Indian Journal of Neonatal Medicine & Research

Pattern of Respiratory Problems in Neonates in a Level III Neonatal Care Unit with Special Reference to Pneumonia

Aukifa Khamim Sabibahul Islam, Reeta Bora, Nibedita Paul, Sutharson Ramasamy

Introduction: Respiratory distress constitutes one of the commonest cause of morbidity and mortality in the neonatal period. It is more commonly encountered within the first 48-72 hours of life. Aim: To find out the incidence, causes and outcome of respiratory distress in inborn newborn babies and also to determine the common organisms of pneumonia. Settings and Design: A hospital based prospective study was carried out for a period of 7 months (October 2015 to April 2016) in the NICU (Neonatal Intensive Care Unit) of AMCH (Assam Medical College and Hospital) . Materials and Methods: All inborn newborn babies admitted to NICU of AMCH who developed respiratory symptoms were included in the study. Maternal and baby details were filled up in a predesigned structured proforma. Statistical Analysis: Data were entered in SPSS (Software package for statistical analysis), version 16 and the frequencies were analyzed. Results: Of all the inborn deliveries during our study period, 5.3% developed respiratory distress. It constituted 22.4% of all NICU admission, 61.5% were males and 38.5% were females. TTNB was the most common cause (42.8%) of respiratory distress followed by pneumonia (29.6%), sepsis (8.9%), MAS (8.2%) and RDS (5.9%). TTNB was more in term babies (54.6%), RDS among preterm babies (94.4%) and MAS was found exclusively in the term babies. Of the 90 Pneumonia cases, sepsis screen was positive in 87.8% cases and blood culture was positive in 14.4% cases. The most common organism was CONS (coagulase negative staphylococcus) which was found in four cases (4.4%), followed by acinetobacter in three cases (3.33%) and klebsiella in two cases (2.2%). In the pneumonia cases, predisposing factors like PROM was detected in 25.6%, maternal fever in 16.6% and foul smelling liquor in 11.1%. The overall case fatality rate is 23%. Mortality is highest (77.8%) in RDS. Conclusion: Respiratory distress is a common cause of NICU admission, TTNB being the commonest cause, followed by pneumonia. The burden of neonatal pneumonia is high in our NICU.

Correlation of Maternal BMI and Neonatal BMI with Placental Weight in Rural South Kerala-India

Introduction: Birth weight and placental weight are good indicators of new born growth parameters. Maternal complications are seen in both lean and obese women. The available studies shows correlations of placental parameters with baby anthropometric variables but limited relationship to maternal BMI which will help very much to anticipate the neonatal outcome and complications. Aim: To find out correlation of maternal BMI and neonatal BMI with placental weight in rural South Kerala. Study Design: Prospective cohort study in a rural medical college in South Kerala. Materials and Methods: All singleton neonates 28 weeks of gestational age and above delivered in the institution and their mothers from January 2015 to October 2015. Neonatal BMI, Maternal BMI and placental weight were calculated. Means (x), standard deviation (SD) and frequency (%) was calculated for the statistical analysis. Student’s ‘t’ test was used to compare the mean results of the continuous variables. Pearson correlation was used to find out the correlation between different anthropometric variables. Results: Out of the 920 live single births 463 (50.3%) were male and 457(49.7%) were females. Among the mothers (86.2%) were between the age group of 25-29 years, about 87.7% of the mothers were unemployed. Mean birth weight was 3000gm (SD=500) Mean baby length was 48.9 (SD=2). The mean placental weight was 499gm (SD=78). Mean maternal BMI was 27 (SD 3.9) and the mean neonatal BMI was 12.5 (SD=1.9). It was found that both maternal BMI (r=0.143 p<0.05) and neonatal BMI (r=0.350; p<0.05) has a positive correlation with placental weight. Conclusion: The placental weight correlates with maternal and neonatal BMI. Hence, the maternal BMI and placental weight can predict the neonatal outcome and postnatal complications. By serial sonological measurement of placental weight and combining it with maternal BMI it is possible to predict neonatal mortality and morbidity more accurately.

Can We Predict the Sex of Babies and their Outcome in Relation to Gravida of Mother with Trimesteral Glucose in Gdm & Ngdm Persistently Elevated Cases?

