Indian Journal of Neonatal Medicine & Research

Organophosphorus Poisoning with Homicidal Intention in a Neonate

Laxman Basany, Roja Aepalapala

Organophosphorus Compounds (OPC) are widely used as pesticides, and poisoning due to OPC is very rare in neonates. A 12-day-old female neonate was admitted with gasping respiration, excessive oral secretions and cold extremities. She had frothing from mouth and nose with an offensive odour, and was hypothermic, hypotonic, cyanosed and in mild stupor. Pupils were pin pointed, capillary refill time was 4-5 sec and had bilateral crepitations of lungs on auscultation. The baby was intubated, given 0.1 mg of atropine followed by 0.9% saline bolus and gastric lavage. She was treated with empirical antibiotics, atropine, Pralidoxime (PAM) and respiratory support. The baby responded well to treatment and was discharged on 10th day of admission. This could be the second case of Organophosphorus (OP) poisoning with homicidal intention reported in neonates.

Suspected Cystic Fibrosis in Infantile Onset Pneumonias: A Case Series and Review of Literature

Hema Gupta, Parasdeep Kaur, Rajesh Bethu, Priti Priya, Anju Yadav

Pneumonias are common in infancy and infections remain the most common aetiology especially in developing countries. A case-series of 14 children (9 males and 5 females) with cystic fibrosis is presented who came with persistent/recurrent pneumonia. Most children had infantile onset of symptoms (mean age 4.6±4.2 months). Despite multiple medical consultations in infancy, a severe delay in diagnosis (mean age of diagnosis 75.5±65.1 months) and presentation was observed. The youngest child in this series was diagnosed at 2 months of age. Most common manifestations were respiratory, gastrointestinal, and failure to thrive (100%). Sweat chloride test was done in 12/14 children and was elevated in 100%. Genetic mutation was reported in 5 children only. Complications included computed tomography diagnosed bronchiectasis in (7/14; 50%), pseudomonas infections (6/14, 43%); other infections (8/14, 57%), pulmonary hypertension (3/14, 21%), gastroesophageal reflux (2/14; 14%). There was a high (5/14, 35.7%) mortality in this series, as most of them presented late. Lack of awareness and meager diagnostic facilities are major limitations in early diagnosis of cystic fibrosis and may lead to increased morbidity and mortality among these children.

Foot Length as a Proxy Indicator for Detection of Birth Weight in Newborns: An Observational Cross-sectional Study

Daasara Gururaju, Manjunathswamy Rangappa, Bheemaraya Shivasharana

Introduction: Birth weight is an important parameter to assess the overall wellbeing of a newborn. In developing countries like India, where large number of home deliveries occur, measuring birth weight is difficult. Studies have reported a positive correlation between birth weight and foot length. Hence, foot length may be considered as an alternative in place of birth weight, the former being an easy and cheap parameter to assess. Aim: To assess the correlation between foot length and birth weight in newborns, delivered or referred within 24 hours of birth. Materials and Methods: This observational cross-sectional study was conducted in the Neonatal Intensive Care Unit (NICU) at Shimoga Institute of Medical Sciences, Karnataka, India, (tertiary care hospital), from February 2021 to October 2021. A total of 902 newborns were included in the study. Foot length was measured with transparent ruler scale with 0.1 cm precision, and birth weight was recorded using digital weighing scale with 10 g precision. The correlation coefficient was calculated between foot length and birth weight. Results: Out of 902 newborns, 495 (54.88%) were males. The mean birth weight was 2.57±0.56 kg. The mean foot lengths were 7.27±0.58 cm in <2.5 kg category, 7.3±0.47 cm in 2.5-3.5 kg category, and 7.82±0.48 cm in >3.5 kg category. The correlation coefficient between foot length and birth weight in <2.5 kg, 2.5-3.5 kg and >3.5 kg group were 0.96, 0.93 and 0.78, respectively. Conclusion: Foot length can be used as a proxy measure to detect low birth weight in newborns in resource-limited settings where weighing is not possible.

