Indian Journal of Neonatal Medicine & Research

Neonatal Sequelae in Association with Maternal Autoantibodies: A Series of Three Cases

SHIVAASHANKARI DHARMALINGAM

Neonates born to mothers with autoantibody-associated syndromes may develop clinical manifestations due to transplacental transfer of maternal antibodies. These include Congenital Heart Block (CHB), cutaneous lesions, haematological abnormalities, and hepatic dysfunction. CHB remains the most serious and potentially life-threatening manifestation. The present study is a series of three neonates born to mothers with anti-Ro/SSA, anti-La/SSB, and Antiphospholipid Syndrome (APS). The clinical spectrum ranged from second-degree atrioventricular block with a structural cardiac defect to complete CHB requiring cardiology management, as well as a neonate without cardiac involvement. Growth parameters varied from Small for Gestational Age (SGA) to Appropriate for Gestational Age (AGA). This series illustrates the variability of cardiac and non-cardiac manifestations in neonates born to mothers with autoimmune conditions and emphasises the need for careful clinical monitoring and multidisciplinary care to optimise neonatal outcomes.

Early Neonatal Weight Changes among Babies Delivered by LSCS versus Normal Vaginal Delivery: A Prospective Observational Study

MOHSIN KHAN, RAJBIR SINGH BERI, PINKY BAHL

Introduction: Weight loss in newborns during the first few days of life is normal, with full-term neonates losing up to 5-10% of their birth weight. The American Academy of Paediatrics considers a loss greater than 7% excessive. Recent studies suggest that the mode of delivery may influence newborn weight loss. Aim: To compare birth weight changes over 28 days in term neonates born via Normal Vaginal Delivery (NVD) and Lower Segment Caesarean Section (LSCS). Materials and Methods: A prospective observational study was conducted at St. Stephen’s Hospital in New Delhi, North India, between September 2020 to September 2021 involving 93 term neonates. Of these, 49 were born vaginally and 44 by LSCS. Weights were measured at six intervals: birth, 24 hours, 48 hours, day 3, day 7, and day 28. Statistical analysis was performed to compare weight loss and gain patterns between the two groups. Continuous variables were presented as mean±SD, and categorical variables as absolute numbers and percentages. The means of two numerical variables were compared using t-test analysis. Nominal data was compared with Chi-square analysis. The p-value <0.05 was considered significant. Results: Out of 93 babies, 48 were male and 45 were female. The mean gestational age for neonates born via NVD was 38.10±0.94 weeks, and for those born via LSCS, it was 38.07±0.99 weeks. Neonates born via LSCS experienced more weight loss, particularly within the first 24 hours (p=0.005). By 48 and 72 hours, the differences were no longer statistically significant. No significant differences were observed in weight gain by day 7 and day 28. Conclusion: As per the present study findings, infants born by caesarean section experience more weight loss in the first 24 hours as compared to vaginally delivered babies.

Diagnostic Performance of Haematological Markers in Iron Deficiency Anaemia among Children Aged Six Months to 15 Years: A Prospective Observational Study

Elakeya Elumalai Saraswathy, Shivaashankari Dharmalingam, Anusha Chelladurai

Introduction: Iron Deficiency Anaemia (IDA) is the most common nutritional deficiency among children and remains a major public health concern in developing countries. Although serum ferritin is considered the gold standard marker for diagnosing IDA, its levels may be falsely elevated during infections and inflammatory conditions. Hence, additional haematological and biochemical markers are required for accurate diagnosis, especially in children with microcytic hypochromic anaemia. Aim: To compare the diagnostic utility of serum iron, Total Iron Binding Capacity (TIBC), Transferrin Saturation (TSAT) and serum ferritin in identifying IDA among children. Materials and Methods: This hospital-based prospective observational study was conducted at the Paediatric Outpatient and Inpatient Departments of Srinivasan Medical College and Hospital, Samayapuram, Tiruchirappalli, Tamil Nadu, India, from July 2025 to November 2025. A total of 120 children with microcytic hypochromic anaemia and normal or low red blood cell counts were included. Blood samples were analysed for serum iron, serum ferritin, TIBC, TSAT, Red cell Distribution Width (RDW), and the Mentzer index. The diagnostic utility of these parameters in identifying IDA was compared. Data were analysed using Spearman’s rank correlation test to assess correlations. Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were calculated. A p-value <0.05 was considered statistically significant. Results: The mean age of the study population was five years four months. Of the 120 children, 63 (52.5%) were males, and 57 (47.5%) were females. Low serum iron was observed in 107 (89.2%) of children, while abnormal TSAT and elevated TIBC were seen in 84 (70.0%) and 76 (63.3%), respectively. TSAT showed the highest diagnostic accuracy (71.7%), whereas serum iron demonstrated the highest sensitivity (88.9%). RDW >13% was present in 111 (92.5%) of children, and Mentzer index >13, was observed in all 120 (100%) cases. Conclusion: Serum iron and TSAT are valuable diagnostic markers for IDA and should be interpreted along with serum ferritin, particularly in hospital-based settings where inflammatory conditions may alter serum ferritin levels. An elevated Mentzer index may also prompt evaluation for possible co-existing haemoglobinopathies in children presenting with microcytic anaemia.

