Search

Introduction: Childhood immunisation is the most cost effective method to prevent vaccine preventable diseases and decrease childhood morbidity and mortality. COVID-19 pandemic has affected routine immunisation of children due to various reasons. We aimed to study the attendance to immunisation clinic at our tertiary care hospital prior and during COVID-19 pandemic. Methods: Retrospective data of monthly attendance to the immunisation clinic at our tertiary care hospital was collected for a study period of 30months, sub-grouped into - January 2019 to March 2020 (pre-COVID) and April 2020 to June 2021 (during COVID). The clinic caters to children from first day of life till 18 years, as per National Immunisation Schedule (NIS). Trends in attendance across the months were studied. Statistical analysis were employed to test whether there was a significant reduction in immunisation clinic attendance. Results: Attendance to the immunisation clinic during the 30 month study period was 37418 children. Among these, 29879 children received birth dose vaccines. This cohort was excluded from further analysis as deliveries continued at our maternity centre in both periods of study. Comparing vaccine recipients above the age of 6weeks till 18years across the months, 6222 and 1502 children received immunisation in the pre-COVID and during COVID pandemic respectively. No child received immunisation from April 2020 to July 2020 during national lockdown. Unpaired t-test showed highly significant reduction in attendance to immunisation clinic during the COVID pandemic in comparison to pre-COVID period (p

Background: Cornelia de Lange syndrome is a genetic syndrome characterized by intellectual disability, facial features with synorphrys or fused eyebrows, upper limb anomalies and atypical growth. It is caused by spontaneous mutations in genes responsible for structural or regulatory function of cohesin complex. Report: We present two newborns cases admitted to our NICU with characteristic dysmorphic features of microcephaly, ectrodactyly and thick eyebrows. One baby also had associated congenital heart defect and sensorineural hearing loss. Both babies are under followup with developmental early intervention programs. Parents were offered genetic counselling for future pregnancies. Conclusion: Cornelia de Lange is predominantly a clinical diagnosis by identifying typical dysmorphic features. Labelling a syndromic diagnosis helps to provide genetic counselling to the parents, identify associated co-morbidities at earlier stages and improve the quality of living of such children.

Aims: Pregnant mothers with SARS-CoV2 infection are postulated to transfer anti-COVID-19 antibodies to their fetus, which may lead to cytokine storm and fetal inflammatory syndrome, similar to multisystem inflammatory syndrome in children (MIS-C). Manifestations of this newly emerging entity are not elucidated, but MIS in Newborn (MIS-NB) must be suspected whenever a neonate born to COVID positive mother is presenting with unusual symptoms. Clinical Description: We report a preterm, low birth weight, Monochorionic Diamniotic (MCDA) twin neonate born to COVID positive mother who developed abdominal distension in first few hours of life, initially suspected to have small bowel atresia. Baby had elevated inflammatory panel and given IVIG, suspecting MIS-NB. Intraoperatively the baby was noted to have gangrenous bowel, which required extensive surgical resection, but baby succumbed postoperatively. Conclusion: This report highlights possible intestinal manifestations of possible COVID-19 related fetal inflammatory syndrome.

The neonatal skin microbiome consists of all the genomes and genetic products of microorganisms harboring on an infant’s skin. Host and the microbiota develop a harmonious environment resulting in symbiosis. Any disruption of this environment could lead to pathological disease. This study was conducted to understand the neonatal skin microbiome of very preterm neonates (under 32 weeks) admitted to the Neonatal Intensive Care Unit(NICU) at a tertiary healthcare setting before and after kangaroo mother care (KMC), using next-generation sequencing (NGS). Skin swabs were collected on two different occasions and analyzed using the NGS technique after amplification via polymerase chain reaction. The results showed relative abundance for Mycobacterium tuberculosis in 83.33% and 66.67% (p = 0.29) and Mycobacteroides abscessus in 100% and 93.33% (p = 0.30) of the very preterm neonates on the skin microbiome before and after KMC, respectively as an incidental finding. The mere presence of these bacilli as commensals or as potential pathogens is alarming due to the risk of early exposure and incidence of tuberculosis from birth. These findings, in our view, are the first findings to be established in such a setting.

