Indian Journal of Neonatal Medicine & Research

Refractory Hypoglycaemia- The Need for Genetic Work Up

Charu Jha, Bhavesh Rathod

Congenital Hyperinsulinism of Infancy (CHI) is a rare condition that causes of persistent hypoglycemia refractory to treatment. Neonatal hypoglycaemia is caused by numerous clinical conditions, such as birth asphyxia, Small for Gestation Age (SGA), premature birth, infant of diabetic mother, systemic disorders and hormonal disorders of fatty acid oxidation disorders. Of them infants that experience birth asphyxia, SGA, premature birth and born to diabetic mother that usually have transient hyperinsulinism resolves quickly, even though it may be quite severe. Hypoglycaemia in CHI occurs secondary to the dysregulation of insulin secretion. CHI has been established as a genetic disorder of islet cell hyperplasia, associated with a mutation of ABCC8 or KCNJ11 genes, which encode the sulfonylurea receptor 1 and inward rectifying potassium channel (kir6.2) subunit of the ATP-sensitive potassium channel, respectively. A case report of a neonatal persistent refractory hypoglycaemia born to primigravida mother as a result of CHI caused by mutation of ABCC8 gene at a secondary care centre was presented.

Neonatal Hypernatremia in Exclusively Breastfed Newborns- A Case Control Study in the Postnatal Ward of a Tertiary Care Hospital

Neha Mohan Rao, Madhuri Maganthi, KS Lakshmi

Introduction: Hypernatremia, defined as a serum sodium level of more than 145 mEq/L, is a common but potentially dangerous condition in newborns. Hypernatremia in exclusively breastfed newborns is usually secondary to insufficient lactation. Aim: To determine the clinical profile and risk factors associated with the development of hypernatremia and to assess whether neonatal hypernatremia is associated with breastfeeding problems. Materials and Methods: This was a case control study conducted in the postnatal ward of Bangalore Baptist Hospital, Bengaluru, Karnataka, India on 64 exclusively breastfed newborns (32 cases and 32 controls), between September 2017 and June 2018. In babies with significant weight loss (more than 10% in term or more than 15% in late preterm), or symptoms suggestive of dehydration like depressed anterior fontanel, excessive cry, lethargy, poor feeding, serum sodium levels of the newborn was measured. Babies with serum sodium >150 mmol/L were in the case group and babies with sodium <145 mmol/L were in the control group. Corresponding breast milk sodium levels were measured and classified into normal or high breast milk sodium based on standard cut-offs. LATCH score of each mother-infant dyad was observed to assess breastfeeding. Maternal and neonatal risk factors were assessed and data interpreted. The data collected was then analysed using Microsoft Excel and SPSS software (version 18). Results: On comparing breast milk sodium levels with standard normal levels, it was found that- amongst mothers with high breast milk sodium, 55.55% babies had hypernatremia, versus mothers with normal breast milk sodium, where only 20% babies had hypernatremia. This was found to be statistically significant (p=0.038) indicating an association between high breast milk sodium and hypernatremia. Conclusion: Breastfeeding associated hypernatremia is a preventable cause of morbidity in the newborn. Mothers with high breast milk sodium are more likely to have babies with hypernatremia than mothers with normal breast milk sodium levels.

Relation of Clinical Features with Microbiological Findings in Children of Suspected Pulmonary Tuberculosis

Introduction: Tuberculosis (TB) is an important cause of morbidity and mortality in children especially in TB endemic settings. In endemic regions of TB, it is a major yet an unrecognised factor for death among children. Children are usually assessed when they present with symptoms or signs associated with TB. The standard tuberculin test can be used as an adjunct in diagnosing TB in children, however definitive proof for lesion being of tuberculous origin is finding of tubercle bacilli. Aim: To determine the association between the clinical features in suspected pulmonary TB with sputum positivity. Materials and Methods: Mantoux test for every child suspected to be suffering from TB was done. X-ray radiography was done and findings were recorded from December 2017 to June 2019. Two sputum samples were collected from every suspected case. One in a sterile specimen cup with a tight-fitting cap was sent for Ziehl-Neelsen staining and the other in a falcon tube was sent for Cartridge Based Nucleic Acid Amplification Test (CBNAAT). The data was analysed using Microsoft SPSS version 26.0 and along with graph pad prism software. Results: Out of 53 subjects, 10 patients (19%) tested positive for acid fast bacilli via Ziehl-Neelsen staining as well as CBNAAT and remaining 43 patients (81%) tested negative. Mantoux test results were not significantly different from the percentage of patients with sputum negativity (93.02%). The percentage of sputum positive patients with cavitations on chest X-ray was 70% which was significantly higher. Conclusion: Females were more likely to suffer from TB disease as compared to the males. Sputum positivity was significantly associated with cavitatory lesion on chest X-ray.