Indian Journal of Neonatal Medicine & Research

Vertical Transmission of COVID-19 Infection in a Newborn

Rita Hajela, Rajeev Vinayak, Manisha Behal

Coronavirus Disease-2019 (COVID-19), in its second wave, is infecting the young children and newborns too. Increasing number of pregnant women with COVID-19 is being reported globally, and the potential for vertical transmission of Severe Acute Respiratory Syndrome- Coronavirus-2 (SARS-CoV-2), either in-utero, intrapartum or in the early postnatal period is of concern. At present, the extent to which SARS-CoV-2 vertical transmission occurs, and timing of such transmission is unclear. This report describes the clinical course and laboratory findings in a neonate in whom SARS-CoV2 infection most likely occurred via vertical transmission. As the baby developed audible grunting and tachypnoea, 10 minutes after birth, all the relevant laboratory investigations were done. The chest X-ray showed bilateral lung opacities. The neonate developed signs and symptoms of severe COVID-19 pneumonia on day 1 of life, completely manifesting within few hours of birth. The nasopharyngeal swab was sent for Reverse Transcriptase- Polymerase Chain Reaction (RT-PCR) for SARS-CoV 2 after two days of birth. The RT-PCR test came out positive. With all other causes been ruled out and contributory laboratory findings (raised D-Dimer, lactate dehydrogenase and erythrocyte sedimentation rate) it can positively be labelled as a case of vertically transmitted intrauterine COVID-19 pneumonia in a newborn. The baby was treated with ventilator support, antibiotics and Low Molecular Weight Heparin (LMWH), and finally discharged after nine days of life and management at the hospital.

Cutaneous and Ocular Findings in Systemic Pseudohypoaldosteronism I: Early Clinical Pointers

Neha Agarwal, Alpa Gupta, Renu Dhasmana, Ashima Mehta, Nitika Agrawal

Systemic Pseudohypoaldosteronism type I (PHA I) is an uncommon and an often missed cause of salt wasting crisis in the neonatal period. In addition to dyselectrolytemia, cutaneous findings in the form of miliaria rubra, and ophthalmic findings secondary to abnormal sebum accumulation in the eye may also be present in patients with systemic PHA I. This article is about systemic PHA in a female neonate (birth weight 2.040 Kg, delivered at 34 weeks of gestation), who presented with life-threatening hyperkalemia, along with characteristic cutaneous and ophthalmic manifestations. Normal female genitalia, history of hyperkalemia with similar cutaneous and ophthalmic manifestations leading to death in the previous sibling, provided clue to the diagnosis. All relevant investigations were performed. Blood chemistry in this neonate revealed hyponatremia and hyperkalemia with metabolic acidosis. Plasma renin and serum aldosterone levels were reportedly high. Neonate was followed and electrolytes were monitored twice weekly on outpatient basis. But the life-threatening hyperkalemia led to multiple episodes of vomiting and, refusal to feed for few hours and the baby succumbed to death at age of 2.5 months. Hence, it was concluded that systemic PHA I should be considered in the differential diagnosis of neonates presenting with hyponatremic dehydration, hyperkalemia, and metabolic acidosis. Timely and appropriate electrolyte correction is pivotal for favourable outcome.

A Retrospective Study of Predictors of Mortality in Low Birth Weight Neonates in a District Hospital of Lucknow, India

Neha Thakur, Narendra Rai

Introduction: Low birth babies account for 10% of neonatal mortality. Survival of these babies depends on gestation, birth weight, presence of associated co-morbidities and quality of neonatal care. Aim: To evaluate predictors of mortality of low birth weight neonates admitted in Special Newborn Care Unit (SNCU) of a district hospital in Lucknow. Materials and Methods: A retrospective analysis of case records were done to assess predictors of mortality of low birth weight babies admitted in SNCU of a district hospital in Lucknow from January 2017 to January 2020 was done. Neonatal variables in the form of gender, place of delivery, birth weight, gestation, mode of delivery, need for resuscitation at birth, respiratory distress, need for oxygen, duration of stay in hospital, neonatal outcome in the form of death, discharge, referral or leave against medical advice was assessed. The association between qualitative variables was assessed using Fisher’s-exact test. Quantitative variables were analysed using unpaired t-test. Results: Out of 2227 babies admitted in SNCU of a district hospital, 47.4% (n=1056) babies were low birth weight. Mean age of admission was 3.32±6.35 hours and mean weight on admission was 1.8±0.46 kg. A 53.41% (n=564) were preterm, 46.31% (n=489) were term and only 3 babies (n=0.28%) were post-term babies. A total of 655 (62%) babies were discharged, 85 (8%) referred and 316 (29%) died. Using univariate Odds Ratio (OR) to calculate the risk for mortality and taking p-value <0.05 statistically significant predictors of mortality were prematurity (p-value=0.001, OR 2.223), extremely low birth weight (<0.001), birth asphyxia (p-value=0.024, OR=1.399), place of delivery p-value=0.036, OR=1.290) and duration of stay in the hospital (p-value <0.001). Conclusion: In the present study, it was seen that gestation less than 28 weeks extremely low birth weight perinatal asphyxia and duration of stay in hospital were the most important predictors of mortality. Timely referral could have saved these babies. Consolidation of the existing infrastructure with better networking among the district and tertiary hospitals is required.

