Indian Journal of Neonatal Medicine & Research

Pathological and Genetic Analysis of Foetuses with Ultrasonogram Detected Congenital Anomalies: A Cross-sectional Study from Southern India

S Ramya Devi, Tanya Salim, Uma Thankam

Introduction: Prenatal Ultrasonogram (USG) detects the majority of congenital anomalies, but a few cases may be missed due to multiple reasons. Hence, a detailed post-mortem evaluation of foetuses following termination of pregnancy can help to arrive at a final diagnosis and aid in counselling couples about future pregnancies. Aim: To compare prenatal ultrasound findings with autopsy findings and karyotyping in medically terminated foetuses between 12 and 20 weeks of gestation. Materials and Methods: A cross-sectional hospital-based study was conducted at Department of Obstetrics and Gynaecology (OBG), Government Medical College, Trivandrum, Kerala, India, from February 2018 to January 2019. Pregnant women who underwent Medical Termination of Pregnancy (MTP) for ultrasound-detected congenital anomalies between 12 and 20 weeks were included in the study. A detailed foetal autopsy was done and karyotyping of the foetuses was carried out. Prenatal ultrasound findings were compared with the ultrasound reports. Descriptive statistics were used and results were expressed in terms of frequency and percentages. Results: The mean maternal age of the study participants was 26.32±4.9 years. Among the 50 foetuses examined, majority had Central Nervous System (CNS) anomalies, with 34 cases (46.5%). Foetal autopsy confirmed the ultrasound findings in all cases except one, resulting in 49 confirmed cases. Autopsy had full agreement with prenatal ultrasonogram in 28 cases (56%). Major additional autopsy findings were noted in 10 cases (20%), minor additional findings in 7 cases (14%) and both minor and major additional findings in 4 cases (8%). Major congenital anomalies are those that have medical, surgical, or cosmetic significance, like neural tube defects or orofacial clefting. Conclusion: Foetal autopsy plays a major role in providing additional information for counselling couples and the management of future pregnancies.

Comparison of Different Neonatal Disease Severity Scoring Systems for Predicting Mortality Risk in Neonatal Intensive Care Unit: A Cross-sectional Study

P Selvaraj, KT Muhammed Basheer

Introduction: To predict the risk of mortality among neonates, birth weight and gestational age have previously been used. However, a single parameter was inadequate to predict the severity of illness and outcomes for neonates. Therefore, a combination of parameters has been employed to create disease severity scoring systems aimed at predicting mortality. Consequently, various scoring systems have been developed in recent years. There is a need to assess the severity of illness in newborns, provide prognostic information to parents and formulate a new disease severity scoring system for the Neonatal Intensive Care Unit (NICU) unit. Aim: To evaluate and compare the predictive accuracy of neonatal disease severity scoring systems {Score for Neonatal Acute Physiology-Perinatal Extension II (SNAP-PE II), Transport Risk Index of Physiologic Stability (TRIPS), Mortality Index for Neonatal Transportation (MINT), Transport Related Mortality Score (TREMS) and Sick Neonate Score (SNS)} in assessing neonatal mortality risk upon admission to the NICU. Materials and Methods: This analytical cross-sectional study was conducted between September 2023 and August 2024 at Level II and Level III NICU of Malabar Medical College Hospital and Research Centre, Ulliyeri, Kozhikode, Kerala, India. Data on neonatal characteristics at admission, perinatal characteristics, maternal characteristics and transport information for 400 newborns who met the inclusion criteria were collected. Each parameter from the five disease severity scoring systems was obtained and recorded. The scores for SNAP-PE II, TRIPS, MINT, TREMS and SNS for all cases were then calculated. At the end of the seventh day of admission, the outcomes were measured as survivors and non survivors. Results: Out of 390 neonates studied, 330 (84.6%) were survivors and 60 (15.4%) were non survivors. The median and interquartile range of the SNAP-PE II, TRIPS, MINT, TREMS and SNS scoring systems were higher for non survivors than for survivors. Key predictors of mortality, including admission weight, birth weight, 1-minute and 5-minute Appearance, Pulse, Grimace, Activity and Respiration (APGAR) scores, gestational age and the need for resuscitation, were identified as strong indicators of mortality, regardless of age at admission. Conclusion: Neonatal disease severity scoring systems provide prognostic information, which assists in counselling parents. They also facilitate the evaluation of transport systems.

