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   Table of Contents - Current issue
January-March 2021
Volume 10 | Issue 1
Page Nos. 1-57

Online since Monday, February 8, 2021

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Impact of early referral on immediate outcome of asphyxiated newborns p. 1
Poorva Gohiya, Namrata Ubriani, Rashmi Dwivedi
Introduction: Perinatal asphyxia is a significant cause of neonatal morbidity and mortality. Early recognition of perinatal asphyxia and timely referral to centers well equipped in postresuscitation management helps to minimize unfavorable consequences. We did this observational study with the aim of finding out the impact of referral timings on early (72 h) outcome of asphyxiated newborns. Materials and Methods: This is a prospective observational study conducted in the sick newborn care unit, of a teaching institute in central India, over a period of 12 months. We enrolled 150 full-term neonates admitted with perinatal asphyxia. Their early outcome was recorded and analyzed. Results: The short-term outcome of asphyxiated neonates at 72 h of admission was significantly better when they were admitted within 6 h of birth. Conclusion: Early recognition of birth asphyxia and timely referral helps in reducing morbidity and mortality in neonates.
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Clinical manifestation of necrotizing enterocolitis in preterm infants: 8 years' expeience in a tertiary care center p. 5
Sarrh Siddig Sobeir, Mustafa Qaraqei, Tariq Wani, Abdulrahman AlMatary
Background: Necrotizing enterocolitis (NEC) is the most common devastating acquired disease of the gastrointestinal tract in preterm infants. Objective: The study is aimed to evaluate maternal, infant risk factors, and radiological manifestation, in addition to the outcome. Methodology: This was a retrospective cohort study, all preterm infants born <32 weeks that were delivered in our tertiary care hospital from January 2011 to December 2018 with a confirmed diagnosis of NEC. Results: Forty-nine infants full-filled the inclusion criteria. The average weight of infants with NEC was 970 g (1028 ± 401) with P= 0.05. The gestational age of affected infants was 27.5 ± 2.9 weeks with P= 0.007, the average age of NEC diagnosis was 14.8 ± 11.2 days and their average length of stay was 79.9 ± 57.5 days with valueP = 0.015. Bowel stricture occurred in 4 (8.2%) infants with P < 0.001. Short bowel syndrome occurred in 1 (2%) infants with P < 0.001. Bronchopulmonary hypoplasia occurred in 24 (49%) with P < 0.001. Retinopathy of prematurity occurred in 9 (18.8%) with P < 0.001. Conclusion: Maternal parity multigravida had increased risk by more than double. More than half of our babies developed advanced NEC, which is double the reported figures found in other studies, which indicate routine needs to use of probiotics.
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Comparison of perfusion index and echocardiographic parameters in preterm infants with hemodynamically significant patent ductus arteriosus p. 11
Melek Buyukeren, Şule Yiğit, Hayrettin Hakan Aykan, Tevfik Karagöz, Hasan Tolga Çelik, Murat Yurdakök
Background/Aim: The aim of the study was to compare echocardiographic parameters and the perfusion index (PI) and plethysmographic variability index (PVI) values obtained by routine pulse oximetry in the diagnosis of hemodynamically significant patent ductus arteriosus (hsPDA). Materials and Methods: This prospective study was conducted between 2016 and 2017 at the HacettepeUniversity Neonatal Intensive Care Unit. The study included premature neonates who had a birth weight below 1500 g. Patients were routinely monitored from the right wrist and right foot using a pulse oximeter (Masimo Radical-7® Pulse CO-Oximetry), and PI and PVI values were recorded. The difference between right-hand and right-leg PI values was calculated as the delta PI (ΔPI). A cardiologist blinded to the results evaluated the presence of patent ductus arteriosus (PDA) with echocardiography on postnatal days 1th, 3rd, and 7th. Results: Of the 66 preterm neonates included in the study, 23 had hsPDA. On postnatal day 1, the hsPDA group had a significantly greater ductal diameter, PDA/left pulmonary artery (LPA) ratio, and left ventricle (LA)/aortic (Ao) ratio (P < 0.05). On day 7, the hsPDA group had a significantly higher ductal velocity, PDA/LPA ratio, LA/Ao ratio, antegrade PA and LPA diastolic flow, and LV/Ao ratio (P < 0.05). In hsPDA group, the median ΔPI