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   Table of Contents - Current issue
Coverpage
April-June 2020
Volume 9 | Issue 2
Page Nos. 93-155

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EDIRORIAL  

Recommendations for the management of newborn with suspected or confirmed coronavirus disease-19 Highly accessed article p. 93
Ali Almudeer, Jubara Alallah, Saad AlSaedi, Jasim Anabrees, Abdulhakiem Kattan, Zakariya AlSalam, Manal Asiri, Emad Khadawardi, Abdulrrahman AlMehery, Ibrahim Alhefzi, Abdulrrahman Alnemri
DOI:10.4103/jcn.JCN_34_20  
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ORIGINAL ARTICLES Top

Magnitude, short-term outcomes and risk factors for hypoxic ischemic encephalopathy at abha maternity and children hospital, Abha City, Saudi Arabia and literature review p. 98
Raja M Thigha, Ahmad A Alzoani, Mufareh H M. Almazkary, Amal A Khormi, Rania H Albar
DOI:10.4103/jcn.JCN_12_19  
Background: When hypoxia is the cause for neonatal encephalopathy, a clinical syndrome has been described known as hypoxic–ischemic encephalopathy (HIE). Aim of the Study: This study aimed to determine the magnitude of HIE occurrence, its short-term outcomes, and associated risk factors. Literature review was included for comparing our reported findings with other published ones. Methods: A retrospective, case–control study was conducted at “Abha Maternity and Children Hospital” (AMCH) that included all inborn term and late-preterm newborns with the “admission diagnosis” of HIE during 2016–2017. Healthy newborn babies were taken as controls. Data were extracted from neonatal medical files for HIE cases and maternal medical files for the controls. Results: Of 15,790 livebirths, 124 cases had HIE (7.85/1000 livebirths), of whom 3.98/1000 and 3.86/1000 livebirths were staged as mild and moderate-to-severe HIE, respectively. Short-term outcomes for HIE were 14 deaths (11.3%) and 33 cases with seizures (26.6%), which occurred exclusively among moderate–severe HIE cases; 87 cases (70.2%) required positive pressure ventilation, and 45 cases (36.3%) required mechanical ventilation, with significantly higher rate among moderate–severe HIE than mild cases (P < 0.001). By the 7th day of admission, moderate-to-severe HIE cases showed significantly higher rates for both lack of nutritive sucking reflex and respiratory support than mild HIE ones (P = 0.016 and P < 0.001, respectively). Among HIE cases who required cooling, 96.2% were subjected to it within the “therapeutic window” of ≤6 h. Risk factors associated with HIE were urinary tract infection/vaginitis (P = 0.001), late preterm (P = 0.002), meconium stain (P = 0.003), abnormal cardiotocographic tracing (P < 0.001), prolonged second stage of labor (P = 0.001), assisted delivery (P = 0.011), sentinel events (P = 0.027), and low 1-min APGAR scores (P < 0.001). Conclusions: The burden of moderate-to-severe HIE at AMCH is high with an associated high mortality rate. Early identification of high-risk pregnancy with improved antepartum, intrapartum, and neonatal care can reduce occurrence of HIE.
