Indian Journal of Neonatal Medicine & Research

A Rare Case of Aplasia Cutis Congenita

Sumita Mehta, Anshuja Singla, Jyoti Saini, Tarun Kumar

Aplasia cutis congenita is a heterogenous group of disorders characterized by the absence of a portion of skin either localized or widespread at birth. Most commonly seen on the scalp (84%), it can affect any part of the body, including the trunk and limbs. We report a case of a baby born with aplasia cutis congenital managed conservatively.

Adverse Drug Reaction following Injection of Amikacin Sulphate in a Cluster of Preterm Newborns

Jayesh Varia, Rajiv Prasad, Vandana M Desai, Vasav D Desai

Although, single case reports regarding adverse effects of Inj. Amikacin sulphate in newborns have been published, simultaneous affection of multiple babies is rare. In this report we present cluster of newborns admitted in a neonatal intensive care setup presenting with Adverse Drug Reaction (ADR) to Inj. Amikacin sulphate. It can cause life threatening adverse effects and neonates are particularly vulnerable to ADR.

A Prospective Study to Compare the Diagnostic Value of Serum Procalcitonin and CRP in Early Onset Sepsis

Introduction: Neonatal sepsis is the most common cause of death in newborns in developing countries. Prompt diagnosis is the critical determinant in its outcome. As manifestations are often vague, clinically it is difficult to differentiate sepsis from non-infective conditions. Timely diagnosis is important as delay in initiation of antimicrobials can prove fatal. On the other hand empirical use of antibiotics not only increases the risk of antibiotic resistance but also delays the diagnosis of true condition. Procalcitonin (PCT) has been well evaluated in late onset sepsis but data pertaining to Early Onset Sepsis (EOS) are still lacking. We compared the diagnostic value of PCT and CRP (C-Reactive Protein) in EOS. Aim: To compare the diagnostic value of serum PCT and CRP in early onset sepsis. Materials and Methods: It was a prospective observational study conducted in Neonatal Intensive Care Unit of the Department of Paediatrics, Dr.S.N. Medical College, Jodhpur, India. All neonates delivered in hospitals attached to this medical college or referred here within 7 days of life and having =2 perinatal risk factors for sepsis or displaying clinical sepsis were included in the study. All enrolled neonates were subjected to sepsis screen, PCT levels and blood culture at birth or admission which ever was the earliest. PCT levels = 0.5 ng/mL and CRP levels above 8mg/l were considered positive for EOS. Results: Sensitivity and negative predictive value of PCT were higher than CRP (90.12% vs. 50.62% and 93.33% vs. 79.06% respectively). Also it had a higher positive predictive value of 40.56% than CRP where it was 37.61%. CRP was more specific (68.95% vs. 51.4%) with overall higher diagnostic accuracy (0.64 vs. 0.61) in comparison to PCT. Conclusion: PCT is more sensitive and has a higher negative predictive value than CRP in early onset sepsis. Higher positive predictive value and specificity of CRP suggest that, PCT should not be used alone rather should be supplemented with CRP to correctly identify early onset neonatal sepsis.

Comparison of Oxidative Stress in Neonates Born by Normal Vaginal and Elective Caesarean Delivery

Tanvi Pai, Rajesh Shimoga Mahabala, Shantharam Baliga

Introduction: Oxidative stress occurs when generation of free radicals (oxidants) exceeds the available antioxidants. In pregnancy and parturition, there is an increased formation of reactive oxygen species. This study aims to evaluate and compare oxidative stress in newborns delivered by two different modes i.e., normal Vaginal Delivery (VD) and elective Caesarean Section (CS). Aim: To evaluate and compare oxidative stress in term new born via two different modes of delivery i.e. Normal VD and elective CS by estimating the following serum biochemical markers in a cord blood sample. 1) Superoxide Dismutase (SOD) 2) Uric Acid (UA) 3) Malondialdehyde (MDA) 4) Ischemia Modified Albumin (IMA). Materials and Methods: A hospital based cross-sectional study was conducted wherein a total 92 neonates, 46 in each group of normal VD and elective CS were included in the study. Cord blood levels of oxidative stress parameters i.e., MDA, IMA and antioxidants - SOD and UA were estimated. Statistical analysis of the outcome variables was done by Chi square, Fischer Exact, unpaired ‘t’-tests and ANOVA. Correlation between parameters by Pearson’s correlation and significant parameters were subjected to ROC curve analysis to see their efficacy. Results: The IMA levels in cord blood were significantly higher in VD (p<0.05) when compared to CS, while MDA levels were not significantly different between the groups (p>0.05). The levels of antioxidant parameters SOD and UA was significantly lower in neonates born by VD than CS (p<0.05). IMA showed a significant weak positive correlation with the period of gestation. The area under ROC of IMA was 0.985 showed significant difference between both groups. Conclusion: There is increased oxidative stress and decreased antioxidant status in neonates born via normal VD as compared to CS. There is decreased oxidative stress during caesarean delivery as depicted by decreased IMA and higher antioxidant reserve (SOD and UA) in the cord blood these babies which in turn is a protective mechanism. The negative correlation between the oxidative parameter (IMA) and antioxidant parameters (SOD, UA) can be explained by the free radical scavenging effect of antioxidants which is reflected with comparatively lower levels.

Methodological Study to Develop Standard Operational Protocol on Intramuscular (IM), Intradermal (ID) and Subcutaneous Drug Administration for Children

Sunil Kumar Bijarania, Sushma Kumari Saini, Sanjay Verma, Sukhwinder Kaur

Introduction: Medicine administration is a major role played by registered nurses. Medicines are prescribed by the physician and dispensed by the pharmacist but responsibility for meticulous administration rests with the registered nurse. It becomes even more important when drugs are to be administered to children. Drug administration via Intramuscular (IM), Intradermal (ID) and Subcutaneous route is a complex process. Errors are associated with medicine administration. Aim: The objective of this study was to develop Standard Operational Protocol (SOP) for IM, ID and Subcutaneous drug administration and checklist to assess the implementation of the developed SOP. Materials and Methods: A methodological research design adapted to carry out the present study to develop standard operational protocol for IM, ID and subcutaneous drug administration for children, admitted in Advanced Paediatric Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India. The study included 58 bedside nurses and 90 observations of medicine administration procedure. Results: The Content Validity Index (CVI) was prepared to assess the validity of content (items) of SOPs and checklists. Over all Cronbach’s-alpha values was calculated to assess the internal consistency of Items in SOPs and checklists. CVI of SOP and checklists were 98.51%, 97.83% and 99.03%. Over all Cronbach’salpha values were calculated 0.96, 0.82 and 0.95. All the nurses felt that SOPs are useful. Conclusion: Valid and feasible SOPs for drug administration in children along with valid and reliable checklists were developed. It is recommended to use this document for drug administration in children to prevent any possible error during drug administration to children.

A Rare Coincidence of Infantile Hypertrophic Pyloric Stenosis and Esophageal Atresia with Tracheo-Esophageal Fistula: A Case Report

Yesim Coskun, Ipekakman, Salih Somuncu

The coincidence of Infantile Hypertrophic Pyloric Stenosis (IHPS) and Esophageal Atresia (EA) with Tracheo-Esophageal Fistula (TEF) is rare. Although, vomiting and regurgitation in operated cases of EA and TEF are attributed to Gastroesophageal Reflux (GER) and the stricture of the anastomosis, it may be also associated with IHPS as well. We report a case of 3-hour-old female infant, who had EA and TEF operation and diagnosed to have IHPS at 9th week of age. Early diagnosis and treatment can prevent complications.