Indian Journal of Neonatal Medicine & Research

A Study on Incidence, Pattern of Clinical Features, Laboratory Abnormalities and Outcome of Neonatal Polycythaemia in a Tertiary Care Hospital, Odisha, India

Introduction: Neonatal polycythaemia is a commonly encountered morbidity and mortality among neonates admitted to neonatal care units and sick newborn care units. Most affected infants have no clinical symptoms and signs, but neonates may present with lethargy, poor feeding, plethora, cyanosis and jaundice within 12-72 hrs. Aim: To find out the incidence and clinical manifestations of neonatal polycythaemia along with detection of disease by laboratory abnormalities. Materials and Methods: This was a hospital-based, prospective, observational study conducted in the Neonatal Care Unit of Sriram Chandra Bhanja Medical College, Eastern Odisha, India, in 1760 neonates, from October 2018 to September 2020. All neonates admitted through Outdoor and Emergency were included in this study irrespective of gestation, birth weight, maturity and mode of delivery with haematocrit >65% at 12 hours of life. These polycythaemic babies were further categorised on the basis of maturity, gestational age, birth weight, gender and the clinical features, laboratory abnormalities were noted, Partial Exchange Transfusion (PET) when required was done through central route, the umbilical venous catheter was used for withdrawing blood while same amount of normal saline was replaced through a peripheral vein, and in asymptomatic cases additional fluid of 20 mL/kg was added to the daily fluid requirements either through enteral or parenteral route and outcomes were noted. Short-term outcome at 48 hours was measured by decreasing haematocrit with improvement of signs and symptoms. Chi-square test was employed to analyse the collected data using Statistical Package for the Social Sciences (SPSS) software version 20.0. The p-value <0.05 was considered statistically significant. Results: Out of 1760 newborns enrolled, (n=75) were polycythaemic. The incidence of polycythaemia was 4.26%, which was significantly higher among Small for Gestational Age (SGA) compared to Large for Gestational Age (LGA) neonates (p-value=0.0214). Clinical features in decreasing order were lethargy (66.6%), poor feeding (66.6%), Plethora (53.3%), cyanosis (40%) and jaundice (33.3%). Main laboratory abnormalities were hypoglycaemia (36%), hyperbilirubinaemia (28%), thrombocytopenia (22.66%) and hypocalcaemia (13.3%). Out of 75 polycythaemic neonates, n=17 (22.67%) underwent PET and rest 58 (77.33%) neonates were treated with extra fluid of 20 mL/kg/day. Conclusion: Study showed that lethargy and poor feeding were the main presentation and hypoglycaemia as the major laboratory abnormality. The incidence of polycythaemia was high among SGA neonates and the response to partial exchange transfusion as well as extra fluid was good which was characterised by decreasing haematocrit values with improvement of signs and symptoms.

Impact of Family Participatory Care on Neonates- A Non Randomised Interventional Study

Amit, Rakesh Kumar, Karnika Agarwal, Brajendra Singh, Surendra Kumar, Nupur Garg

Introduction: Family Participatory Care (FPC) is a unique concept which involves parents in caregiving to their admitted babies. It helps in defining the family's role in clinical care delivery to newborns along with doctors and nurses. The Neonatal Intensive Care Unit (NICU) is the ideal area for FPC to take place because of the unique and vulnerable nature of the mother-neonate relationship as neonates that are admitted, face immense trials from their first day of life. Aim: To know the effect of FPC on outcome of admitted neonates, analyse the impact of this model on breastfeeding rate and to compare the rate of Kangaroo Mother Care (KMC) being given to neonates at follow-up. Materials and Methods: It was a non randomised interventional study done from August 2020 to April 2021, in the NICU at Maharaja Agrasen Medical College, Agroha, Hisar, Haryana, India. Two hundred neonates, who were sequentially admitted and later discharged, were taken into account, out of which, first 100 were taken as controls and next 100 were taken in the intervention group. Routine treatment and care were given to all the admitted neonates. In addition to this, parents of the study group of newborns were given education through four audio-visual sessions, comprising hygiene measures for entry into nursery, correct method of breastfeeding, KMC and then care at home after discharge. Follow-up was done after one week of discharge and at six weeks of age. Outcome measures were breastfeeding rate and KMC rate which were compared between two groups, at discharge and at follow-up of six weeks of age. Results: The mean birth weight of neonates, mean gestational age and the socioeconomic status were comparable in both the groups. Mean duration of hospital stay was 7.13 (±4.95) days in study group and 8.06 (±5.40) days in control group (p=0.206). Mean weight at discharge and that at six weeks was similar in both groups. However, the average weight gain per day was significantly higher (25.61 g) in the study group than the control group (18.92 g). At discharge, 92 in the control group and 87 in the study group were given exclusive breastfeeding or expressed breast milk with spoon feeding. At six weeks follow-up, this number was 91 in the study group and 70 infants in the control group (p=0.001). KMC was given to all the neonates at discharge who had birth weight less than two kg. Among them, at the time of follow-up, 33/36 in the case group and 5/37 in the control group were receiving KMC (p-value 0.001). Conclusion: FPC is feasible and effective model in terms of better neonatal outcome.