Characteristics of Paediatric Patients Transported by Emergency Care Personnel in a Government Tertiary Care Centre, Mysuru, India: A Cross-sectional Study

K Nagendra, Girish Gopal, Sudha Rudrappa, D Karthick

Introduction: Emergency Medical Service (EMS) systems have been well established and designed largely to cater to the needs of the cardiac and trauma related emergencies in adult patients. Paediatric emergencies are different; the benefits and outcomes of paediatric EMS have been assumed but without much evidence. With the emergence of paediatric and neonatal Advanced Life Support (ALS); it is imperative to have data that define the problems encountered in the prehospital care setting and also their outcome. This analysis may also provide insights into any modifications that may be required in the EMS system that exists to transport sick children. Aim: To characterise the paediatric prehospital care with emphasis on demography, presenting symptoms, treatment given, prehospital times, vitals monitoring and interventions done during EMS transport affiliated to Emergency Medical Service Agency. Materials and Methods: This descriptive cross-sectional study was conducted from July 2018 to June 2019 in Cheluvamba Hospital, a tertiary care referral teaching hospital attached to Mysore Medical College and Research Institute, Mysuru, India. The study included 147 children who were provided EMS by the 108 ambulance affiliated to the state/central government. Data pertaining to demography, presenting symptoms, vital sign monitoring, treatment given, various prehospital times, and interventions done during transport was obtained and analysed. Inpatient diagnosis with the duration of hospital stay and outcome in these childrens were also described. Results: Among the 147 children included; 3 were brought dead, hence the studied population comprised of 144 children. Amongst them, 42 were neonates and the remaining 102 belonged to the general paediatric population (older children). Overall, 61.8% were males and 57.64% hailed from a rural background. Mean ‘on-scene’ time was 12.12±2.34 minutes and 5.50±5.01 minutes, and ‘transport time’ was 33.79±16.78 minutes, and 26.11±14.2 minutes for neonates and older children, respectively. Respiratory distress was the most common presenting symptom. The mean Heart Rate (HR, beats/min), Respiratory Rate (RR, cycles/min) and temperature (°C) in neonates was 129.86±27.91, 59.90±15.40 and 36.14±0.84 whereas in older children it was 112.81±28.39, 34.87±14.86, and 37.40±0.96, respectively. Mean systolic blood pressure (SBP mmHg) in children aged more than 10 years was 116.67±8.61. Of the 39 children aged more than 6 years, 36 (92.30%) had a Glasgow Coma Scale (GCS) between 13-15. The most common intervention done was administering oxygen in 84.02% (121/144) of children; 34.02% (49/144) of children were unstable at admission; 127 (88.2%) were discharged; remaining 17 (11.8%) succumbed to their illness. On-scene time of more than 15 minutes, transport time of more than 30 minutes and factors such as hypoxia, respiratory failure and shock at admission were significantly associated with mortality (p<0.001). Conclusion: Majority of the EMS transports were related to medical conditions. Basic Life Support (BLS) interventions were done albeit mostly in older children. Emergency Medical Technicians (EMT)/paramedics delivering EMS need special training to orient themselves to the special needs of critically ill children and to improve their outcome.

