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   Table of Contents - Current issue
July-September 2019
Volume 8 | Issue 3
Page Nos. 137-191

Online since Tuesday, August 6, 2019

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Relation of low birth weight and low-density lipoprotein cholesterol of neonates with postpartum maternal body mass index Highly accessed article p. 137
Mohammad Kamrul Hassan Shabuj, Varsha Verma, Sanjoy Kumer Dey, Ismat Jahan
Objectives: This study was undertaken to compare the relation of low birth weight (LBW) categories and level of low-density lipoprotein (LDL) of LBW neonates with maternal postpartum body mass index (BMI). Materials and Methods: This was a hospital-based observational cross-sectional study conducted in the Department of Neonatology and in the Department of Obstetrics and Gynecology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. Results: A total of 81 LBW neonates and mothers pairs were included in the study. There was no difference in LBW categories with maternal postpartum BMI categories (P = 0.15, post hoc). There was an increase in LDL level in the neonates of the obese mother (P = 0.02), but the difference of LDL level was not significant in the neonates of the normal and overweight mother. Conclusion: LBW categories do not differ with maternal BMI categories, but the LDL level is more in the neonates of obese mother than that of overweight mothers and normal weight mother.
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Does routine prophylaxis with caffeine prevent bronchopulmonary dysplasia in extremely low birth weight infants? p. 141
Varsha Bhatt-Mehta, Todd Hershberger, Julie Sturza, Robert E Schumacher
Objective: The objective of the study was to determine the risk of developing bronchopulmonary dysplasia (BPD) in extremely low birth weight (ELBW) infants with and without caffeine prophylaxis. We hypothesized that there would be no difference in the risk of BPD between the two groups. Study Design: This was a comparative, single-center, retrospective cohort study comparing risk of BPD in ELBW infants (≤28-week gestation or ≤1001 g if gestational age [GA] unknown) receiving caffeine for BPD prophylaxis within the first 24 h of life to those with no prophylaxis. Materials and Methods: The risk of developing BPD in infants receiving caffeine for BPD prophylaxis was compared with a matched nonprophylaxis group. BPD was defined as the need for oxygen support at 36-week corrected GA (CGA). Secondary outcomes included total caffeine exposure, average weekly maintenance dose, and length of treatment and duration of mechanical ventilation. Results: One hundred and eight out of 153 infants (71%) received caffeine prophylaxis. The risk of developing BPD at 34–36-week CGA was not significantly different between the two groups (odds ratio [OR]: 0.92, 95% confidence interval [CI]: 0.45–1.84). Infants in the prophylaxis group had higher total caffeine exposure and daily caffeine dose. There was no association between a patient's average daily dose of caffeine and risk of BPD (OR = 1.03, 95% CI: 0.91–1.18;P = 0.62). The duration of caffeine treatment was longer in the nonprophylaxis group. Infants in the prophylaxis group spent fewer days on mechanical ventilator (P = 0.03). Conclusion: The risk of BPD in infants receiving caffeine prophylaxis for BPD prevention was similar to a matched group of infants with no caffeine prophylaxis.
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A comparative study of outcomes of nasal prongs and nasal mask as CPAP interface in preterm neonates: A randomized control trial p. 147
Sneha Prakash, Archana Dubey, Sunil Malik
Background: Nasal prongs are a common method of providing CPAP to newborn babies. They are the cause of mild to severe trauma to the nose and nasal septum and may result in CPAP failure. Nasal masks are now being used to try and mitigate the trauma.These are form fitting masks placed over the nose and are thought to cause less trauma than nasal prongs. Methods: A study was conducted on preterm neonates (28–34-week gestation) with respiratory distress within 24 h of life, admitted in a tertiary care center, Meerut. Babies were randomized and divided into two groups while being put on bubble continuous positive airway pressure (CPAP), using either nasal prongs (Group A) or nasal masks (Group B). The data generated were collected and analyzed for mean duration of CPAP, duration of hospital stay, CPAP failure, retinopathy of prematurity, necrotizing enterocolitis, patent ductus arteriosus, and nasal trauma among both groups. Results: Eighty neonates were analyzed in the study, of which the mean duration of CPAP was 4.53 days in Group A and 5.20 days in Group B; the mean duration of hospital stay was 21.36 days in Group A and 24.58 days in Group B; CPAP failure was observed in 21.95% cases in Group A and 23.07% cases in Group B; and nasal trauma was seen in 46.34% cases in Group A and 43.58% in Group B. Statistical analysis showed no significant difference among both groups. Conclusion: The outcomes of nasal mask as interface are as effective as nasal prongs in preterm infants on CPAP therapy.
