Indian Journal of Neonatal Medicine & Research

Dandy-Walker Malformation in an Infant with Lambotte Syndrome: A Rare Case Report

Suman Das, Madhumita Nandi

Lambotte Syndrome (LS) comprises Intrauterine Growth Retardation (IUGR), cerebral dysgenesis, microcephaly, and early mortality. Dandy-Walker Syndrome (DWS) is characterised by a triad of hypoplastic cerebellar vermis, cystic dilatation of the fourth ventricle, and enlargement of the posterior fossa with torcular-lambdoid inversion. The index case was delivered late preterm at 36 weeks of gestational age and exhibited evidence of IUGR and postnatal failure to thrive. A male infant was admitted at 1.5 months of age due to recurrent unprovoked seizures, which were controlled with phenobarbitone and phenytoin injections. He displayed grade I hypertelorism, fixed flexion deformities of the fingers and toes, and generalised hypotonia. Brain Magnetic Resonance Imaging (MRI) revealed severe semilobar holoprosencephaly, a polymicrogyria-pachygyria complex, multiple heterotopias, DWS, and brainstem malformations. Sudden infant death occurred on the third day after admission. He fulfilled the tetrad of LS. Hereby, the authors present the first case of LS outside an Arab sibship, the eighth case worldwide, and present the radiological details of DWS and complex brainstem malformations, which were previously unreported in LS.

Clinical and Biochemical Profile of Term and Preterm Infants of Diabetic Mothers: A Prospective Observational Study

H Tara, K Vijaya Narayana Holla, Madhava Kamath, Nikhil Shetty

Introduction: Gestational diabetes affects 5-25% of pregnancies, while pre-gestational diabetes complicates 1-2% of all pregnancies. Women with any form of diabetes during pregnancy have higher rates of maternal and perinatal complications. Preterm babies are more prone to complications and are at greater risk when born to mothers with Gestational Diabetes Mellitus (GDM). Although there have been many studies focusing on the clinical and biochemical profiles of Infants of Diabetic Mothers (IDM), limited information is available regarding the parameters of preterm babies born to diabetic mothers. Aim: To compare the clinical and biochemical profiles of preterm and term babies born to diabetic mothers. Materials and Methods: This prospective observational study was conducted in the Department of Paediatrics at Srinivas Hospital, attached to Srinivas Institute of Medical Sciences and the Research Center, Karnataka, India. A total of 151 neonates were included in the study, adhering to the specified inclusion and exclusion criteria. The birth weights of the newborns were recorded. Serum blood glucose, total bilirubin, and total calcium levels were assessed. Radiological investigations (chest X-ray) were performed in cases of respiratory distress, along with other investigations as clinically indicated. Comparisons between the two groups were made using the Student’s unpaired t-test or Mann-Whitney U test, with p<0.05 considered significant. Results: Out of the 151 newborns born to mothers with diabetes, 51 (33.7%) were born preterm, while 100 (66.2%) were term. Among the preterm newborns, the majority were delivered via Lower-Segment Cesarean Section (LSCS) (74.5%), compared to 56.5% of term newborns whose mothers underwent LSCS (p-value <0.05). Notably, 54.9% of preterm deliveries occurred in mothers with a gravida of three or more (p-value=0.09). Among preterm Infants with Diabetic Mothers (IDM), 22 out of 51 (43.1%) experienced at least one adverse event, such as hypoglycemia, hyperbilirubinemia, hypocalcemia, polycythemia, birth asphyxia, birth injuries, congenital anomalies, or respiratory distress, compared to 35% of term babies facing one of these adverse events. Conclusion: Although the clinical and biochemical parameters were poorer in preterm babies born to mothers with diabetes, there was no statistically significant difference when compared to term babies.

Screening of Hypoglycaemia in Low Birth Weight Neonates Admitted in Postnatal Ward: A Prospective Cohort Study