Early Neurodevelopmental Outcome of Asphyxiated Newborns Treated with Therapeutic Hypothermia: A Non Randomised Cohort Study

Jyoti Prajapati, Devraj Singh, Pramila Ramawat, Nilesh Jain

Introduction: Therapeutic Hypothermia (TH) is now a proven model of treatment to prevent complications in asphyxiated newborns. Perinatal asphyxia is the leading cause of mortality and disability in India and developing countries. The TH is still not the standard treatment protocol in developing India, and data regarding early neurological outcomes after TH is lacking. Aim: To evaluate the early neurological outcome at three, six and nine months of asphyxiated newborns who received TH compared to non recipients. Materials and Methods: This was a non randomised cohort study conducted at the tertiary care teaching hospital. A total of 190 asphyxiated newborns admitted to Neonatal Intensive Care Unit (NICU) within 24 hours of life, meeting the laboratory and/or clinical criteria of perinatal asphyxia were enrolled. Eligible newborns admitted within six hours of birth receiving TH were labelled as recipients, and those who received standard care were labelled as non-recipients. Neonates were assessed at three, six, and nine months and compared for neurodevelopment using the Hammersmith Infant Neurological Examination (HINE) optimality score and Denver Developmental Screening Test II. Both groups were compared using t-test and chi-square test. Results: Out of the total 190 enrolled participants, 14 were excluded and 176 newborns were further divided into recipients and non recipients groups. Baseline demographic characters were similar in both groups. Seventy-five recipients were followed-up till three months, 72 at six months, and 69 at nine months vs 62, 60, and 56 non recipients, respectively. Lesser number of recipients scored suboptimal scores (HINE score <67) at three months vs non recipients (20% vs 35.4%, mean/SD 63 [3.43] vs 57 [4.55], [p<0.001]). At six months (HINE score <70), the incidence was 18% vs 21% (p=0.02), mean score 67 vs 61 (p<0.0001); and at nine months (HINE score <73) the incidence was 14.4% vs 30.3% (p=0.048), mean score 72 vs 65 among recipient vs non recipients (p<0.0001). Recipients also had less incidence of severe disability (HINE score <40) at six months (8.3% vs 21.6% p<0.02), and nine months (8.6% vs. 19.6%, p<0.04) as compared to non recipients. More recipients had a normal developmental screening at three, six, and nine months on the DDST scale. Recipients required fewer anti-epileptics at three and six months (3 vs 11) as compared to non recipients (p<0.05). Mortality was also less in recipients (7.8% vs 20.9%, p<0.05) as compared to non recipients. Conclusion: There was a significant developmental and neurological improvement with decreased mortality, less episode of seizures, reduction in the need for antiepileptic among recipients of TH compared to non recipients at three, six, and nine months of age.

Impact of Prenatal Diagnosis on the Management and Prognosis of Infants with Congenital Heart Disease- A Retrospective Study