The neonatal skin microbiome consists of all the genomes and genetic products of micro-organisms harbouring the skin of babies. Host and the microbiota develop a harmonious environment resulting in symbiosis. Any disruption of this environment could lead to pathological disease. Our study was conducted to explore the neonatal skin fungal microbiome of very preterm neonates admitted to Neonatal Intensive Care Unit at a tertiary health care setting using Next Generation Sequencing of the18S rRNA gene. The most abundant genera found in 22/30 samples were Candida followed by Bipolaris & Cladosporium on the skin microbiome of these neonates. The presence of these fungi, whether just as commensals or as potential pathogens, is currently under research, owing to the risk of early exposure and incidence of infection right from birth.

The neonatal skin microbiome consists of all the genomes and genetic products of microorganisms harbouring on the skin of babies. Host and the microbiota develop a harmonious environment resulting in symbiosis. Any disruption of this environment could lead to pathological disease. We conducted this study to understand the neonatal skin microbiome of very preterm neonates admitted to NICU at a tertiary health care setting before and after Kangaroo Mother Care. Next Generation sequencing showed relative abundance for Mycobacterium tuberculosis in 83.33% & 66.67% (p0.285) and Mycobacteroides abscessus in 100% & 93.33%( p0.303) of the very preterm neonates on the skin microbiome before and after KMC respectively. The mere presence of Mycobcaterium species as commensals or as potential pathogens, is alarming due to the risk of early exposure and incidence of tuberculosis right from birth. These findings, in our view, are the first findings to be established in such a setting.

COVID-19 pandemic is increasingly being recognized in infants and some develop cytokine storm mediated tissue damage. We report 5-month-old infant presenting with fever, refusal of feeds, developing altered sensorium and convulsions during the hospital course, tested positive for SARS-CoV2 RT-PCR in second week of illness. Her serology was also Dengue positive. She had features of cytokine storm and her MRI Brain suggested acute demyelinating encephalomyelitis (ADEM). She was treated with high-dose methylprednisolone followed oral prednisolone, under antibiotics cover. Infant improved gradually over 3 weeks duration following a stormy hospital course. On follow-up, infant showed delayed motor milestones with epileptic spasms and hysparrhthymia on EEG, progressing to develop secondary West syndrome. Features of acute encephalopathy, hypercytokinemia and restricted diffusion on DWI–MRI, with post-encephalopathic epilepsy, pointed to a differential of ADEM—acute leukoencephalopathy with restricted diffusion (ALERD) as the primary diagnosis; establishing ALERD as a possible neurological complication of COVID-19 infection in infants. Timeline of events. There is a demonstrable fall in the inflammatory markers with clinical improvement following the start of intravenous methylprednisolone. Epileptic spasms and developmental delay with hypsarrhthymia noted on follow-up, suggestive of secondary West syndrome.

Johanson-Blizzard syndrome is a rare genetic entity reported in medical literature resulting from mutations in UBR1 gene, affecting pancreas, craniofacial and urogenital development, causing significant morbidity and mortality. We report a neonate presenting with anorectal malformation requiring surgical intervention at birth, with similar surgeries being performed in two elder siblings. Surviving sibling of the proband neonate also has similar dysmorphic features of absent ala nasi, aplasia cutis of scalp along with pancreatic insufficiency, profound sensorineural hearing loss, pheno-type corresponding to Johanson-Blizzard syndrome. Syndromic diagnosis helps in screening for associated potential issues, which can intervened at early stages.

Bell’s palsy, an acute onset, acquired, isolated peripheral facial palsy, usually follows a viral illness, is common disorder post infancy to adolescence. It has a favourable prognosis with spontaneous resolution, or with use of oral corticosteroids. Its presentation in early infancy is very unusual, as in our case report of 3 month old infant with an ovoid mass lesion in parotid, which disappeared after therapy with corticosteroids with no residual deficit.

