Indian Journal of Neonatal Medicine & Research

Unravelling Anaesthetic Challenges in Neonate with Cavernous Haemangioma: A Case Report

Monika, Madhu, Urmi Malik, Neha, Sahil Shiva

Haemangiomas are developmental vascular abnormalities characterised by hyperplasia of blood vessels, usually veins and capillaries. Haemangiomas show a higher prevalence in females. More than 50% of lesions are found in the head and neck region, with a particular preponderance over the face, lips, buccal mucosa, tongue, palate, and trunk. The aetiology can be neoplastic or reactive, influenced by factors such as hormones, infections, and trauma. Large lingual vascular malformations may present with obstructive symptoms, including difficulty in breathing, chewing, swallowing, and speech, which can lead to delays in linguistic development and compromised airway function. Haemangiomas are more susceptible to trauma, which can result in bleeding and further compromise the airway. Typically, this kind of presentation is managed conservatively until obstructive symptoms arise, at which point surgical removal or local site steroid instillation is considered. Here, a case of a 28-day-old child with a cavernous haemangioma of the tongue who was scheduled for excision and instillation of Kenacort injection at the base of the tongue has been reported. Due to the child’s small age and the presence of a lingual mass, the use of intravenous anaesthetic agents was precluded. In this case, because of the non-availability of a paediatric fibreoptic bronchoscope, blind nasal intubation was considered for securing the airway. Managing a compromised airway is a challenging situation, even for an experienced anaesthesiologist, in a routine operating room set-up. However, maintaining spontaneous ventilation is a crucial element during general anaesthesia.

Seroprevalence of TORCH Infection in Paediatric Population and Women of Reproductive Age Group: A Cross-sectional Study

Introduction: The acronym ‘TORCH’ complex includes infections due to Toxoplasma gondii, as well as others such as Syphilis, Hepatitis B, Rubella virus, Cytomegalovirus (CMV), and Herpes Simplex Virus (HSV), respectively. Primary infections due to these agents during pregnancy are associated with congenital malformations in newborns. Seroprevalence data is important to gather estimates of immunity levels, vaccination status, as well as levels of exposure, and will correlate with the risk of acquiring infections during pregnancy. Aim: To determine the seroprevalence of TORCH infections in paediatric populations with suspected clinical conditions and women of reproductive age group, and also to assess the associated risk factors in mothers and newborns, and evaluate their clinical outcomes. Materials and Methods: This cross-sectional study was conducted between January 2019 and January 2022 in the Serology laboratory of the Department of Microbiology at the Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India. A total of 92 consecutive antenatal females for whom TORCH antibody levels were determined and 343 suspected neonatal/paediatric populations were included in the study. The serum samples were subjected to IgM and IgG TORCH Enzyme Linked Immunosorbent Assay (ELISA). Demographic data and clinical details of patients were analysed from the Hospital Information System (HIS) and data records maintained in the department. Categorical variables are expressed as numbers and percentages. Results: A total of 435 samples (343 paediatric and 92 women) were screened for TORCH infection in the laboratory. A total of 57 (13.1%) were seropositive for TORCH infection. The most commonly affected were infants (28 days- 1 year). Among the total screened population, the positive cases of CMV were 40 (9.1%), rubella 11 (2.5%), and toxoplasma 6 (1.3%). Biliary Atresia (BA) and neonatal cholestasis were the most common clinical conditions associated with CMV infection. Conclusion: A high seroprevalence of IgM-specific CMV (9.1%) was observed in the present study. BA and neonatal cholestasis were the common complications in neonates associated with CMV infection.

Evaluation of Caesarean Section Rates Utilising Robson’s Classification System: A Retrospective Observational Study from Eastern India

Vaibhav Shivaji Patil, Sohini Bhattacharya, Selim Akhtar

Introduction: The increasing trends in Caesarean Section (CS) globally are undoubtedly alarming. Although the World Health Organisation (WHO) did not specify an ‘optimal’ rate in 2015, it is essential to study caesarean deliveries to understand the causes of the rising rates and prevent unnecessary CS. Robson’s classification system, recommended by the WHO, is the most appropriate tool for this purpose. Aim: To identify groups of women according to Robson’s Ten-group Classification System (TGCS) assess the complications and morbidities of both mothers and neonates, and analyse the indications for caesarean delivery. Materials and Methods: A retrospective observational study was conducted in the Department of Obstetrics and Gynaecology at Jalpaiguri District Hospital, Jalpaiguri, West Bengal, India, from April 2021 to March 2022. A total of 350 women who underwent CS were included in the study, The study population was divided into ten groups (1-10) according to Robson’s TGCS. The variables assessed included the age group and gravidity status of the mothers, indications for CS, and maternal and neonatal mortality and morbidity. Data were collected from the operating theatre register, mother and baby bed head tickets, sick neonatal care unit admission registers, and Critical Care Unit (CCU)/High Dependency Unit (HDU) admission registers at one-month intervals. Frequencies and percentages were calculated. Results: Most of the women (120 mothers) belonged to the age group of 20-24 years. Out of the total, 206 mothers (59%) were primigravida, while 144 (41%) were multigravida. A total of 73 mothers (20.9%) fell under Group 2 of Robson’s classification system, followed by Group 1 50 (14,3%) and Group 4 49 (14%). The least number of women were in Group 7 11 (3.1%). Oligohydramnios was the indication for 45 mothers (12.8%). Total 10 mothers required HDU admission, and two required CCU admission postoperatively. There were no maternal deaths and no cases of peripartum hysterectomy. One birth was stillborn, and there were 13 neonatal deaths among 349 live neonates. Conclusion: In present study, authors found that most of the mothers were primigravida and fell under Group 2 of Robson’s classification system. The most common indication for CS was foetal distress, followed by a history of previous CS.