Saturation Oxygenation Pressure Index: A Novel Non-invasive Approach for Evaluating Pulmonary Disease Severity in Neonates on Non Invasive Ventilation

Swetha Naikodi, AS Jagadish, R Premalatha, B Ravichander

Introduction: Pulmonary disease poses a significant health challenge for neonates, necessitating precise assessment for effective management. Continuous distending pressure is crucial for achieving adequate Functional Residual Capacity (FRC) in these patients. Changes in distending pressure requirements, Fraction of Inspired Oxygen (FiO2), or both, indicate variations in disease severity. An integrated tool that incorporates these parameters would facilitate an objective evaluation of disease severity. The Saturation Oxygenation Pressure Index (SOPI) tool effectively scores and quantifies severity based on factors relevant to neonates receiving Non Invasive Positive Pressure Ventilation (NIPPV) or Continuous Positive Airway Pressure (CPAP). Aim: To determine the correlation between SOPI and the Alveolar-Arterial Oxygen Gradient (AaDO2). Additionally, it seeks to establish the cut-off values of SOPI that correspond to AaDO2 values of 70 (mild), 85 (moderate), and 100 (severe) respiratory diseases, respectively. Materials and Methods: This cross-sectional study took place at MVJ Medical College and Research Hospital in Bengaluru, Karnataka, India from July 2022 to July 2024. It included a cohort of 125 neonates, all with a gestational age of 28 weeks or older, who were admitted to the Neonatal Intensive Care Unit (NICU) due to pulmonary disease and met the defined inclusion and exclusion criteria. The severity of the condition was assessed using SOPI and AaDO2 values. Spearman’s correlation was used to analyse the relationship between SOPI and AaDO2 values. Results: In the present study, the median age of neonates was one day, with an Interquartile Range (IQR) from 1 to 5 days, and there were 86 males and 39 female babies. The study revealed a strong positive correlation between SOPI and AaDO2, with a correlation coefficient of 0.903 (p-value <0.001). Cut-off values for SOPI were established at 1.33 (sensitivity: 99%, specificity: 96.7%), 1.59 (sensitivity: 99%, specificity: 89.8%), and 1.77 (sensitivity: 97.7%, specificity: 67.6%). These thresholds correspond to AaDO2 levels indicative of mild, moderate, and severe respiratory diseases, respectively, and were statistically significant. Conclusion: A positive correlation exists between SOPI and AaDO2, with a Spearman’s correlation coefficient of 0.903 and p-value <0.001, making it a vital non invasive tool for assessing the severity of respiratory distress in neonates and eliminating the need for Arterial Blood Gas (ABG) analysis.

Comparison of WHO Growth Standards with 2019 Indian Synthetic Growth Charts in Children under Five Years of Age: A Cross-sectional Study from Rural Area of Karnataka, India

Shalini Yadhav, AS Jagadish, R Premalatha, B Ravichander

Introduction: Growth monitoring is a crucial screening tool that aids in the early diagnosis of various nutritional, chronic systemic and endocrine diseases. The choice of reference charts used to measure different measures of nutritional status can significantly impact the accuracy of these indicators, which, in turn, affects the assessment of government initiatives aimed at improving healthcare outcomes. Aim: To compare the World Health Organisation (WHO) and 2019 Indian synthetic growth charts in children under five years of age from rural area of Karnataka, and to study the nutritional status of predominantly breastfed infants less than six months of age using the two charts. Materials and Methods: This cross-sectional study was conducted at MVJ Medical College and Research Hospital, Bengaluru, Karnataka, India, from July 2022 to July 2024. The study included a sample size of 1,252 children between the ages of 0-60 months who presented to the Outpatient Department (OPD) or attended Anganwadi centres. Demographic details such as name, age, sex, birth weight, and gestation at birth were collected using a predesigned proforma. Anthropometric parameters were measured. The measured variables (height, weight, and Body Mass Index (BMI)) were plotted on both the WHO charts and the 2019 Indian synthetic charts and classified accordingly. A paired t-test was used to compare the mean values between variables, while McNemar’s test was used to compare the proportions for the variables. Results: Of the 1,252 children included in the study, 764 (61%) were males and 488 (39%) were females. Mean birth weight of the subjects was 2.85±0.44 kg. On WHO charts, the mean Z scores for height, weight and BMI was -1.28±1.54, -1.18±1.12, and -0.58±1.32 whereas on Synthetic charts, it was -0.61±1.36, -0.58±1.34, and 0.36±1.70, respectively. The analysis revealed a significant difference in Z scores when measured by WHO charts and synthetic charts (p-value <0.001). Conclusion: The use of synthetic growth charts may be more suitable for Indian children when compared to the WHO charts, as suggested by statistically significant difference in Z scores of measured variables.

Knowledge, Attitude and Practice about Neonatal Jaundice among Mothers at a Tertiary Care Hospital: A Questionnaire-based Cross-sectional Study

