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Background Antenatal corticosteroid (ACS) is used in women at risk of preterm births to reduce mortality and morbidity of the neonate born. However it's effect may not always be beneficial especially in the women with risk factors for sepsis which is quiet high in developing countries. Methods Neonates (26–35 weeks gestational age) delivered to mothers who received 2–4 doses of ACS (group1) or 0–1 dose (group 2) were compared for incidence, severity of Respiratory distress syndrome (RDS) and death. Various morbidities of prematurity were also compared among the two groups. Results Less number of neonates developed RDS in group1 (28.1%) than group 2(37.8%) (p = 0.011). Few babies needed CPAP in group 1 (34.1% vs 53.9%; 0.006), however more babies needed mechanical ventilation (MV) (62.2% vs 41.7%; 0.005) in group 1. Mortality was similar (20.5% vs 20.1%; p = 0.71). Group 1 neonates with 2–4 doses of ACS had less Intraventricular hemorrhage (IVH) (0.3% vs 2.6%; p = 0.04) but sepsis rates (12% vs 6.2%; 0.02) were increased. Other morbidities of prematurity were comparable. Conclusion Similar to the previous literature, decrease in incidence of RDS and IVH was found in neonates with higher (2–4) doses of ACS. However more cases of culture positive sepsis and severe RDS occurred in these neonates.

Background: Oral application of mother's own milk (MOM) in very low birth weight (VLBW) neonates may provide an effective method of cleaning the oral cavity and influencing the immunocompetent cells there. Methods: A double-blind randomized controlled trial was conducted in a tertiary level neonatal unit on VLBW neonates; that is, neonates with birth weight

Citrobacter sedlakii is a Gram-negative bacillus, usually a non-pathogenic organism, found in human stool. However, it may rarely cause devastating illness in human beings. We are describing a case of C. sedlakii meningitis and brain abscess in a neonate. To the best of our knowledge, this is the second case, of C. sedlakii causing complicated meningitis in a neonate in the world.

Background Depressed neonates born through meconium stained amniotic fluid (MSAF) are at high risk for developing meconium aspiration syndrome (MAS). Benefits and risk of endotracheal suctioning in non-vigorous infants at birth, though widely practiced till recent have not been established. Objectives To evaluate effect of endotracheal suctioning at birth on incidence of MAS, its severity and outcome among non-vigorous MSAF born infants. Methods This randomized open level trial was conducted over one year period at a tertiary care teaching hospital. 155 non-vigorous infants (vigour assessed within 5–10s of birth) were randomized to receive either endotracheal (ET) suctioning just after birth (n=76) or no-endotracheal suction (n=79). Subsequent resuscitation was performed as per neonatal resuscitation guideline. All infants were admitted for subsequent care and monitoring. Antenatal, intrapartum, and neonatal details; respiratory support; complications, hospital stay and outcome were recorded. Results Incidence of respiratory distress due to MAS (with consistent chest radiology) was 41.3% and 57.1% [OR=0.53(0.28to 1.01); p=0.052], while non-MAS respiratory distress was 33.3% and 27.3% [OR=1.69(0.81 to 3.54); p=0.17] in ET suction and no-ET suction group, respectively. Severity of MAS in ET suction vs. no-ET suction group were mild:16.1%(5/31)vs15.9%(7/44); moderate:61.3%(19/31)vs65.9%(29/44) and severe:22.6%(7/31)vs18.2% (8/44). Respiratory support requirement including mechanical ventilation; its duration, and mortality were similar in both groups, however, hospital stay was shorter in ET suction group (9.91±3.22vs. 11.17±3.73days; mean diff:−1.26(−3.36 to −0.17); p=0.024). Conclusions Endotracheal suctioning at birth in non-vigorous infants born through MSAF tends to decrease the incidence of MAS and duration of hospital stay, however, overall incidence of respiratory distress and mortality remain unchanged.