values were 0.85 (25–75 interquartile range [IQR]; 0.62–1.15) on day 1; 1.03 (25–75 IQR; 0.85–1.26) on day 3; and 0.89 (25–75 IQR; 0.64–1.22) on day 7. The median (25–75 IQR) ΔPI values were higher in the hsPDA group than in the non-hsPDA group on postnatal days 1, 3, and 7 (P < 0.001, P < 0.001, and P < 0.001, respectively). The ΔPI cutoff values for the diagnosis of hsPDA were 0.47 on day 1 (91.3% specificity; 90.5% sensitivity), 0.41 on day 3 (100% specificity; 97.3% sensitivity), and 0.47 on day 7 (90% specificity; 100% sensitivity). Conclusions: Our study shows that the difference between PI values (ΔPI) in the right hand and right leg obtained by pulse oximetry has diagnostic value in hsPDA and can assist diagnosis when echocardiography is not available.
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The predictive factors for poor outcomes in preterm infants with coagulase-negative staphylococci infection p. 19
Abdulrahman Al-Matary, Roya Huseynova, Mostafa Qaraqe, Faisal K Aldandan
Background: The main pathogen for neonatal nosocomial infections is coagulase-negative staphylococci (CoNS), particularly in very low-birth-weight and premature newborns. The current study is aimed to assess the outcomes of preterm infants with CoNS infection via a retrospective analysis, to determine the correlation between the clinical profile and mortality and morbidity, and to determine the factors associated with poor outcomes. Materials and Methods: This retrospective case–control study was conducted in the Children's and Women's Health Centre of King Fahad Medical City neonatal intensive care unit in Saudi Arabia. The study period was from January 2013 to December 2019. Results: There were 1333 controls and 137 cases of CoNS infection. There was a significant association between total parenteral nutrition use, surgical insertion of a central line, inotrope use, and spontaneous intestinal perforation and CoNS infection. There was a significant association between umbilical vein catheter (UVC) and peripherally inserted central catheter (PICC) line use and CoNS infection. The use of a UVC or PICC line significantly impacted. The presence of patent ductus arteriosus also significantly impacted. Conclusions: There was a significant association between UVC and PICC line use and outcome. The presence of patent ductus arteriosus or a perforated bowel and the need for inotrope use in CoNS infection was associated with poor outcomes. Mortality, retinopathy of prematurity, and necrotizing enterocolitis requiring surgery were more common in infants with CoNS infections.
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Early clinical outcome and complications associated in neonates with hypoxic ischemic encephalopathy grade II/III who underwent treatment with servo controlled whole-body therapeutic hypothermia: A prospective observational study p. 24
Abhishek K Phadke, Ali Kumble, Kushal Ravikumar
Background: There are limited data regarding servo-controlled whole-body therapeutic hypothermia (TH) for neonates with hypoxic-ischemic encephalopathy (HIE) Stage II/III in the Indian setting. The objectives of this study were to determine the early clinical outcome of neonates with HIE Stage II/III treated with TH and to determine the mortality rate and associated complications. Methods: This study was a prospective observational study done at a Level 3A National Neonatology Forum accredited tertiary care neonatal intensive care unit (NICU). Term neonates with HIE Grade II/III admitted to NICU within 6 h of birth were enrolled in the study. Subjects underwent servo-controlled whole-body therapeutic cooling as per the research protocol. Results: Out of 54 subjects, 22 (40.7%) had stage II HIE and 32 (59.3%) had Stage III. The mortality rate was 24% (n = 13), with all having Stage 3. Direct breastfeeds was achieved in 65.9% of successfully cooled babies within 48 h after TH treatment. About 85.4% of babies who were successfully cooled had good early clinical outcomes as evidenced by good activity, normal tone, successful direct breastfeeding, and early discharge within 72 h post treatment with TH. Coagulopathy was observed in 70.4%, raised liver enzymes in 96.3% and thrombocytopenia in 9.3%. Conclusion: There is a significant correlation of grade of encephalopathy and blood gas abnormality at admission with the outcome in babies with HIE treated with TH. Majority of babies with HIE stage 2/3 who successfully completed TH had good early clinical outcomes at the time of discharge.