Prashant Hari Bhadane, Ravindra Sonawane

Introduction: Prenatal diagnosis is important in outcome of various congenital anomalies in recent times, especially in congenital heart diseases. The present study would help in recognising the importance of prenatal diagnosis and in understanding the management of newborns with congenital heart diseases. Aim: To evaluate the impact of prenatal diagnosis on the management and prognosis of infants with congenital heart disease. Materials and Methods: This retrospective study was conducted in Department of Paediatrics at Dr. Vasantrao Pawar Medical College, Nashik, Maharashtra, India, from January 2018 to January 2021. The study was performed on newborns who were diagnosed with Congenital Heart Diseases (CHD) during hospitalisation, in an inborn and outborn unit of Neonatal Intensive Care Unit (NICU). The data recorded for requirement of inotropes, ventilation, arterial blood gas analysis and outcome in the form of survival. The babies were classified into Prenatal ECHO (PNE) group and No Prenatal ECHO Available (NPEA) group, based on availability of prenatal Echocardiogram (ECHO) diagnostic report. CHDs were categorised into critical/major and minor. For the comparison of quantitative variables, Unpaired t-test/Mann-Whitney test was used. For the comparison of qualitative variable, Fisher’s-exact test/Chi-square test was used, as necessary. Results: There were 5000 admissions in the inborn and outborn neonatal unit during the study period, of which 159 cases had diagnosis of CHDs. The PNE group consisted of 61 neonates who had been diagnosed with CHD and the NPEA group consisted of 67 neonates who were not antenatally diagnosed to have CHD. Ionotropic support needed for PNE group (4.5%) was comparatively lesser than NPEA group (14.3%). Need for ventilation was reduced in PNE group (4.5%) as compared to NPEA group (14.3%). Mean for serum lactate and serum bicarbonate was 3.49±2.58 and 16.24±4.31 in PNE group, whereas, it was 5.08±2.79 and 15.12±4.13 in NPEA group on admission in NICU. In management of critical CHDs, 2/31 (6.5%) babies died in PNE group compared to 11/37 (29.7%) in NPEA group (p-value=0.09). Conclusion: Antenatal diagnosis helps in meticulous management of neonates with congenital heart diseases in terms of fewer requirement of inotropes, need of ventilation and improved management. There was no significant difference in outcome in the form of survival.

Clinical and Haematological Profile of Dengue during 2021 Epidemic at a Tertiary Care Centre, Western Uttar Pradesh, India: A Cross-sectional Study

Payal Mittal, Shehraz Firoz, Neetipriya Pandey, Digvijay Ghangas, Sonia Bhatt

Introduction: Incidence of dengue fever has significantly increased in the last few years in developing countries. Its clinical presentation may be variable in paediatrics with high-risk of complications. Dengue fever causes high mortality and morbidity at the paediatric age group. Aim: To evaluate the clinical features and haematological parameters of dengue in paediatric cases at a tertiary care hospital. Materials and Methods: A cross-sectional observational study was conducted in the Department of Paediatrics, FH Medical College, Agra, Uttar Pradesh, India, on patients diagnosed with dengue fever from August 2021 to November 2021. All cases were subjected to detailed clinical history, examination and relevant investigations (laboratory parameters and clinical features). Data was collected in predesigned proforma, entered in Microsoft Excel sheet and analysed. Results: Out of 801 patients, 486 (60.67%) were males and 315 (39.33%) were females. The commonest symptoms were fever (n=779, 97.25%) followed by body pain/ arthralgia (n=700, 87.39%), flushing (n=622, 77.65%), abdominal pain (n=437, 54.55%), and vomiting (n=428, 53.43%). Highest number of cases (n=399, 49.82%), were from dengue with warning signs. Of total, 759 (94.75%) cases had thrombocytopaenia. Common complications were pleural effusion (26.8%) and ascites (11.88%). Of total, 611 (76.27%) cases got cured while 81 (10.11%) patients expired. Conclusion: Dengue fever is more common in paediatric age group with high rate of complications and disease severity, which has high mortality rate. High clinical suspicion and early fluid management are the only measures to reduce the mortality and morbidity.

Cardiac Involvement among HIV-positive Individuals less than 18 years of Age on Antiretroviral Therapy- An Observational Study from a Rural Tertiary Care Hospital, West Bengal, India