Evaluation of Adverse Outcome Predictors in Neonatal Seizure: A Longitudinal Study from a Tertiary Centre of Eastern India Indian

Bidyut Kumar Khuntdar, Sumon Mondal, Surjit Naik, Mahesh Prasad Mohanta

Introduction: Neonatal seizures are common but can be manifestations of serious underlying disorders and sometimes have a grave prognosis. Predictors for adverse outcomes are important for early referral and advanced interventions. Aim: To study the incidence and factors associated with neonatal seizure and to determine the predictors of adverse outcomes. Materials and Methods: This was a longitudinal study, conducted from April 2020 to March 2021 at a Rural Medical College (Midnapore Medical College and Hospital, West Bengal) in Eastern India. All the admitted newborns (N=143) in the Special Newborn Care Unit (SNCU), who had clinically evident seizures, were included in the study. Data were collected regarding the perinatal history, gestational age, type of delivery, birth weight, Appearance, Pulse, Grimace, Activity and Respiration (APGAR) score at one and five minutes, and need for resuscitation at birth. The onset of the seizure, seizure type, investigation findings, possible aetiological diagnosis, and final outcome was noted. The management of neonatal seizures was as per the institutional protocol. Babies were followed-up for a minimum of 28 days or throughout their hospital stay till discharge/death. The outcome was categorised into two categories: ‘favourable’ when there was a normal neurological examination and ‘unfavourable’ when there was any neurological impairment or death. Statistical analyses were performed using the Statistical Package for Social Sciences software version 25 (SPSS Inc., Chicago, IL, USA). Risk factors were determined by analysing outcomes using simple and multivariate logistic regression analysis. The p-values less than 0.05 were considered as statistically significant. Results: A total of 143 newborns had seizures out of 3126, making the incidence of neonatal seizures 4.57%. Males outnumbered females. Total 64.33% were preterm. Five minutes APGAR score <7 was noticed in 44.75%. The most common type was subtle seizure. Advanced resuscitation manoeuvre was required for 46.8% cases whereas mechanical ventilation was required in 11.88%. The most common aetiology was birth asphyxia (46.15%), and the cranial ultrasound showed Hypoxic Ishchaemic Encephalopathy (HIE) changes in 30.77% of cases. Multiple logistic regressions revealed only four factors, namely, preterm delivery (OR 5.82), need for extensive resuscitation manoeuvre (OR 6.21), presence of status epilepticus (OR 3.49) and abnormal cranial ultrasound (OR 1.02) to be the independent risk factors for unfavourable outcome. Conclusion: Clinical diagnosis of neonatal seizure could be useful in resource poor centres, where video-Electroencephalogram (EEG) is not available. Premature delivery, need for extensive resuscitation, presence of status epilepticus and abnormal cranial ultrasound were associated with poor short-term outcome.

Estimating the Frequency of Hanifin and Rajka’s Minor Criteria among Paediatric Atopic Cases at a Tertiary Care Hospital in Western Tamil Nadu, India- A Cross-sectional Study