Shivangi Kimothi, Jolly Vaishnav

Introduction: Low Birth Weight (LBW) neonates show minimal signs of hypoglycaemia, with immature compensatory mechanisms and nonspecific symptoms complicating the diagnosis. Both symptomatic and asymptomatic cases risk neurological damage, stressing the need for prompt detection and treatment. Aim: The aim of this study was to determine the incidence of hypoglycaemia in LBW neonates within the first 48 hours of life, assess mean glucose levels at the 1st, 24th, and 48th hours, identify etiological factors, and evaluate treatment response and immediate outcomes. Materials and Methods: This prospective cohort study was conducted at BJ Medical College and Civil Hospital, Ahmedabad, India, over a one-year period from January 2023 to December 2023. The study included 2,143 LBW neonates (birth weight between 1.8 kg and 2.5 kg) admitted to the postnatal ward. Blood glucose levels were screened at the 1st, 24th, and 48th hours of life. In neonates identified with hypoglycaemia, venous blood samples were collected and sent to the laboratory for confirmation. The Chi-square test was applied for comparison, and a p-value of <0.05 was considered statistically significant. Results: During the study, 2,143 neonates were screened, with a nearly equal male-to-female ratio: 1,080 (50.39%) were male and 1,063 (49.6%) were female. The mean gestational age was 37.5±1.18 weeks. The overall incidence of hypoglycaemia was 6.9%, significantly higher among preterm neonates, Small-for-Gestational-Age (SGA) infants, those with a birth weight below 2 kg, those receiving mixed feeding, those breastfed fewer than eight times in the first 24 hours, and those delivered via caesarean section. Most hypoglycemic episodes occurred within the first 24 hours after birth. Conclusion: In LBW neonates, hypoglycaemia was more commonly observed in preterm infants, those classified as SGA, those delivered by caesarean section, and those on mixed feeding. Inadequate breastfeeding was the most important cause, followed by sepsis, hypothermia, and polycythemia.

Distribution and Variations of Foetal Renal Arteries: A Morphological Study

Roli Joshi, Sadhna Sachan, Navodita Chaudhary

Introduction: Renal vascularisation variants differ significantly between individuals due to the complex embryogenesis of the kidneys. Understanding the anatomy of the renal vascular pattern is essential for conducting various procedures such as renal transplantation, interventional radiological procedures, nephrectomy, and renal vascular segmental operations more safely and efficiently. Aim: The aim of this study was to comprehensively identify the normal foetal renal artery and variations within multiple renal arteries, as well as to highlight the connections between the presence of accessory renal arteries and the coexistence of other variants of renal vascularisation in human foetuses. Materials and Methods: This cross-sectional morphological study was conducted at GMC Haldwani, Uttarakhand, India from August 2016 to September 2022. With the guardian’s consent, 65 formally fixed normal human foetuses were studied for their embryological and clinical correlation. Dissections of the foetuses were performed to achieve better visualisation of the foetal kidneys and renal arteries. The origin, insertion, and number of renal arteries, including polar and hilar arteries, were counted in situ. Results: Out of 130 foetal kidneys (both male and female), a single main renal artery was observed in 88 cases (67.69%), while multiple renal arteries were present in 42 cases (32.3%). The number of hilar arteries was 22 (16.9%), and polar arteries were noted in 20 cases (15.3%). The incidence of multiple renal arteries was more common in male foetuses and occurred predominantly at the upper pole of the right kidney. Ninety percent of the arteries originated from the abdominal aorta. Conclusion: A thorough understanding of the branching pattern and the correct number of renal arteries is of great importance for urologists, interventional radiologists, nephrologists, and vascular surgeons to provide accurate diagnosis, effective treatments, and conduct major surgeries such as renal transplantation.

Evaluation of Renal Artery Resistive Index as a Predictor of Acute Kidney Injury in Perinatal Asphyxia: A Prospective Observational Study

Sachin Verma, Siddharth Patodi, Niranjan Kumar Singh

Introduction: Acute Kidney Injury (AKI) is a serious but challenging complication of perinatal asphyxia. Doppler flowmetric studies have demonstrated the potential for its prediction. Renal artery resistive index, a non-invasive modality and prompt intervention can help in early detection of AKI. Aim: To evaluate the utility of renal artery resistive index as a predictor of acute kidney injury in perinatal asphyxia. Materials and Methods: The present prospective observational study was conducted at Department of Paediatrics, VPIMS, Lucknow, Uttar Pradesh, India from December 2019 to February 2021. Sixty newborns with perinatal asphyxia were enrolled in the study. At enrollment, sex, gestational age at birth, mode of delivery, birth weight, and Apgar scores at 1 and 5-min were recorded. Renal artery Resistive Indices (RRI) were measured using color doppler at 2-24 hr and 48-72 hr intervals. Maternal Serum Creatinine (S.Cr) levels were assessed at enrollment. Neonatal S.Cr. levels were assessed at enrollment and every 24-hr interval till day 7. The chi-square test was used for proportions, whereas the independent samples t-test was used to compare the mean values. Comparative differences were considered significant at ‘p’ value <0.05. Results: The majority of newborns were males 38 (63.3%), born at term 37 (61.7%), through caesarean delivery 40 (66.7%), and had a birth weight of >2500 g, 34 (56.7%). The incidence of AKI was found in 17 neonates (28.3%). No significant association between AKI and the demographic, baseline characteristics of the newborns was observed. RRI at 2-24 hr as well as 48-72 hr too did not significantly associated with AKI (p-value 0.460 and 0.423, respectively). Conclusion: RRI failed to predict AKI in newborns with perinatal asphyxia. Additional studies with large sample sizes and incorporation of other non-invasive measures such as Near Infrared Spectroscopy (NIRS) may provide more insight into this relationship.