Sudhanshu Kumar Das, Monalisa Subudhi, Khetrabasi Subudhi

Introduction: Gestational diabetes mellitus is defined as diabetes diagnosed for the first time during pregnancy and its incidence is 3-7% of pregnancies. There are many risk factors like sex, birth weight of babies. Fetal sex potentially may influence maternal glucose metabolism in pregnancy. Some studies found that higher maternal fasting glucose during 4-12 weeks gestation of pregnancy was associated with more birth weight and birth height. So, despite of tremendous research there is no consensus about universal screening and selective screening for GDM. Treatment of GDM reduces serious perinatal morbidity, improves neonatal outcome. Aim: To find out the correlation between sex and birth weight of babies, time and mode of delivery by gestational age and outcome in relation to gravid of mothers with trimesteral glucose in persistently elevated and confirmed GDM cases. Materials and Methods: A prospective randomised study was done in KIMS Medical College and Hospital, Amlapuram from January 2014 to January 2016, with patients consent and ethical committe approval. It included 150 cases attending in the antenatal clinic of Obstetrics and Gynaecology Department and Hospital delivery in KIMS Medical College. After detailed history and clinical examination, investigation OGTT (Oral Glucose Tolerance Test) in the first trimester of pregnancy was done. Babies delivered from NGDM persistently elevated (PGBS >100mg/dl) and confirmed GDM (Gestational Diabetes mellitus) (PGBS >140mg/dl) cases were admitted with complication in NICU. Results: Most GDM cases (76%) were in the age >30 years in compared to NGDM cases (57.77%). In 20 -25 years of age, majority GDM (80%) were in multi and 64.44% of NGDM persistently elevated in primi cases. Most of cases (50%) delivered after 37 weeks of gestation. The commonest mode of delivery was LSCS in all groups of blood sugar level of 100-120mg/dl,120-140mg/dl and >140mg/dl. In the present study, male babies were predominantly delivered from primi mothers not from multigravida as in other study. Whereas, in NGDM persistently elevated level, babies predominantly delivered from multigravida mothers were male babies. Those mothers who were diagnosed early and undergone treatment delivered term babies, whereas those who were late diagnosed had preterm deliveries. Conclusion: Though, the neonatal complications are poorly predictable by maternal history and risk factors like sex, birth weight of babies especially in nullipara. From this study, it was observed that sex of babies had important effect on mother’s glucose status and early treatment of GDM cases reduces perinatal outcome.

A Community Based Survey on Prevalence of Iodine Deficiency among Pregnant Women in a Municipality Area of West Bengal, India

Agnihotri Bhattacharyya, Baishakhi Paria, Dilip Kumar Pal

Introduction: In India, an estimated 200 million people were at risk for iodine deficiency disorders. Iodine Deficiency Disorder (IDD) is one of the most challenging nutritional problems in India. The pregnant women and their neonates are most vulnerable target groups of iodine deficiency disorder. Aim: To assess the prevalence of iodine deficiency among pregnant women and to find out any association between urinary iodine excretion level of pregnant women and prevalence of low birth weight among newborn babies, if any. Materials and Methods: The study was conducted in a block primary health centre of South 24 Paraganas West Bengal, among 1139 pregnant women admitted for delivery. Urinary iodine was measured by FAST B method. Results: Out of all, 36.69% of the pregnant women were found to have inadequate urinary iodine concentration and there was significant association between maternal insufficient urinary iodine concentration and low birth weight of their babies. Conclusion: As 24 Paraganas district is an iodinereplete area, about one third of the pregnant study population had inadequate urinary iodine excretion (<150µg/litre). There was significant association between the urinary iodine excretion and low birth weights of their babies. In conclusion, iodine supplementation through salt iodination programme should be strengthened.

Crouzon Syndrome with Ocular Abnormalities: A Case Report

Shakeen Singh, Anubha Bhatti, Mabel Bishnoi

Crouzon syndrome is a rare genetic disorder characterized by premature closure of cranial sutures, exophthalmos, beak-like nose and mid facial hypoplasia. It was initially described as hereditary syndrome of craniofacial synostosis. There is premature fusion of one or more cranial sutures in craniosynostosis leading to skull deformities. Craniofacial abnormalities are usually present at birth and may progress with time. The most common presentation is brachycephaly but the timing and order of suture fusion contributes to the shape of head. The orbits are shallow resulting in ocular proptosis with or without divergent strabismus. Hypoplasia of maxilla with curved parrot like nose and orbital hypertelorism are typical facial features. The diagnosis and management of craniofacial abnormalities have always been a challenge therefore understanding of these abnormalities is necessary to monitor subsequent growth and to ensure that the patient receives the best available care. Herein, we report this rare entity of Crouzon syndrome showing characteristic features with ocular abnormalities.

Goldston Syndrome – A Rare Case Report

Nagabhushan BM, Pavitra N Aralikatti, Vijayalaxmi Gagandeep

Goldston syndrome is a condition where Dandy-Walker malformation of brain is associated with polycystic kidneys. Newborn on day one came to Neonatal Intensive Care Unit for evaluation of hydrocephalus. Fetal cranial ultrasound revealed deficient vermis with a posterior fossa cyst communicating with 4th ventricle suggestive of Dandy-Walker malformation. Ultrasound abdomen and pelvis showed echogenic enlarged kidneys containing small cysts. The diagnosis of Goldston syndrome was suggested. Dandy-Walker malformation was confirmed by MRI brain.

Umbilical Cyst with Edward Syndrome

Bhavesh Dinesh Rathod, Preethi Tamilarasan

The advances in Obstetric ultrasonography have allowed early and accurate detection of anomalies in utero. Umbilical cord anomalies may include cysts, vascular anomalies and masses. Cysts detected in first trimester are mostly transient and the children are born normal. If detected in second or third trimester, the risk of fetal anomalies are high, and warrants a chromosomal analysis. We present a case report where antenatally cord cyst was detected in second trimester, with the fetus progressing to have oligohydramnios and Intrauterine growth retardation (IUGR). The neonate was born with Edward syndrome.

Letter to Editor: Utility of Sepsis Screen in the Early Diagnosis of Neonatal Sepsis

Anirban Mandal, Puneet Kaur Sahi