Comparison of Placental Histopathological Findings with Good and Adverse Neonatal Outcomes- A Prospective Observational Study

Nidhi Sachan, Niharika Bisht, Amrita Chaurasia

Introduction: The placenta plays a crucial role in the growth and survival of foetus by performing most of the vital functions for the foetus before delivery. Histopathological examination of placenta can help in investigating the mechanism of placental dysfunction, which can further help in devising more precise intervention strategies and can contribute to more effective therapies in the future. Aim: To compare the placental histopathological findings of patients with adverse neonatal outcomes and good neonatal outcomes. Materials and Methods: This was a prospective observational study conducted on 200 antenatal cases with gestational age >34 weeks were enrolled in the study from IPD of Department of Obstetrics and Gynaecology, Swaroop Rani Hospital, Prayagraj, Uttar Pradesh, India, over a period of 1 year. They were followed-up till delivery and assessed for neonatal outcomes. On the basis of neonatal outcome, patients were divided into two groups- group A with normal neonatal outcomes and group B with adverse neonatal outcomes. A gross and histopathological examination of placenta was performed for each case. The results were compiled and statistically analysed to compare the findings between the groups. The p-value was calculated using Chi-square score and value of <0.05 was considered significant. Results: Out of 200 cases, 143 belonged to group A (with normal neonatal outcomes), in which majority 121 (84%) had normal placental histopathology, 8 (5.5%) had villous infarcts, 9 (6.2%) had syncytial knots and 5 (3.4%) had calcifications. Mean placental weight in group A was 425.88 grams while that in group B was 363.70 grams (p-value <0.0001). Group B (with adverse neonatal outcomes) had 57 cases, 8.8% cases were delivered via vaginal delivery, with low Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) score in 53 (26.5%), need for Neonatal Intensive Care Unit (NICU) admission in 57 (28.5%), need for mechanical ventilation in 12 (6%) and death in 6 (3%) cases. Villous infarcts was the placental histopathological feature in all cases with neonatal complications low APGAR score, NICU admission, those requiring mechanical ventilation or neonatal death. Out of these 57 cases, 8 (14%) had normal placental histopathology while 15 (26.3%) had infarcts, 12 (21%) syncytial knots, 9 (15.8%) had calcifications, and 13 (22.8%) had necrosis. Statistically significant difference (p-value <0.05) was found between the two groups in terms of abnormal histopathological findings and mean placental weight. Conclusion: Neonates with adverse outcomes had abnormal placental histopathological findings like villous infarcts, syncytial knots, calcifications, and necrosis.

Comparison of Various Infant Milk Substitutes with the Guidelines by European Society of Paediatric Gastroenterology, Hepatology and Nutrition: A Cross-sectional Study

Introduction: When mother’s milk is not available, Infant Milk Substitutes (IMS) must be supplemented with medical advice. Human milk can be digested easily because of the whey protein present in it and which is less in other animal milk. Considering this fact the manufacturers have attempted to make IMS as close to breast milk. Aim: To compare the composition of different IMS with breast milk, and with international guidelines given by European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN). Materials and Methods: A cross-sectional study was performed between April to May 2020, at a tertiary centre in Puducherry, India. Total 11 whey protein containing IMS brands that were commercially available in the Indian market for children aged up to six months were included in the study. The IMS for preterm babies and those without whey protein like hydrolysed milk, IMS with soya bean extract were excluded from the study. The details of IMS was collected and compared. The composition of the IMS was taken from the information provided by the manufacturer. The data was entered in Microsoft excel and was analysed using statistical software Statistical Package for the Social Sciences (SPSS) version 20.0. Results: With respect to calories, protein, fats and vitamins all IMS met the requirements. Nucleotide content exceeded in 18.1%. Sialic acid was added in 9% IMS. Iron content is more than the ESPGHAN requirement in 9% IMS. Conclusion: All the IMS were almost within the range advised by ESPGHAN. The children who fail to gain adequate weight can be given the brands with more calories. Babies with features of iron deficiency, can be given Brand VIII. For parents who cannot afford to buy the IMS with smart nutrients, they can choose the basic IMS which are of low cost, but meets the requirements.

