Indian Journal of Neonatal Medicine & Research

Adrenal Haemorrhage Associated with Scrotal Swelling in a Neonate

Rakesh Kumar, Sanober Wasim, Yasir Ahmed Lone, Girish Gupta, Talha Rehman

Primary Cerebral Hydatidosis in a Child: A Case Report with a Rare Site of Occurrence

Hydatid cyst of brain in an extremely rare entity. A case of primary hydatidosis of brain without any involvement of other areas is even rarer. Most commonly involved areas are liver and lung because of rich vascularity and vicinity to portal circulation. Central Nervous System (CNS) or most importantly cases of hydatid cysts of brain are very rare. This case report is about a 7-year-old girl, from eastern India, who presented with multiple hydatid cysts in cranial cavity. She presented with headache, sudden loss of balance, short time memory loss. On Magnetic Resonanace Imaging (MRI), multiple cystic lesions were noted in cranial cavity. Magnetic Resonance (MR) Spectroscopy findings were suggestive of hydatid disease. These cysts were removed through neurosurgical intervention. The diagnosis was confirmed by gross and microscopic examination. Importance of keeping hydatidosis as a differential diagnosis while working up cases of cystic Space-occupying Lesion (SOL) of the brain in children is evident here.

Anaesthetic Management of Congenital Lobar Emphysema- A Case Report

Ajay S Shandilya, Anil Kumar Narayan, Harini Krishna, Ramya

Congenital Lobar Emphysema (CLE) is a rare congenital disorder causing overinflation of a lobe or lobes of the lung. The left upper lobe is most commonly involved. Surgery is the preferred treatment in cases of CLE, with the patients recovering well after surgery, even with excision of more than one lobe. Here authors report a case of 2-week-old female infant with worsening respiratory distress that did not resolve despite supplemental oxygen and non invasive ventilatory support and was subsequently diagnosed with CLE. The pathology in CLE is the overinflation of the affected lobes and consequent collapse of the normal lobes, leading to hypoxia and reduced gas exchange. The emphysematous lobe causes the mediastinum to shift to the other side and severe cases may have a haemodynamic compromise. Anaesthesia in such infants is a precarious proposition. The infants may also have other congenital abnormalities. Furthermore, the over distended lobe will cause several problems affecting the infant’s cardiorespiratory physiology. Hence, the preanaesthetic evaluation, anaesthesia plan and execution should be meticulously planned.

Effect of Antenatal Counselling by Healthcare Professionals in Initiating Precise Early Breastfeeding Practices in Primigravida Mothers: A Quasi-experimental Study

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.

Evaluating Thyroid Function in Paediatric Nephrotic Syndrome in a Tertiary Care Hospital of Northern India: A Case-control Study

Koushal Kumar Khajuria, Ashima Badyal

Introduction: Nephrotic Syndrome (NS) is a glomerular disease characterised by oedema, hypoalbuminaemia and substantial proteinuria, which includes loss of thyroxine binding globulin and thyroid hormones, often resulting in subclinical or overt hypothyroidism. Studies reporting on the relationship between NS and thyroid dysfunction elude consensus. Aim: To evaluate Triiodothyronine (T3), Thyroxine (T4) and Thyroid Stimulating Hormone (TSH), and lipid levels to identify clinical predictors of thyroid dysfunction in paediatric cases of NS. Materials and Methods: A hospital based case-control study was undertaken on 100 children, attending Paediatric Nephrology Clinic, from October 2020 to March 2021.Patients were divided into two groups: 50 cases under various stages of nephrotic syndrome, and 50 healthy controls in the age group of 1 to 18 years, of either gender. Investigations on serum creatinine, Haemoglobin (Hb), white blood cell count, platelet count, serum T3, T4, TSH, and blood lipids like: Triglyceride (TG), Total Cholesterol (TC) and Low Density Lipoprotein (LDL), were performed on all the children, and compared for analysis of corresponding data of cases and controls. Statistical analysis was carried out using ANOVA test. Results: The mean age of the cases and controls was 12.6±4.2 and 11.8±4.0 years, respectively. Mean T3 value in the case group was 117±63 ng/dL, and in control was 176±95 ng/dL (p=0.104). Mean T4 value among the case group (9.9±5.1 μg/dL) was significantly lower than that of controls (14.2±8.4 μg/dL) (p=0.016). The difference of TSH levels in the case group was 3.8±2.9 μIU/mL, and control was 2.5±2.2 μIU/mL (p<0.001). Hypothyroidism was observed in 9 (45%) children with first episode, 7 (53.84%) in remission, and 6 (60%) relapsed patients. Conclusion: Urinary losses of binding proteins such as Thyroxine Binding Globulin (TBG), transthyretin or prealbumin and albumin, may have caused lower levels of T3 and T4 and higher value of TSH. T3, T4 and TSH are important clinical predictors of thyroid dysfunction in patients with NS, therefore hypothyroidism should be investigated in all children with NS.

