Indian Journal of Neonatal Medicine & Research

Role of Haematological Markers in Predicting Short-term Outcome in Neonates with Birth Asphyxia

Sharath Keerthy, Shankargouda Patil, Ss Kalyanshettar

Introduction: Perinatal asphyxia is a major global cause of neurological morbidity and mortality in neonates. In a developing country with major over population crisis, a large number of deliveries occur in peripheral healthcare facilities and at home by trained and untrained birth attendants in a very minimal infrastructure. In these scenarios, an accurate and reliable marker for birth asphyxia is needed for both diagnostic as well as prognostic evaluation. Aim: To study neonates with birth asphyxia in terms of Nucleated RBC (NRBC) and Reticulocyte Count in cord blood and/or neonatal venous blood and correlate it with the short-term outcome (up to discharge). Materials and Methods: A prospective observational study conducted in Neonatal Intensive Care Unit (NICU) in teaching hospital affiliated with medical college involving 125 term neonates with birth asphyxia. Cord blood/peripheral venous blood collected within six hours of birth was used for preparation of peripheral smear for evaluating NRBC count and Reticulocyte count. Reticulocyte counts more than 7% were considered high/positive and NRBC counts more than 10/100 WBC’s were considered high/positive. Duration of NICU stay more than five days was considered significant among asphyxiated babies. Babies less than 37 weeks gestational age or with birth weight less than 1500 g, syndromic babies or with any congenital anomalies were excluded. Results: Both NRBC counts and Reticulocyte counts were statistically significant with relation to duration of NICU stay. NRBC counts were statistically significant with relation to Hypoxic Ischemic Encephalopathy (HIE) staging, even though Reticulocyte counts were higher in neonates with higher staging of the disease it was statistically not significant. Both NRBC counts and Reticulocyte counts were statistically not significant with relation to neurological outcome at discharge. Conclusion: It can be concluded that NRBC count and Reticulocyte count are simple markers for assessment of severity and early outcomes of perinatal asphyxia and duration of stay in NICU.

Type 1 Congenital Pulmonary Airway Malformation (CPAM): A Case Report

RR Pradheep, Sahana Devadas

Congenital Pulmonary Airway Malformation (CPAM) is a lower respiratory tract developmental malformation. It is due to overgrowth of terminal bronchiole causing a dysplastic lesion. Affected areas consist of mass of cysts lined by bronchial or cuboidal epithelium, which may contain cystic and adenomatoid portions with intervening normal lung tissue. We present a rare case of full term female baby with type 1 CPAM, antenatally diagnosed and successfully managed with left lung lower lobe complete lobectomy with maximum cyst size measuring about 5.3x2.3 cm. Histologically cyst resembling bronchioles.

Thyroid Hormone Abnormalities in Septic Neonates: A Prospective Study

Pikala Tarakeswara Rao, Bonela Sai Kumar, Kondepati Sindura

Introduction: Thyroid abnormalities are common in neonates with sepsis and non-thyroidal critical illness. Alteration of thyroid function in septic neonates is mediated by various cytokines as a nonspecific response. Alteration of thyroid hormone abnormalities can adversely impact prognosis in children with critical illness. There is paucity of studies regarding thyroid hormone function in neonates with sepsis and relation between thyroid hormone abnormalities and risk of mortality. Aim: To compare mean serum levels of T3, T4, TSH, Free T3 and Free T4 levels between neonates with sepsis and gestational age matched normal controls and to assess severity of thyroid hormone abnormalities at admission between non-survivors and survivors among septic neonates. Materials and Methods: The prospective study was done in a level III neonatal intensive care unit. Neonates who were admitted with diagnosis of sepsis beyond day 3 of life were recruited as cases. Normal gestation matched neonates beyond day 3 were enrolled as control. Total 51 cases and 48 controls were enrolled in the study. Thyroid Function Tests (TFTs) were obtained at enrollment. Cases were divided into ‘survivors’ (86.3%) and ‘non-survivors’ (13.7%). Analysis was done using statistical software packages SPSS and Microsoft Excel. Comparison of mean levels of thyroid hormones between cases and controls was done by t-test or Mann-Whitney U test. Results: Serum T3, T4, Free T3 and Free T4 levels were significantly lower among cases as compared to gestational age matched control. {For both groups respectively T3: median (IQR) 69 (55,112) vs. 118 (81.5,142), p=0.002; for T4: 8.3 (5.9,11.7) vs. 12.7 (11.3,16.9) p<0.001; Free T3: 2.1 (1.7,2.6) vs. 3.1 (2.4,3.4) p=0.002; Free T4: 1.18 (0.9,1.48) vs. 1.72 (1.46,2.05), p<0.001}. TSH was not significantly different among the groups. The non-survivors among cases had significantly lesser T3,T4 and Free T4 levels as compared to survivors. {For both groups respectively T3:median (IQR) 38 (34,48) vs. 89 (61.2,112), p<0.001; for T4: 6.2 (5.9,7.5) vs. 9 (6.4,12) p<0.001; Free T4: 1.12 (0.87,1.18) vs. 1.2 (0.95,1.5) p=0.02}. Rest of the TFTs were similar in both the groups. Conclusion: Neonatal sepsis causes significant decrease of thyroid hormones. Non survivor group of Septic neonates had significant low levels of T3 and T4 at admission. Low T3 and T4 levels at admission may serve as prognostic indicator in neonatal sepsis.

Indian Journal of Neonatal Medicine & Research

Role of Haematological Markers in Predicting Short-term Outcome in Neonates with Birth Asphyxia

Type 1 Congenital Pulmonary Airway Malformation (CPAM): A Case Report

Thyroid Hormone Abnormalities in Septic Neonates: A Prospective Study

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