Uttam Kumar Sarkar, Indrajit Mandal, Somenath Ganguly, Akash Rai, Kaushik Ishore

Introduction: With advancement of medical science, individuals diagnosed with Human Immunodeficiency Virus (HIV) infections are getting treated earlier and a fewer of them develop Acquired Immunodeficiency Syndrome (AIDS)-related complications. But the downside is that, there is an earlier onset and higher relative risks for different chronic diseases including cardiovascular diseases. Aim: To determine the proportion and pattern of cardiac involvements among children undergoing treatment for HIV infection and to correlate various cardiac findings with duration of Antiretroviral Therapy (ART) among them. Materials and Methods: An observational cross-sectional study was conducted among 136 HIV infected patients attending Paediatrics and General Medicine Outpatient Departments of North Bengal Medical College and Hospital (NBMCH) from October 2019 to March 2021. All patients were assessed clinically and underwent two dimensional (2D) Echocardiography, Motion mode (M mode) and colour doppler for assessing cardiac involvement. Collected data were analysed using Statistical Package for the Social Sciences (SPSS) software version 22.0 and Pearson’s correlation test was applied to test association between duration of ART and different echocardiographic parameters. Results: The mean age of the study participants was 10.14 years and the mean duration of ART was 49.18 months. Almost 1/2 (48.5%) of the HIV-positive individuals had cardiovascular findings. The most common echocardiographic change noted in patients was diastolic dysfunction 39 (28.7%) followed by Pericardial Effusion (PE) 29 (21.3%) and systolic dysfunction 28 (20.6%). Statistically significant positive correlation between changes in the values of Left Ventricular Internal Diameter in Diastole (LVIDD) (r=0.982), Left Atrium (LA) (r=0.634), mean Pulmonary Artery Pressure (mPAP) (r=0.200) with duration of ART was noted. Negative correlation was seen between duration of ART with ejection fraction (r=-0.984) and Tricuspid Annular Plain Systolic Excursion (TAPSE) (r=-0.438). This indicated that, all these important cardiological parameters became worser with advancement of treatment. Conclusion: Cardiac involvements among HIV-positive individuals undergoing ART were still high. There was definite correlation between cardiac involvement and duration of ART.

Knowledge, Attitude and Practices on Childhood Immunisation among Parents Attending Paediatric OPD at a Tertiary Care Centre, Kanchipuram District, Tamil Nadu, India

Parvathy Devi, Sowjan Manohar, R Lavanya, Sekar Pasupathy

Introduction: Vaccine-preventable diseases (VPD) are considered one of the leading causes of sicknesses and deaths among children worldwide. Parents’ knowledge and attitude towards immunisation are likely to influence uptake. Vaccination is one of the most cost-effective public health tools, to prevent infectious diseases. Aim: The present study assessed parents’ knowledge, attitudes, and practice towards their children’s vaccination. Materials and Methods: A cross-sectional study was conducted in the Department of Paediatrics, at Karpaga Vinayaga Institute of Medical Sciences and Research Centre, Chengalpattu, Tamil Nadu, India from April 2019 to June 2019. Two hundred and sixty-six parents of 0 to 12-year-old children, attending the Paediatric Outpatient Department (OPD), were recruited for the study. A prestructured questionnaire on knowledge, attitude, and practices regarding immunisation was administered, and other socio-demographic details were collected. Descriptive analysis was done by frequency and percentage. Data entry and analysis were performed in Microsoft Excel. Results: Among the 266 parents studied, a majority 129 (48.5%) of the mothers were 26-30 years old, and fathers were in the age group of 31-35 years 98 (36.8%). The majority 89 (33.5%) of the fathers were semi-skilled workers, and mothers were unskilled workers 180 (67.7%). Overall, 36.5% of children were 6-10 years old, and 53.4% were male children. Among the parents, 98.1% stated vaccines were safe, 95.1% knew that vaccine would prevent their children from diseases. A total of 99.2% agreed that, all children should be vaccinated, 96.2% maintained a vaccination card, 81.2% were aware of the following vaccination date for their children. Conclusion: According to the present study findings, there is generally good knowledge, attitude, and practices regarding vaccination of children among their parents. Knowledge regarding optional vaccinations needs to be improved through creating awareness.

Effect of Haemoglobin and Iron Status of the Antenatal Mothers on their Newborns at Birth: A Cross-sectional Study.

