Indian Journal of Neonatal Medicine & Research

COVID-19 in a Newborn Caught on Magnetic Resonance Imaging: A Case Report

Krishna Kiran Somashekar Karanth, BK Praveen, Aysha N Abna

The Coronavirus Disease 2019 (COVID-19) remains a global public health threat. It is generally believed that children, especially neonates, are relatively spared from the disastrous effects of COVID-19 compared to adults. Most symptomatic children experience only mild respiratory and gastrointestinal symptoms. Central Nervous System (CNS) complications in COVID-19 are unusual in children and neonates. In this report, the authors present the case of a five-day-old COVID-19 positive neonate who presented with convulsions and tachypnoea. Magnetic Resonance Imaging (MRI) findings suggested a cytotoxic oedematous pattern. This child made a complete recovery after receiving appropriate management. There is limited data available regarding COVID-19 in neonates, and only a few similar cases of neonatal involvement have been described in the literature. The aim of this report is to highlight the unusual imaging manifestations of COVID-19 in a neonate.

Isolated Protein S Deficiency Presenting in Neonatal Inferior Vena Cava as Right Atrial Thrombus: A Case Report

Amritha Vinod, Karthikeyan Kadirvel, Amirtha Ganesh, V Premnath

Critically ill neonates are at the greatest risk of developing thromboembolic disease. Multiple risk factors have been identified, one of which is isolated Protein S deficiency-a rare cause. The free form of Protein S plays a role in anticoagulation, and its deficiency can manifest as deep venous thrombosis, pulmonary emboli, and superficial thrombophlebitis. Hereby, the authors present a case report of a two-day-old female neonate, born to a gestational diabetic mother, who was initially managed for hypoglycaemia and polycythaemia. On day 4 of life, the baby was shifted to the mother’s side. Twenty-four hours later, she developed late-onset neonatal sepsis with disseminated intravascular coagulation and required management with a mechanical ventilator, Intravenous (IV) antibiotics, and inotropic support. Echocardiography (ECHO) revealed a thrombus (8.9×6.8 mm) attached to the septum of the right atrium, extending from the Inferior Vena Cava (IVC). Treatment with Low Molecular Weight Heparin (LMWH) was initiated, and a follow-up ECHO after three months showed complete resolution of the thrombus. Interval analysis revealed isolated Protein S deficiency with normal Protein C levels. The present report emphasises the importance of interval analysis in identifying causes of Neonatal Thrombotic Events (NTE). Early diagnosis and management can reduce associated morbidity and mortality.

Varied Clinical Presentations of Congenital Syphilis in Infants: A Case Series of 7 Cases

KS Sanjay, Usha Bangalore Kantharajanna, Ratakonda Sruthi, Chandana Kalavala

Congenital Syphilis (CS), also known as mother-to-child transmission of syphilis is caused by Treponema pallidum. Infected pregnant women can transmit the infection vertically to the foetus. Diagnosis of CS can be difficult because more than two-thirds of affected infants remain asymptomatic at birth, and signs may be non-specific or subtle. In this case series, seven cases of CS with varied presentations are described. In cases 1, 2, 6, mothers were screened after the baby was tested positive for Venereal Disease Research Laboratory (VDRL) test. In two cases (Case-4,6), the mothers received inadequate treatment for syphilis antenatally. In the present case series, Case-6 presented with renal manifestations early in the course of the disease, Case-2 had skin manifestations like vesicular lesions and peeling of skin and Case-7 had symptoms suggestive of meningitis. Because of its varied presentations, high index of suspicion is the key to diagnosis and treatment of CS and prognosis. Screening of pregnant women and treating them is the most effective way in preventing CS and its related morbidity and mortality.

Relationship between Placental Pathology and Birth Weight of Newborns at a Tertiary Care Centre in Central Kerala, India: A Cross-sectional Study