Association of Hypocalcaemia and Vitamin D Deficiency in Newborns Admitted in NICU: A Cross-sectional Study from a Tertiary Care Centre, Prayagraj, Northern India

Introduction: Hypocalcaemia is very common in sick newborns and is frequently associated with severe Vitamin D Deficiency (VDD). VDD can lead to both acute and long-term complications in newborns. Estimating vitamin D levels in hypocalcaemic newborns may therefore be cost-effective. Aim: To determine the association between hypocalcaemia and VDD in newborns admitted to the Neonatal Intensive Care Unit (NICU) of a tertiary care centre. Materials and Methods: The present cross-sectional study was conducted in the NICU of the Department of Paediatrics, MLN Medical College, Prayagraj, Uttar Pradesh, India, from 1st August 2021 to 31st July 2022. A total of 100 newborns (up to 28 days old) were enrolled and divided into two groups of 50 each. Group 1 included hypocalcaemic newborns (serum ionic calcium <1.2 mmol/L in term and <1.0 mmol/L in preterm infants), and Group 2 included newborns with normocalcaemia. Vitamin D levels were estimated in both groups. Maternal history regarding the intake of calcium (1000 mg/day) and vitamin D (500 IU/day) from 14 weeks of pregnancy until delivery was also recorded. The Chi-square test was used to assess the association of hypocalcaemia with vitamin D levels. Results: The mean age of the newborns was 4.93±4.61 days, with a male-to-female ratio of 2.03:1. VDD was observed in 74% (74/100) of the newborns. Among hypocalcaemic newborns, 46 (92%) were vitamin D deficient. Hypocalcaemia was significantly associated with VDD (p<0.001). Sixty-five mothers had a history of either no or inadequate calcium and vitamin D intake. Among these, 32 mothers of hypocalcaemic newborns had inadequate or no intake, which was not significantly associated with neonatal hypocalcaemia (p=0.580). Breastfeeding was significantly associated with normocalcaemia (p=0.037). Conclusion: There was a very high prevalence of VDD in the study population, with 74% of NICU-admitted newborns being vitamin D deficient. VDD was significantly associated with hypocalcaemia in the present cross-sectional study.

Validity of the SNAP-II Score in Predicting Neonatal Mortality and Morbidity at a Tertiary Care NICU: A Prospective Observational Study

Roli Verma, Payal Mittal, Sonia Bhatt

Introduction: The Neonatal Mortality Rate (NMR) remains high in India despite various advances in neonatal care. A reliable scoring system may help identify sick neonates and facilitate early interventions. The Score for Neonatal Acute Physiology (SNAP)-II scoring system was developed to assess the severity of illness and predict mortality and morbidity among neonates admitted to the Neonatal Intensive Care Unit (NICU). Aim: To validate the SNAP-II scoring system in predicting neonatal outcomes at a tertiary care NICU in Uttar Pradesh. Materials and Methods: A prospective observational study was conducted in the NICU of the Department of Paediatrics at FH Medical College and Hospital, Agra-Etmadpur, Uttar Pradesh, India. A total of 259 neonates aged between 1 and 28 days, who were admitted to the NICU between September 2022 and March 2024, were included in the study after obtaining consent from parents. Physiological parameters were recorded within 12 hours of admission to calculate SNAP-II scores. Neonatal outcomes, including mortality, need for respiratory support, inotropic use, and length of stay in the NICU, were analysed. Statistical analysis included t-tests, chi-square tests, Receiver Operating Characteristics (ROC) curves, and sensitivity-specificity assessments. Results: A total of 259 babies were enrolled, but 32 were excluded from the study (9 expired within 24 hours, and 23 left against medical advice). In the remaining 227 babies, there were 146 (64.3%) males and 81 (35.7%) were females. Most of the babies were preterm 120 (52.9%), while 107 (47.1%) were term. The study found a significant association between higher SNAP-II scores and increased mortality, prolonged NICU stay, and a greater need for respiratory support and inotropes (p<0.001). A SNAP-II cut-off of 46 showed 93.3% sensitivity and 89% specificity for predicting mortality. Individual parameters of SNAP-II did not independently predict outcomes. Conclusion: The SNAP-II scoring system is a reliable tool for early risk stratification in NICUs, facilitating targeted interventions and optimising resources. Its integration into NICU protocols can significantly improve neonatal outcomes.