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Retinopathy of prematurity: Incidence and perinatal risk factors in a tertiary hospital in Saudi Arabia p. 31
Huda Khalid Ahmedhussain, Waleed W Khayyat, Bashaer M Aldhahwani, Abdullah Omar Aljuwaybiri, Nooran Osama Badeeb, Muhammad Anwar Khan, Mansour Abdullah Al-Qurashi, Hashem S Almarzouki
Purpose: This study aims to estimate the incidence of retinopathy of prematurity (ROP) and investigate its perinatal and neonatal risk factors in a tertiary hospital in Saudi Arabia. Methodology: This was a retrospective cohort study of premature infants admitted to a neonatal intensive care unit at a tertiary hospital in Jeddah, Saudi Arabia, from January 2016 to December 2017. Participants who met the screening criteria for ROP were included and followed up until spontaneous recovery or laser treatment. Results: A total of 119 infants screened, the incidence of ROP was 21.8% (26/119). A plus disease was diagnosed in 15.4% (4/26) of the ROP infants. For most, 80.7% (21/26) of the ROP regressed spontaneously, and 19.2% (5/26) required a laser intervention. The mean gestational age (GA) of infants diagnosed with ROP was 25.62 ± 1.58 weeks and the median birth weight (BW) 750 (interquartile range: 280) g. Lower GA, lower BW, prolonged oxygen therapy, and mechanical ventilation (MV) were significantly related to ROP disease and severity. Requiring resuscitation at birth, a lower Apgar score at 1-min, poor weight gain proportion at 6 weeks, and requiring a blood transfusion were significantly associated with ROP disease. Conclusion: Compared to other local studies, the incidence of ROP was lower in our population. Lower GA, low BW, prolonged oxygen therapy and MV, and poor weight gain at 6 weeks are well-documented risk factors. We recommend close monitoring of weight gain and oxygen therapy and modifying risk factors in preterm infants to lower the incidence and the severity of ROP.
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Utilization of health-care resources of preterm infants during their first 2 years of life after discharge from neonatal intensive care unit p. 37
Mohammed Yasir Al-Hindi, Zeyad Mohammed Alshamrani, Waiel Ahmed Alkhotani, Abdulrahman Bassam Albassam, Abdullah Mohammed Amin Tashkandi, Mansour Abdullah AlQurashi
Background: Preterm birth is the most significant factor for infant morbidity and mortality. Preterm infants are highly vulnerable to substantial comorbidities and need to be admitted to the neonatal intensive care unit (NICU). Prematurity and low birth weight (LBW) of infants, in particular, have been found to have a higher substantial burden on family resources and health-care resources after discharge from the hospital. Objective: To obtain data as a basis for strategic planning and efficient delivery of health-care resources, this study aims to determine the extent of health-care facility utilization among preterm infants during their first 2 years of life after discharge from the NICU. Materials and Methods: This was a retrospective cohort study design by reviewing the electronic medical records of preterm infants (i.e., <37 weeks' gestation) who were discharged from the NICU. Their outcomes were compared to healthy term infants. All examined infants were delivered at King Abdulaziz Medical City, Jeddah, Saudi Arabia, from June 1, 2016, to April 30, 2018. Results: In this single-center study, the NICU admission rate was 8.6%, and 4.18% of those were premature. In terms of facility utilization, preterm infants had a significantly higher frequency of outpatient visits, laboratory, and radiology performed as compared to healthy term infants. Preterm infants were also significantly and more likely to be admitted to the inpatient department. In subgroup analysis, very preterm, extremely preterm, low birth weight (LBW), very LBW (VLBW), and extremely LBW (ELBW) infants had higher outpatient visits and higher laboratory and radiology performed. Conclusions: Preterm infants utilized more health-care resources than healthy term infants. Very preterm, extremely preterm, VLBW, and ELBW infants had more outpatient visits and utilized the laboratory and radiology services more often than other subgroups. This study suggests developing an innovative strategic plan to effectively meet preterm infants' health-care needs, particularly by improving services in mostly utilized hospital resources.