Introduction: Atopic Dermatitis (AD) is a common relapsing inflammatory disorder, among the paediatric population clinically, characterised by pruritus and recurring eczematous skin lesions and a host of other cutaneous changes. Diagnosis is done on the basis of clinical findings with the usage of Hanifin and Rajka’s criteria which includes 4 major and 23 minor criteria. Geographical, climatic factors and other population factors have been reported to influence the occurrence of minor criteria. Aim: To estimate the frequency of Minor criteria among paediatric atopic dermatitis in Western Tamil Nadu, India. Materials and Methods: This cross-sectional observational study was done by including 110 atopic children attending Paediatric and Dermatology Outpatient Departments (OPD) of KMCH IHSR, Coimbatore, Western Tamil Nadu, India, between March 2022 to August 2022. The clinical and ophthalmological findings were documented. Categorical variables were presented as frequency and percentages, Continuous variables were presented as Mean±Standard deviation. The data was entered in excel and was analysed using Statistical Package For Social Sciences (SPSS) version 27. Results: Among the total study population of 110, 53 (48.2%) were males and the rest 57 (51.8%) were females. The mean age was 24.73±5.18 years with a range of 2-15 years. Early age of onset was seen in 73.6% of study population. Hyperlinear palms were found in 70% of the study patients. 68.2% had Dennie Morgan infraorbital fold, 64.5% had xerosis, 61% had pityriasis alba and 60% had a family history of atopy. Conclusion: Certain minor manifestations of AD like xerosis, icthyosis, hyperlinear palms, and perifollicular accentuation were more common in the present study. Western Tamil Nadu having a tropical semi-arid climate tempered by higher altitude could explain the differences noted in the frequency of certain minor criteria.

A Retrospective Cross-sectional Study of Paediatric Dermatoses during the COVID-19 Pandemic in a Tertiary Care Hospital in Bengaluru, Karnataka, India

KA Rajeswari, M Geetha

Introduction: Dermatologic conditions constitute atleast 30% of all outpatient visits to paediatricians and 30% of all visits to dermatologists involve children. Skin conditions that manifest themselves during childhood and adolescence are referred as paediatric dermatoses and make up their own unique category of skin conditions. Aim: To identify the dermatological conditions which were prevalent during the Coronavirus Disease 2019 (COVID-19) pandemic in a tertiary care hospital in Bangalore. Materials and Methods: This retrospective cross-sectional study was conducted by reviewing records of Outpatient Department (OPD) of Dermatology and Paediatrics in the tertiary care centre, Bengaluru from February 2020 to February 2022. The demographic details and diagnosis were recorded. The diagnosis was made according to ICD-10 (International Classification of Diseases 10th Revision) and the prevalence of different dermatoses was calculated. Mean and standard deviation was calculated for descriptive statistics. Data were statistically evaluated with IBM Social Package for Statistical Analysis (SPSS) Statistics for Windows version 26.0., IBM Corp., Chicago, IL. Results: The total number of paediatric cases attended dermatology OPD during the two year pandemic was 558. The prevalence of paediatric dermatoses in the present study was 193 (34.58%). There were 283 girls and 275 boys with Male:Female was 1:1.02. There was a female preponderance of 50.7% against 49.28%. The majority was infectious lesions 153 (27.41%), congenital dermatoses 9 (1.61%), Papulosquamous disorders 23 (4.12%), Pilosebaceous disorders 111 (19.89%), dermatitis 193 (34.58%) followed by Miscellaneous 69 (12.36%). Conclusion: This study was conducted during COVID-19 pandemic which in comparison to the other studies shows a similar distribution of dermatoses. But there was a significant shift of age group affected which can be well explained by the lockdown and social isolation.

Neonatal Candidiasis: Clinical Spectrum and Epidemiology at a Tertiary Care Centre, Bhopal, India

Minhajuddin Ahmed, Nitesh Upadhyay, Mohammed Iqbal Ansari, Manal Ashraf Ali

Introduction: Neonatal candidiasis is one of the leading cause of sepsis amongst newborns admitted to newborn care unit, especially premature and Low Birth Weight (LBW) babies. It is one of the significant contributors to neonatal morbidity and mortality. Aim: To describe the clinical spectrum and epidemiology of fungal sepsis in Neonatal Intensive Care Unit (NICU) at a tertiary care level. Materials and Methods: A longitudinal study was conducted from January 2018 to December 2019 in NICU of Chirayu Medical College and Hospital, a tertiary level hospital in Bhopal, Central India. All neonates, who had positive fungal blood culture were included in the study, their demographic data was analysed (age, birth weight, predisposing factors etc.,), maternal history, their response to the antifungal treatment was documented and complications were noted. Statistical analysis was done using the Chi-square test with the help of Statistical Package for Social Sciences (SPSS) software version 2.0. Results: A total of 409 neonates admitted in the NICU during the study period, were suspected clinically to have sepsis and their blood culture was done, of which 110 samples were culture positive. Amongst the 110 neonates, 41(37.2%) were positive for fungal infection {29 showed Candida albicans, 12 showed Non Albicans Candida (NAC)}. Total 25 neonates were preterm (60.97%). The mean age of admission was 3.02 days, 51.2% (21/41) of the neonates had a history of respiratory distress and related symptoms at birth. There was no significant maternal history. Among various risk factors only central line and invasive ventilation had significant association (p-value <0.05) with the poor outcome of diseases in neonates. Urine for candidial hyphae was positive in 12 out of 41 cases (29.27%). Incidence of candidal meningitis was seen in four neonates (13.33%). Thrombocytopenia was the most common laboratory finding amongst these cases (32/41). Among the different regimens used the combination regimen of Lipid based amphotericin B and voriconazole was associated with a better survival. Conclusion: Candida sepsis was found to be the most common cause of septicaemia in the NICU. LBW and preterm babies are especially at greater risk of candida sepsis. Candida albicans still continues to be a dominant aetiology for fungal sepsis, as compared to non candida species.

