Indian Journal of Neonatal Medicine & Research

Current Insights into Newborn Hearing Screening: A Prospective Observational Study from a Tertiary Care Hospital in Northern India

Prakash Chandra Joshi, Bindiya Verma, Niranjan Kumar Singh, Sachin Verma

Introduction: Hearing impairment is one of the most common congenital disorders and can significantly affect speech, language, and cognitive development if not identified early. Universal newborn hearing screening plays a vital role in early diagnosis and intervention. However, data on neonatal hearing loss from developing countries, including India, remain limited. Aim: To determine the prevalence of screen positive hearing impairment among neonates attending a tertiary care hospital using Automated Auditory Brainstem Response (AABR) and its association with demographic variables and risk indicators. Materials and Methods: This prospective observational study was conducted at a tertiary care hospital in Northern India from September 2023 to August 2025. A total of 404 neonates were screened using a two-stage AABR protocol. Neonates who failed or had an aborted first-stage AABR underwent second-stage AABR screening. Those who failed the second stage were referred for diagnostic Brainstem Evoked Response Audiometry (BERA) at three months of age. Chi-square test was used to determine the association between different factors and outcomes. Results: Of the 404 neonates screened, AABR testing was aborted in 2 (0.5%), 62 (15.35%) failed, and 340 (84.15%) passed the first-stage screening. Of the 64 neonates who failed or had aborted tests, 37 underwent second-stage screening. Only 3 (8.11%) passed the second- stage AABR, while 34 (91.89%) failed. Overall, hearing impairment was detected in 34 neonates by two-stage screening, giving a prevalence of 8.42%, while the prevalence of confirmed hearing impairment was 0.74% (3/404). The association between neonatal morbidity and hearing abnormalities was highly significant (p-value <0.001). Conclusion: The prevalence of screen positive hearing impairment observed in this study (8.42%) was higher than that reported in Western literature but comparable to that in recent Indian studies. Poor follow-up compliance remains a major challenge in implementing universal newborn hearing screening programs. Strengthening follow-up mechanisms and ensuring early intervention for screen-positive neonates are essential to reduce the burden of childhood hearing loss.

Early Onset Sepsis and its Relation with Maternal Vaginal Infection: A Prospective Observational Study

Introduction: The risk of Early Onset Sepsis (EOS) is higher in newborns born to mothers with vaginal infections. High Vaginal Swab (HVS) is a simple technique for identifying causative organisms and for early detection of newborns at risk of sepsis. This method helps us to detect the organism in the vaginal canal, and thus help in understanding the causative organism and early initiation of empiric antibiotics for EOS in newborn infant. Aim: To evaluate the role of HVS culture in detecting the maternal vaginal infection and its relationship with EOS in newborns. Materials and Methods: The present prospective observational study was conducted at Department of Paediatrics, Prashanthi Hospital a tertiary care hospital at Warangal, Telangana state of India, over a period of two years, extending from June 2022 to May 2024. The study included all mothers with term gestation having vaginal discharge, Prolonged Rupture of Membranes (PROM) and chorioamnionitis. A total of 112 cases were collected, from the mothers included age, parity, delivery method, PROM, presence of chorioamnionitis, and maternal fever. The neonatal birth weight, gender, A- Appearance (skin color), P- Pulse (heart rate), G- Grimace (reflex irritability), A- Activity (muscle tone) and R- Respiration (breathing effort)(APGAR) scores, need for resuscitation, respiratory distress, lethargy, feeding difficulty, and need for treatment along with lab parameters were collected. Chi-square test was applied to test the association between the maternal HVS status and early onset neonatal sepsis. A p-value of <0.05 was considered significant. Results: The mean age of mothers was 26±2.47 years. Among 112 patients with suspected infection, HVS culture was positive in 75 (66.9%) and was found to be culture negative in 37 (33.1%) of women. The newborns, who were born to mothers who’s HVS culture was positive, 64 (85.3%) of newborns had sepsis screen positive. The association between the maternal HVS positive culture and sepsis screen in newborn were statistically significant (p<0.001). Conclusion: The risk of developing EOS in newborns born to mother with vaginal infection is high. Hence, HVS is simple and easy technique to identify the causative organism and prevent the morbidity and mortality in both mother and newborns.

Incidence and Pattern of Morbidity among Neonates with Premature Rupture of Membranes: A Prospective Cohort Study