Sankeerthana Kamani, GN Shreekrishna, MO Abhishek, Santosh T Soans

Introduction: Neonatal jaundice, also known as hyperbilirubinaemia, is a commonly encountered clinical condition in the postnatal period due to the immaturity of an infant’s liver’s ability to metabolise bilirubin efficiently. Early detection and prompt intervention are necessary to reduce the risk of severe hyperbilirubinaemia and associated complications, such as kernicterus. Parents are more inclined to seek early medical attention if they have better knowledge and awareness, a positive outlook and are not influenced by antiquated sociocultural beliefs and practices. Aim: To study the knowledge, attitudes and practices of mothers regarding neonatal jaundice in a tertiary care hospital. Materials and Methods: This questionnaire-based cross-sectional study was conducted at Department of Paediatrics, A.J. Institute of Medical Sciences and Research Centre, Mangaluru, Karnataka, India. All 108 mothers admitted to the postnatal ward following delivery and those visiting the postnatal clinic in the tertiary care centre during one month in April 2023 were included. Data were gathered using a structured questionnaire, which evaluated the mothers’ knowledge, attitudes and practices. Demographics and categorical variables were described using frequencies and percentages. Results: Out of 108 mothers, the majority belonged to the 25-34 years age group. Most of the mothers had good knowledge about detecting jaundice and its possible causes. A total of 64 (59.3%) mothers reported that cost was a barrier to accessing healthcare. Despite this, the study showed that 82 (75.9%) of them would still visit the hospital for a check-up, suggesting an overall good attitude. Only 2 (1.9%) believed in home remedies as a treatment. Knowledge gaps regarding danger signs and complications of neonatal jaundice were noted. Conclusion: The present study indicates that mothers possess good knowledge, attitudes and practices regarding neonatal jaundice. Counselling the mothers and conducting awareness programmes for caregivers can help improve knowledge, leading to early detection and treatment.

Incidence, Morbidity Pattern and Outcomes among Preterm Babies Admitted in Special Newborn Care Unit: A Retrospective Observational Study from Nellore, Andhra Pradesh, India

Nerella Jwala Vasavi, Sandhyadevi Lingala, Suresh Reddeppagari, Nanaji Rao Pala

Introduction: Neonatal mortality and morbidity remain a significant challenge in India, accounting for 24% of global neonatal mortality. Special Newborn Care Units (SNCUs) have been established to address this issue. Therefore, it is important to evaluate the outcomes of SNCUs by measuring morbidity patterns and hospital stays among preterm neonates in these units. Aim: To evaluate the incidence, morbidity patterns and outcomes of preterm neonates admitted to the SNCU. Materials and Methods: This was a retrospective observational study conducted at ACSR Government Medical College, Nellore, Andhra Pradesh, India, from January 2020 to December 2022, during which 4,135 neonatal admissions were analysed. The study included all preterm newborns admitted to the SNCU. Additionally, only live births were included to ensure consistency in data analysis. The variables studied included gender, prematurity, birth weight, twin gestations, inborn/outborn status, outcomes in terms of mortality and morbidity, and complications. The Chi-square test was used for analysing differences in proportions. Results: Out of 4,135 neonates, 1,559 (37.7%) were preterm, with annual variations of (494/1,461) 33.8% in 2020, increasing to (542/1,322) 41% in 2021, before slightly decreasing to (523/1,352) 38.7% in 2022. Among the preterm neonates, 809 (51.9%) were males and 750 (48.1%) were females. Early preterm births (≤32 weeks’ gestation) constituted 69% (1,076) of the cases, while late preterm births accounted for 31% (483). Co-morbidities included Respiratory Distress Syndrome (RDS) 1,141 (73.2%), Low Birth Weight (LBW) 637 (40.9%), and birth asphyxia 139 (8.9%). Conclusion: There was a relatively high incidence of preterm births in the SNCU. Mortality was observed to be notably higher among outborn neonates compared to inborn neonates, particularly due to RDS and sepsis. The study underscores the significant burden of preterm births in Nellore, highlighting the need for enhanced perinatal care, early referral systems and targeted interventions to mitigate neonatal morbidity and mortality in this region.

Impact of Probiotics Supplementation on Enteral Feed Tolerance in Very Low Birth Weight Neonates: An Open Label Randomised Controlled Trial

Introduction: Probiotics are live microorganisms recognised for their potential health benefits. While the evidence regarding their effectiveness in improving feed tolerance among very low birth weight (VLBW) newborns remains inconclusive, this study seeks to investigate whether probiotic supplementation can significantly reduce the time it takes for VLBW neonates to achieve full feeding. Aim: To study the impact of probiotics supplementation on enteral feed tolerance in very low birth weight neonates. Materials and Methods: An open-label, randomised-controlled trial was conducted at the Neonatal Intensive Care Unit of a tertiary care center, PGIMS, Rohtak, Haryana. All the study participants were screened and enrolled based on the eligibility criteria from September 2022- January 2024. A total of 100 participants were recruited and divided equally into two groups (n=50 each): the probiotic group and the control group. The probiotic group received 1 gm of multistrain probiotics in breast milk. The control group received breast milk with 1 gm of formula milk powder and no probiotics. Statistical analysis was done using appropriate tests for baseline characteristics, and primary and secondary outcomes, and a p-value <0.05 was considered to be statistically significant. Results: Neonates in the probiotic group achieved full feeds much earlier, averaging 4.22±2.88 days as compared to 9.56±3.56 days in the control group (p-value <0.001). They also had a shorter hospital stay of 17.68±3.48 days versus 29.6±2.59 days. Moreover, the incidence of necrotising enterocolitis (NEC) and sepsis was significantly lower in the probiotic group (p-values of 0.05 and 0.04), underscoring the positive health effects of probiotics on neonatal well-being. Conclusion: This study concluded that probiotics should be used in very low birth weight neonates as soon as the feed is started which can reduce the time to attain full feeds, duration of hospital stay, and also preventing from potential complications such as sepsis, necrotising enterocolitis.