Brainstem Auditory Evoked Potential in Common Causes of Neonatal Haemolytic Hyperbilirubinaemia- A Cross-sectional Study

Sonali Majumdar Das, Hiya Bhattacharya

Introduction: Neonatal haemolytic hyperbilirubinaemia often leads to multiple neurological consequences. There are various haemolytic causes among which ABO incompatibility, Rh incompatibility, G6PD deficiency are much common in Indian population. High concentration of serum Unconjugated Bilirubin (UCB) is lethal for the auditory pathway as that delays sound transmission and causes speech problem in later life. Though, for infant population no subjective test of hearing is dependable, auditory assessment can be done by Brainstem Evoked Response Audiometry (BERA) that can measure Brainstem Auditory Evoked Potential (BAEP) among children reliably. Aim: To assess the effect of neonatal haemolytic hyperbilirubinaemia on auditory pathway by BERA and compare Auditory Brainstem Response (ABR) in different haemolytic groups (Rh incompatibility, ABO incompatibility, G6PD deficiency, other haemolytic causes like hereditary spherocytosis, elliptocytosis etc. Materials and Methods: This cross-sectional analytical study was commenced in Applied Neurophysiology laboratory of Department of Physiology, RG Kar Medical College, Kolkata, West Bengal, India from July 2019 to December 2024. Altogether 96 infants, suffering from neonatal hyperbilirubinaemia due to different haemolytic causes were taken from Department of Paediatric Medicine. The total population was categorised into four groups as per causes i.e., ABO incompatibility, Rh incompatibility, G6PD deficiency and other haemolytic causes (spherocytosis, elliptocytosis etc.,). The BAEP wave latencies of case population was compared with normative data, taken from previous study. Intergroup and intragroup comparison was done by student’s t-test, Hedges’g value, Analysis of Variance (ANOVA) test and post-hoc test. Results: In the present study, out of total 96 subjects, there were 58 male and 38 female infants with mean age of 1.98±0.87 months. All the subjects had bilateral statistically significant delayed wave V and I-V interwave latency. Though as per effect size, highly significant difference was present in right-sided waves. ABO incompatibility, Rh incompatibility, and other haemolytic causes showed similar BAEP findings though the parameters delay was more significant in Rh incompatibility in comparison with other three groups. In G6PD deficiency, only right-sided wave I was delayed. A total of 26 infants showed unilateral or bilateral absent waves, while maximally it was present in G6PD deficient group. Conclusion: Infants with neonatal haemolytic hyperbilirubinaemia, alongside the three aforementioned groups, showed positive association between high serum bilirubin and prolonged central auditory pathway conduction; though in G6PD deficient infants, only the right-sided peripheral pathway was impacted, while infants with Rh incompatibility showed a more significant involvement of the right-sided central auditory pathway than the other three groups.

Prognostic Value of Serial Serum Lactate and Lactate Clearance in Paediatric Shock: A Prospective Observational Study

Fatema Huda, Vinod Ingale, Mohammad Haseeb, Imtiyaz Ahmad

Introduction: Paediatric shock remains a major cause of morbidity and mortality in intensive care units. Early identification of children at high-risk of adverse outcomes is crucial. Serum lactate and lactate clearance have emerged as potential biomarkers of tissue hypoxia and adequacy of resuscitation, but data in paediatric shock across diverse aetiologies remain limited. Aim: To evaluate the prognostic significance of serial serum lactate levels and lactate clearance at 6, 12, and 24 hours in predicting mortality among children with shock. Materials and Methods: This prospective observational study was conducted over six months (April 2024 to September 2024) in the Paediatric Intensive Care Unit (PICU) of MGM Medical College and Hospital, Aurangabad, Maharashtra, India. Total 100 children aged 1 month to 18 years admitted with clinical shock and an initial serum lactate level ≥2 mmol/L were enrolled. Serum lactate levels were measured at admission and at 6, 12, and 24 hours. Lactate clearance was calculated for each interval. The primary outcome was survival status at hospital discharge. Comparisons between survivors and non-survivors were performed using the independent t-test/Mann-Whitney U test and Chi-square/Fisher’s-exact test as appropriate. ROC analysis was used to assess prognostic performance. Results: A total of 100 children were included; out of them, 72 survived and 28 died (mortality 28%). Non-survivors had significantly higher serum lactate levels at admission and at all subsequent time points (p<0.01). Lactate clearance was significantly lower in non-survivors than survivors at 6, 12, and 24 hours (13.4%, 22.4%, and 26.9% vs. 20.7%, 37.9%, and 55.2%, respectively; p<0.001). Persistently elevated lactate levels and poor lactate clearance were associated with increased mortality. Conclusion: Serial serum lactate measurements and lactate clearance during the first 24 hours of PICU admission are valuable prognostic markers in paediatric shock. Low lactate clearance identifies children at higher risk of mortality and may aid in early risk stratification and monitoring of resuscitation.