Introduction Vitamin D deficiency (VDD) is rampant in neonates. Recommendations for supplementation are variable. Methods An observational study was done on less than 32 weeks of very low birth weight neonates to find prevalence of VDD ( Results Of 83 neonates, 81 (97.6%) were VDD at baseline and 5 (6%) at 38 ± 2 weeks PMA. Determinants for VDD at baseline were inadequate maternal sun exposure (p 24 h ( Conclusions In preterm VLBW neonates, the prevalence of VDD was 97.6% but decreased by >90% at 38 ± 2 weeks with a daily intake of 800 IU vit D. Inadequate maternal vit D intake and sun exposure determined low baseline vit D status of neonates. Male gender, morbidities, ventilation, sepsis, caffeine, missed vitamin D supplements were determinants of poor vit D status at follow-up. Weight gain and length increments were more in the VDS group.

Congenital heart disease is a major cause of morbidity and mortality in children. We are presenting a 2-month-old infant with large ostium secundum atrial septal defect (ASD) with congestive heart failure. Isolated ASD usually does not present at this age. We are presenting this case due to unusual early presentation with isolated ASD.

Background: Most of the morbidity and mortality of very low birth weight (VLBW) neonates are due to oxidative stress and infection. Selenium can address these issues due to its antioxidant role and synthesis of glutathione peroxidase for scavenging free radicals. Objective: The objective of the study was to find the serum selenium levels in hospitalized preterm VLBW neonates. Materials and Methods: This was a prospective observational study conducted in the Neonatal Unit of Department of Paediatrics in a tertiary care hospital, Lucknow, for the duration of 1 year. A total of 126 preterm VLBW neonates admitted within 72 h of birth and having a venepuncture for any reason were enrolled, and those with major congenital abnormality, prior supplementation, and necrotizing enterocolitis on admission were excluded. Blood sample was collected after enrollment in plain vacutainer under aseptic precautions and after ½ h serum was separated by centrifugation. Selenium levels were estimated in serum by inductively coupled plasma optical emission spectrometry method (Perkin Elmer Optima 8000). Results: Mean birth weight was 1150±210 g and mean gestational age was 30.21±3.76 weeks in our study population. Mean levels of selenium were 9.49±3.49 ?g/dl. Mean selenium levels in neonates with gestational age 32 weeks were 8.90±3.32, 9.32±3.74, and 10.57±3.15 ?g/dl (p=0.107), respectively. Thus, the selenium levels were seen increasing with an increase in the gestational age. Furthermore, serum selenium level of neonates with birth weight >1 kg (10.08±3.55 ?g/dl) was found to be significantly higher than those with birth weight ?1 kg (8.40±3.12 ?g/dl) (p=0.009). No significant association was seen with birth centiles or gender. Conclusion: Serum selenium levels were significantly lower in preterm neonates with lesser gestational age and lower birth weight although the baseline levels were within normal limits. Thus, the significant difference in levels can be linked with most of the morbidities and mortality in preterm neonates.

Background The mortality of neonatal pyogenic meningitis is reduced to 10-15%, but morbidity is unchanged. Methods Primary objective is to determine the outcome, i.e. death or abnormal neurological examination (NE) at discharge and abnormal developmental quotient (DQ) at 3 months. Secondary objective is to find predictors of poor outcome. Results In all, 89 neonates enrolled, 10 expired and 24 neonates had abnormal NE at discharge. A total of 59 neonates came for follow up, 13 had DQ

Background: Studies comparing serum bilirubin trend and hematological profile of neonates with hemolytic and nonhemolytic etiology are limited. Apart from high bilirubin load, they are at increased risk of developing anemia in early days of life. Methods: A prospective observational study was conducted in neonatal unit on late preterm and term neonates (>35 weeks) with unconjugated hyperbilirubinemia (UH) to compare serum bilirubin trend (initial and peak), hematological profile (hemoglobin [Hb] and hematocrit [PCV]) (initial and at 3 months), between hemolytic and non-hemolytic cases. Result: Among 240 enrolled neonates, initial serum bilirubin level was higher in haemolytic group than non-hemolytic (mg/dl) (16.9 ± 3.2 vs. 14.6 ± 4.1; p