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Systemic Candida infection in preterm babies: Experience from a tertiary care hospital of North India p. 151
Bashir Ahmad Charoo, Younis Ashraf, Javeed Iqbal Bhat, Iqbal Ahmad Qazi
Background: Neonatal fungal infection is an important cause of late-onset sepsis with very high mortality. The incidence is progressively increasing due to a marked improvement in the survival of low-birth weight neonates. Materials and Methods: This was a 2-year observational study. Very low-birth weight (VLBW) and extremely low-birth weight (ELBW) with suspected fungal sepsis were enrolled. All suspected neonates were evaluated for possible Candida infection. Complete clinicodemographic and laboratory profile was noted from the study participants. The main outcome measure was hospital incidence, clinical profile, and the frequency of end-organ involvement. Results: During the study, 304 ELBW and VLBW neonates were screened for invasive fungal sepsis. Sixty-four neonates were found positive for invasive Candida sepsis making the incidence of 11.6%. Majority of patients developed worsening of respiratory distress and shock. Necrotizing enterocolitis (NEC) was seen in 10 patients and disseminated intravascular coagulation (DIC) in nine patients. Nearly 7.8% had cerebrospinal fluid culture positive for Candida. Renal abscess was seen in two patients. Endohpthalmitis and endocarditis each were observed in one patient. The mortality rate in our study group was 55%. Conclusion: We found 11.9% incidence of invasive fungal incidence. Majority of neonates developed worsening of respiratory distress, shock, NEC, DIC, and thrombocytopenia. End-organ damage was noticed in 14% of patients. Mortality was around 55% in our cohort.
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Clinical profile and outcome of newborns admitted to a secondary-level neonatal intensive care unit in tribal region of Odisha p. 155
Prateek Kumar Panda, Pramod Kumar Panda
Introduction: Neonatal deaths constitute major proportion of under-five mortalities in India. Secondary-level neonatal intensive care units (NICUs) currently provide care to majority of sick newborns in India. Only few clinical studies have described the management outcome of newborns admitted into these secondary-level NICUs in India. Methods: The current study was conducted in Koraput District Headquarter Hospital and associated Medical College Hospital located in tribal regions of Odisha catering to 13.8 lakhs population of predominantly lower socioeconomic status. The study included in-depth retrospective case record analysis of all the NICU admissions in 3 months between April and June 2018, after a broad overview of all admissions in 3 years between July 2015 and June 2018. Predesigned pro forma was used to document clinical profile, indication for admission, microbiological characteristics of neonatal sepsis, and outcome in terms of discharge, death, referral, or left against medical advice. Results: Of 4127 total NICU admissions between July 2015 and January 2018, 3159 (76%) newborns were discharged. The most common indications for admissions in inborn babies were prematurity and related complications (23%), birth asphyxia (19%), and neonatal hyperbilirubinemia (18%). For outborn newborns, along with these causes, neonatal sepsis (20%) was another important cause of NICU admission. Escherichia coli and Klebsiella species were predominant microorganisms to be isolated in blood culture. About 11% of newborns received kangaroo mother care, with median duration of 6 days. Predominant causes of death among newborn babies were prematurity-related complications (51%) and neonatal sepsis (37%). Conclusion: Prematurity-related complications, birth asphyxia, neonatal hyperbilirubinemia, and sepsis are the predominant indications for admission to a secondary-level NICU in India. About three-fourth of neonates can be treated successfully within the existing infrastructure.
