Indian Journal of Neonatal Medicine & Research

Candida Funisitis: Common Organism with Uncommon Presentation

Funisitis is the inflammation of umbilical cord while, chorioamnionitis is inflammation of placental membranes i.e., chorion and amnion. The mucus plug in lower genital tract acts as barrier during pregnancy. The intramniotic entry of Candida can be via haematogenous or penetration of intact membranes. Presence of intrauterine contraceptive device and prolonged rupture of membranes are proven risk factors for candidal infection. The prevalence of candidal vaginitis is high but involvement of placenta and subsequent foetal involvement is rare. Good placental examination especially, cords and membranes can clinch the diagnosis and can help in initiating investigations in the newborn for congenital candidiasis. We here presenting a case of 23-year-old fourth gravida female with previous two spontaneous abortions and history of preterm labour during current pregnancy came with complains of leaking per vagina at 33.6 weeks. The placenta sent for histopathological examination revealed presence of tiny yellowish white tubercles on umbilical cord especially near the site of insertion to placental disc. Microscopic examination of section of umbilical cord revealed presence of typical subamniontic neutrophilic micro abscesses along with candidal yeast as well as pseudohyphae forms, the latter being highlighted by special stains for fungi.

Clinical and Etiological Profile of Neonates with Persistent Hypoglycaemia

Satish Datla, Ganavi Ramagopal, Giridhar Sethuraman, Manikumar K, Srinivasan K

Disturbances of glucose homeostasis that result in hypoglycaemia is a common metabolic issue encountered in newborn. Most of the times, awareness of various risk factors that predispose infants to hypoglycaemia allows for screening of newborns at risk, so that clinically undetectable hypoglycaemia can be treated promptly, thus preventing the development of severe or symptomatic hypoglycaemia, which is associated with adverse outcomes. Persistent, recurrent or severe hypoglycaemia may cause irreversible injury to the developing brain. The present study reported outcome of seven neonates who presented with varied symptoms of persistent hypoglycaemia.

Severe Neonatal Hyperbilirubinaemia in the First 24 Hours of Life: Tertiary Center Experience in Oman

Introduction: Neonatal jaundice is a common condition observed in approximately two-thirds of all newborns in the first postnatal week of life. In most cases it is benign and no treatment is required. However, in severe cases, pathological jaundice can lead to acute bilirubin encephalopathy and kernicterus. Aim: To characterise the main predisposing factors as well as the treatment modalities of babies with significant neonatal jaundice presenting in the first 24 hours of life. Materials and Methods: We conducted a retrospective, observational study of all babies admitted to the neonatal unit at the Royal hospital in Oman in the period between 1st January 2014 and 31st December 2014 and treated for significant hyperbilirubinaemia presenting in the first 24 hours of life. Patients were selected from the Royal Hospital neonatal admission registry. A total of 125 patients records were analysed for the sake of the study. Results: The mean gestational age was 34 weeks and the mean birth weight was 2070 grams. Male to female ratio was 1:1.2. About 30 (45%) of the males and 15 (26%) of the females had Glucose-6-Phosphate Dehydrogenase (G6PD) deficiency. Blood group of the babies was A 42 (33.6%), B 34 (27.2%), AB 4 (3.2%) and O 45 (36%). About 4.8% were Rhesus negative. In all 27 (21.6%) of the babies tested positive for Direct Coombs Test. The maximum Total Serum Bilirubin (TSB) in the first 24 hours of life was 130±65 µmol/L and the maximum TSB anytime during the admission was 215±80 µmol/L. About 88 (70%) of the babies received standard phototherapy and 37 (30%) received intensive phototherapy. Intravenous Immunoglobulin (IVIG) in addition to phototherapy was administered in 21 (17%) of the babies. None of the babies required exchange transfusion. Conclusion: It was observed that the most common predisposing factors for significant neonatal jaundice presenting in the first 24 hours of life were prematurity, G6PD deficiency and isoimmune hemolytic disease. Phototherapy and IVIG was the treatment modalities used.

Prediction of Neurological Outcome in High Risk Neonates: Prospective Study

Introduction: High risk babies are vulnerable to neurological brain injury. Early identification of injury will help in initiating strategies to reduce the neurological damage and hence prevent long term sequeale. It’s also help in counselling the parents regarding the prognosis. Neurosonography and Doppler are point of care tests commonly used to identify neurological damage. Aim: To identify spectrum of neurological abnormalities in high risk neonates. Second objective is to know the predictive ablility of initial findings of neurosonogram and Doppler findings on neurological outcome. Materials and Methods: This is a prospective study conducted in neonatal care unit of tertiary hospital. Total of 138 neonates admitted to hospital are enrolled in the study. All neonates underwent transcranial USG using standard probe and Resistive Index (RI) measured in right anterior and right Middle Cerebral Artery (MCA) with color Doppler equipment within 72 hours of life. Babies upon discharge followed up in neonatal clinic and neurological assessment done at six months of age. Analysis was done using statistical software packages SPSS and Microsoft Excel. Results: Diffuse cerebral oedema was detected by neurosonogram in 20 (19.2%) of high risk neonates. RI index less than 0.6 was observed in 32 (30.8%) Anterior Cerebral Artery (ACA) and 47 (45.3%) MCA. Statistically significant neonates with initial abnormal USG findings had abnormal outcome at six months of age compared to neonates with normal USG findings (p=0.014). Low RI in the middle and ACA was associated with abnormal outcome at six months in significant number of neonates (p<0.001). RI of right MCA is more specific in predicting neurological outcome at six months of age. The positive likelihood ratio is more for low RI of MCA (18) as compared to neurosonogram. Conclusion: Abnormal neurological outcome was significantly more in neonates with abnormal findings on USG and Doppler. Doppler RI abnormalities done within 72 hours had more specificity and better likelihood ratio for predicting abnormal neurological outcome than neurosonogram.