Sundar Singh, Dhanya Roy, Latha Abraham, Leela Kamath, Krishna Kumar Diwakar

Introduction: Even minor changes in the placenta are associated with the mortality and morbidity of the growing foetus and mother, which may have long-standing effects on the foetus. Aim: To study the relationship between placental pathological changes and the birth weight of newborn infants. Materials and Methods: In this cross-sectional study conducted at Malankara Orthodox Syrian Church (MOSC) Medical College, Kolenchery, Ernakulam, Kerala, India, over a period of two months, all inborn neonates, irrespective of gestational age, were considered. The first 63 placental samples (with birth weight <2.5 kg) were taken as cases, and the immediately succeeding next 63 were taken as controls (birth weight >2.5 kilograms). At birth, neonatal details including birth weight, gestational age, placental weight, Small for Gestational Age (SGA)/Appropriate for Gestational Age (AGA)/Large for Gestational Age (LGA), etc., were noted. The placentae were carefully removed, weighed before fixation, and subjected to pathological examination (including gross and microscopic examination). Data were analysed using Statistical Package for the Social Sciences (SPSS) version 14.0 software by Chi-square test. Results: A total of 126 placentae were examined. Increased fibrin deposition in the placenta (perivillous, intervillous, or subchorionic) was associated with Low Birth Weight (LBW) neonates (p-value=0.024), but infarcts were not. Increased fibrin deposition in the placenta (p-value=0.016) and infarcts in the placenta (p-value=0.02) were associated with SGA neonates. However, other findings like haemorrhage, thrombus, calcification, metaplasia, necrosis, vasculopathy, infections, fibrosis, vasculitis were not found to be associated with LBW or SGA neonates. There was a moderate positive correlation between placental weight and the birth weight of neonates (r-value=0.59). Conclusion: Abnormal histopathological changes like infarcts and fibrin deposition in the placenta result in LBW infants. Therefore, proper antenatal screening of the mother for immunology-based rejection-like disorders, maternal coagulopathies, and imbalances between angiogenic or antiangiogenic pathways is necessary. Regular follow-up of infants with placental pathological changes are also essential.

Effect of Phototherapy on Transcutaneous vs Total Serum Bilirubin Level in Preterm Neonates- A Prospective Cohort Study

M Soumya, Vinod Chavan, Aishwarya Manthale, Kavitha S Konded

Introduction: Neonatal jaundice is one of the most common problems encountered in the first week after birth. Neonates who develop significant hyperbilirubinemia require phototherapy. Delay in the diagnosis and management of jaundice may lead to neonatal morbidity and mortality. Total Serum Bilirubin (TSB) estimation is considered the gold standard method. However, this invasive procedure causes pain, anxiety, and may lead to infection and iatrogenic anaemia, especially in preterm neonates. Transcutaneous Bilirubin (TcB) estimation, which measures bilirubin through the skin, has been proposed as an alternative screening method for hyperbilirubinemia in term and near-term neonates. Aim: To compare TcB to TSB in preterm neonates of 30-34 6/7 weeks gestational age before, during, and after phototherapy. Materials and Methods: This hospital-based prospective cohort study was conducted at SDMCMS&H, Dharwad, Karnataka, India, between December 2019 and November 2020. A total of 100 preterm neonates between 30 to 34 6/7 weeks of gestation with clinically suspected jaundice were enrolled in the study. TSB was measured in the laboratory using the Diazo Method, while TcB was measured using the Drager jaundice meter JM 103. TcB and TSB were measured and compared in preterm neonates with clinically suspected jaundice before phototherapy, during phototherapy (8 to 12 hours after initiation), and after 12-18 hours of discontinuation of phototherapy. The collected data was analysed statistically using the mean, standard deviation, dependent t-test, Karl Pearson’s correlation coefficient, and scatter plots. Results: This study enrolled 100 neonates diagnosed with neonatal jaundice, of which 57 were males and 43 were females, resulting in a male-to-female ratio of 1:1.3. Phototherapy was administered to neonates with TSB values, with 79% of the babies between 30-32 weeks and 21% between 32-34 weeks. In the present study, TcB and TSB were compared before, during, and after phototherapy, and the results were analysed, showing statistical significance. The mean TcB levels were 12.05, 9.66, and 7.23 before, during, and after phototherapy, respectively. The mean TSB levels were 11.28, 10.16, and 7.65 before, during, and after phototherapy, respectively. Based on Karl Pearson’s correlation coefficient, a positive correlation was found between TcB and TSB before (r=0.8319, p-value <0.001), during (r=0.6069, p<0.001), and after phototherapy (r=0.8154, p<0.001). Conclusion: TcB values are comparable to TSB values and can be adopted as the standard method to measure bilirubin levels in preterm babies in a clinical setting.

Growth and Neurodevelopmental Outcomes of Very Low Birth Weight Infants upto Six Months of Age at a Tertiary Level NICU in Central India: A Prospective Cohort Study