Comparison of Serum Electrolytes among Febrile Children with and without Seizures: A Cross-sectional Study

N Supriya, DH Marthandappa, V Vidhyadhar

Introduction: Febrile Seizures (FS) are common in early childhood, and bedside biochemical testing is frequently ordered despite mixed evidence regarding underlying biochemical drivers. Clarifying which analytes truly differ at presentation can help streamline acute care, particularly in resource-constrained settings. Aim: To compare serum sodium, magnesium, total calcium, ionised calcium, and 25-hydroxyvitamin D levels between children with Febrile Seizures (FS) and age-matched children with febrile illness without seizures (FI). A secondary objective was to evaluate these analytes across FS subgroups based on seizure type (simple vs. complex). Materials and Methods: A cross-sectional study was conducted at Max Super Speciality Hospital, Saket, New Delhi, India, from April to November 2016. Children aged six months to five years were enrolled as FS cases (n=64) and febrile illness controls without seizures (FI; n=64). FS cases were included according to the International League Against Epilepsy (ILAE) and American Academy of Paediatrics (AAP) criteria. Serum sodium and total calcium were measured using ion-selective electrodes (indirect potentiometry), magnesium by the calmagite timed endpoint method, ionised calcium by direct potentiometry, and 25-hydroxyvitamin D by chemiluminescent immunoassay. Student’s t-test/ANOVA and χ² tests were used for statistical analysis. Results: The FS and FI groups were comparable with respect to age and sex. Within the FS cohort, 19 children (29.7%) had a prior history of febrile seizures, and 8 (12.5%) reported a positive family history. Forty children (62.5%) presented with complex febrile seizures. Mean±SD analyte values in the FS versus FI groups were as follows: sodium 138.17±5.10 vs. 138.61±4.72 mEq/L (p-value=0.615); magnesium 1.85±0.26 vs. 1.79±0.22 mg/dL (p-value=0.179); total calcium 8.88±0.56 vs. 9.27±0.55 mg/dL (p-value <0.0001); ionised calcium 0.97±0.14 vs. 1.01±0.11 mmol/L (p-value˜0.07); and vitamin D 20.02±8.08 vs. 20.43±9.77 ng/mL (p-value=0.792). No meaningful inter-relationships were observed among the five biomarkers. Conclusion: Children with FS had significantly lower total calcium levels and a non significant trend toward lower ionised calcium levels compared with febrile controls, while sodium, magnesium, and vitamin D levels did not differ significantly. In this clinical setting, routine assessment of total and ionised calcium in children with FS appears justified. Vitamin D levels were low in both groups, supporting the need for population-level vitamin D optimisation strategies.

Comparative Clinical Outcome Based on Direct Antiglobulin Test Status in Neonates with ABO Incompatibility: A Prospective Cohort Study

Sivashankar Balamurugan, Chandrababu Chandran, Monisha Rameshbabu

Introduction: ABO Haemolytic Disease of the Newborn (ABOHDN) is a significant but often under-recognised cause of neonatal haemolysis. A positive Direct Antiglobulin Test (DAT) is observed in 20-40% of ABO incompatible cases. Aim: To compare clinical outcomes between DAT-positive and DAT-negative neonates and evaluate the predictive value of DAT in ABO incompatible newborns. Materials and Methods: This prospective cohort study was conducted at Chettinad Hospital and Research Institute, Kelambakkam, Chennai, Tamil Nadu, Southern India, from February 2024 to March 2025. A total of 288 neonates born to mothers with blood group O who underwent cord blood DAT testing were included. Based on DAT results, neonates were categorised as DAT-positive or DAT-negative. The primary outcome was the need for phototherapy. Secondary outcomes included the timing of hyperbilirubinemia, peak bilirubin levels, duration of phototherapy, haemoglobin levels, and readmission rates. Data were statistically analysed using Student’s t-test or the Wilcoxon rank-sum test for continuous variables and the Chi-square or Fisher’s exact test for categorical variables. Results: Among 288 neonates, 60 (20.8%) were DAT-positive and 228 (79.2%) were DAT-negative. Phototherapy was needed in 62% of DAT-positive neonates versus 28% in DAT-negative (RR: 2.98, 95% CI: 1.88-4.72; p<0.001). DAT-positive neonates required phototherapy earlier, by a mean of 28.7 hours (p<0.001). No significant differences were noted in peak bilirubin, phototherapy duration, or haemoglobin levels. Readmission for phototherapy was higher in DAT-positive neonates (RR: 2.34; p=0.047). DAT positivity and gestational age independently predicted phototherapy need. DAT showed moderate specificity of 0.88 (95% CI: 0.83-0.92) but low sensitivity of 0.37 (95% CI: 0.27-0.45), with an AUC of 0.621 (95% CI: 0.569-0.674). Conclusion: Cord blood DAT performed in neonates born to O-positive mothers can independently predict the need for phototherapy. However, its limited sensitivity restricts its utility as a sole screening tool in ABOHDN.

