Home Print this page Email this page Small font sizeDefault font sizeIncrease font size
Users Online: 239
 
About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Advertise Reader Login
     
Export selected to
Endnote
Reference Manager
Procite
Medlars Format
RefWorks Format
BibTex Format
  Citation statistics : Table of Contents
   2013| April-June  | Volume 2 | Issue 2  
    Online since August 13, 2013

 
 
  Archives   Previous Issue   Next Issue   Most popular articles   Most cited articles
 
Hide all abstracts  Show selected abstracts  Export selected to
  Cited Viewed PDF
REVIEW ARTICLE
Bilirubin neurotoxicity in preterm infants: Risk and prevention
Vinod K Bhutani, Ronald J Wong
April-June 2013, 2(2):61-69
DOI:10.4103/2249-4847.116402  PMID:24049745
Hemolytic conditions in preterm neonates, including Rhesus (Rh) disease, can lead to mortality and long-term impairments due to bilirubin neurotoxicity. Universal access to Rh immunoprophylaxis, coordinated perinatal-neonatal care, and effective phototherapy has virtually eliminated the risk of kernicterus in many countries. In the absence of jaundice due to isoimmunization and without access to phototherapy or exchange transfusion (in 1955), kernicterus was reported at 10.1%, 5.5%, and 1.2% in babies <30, 31-32, and 33-34 wks gestational age, respectively. Phototherapy initiated at 24±12 hr effectively prevented hyperbilirubinemia in infants <2,000 g even in the presence of hemolysis. This approach (in 1985) reduced exchange transfusions from 23.9% to 4.8%. Now with 3 decades of experience in implementing effective phototherapy, the need for exchange transfusions has virtually been eliminated. However, bilirubin neurotoxicity continues to be associated with prematurity alone. The ability to better predict this risk, other than birthweight and gestation, has been elusive. Objective tests such as total bilirubin, unbound or free bilirubin, albumin levels, and albumin-bilirubin binding, together with observations of concurrent hemolysis, sepsis, and rapid rate of bilirubin rise have been considered, but their individual or combined predictive utility has yet to be refined. The disruptive effects of immaturity, concurrent neonatal disease, cholestasis, use of total parenteral nutrition or drugs that alter bilirubin-binding abilities augment the clinical risk of neurotoxicity. Current management options rely on the "fine-tuning" of each infant's exposure to beneficial antioxidants and avoidance of silent neurotoxic properties of bilirubin navigated within the safe spectrum of operational thresholds demarcated by experts.
  28 8,796 1,902
CASE REPORTS
Pentalogy of cantrell: An extremely rare congenital anomaly
Suresh Chandran, Dinesh Ari
April-June 2013, 2(2):95-97
DOI:10.4103/2249-4847.116410  PMID:24049753
A baby with the complete form of pentalogy of Cantrell was delivered at 33 weeks of gestation. The hallmark of this syndrome is ectopia cordis (EC) with omphalocele. Even though a fetal diagnosis was made at 14 weeks, parents have decided to continue with the pregnancy. Early antenatal ultrasonographic diagnosis is essential as survival depends mostly on the EC, associated cardiac anomalies and degree of thoraco-abdominal defect. Fetal diagnosis of this lethal anomaly before viability gives the parents an option of termination.
  21 9,398 645
ORIGINAL ARTICLES
Oral nystatin versus intravenous fluconazole as neonatal antifungal prophylaxis: Non-inferiority trial
Ali Mersal, Ibrahim Alzahrani, Mahasen Azzouz, Adel Alsubhi, Heba Alsawaigh, Nouf Albshri, Manal Bajammal, Ghazal Avand, Abdulmajid Almahbosh
April-June 2013, 2(2):88-92
DOI:10.4103/2249-4847.116408  PMID:24049751
Background: Fluconazole has shown to be effective in reducing both colonization and invasive Candida infection (ICI) in ELBW neonates; we conducted a randomized trial to compare oral nystatin with intravenous fluconazole for prophylaxis against invasive Candidiasis in high risk neonates. Materials and Methods: By using SPSS, preterm less than 30 weeks gestation and/or birth weight 1200 grams or less assigned to receive either intravenous Fluconazole (6 mg/kg q72 hr for 1 st week then q48 h for 6 wks) or oral Nystatin (100,000 unit q8 hr for 6 wks). The medications commenced at one week of age after obtaining the base line investigations and check for Candida colonization by urine culture and rectal swab; subsequently all lab work and the clinical data were monitered regularly. Risk factors were assessed. The data collected prospectively looking for primary end point the invasive Candida infection (ICI) and 2 ndry outcomes include medication safety, tolerance and cost. Results: 65 neonate randomly assigned however only 57 neonates comleted the study 33/57 (57%) to intravenous fluconazole group and 24/57 (42%) to oral nystatin group. No differences in birth weights Nystatin (1.15 Kg) Fluconazole (1.01 Kg), gender males (26/57), female (32/57), Gestational age (29.28 vs l28.22) or risk factors between the two groups. Rectal swab Colonization occurred in 2/24 (8%) in Nystatin group and 4/33 (12%) in the Fluconazole group, but none of the neonates developed ICI or side effects, although in the Fluconazole group transient transaminase elevation 2SD standard deviation above the mean was observed. Central line duration was 2 SD above the mean for fluconazole group, The cost of the Fluconazole treated group (7,581 SAR) 106.4 US/pt double the cost of Nystatin treated group (3,375 SAR) 50 US/pt. Conclusion: Intravenous Fluconazole and oral Nystatin at the prophylactic doses are equally effective and safe in preventing (ICI) in preterm neonates, however oral Nystatin is readily available, easily administered with lower cost per neonate.
