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Objectives: To define the recognition, age at admission, referral time and referral pattern of neonatal cholestasis in India.Methods: This prospective, observational study was conducted from February 2015 through March 2016 in the Pediatric gastroenterology unit of JIPMER, Pondicherry in infants with cholestasis < 6 mo of age.Results: Among 64 infants, median age of admission was 52 d (IQR 28-63 d). Fifty of sixty four infants (78.1%) came with parent-reported cholestasis-related symptoms of either jaundice alone (57.8%) or bleeding manifestations (20.3%). In 21.9% infants, jaundice was detected by physicians at a median age of 45 d (IQR 38.5-53.2 d). Two infants had intracranial bleed. Only 34% infants with pale stools were identified by the mother. The median healthcare-seeking time was 5.5 d (IQR 2.5-12 d). Among infants presenting to primary healthcare physicians (PHPs) with cholestasis-related symptoms, median time to referral was 5 d (IQR 2.5-12 d). The first point of healthcare contact in 54.7% was a PHP; 17.1% PHPs had reassured the parents. Herbal preparations were prescribed by 14.3%. Only 11.8% of those with jaundice as the only problem were given vitamin K before referral. Biliary atresia (BA) was missed in neonatal intensive care units in 9 cases.Conclusions: The above issues need to be accounted for before evaluating or implementing screening strategies in India. [ABSTRACT FROM AUTHOR]

Introduction: A variety of lesions which may be transient, physiological, or pathological may be present during the neonatal period. However, most of these conditions are benign and self-limiting. Objective: To study the hospital-based incidence and clinical pattern of dermatoses during the early neonatal period. Methods: A hospital-based, cross-sectional study was conducted in a government hospital. A total of 1260 consecutive live babies delivered over a period of 1 year at the Department of Obstetrics and Gynecology were examined up to 7 days of extrauterine life. Results: Among 1260 newborns, 1242 (98.5%) had cutaneous lesions. Among them, 700 (55.5%) were males and 560 (44.4%) were females. Of these, 1119 (88.1%) weighed >2.5 kg, whereas 141 (11.9%) weighed <2.50 kg. 1176 (93.3) were born at term, 66 (5.3%) were preterm, and 18 (1.4%) were postterm. History of consanguinity was present in 211 (16.7%) cases. 817 (64.8%) newborns were delivered by normal vaginal route and 443 (35.1%) by cesarean section. Majority, i.e., 764 (60.6%) mothers were in the age group of 21-25 years, 318 (25.23%) below 20 years, 162 between 26 and 30 years (12.86%), and 16 (1.26) were more than 30 years. Mongolian spot, milia, sebaceous hyperplasia, erythema toxicum, and physiological scaling were the common physiological and transient dermatoses seen. A few pathological conditions such as Waardenburg syndrome and bathing trunk nevus were seen. Conclusion: The hospital-based incidence of neonatal dermatoses was 98.5% with no sexual predilection. Although common, most of the skin lesions in newborn are self-limiting requiring no treatment. Correct diagnosis and counseling the parents may relieve the anxiety and mental trauma. [ABSTRACT FROM AUTHOR]

Objectives: To generate normative data on clitoris length, anogenital distance and anogenital ratio in Indian newborns. Design: Cross-sectional study. Setting: Neonatal unit of a tertiary care teaching hospital in Kolkata. Participants: 378 female neonates, who were hemo-dynamically stable without critical illness or chromosomal anomaly, and without any vulval hematoma or genital abnormalities. Interventions: Measurements were recorded using a digital vernier caliper between 24-72 hours. Infant was held in position by an assistant, while the investigator measured clitoral length by gently retracting the labia majora. Anogenital distance (centre of the anus to posterior convergence of the fourchette) and anogenital ratio (anogenital distance divided by the distance from centre of the anus to base of the clitoris) was also measured. Main outcome measures: Gestational age- and birthweight-wise normative values of clitoral length, anogenital distance and anogenital ratios. Results: Mean clitoral length was 3.1 (1.54) mm for the whole cohort while anogenital distance and anogenital ratio were 10.2 (2.78) mm and 0.34 (0.07) mm, respectively. The gestation age-wise percentile charts of clitoral length, anogenital distance and anogenital ratio have been generated. There was no correlation between clitoral length and gestational age, body length, head circumference and birth weight. Correlations were also weak for anogenital distance. Conclusions: The normative values generated can serve as reference standard in the assessment of clitoromegaly, ambiguous genitalia, virilizing effects and suspected in utero androgen exposure. [ABSTRACT FROM AUTHOR]

