Indian Journal of Neonatal Medicine & Research

Clinically Detectable Congenital Anomalies in Newborn Babies Admitted in Neonatal Intensive Care Unit at Teaching Hospital

Suresh Kumar Meena, Rajendra Prasad Nagar

Introduction: Any structural and chromosomal malformations can leads to significant impact on overall growth and development of a child and are among the leading cause of morbidity and mortality in newborn. Aim: To know the overall incidence of clinically detectable congenital anomaly and the types of different congenital anomaly in newborn at tertiary care hospital. Materials and Methods: All the newborn admitted in newborn intensive care unit with clinical detected congenital malformation over a period of one year. Data were recorded from medical records of admitted newborns. Results: During the study period total 9440 deliveries occurred in hospital; out of them 140 newborns were having clinically detectable malformations with Incidence of 3.6%. Mean birth weight was 2600±650 gm and mean gestational age was 36±2.8 weeks. Most common affected system was gastrointestinal (37.8%) followed by central nervous system (15%). Most common central nervous system malformations were neural tube defects. Congenital Talipus Equino Varus (CTEV) 10 (21%) was most common musculoskeletal malformation. Among all congenitally malformed patients; cleft lip and cleft palate 11 (7.8%) was most common congenital anomaly. Conclusion: Birth defects services including components of care, prevention and surveillance in the form of a well defined programme are needed in the country

Correlation of C-Reactive Protein and Blood Culture in Neonatal Sepsis

Niza Monga, Nitya vyas, Babita Sharma

Introduction: In neonates, septicaemia is one of leading cause of morbidity and mortality. Therefore, timely diagnosis is important to prevent fatal outcome. C-reactive protein is an important biomarker that aids in the timely diagnosis of neonatal septicaemia. Aim: The present study was carried out to determine the accuracy of CRP in the diagnosis of neonatal septicaemia and to compare it with blood culture. Materials and Methods: One hundred neonates suspected of neonatal sepsis were included in the study over a period of one year. Blood culture and qualitative assessment of CRP was done for all the patients. CRP quantification was done for the patients who were CRP positive. Results: Of the 100 neonates studied, 47 were blood culture positive while 70 were CRP positive. The sensitivity, specificity, positive and negative predictive values and diagnostic accuracy of CRP were 85.11%, 43.40%, 57.14%, 76.67% and 63% respectively. Conclusion: CRP estimation is a rapid test with good sensitivity and aids in rapid diagnosis of neonatal septicaemia.

Relation of Birth Weight with Maternal Pre-pregnancy Weight and Weight Gain during Pregnancy

Sunil Gavhane, Avinash Sangle, Ramesh Gaikwad

Introduction: Birth weight is an important factor which determines the outcome in neonate and also affects the chances of survival. There is a need to identify the modifiable factors which can impact the birth weight. Aim: To evaluate the relation of pre-pregnancy weight of the mother and gestational weight gain with the birth weight of the baby among the study population. Materials and Methods: This prospective study was done during August 2006 to December 2008. It comprised of 100 pregnant women. After registration with a positive pregnancy test, patients were enrolled and examined and then followed up till delivery. Maternal weight was monitored using same digital scale and the neonatal weight was measured within 30 minutes of the delivery of the baby. All the newborns were weighed with the same weighing machine for neonates. This study was attempted to correlate maternal pre-pregnancy weight to foetal weight and maternal weight gain during pregnancy to foetal weight. Results: The pre-pregnancy weight of the study subjects had a range from 35 Kg to 74 Kg (mean 51.93±8.62) with gestational weight gain range from 7 to 20 Kg (mean 11.33±2.55) throughout pregnancy. Foetal weight ranged from a minimum of 2 Kg to maximum of 3.7 Kg with mean weight being 2.88±0.32 Kg. There was a direct proportion observed between birth weight and pre-pregnancy weight as well as between birth weight and gestational weight gain. Conclusion: Pre-pregnancy weight of mother being an important determinant of birth weight of baby, the women of reproductive age group need to be counselled regarding its significance. Gestational weight gain is an important determinant of birth weight of baby and mothers should be advised regarding recommended weight gain ranges during the antenatal visits.

Neonatal Candida Blood Stream Infection in A Tertiary Care Hospitalis

Anurekha V, Kumaravel K S, Kumar P, Satheesh Kumar D, Sakthi Ganesan A

Introduction: Candidemia or Candida Blood Stream Infection (BSI) is associated with medical advancements. Since the survival of Very Low Birth Weight (VLBW) and Extreme Low Birth Weight (ELBW) babies has improved, there is a surge of Candida BSI. Aim: The aim of the study is to describe the clinical profile of Candida BSI in neonates including the risk factors, symptoms and signs associated with mortality. Materials and Methods: This is a retrospective descriptive study conducted in NICU of Government Mohan Kumaramangalam Medical College, Salem. The inclusion criteria were to include all neonates with Candida species in blood culture during the study period. The neonates who left against medical advice were excluded. Results: The incidence of Candida BSI is 1.43% (n=60). About 86% of the neonates weighed less than 2.5kgs and 84% were preterm. More than half neonates received an Aminoglycoside and about one fourth received third generation Cephalosporins. About 82% stayed in the NICU for more than 10 days. More than half of the neonates had clinical features of lethargy, apnoea, temperature instability, feeding intolerance, shock, thrombocytopenia and hypo/ hyperglycemia. About 39% of neonates expired. Conclusion: Candida BSI is an important morbidity in NICU with a high mortality rates. Every NICU should have a written antifungal policy to prevent the morbidity and mortality associated with Candida BSI.

Value of Cranial Ultrasonography and Resistive Index of Cerebral Arteries in Predicting Neuromotor Outcomes in Newborns with Hypoxic Ischaemic Encephalopathy

Introduction: Perinatal asphyxia is one of the leading cause of neonatal mortality and childhood morbidity. Use of cranial Ultrasonography (USG) and cranial arterial doppler indices has been evaluated for predicting risk of neuromotor impairment. Aim: Study was aimed to evaluate the role of cranial USG and Resistive Index (RI) of Anterior and Middle Cerebral Arteries (ACA, MCA) in predicting neuromotor outcomes at six months of age in term neonates with perinatal asphyxia and Hypoxic Ischaemic Encephalopathy (HIE). Materials and Methods: This prospective study was carried out at a tertiary care teaching hospital. Subjects with perinatal asphyxia and HIE were grouped in different Sarnat and Sarnat stages. Cranial USG and RI measurement of ACA, MCA was done within five days of birth. They were followed up at six months of age for neuromotor outcome. Outcome was correlated with Sarnat stages, USG finding and RI of ACA, MCA. It was carried out using R statistical environment. Results: A total of 43 neonates with perinatal asphyxia and HIE were evaluated for neuromotor outcomes. Both ACA and MCA, RI were also significantly associated with the clinical stages (p<0.0001). Out of these 19 cases presented with neuromotor abnormality. USG was abnormal in 14 cases. RI of MCA and ACA in subjects with abnormal neuromotor outcome were 0.57 and 0.53 respectively. There was significant association between abnormal USG and decreasing RI with increasing neuromotor scale. Both ACA RI and MCA, RI were significant predictors for neuromotor impairment by univariate and multivariate logistic regression and USG was significant in univariate logistic regression. Conclusion: Abnormality detected by cranial USG and RI of cerebral vessels within few days of life in cases of perinatal asphyxia and HIE were significantly associated with poor neuromotor outcome. The strength of association in predicting neuromotor outcome was more marked with RI than USG.