Retrospective Study of COVID-19 Positive Paediatric Patients Admitted in a Tertiary Care Hospital, Mizoram, India

Introduction: The clinical presentation and the difference in the pattern of presentation of paediatric Coronavirus Disease 2019 (COVID-19) positive cases between the first wave and second wave have not been studied in North Eastern region of India. Aim: To study the socio-demographic factors, clinical presentations and also to compare the pattern of presentation of paediatric COVID-19 positive cases between the first COVID-19 wave and second COVID-19 wave. Materials and Methods: A retrospective observational study of 85 paediatric COVID-19 positive cases admitted in Zoram Medical College, Mizoram, India, during the period from July 2020 to June 2021 was conducted. Children of age group <14 years were included in the study. The data like age, sex, type of testing done, possible primary contact, symptoms, treatment given, and prognosis were collected from the case sheets in the Medical Records Department. Descriptive analysis was carried out by mean and standard deviation for quantitative variables, frequency and proportion for categorical variables. Categorical outcomes were compared between study groups using Chi-square test/Fisher's Exact test. Results: Records of total of 85 participants were included in the final analysis. The mean age of the study population was 6.59 years. Out of total, 45 (52.94%) were male patients. Majority, 46 (54.11%) had contracted the infection from their parents. The most common symptoms reported were fever (36.47%), cough (24.71%) and cold (22.4%). A total of 9.42% had co-morbidity. The mean duration of hospital stay was 10.14±5.2 days. In age group <5 years, (58.33%) were symptomatic when compared with 5 to 10 years (16.67%) and 25% in children >10 years (p<0.001). There was a significant difference in the mean age group admitted in first wave (2.91±2.94 years) versus second wave (11.38±2.91 years) (p<0.001). Conclusion: The children less than 5 years were more symptomatic when compared with other age groups. Also, there was a transition in age group being infected, which was greater than 10 years old in the second wave. Hence, there is an urgent need to vaccinate the population less than 18 years of age.

Effectiveness of Sensitisation Programme on Prazosin Therapy for Scorpion Envenomation at Primary and Secondary Healthcare Level

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.

Comparison of Lipid Profiles from Cord Blood of Appropriate and Small for Gestational Age Babies in a Tertiary Care Hospital:A Case-control Study

Introduction: Hyperlipidemia and its complications are common health issues in the current era with multifactorial in origin. Foetal malnutrition results in neuroendocrine, pancreatic, and adipose tissue dysfunction, ultimately increasing food intake and decreasing energy utilisation. It leads to an increase in adiposity and insulin resistance and ultimately increase adult diseases in later life. Aim: To compare the lipid profiles of Small for Gestational Age (SGA) and Appropriate for Gestational Age (AGA) babies. Materials and Methods: This case-control study was conducted in the Department of Paediatrics, Obstetrics and Gynaecology of Karwar Institute of Medical Sciences, Karwar, Karnataka, India over a period from December 2020 to March 2021. A total of 133 deliveries were recruited randomly and babies were divided into cases including those small for gestational age and controls including those appropriate for gestational age. Data was analysed and described using descriptive (mean, standard deviation, and range) and inferential statistics (Students’ t-test). Results: There were 99 Appropriate for Gestational Age (AGA) and 34 small for Gestational Age (SGA) babies studied. This study found that SGA-babies had statistically significantly lower gestational age (37.69±2.45 weeks) at birth compared to AGA-babies (Mean 38.55±1.11 weeks) t=-2.351 p=0.022. The mean Total Cholesterol (TC) level (63.62±40.48 mg/dL) was higher in SGA-babies compared to AGA-babies (48.69±2.29 mg/dL) and this difference was statistically significant (p-value=0.007). The mean High Density Lipoprotein (HDL) levels of SGA and AGA babies were comparable with no statistical significance (21.82±13.26mg/dL of SGA; 21.49±14.64mg/dL of AGA; p-value 0.907). The mean Very Low Density Lipoprotein (VLDL) level (17.11±25.35 mg/dL) was higher in SGA-babies compared to AGA-babies (9.47±9.35 mg/dL) and this difference was statistically significant (p-value=0.012). Conclusion: Levels of all lipids were found to be higher in SGA-babies than in AGA-babies.