Early Cranial Ultrasound Changes as Predictors of Outcome during First Year of Life in Infants with Perinatal Asphyxia- A Prospective Cohort Study

Shilpi Agrawal, Ravanagomagan, Sethi Rohith Shamsher, Chaurasiya Rachna

Introduction: Perinatal Asphyxia (PA) causes impaired exchange of ventilatory gases, or ischaemia that leads to persistent decrease in oxygen levels (hypoxemia) and increase in carbon dioxide levels (hypercarbia). It occurs during the peripartum period can contribute to early neonatal mortality and morbidity. Aim: To assess the role of early changes in cranial ultrasound a predictor of outcome in babes with PA. Materials and Methods: This prospective cohort study was conducted in a tertiary care neonatal unit in Maharani Laxmi Bai Medical College, Jhansi, Uttar Pradesh, India, from July 2018 to October 2019. A total of 50 neonates with PA were studied. Cranial ultrasound was performed at or after seven days of life. Neurodevelopment assessment of the subjects were done at three, six, nine and 12 months of life using Development Quotient (DQ). Variables were analysed by student’s t-test and categorical variables were analysed by Fisher’s-exact probability test using graph pad software. Results: Out of 50 infants of PA, 29 had an abnormal ultrasound scan and 21 had normal ultrasound scan. A 16 out of 29 patients had abnormal outcome along with abnormal ultrasound scan while rest of the 13 had normal outcome. The mean DQ of the neonates having abnormal ultra sonographic examination was significantly lower as compared to those with normal examination. A six out of 21 neonates had abnormal outcome inspite of having normal ultrasound scan. Cranial ultrasound has a specificity 55%, sensitivity 73%, Positive Predictive Value (PPV) 58% and Negative Predictive Value (NPV) 71% in predicting neurodevelopment outcome of patients with birth asphyxia. Conclusion: Cranial Ultrasonography (USG) findings in PA babies reveal a strong association with the development severity.

Increasing the Screening Rate of Retinopathy of Prematurity in at-risk NewbornsAn Improvement Project in Special Newborn Care Unit of a Tertiary Care Maternity Hospital in Telangana

Anita Sethi, Swathy Talishetty

Introduction: Retinopathy of Prematurity (ROP) is a vasoproliferative disorder of the retinal vessels in premature neonates and is one of the leading causes of preventable blindness. The incidence of ROP across India ranges from 38-47%. This wide range is due to a lack of awareness among parents and a lack of high-quality care in the Special New-born Care Unit (SNCU). Paediatricians, neonatologists, and ophthalmologists play a vital role in improving the screening rate. Aim: To improve the screening rate of ROP at four weeks of age in at-risk new-borns by sensitising paediatricians and educating neonatal nurses and parents regarding ROP from the current 38.3-90% within three months. Materials and Methods: The Plan Do Study Act (PDSA) quality improvement method was used for this project. It is a quality improvement (QI) study done in the SNCU of a tertiary care maternity hospital in Hyderabad, Telangana, India. The study was done over a period of 13 months from January 2020 to February 2021. Baseline assessment was done by reviewing records and phone calls to know the baseline ROP screening rate. To improve the screening rate, the authors conducted periodic training of nurses, and awareness was increased among parents through audio-visual counselling, ROP posters, and timely reminders. Results: In 368 preterm babies, the ROP screening rate increased from 38.3-89.95% in phase 3. The knowledge in nurses’ and parent’s also increased significantly post-training (p<0.05). The incidence of ROP was found to be 6.04% (20) in the present study. Conclusion: The Point of Care Quality Improvement (POCQI) method helped in improving the ROP screening rate tremendously without many resources. It also significantly improved the knowledge of nurses and awareness among parents. The nurses had a sense of empowerment and satisfaction and could effectively communicate with parents.