Neonates born with critical duct dependent congenital heart diseases acutely deteriorate in first few days after birth when physiological conduits which allow for mixing blood close. Balloon Atrial septostomy is performed on emergency basis in such neonates to create a right to left intracardiac shunt, until a definitive surgery is performed, but requires a cardiac intervention setup. In settings where advanced cardiac interventions are not available, we propose an alternative approach for atrial septostomy using nasogastric feeding tube through umbilical venous route, under echocardiographic guidance. Feeding tube gradually inserted into the umbilical vein, reaches the right atrium, following which it is thrust into the atrial septum at the location of foramen ovale, perforating it to create an emergency conduit between the atria. We performed the above procedure in a neonate with dTGA at our NICU setup, with partially successful outcome. We propose this method as an alternative, safe, simple and cost effective procedure, though not definitive, in resource limited settings for emergency stabilisation of neonates with critical duct dependent heart defects.

COVID-19, a clinical syndrome caused by the coronavirus (SARS-CoV-2) became a pandemic following an outbreak of viral pneumonitis, first identified in Wuhan, China. The disease manifestations vary ranging from mild upper respiratory tract infection to severe pneumonitis, acute respiratory distress syndrome (ARDS) and even death. Although most of the neonatal cases are asymptomatic, rarely, they can present with cytokine storm mimicking with similar features of sepsis. This is a case report of SARS-CoV19 positive neonate presenting with sepsis and cytokine storm, 5-day old baby born to SARS-COVID 19 positive mother presented with fever and investigations showed elevated total counts with neutrophilic predominance, thrombocytopenia suggestive of sepsis and increased inflammatory markers suggestive of cytokine storm. Blood culture was sent and baby was started on intravenous antibiotics. In view of cytokine storm intravenous dexamethasone 0.5 mg/kg/day was given intravenously for 5 days. Neonate recovered from illness after 1 week as evidenced clinically and and by the fall in inflammatory markers before discharge. This report opens the possibility of having both sepsis and cytokine storm in a SARS-CoV19 positive neonate.

Malignant infantile osteopetrosis is a rare, fatal autosomal recessive disorder due to abnormal osteoclast activity. We report a 1-year-old infant, born to consanguineously married couple, who presented to our ER with acute respiratory distress and bicytopenia. He had tender hepatomegaly, splenomegaly, failure to thrive and features of rickets. He was evaluated previously for possible hydrocephalus secondary to his abnormal shape of head with proptosis, MRI revealed a subarachnoid cyst, but possibility of osteopetrosis was missed. Skeletal radiographs done later detected dense, sclerotic bone with sandwich vertebra, provided a delayed diagnosis of MIOP. Rickets, a paradoxical association, was also seen in our case, with low serum calcium and vitamin D3 levels. He succumbed due to severe bronchopneumonia with septic shock. Early diagnosis and timely hematopoietic stem cell transplant are the only curative approach for MIOP, which is otherwise fatal.

Children with COVID-19 largely remain asymptomatic or mildly symptomatic with gastroenteritis or influenza like presentation. However, few of them go on to develop features of multi-system inflammatory syndrome secondary to dysregulated cytokine release, resulting even in death. We report a 45 days old infant who presented to us with fluid unresponsive shock following protracted vomiting few hours prior to arrival. Eight days prior, child was admitted in COVID Isolation centre with mild illness, after testing positive on rapid Antigen Test and discharged 3 days later. Child when brought was severely acidotic and hence electively intubated. Shock did not improve even following multiple boluses and inotropic support on mechanical ventilation. Encephalopathy, myocardial dysfunction and acute kidney injury, with elevated inflammatory markers post COVID-19 suggested multi-system inflammation syndrome in him. The infant deteriorated rapidly and succumbed even before targeted therapy could be initiated. MIS-C presenting with refractory shock is increasingly being reported in pediatric age group and these children rapidly deteriorate without early recognition and treatment. Clinicians need a heightened suspicion for cytokine storm related complications and institute early immune-modulative therapy, especially during the present COVID-19 pandemic.

Jarcho-Levin syndrome or spondylocostal dysostosis, is a rare axial skeleton anomaly due to mutation in genes involved in somitic segmentation during embryogenesis. We describe a term, newborn baby with antenatally detected midthoracic lordotic deformity with skeletal features of multiple rib anomalies and vertebral defects, but with normal limb lengths. Baby had recurrent apnea requiring non-invasive ventilation and was successfully weaned to room air within 2 days. This syndrome is underdiagnosed and we wish to highlight the simple process involved in making a clinico-radiological diagnosis.