A Study of Neurodevelopemental Outcome in Hyperbilirubinaemic Neonates Admitted in NICUdysfunction

Introduction: Hyperbilirubinaemia may be toxic to the developing central nervous system and may cause neurological impairment. The developing brain of premature babies is extremely vulnerable to injury. With increased level of bilirubin, the risk for neurodevelopmental deficit increases with decreasing gestational age and birth weight resulting in relatively high risk of cerebral palsy, developmental delay, hearing and vision impairment and subnormal academic achievement. Aim: This study was conducted to identify factors and pattern of abnormal neurodevelopment at three and 12 months in babies having birth weight >1.5 Kg and gestational age >34 weeks with neonatal hyperbilirubinaemia. Materials and Methods: This prospective study was conducted at Sardar Patel Medical College, Bikaner (Rajasthan), India, from 2014 to 2015. Hyperbilirubinaemia in newborns were examined at three month and 12 month age and their neurodevelopmental assessment done by DASI method. All the collected data was tabulated and stastically analysed by using SPSS software. Results: Out of 96, 67 (69.79%) of hyperbilirubinaemic neonates were males and 29 (30.21%) were females. The prevalence of neurodevelopmental abnormalities (DQ=70) was 10.42% at three months where as it was 6.25% at 12 months follow-up. Early onset of jaundice (=1 day), serum bilirubin level >25 mg/dL, duration of hospital stay >3 days and requirement of exchange transfusion was significantly associated with adverse neurodevelopmental outcomes (DQ=70) at three and 12 months of age. Conclusion: This study found a high prevalence of adverse neurodevelopmental outcome in neonates with hyperbilirubinaemia. Early detection of neurodevelopmental abnormalities and initiation of early intervention measures to reduce the prevalence of neurodevelopmental abnormalities in hyperbilirubinaemic neonates.

Effectiveness of Kangaroo Mother Care in Reducing Pain during Minor Procedures in Preterm Neonates

Heena Bhandekar, Sushma Malik

Introduction: Premature babies admitted in Neonatal Intensive Care Unit (NICU) are subjected to many painful invasive procedures. The exposure to pain leads to immediate and long term changes in the structure and function of preterm newborn’s brain and therefore pain must be avoided in neonates to prevent the adverse effects. Kangaroo Mother Care (KMC) is one of the effective non pharmacological methods of reducing neonatal pain for minor procedures. Aim: Evaluate the effectiveness of KMC versus conventional care in reducing pain in premature neonates during minor procedures. Materials and Methods: Prospective study done in a Tertiary Care Hospital over eighteen months. Eighty premature neonates with gestational age between 28 to 37 weeks and birth weight <2000 grams, requiring venepuncture for blood collection were included and alternately allocated into study and control group. Preterm neonates in KMC (study) group were given kangaroo care for 30 minutes uninterrupted prior to and throughout the venepuncture procedure and this was followed by at least 10 minutes KMC after the procedure. Neonates in control group receiving conventional care were placed in a cradle 30 minutes before, during and after venepuncture procedure. In all these neonates, pain assessment was done, using the Premature Infant Pain Profile (PIPP) score which was estimated at one minute prior and 1, 3, 5 minutes after the venepuncture procedure. Results: Mean PIPP scores in study (KMC) group at 1, 3 and 5 minutes after procedure were less than mean scores in control group and this difference between the scores was statistically significant (p<0.001). Conclusion: Our study revealed that KMC is an effective non pharmacological and safe modality in reducing pain in premature neonates during minor painful procedure like venepuncture as compared to conventional care.

Effect of Maternal Nutritional Status, Socioeconomic Class and Literacy Level on Birth Weight of Babies

Abhijit Ambike, Subhash Shankar Poyekar, Deepali Ambike, Amar Dattatray Kore

Introduction: The prevalence of Low Birth Weight (LBW) is higher in Asia than elsewhere predominantly because of undernutrition and poor socioeconomic status of mothers. Nearly half of the pregnant women still suffer from varying degrees of anaemia with the highest prevalence in India. Optimal weight gain during pregnancy and a desirable foetal outcome in terms of normal birth weight of the baby may be a result of synergistic effect of literacy, knowledge, improved food intake, and higher level of socioeconomic status of the pregnant women and their family. Aim: To observe the influence of maternal nutritional, socioeconomic status and literacy level on birth weight of babies. Materials and Methods: Total 250 mothers who delivered babies and admitted to the post natal ward of B.S.T. Rural Hospital, Talegaon Dabhade, District Pune, Maharashtra, India, were randomly selected and the relevant information was recorded in self prepared and pre validated questionnaire. Dietary history was collected by 24 hours recall method. Results: A total of 250 mothers and their babies were included. The average birth weight of babies was 2.65 Kg with the lowest birth weight of 1.2 Kg while the highest birth weight of 4 Kg. The prevalence of LBW babies was 27.6%. Most of the women (77.2%) had caloric intake less than 1800 Kcal, 80% of mothers had protein intake of less than 45 gm. Nearly, 31.60% of women who were taking daily intake of calories less than 1800 Kcal delivered LBW babies. About 30.50% of the women with protein intake less than 45 gm/ day delivered LBW babies. In all 34.86% of the women with haemoglobin level below 11 gm% delivered LBW babies. These findings were statistically significant. Conclusion: Maternal caloric and protein deficiencies including anaemia during pregnancy had direct effect on the birth weight of newborns, as less nourished mothers were found to deliver higher percentage of LBW babies as compared to the mothers who were better nourished. Mother’s educational level and socioeconomic class also had influence on the birth weight of babies.