Thamaraikannan A Arulselvan, Sridevi A Naaraayan, Krishnaswami A Devimeenakshi

Introduction: Conventionally, Premature Rupture of Membranes (PROM) lasting more than 18 hours is considered to be associated with neonatal morbidities. However, recent research has shown that PROM of shorter duration is also associated with neonatal morbidity. Aim: The present study was conducted to estimate the incidence and pattern of morbidity in neonates born following PROM of more than 12 hours. Materials and Methods: The present prospective cohort study was conducted in the Neonatal Intensive Care Unit (NICU) of Kilpauk Medical College, Chennai, Tamil Nadu, India. from September 2019 to September 2020. One hundred neonates born following PROM of more than 12 hours were recruited and followed until recovery. Their clinical morbidities, including sepsis and duration of hospital stay, were recorded. The primary outcome was expressed as proportion. Secondary outcomes were analysed using the Chi-square test, and a p-value less than 0.05 was considered statistically significant. Results: The mean {Standard Deviation (SD)} birth weight of the cohort was 2.84 (0.47) kg. Fourteen percent of the neonates were preterm, and 52% were male. The incidence of morbidity among the study population was 40%. The morbidities encountered in neonates born following PROM of more than 12 hours included respiratory distress, birth asphyxia, Small for Gestational Age (SGA), and sepsis. Morbidities were almost equal (41% vs 39%) in neonates born following PROM of 12-18 hours and more than 18 hours. Culture-positive sepsis and duration of hospital stay were higher in neonates born following PROM of more than 18 hours (p=0.017). The rate of culture-positive sepsis increased with longer duration of PROM (p=0.009). Conclusion: According to the present study findings, a significant number of neonates born following PROM of more than 12 hours experienced morbidities. Hence the conventional PROM cut-off of 18 hours should be reconsidered.

Clinical Profile and Outcome of Neonates Admitted to the Neonatal Intensive Care Unit: A Prospective Observational Study from a Tertiary Care Hospital, Raipur, Chhattisgarh, India

Introduction: Neonatal morbidity and mortality are major public health challenges in India, particularly in resource-limited regions. Understanding the clinical profile and outcomes of neonates admitted to tertiary-care Neonatal Intensive Care Unit (NICU) is essential for improving neonatal survival and guiding region-specific health strategies. Aim: To evaluate the clinical profile, morbidity pattern, management practices, and outcomes of neonates admitted to a tertiary-care NICU in central India and to assess factors associated with mortality. Materials and Methods: This prospective observational study was conducted from October 2018 to March 2019 in the NICU of a tertiary-care hospital in Raipur, Chhattisgarh, India. Both inborn and outborn neonates with gestational age ≥28 weeks and birth weight ≥800 g admitted during the study period were included. Of 953 admitted neonates, 939 fulfilled the inclusion criteria. Data regarding demographic characteristics, clinical diagnoses, interventions, and outcomes were collected using a structured proforma. Continuous variables were expressed as mean±standard deviation, and categorical variables as n (%). Associations with mortality were analysed using Chi-square test or Fisher’s exact test, wherever appropriate. A p-value <0.05 was considered statistically significant. Results: Among 939 neonates, 606 (64.5%) were male and 494 (52.6%) were admitted within 48 hours of life. Preterm neonates constituted 318 (33.9%), and 436 (46.4%) had low birth weight (<2.5 kg). The most common morbidities were hyperbilirubinaemia 518 (55.2%), neonatal sepsis 372 (39.6%), Respiratory Distress Syndrome (RDS) 179 (19.1%), and birth asphyxia 183 (19.5%). The overall mortality was 15 (1.6%). Neonatal sepsis accounted for 8/15 (53.3%) deaths, followed by birth asphyxia 4/15 (26.7%). No statistically significant association with mortality was observed for the studied demographic and perinatal variables on bivariate analysis. Conclusion: Hyperbilirubinaemia and neonatal sepsis were the most frequent causes of NICU admission, while infections and birth asphyxia were the leading causes of mortality. Strengthening antenatal care, infection control practices, early referral systems, and parental counseling may further improve neonatal outcomes in tertiary-care settings.

Role of Therapeutic Hypothermia in Prevention of Acute Kidney Injury in Neonates with Perinatal Asphyxia- A Prospective Observational Study

Shubham Raheja, Payal Mittal

Introduction: Perinatal Asphyxia (PA) remains a leading cause of neonatal mortality, especially in resource-limited settings like India, contributing to over 13% of neonatal deaths. Acute Kidney Injury (AKI) is a significant complication of PA, with an incidence ranging from 50-72%. Therapeutic Hypothermia (TH), the only evidence-based intervention for Hypoxic Ischaemic Encephalopathy (HIE), has demonstrated neuroprotective effects. However, its renoprotective potential in preventing AKI is inadequately explored. Aim: To evaluate the role of TH in preventing AKI in term neonates with PA by comparing renal outcomes between neonates receiving TH and those receiving standard care. Materials and Methods: This prospective observational study was conducted in the Neonatal Intensive Care Unit (NICU) of FH Medical College in Agra, Uttar Pradesh, India, from September 2022 to May 2024. A total of 81 neonates with moderate to severe HIE were enrolled. The enrolled neonates were categorised into two groups: Group A received standard care (n=40), while Group B received TH (n=41). AKI was diagnosed according to the neonatal modified Kidney Disease: Improving Global Outcomes (KDIGO) criteria, and outcomes were monitored over a 72-hour period. Neurological outcomes were additionally assessed using the Thompson encephalopathy score. Data were analysed using Statistical Package for Social Sciences (SPSS) version 21.0, with a p-value <0.05 considered statistically significant. Results: The incidence of AKI was significantly lower in the TH group (31.7%) compared to the non TH (52.5%) (p=0.047*). Neonates in group B also demonstrated better neurological outcomes, with 73% achieving mild Thompson scores at discharge compared to 51.5% in group A. Complications like hypotension and coagulopathy showed no significant differences between groups. Conclusion: TH significantly reduces AKI incidence and improves neurological outcomes in neonates with PA, reinforcing its role in neonatal care.