Prevalence of Haemoglobin Variants and Haemoglobinopathies in a Single Paediatric Centre in Southern India: A Retrospective Cross-sectional Study

Introduction: Haemoglobinopathies are qualitative disorders of Haemoglobin (Hb) resulting from structural defects in the amino acid sequence of one of the globin chains, whereas, thalassaemia results from quantitative defects in the synthesis of one or more of the globin chain subunits of the Hb tetramer. Cation Exchange-High Performance Liquid Chromatography (CE-HPLC) is one of the methods for initial screening of Hb variants like HbS, HbD, HbE etc and for quantification of HbF, HbA and HbA2 levels. Aim: To find out the prevalence of haemoglobinopathies in patients of a Government paediatric tertiary care hospital in south India. Materials and Methods: In this retrospective, cross-sectional study, all laboratory requests, in the period from August 2019 to July 2021, for Hb variant analysis by HPLC were collected, irrespective of provisional diagnosis. The Hb variant analysis was carried out by CE-HPLC on the Bio-Rad D-10 analyser. This study was conducted in a Government Paediatric tertiary care hospital in Southern India for patients who had any clinical or familial suspicion of haemoglobinopathies. The Statistical analysis was performed using Microsoft Excel 2010. Results: Total data of 704 laboratory requests for Hb Variant analysis were obtained. Out of 704 laboratory request, 585 were from children younger than 12 years of age and 119 were parental screening. There were 164 abnormal chromatograms. Out of 164 patients, 91 were female patients and 73 were male patients. Out of 164 abnormal chromatograms, 97 (59.15%) were beta-thalassaemia trait, 18 (10.98%) were beta-thalassaemia major, 13 (7.93%) were sickle cell trait, 2 (1.22%) were sickle cell disease, 21 (12.80%) were HbE trait, 2 (1.22%) were homozygous HbE, 2 (1.22%) were HbD trait, 3 (1.83%) were Hereditary Persistence of Foetal Hb (HPFH)/delta beta-thalassaemia, 2 (1.22%) were HbJ trait, 1 (0.61%) was HbE beta-thalassaemia, 1 (0.61%) was sickle-beta-thalassaemia and 2 (1.22%) were alpha thalassaemia. Conclusion: From this study, beta-thalassaemia trait and beta-thalassaemia major were found to be the first and second most prevalent haemoglobinopathies in children below 12 years of age. This data suggests the importance of premarital and antenatal screening procedures that can help in reducing the possibility of such haemoglobinopathies in the future generation, suffering and burden of disease to the family and society.

Analysis of Five Years Data of Special Newborn Care Unit in a Rural Medical College: Scope for Improvement in Neonatal Mortality and Morbidity

Bidyut Kumar Khuntdar, Sumon Mondal, Umesh Mudi, Mahesh Prasad Mohanta

Introduction: Neonatal mortality is the most important contributor towards infant mortality. Special Newborn Care Units (SNCUs) are part of the facility based newborn care of National Health Mission (NHM) and cornerstones for reducing neonatal mortality. Aim: To study the mortality and morbidity data of a tertiary care SNCU of rural tribal Eastern India and find out the focus area for improvement. Materials and Methods: This was a retrospective observational study carried out on 19397 babies admitted in the SNCU of Midnapore Medical College, Midnapore, West Bengal, India, from February 2016 to January 2021. Data were collected from the SNCU admission register and computerised reporting data of SNCU. In this study, five years admission and mortality data of the SNCU was analysed. Results: There were 67729 live births during the period between February 2016 and January 2021, out of which 8627 were admitted to the SNCU (inborn). There were 1195 deaths among the inborn babies, thus the mortality rate was13.8%. The number of outborn babies admitted during the study period was 10770, out of which 1357 babies died, thus the mortality rate was 12.6%. There was significantly higher mortality among inborn babies than outborn babies (13.8% vs. 12.6%). The major causes of admissions in the SNCU were prematurity (n=10167, 52.5%), Low Birth Weight (LBW) (n=11519, 59.3%), jaundice (n=4692, 24.19%), Hypoxic Ischaemic Encephalopathy (HIE) (n=4278, 22%) and sepsis (n=2161, 11.14%). The main causes of mortality were HIE (n=766, 30%), and sepsis (n=709, 27.78%), followed by respiratory distress syndrome (n=162, 6.3%), congenital malformations (n=77, 3%), and meconium aspiration syndrome (n=37, 1.45%). Conclusion: Prematurity and LBW were the major causes of morbidity and mortality. Sepsis and HIE were the major direct causes of mortality. Hence to reduce neonatal morbidity and mortality focus should be on preventing the above causes.