KP Malini, Avyakt Aggarwal, Lalit M Malviya, Vidya Kumari Saurabh

Introduction: The long-term outcomes of Very Low Birth Weight (VLBW) infants are influenced by prematurity, as well as the occurrence of various short-term morbidities, such as Respiratory Distress Syndrome (RDS), sepsis, Necrotising Enterocolitis (NEC), Patent Ductus Arteriosus (PDA), Intraventricular Haemorrhage (IVH), Periventricular Leukomalacia (PVL), Retinopathy Of Prematurity (ROP), and Chronic Lung Disease (CLD). It has been estimated that approximately half of all VLBW infants develop cognitive and behavioural deficits in the future. Therefore, studying VLBW infants and providing longitudinal follow-up after their hospital discharge is increasingly important. This helps in the early diagnosis of neurodevelopmental abnormalities and enables timely intervention for a better quality of life in the future. Aim: To assess the growth and neurodevelopmental outcomes of VLBW infants discharged from the NICU until six months of age. Materials and Methods: A prospective cohort study was conducted in the Neonatal In tensive Crae Unit (NICU) at NSCB Medical College, Jabalpur, Madhya Pradesh, India. The duration of the study was one year and six months, from March 2018 to September 2019. A total of 40 VLBW infants were enrolled and followed-up for six months. The infants were divided into two groups: Group 1 (<32 weeks) and group 2 (>32 weeks). Physical parameters such as weight, length, and head circumference were recorded on admission and at one, three and six months of corrected gestational age. Developmental assessment was performed using the Denver Developmental Screening Test-II (DDST-II) method. The association of risk factors with neurodevelopmental outcomes was also assessed. Data were analysed using Statistical Package for Social Sciences (SPSS) version 20.0, and the Chi-square test, Fisher’s-exact test, and Student’s t-test were used. A p-value less than 0.05 was considered significant. Results: Among the 40 subjects, 12 (30%) were <32 weeks, and 28 (70%) were ≥32 weeks. Overall, parameters were higher in infants ≥32 weeks. Weight and head circumference gain velocity were greater in infants ≥32 weeks during the first three months of life (p<0.05). From three to six months, <32 weeks infants showed a significant increase (p<0.001) in weight and head circumference gain velocity. The length gain velocity in both groups was comparable since birth, and <32 weeks VLBW infants demonstrated good catch-up growth, which was statistically significant (p<0.05). At six months of corrected age, 16 (40%) infants out of the total 40 infants had abnormal neurodevelopmental outcomes. A total of 7 (58.33%) of the <32 weeks VLBW infants and 9 (32.14%) of the ≥32 weeks VLBW infants had Neurodevelopmental Delay (NDD). Hypoglycaemia, shock, hyaline membrane disease, and mechanical ventilation were significantly associated with an increased risk of NDD. Conclusion: The incidence of NDD was significantly higher in infants with lower gestational age, lower birth weight and the presence of associated factors such as hyaline membrane disease, hypoglycaemia, shock, ventilation, and hyperbilirubinaemia. Improved perinatal care, early assessment of development using appropriate tools, and early intervention are necessary to improve the outcomes of these infants.

LATCH Score as a Tool to Predict Weight Gain in Term Babies at Six Weeks Post-discharge: A Prospective Cohort Study

S Kavitha Lakshmi, AS Jagadish, R Premalatha, B Ravichander

Introduction: The LATCH score is an acronym representing L- LATCH, A- Audible swallowing, T- Type of nipple, C- Comfort, H- Hold. It is a comprehensive yet simple breastfeeding assessment tool used to evaluate breastfeeding practices. Babies with a poor LATCH score at discharge are at an increased risk of early breastfeeding cessation and inadequate weight gain. According to World Health Organisation (WHO), only about 44% of infants aged 0-6 months worldwide were exclusively breastfed from 2015-2020, with a goal of increasing this rate to atleast 50% by 2025. There have been very few studies conducted in developing countries regarding this matter. Aim: To determine the correlation between the LATCH score and weight gain at six weeks post-discharge in term babies. Materials and Methods: This prospective cohort study was conducted at MVJ Medical College and Research Hospital, Bengaluru, Karnataka, India, from January 2023 to June 2023. The study included 355 healthy term and singleton babies. LATCH scores were assessed at the time of the first feed, 24 hours, 48 hours, 72 hours, and at the time of discharge. Mothers with a low LATCH score and the reasons for the low score were identified, corrected, and counselled until discharge. Weight gain velocity was analysed at the six-week follow-up. Analysis of Variance (ANOVA) was used to compare the mean values between variables, and Pearson’s correlation was used to analyse the correlation between the LATCH score and weight gain at six weeks post-discharge in term babies. Results: In the present study, the mean age of mothers was 26.21±5.40 years, and there were 200 males and 155 females babies. The mean LATCH score at the time of the first feed was found to be 3.91±1.09, which improved to 5.61±0.890, 7.03±0.742, 7.67±0.578, and 9.12±0.662 at 24 hours, 48 hours, 72 hours, and at the time of discharge, respectively. The reasons for a poor LATCH score were mainly attributed to primiparous mothers (42%) and incorrect positioning (35.5%). A significant positive correlation was found between the improvement of the LATCH score and weight gain at the six-week follow-up. Conclusion: The LATCH score was found to be a simple tool for identifying mothers and infants who require breastfeeding support and timely intervention to sustain breastfeeding. The LATCH score can serve as an effective predictor of weight gain at the six-week follow-up.

