of parenteral AA on day 1, which was increased to 4 g/kg/day on the next day. Both the groups were continued on AA till they reached 75% of enteral feeds. Independent sample and chi-square test were used to analyse the data. Results: With similar baseline characteristics, serum sodium (p=0.001) and blood urea (p=0.041) levels were higher during 1st week of hospital stay. The daily physiological weight loss was more in neonates who received high AA from day 1 of life. There was no significant difference in weight gain (p>0.05) between the two groups during the hospital stay. The mean hospital stay was 23±4.5 days for Group A and 22.4± 3.6 days for Group B. Conclusion: Supplementation of high dose parenteral AA in VLBW infants receiving PPN does not help in weight gain during hospital stay, although well tolerated.

Diagnostic Utility of Haematologic Scoring System in Neonatal Sepsis

Modali Rishita Sarma, Jinkala Sree Rekha, Srikanta Kanungo

Introduction: Sepsis is an important cause of neonatal mortality and morbidity. Numerous serological markers exist for diagnosis of sepsis which acts as adjuvants to the clinical signs. A Haematological Scoring System (HSS) for predicting sepsis in neonates which includes the total leucocyte count, immature neutrophil count, toxic changes in the neutrophils and various other parameters in the routine haemogram was used. Aim: In the present study, authors evaluated the diagnostic utility of HSS in predicting neonatal sepsis in neonates admitted with clinical diagnosis/suspicion of sepsis. Materials and Methods: This was a prospective observational study, conducted on neonates with clinical diagnosis/suspicion of sepsis. The various parameters included in the HSS for neonatal sepsis were analysed in all the smears. Statistical analyses were conducted; the sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) of each variable of HSS score was calculated. The comparison of HSS score between the culture positive sepsis and culture negative sepsis was carried out by using Independent t-test or Mann-Whitney U test. Results: Seventy-eight samples were received from neonates with clinical diagnosis/ suspicion of neonatal sepsis. Among the variables in HSS score, Total Neutrophil Count (TNC) and Immature Neutrophil Count (INC) show high sensitivity; Immature to Mature neutrophil ratio (I:M ratio) and low platelet count showed high specificity; TNC and INC showed high PPV; toxic change and low platelet count showed high NPV in predicting neonatal sepsis. Presence of Schistocytes in the peripheral smear showed high specificity of 80% in predicting neonatal sepsis. Increased band count has a high specificity (91%) and NPV (72%) in predicting neonatal sepsis. Conclusion: HSS score had high sensitivity and NPV of 91% in predicting neonatal sepsis. The prevalence rate ratio of neonates developing sepsis with high HSS score is 3.9 times more compared with neonates with low HSS score. HSS is a simple, quick, cost-effective and routine laboratory test which helps in predicting neonatal sepsis. The higher the HSS score, more is the probability of neonatal sepsis.

Pattern of Neonatal Intestinal Obstruction in a Tertiary Care Hospital and its Management: A Prospective Study

Introduction: Intestinal obstructions are the most common conditions in neonates, requiring emergency surgical intervention. The management and outcome are challenging particularly in a developing country. Aim: To find the pattern of neonatal intestinal obstruction, the management approach and outcome in a paediatric surgery centre in Eastern India. Materials and Methods: This prospective cohort study was conducted in Department of Paediatric Surgery of SVP Postgraduate Institute of Paediatric, SCB Medical College, Cuttack, Odisha, India. It was conducted over a period of two years from October 2016 to September 2018. Patients with oesophageal atresia and anorectal malformation were excluded from the study. Results: Out of 126 newborns included in the study, intestinal atresia (56 cases) was the leading cause of obstruction and was found most commonly at the level of jejunum. A case of pyloric atresia associated with epidermolysis bullosa, a case of apple-peel type of intestinal atresia associated with jejunal duplication cyst and a case of colonic atresia associated with anorectal malformation were rare findings detected in the study. Hirschsprung’s disease was the second most common pathology, found in 42 cases. Laparotomy, levelling biopsy and colostomy was done in all cases of Hirschsprung’s disease. Malrotation (14 cases) and Meconium ileus (12cases) were also important causes of neonatal intestinal obstruction. Fourteen cases (11.1%) died during hospitalisation and septicaemia was the common cause of morbidity and mortality. Conclusion: Intestinal atresias are the most common cause of neonatal intestinal obstruction in our study (44% cases) followed by Hirschsprung’s disease (33% cases). Male newborns were more commonly affected and majority of neonates presented during first week of life. Post-operative septicaemia, pneumonia and wound infection should be adequately managed. Early recognition of the problem and referral from peripheral hospitals in recent years were important for improved survival (89%) in the present study. Urgent resuscitation, diagnosis, surgical intervention and utmost utilization of available neonatal supporting system are the key factors.