Objective To assess etiology, clinical profile, and outcome of pathological neonatal unconjugated hyperbilirubinemia, including various Rhesus (Rh) blood group incompatibilities. Methods This was a prospective observational study of 200 neonates, with unconjugated hyperbilirubinemia requiring phototherapy and/or exchange transfusion, presented at tertiary care neonatal unit during August 2011 to July 2012. Detailed history, physical examination, and laboratory work-up were performed. In case, if major blood group incompatibility was found negative, the blood was further processed for G-6PD status, hereditary spherocytosis, and for non-Rh D incompatibility by testing non-Rh D antigens status in mother–infant pair. Result ABO incompatibility (64 cases, 32%), Rh D incompatibility (28 cases, 14%), and sepsis (42 cases, 21%) were major causes of neonatal unconjugated hyperbilirubinemia, while the etiology could not be ascertained in 31 (15.5%) cases. Rh C and Rh E incompatibilities were observed in 28 (14%) and 6 (3%) cases, respectively among those neonates who did not exhibit major blood group incompatibility (ABO and Rh D). Rh C incompatibility was less severe than Rh D, and Rh E was least. Conclusions Blood group incompatibilities (ABO and Rh D) and sepsis are important causes of unconjugated hyperbilirubinemia in neonates requiring treatment. Though less common, non-Rh D incompatibility can contribute to severe neonatal hyperbilirubinemia, and needs to be investigated.

Objectives The primary objective was to determine the outcome, in terms of mortality and development of bilirubin encephalopathy, of neonates with severe hyperbilirubinemia. The secondary objective was to determine the possible risk factors for development of acute bilirubin encephalopathy (ABE). Methods Consecutive neonates of >35 weeks gestation admitted to Neonatal Intensive Care Unit (NICU) with a serum bilirubin >20mg% in first 72h of life or >25mg% later were enrolled in the study. The clinical and demographic characteristics of the neonates were recorded. Neonates were treated with phototherapy and exchange transfusion as required. Outcome in terms of mortality and development of bilirubin encephalopathy was noted. Discharged neonates were followed at 1, 3, and 6 months for chronic bilirubin encephalopathy (CBE). Results Out of 64 neonates enrolled, 28 (44%) were admitted with ABE. Four with ABE left against medical advice. Out of 60 neonates studied, 5 (8.3%) expired. A total of 17 (89.5%) neonates of ABE group and 25% of all neonates developed CBE on follow-up. A lower weight on admission (2254.68+417g vs 2481.75+369g; p=0.0195), ABO/Rh incompatibility (odds ratio 4.00; 95% CI: 1.13–14, p=0.030), a positive Coomb's test (odds ratio 5.7; 95% CI: 1.53–21.4, p=0.0096), culture-proven sepsis (odds ratio 16; 95% CI: 0.82–312, p=0.067), and normal vaginal delivery (odds ratio 5.5; 95% CI: 1.1–27.4, p=0.037) were found to be significant risk factors for development of ABE. Conclusion Nearly half of the neonates admitted in a tertiary care NICU with severe hyperbilirubinemia had features of ABE on admission. The risk was more if they were born vaginally, had a lower weight on admission, had blood group incompatibility with positive Coomb's test, and had sepsis.

Congenital tuberculosis is an uncommon condition, but in a country like India, where largest tuberculosis burden is found, there should be an eye on early diagnosis and management of this condition so as to prevent the devastating consequences of this disease considering the absence of specific pathogenic signs and symptoms. Here, we present a case of congenital tuberculosis in a newborn who was admitted on the 17th day after birth with the complaint of difficulty in breathing and lethargy for 3 days. On observing the antenatal history, it was found that mother after conception was diagnosed with pulmonary tuberculosis and was inadequately treated. The clinical indexes included no increase in body weight, hepatosplenomegaly, lethargy, and emaciated appearance. The treatment was initiated with antibiotics in intravenous form along with 4-drug antitubercular treatment (ATT). The 4-drug ATT was stopped after 1 week due to negative outcome in the tubercular screening, which leads to respiratory complications. The 4-drug ATT regimen was started again after a week on clinical basis which resulted in significant improvement within a few days. Hence, the present case presents a perspective that congenital tuberculosis can be considered in a newborn when mother has a history of tuberculosis before or during pregnancy.