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Long- and short-term effects of propranolol hydrochloride treatment on very preterm newborns p. 111
Levent Korkmaz, Ahmet Ozdemir, Sabriye Korkut, Osman Bastug
DOI:10.4103/jcn.JCN_28_19  
Background: While propranolol hydrochloride (PH) is being more widely used in adult patients, its administration in the neonatal period as well is progressively on the rise in our time. With the increasing use of PH in the neonatal age period, worries resulting from the potential adverse effects of the agent on vital organs, such as brain, in particular, have come to the fore. Such concerns increase even more when PH is used in treating preterm infants. Our study, aiming to clarify these increasing concerns, is the first clinical one of its kind in the literature, conducted on very preterm infants, the patient group most vulnerable to PH treatment. Aims: To investigate possible short- and long-term side effects of using PH during the neonatal period and to provide information to clinicians regarding such side effects. Study Design: Case–control study. Materials and Methods: This was a double-blind, randomized, and placebo-controlled trial. In the study, we included 36 very preterm infants subjected to PH treatment (0.5 mg/kg/6 h) initiated in the first postnatal month and lasting for approximately 1 month (PH group [PHG]) and 40 very preterm infants who received distilled water in place of PH (control group [CG]). The gestational age of all infants in the study was below 31+6 weeks, and their birth weight was under 1500 g. The patients' vital functions and physical development were monitored and recorded in patient follow-up forms. At approximately 1 year of age (CG: 9.73 ± 4.56 months and PHG: 10.8 ± 5.73 months), the Ankara Developmental Screening Inventory (ADSI) and the Denver Developmental Screening Test II (DDST-II) were used to assess the mental development of the children. Results: In the PHG patients, PH treatment was initiated at 27.0 ± 2.7 days of life and lasted for 26.5 ± 8.7 days. The newborns in the CG received distilled water for similar durations. A statistically significant difference in blood sugar levels was detected between CG (78.4 ± 12.5) and PHG (65.6 ± 7.5) (P = 0.006). However, no statistically significant difference was found between the two groups in terms of physical and mental development (ADSI and DDST-II) of the children at the end of the study (P > 0.05). Conclusions: When used on very preterm infants, PH may have some temporary effects on the patients' vital functions in the short term; however, no serious side effects were detected that may affect the physical and mental development in the long run.
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Incidence, risk factors, and outcome of acute kidney injury in hospitalized term newborns p. 121
N Nandhagopal, Uzma Firdaus, Syed Manazir Ali, Kamran Afzal
DOI:10.4103/jcn.JCN_84_19  
Background: Acute kidney injury (AKI) is a common and devastating medical condition. However, the true incidence of AKI around the world is not known. In newborns patients, AKI importance and dilemmas are even more pronounced, as a newborn's kidneys are more susceptible to hypoperfusion and have low glomerular filtration rate. Objective: The objective is to determine the incidence, risk factors, and outcome of AKI in term newborns. Design: Prospective observational. Study Setting: Neonatology Division, Department of Pediatrics, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh. Methods: A hospital-based prospective study was done on 160 term inborn newborns. Babies were closely examined for the occurrence of AKI based on rising creatinine level or falling urine output. Results: The mean birth weight and the mean gestational of the study population were 2.64 (standard deviation [SD] 0.52) and 38.4 weeks (SD 1.05), respectively. Thirty-five babies developed AKI between 24 and 48 h of life. On applying nRIFLE criteria, 21, 7, and 7 babies fell into Stage 1 (risk), Stage 2 (injury), and Stage 3 (failure), respectively. At discharge, all babies showed normalization of renal function test and follow-up ultrasound at 3 months of age did not show any significant abnormality. The presence of asphyxia, comorbid sepsis, and circulatory collapse were found to have a significant association with AKI. The stage of AKI as per nRIFLE criteria significantly affected the outcome of newborns. Conclusion: AKI is a significant problem seen in newborns admitted to NICU. The most common risk factors identified were perinatal asphyxia, sepsis, and circulatory failure. There is a pressing need to improve antenatal care to decrease the burden of asphyxiated newborn and preventing hospital-acquired infection. This may translate into future wellbeing of the newborns.