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Meconium peritonitis in trisomy 21 masquerading as hydrops fetalis p. 45
Pamela Si Min Ng, Priyantha Ebenezer Edison, Narasimhan Kannan Laksmi, Ashwani Bhatia, Sridhar Arunachalam
Meconium peritonitis (MP) is a rare etiology for nonimmune hydrops fetalis. We report a neonate delivered at 32 weeks' gestation in the context of antenatally diagnosed hydrops fetalis and first-trimester screening at high risk for Trisomy 21. The postnatal abdominal radiograph was striking for gross ascites, the paucity of bowel gas, and widespread calcifications, suggestive of MP and chromosomal analysis confirmed Trisomy 21. Exploratory laparotomy performed on day 3 of life revealed a large pseudocyst, ileal atresia with ileal perforation. MP masquerading as nonimmune hydrops fetalis in Trisomy 21 with ileal atresia is an extremely rare presentation, seldom reported in the literature.
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Early-onset neonatal sepsis due to Streptococcus Pneumoniae: A rare causative organism in neonates p. 48
Sana Niaz, Azeem Khan, Vikram Kumar, Syed Rehan Ali
Streptococcus pneumoniae (pneumococcus) is a common respiratory tract pathogen in children causing otitis media, sinusitis, bacteremia, and meningitis. Although comparatively rare, this pathogen can also cause early-onset neonatal sepsis (EONS) as well as late-onset neonatal sepsis and can mimic Group B streptococcal sepsis-like illness in neonates. S. pneumoniae can be transmitted vertically from maternal vaginal tract colonization or from the placenta through hematogenous spread. Two consecutive case reports of EONS are reported. Vaccination of the mother with pneumococcal polysaccharide vaccine during the third trimester may provide protection to infants by enhancing the transplacental transfer of active immunoglobulin (IgG) to the fetus, as well as improving the availability of secretory antibodies for the fetus through mother's milk. Immunization of the mother may also prevent genital colonization through resulting high levels of IgG plus mucosal CD17 lymphocytes.
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Congenital mandibular granular cell tumor in a male neonate: A rare case report p. 52
Ananta Rattan, Kamal Nain Rattan
Congenital epulis or granular cell tumors are rare neonatal oral tumors. We report the case scenario of a male neonate presenting with congenital epulis on day 2 of life on the mandibular alveolar ridge. It was successfully treated with surgical resection under general anesthesia. During our wide review of the literature, we could not find a single case reporting a mandibular granular cell tumor in a male neonate.
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Leprechaunism as initial presentation in french canadian type of leigh disease in a neonate: Index of suspicion p. 54
Anil Kumar Poonia, Suchitra Garhwal, Anupam Chaturvedi
French Canadian type of Leigh syndrome (LSFC) presents with various neurological manifestations such as mental retardation, dysmorphic facies, hypotonia, ataxia, and have high risk of mortality. Leprechaunism is manifest as persistent hyperglycemia because of extreme insulin resistance. Our case is unique as the association of leprechaunism and LSFC is not documented in any literature. We hereby report a case of leprechaunism as initial presentation in LSFC.
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Study determinants of neonatal mortality among newborns admitted to neonatal intensive care unit Adama, Ethiopia: A case–control study p. 56
Ghulam Nabi
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