Mortality and Morbidity among Neonates Born to COVID-19 Positive Mothers in a Tertiary Care Hospital, Chennai: An Ambispective Cohort Study

Rajagopal Velu Aswini, Sridevi A Naaraayan, Krishnaswami Devimeenakshi

Introduction: The Coronavirus Disease-2019 (COVID-19) pandemic, caused by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) virus, has had varied clinical impacts across different age groups. Understanding the morbidity and mortality rates among neonates born to COVID-19 positive mothers is crucial for ensuring preparedness within the healthcare system. Aim: To compare the morbidity and mortality rates of newborns born to COVID-19 positive and negative mothers. Materials and Methods: This ambispective cohort study was conducted at a tertiary care hospital in Chennai, Tamil Nadu, India between August 2021 and October 2022. Newborns born to mothers with COVID-19 at the time of delivery were classified as cases, while newborns born to the next two COVID-19 negative pregnant women who delivered immediately after the COVID-19 positive mother were considered as controls. The study included a sample of 214 COVID-19 positive mothers and 426 COVID-19 negative mothers. Clinical data were recorded, and all newborns were followed for one week to assess their morbidity and outcomes. Logistic regression analysis was performed to determine whether COVID-19 infection is a risk factor for adverse neonatal outcomes. Results: Among the newborns, 357 (55.8%) were females, and 333 (52%) were delivered via caesarean section. Of the newborns, 39 (6.1%) were preterm and 95 (14.8%) had low birth weight. The overall mortality rate was 1.25%. Four (1.8%) neonates tested positive for COVID-19. Logistic regression analysis revealed that caesarean section, respiratory distress syndrome, and prematurity were statistically significant morbidities associated with maternal COVID-19 positive status. The odds ratios (with 95% confidence intervals) were 4.090 (2.840-5.882) for caesarean section, 2.291 (1.508-3.480) for respiratory distress syndrome, and 2.359 (1.181-4.712) for prematurity. The mortality and other morbidities were similar between the two groups. Conclusion: Respiratory distress syndrome and prematurity were the common morbidities observed in newborns born to COVID-19 positive mothers.

Clinico-aetiological Profile and Outcome of Hypernatremic Dehydration in Term Neonates Admitted to the NICU at a Tertiary Care Centre in Udaipur, Rajasthan, India

Introduction: Hypernatremic dehydration is commonly found in the first week of neonatal life. Hypernatremia develops when water loss exceeds sodium loss, as in lactational failure with inadequate breastfeeding, or when sodium intake exceeds water intake disproportionately (salt poisoning), such as when neonates receive concentrated formula or top milk. The common presentations include lethargy, irritability, poor feeding, dehydration, reduced urinary frequency, significant weight loss, and fever. Aim: The aim of this study was to investigate the clinico-etiological profile and outcome of hypernatremic dehydration in term neonates admitted to the Neonatal Intensive Care Unit (NICU) at a tertiary care centre. Additionally, the study aimed to examine the factors contributing to hypernatremic dehydration. Materials and Methods: This prospective cohort study was conducted at the NICU, Department of Paediatrics, of Geetanjali Medical College, Udaipur, Rajasthan, India from February 2021 to July 2022. A total of 51 term neonates with a history of inadequate breastfeeding, maternal history of lactational failure, significant weight loss (>10% weight loss within a short period of time), or dehydration fever, along with hypernatremia (serum sodium > 145 mEq/L), were enrolled in the study. Data regarding serum sodium level, serum bilirubin level, Kidney Function Test (KFT), Ultrasonography of Kidney, Ureters and Bladder (USG KUB), and neuroimaging were collected for all study subjects and statistically analysed using the Chi-square test. Results: A total of 51 neonates were admitted to the NICU during the study period, with a mean age of 6.05±2.2 days (range 0-15 days) and a mean birth weight of 2810 grams. The study showed that the mean weight (in %) loss was 13.75±4.1 (range 10.1-21%). The study also revealed that 64.7% of the mothers of neonates experienced lactational failure, with a p-value <0.05. The presenting complaints were poor feeding (92.2%), fever (45.1%), excessive crying (96.1%), and decreased urine output (47%). The mean Standard Deviation (SD) sodium level on admission was 155.3 mEq/L. Two neonates developed neurological complications (intracranial haemorrhage and cerebral oedema), and 62.7% of neonates developed Acute Kidney Injury (AKI). Conclusion: Hypernatremic dehydration poses a significant threat in early neonatal life and is often underdiagnosed. Common causes include a lack of awareness about exclusive breastfeeding, lactational failure, and improper breastfeeding techniques, as well as feeding problems due to inverted/flat nipples or cracked nipples/breast engorgement. These findings were observed in the present study.