Missed Vaccinations in Children during the COVID-19 Pandemic

Introduction: During the Coronavirus Disease 2019 (COVID-19) pandemic, lockdown was imposed to break the rapid spread of infection which hampered many essential services. This included medical services and particularly the scheduled vaccinations among children. Consequently, many children missed or delayed vaccinations. Aim: To find the incidence and reasons for missed/delayed vaccination in children during the COVID-19 pandemic. Materials and Methods: This was a prospective hospital-based cross-sectional study done in the Department of Paediatrics, East Point College of Medical Sciences and Research Centre, Bengaluru, Karnataka, India from March 2020 to February 2021.The total number of patients studied were 515. The samples included all children aged 0-10 years attending the Paediatric Outpatient Department (OPD) for vaccination. Details about age, gender, address, parental details of education, occupation and income were recorded, using a questionnaire. Immunisation card was checked to ascertain whether any of the vaccines were missed or delayed and advice about catch up vaccination was given. The reasons for delay or missed vaccinations were recorded. Multivariate logistic regression was used to compare different classes of population with delay and as per schedule classes of children for individual vaccines. Results: The mean age of the population was 13.77 months. Delay in vaccinations was seen in 213 (41.35%) children, among among them were 94 (44.13%) girls, and 119 (55.86%) boys. Mean age of the population with delay/missed vaccinations were 21.23 months. Main cause cited in 88.2% cases for delayed/missed vaccination was fear of getting infected with Covid-19 during hospital visits. The vaccinations with most significant delay were pentavalent vaccination at 10 weeks with a mean age of delay being 1.1 month as per National Immunisation Schedule (NIS) and Typhoid vaccination as per in Indian Academy of Paediatrics (IAP) schedule with a mean age of delay of 5.2 months. The vaccinations were delayed in all socio-economic classes of the populations during the study period. Conclusion: The COVID-19 pandemic has hampered all healthcare services including immunisation. Intentional vaccine delay due to any reason by parents should be avoided and catch up immunisation should be given at the earliest.

Clinical Profile of Hypoglycaemia in Neonates at Risk in a Tertiary Care Teaching Institute in Southern India: A Longitudinal Study