Carnitine Cycle Defect in Newborn: A Rare Case Report

T Hari Sankar, TV Ramkumar, Saroj Sekhar Rath, Pradeep Mallik, Bharati Das

Carnitine Acylcarnitine Translocase (CACT) deficiency and Carnitine Palmitoyl Transferase (CPT I and II) deficiency comes under a group of disorders called mitochondrial fatty acid oxidation disorders, due to defects in the carnitine cycle. The CPT and CACT enzymes play a pivotal role in the transfer of Long Chain Fatty Acids (LCFA) from the cytoplasm to the mitochondrial matrix, where ß-oxidation take place. In the present case, a male baby presented on day 2 of life with chief complaints of respiratory distress, apnoea, lethargy and seizures. The baby had multiple episodes of hypoglycaemia and seizures after admission. Diagnosis was made with the help of extended newborn screening using Tandem Mass Spectrometry (TMS) showing accumulation of hexadecanoyl carnitine due to CACT/CPT II deficiency. Echocardiography showed features of cardiomyopathy with cardiomegaly. Liver Function Test (LFT) and Prothrombin Time-International Normalisation Ratio (PT-INR) of the child was also deranged, with hypotonia of all muscles. Early detection along with carnitine supplementation and further prevention of fasting episodes resulted in generalised improvement of the baby. So, a high degree of suspicion of Inborn Error of Metabolism (IEM) and timely diagnosis can save the baby.

Risk Factors for Retinopathy of Prematurity with Specific Emphasis on Postnatal Weight Gain: An Observational Study

Sheila Aiyer, Anuja Milind Datar

Introduction: Retinopathy Of Prematurity (ROP) is a vasoproliferative disorder that affects premature infants with multiple risk factors. Timely screening and treatment can help decrease this preventable cause of blindness. Aim: To assess the risk factors for development of ROP, and to study its association with postnatal weight gain. Materials and Methods: This was an observational study with both prospective and retrospective arms. In the retrospective component, the case files and ROP screening records of the infants were screened, in the duration of July 2019 to February 2020. The prospective data was collected from the ongoing screening sessions, during March 2020 to November 2020. The risk factors for ROP, and postnatal weight gain was observed during the ROP screening programme conducted at the intramural Neonatal Intensive Care Unit (NICU) of Sir Sayajirao Hospital, Vadodara, Gujarat, India. Infants with Birth Weight (BW) <2000 g and Gestational Age (GA) <34 weeks and those with high risk factors {prolonged oxygen exposure, mechanical ventilation, anaemia requiring blood transfusion, Intraventricular Haemorrhage (IVH), Respiratory Distress Syndrome (RDS), Bronchopulmonary Dysplasia (BPD), recurrent apnea, hypotension requiring inotropes, surgery during first week of life, sepsis and hypoglycaemia} were included in the study. Subjects were followed-up till 44 weeks Post-Menstrual Age (PMA), or till complete vascularisation of retina or regression of ROP on retinal examination whichever was earlier. Risk factors were studied using univariate analysis and multivariate regression. Weight gain was studied using independent sample t-test. Results: A total of 486 neonates were enrolled, who underwent serial ophthalmological examinations. Out of these, 375 infants (198 (52.8%) male and 177 (42.7%) females) underwent examinations until 44 weeks of PMA or till complete retinal vascularisation, or till complete regression of ROP with or without treatment. Out of these, 173 patients had no ROP, 120 patients developed ROP which got spontaneously regressed over time and 82 patients developed severe ROP which required treatment. Mean Gestational Age (GA) in the study population was 34.35 week (±2.64 wk), and mean Birth Weight (BW) was 1.67 kg (±0.45 kg). In the group of severe ROP, mean GA was 32.03 week (±1.33 wk) and mean BW was 1.33 kg (±0.35 kg); and the mean number of positive risk factors were 5.93 (±1.77). Poor postnatal weight gain was associated with more risk of severe ROP. GA <34 week (p-value <0.0001), BW <1750 g (p-value <0.0001), oxygen exposure (p-value <0.0001), IVH (p-value <0.0001), RDS (p-value=0.0111), BPD (p-value=0.0058), hypotension requiring inotropes (p-value=0.0001) and sepsis (p-value <0.0001) were significant risk factors. On multivariate logistic regression, BW <1750 g, GA <34 week, sepsis and hypotension requiring inotropes were most important risk factors for ROP, along with poor postnatal weight gain. Conclusion: Poor postnatal weight gain is associated with increased risk of severe ROP.