Introduction: Iron deficiency (ID) anaemia in pregnant mothers can affect the iron reserves of their newborns and lead to anaemia later. The haematological indices and iron status of pregnant women and its correlation with their neonates is still unclear. Aim: To assess the correlation between maternal and cord blood Hb and iron status. Materials and Methods: The present cross-sectional study included 134 antenatal mothers, at term gestation without any significant antenatal complications. Complete haemogram, serum iron, ferritin, and iron binding capacity were assessed for these mothers before delivery and also, from the cord blood samples of their newborns at birth. Statistical difference and correlation were observed using Chi-square test and Pearson’s correlation coefficient. Results: Maternal anaemia (Hb <11 gm/dL) was observed in 62 (46.3%) mothers. The mean Hb and ferritin of the mothers were 11.06±1.02 gm/dL and 113.3±7.1 μg/L, respectively. The mean Hb and ferritin levels of the cord blood samples were 12.24±0.17 gm/dL and 214.3±20.1 μg/L, respectively. In univariate analysis, maternal Hb showed a significant correlation with cord blood Hb with Odds Ratio (OR) 0.508 and 95% Confidence Interval (CI): 0.428-0.603. The Pearson’s correlation showed a moderate correlation between mother and cord blood Packed Cell Volume (PCV) (r=0.344, p<0.001) and weak correlation between other maternal and cord blood iron indices and serum ferritin (r=0.191, p-value=0.027 and r=0.203, p-value=0.019). Conclusion: There is a significant correlation between maternal and cord blood Hb in term neonates. The study indicates that, the haematological indices of pregnant women determine the neonatal Hb in term babies.

Probiotics (Bacillus clausii) for Prevention of Late-onset Sepsis in Preterm Infants (<34 weeks): A Randomised Controlled Trial

P Namratha, Chinmayi R Joshi, Shailesh S Patil, Vijaykumar B Murteli

Introduction: Late-Onset Sepsis (LOS) causes significant morbidity and mortality in preterm infants. Probiotics have been suggested to improve the integrity of mucosal barrier by modifying the enteric microflora and suppress the overgrowth and translocation of pathogens in the gut, thus preventing life-threatening infections. Although probiotics have a definite role in prevention of Necrotising Enterocolitis (NEC) in preterm neonates, their effect on prevention of LOS in preterm neonates is still uncertain. Aim: To evaluate the role of probiotics in reducing incidence of LOS in preterm neonates (<34 weeks). Materials and Methods: A double blinded randomised control trial was conducted in a tertiary care Neonatal Intensive Care Unit (NICU) in Karnataka, India between 1st January 2019 to 31st December 2019. Seventy haemodynamically stable preterm neonates, <34 weeks of Gestational Age (GA), were randomised into ‘Probiotic’ and ‘Placebo’ group. The probiotic group (n=36) was prophylactically administered Bacillus clausii suspension at a dose of 2.5 mL per oral (0.4×109 spores in 1 mL) BD with breast milk, from initiation of enteral feeds till seven days, discharge/ death/LOS, whichever was earlier. The placebo group (n=34) received breast milk with sterile water 2.5 mL per oral BD. All the neonates were investigated and managed as per standard hospital protocol. Primary outcome of the study was to find the incidence of LOS. Student’s t-test, Mann-Whitney U test, Chi-square test and Fisher’s-exact test were used for statistical analysis. Results: There was no significant difference between the probiotic vs placebo group, with respect to incidence of LOS {(11.11% vs 17.7%); p-value >0.05} and duration of hospital stay {(10.86±3.19 vs 11.23±2.98 days); p-value >0.05}. However, incidence of feed intolerance in the probiotic group (11.11%) was significantly less than that the other (26.47%) (p<0.05). Conclusion: Probiotics, prophylactically fed enterally, did not reduce the incidence of LOS but provide a promising strategy to prevent feed intolerance in premature neonates.