Correlation of NT-proBNP with Procalcitonin and C-Reactive Protein in Neonatal Sepsis: A Retrospective Observational Study

Sanjukta Naik, Anisha Mathew, Seema Patel, Preeti Chauhan

Introduction: Neonatal Sepsis (NS) is a life-threatening condition characterised by high morbidity and mortality rates, necessitating prompt diagnosis and treatment. To ensure the early, specific, and reliable identification of NS, selecting optimal biomarkers is crucial due to the limitations of traditional haematological and microbiological techniques. Procalcitonin (PCT) and C-Reactive Protein (CRP) are most frequently used in hospitals for diagnosis and follow-up. Another biomarker N terminal Brain Natriuretic Peptide (NT-proBNP) can be used in correlation with CRP and PCT to aid in diagnosis and prognosis of NS. Aim: To study the role of NT-ProBNP in NS and its correlation with PCT and CRP. Materials and Methods: The present retrospective observational study was conducted at a Tertiary Care Hospital in North India Action Balaji Hospital, for a period of six months. Study included 50 neonates diagnosed with NS admitted for treatment. Blood samples reports were collected for blood culture, PCT, CRP, NT-proBNP. Correlation between NT-proBNP and CRP, PCT was determined by Spearman’s correlation and linear regression. Results: Out of total 40 neonates, 70% were females and 30% males. The mean birth weight was 2.01±0.28 Kg. An 80% of neonates were with early onset and 20% with late onset sepsis. The mean±SD of PCT and CRP were 2.677±3.67 ng/mL and 39.7±19.82.6 mg/L and NT-proBNP 3595±4472 pg/mL, respectively. NT-proBNP had significant correlation with CRP (r=0.692, p<0.001) and PCT (r=0.609, p<0.001). Conclusion: In the present study, NT-proBNP was elevated and had significant correlation with CRP and PCT. Larger prospective studies are required to confirm utility of NT-proBNP in combination with other sepsis markers like PCT and CRP to detect early sepsis leading to timely and appropriate treatment.

Diagnostic Accuracy of Creatine Kinase-Muscle Brain Fraction and Lactate Dehydrogenase in Hypoxic Ischaemic Injury among Newborns: A Prospective Observational Study

Ankit Kumar, Ritu Rakholia, Bindu Deopa

Introduction: Perinatal asphyxia, contributes significantly to neonatal morbidity and mortality. In India, one third of deliveries are institutional and many asphyxiated newborns are brought late to health facility. These newborns don’t have proper perinatal records making it difficult to retrospectively diagnose perinatal asphyxia. There is an urgent need to identify new-born with asphyxia who are at high-risk for Hypoxic Ischaemic Encephalopathy (HIE) and multiorgan dysfunction. Aim: To study the Lactate Dehydrogenase (LDH) and Creatine Kinase-MB (CK-MB) levels in neonates suspected of hypoxic ischaemic injury for better diagnosis and treatment of perinatal asphyxia. Materials and Methods: The present prospective observational study was done from February 2023 to May 2024 in Special Newborn Care Unit (SNCU) of Government Medical College, Haldwani, Uttarakhand, India. Total 180 randomly selected neonates comprising of 90 asphyxiated and 90 non-asphyxiated newborns were included in the study. The blood samples for CK-MB and LDH were drawn at 8±2 hours and 72±2 hours of age, respectively and were immediately sent for analysis and sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Values (NPV) were calculated for each. Results: In present study, there were 100 males and 80 females with mean birth weight and age to be 2.9±0.5 kg and 38.3±1.4 weeks. CK-MB value of >92.6 U/L was found in 73 (81.1%) of asphyxiated new-born and LDH >580 U/L was found in 69 (76.6%) asphyxiated. LDH had a sensitivity of 83.13%, specificity of 97.78%, PPV of 97.40%, and NPV of 86.27%. CK-MB showed a sensitivity of 81.11%, specificity of 97.78%, PPV of 97.33%, and NPV of 83.81%. Conclusion: CK-MB and LDH were elevated in asphyxiated neonates compared to non-asphyxiated neonates and LDH was better at predicting hypoxic ischaemic injury as compared to CK-MB.