Background: Neonatal sepsis is a continuing problem causing significant burden on health care, especially in developing world. As blood culture has low sensitivity in diagnosis of neonatal sepsis, strong clinical suspicion along with combination of different laboratory tests is required. The data available for extensively studied acute phase reactant, procalcitonin (PCT) remains controversial. This study was done to assess role of PCT alone and in combination with different tests for diagnosing neonatal sepsis.Methods: Blood samples of 275 neonates (>35 weeks of gestation) admitted to NICU, with suspicion of neonatal sepsis were collected for bacterial culture, serum procalcitonin level and sepsis screen (CRP, mESR, I/T ratio, Total Leucocyte Count, Absolute Neutrophil Count).Results: Blood culture was positive in 30.5% of enrolled neonates. At a cut-off value of 0.5 ng/ml the sensitivity, specificity, PPV, NPV of serum PCT in neonatal sepsis cases was 73.8%, 47.1%, 48%, 80.4% respectively. Serum PCT was found raised in 60 (48.8%) clinically suspected cases of neonatal sepsis where sepsis screen and blood culture both were negative, also it was not raised in 17 (32.7%) of clinically suspected cases of septicemia where both blood culture and sepsis screen were positive. Amongst other individual tests, CRP was found to have best sensitivity (79.7%) and NPV (85%) followed by PCT (73.8% and 80.4%) while best specificity was found for I/T ratio (93.7%) followed by mESR (89%) for diagnosis of neonatal sepsis with positive blood culture. Best NPV was seen for combination of PCT+CRP+I/T ratio (95.6%) for the suspected cases of neonatal sepsis.Conclusions: Thus, we conclude that serum PCT can play a useful role when combined with other test markers but may not find its way as a sole diagnostic marker for diagnosing neonatal sepsis in term/near term babies.

Chryseobacterium species are widely distributed in nature and can rarely cause human infection. Few cases reported in hospitalized patients are in immunocompromised hosts with indwelling devices and associated comorbidities. Chryseobacterium species are usually multidrug resistant. We describe 2 cases of Chryseobacterium indologenes-associated pneumonia in neonates and review the published infant cases.

Hypovitaminosis D is common in India. In the present prospective partially randomised study of vitamin D (D3) supplementation during pregnancy, subjects were randomised in the second trimester to receive either one oral dose of 1500 μg vitamin D3(group 1,n48) or two doses of 3000 μg vitamin D3each in the second and third trimesters (group 2,n49). Maternal 25-hydroxyvitamin D (25(OH)D) at term, cord blood (CB) alkaline phosphatase (ALP), neonatal serum Ca and anthropometry were measured in these subjects and in forty-three non-supplemented mother–infant pairs (usual care). Median maternal 25(OH)D at term was higher in group 2 (58·7, interquartile range (IQR) 38·4–89·4 nmol/l)v. group 1 (26·2, IQR 17·7–57·7 nmol/l) and usual-care group (39·2, IQR 21·2–73·4 nmol/l) (P = 0·000). CB ALP was increased (>8.02 μkat/l or >480 IU/l) in 66·7 % of the usual-care groupv. 41·9 % of group 1 and 38·9 % of group 2 (P = 0·03). Neonatal Ca and CB 25(OH)D did not differ significantly in the three groups. Birth weight, length and head circumference were greater and the anterior fontanelle was smaller in groups 1 and 2 (3·08 and 3·03 kg, 50·3 and 50·1 cm, 34·5 and 34·4 cm, 2·6 and 2·5 cm, respectively)v. usual care (2·77 kg, 49·4, 33·6, 3·3 cm;P = 0·000 for length, head circumference and fontanelle andP = 0·003 for weight). These differences were still evident at 9 months. We conclude that both 1500 μg and two doses of 3000 μg vitamin D3had a beneficial effect on infant anthropometry, the larger dose also improving CB ALP and maternal 25(OH)D.

The present study was undertaken to investigate the high incidence of multiresistant Gram-negative bacilli causing neonatal septicaemia. Samples of neonatal blood from 728 suspected cases were obtained in brain heart infusion broth with sodium polyanethol sulfonate. All Gram-negative rods isolated were subsequently subjected to routine antimicrobial susceptibility testing and tests for extended-spectrum beta-lactamase (ESBL) production, as per NCCLS recommendations. ESBL was detected in 86.6% of Klebsiella spp., 73.4% of Enterobacter spp. and 63.6% of Escherichia coli strains. It was also observed that 74.4-80.9% of these ESBL producers were resistant to cefotaxime and 47.6-59.5% were resistant to ceftazidime in routine susceptibility testing. Some ESBL producers (36.3-61.5%) were found to be susceptible to either or both cephalosporins used in this study. It is concluded that indiscriminate use of third-generation cephalosporins may be responsible for the selection of ESBL-producing multiresistant strains in the neonatal intensive-care unit (NICU).

