Indian Journal of Neonatal Medicine & Research

A Study in Late Preterm Babies for Early Neonatal Outcome

Sanjeet Kumar Tiwari, Nitish Kumar, Santosh Kumar, Renu Prabha

Introduction: Infants born between 34 and 36 weeks gestation have an increased risk of neonatal morbidity requiring admission to a neonatal unit compared with those born at/or beyond 37 weeks gestation. Aim: To estimate the short term outcomes of late preterm babies in comparison with term babies and to study indication of caesarian section in late preterm deliveries. Materials and Methods: This prospective observational study was carried out at level II and level III Neonatal Care Unit and Obstetrics and Gynecology Department of North Bengal Medical College and Hospital. Total 7138 live babies were delivered during study period, out of them, 4891 babies were included in study group. Results: Total 919 late preterm were taken as cases and 3972 term neonates as control. Mean birth weight of term and late preterm neonates were 2.78 and 2.71kg respectively with standard deviation of 0.41 (p-value <0.01). Maternal age of term babies were 22.78 year with 3.81 standard deviation as against maternal age of late preterm were 23.03 with standard deviation 3.95 (p-value=0.0543). Among late preterm 120 (13.06%) developed respiratory distress as against 68 (1.71%) term neonates developed it during study period with a statistically significant p-value (p<0.01). 483 (52.56%) late preterm had jaundice while 1213 (30.54%) term babies developed it (p-value<0.001). Among all late preterm neonates 101 (10.99%) experienced one or more episodes of hypoglycemia while 57 (1.44%) term neonates experienced it (p-value<0.001). Hypothermia occurred in 73 (7.94%) late preterm neonates as against 69 (1.74%) term neonates (p-value<0.001). 39 (4.24%) late preterm experienced one or more episodes of apnoea as against 49 (1.23%) term babies (p-value<0.001). 166 (18.06%) late preterm babies had feeding problems but only 113 (2.84%) term babies had it (p-value<0.001). 90 (9.79%) term babies had confirmed sepsis while 70 (1.76%) term babies developed sepsis during study period (p-value<0.001). among all late preterm babies, 404 (43.96%) were delivered by caesarian section while rest 515 (56.04%) were delivered by spontaneous vaginal delivery. Among caesarian deliveries most common indication were foetal distress accounting for 12.8% of all deliveries followed by oligohydramnios (10.1%), meconium stained liquor (8.6%), IUGR (4%), Eclampsia (3.7%). Others less common are placental abruption, breech, CPD, uterine dehiscence. Mortality of late preterm was 7.29% (67) as against 47 (1.18%) terms. Conclusion: In contrast to very preterm infants, serious neonatal morbidity in (Late/Moderately Preterm) LMPT infants is uncommon. However, even modest increases in morbidity in this sizeable group exert very significant demands on neonatal service.

Transient Abnormal Myelopoiesis in Down Syndrome

Ayesha Majeed, Natasha Ali

We report peripheral blood film and cytogenetic results of a five day old neonate who presented with history of high grade fever, vomiting and jaundice. Peripheral blood film showed presence of 30% blast cells which were large in size having abundant granular cytoplasm. Karyotyping results revealed presence of trisomy 21. She was diagnosed as a case of Down syndrome with congenital leukemia. Approximately 10% of such cases present as Transient Abnormal Myelopoiesis. Persistence of blast cells beyond six months is an indication for treatment. As the diagnosis was made retrospectively, this case highlights the importance of peripheral smear review which showed presence of abnormal cells prompting for further investigations.

Cardiac Tamponade and Right Side Pleural Effusion in a Preterm Neonate

Priya Shivalli, Aiswarya Sankar, Ravi Kumar, Suman Rath

Umbilical venous catheterization is a common procedure in NICU, especially for parenteral nutrition in preterm and as long term intravenous access for term babies. However these “life lines” are not without complications, they may even cause life threatening complications like pericardial effusion and cardiac tamponade. We report a case of newborn with cardiac tamponade and right sided pleural effusion as a complication of umbilical venous catheterization.

A Term Female Neonate with Achondroplasia: A Case Report

Arun P, Vijayalaxmi Gagandeep, MD Khaja Moinuddin, Nagabhushan BM

Achondroplasia is one of the commonest causes of dwarfism, inherited as autosomal dominant trait. Majority of the cases are due to mutation in the Fibroblast Growth Factor Receptor 3 (FGFR3). The mutation results in gain of FGFR3 function, which affects cartilaginous growth plate in the growing bone causing the skeletal changes. At birth it manifest as short limbs, large head with midfacial hypoplasia and narrow trunk. Diagnosis is mainly based on clinical features and skeletal radiography. Complications are hypotonia, delayed development, hydrocephalus, recurrent ear infections and dental malocclusion.