Christy Tom, Susy Joseph, Bindusha Sasidharan, Veena Anand, A Santhoshkumar

Introduction: Hypoglycaemia is common in babies at risk. Without early detection, timely diagnosis and treatment, hypoglycaemia can cause disastrous consequences on neurological and developmental outcomes. Therefore, continuous monitoring of blood glucose levels in babies at risk should be done to reduce its impact. Aim: To describe the clinical profile and sequential blood sugar levels in the first four postnatal days in at-risk neonates and to identify the risk group of neonates with recurrent hypoglycaemia. Materials and Methods: This was a longitudinal study done in the Neonatal Intensive Care Unit (NICU) and Special Newborn Care Unit (SNCU) of a tertiary care teaching institute; Sri Avittam Thirunal Hospital (SATH), Government Medical College, Thiruvananthapuram, Kerala, India, from October 2017 to October 2018. Neonates admitted with risk factors for hypoglycaemia according to ‘National Neonatology Forum’ clinical guidelines with low capillary blood sugar (<40 mg/dL) within the first two to four hours of life were included in the study. These neonates were followed-up clinically till fourth postnatal day with glucose monitoring. Statistical analysis was done using Statistical Package for the Social Sciences (SPSS) software version 22. Categorical variables were expressed as proportions and compared using the Chi-square test. A p-value <0.05 was considered statistically significant. Results: A total of 368 ‘at risk’neonates had hypoglycaemia at admission (2 to 4 hours) and of these 200 (54.3%) developed recurrent hypoglycaemia. Out of the neonates with recurrent hypoglycaemia, 150 (75%) were preterm and 50 (25%) were term. The preterm Small for Gestational Age (SGA) had a higher chance of developing recurrent hypoglycaemia than preterm Appropriate for Gestational Age (AGA) and Large for Gestational Age (LGA) (p-value=0.0256). Although, 102 (40.2%) preterm had asymptomatic hypoglycaemia, 90 (78.9%) term neonates showed symptoms of hypoglycaemia. The major clinical manifestation was jitteriness in those with a single episode 31 (18.45%) and lethargy/poor activity in those with more than one episode 66 (33%). The blood glucose levels less than 25 mg/dL at admission was significantly associated with the occurrence of a repeat episode of hypoglycaemia (p-value=0.028). Conclusion: Blood glucose monitoring in neonates with risk factors is mandatory as 54.3% of neonates developed recurrent hypoglycaemia. Of these, preterm SGA had a high chance of developing recurrent hypoglycaemia. The variable presentations in neonatal hypoglycaemia indicates the need for detailed and thorough clinical examination with glucose monitoring in these at-risk neonates. Initial blood glucose level less than 25 mg/dL was significantly associated with recurrent hypoglycaemia.

Clinical Profile and Outcome of Children with Acute Central Nervous System (CNS) Infection from a Tertiary Care Centre in the Present Vaccination Era

B Ramesh Babu, P Punitha, Adithya Vijayaraghavan, A Prakash, J Balaji

Introduction: Meningitis is a common tropical infection which causes significant morbidity and mortality in children. Vaccination is available now-a-days for Haemophilus influenza and pneumococcus which are the common infection causing meningitis. Profile of acute Central Nervous System (CNS) infection in children varies with time to time as it depends on the organism, age, seasonal period, outbreaks, immunisation and place. Aim: To study the clinical, microbiological, radiological profile and outcome of children with acute CNS infection in a tertiary care centre in the present vaccination era. Materials and Methods: This prospective observational study was done in the Department of Paediatrics, Government Dharmapuri Medical College Hospital, Tamil Nadu, India, from December 2018 to June 2020. Total 50 children from one month to 12 years with features of acute CNS infection were included in the study. Clinical features, Cerebrospinal Fluid (CSF) and serology findings, Computed Tomography (CT) scan findings and outcome were taken for analysis. The data were entered in Microsoft Excel software and analysed using Statistical Package for the Social Sciences (SPSS) version 23.0. Results: During the study period, 50 children were diagnosed with acute CNS infection. A total of 37 (74%) children were less than 3 years and 31 (62%) male children were commonly affected. Fever 42 (84%), seizures 46 (92%) and altered sensorium 31 (62%) were the common symptoms. Status epilepticus 40 (87%), shock 18 (36%), respiratory distress 16 (32%) were common findings. In CSF, elevated cell count, reduced sugar, elevated protein were seen in 21 (42%), 14 (28%) and 27 (54%), respectively. Pneumococcus 3 (6%), Japanese Encephalitis (JE) 8 (16%), dengue 5 (10%), herpes 4 (8%), scrub typhus (aetiological agent Orientia tsutsugamushi) 2 (4%) were the common aetiological agents for CNS infection. CT brain was abnormal in 8 (16%) children. Nine children died (18%) and rest 41 (82%) recovered. Conclusion: In the present vaccination era, viruses and tropical fevers- JE, dengue, herpes and scrub typhus were common causes for acute CNS infection in children. Common clinical features were status epilepticus, fever, altered sensorium, respiratory distress and shock. Initial stabilisation of physiological status, specific management and JE vaccination are mandatory to improve the outcome in CNS infection.

Cutaneous Manifestations Among Hospitalised COVID-19 Infected Children from Northern India: A Cross-sectional Study

Introduction: Novel Coronavirus Disease-2019 (COVID-19) is caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). Besides the systemic manifestations, mucocutaneous 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. Total 50 SARS-CoV-2 positive children, admitted during the study period (between July to December, 2020) and fulfilling inclusion criteria were screened for mucocutaneous 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 by 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.