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Caffeine use for apnea of prematurity in moderate and late preterm infants: A systematic review p. 162
Mohammed Bahari, Jose Carlos Aldana, Robin Featherstone, Manoj Kumar
Objective: The objective is to perform a systemic review of the literature on the use of caffeine for the management of apnea of prematurity (AOP) in moderate and late preterm infants. Data Sources: In May 2016, we searched the following databases from the beginning of the year 1980: Medline, Embase, CENTRAL, CINAHL, ProQuest Dissertations and theses Global, and PubMed. Additional citations were searched in the clinical trial registries and from the bibliography of the selected articles. We updated our search in May 2018 to identify any new citations. Methods: Studies were included if they were randomized controlled trials (RCTs) involving preterm infants ≥32 weeks gestation and compared caffeine with placebo, reporting any of the prespecified clinical outcomes. Search strategies combined controlled vocabulary and keywords terms for apnea, caffeine, and preterm infants. No language restriction was applied. Two researchers independently reviewed the retrieved articles for inclusion. Disagreements were resolved by consensus among the review team. Results: The search strategy identified 839 citations after removing duplicates. We did not identify any published RCT that described the use of caffeine for AOP in moderate to late preterm infants. The updated search also did not identify an RCT. Conclusions: There is a lack of good quality evidence for the use of caffeine for the management of AOP in moderate and late preterm infants. An RCT is urgently needed to investigate the clinical benefits of caffeine use in this population and the potential savings in health-care resource utilization.
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Granular cell tumor (Epulis): Simple excision is the treatment of choice p. 166
Osama A Bawazir, Ahmed H Al-Salem
Background: Epulis, which is also called granular cell tumor (GCT), is a rare tumor of the newborn. Aims and Objectives: to evaluate the outcome of surgical management of (GCT) and the efficacy of simple excision in neonates at our centers. Materials and Methods: We reviewed the medical records of 10 patients who had simple excision for granular cell tumor (GCT) in the period from 2006 to 2019. Result: This report describes 10 patients with GCT. All were newborns (nine females and one male). They presented with a mass of variable size protruding from the mouth and in five this interfered with feeding. In 7 patients, the mass was solitary, but three had two lesions. One had two masses arising from the maxillary alveolar ridge; one had two masses one arising from the maxillary alveolar ridge, while the other arising from the mandibular alveolar ridge and the third had two masses arising from the mandibular alveolar ridge. All were treated surgically with simple excision which was curative and on a mean follow-up of 3 years (10 months–6 years); there was no noticeable defect in the gum. Conclusion: Simple excision is the treatment of choice of epulis. It is simple, safe, and curative.
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Neonatal adrenal mass with jaundice p. 170
Parveen Kumar, Shasanka Shekhar Panda, Aravindha Radhakrishnan, Yogesh Kumar Sarin
A neonate presenting with lumbar mass, late jaundice, and pallor, investigated on, shows echogenic mass in the right suprarenal position. Contrast-enhanced computed tomography scan revealed a cystic lesion without any enhancement, suggesting adrenal hemorrhage. Neonate was managed conservatively with serial hemoglobin and bilirubin levels. We present this case in view of rare presentation with mass, pallor, and direct hyperbilirubinemia.
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Skin necrosis after extravasation of intravenous vancomycin in a 1-month-old infant: A case report and description of treatment options p. 172
Robabeh Ahmadli, Narges Farshadpour, Zahra Kaffash, Abolfazl Mohammadbeigi
In this case report, we describe a patient with extravasation injury with vancomycin given through a peripheral catheter. Extravasation occurs more in children and old people. A 1-month-old girl came to the hospital complaining of lethargy, poor feeding, fever, dyspnea, coughing, and cyanosis and was admitted in the neonatal department. The patient was diagnosed with pneumonia after blood tests and chest radiography. On the 2nd day of treatment, the nurse noticed extravasation of vancomycin with severe painful blistering surrounding the infusion site on the patient's left leg. Necrotic ulcer at the vancomycin leakage site was visible. Moreover, according to the surgeon, necrotic ulcer needed debride. However, modern dressing with collagen besides the combination dressing of Aquasel Ag+, foam Aquasel, and ColActive collagen was used for treatment. The patient's wound was improved with modern dressing and was recovered after 31 days. She was discharged from the hospital without a certain problem.