Demographic Characteristics and Outcome of Children with SARS-CoV-2 Infection Admitted in a Tertiary Care Centre in Central India- A Retrospective Study

Introduction: Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) is an event of utmost importance in the medical field. It has affected the lives of millions worldwide, affecting adults more than children. But paediatric coronavirus disease is also complicated by its varied clinical presentation, difficulty in diagnosis and non availability of any rational protocol when it comes to the identification and management of cases. Aim: To assess demographic characteristics and outcome of children with SARS-CoV-2 infection. Materials and Methods: A single-centre retrospective hospital-based observational study was carried out among 150 children. Nasopharyngeal swabs were taken and tested using real-time Reverse Transcription-Polymerase Chain Reaction (RT-PCR) for SARS-CoV-2 infection to confirm Coronavirus Disease-2019 (COVID-19). The information was collected from Medical Record Department (MRD) through Case Record Form (CRF). The clinical and laboratory features of all children (age ≥1 months to ≤12 years) were selected between 1st March 2020 to 31st October 2020 were noted and selected. The collected data was tabulated and all statistical analysis was done. Results: Out of 150 children, 81 (54%) were male and 69 (46%) were female. Only 26 (17.3%) were symptomatic. In these 26, respiratory system involved 12 (46.2%) children, followed by acute febrile illness in 7 (26.9%) and then neurological 3 (11.6%), gastrointestinal 2 (7.7%), haematological 1 (3.8%), and cardiovascular 1 (3.8%). Co-morbidities (thalassaemia, cerebral palsy, seizure disorder and heart disease) were present in 5 (3.3%) children, in which 3 (60%) developed moderate and severe degree of illness. The treatment was given as per the protocol developed at Institutional level from Indian Council of Medical Research (ICMR), and Ministry of Health and Family Welfare (MoHFW) guidelines. One child died and the rest were discharged. Conclusion: Majority of the children having SARS-CoV-2 infection were asymptomatic, however, few had mild illness. Furthermore, co-morbidities were contributed for severity of illness in the children affected with SARS-CoV-2 infection which leads into more vulnerable outcome.

Correlation of Severity of Maternal Hypertension and Birth Weight of Neonates- A Longitudinal Study

Introduction: Pregnancy Induced Hypertension (PIH) can lead to intrauterine growth restriction resulting in Low Birth Weight (LBW) neonates. LBW remains a significant cause of under-five mortality in India and Asia. Aim: To calculate the prevalence of PIH and to study the correlation between Birth Weight (BW) of neonates and severity of maternal hypertension; and compare the incidence of neonatal morbidities across varying severity of maternal hypertension. Materials and Methods: A longitudinal study was conducted among 153 pregnant mothers, diagnosed with PIH. They were classified into mild {Systolic Blood Pressure (SBP) ≥140-149 mmHg or Diastolic Blood Pressure (DBP) ≥90-99 mmHg}, moderate (SBP ≥150-159 mmHg or DBP ≥100-109 mmHg) and severe (SBP ≥160 mmHg or DBP ≥110 mmHg) hypertension. A total of 142 neonates, born to PIH mothers, were included. The neonates were followed-up for seven days to check for early neonatal outcomes and deaths. Correlation between maternal blood pressure (systolic and diastolic) and BW of the neonates was assessed using Pearson’s correlation coefficient (r). Binary Logistic Regression (BLR) was performed to analyse the impact of confounders on BW. Results: The prevalence of PIH was 7.76% (153/1972). The mean BW of neonates born to mothers with moderate (2.435 kg) and severe hypertension (2.342 kg) was significantly lower than that of neonates born to mothers with mild hypertension (2.828 kg) (p<0.00001). 1SD increase in SBP resulted in 0.245 kg decrease in BW, while an 1SD increase in DBP resulted in 0.312 kg decrease in BW. After accounting for confounders using BLR, maternal DBP still had a significant negative correlation with BW (r=-0.663; p<0.001). The incidence of prematurity (p<0.0001), small for Gestational Age (GA) (p=0.0283), Respiratory Distress (RD) (p=0.002), Neonatal Hyperbilirubinemia (NNH) (p=0.033) and Neonatal Intensive Care Unit (NICU) admissions (p=0.003) were significantly higher among neonates born to mothers with moderate and severe hypertension than those born to mothers with mild hypertension. Three neonatal deaths (all due to perinatal asphyxia) were observed in this study and there was no statistical significance with respect to deaths across neonates of the three groups (p=0.219). Conclusion: Maternal DBP had a significant negative correlation with BW. The mean BW of neonates born to mothers with severe hypertension was significantly lower compared to those born to mild hypertension.