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Study of hepatic enzymes in term neonates with perinatal asphyxia p. 125
Vibha Kariya, Manish Jain, Smita Jategaonkar
DOI:10.4103/jcn.JCN_116_19  
Introduction: Perinatal asphyxia is among the three most common causes of neonatal deaths. Neonates with birth asphyxia suffer from hypoxic ischemic encephalopathy. They also develop multiorgan dysfunction including hepatic injury which leads to increase in liver enzymes in the blood. In this case control study, we studied the severity of liver dysfunction in term neonates with perinatal asphyxia as compared to normal neonates. Materials and Method: This case control study was conducted in the Department of Paediatrics of a tertiary care hospital in central rural India from January 2016 to June 2017. 75 term neonates were recruited in the study as cases and sex – matched 150 term neonates without birth asphyxia as controls. Basic socio- demographic factors, obstetrical history, birth weight, gestational age, apgar score of the neonates at 1 minute and 5 minutes were noted. Serum alkaline phosphatase (ALP), alanine transaminase (ALT) and aspartate transaminase (AST) were measured at 72 ± 2 hrs. Data was analyzed to understand the strength of relationship between enzyme levels and severity of asphyxia. Result: Mean Serum alanine transaminase (ALT) and aspartate transaminase (AST) in cases (90.44 U/L and 114.56 U/L respectively) were found to be significantly higher than in controls (28.34 U/L and 71.48 U/L respectively). There was no significant correlation in serum alkaline phosphatase in these groups. There was statistically significant negative correlation between Apgar scores and Serum alanine transaminase (ALT) and aspartate transaminase (AST). Conclusion: In the present study, we found a significant correlation between presence of a low Apgar score and raised serum alanine transaminase and aspartate transaminase. These biochemical parameters indicate the presence of hepatic dysfunction in asphyxiated neonates.
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Maternal satisfaction with services provided in the neonatal step-down ward in a public sector hospital in North India p. 132
Raghav Taneja, Prerna Batra, Jagdish Sadiza
DOI:10.4103/jcn.JCN_137_19  
Background: Early transfer of baby to mother in step down ward is an approach that can improve maternal satisfaction among parents of neonates admitted in NICU. Objective: To assess the satisfaction of mothers of neonates admitted in the neonatal step down ward of a public sector hospital. Methods: This cross sectional study was conducted in neonatal step down ward of a public sector hospital in North India. One hundred mothers of neonates (< 34 weeks gestation and/or <1800 g birth weight) admitted to the step down ward were included in the study. Mothers of neonates born with major congenital malformations, mothers who were HIV or Hepatitis B positive or had any other chronic illness were excluded. The mothers were interviewed on the day of discharge using a semi-structured questionnaire. It comprised of 35 questions, categorized into 8 domains, namely interpersonal relationships with staff, personal requirements of mother, health services provided by hospital, caregiver proficiency, education and guidance, kangaroo mother care, food provision, and environment of the ward. Maternal satisfaction was marked on a three-point Likert scale. Results: Among the mothers interviewed, a vast majority expressed the utmost satisfaction with the interpersonal relationships with the staff (97.5%). Deficit in satisfaction was observed with the health services (79.57%), and education and guidance by the hospital (78.87%). Conclusion: Neonatal step down set up with early involvement of mother in care of neonates makes mother-baby duo ready for discharge and offers new possibilities for neonatal management in resource-poor countries. Multicentric studies with objectivized outcomes and larger sample size are required for implementing this setup.
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Neurodevelopmental outcome at 6 months of age in full-term healthy newborns with neonatal hyperbilirubinemia p. 138
Amit Agrawal, Shilpa Pandya, Jyotsna Shrivastava
DOI:10.4103/jcn.JCN_19_20  
Background: Neonatal hyperbilirubinemia (NNH) is an important cause of preventable brain damage among infants. Neurodevelopmental assessment and Brainstem-Evoked Response Audiometry (BERA) may help in the early identification and management of neurodevelopmental sequelae. Objectives: The objectives of this study were to find the association between neonatal peak serum bilirubin levels and the neurodevelopmental outcomes at 6 months in term infants with NNH and to assess the changes in BERA of these neonates. Methodology: A prospective cohort study was conducted in the Department of Pediatrics, Gandhi Medical College, Bhopal. All healthy, full-term, appropriate-for-date neonates, admitted from December 2014 to June 2015 with hyperbilirubinemia and serum bilirubin >12 mg/dL, were included in the study and were followed up till 6 months of age. The neurodevelopmental assessment was done using the Denver Developmental Screening Test II and BERA was done at an average age of 69 ± 6 days. Results: A total of 77 newborns were enrolled, and 73 completed the study. Of these 77 neonates, 40 (51.65%) had abnormal BERA results, whereas 3 (3.9%) had neurodevelopmental abnormalities. BERA and neurodevelopmental abnormalities were associated with a mean serum bilirubin of 22.58 mg/dL and 31.33 mg/dL, respectively. The cutoff value of serum bilirubin was 16.3 mg/dL and 23.8 mg/dL, respectively, to detect BERA and neurodevelopmental abnormalities, respectively. All patients (11) who received exchange transfusion had BERA abnormalities, and 3/11 (27.3%) had neurodevelopmental abnormalities. The association of ABO incompatibility was significant (P < 0.001) with abnormal BERA. Conclusion: Serum bilirubin is linearly associated with BERA and neurodevelopmental abnormalities. Patients receiving exchange transfusion have higher odds of neurodevelopmental sequelae. Regular follow-up and early intervention may help infants to have better neurodevelopmental and auditory outcomes.