Predictive Value of Early Brain MRI for Neurodevelopmental Outcome at 12 Months of Age in Neonates with Hypoxic Ischaemic Encephalopathy: A Prospective Observational Study from a Tertiary Care Centre

Introduction: Perinatal asphyxia with Hypoxic Ischaemic Encephalopathy (HIE) is a common cause of neonatal mortality and morbidity in Low and Middle Income Countries (LMIC) including India. Early objective assessment of severity of brain injury in these neonates is vital in important prognostication and timely optimisation of early intervention. Early Magnetic Resonance Imaging (MRI) is a tool commonly used to predict neurodevelopmental outcome in these neonates, however, studies are limited to assess this association in the Indian context. Aim: To determine the association between early MRI brain findings and neurodevelopmental outcome at 12 months of age in neonates with HIE. Materials and Methods: This prospective observational study was conducted in neonatal intensive care unit FH Medical College and Hospital, Agra, Uttar Pradesh, India. A total of 123 babies admitted with diagnosis of perinatal asphyxia by National Neonatal-Perinatal Database (NNPD) criteria were enrolled between October 2020 to September 2023. HIE staging was done by Sarnat and Sarnat staging. MRI was done at 7 to 14 days of life. Neonates were assessed for anthropometry, neurological examination and a DDST-II (Denver Developmental screening- II) at 12 months of age. Normally distributed continuous variables were summarised as Mean±SD and compared using Analysis of Variance (ANOVA). Categorical variables were analysed using the Chi-square test, and correlations were assessed using Pearson’s correlation coefficient and p-value <0.05 was significant. Results: Out of total 123 participants, 93 (75.6%) were male. A total of 91 (74%) deliveries were vaginal, while 32 (26%) were performed by caesarean section. Of 123, 101 (82%) babies completed the follow-up and DDST-2 was done at 12 month. Correlation of MRI brain with developmental screening was done at 12 months of age showed 100% sensitivity, 51.5% specificity with Positive Predictive Value (PPV) 55% and Negative Predictive Value (NPV) of 100%. Conclusion: In neonates with HIE, increasing severity was strongly associated with abnormal MRI findings, worse neurological status at discharge, and delayed neurodevelopment at 12 months. Abnormal MRI was common in HIE stage II-III and predicted poor outcomes, while normal MRI was associated with normal development. So MRI is a reliable prognostic tool.

Strengthening Modified Sick Neonatal Score and Delta MSNS for a Better Prediction of Outcome in Critically-ill Neonates at a Tertiary Care Centre: A Prospective Observational Study

Nittu Joseph James, Darly Saramma Mammen, Keerthi Kumaran

Introduction: The Modified Sick Neonatal Score (MSNS) and delta MSNS are simplified clinical scoring system designed to assess the severity of illness in neonates. The present study has focused to determine whether delta MSNS as an independent factor and as a combination with MSNS at admission, need for mechanical ventilation and ionotropic support will have a better prognostic value than single MSNS recording at admission. Aim: To assess the predictive value of MSNS and Delta MSNS for outcome in critically-ill neonates. Materials and Methods: This prospective observational study was conducted in the level III Neonatal Intensive Care Unit of Government Medical College, Kottayam, Kerala, India, from July 2023 to June 2024. A total of 122 newborns were scored using MSNS at admission and after 24 hours. Delta MSNS was calculated as the change of score over 24 hours. In addition to this the need for ionotropic support and mechanical ventilation and the number of days of hospital stay were recorded. Outcome was measured as mortality. Logistic regression was used to determine the ability to predict the outcome, of MSNS score at admission, delta MSNS, the ionotropic support and mechanical ventilation requirement. Results: A total of 122 neonates were included in the study. The female-to-male sex ratio in the study population was 1.6:1.0. The mean score of MSNS at admission was 12.47±2.085 and 8.67±3.086, in neonates who survived and expired, respectively (p=0.001). The mean score of Delta MSNS was 1.94±1.235 and -2.20±1.935, in neonates who survived and expired, respectively (p=0.001), with a rank-biserial effect size of -0.952. So, both MSNS and delta MSNS are indicators of outcome. Receiver Operating Characteristic (ROC) curve generated using only delta MSNS, the area under the curve {unadjusted Area Under Curve (AUC)} was 0.976. The adjusted AUC (with additional variables like MSNS at admission, ionotropic requirement and mechanical ventilation requirement) was 0.999, making this model almost perfect. Conclusion: Delta MSNS is an equally good predictor of mortality in a critically-ill neonate compared to MSNS. Also, addition of other variables makes the score almost perfect in predicting neonatal mortality.