  11 4,272 614
EBN SYNOPSIS
Oxygen saturation and outcomes in preterm infants the boost ii United Kingdom, Australia, and New Zealand collaborative groups
Emad Khadawardi, Fahad Al Hazzani
April-June 2013, 2(2):73-75
DOI:10.4103/2249-4847.116404  PMID:24049747
  10 2,806 460
ORIGINAL ARTICLES
Risk factors and outcomes of persistent pulmonary hypertension of the newborn in neonatal intensive care unit of al-minya university hospital in Egypt
Abdel Hakeem Abdel Mohsen, Amr Salah Amin
April-June 2013, 2(2):78-82
DOI:10.4103/2249-4847.116406  PMID:24049749
Background: Persistent pulmonary hypertension of the newborn (PPHN) result from the failure of the normal fetal-to-neonatal circulatory transition is associated with substantial infant mortality and morbidity. Objective: To estimate the possible risk factors and assess the outcome of these cases. Materials and Methods: Prospective study was performed enrolling all full-term and post-term newborn admitted to the NICU from January 2009 to April 2012, All neonates were subjected to complete history and physical examination, laboratory data including a complete blood count, arterial blood gases, blood glucose, serum electrolytes, and blood culture to exclude sepsis. Cases with PPHN had a continuous pulse oximeter, blood pressure and electrocardiography monitoring. Chest X-ray and echocardiogarphy were carried out to verify shunt and exclude structural congenital heart disease. Results: Out of the studied 640 infants, 32 infants (5%) developed PPHN, Meconium aspiration, birth asphyxia, hyaline membrane diseases, neonatal septicemia, post-term birth being large for gestational age, cesarean section, maternal overweight, and diabetes mellitus were associated with an elevated risk for PPHN. All neonates treated with O 2 , 10 neonates with Mg sulphate, 16 with oral sildenafil and 12 with mechanical ventilation. After 6 months follow-up, 12 (37.54%) improved and followed-up without sequelae, 4 (12.5%) developed some neurodevelopmental impairment, 8 (25%) died, 3 (9.3%) developed chronic lungs diseases, 2 (6.2%) developed hearing defects and another 3 (9.3%) missed follow-up. Conclusion: PPHN was found in 5% of the studied population. Meconium aspiration, birth asphyxia, neonatal septicemia, post-term were associated with an elevated risk for PPHN. As this is a unit based study, a comprehensive countrywide survey on PPHN in Egypt is recommended to determine any regional differences in disease incidence.
  7 3,997 817
CASE REPORTS
Caudal duplication syndrome
Amitava Sur, Syamal Kumar Sardar, Anshuman Paria
April-June 2013, 2(2):101-102
DOI:10.4103/2249-4847.116412  PMID:24049755
Caudal duplication syndrome is a rare entity in which structures derived from the embryonic cloaca and notochord are duplicated to various extents. Its prevalence at birth is less than 1 per 100,000. The term caudal duplication encompasses a spectrum of anomalies and is often used to describe incomplete separation of monovular twins or referred to as part of the spectrum of anomalies associated with conjoined twinning. It usually includes multiple rare malformations and duplications of distal organs derived from the hindgut, neural tube, and caudal mesoderm. It was postulated that the disorder is related to misexpression of one or more of the distal HOX genes, potentially HOX10 or HOX11, leading to abnormal proliferation of caudal mesenchyme. The malformations are usually diagnosed by anomaly scan in the second trimester. Here we report the case of a baby presenting on the first day of life with complete duplication of caudal structures below the dorsolumbar level.
  6 3,535 329
Imaging in classic form of maple syrup urine disease: A rare metabolic central nervous system
Aditi Jain, K Jagdeesh, Ranoji Mane, Saurabh Singla
April-June 2013, 2(2):98-100
DOI:10.4103/2249-4847.116411  PMID:24049754
Maple syrup urine disease (MSUD) is a rare autosomal recessive disorder of branched-chain amino acid metabolism. The condition gets its name from the distinctive sweet odour of affected infants' urine. MSUD is caused by a deficiency of the branched-chain α-ketoacid dehydrogenase enzyme complex, leading to accumulation of the branched-chain amino acids (leucine, isoleucine, and valine) and their toxic by-products (ketoacids) in the blood and urine. Imaging is characterestized by MSUD oedema affecting the myelinated white matter. We present a neonate with classic type of MSUD and its imaging features on computed tomography, conventional magnetic resonance imaging, diffusion-weighted imaging, and magnetic resonance spectroscopy.