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CASE REPORTS Top

Rare presentation of ectrodactyly in trisomy 13 p. 143
Wafaa Al Rawi, Kamal Mustafa, Ashraf Abuobayda, Laila Obaid
DOI:10.4103/jcn.JCN_130_16  
Trisomy 13 (Patau syndrome) is third common trisomy and associated with multiple congenital anomalies including limb malformation like polydactyly. However, the presence of ectrodactyly or split-hand and/or foot malformation, a lobster claw-like appearance of the hand and/or foot, which may occur as an isolated entity or as part of a syndrome, in trisomy 13 is uncommon. This is a case report of a rare presentation of trisomy 13 with ectrodactyly or split-hand malformation. To the best of our knowledge, only a few isolated reports of ectrodactyly in trisomy 13 such our patients have been documented in the literature, and this could be one of the few reported cases to show such association.
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Hemolytic disease of the newborn due to anti-e p. 146
Hammam A H. Ali, Osayd Samer Zohud
DOI:10.4103/jcn.JCN_102_19  
In Palestine, antibody screening is done antenatally only for pregnant women who are Rh-D negative. However, we report the first hemolytic disease of the newborn (HDN) due to anti-e in Palestine, illustrating the importance of alloantibodies other than anti-D as a cause of HDN. A pregnant woman had e-antigen negative and her blood group was B positive developed alloantibody against her infant erythrocyte e-antigen that lead to severe jaundice due to fetal erythrocyte destruction by this maternal alloantibody. Postnatal workup for the severe hyperbilirubinemia indicated that the newborn' erythrocytes were sensitized by the maternal anti-e alloantibody. Furthermore, the positive direct Coombs test was reported. This case highlights the importance of antibody screening for all pregnant women irrespective of the D antigen status to detect and manage erythrocyte alloimmunization to any other clinically significant blood group antigens.
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Successful use of I-gel™ in a neonate with crouzon syndrome p. 149
Arnab Banerjee, Geeta Ahlawat, Richa Aggarwal
DOI:10.4103/jcn.JCN_107_19  
Craniosynostosis is a birth defect syndrome characterized by the premature closure of one or more of the fibrous joints between the bones of the skull. The most common among these craniosynostosis syndromes is Crouzon syndrome. Airway management in such patients becomes challenging and requires an experienced and calm anesthesiologist for expert management. We report a case of successful usage of i-gel™ supraglottic airway device in the airway management of a newborn with craniosynostosis to be operated for enucleation for proptosis in the right eye. Well-planned anesthesia (induction-maintenance-extubation sequence) remains the key to success.
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Loss of both eyes from endogenous endophthalmitis in a term neonate with pseudomonas sepsis p. 152
Abubakar Sani Lugga, Nuraddeen Ibrahim, Amina Oiza Ibrahim, Sule Garba Paret
DOI:10.4103/jcn.JCN_114_19  
Pseudomonas aeruginosa sepsis is associated with high morbidity and mortality in the neonatal period. It is the most common cause of endogenous endophthalmitis which is a rare ophthalmic emergency that can result in complete blindness. Diagnosis can be a challenge in the neonate, hence the need for early ophthalmic consultation in babies presenting with fever, eye swelling, and discharge. Early diagnosis and prompt appropriate treatment are very important to prevent death and disability. This case report demonstrates the rapid progression of endogenous endophthalmitis due to Pseudomonas sepsis, which resulted in the loss of both eyes within a few days of onset.
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