Predictability of Umbilical Cord Serum Bilirubin in Estimating the Risk of Hyperbilirubinemia in Term Neonates with ABO Incompatibility- A Prospective Cohort Study

Anuradha Bansal, Kabir Bansal, Noopur Sud, Jatinder Singh

Introduction: Neonatal hyperbilirubinemia is a significant cause of morbidity among term neonates. Delayed follow-up of newborns may lead to considerable morbidity and encephalopathy. High bilirubin levels may necessitate exchange transfusion, especially in infants with ABO or Rh blood incompatibility. Measurement of Umbilical Cord Bilirubin (UCB) is an easily available, inexpensive and non invasive method to predict the development of hyperbilirubinemia in newborns. Aim: To determine the predictive value of UCB in estimating the risk of subsequent hyperbilirubinemia in term neonates with ABO incompatibility and to establish a UCB cut-off associated with the risk of hyperbilirubinemia development. Materials and Methods: This prospective cohort study was conducted at the Punjab Institute of Medical Sciences (PIMS) in Jalandhar, Punjab, India, from June 2022 to March 2023. A total of 113 term babies born to O+ mothers were included in the study. At the time of delivery, cord blood was drawn from the placental side of the cord for blood group, Direct Coomb’s Test (DCT), and serum bilirubin analysis. Infants were followed-up every 12 hours while inpatient and every 48 hours after discharge until day 5 for assessment of clinical jaundice. Significant hyperbilirubinemia was managed with phototherapy according to American Academy of Paediatrics (AAP) guidelines. The data was collected and subjected to statistical analysis using IBM Statistical Package for Social Sciences (SPSS) 20.0 software, with a significance level set at p-value <0.05, utilising Receiver Operating Characteristic (ROC) curve analysis. Results: A total of 113 term neonates were enrolled in the study, of which 57 (50.4%) were females. The mean cord bilirubin level was 2.6±1.06 mg/dL. A total of 40 (35.3%) babies developed significant jaundice requiring phototherapy, with a mean highest bilirubin level of 15±3.2 mg/dL. Using a cord bilirubin level of ≥2.0 mg/dL, significant hyperbilirubinemia could be predicted with a sensitivity of 80%, specificity of 54%, positive predictive value of 57.97%, and negative predictive value of 75%. There was a positive correlation between cord bilirubin and postnatal serum bilirubin in the present study, as determined by ROC analysis {Area Under Curve (AUC) >0.5}. Conclusion: The present study concluded that UCB is an important predictor of significant hyperbilirubinemia occurrence in newborns with ABO incompatibility.

Spectrum of Neonatal Surgical Emergencies at a Government Tertiary Care Centre in Madhya Pradesh: An Observational Study

Vinay Mathur, Umesh Bahadur Singh, Dileep Garg, Jitendra Kumar Grover, Ajay Gaur

Introduction: This impoverished region of India, where the majority of the population suffers from poverty and malnourishment, lacks data regarding the epidemiological pattern for surgical congenital abnormalities to date. Hence, there is a dire need to gather epidemiological data on newborn surgical emergencies, which has been lacking. Aim: To study the epidemiological data of neonatal patients requiring emergency surgery and to evaluate the variables affecting morbidity and mortality in emergency newborn surgery cases. Materials and Methods: This retrospective observational study was carried out at Gajra Raja Medical College, Gwalior, Madhya Pradesh, India from October 2018 to August 2022. Case records of emergency surgical interventions in neonates presenting to the Emergency Department under the age of 30 days of life were reviewed. The outcomes, postoperative morbidity, and mortality were noted. The data was presented descriptively using frequency and percentages. Results: In the present study, the male-to-female ratio was 1:1.2, the mean age was 4.9 days±4.1 days, and the mean birth weight was 2025±635 grams. Anorectal Malformations (ARM), 178 (37.71%) and Oesophageal Atresia (EA), 133 (27.8%) were the most prevalent congenital abnormalities in the current investigation, followed by other congenital gastrointestinal anomalies. Nonetheless, the remarkably elevated prevalence of pouch colon among patients with ARM deserves particular attention. In compared to a well-prepared Neonatal Intensive Care Unit (NICU), an inadequately equipped Sick Newborn Care Unit (SNCU) with a small nursing staff represents inadequate infrastructure for the management of a surgical neonatal emergency. Conclusion: The majority of patients died from postoperative septicaemias, accounting for 35.5% of the mortality rate among these neonates who underwent emergency surgery. A large percentage of infant mortality in underdeveloped nations like India might be avoided with proper perioperative care, especially for surgical infants.