To assess feasibility and recall rates for newborn screening for congenital hypothyroidism, galactosemia and biotinidase deficiency in a predominantly rural and inner city population in and around the City of Lucknow in Uttar Pradesh, India. Prospective observational study. Two tertiary-care and 5 district hospitals in and around Lucknow. All babies born in above hospitals during the study period. Heel prick samples were collected after 24 hours of life. Dried blood spot TSH, total galactose and biotinidase were assayed by immunofluorometry. Age related cut-offs were applied for recall for TSH. For galactosemia and biotinidase deficiency, manufacturer-suggested recall cut-offs used initially were modified after analysis of initial data. Recall rate for hypothyroidism, galactosemia and biotinidase deficiency. Screening was carried out for 13426 newborns, 73% of all deliveries. Eighty-five percent of those recalled for confirmatory sampling responded. Using fixed TSH cut off of 20 mIU/L yielded high recall rate of 1.39%, which decreased to 0.84% with use of age-related cut-offs. Mean TSH was higher in males, and in low birth weight and vaginally delivered babies. Eleven babies had congenital hypothyroidism. Recall rates with modified cut-offs for galactosemia and biotinidase deficiency were 0.32% and 0.16%, respectively. An outreach program for newborn screening can be successfully carried out in similar socio-cultural settings in India. For hypothyroidism, the high recall rate due to early discharge was addressed by age-related cut-offs.

This study aimed to find out incidence, predictors, onset and severity of respiratory distress including meconium aspiration syndrome (MAS) among vigorous neonates born through meconium stained amniotic fluid (MSAF), which may or may not be evident at birth. Two hundred ninety vigorous neonates were studied. Data were collected on perinatal risk factors, clinical course and development of respiratory distress. Predictors of respiratory distress were identified by logistic regression and a score based on adjusted OR was assigned for each. Diagnostic performance of the score (0–24) was assessed on another 247 vigorous neonates using receiver operator characteristic analysis (ROC). Respiratory distress developed in 97(33.4 %) infants, MAS in 75(25.9 %). The distress appeared within 12 h in 97.9 %, was severe in only 21.7 %. Of 10 risk factors significantly associated with respiratory distress, seven entered in regression analysis. Fetal distress(adj OR = 11.8; 95%CI = 6.2–22.5), prolonged labor(adj OR = 5.2; 95%CI = 2.5–10.7), and absent/poor cry(adj OR = 5.6; 95%CI = 2.4–13.3) were identified as independent predictors; each assigned a score of 12, 6 and 6, respectively. To predict respiratory distress, a cut-off score of 9 points had sensitivity-74.1 % (95%CI = 63.3 %–82.7 %), specificity-84.6 % (95 % CI = 77.9 %–89.6 %), positive predictive value- 71.6 % (95%CI = 60.8 %–80.4 %), negative predictive value- 86.2 % (95 % CI = 79.6 %–90.9 %), likelihood ratio (LR) + ve 4.8(95%CI = 3.3–7.0) and LR-ve 0.3(95%CI = 0.2–0.4). Respiratory distress occurred in one third neonates, mostly had onset within 12 h of birth, and it was mild to moderate in majority. Fetal distress, prolonged labor, and absent/poor cry predicted respiratory distress and were validated. However, larger studies in different settings are required to confirm its utility.

We describe two children presenting with acute left ventricular dysfunction. Both cases had evidence of dilated cardiomyopathy, requiring inotropic support and were tested for cardiotropic viruses by conventional or real-time polymerase chain reaction using specific primers for enteroviruses, human parvovirus B19, Adenoviruses, Epstein-Barr virus (EBV), herpes simplex viruses 1 and 2 (HSV), human herpes virus-6 (HHV-6) and cytomegalovirus (CMV). IgG and IgM antibodies against parvovirus B19, EBV, HSV and CMV were also tested by ELISA. One case tested positive for parvovirus B19 infection and recovered completely within 6 months in absence of any specific therapy. The other case tested positive for parvovirus B19 infection in association with hypocalcaemia and was cured following standard heart failure therapy along with calcium and vitamin D supplementation. Sequence analysis of DNA products from both patients revealed genotype 3. To best of our knowledge this is first report of circulating genotype 3 from India.