Indian Journal of Neonatal Medicine & Research

Cardiac Hypertrophy in an Infant of a Diabetic Mother: A Case of Reversible Cardiomyopathy

Basany Laxman, Naga Priyanka Gandrakota, Vinay Batthula, Rajesh Babu Gudipati

Diabetes Mellitus (DM) is a chronic metabolic disorder characterised by insulin deficiency or resistance and/or β-cell defects. High Body Mass Index (BMI) at conception, undiagnosed pregestational diabetes, and poor glycaemic control significantly affect the foetal heart, foetoplacental circulation and foetal growth. Myocardial hypertrophy and cardiac defects are more prevalent in Infants of Diabetic Mothers (IDMs). Cardiac Hypertrophy (CH) is characterised by a significant thickening of the interventricular septum, reduction in the size of the ventricular cavity, systolic and diastolic dysfunction and subaortic stenosis. A term neonate born to a mother with pregestational insulin-dependent Type I Diabetes Mellitus (T1DM) developed respiratory distress soon after birth, and Echocardiography (ECHO) showed Asymmetric Septal Hypertrophy (ASH) and Left Ventricular Outflow Tract (LVOT) obstruction. The baby responded well to oral propranolol, which was continued for four weeks, resulting in the resolution of CH at four months of age on follow-up. The present case underscores the importance of ECHO, even in infants born to mothers with good glycaemic control.

Correlation between Selected Micronutrient Status in Maternal Blood and Cord Blood of Newborn from a Tertiary Care Hospital in West Bengal, India: A Cross-sectional Study

Sanjoy Kumar Kunti, Sharmistha Chatterjee, Indranil Chakraborty

Introduction: The demand for most micronutrients increases during pregnancy for obvious reasons. Micronutrients like copper and zinc are indispensable co-factors for various enzymes in metabolism. The reduction in the concentration of serum iron and ferritin is a common phenomenon in pregnancy, and early diagnosis is crucial for favourable maternal and foetal outcomes. However, there is a dearth of studies on the metabolism of micronutrients in pregnancy. Aim: The aim of this cross-sectional study, conducted from July 2018 to February 2019 in the Department of Gynaecology and Obstetrics and the Department of Biochemistry, College of Medicine and Sagore Dutta Hospital, West Bengal, India, was to assess the serum levels of copper, zinc, and iron in maternal serum and foetal cord blood. Additionally, the study aimed to correlate the concentrations of these micronutrients between maternal serum and foetal cord blood. Materials and Methods: A total of 336 pregnant women of childbearing age, irrespective of gravida, were included in the study. Blood samples were collected from the pregnant women, and cord blood samples were collected from the foetal end in clot vials for the estimation of copper, zinc, and iron levels. Correlation was assessed between the concentration of these micronutrients in maternal serum and cord blood of the newborn. Data normality was determined using the Shapiro-Wilk normality tests, and the significance level was set at p-value ≤0.05. Results: The study included a total of 336 pregnant women in the age group of 18-33 years, with a mean age of 29.72±4.39 years. In maternal serum, the mean concentration of copper was 122.79±33.67 μg/dL, zinc was 78.47±27.62 μg/dL, and iron was 114.5±45.05 μg/dL. In foetal cord blood, the mean concentration of copper was 48.02±16.37 μg/dL, zinc was 75.82±27.64 μg/dL, and iron was 185.30±52.74 μg/dL. The correlation coefficients between maternal serum and foetal cord blood concentrations were statistically significant for zinc and iron (p-value <0.05). Additionally, the correlation was statistically significant for copper (p-value=0.030). The mean concentration of haemoglobin in maternal serum was 10.9±1.96 g/dL, compared to 14.05±2.13 g/dL in cord blood. The mean maternal serum ferritin was 73.53±56.15 μg/L, and the mean cord blood ferritin was 147.21±61.13 μg/L. Conclusion: The study demonstrated a positive correlation between the concentrations of iron and zinc in maternal serum and foetal cord blood, while a negative correlation was observed for copper concentration.

Screening of G6PD Deficiency in Newborns at a Tertiary Care Teaching Hospital in Assam, North East India: A Cross-sectional Study

Bhaskar Borah Sonowal, Rita Panyang Kataki, Alaka Das, Arpita Gogoi

Introduction: Glucose-6-Phosphate Dehydrogenase (G6PD) deficiency is the most frequently encountered enzymopathy in humans. It is closely linked to neonatal jaundice, chronic non-spherocytic haemolytic anaemia, and acute haemolytic anaemia. G6PD deficiency is a common cause of jaundice among neonates. Aim: To screen for G6PD deficiency among newborns at a tertiary care teaching centre in Assam. Materials and Methods: This hospital-based cross-sectional study was conducted in the postnatal ward of the Department of Paediatrics at Medical College and Hospital, Dibrugarh, Assam, India, from June 2021 to May 2022. A randomly selected sample of 630 term neonates aged between 24 hours and 7 days of life was included in the study. A 2 mL blood sample was collected in an Ethylenediamine Tetra-acetic Acid (EDTA) vial from each neonate, and G6PD enzyme activity was estimated using the Kinetic Method with a commercially available G-six kit. Newborns with G6PD enzyme activity values less than 6.4 U/g Haemoglobin (Hb) were considered G6PD deficient. Data, including age, sex, religion, Total Serum Bilirubin (TSB/NBIL), G6PD activity, and Hb of the neonates, were entered into pre-designed forms. The data were analysed using the Chi-square test. Results: Among the 630 screened neonates, 48 were found to be G6PD deficient, of which the majority were males (34 males, 14 females), resulting in a male-to-female ratio of 2.4:1. The occurrence of G6PD deficiency was 7.62%. The mean G6PD enzyme activity in deficient neonates was 4.53±1.17 U/g Hb. Conclusion: This study identified a significant occurrence of G6PD deficiency in newborns, including females. The mean G6PD enzyme activity in deficient neonates was significantly lower than in normal cases.