Clinico-epidemiological Characteristics and Short-term Outcomes of Neonates Born to COVID-19 Positive Mothers at a Tertiary Care Hospital in North Karnataka- A Retrospective Study

Introduction: Coronavirus Disease-2019 (COVID-19) infection in pregnant women can have important effects on the perinatal and neonatal outcomes. Multiple modes of transmission of infection from mother to the newborn have been suggested as also the increased risk of complications in COVID-19 infected neonates. Aim: To study the clinico-epidemiological characteristics and short-term outcomes of neonates born to mothers infected with COVID-19 in relation to maternal COVID-19 severity and co-morbidities and to compare the same between COVID-19 infected and non infected neonates. Materials and Methods: This was a retrospective study of 174 neonates born to COVID-19 positive mothers admitted and delivered from 1st August 2020 to 31st October 2020, at Belagavi Institute of Medical Sciences (BIMS), North Karnataka, India. Data was collected from medical records about the clinical and epidemiological characteristics of the mothers and their neonates, symptoms and severity of COVID-19 and their management and short-term outcomes. Pearson’s Chi-square or Fisher’s-exact test was used for statistical analysis. The p-value of less than 0.05 was considered statistically significant. Results: Out of 174, 18 (10.35%) neonates tested positive for COVID-19 by Reverse Transcriptase Polymerase Chain Reaction (RT-PCR). The rates of prematurity and low birth weight amongst all 174 neonates were 17.24% and 24.14%, respectively. There were no significant differences in demographic features, in the need for resuscitation and incidence of complications like prematurity, low birth weight, birth asphyxia, meconium aspiration syndrome, sepsis between COVID-19 infected and non infected neonates. However, an increased risk of Early Onset Sepsis (EOS) (OR-2.21) in COVID-19 infected neonates. None of the COVID-19 infected neonates required Continuous Positive Airway Pressure (CPAP) or mechanical ventilation and all were discharged subsequently. In this study there were 3 (1.72%) deaths, all among COVID-19 non infected, neonates. Conclusion: The incidence of COVID-19 infection in neonates born to COVID-19 infected mothers in this study was 10.35%. Most of the infections in neonates were of less severity without a significantly increased need for respiratory support and without significant mortality.

Impact of COVID-19 Pandemic on Routine Children Immunisation: Experience from a Tertiary Care Centre, in New Delhi, India

Dheeraj Bahl, Varun Alwadhi, Parasdeep Kaur, Hema G Mittal

Introduction: Coronavirus Disease-2019 (COVID-19) pandemic was a global emergency in 2019 with multiphasic national lockdowns in most countries. Poor accessibility to travel and disease scare led to major fall in routine children vaccination. Aim: To study the impact of COVID-19 pandemic on routine children immunisation at a tertiary care centre in New Delhi, India. Materials and Methods: This retrospective cross-sectional study was carried out in May and June 2022, by collecting retrospective data from Immunisation Clinic of Paediatric Department of Dr. Ram Manohar Lohia hospital, a tertiary care public hospital in New Delhi from January 2018 to December 2021. The data of routine immunisation was further analysed to know the impact of the COVID-19 pandemic in children from birth to 5 years of age in 2019 i.e., before the lockdown versus the first and second major waves of COVID-19 in 2020 and 2021, respectively. The data was entered in an Ms Excel chart and statistical testing was conducted with Statistical Package for the Social Sciences (SPSS) version 27.0. Unpaired t-test of equal variance was used for data analysis and p-value <0.05 was considered as statistically significant. Results: There was a sharp fall in children receiving routine immunisation during COVID-19 pandemic in 2020 (30.5%) and 2021 (24.9%) as compared to pre COVID-19 period (2019). The overall vaccination coverage was significantly lower (p-value <0.001) in postlockdown-1 phase (July/Aug 2020; n=521) and postlockdown-2 phase (July/Aug 2021; n=735) in comparison to pre COVID-19 period (July/Aug 2019; n=899). Significant fall in vaccination (p<0.05) was seen in postlockdown phase 1 for birth dose vaccines, primary doses of combination vaccines, Measles-Rubella (MR-1) vaccine 1st dose, MR-2 and booster doses of Diphtheria, Pertussis, Tetanus (DPT) and for primary doses of combination vaccines, MR-1 vaccine 1st dose, MR-2 for postlockdown phase 2 (p-value <0.05). Conclusion: Routine immunisation for all vaccines had a major setback during unlockdown period in 2020 and 2021. There is an urge for national drive for routine Vaccine Preventable Diseases (VPD) to prevent their re-surgence.