  5 4,397 510
EBN SYNOPSIS
A randomized controlled trial to compare heated humidified high-flow nasal cannulae with nasal continuous positive airway pressure postextubation in premature infants
Lena Ignacio, Khalid AlFaleh
April-June 2013, 2(2):75-77
DOI:10.4103/2249-4847.116405  PMID:24049748
  4 2,332 471
CASE REPORTS
Salmonella paratyphi B septicemia in a neonate
Pratibha Bhat, Meena Dias, Roopa Hegde, Hilda Pinto
April-June 2013, 2(2):93-94
DOI:10.4103/2249-4847.116409  PMID:24049752
Septicemia is a major cause of death in neonates especially in developing countries. We report a case of septicemia in a neonate due to Salmonella Paratyphi B. The baby responded well to therapy and recovered completely.
  3 2,157 229
EBN SYNOPSIS
Effects of targeting higher VS lower arterial oxygen saturations on death or disability in extremely preterm infants: The canadian oxygen trial
Fahad Al Hazzani, Emad Khadawardi
April-June 2013, 2(2):70-72
DOI:10.4103/2249-4847.116403  PMID:24049746
  3 2,170 384
IMAGES IN CLINICAL NEONATOLOGY
A typical manifestation of birthmark-becker's nevus syndrome
Rajdhar Dutt, Chandrakala Dutt
April-June 2013, 2(2):106-107
DOI:10.4103/2249-4847.116414  PMID:24049757
Full born term male baby having hyperpigmentation over back of neck and back of chest. The colour of nevus is black coloured. Hyperpigmented area is slightly hypertrophy. Imaging, X-ray spine, X-ray fingers and toes, X-ray chest, ultrasound of abdomen, CT scan of brain-normal. Treatment advised: Pigmentation can be reduced by pigment laser.
  1 2,519 238
An atypical form rhizomelic chondrodysplasia punctata in a newborn
Sitangshu Chatterjee, Praytay Roy, Ira Das, MK Sinha
April-June 2013, 2(2):108-109
DOI:10.4103/2249-4847.116415  PMID:24049758
Rhizomelic Chondrodysplasia punctata (RCDP) is an autosomal recessive metabolic disorder affecting mainly peroxisomal function. We describe a case of RCDP in a 12 days old newborn based on the clinical and radiological ground without any major systemic structural or functional abnormalities.
  1 3,317 265
ORIGINAL ARTICLES
Importance of obtaining lumbar puncture in neonates with late onset septicemia a hospital based observational study from north-west India
Varun Kaul, Rekha Harish, Sandesh Ganjoo, Bella Mahajan, Sunil Kumar Raina, Diptiman Koul
April-June 2013, 2(2):83-87
DOI:10.4103/2249-4847.116407  PMID:24049750
Objectives: The objective of this study was to estimate the prevalence of meningitis in cases with late onset septicemia (LOS). Materials and Methods: A prospective study was carried out for a period of 1 year in a tertiary care hospital in North West India to estimate the prevalence of meningitis in cases of LOS. In all the admitted neonates with features of sepsis with a positive C-reactive protein, a lumbar puncture (LP) was carried out and results interpreted on the basis of cerebrospinal fluid (CSF) cytology and biochemistry. Simultaneous blood and CSF cultures were also taken. All other baseline investigations were performed and in those diagnosed as meningitis an ultrasound head was carried out prior to discharge. No urine cultures were obtained. Results: The study showed the prevalence of meningitis as 22.5% in neonates with LOS with statistically significant implications of meningitis versus gestation, sex, acquired the place of infection, and outcome in terms of sequelae/mortality. Conclusions: Meningitis is commonly associated with late onset sepsis hence LP should be the standard of care in such neonates as the treatment protocol and the outcome is directly proportional to the diagnosis at initial presentation.
  1 2,503 400
CASE REPORTS
Near total jejuno ileal atresia: A management challenge
Minakshi Sham, Dasmit Singh
April-June 2013, 2(2):103-105
DOI:10.4103/2249-4847.116413  PMID:24049756
A 2-day-old female neonate with the clinical picture of proximal small bowel atresia, on exploration, turned out to have intestinal atresia of a rare variety, i.e., a near-total jejuno-ileal atresia. The baby had total small bowel length of less than 10 cm. She survived for 3 months on enteral feeding after end-to-back duodeno-ileal anastomosis and thereafter succumbed to septicemia. The case is presented for it's extreme rarity and consideration of this extreme form of small bowel atresia as an offshoot of the existing classifications of jejuno-ileal atresia since it has dismal prognosis and presents as a management challenge even today.
  - 3,026 244
ERRATUM
Erratum

April-June 2013, 2(2):111-111
  - 1,053 101
LETTER TO EDITOR
Neonatal early onset sepsis due to anaerobies: Myth or realities: A review of medical record in one neonatal centre
Herve B Chatue Kamga
April-June 2013, 2(2):110-111
DOI:10.4103/2249-4847.116416  PMID:24049759
  - 1,648 216
Feedback
Subscribe