Objective: To evaluate an objective score to assess the condition of sick neonates at arrival and its use in predicting mortality.Methods: This descriptive study included 303 extramural neonates who were evaluated using a simple clinical score - Sick neonate score (SNS). All neonates were followed up till discharge or expiry. The score and its individual components were correlated with outcome. A receiver operating curve was plotted to determine the cutoff value for SNS in predicting mortality.Results: The common indications for neonatal transport were sepsis (30.7 %), birth asphyxia (17.5 %) and respiratory distress (15.2 %). Sixty neonates (20 %) expired and among them 76 % were hypothermic and 10 % hypoglycemic at admission. The average SNS for all neonates was 10 while it was 6 for those who expired. A cutoff value of SNS ≤ 8 predicted mortality with a sensitivity of 58.3 % and specificity of 52.7 %.Conclusions: SNS is a useful scoring system to predict outcome of sick neonates in resource restricted settings. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article regarding elevated mean neutrophil volume+CRP is a highly sensitive and specific predictor of neonatal sepsis.

Abstract: Objectives: The present study is aimed at figuring out the status of new-born hearing screening program being conducted in India, estimate the use of different screening instruments used and tests practiced, study the role of various professionals involved and document the current practices of audiologists in the country. Method: A questionnaire on “Newborn Hearing Screening Survey” was sent to 185 institutions (165 medical colleges and 20 Speech and hearing centers) all over India and the information gathered was subjected to appropriate analyses. Results: On a 16.75% return rate of the questionnaire, almost half of the colleges have their annual birthing census more than 2000. The majority of sites (57.13%) report an average length of stay for a vaginal delivery to be more than 24 hours with 78.94% also reporting of a NICU of Level II/III type. Only 38.09% of the medical colleges have a universal Newborn Hearing screening program (NBHS) in comparison to 80% of the Speech and Hearing centers. Again 43.8% of the medical colleges who conduct NBHS program have an audiologist and majority of them work towards screening. Almost 63% of the speech and hearing centers use physiological tests like ABR, OAE or their combination to screen newborns. Both medical and speech and hearing organizations prefer that the audiologist inform and even give a written material regarding the results of the tests to the parents. Only 62.65% of the institutions refer less than 11% of their clients for further testing at the time of discharge. In 50% of the medical colleges the results of a test are reported to the parents and primary care physicians/doctors and in 37.5% of the speech and hearing centers the results are informed to the parents. Conclusions: While keeping in mind the incidence of hearing impairment in the neonatal population of India, the results of this survey warrant the need for an urgent implementation of universal neonatal hearing screening in all the health care facilities in the country, at large. [Copyright &y& Elsevier]

Normal thyroid function is essential for brain development postnatally, in the first two to three years of life. Over 80% newborns with congenital hypothyroidism appear normal, and cannot be suspected to have CH on the basis of clinical features alone. Delayed thyroxin replacement results in permanent mental retardation. Therefore, neonatal thyroid screening programs have been set up in developed countries, so that appropriate replacement can be started in the first 2 weeks of life. These programs have been shown to be highly cost effective. Worldwide, CH occurs in 1/3,000–4,000 newborns; in India, where the incidence may be higher, screening is not being done universally. In Indraprastha Apollo Hospital, the neonatal team has been screening all newborns (inborn and outborn) almost since its inception (Jan 1997). Most countries have opted for primary TSH screening, while the US uses primary T4. For logistical reasons, we have so far done both tests in each baby, and have moved from screening in the second week of life, to just before discharge (48–72 hrs of life), to testing in the cord blood (liquid sample, not filter paper), keeping the TSH cut-off as 30 uU/ml. Our incidence appears to be much higher than the universal incidence. [Copyright &y& Elsevier]

