Indian Journal of Neonatal Medicine & Research

Urogenital Tract Infections in Preterm Labour and Preterm Premature Rupture of Membrane- An Observational Study

Introduction: Preterm birth is the leading cause of neonatal morbidity and mortality. One of the major causes for Preterm Labour (PTL) and Premature Rupture of Membrane (PROM) is infection of urogenital tract. Aim: To study the incidence of genitourinary infection in patients with preterm labour and preterm premature rupture of membrane. Materials and Methods: A Prospective study was conducted at BLDE (DU) Shri BM Patil Medical College. We enrolled 100 pregnant women with preterm/preterm PROM in the study and evaluated for the genitourinary infection by doing urine culture, cervical swab culture, vaginal swab culture and examination of urine for pus cells. The participants were given appropriate obstetric care and followed till delivery. Results: In the present study, study the incidence of genitourinary infection in preterm/preterm PROM was 59%. The cervical swab was positive in 33 participants, the vaginal swab was positive in 26 participants, the urine culture was positive in 19 participants, 35 participants had significant pus cells indicating urinary tract infection. A total of 59 participants had one or the other form of genitourinary infection. Out of the 100 participants enrolled in the study, 82 patients continued the pregnancy till full term. Conclusion: Genitourinary infection is highly prevalent among patients of Preterm labour/preterm PROMs. There is a need for educating pregnant women regarding personal hygiene to prevent the genitourinary infections.

Spectrum, Prevalence and Fetomaternal Outcome of Cardiac Diseases in Pregnancy: A Single Center Tertiary Care Experiencehave

Introduction: Cardiovascular Disorders (CVD) are significant cause of fetomaternal morbidity and mortality. Prevalence of CVD in pregnancy is less than 1% (varies from 0.3-3.5%). Aim: To study spectrum, prevalence and fetomaternal outcome of cardiac diseases in pregnancy at a tertiary care center. Materials and Methods: A retrospective study was conducted in which data of all antenatal patients visiting the hospital over a period of 27 months from March 2017 to June 2019 were analysed for cardiac diseases by clinical history, examination, Electocardiograpy and echocardiography. Type, Severity of heart disease was noted as per New York Heart Association (NYHA) criteria. Maternal outcome recorded in terms of Maternal death, Congestive Cardiac failure requiring ICU Care, Pregnancy Induced Hypertension, Antepartum Haemorrhage, Postpartum Haemorrhage, Deep vein Thrombosis, Anaemia and termination of pregnancy. Fetal outcome was recorded in terms Live Birth, Pre Term, Low Birth Weight, Intrauterine Death, Neonatal Death, Acute Fetal distress and Abortion. Results: A total of 9298 pregnant females were screened. A total of 73 had cardiac disease, with a based prevalence of 7.85/1000. About 22 (30.13%) patients were diagnosed first time during pregnancy. Mean age was 27.46±4.4 years. Thirty two (45%) were primigravida. About 58(80%) were in either NYHA Class I or II. Rheumatic Heart Disease (RHD) was the most common {36 (46.5%)} cardiac disorder. Maternal mortality occurred in 3 (4.1%) patients. Cardiac failure occurred in 10 (13.6%) patients. Fetal outcome included abortion in 1 (1.36%), acute fetal distress in 5 (6.84%), Intrauterine death in 2 (2.73%), Low birth weight in 8 (10.9%), preterm delivery in 4 (5.4%) patients and neonatal mortality in 1 (1.36%). Medical Termination of Pregnancy (MTP) was done in 6 (8.2%) patients. Predictors of combined maternal & fetal morbidity and mortality were advanced NYHA Class (III & IV) (p=0.0001, OR 5.98 95% CI 1.2940 to 27.3424), severe left sided obstructive lesions (p=0.0001, OR 14.0 95% CI 3.8430 to 51.0019) and left ventricular dysfunction (p=0.0018, OR 18.27 95% CI 2.0982 to 159.2223). Conclusion: RHD was the most common cardiac disorder reflecting need of secondary antibiotic prophylaxis. Patients who present with higher NYHA class, severe LV dysfunction and severe left heart obstructive disease represent high risk group.

Prevalence of Hypernatremic Dehydration in Breast Fed Neonates: A Retrospective Study in a Tertiary Care Hospitalsporadic

Ritu Agarwal, Ram Pal Singh Tomar, Ashish Kumar Gupta, Niranjan Sahoo

Introduction: Neonatal Hypernatremic Dehydration (NHD) is a common occurrence in neonates. Important causes include inadequate breastfeeding, high content of sodium in breast milk, improper preparation of infant formula feeds, diarrhoea, vomiting and rarer causes such as Diabetes insipidus. Hypernatremia carries a high morbidity and mortality and therefore it is important to address the aetiological factors to prevent complications. Aim: To investigate the incidence of NHD, maternal and neonatal risk factors contributing to this problem along with its presenting symptoms and outcome after management. Materials and Methods: This was a retrospective study done in a tertiary centre over a five-year period, where all neonates admitted in Neonatal Intensive Care Unit (NICU) with serum sodium >145 mmol/l were included in the study. Neonatal data and maternal data were noted. Initiation and frequency, technique and any problems of breastfeeding were recorded. Management of hypernatremic dehydration was done as per the standard unit protocol. The results were plotted in MS Excel and analysed using SPSS 22 (Chicago, IL USA). Results were expressed in mean and SD in tables and compared using the Fisher’s-extract test. Results: A total of 68 mothers-neonate dyads were included in the study. The mean day of presentation by the neonates was day 8 of life (SD 3.5). Moderate and severe hypernatremia were noted in 23 (33.2%) and 11 (16.8%) cases with total mortality in 3 cases. Factors that positively correlated with severe disease were primigravida mothers, latching difficulties, breast related problems, feeds less than 6 times/day, severe weight loss (>10%) and decreased urine frequency (<4/day). Conclusion: Inadequate breast feeding was associated with hypernatremic dehydration hence it is important to take care of breast problems starting from antenatal checkups along with proper education of mothers on breast feeding with advice for early follow-up in baby clinic to detect early breast feeding issues so as to take early corrective steps.

Intrauterine Blood Transfusion for Haemolytic Disease of Foetus: Current Indications, Intrauterine Transfusion Methods, Complications and Outcome

Romesh Jain, Rakesh Kumar, Shubhangi Jain, Jai Bhagwan Sharma

Foetal anaemia remains a serious complication in pregnancy which can lead to hydrops and perinatal death. It is important to detect it timely in order to prevent formation of hydrops and improve the long term outcome. Foetal anaemia can be successfully treated by Intrauterine Transfusion (IUT), if it occurs due to red cell alloimmunisation. Management involves a multidisciplinary approach involving foetal medicine specialist, transfusion medicine specialist, obstetrics and gynaecology specialist and paediatrician. This review article focuses on current IUT indications, methods, complications and outcome.

A Rare Case of Streptococcal Toxic Shock Syndrome

Janani Arul, Poornima Kumar, Lalitha Krishnan

This article reports a case of 16-day-old male baby with features of cellulitis in the diaper area and shock. Blood culture report of baby and high vaginal swab of mother grew Group A Streptococcus (GAS) and the neonate was diagnosed to have Streptococcal toxic shock syndrome. Hence, a case of Streptococcal toxic shock syndrome must be identified as early as possible, which is a rare and life threatening condition in a newborn.