Risk Factors for Hearing Loss in High-risk Neonates at a Tertiary Care Centre in Central India: A Prospective Observational Study

Leena Dhande, Prerana Ganaboor, Rasika Hattewar, Chetan Jaiswal

Introduction: Hearing impairment and deafness are global issues that affect 5% of the world’s population, with nearly 34 million children requiring rehabilitation to address their Hearing Loss (HL). An approximately 10-20 fold higher incidence of audiological risk factors has been noted in Neonatal Intensive Care Units (NICUs), which translates that 2-5% of all newborns in NICUs may be affected. Early diagnosis of HL and intervention can be advantageous from the timely fitting of hearing aids or cochlear implants. Aim: The aim of this study was to evaluate the risk factors for HL in NICUs and Special Neonatal Care Units (SNCUs) at a tertiary care hospital in Central India. Materials and Methods: This prospective, observational, single-centre study was conducted from October 2019 to September 2021 in the Department of Paediatrics at Indira Gandhi Government Medical College and Hospital, Nagpur, Maharashtra, India. A total of 319 neonates at high-risk for HL, discharged from NICUs and SNCUs, were included in the study. The association between risk factors like prematurity, Low Birth Weight (LBW), Toxoplasmosis, Rubella, Cytomegalovirus, Herpes Simplex (TORCH) infections, neonatal asphyxia, neonatal sepsis, meningitis, exchange transfusion, assisted ventilation, and HL were studied. The chi-square test was used to assess the association between SNHL and risk factors. Results: The incidence of Sensorineural Hearing Loss (SNHL) was 3.76%. Neonatal asphyxia (p-value <0.01), exchange transfusion (p-value <0.001), TORCH infections (p-value <0.001), meningitis (p-value <0.001), and assisted ventilation (p-value <0.001) were found to be significant risk factors associated with SNHL. Conclusion: Based on the assessment of risk factors, it was concluded that neonates should undergo hearing screening tests within the first month of life, and a diagnosis should be made by three months of age. This allows specialists to initiate treatment and intervention by six months of age, helping children with impaired hearing avoid the harmful consequences of semantic deprivation.

Assessment of Neonates with Extended Sick Neonate Score (ESNS) for Predicting Mortality in a Tertiary Care Center in Dharwad, Karnataka, India: A Prospective Cohort Study

Introduction: High neonatal mortality rates may be attributed to the lack of early recognition of severe illness, early and safe referral, and proper care. Therefore, there is a need to develop a simple, cost-effective scoring system that can be quickly applied to newborns referred from peripheral to tertiary care settings in resource-constrained areas. The Extended Sick Neonate Score (ESNS) is one such scoring system used to assess the severity of illness in critically ill neonates and predict their outcomes. Aim: To evaluate the effectiveness of the Extended Sick Newborn Score in predicting outcomes for neonates admitted to the Neonatal Intensive Care Unit (NICU) of a tertiary care centre. Materials and Methods: This prospective cohort study included 122 outborn neonates admitted to the NICU of SDM College of Medical Sciences and Hospital in Dharwad, Karnataka, India, from June 2021 to June 2022. All the required parameters for scoring, such as respiratory effort, heart rate, mean blood pressure, axillary temperature, capillary filling time, random blood sugar, SpO2, Moro reflex, and modified Downe’s score, were assessed and documented in a predesigned proforma. The ESNS was calculated upon admission to predict the outcomes. Statistical analysis included ANOVA test and independent t-test, using SPSS version 17.0 and MS Excel. Results: The study evaluated a total of 122 neonates, including 78 males and 44 females. Of these, 99 were term neonates and 23 were preterm neonates. The mean age for term neonates was 8.5 days ±8.6, and for preterm neonates, it was 4.1 days ±4.3. Term neonates with an ESNS Score ≤11 exhibited higher mortality, while preterm neonates with an ESNS score ≤12 showed higher mortality. The sensitivity and specificity of the ESNS score in predicting death were 78.57% and 99.07%, respectively. The ESNS score at admission was significantly lower in non-survivors compared to survivors, and it demonstrated a positive correlation with the outcome. Conclusion: This study found a significant correlation between the ESNS score at admission and in-hospital mortality. The use of the ESNS score is an acceptable method for risk stratification and prognosis of newborns in the NICU.