Objectives: To assess the validity of SNAP in predicting the outcome in terms of mortality and duration of hospital stay. The study was also undertaken to evolve the best cut-off SNAP scores for predicting mortality in different individual neonatal conditions.Methods: 295 consecutive newborn admitted to NICU during an eleven month period were evaluated with the investigations required as per the specifications of SNAP. Neonates who succumbed within 24 hours of admission and those who were shifted to the NICU for observation purposes were excluded.Results: In general, SNAP correlated well with mortality; the sensitivity and specificity of SNAP score > 15 in predicting mortality were 63% and 95% respectively. The positive and negative predictive values were 72% and 92.5% respectively. Very low birth weight babies and ventilated preterm neonates had higher mortality and the best cut-off SNAP score for predicting mortality in these groups was 10. In all the other groups, SNAP score > 15 correlated well with higher mortality. By using multiple regression analysis on three variables including birth weight, gestational age and SNAP, SNAP was found to show the best correlation with mortality. On correlating SNAP with duration of hospital stay, 76.8% of the surviving neonates with SNAP < 16 stayed for < 15 days, whereas the rest stayed longer despite low SNAP. All the 9 babies with SNAP > 15 who survived stayed for > 15 days.Conclusions: SNAP is a measure of illness severity and correlates well with neonatal mortality. SNAP may assist the clinician in explaining the probable outcome and therapeutic intervention needed and the cost of treatment to the parents. SNAP scores > 10 in VLBW babies and > 15 in others are associated with higher mortality. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the use of pulse oximetry as a screening tool for detecting major congenital heart defects (CHDs) in Indian newborns. Design: Cross-sectional observational study. Patients: In a community hospital of north India, babies born during a specific 8 h period of the day were recruited over a period of 3 years. Newborns with incomplete documentation were excluded. Intervention: Routine clinical examination, pulse oximetry and bedside echocardiography. Outcome measures: Any abnormalities in clinical examination and pulse oximetry were recorded. CHDs were diagnosed using bedside echocardiography. Accuracy of pulse oximetry, clinical examination and their combination for detecting major CHDs was calculated. Results: Among the 19 009 newborns screened, 70 had major CHDs at birth (44 serious, 26 critical). Pulse oximetry detected 39 major (sensitivity 55.7%, 95% CI 44.1% to 66.8%; specificity 68.3%, 67.6% to 68.9%) and 22 critical CHDs (sensitivity 84.6%, 66.5% to 93.9%; specificity 68.3%, 67.6% to 68.9%). Addition of pulse oximetry to clinical examination significantly improved sensitivity for major CHDs (35.7% (25.5% to 47.4%) to 75.7% (64.5% to 85.3%), p<0.01) and critical CHDs (11.5% (4.0% to 29.0%) to 84.6% (66.5% to 93.9%), p<0.01). Conclusions: Pulse oximetry is a sensitive screening tool for detecting major CHDs in Indian newborns. It adds significant value to the current practice of using clinical examination as a sole screening tool for detecting major CHDs. However, specificity of pulse oximetry was much lower in our study. Possible reasons for low specificity could be non-repetition of pulse oximetry in newborns with initial lower saturations, high prevalence of infections and respiratory issues in our cohort and use of non-motion tolerant oximeter. [ABSTRACT FROM AUTHOR]

Features a study of congenital rubella diagnosis in south India using test results in saliva from infants with cataract. Saliva as a reliable factor in detecting rubella specific IgM in infants; Comparison with the reliability of serum a determiner of rubella; Congenital rubella as a significant cause of congenital cataract in India.