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Double encephalocele arising from single bone defect: A rare case p. 176
Dileep Garg, Aditya Pratap Singh, Ramesh Tanger, Arun K Gupta
Encephalocele is the protrusion of the cranial contents beyond the normal confines of the skull through a defect in the calvarium. The occurrence of more than one encephalocele in a patient is very rare, and very few cases of double encephalocele have been reported. We report here a case of double encephalocele over the occipital area in a newborn. At the time of surgery, we found that both were arising from a single bone defect with separate sac. Both were repaired, and the patient was discharged uneventfully.
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Congenital midline cervical cleft in a neonate born to diabetic mother – An unusual association p. 178
Haseena Sait, Ashish Jain, Seema Kapoor
Congenital midline cervical cleft is a rare developmental anomaly of the neck region with only 200 cases reported till date. This case report highlights an unusual association of congenital midline cervical cleft and maternal diabetes. We report a neonate born to a mother with uncontrolled type 2 diabetes who presented with a midline neck lesion characterized by a proximal skin tag, middle mucosal surface and a distal blind sinus causing micro retrognathia with no other visible malformation. Most of the cases reported till date have a sporadic occurrence. This is the first possible report of this anomaly in a neonate of diabetic mother. This raises a possibility of being a part of diabetic embryopathy, however occurrence by chance cannot be completely ruled out.
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Term neonate with necrotizing enterocolitis and prothrombin mutation p. 180
Samuel Morrison Miller, Amanda Zhou, David J Worhunsky, Daniel G Solomon, Doruk E Ozgediz
The pathophysiology of necrotizing enterocolitis (NEC) in term neonates is unknown. A 37-week-old coagulopathic newborn with NEC was taken to the operating room for exploratory laparotomy and was found to have intermittent areas of necrosis from the cecum through the transverse colon. Right hemicolectomy was performed with end ileostomy. Genetic testing at 9 months of age revealed a prothrombin G20210A mutation. Hypercoagulation workup should be considered for term neonates found to have NEC without a clear etiology.
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Early-Onset Neonatal Pneumococcal Sepsis and Meningitis p. 183
Amaia Aguirre-Quiñonero, Felicitas Elena Calvo Muro, Blanca Lodoso Torrecilla, Andrés Canut Blasco
Streptococcus pneumoniae invasive neonatal infection usually occurs during the second or third week of life and is infrequent in developed countries. Diagnosis remains challenging since clinical features of pneumococcal neonatal sepsis are indistinguishable to those produced by Streptococcus agalactiae (GBS) sepsis. Here we report a case of early-onset S. pneumoniae sepsis and meningitis by serotype 23F, included in the 13-valent vaccine (PVC13).
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Neonatal thrombosis after antenatal treatment of neonatal alloimmune thrombocytopenia with intravenous immunoglobulin p. 186
Ashley R. P Hinson, Matthew Saxonhouse
Neonatal alloimmune thrombocytopenia (NAIT) may lead to serious complications, including perinatal intracranial hemorrhage and death. Mothers with a history of previously affected pregnancies should receive antenatal treatment with intravenous immunoglobulin (IVIG), which can be associated with toxicities including thrombosis. An infant born to a mother treated with IVIG and steroids was diagnosed with an inferior vena cava thrombus shortly after birth, was anticoagulated and recovered. Thus, this side effect can be seen, and should be considered, in infants of NAIT-affected pregnancies treated with IVIG.
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Spontaneous duodenal perforation in a neonate: A rare case report p. 189
Jayalaxmi Shripati Aihole
Spontaneous duodenal perforation in neonates (SDPN) is a rare surgical emergency. Only few cases have been reported occurring at the second part of the posterior part of duodenum. The author presents such a rare case of SDPN in a healthy female neonate managed successfully at a tertiary care institute.
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