Diagnostic Accuracy of Platelet Indices as a Marker for Sepsis in Neonates: A Case-control Study

Introduction: Diagnosis of sepsis in neonates is challenging due to overlapping of signs and symptoms. Currently blood culture and sepsis screen are used for diagnosis. Blood culture is the gold standard but its usefulness is limited due to low positivity, delay in reporting. Sepsis screen has variable sensitivity and specificity. To overcome these limitations, platelet indices can be used in diagnosis. Aim: To assess platelet indices as a marker to diagnose neonatal sepsis and to calculate sensitivity and specificity of platelet indices in comparison to clinical symptoms, sepsis screen and blood culture. Materials and Methods: This case-control study was conducted from June 2021 to November 2021 in Neonatal Intensive Care Unit (NICU) of tertiary care centre, Karnataka, India. Total of 198 neonates with signs and symptoms of sepsis and/or risk factors of sepsis were included. Weight and gestational age matched 198 healthy neonates served as control. Investigations include blood culture, sepsis screen and platelet indices were sent. Platelet indices were compared between cases and controls. Sensitivity and specificity of platelet indices were calculated in culture positive, screen positive and both negative groups. Data of both the groups were compared using Independent t-test and Chi-square test. Results: Demographic profile was homogenous between both study groups. Out of 198 cases, 145 (73.2%) had platelet count <1.5 lakhs, 132 (66.7%) had Mean Platelet Volume (MPV) >10.8 fl and 109 (55.05%) had Platelet Distribution Width (PDW) >19.1 fl. These values were statistically significant (p-value<0.001) when compared with controls. Statistically significant (p-value <0.001) difference was seen in mean of platelet count (1.3±0.7 lakhs/cumm), MPV (10.7±0.8 fl), PDW (19.1±2.3 fl) and Plateletcrit (PCT) (0.1±0.1) between cases and controls. Platelet count was more sensitive (73.2%) and specific (81.3%) marker when compared between cases and controls. Conclusion: Platelet indices are cheaper and widely available markers in diagnosing neonatal sepsis. Thrombocytopenia, high MPV and high PDW were associated with neonatal sepsis.

Effect of Maternal Haemoglobin on Neonatal Anthropometry: A Prospective Observational Study

Divyani Dhole, Shital Kolhe, Amit Saxena, Mumtaz Sharif, Vinaykumar P Hedaginal

Introduction: Anaemia during pregnancy is highly prevalent especially in developing nations (65-75% in India). The causes are multifactorial, nutritional anaemia being the most common cause. Maternal anaemia is known to have adverse neonatal outcomes, including anthropometric measurements. Aim: To study the correlation between maternal haemoglobin level and neonatal birth weight, length and head circumference. Materials and Methods: It was a prospective observational study carried out at DY Patil University School of Medicine and Hospital, Nerul, Navi Mumbai, Maharashtra, India done over two years between November 2018-November 2020. Maternal history, blood samples and neonatal birth weight, length and head circumference were taken. Results were recorded, and qualitative data was presented using frequency, percentage while quantitative data was presented using descriptive statistics. Further statistical analysis was carried out with the help of tests such as Wilcoxon Mann-whitney U test, Kruskal Walis test and Spearman’s correlation test for association. Results: A total of 550 anaemic mothers fulfilling the inclusion criteria were enrolled in the study. Neonatal birth weight, length and head circumference were negatively affected by the severity of maternal anaemia which was statistically significant. Higher Body Mass Index (BMI), compliance with Iron Folic Acid (IFA) supplementation, adequate interpregnancy interval between pregnancies and adequate calorie intake during pregnancy resulted in significant differences in birth weight and length. Conclusion: Maternal anaemia, malnutrition, irregular IFA supplementation, inadequate spacing and inadequate calorie intake significantly hampers neonatal anthropometry.

Spectrum of Congenital Malformations and Associated Factors: A Cross-sectional Study from Eastern India

Tarapada Ghosh, Sumanta Das, Mahesh Prasad Mohanta, Bidyut Kumar Khuntdar

Introduction: Congenital malformations are important contributors for neonatal and infant mortality after prematurity, intrapartum complications and infections. Aim: To find out the prevalence and pattern of congenital malformations among the live born neonates in study area as well as to identify the associated risk factors. Materials and Methods: This descriptive hospital based cross-sectional study was carried out in 305 cases at Midnapore Medical College, Medinipur, West Bengal, from July 2016 to June 2017. All live inborn neonates were assessed for the presence of any malformation(s). The still born or out born babies were excluded. Congenital malformations were diagnosed by clinical examination as well as imaging studies. Data regarding risk factors were collected from the history and the case records. Chi-square test was done to find out the significance of the risk factors. Results: During the study period, there were 14240 live births, out of which 305 cases of congenital malformations were noted. Prevalence of congenital malformations was 214.1 per 10,000 live births or 2.14%. Out of 305 cases, 165 (54.10%) were males, 137 (44.92%) were females, and 3 (0.98%) had ambiguous genitalia. Prevalence of malformations was not significantly different between primi and multipara mothers, and for the different socio-economic backgrounds. A higher prevalence of congenital malformations in mothers above 30 years, consanguinity, low birth weight and prematurity were observed. History of abortion and still birth were associated with higher prevalence. Polyhydramnios, pregnancy induced hypertension and previous abortion and still birth were also associated with higher prevalence of malformations. Musculoskeletal system was majorly involved in 92 (30.16%) cases, followed by central nervous system 48 (15.74%). Conclusion: Prevalence of congenital malformations was found to be 214.1 per 10,000 live births or 2.14%. Maternal age >30, consanguinity, prematurity and low birth weight were associated with increased prevalence of congenital malformations. Musculoskeletal system was the most commonly involved system.

Central Line Associated Blood Stream Infections and Effectiveness of Care Bundle Approach: A Prospective Cohort Study

G Sridhar, SN Harsha Kumar, K Nagendra, Girish Gopal, Sudha Rudrappa

Introduction: Insertion and maintenance of Central Venous Catheters (CVC) are integral components for the supportive care of critically ill neonates. Their use is often associated with the unavoidable risk of acquiring Healthcare Associated Infections (HAI) like Central Line Associated Blood Stream Infections (CLABSI) especially in resource limited public sector Neonatal Intensive Care Units (NICU). Adopting a care bundle approach to decrease CLABSI rates in such NICUs still remains a challenge. Aim: To determine the baseline CLABSI rate, identify the risk factors associated with it and also to determine the effectiveness of care bundle approach in decreasing CLABSI. Materials and Methods: An analytical prospective cohort study was conducted in Cheluvamba Hospital, attached to Mysore Medical College and Research Institute, Mysuru, Karnataka, India, from June 2018 to June 2020. In the preintervention phase (June 2018 to May 2019), the data of 307 neonates in whom Central Line (CL) was inserted were analysed to determine the baseline CLABSI rate and risk factors. CLABSI bundle involves a group of evidence-based practices which when implemented reliably and consistently have shown to significantly reduce CLABSI rates. CLABSI bundle was implemented in June 2019 and in the postintervention phase (July 2019 to June 2020), the data of 283 neonates were analysed and compared to those in the preintervention group in order to assess the effectiveness of the care bundle approach. Chi-square test was used to compare categorical variables whereas a two sample t-test was used to compare continuous variables. Results: A total of 41 CLABSI episodes were documented in the preintervention phase (Group 1) as compared to 12 in the postintervention phase (Group 2). Mean birth weight and gestational age was significantly lower in neonates with CLABSI as compared to neonates without CLABSI in both the groups. The incidence of CLABSI was significantly higher in neonates with a catheter dwell time of more than eight days and in those who received Total Parenteral Nutrition (TPN). Implementation of the CLABSI bundle resulted in the reduction of the baseline CLABSI rate from 16.25 to 8.3/1000 CL days; a significant reduction in the catheter dwell time and duration of NICU stay was also noted in group 2. Duration of NICU stay and death rate among neonates who developed CLABSI did not differ significantly between both the groups. Conclusion: Despite incorporating the care bundle approach, CLABSI rate remained to be high. Very preterm neonates with birth weight of <1500 grams and NICU stay of more than 25 days were more likely to develop CLABSI. Significant reduction in CLABSI rates can be achieved with widespread implementation of the CLABSI bundle in resource limited NICUs across India.