Aakash Pandita

Bacteriological profile and clinical predictors of ESBL neonatal sepsis.

Abstract Study objective: Bacteriologic profile and risk factors for ESBL sepsis in newborns admitted to a Level III NICU. Methods: This was a retrospective observational study that enrolled newborns admitted to NICU with perinatal risk factors or clinical signs of sepsis and positive blood culture from January 2013 to August 2014. Blood cultures were done by BACTEC and ESBL production was evaluated from double-disc synergy method. Maternal, perinatal and neonatal risk factors were recorded from the case records and computerized information base. Mothers received cephalosporins for PPROM but its use was restricted in newborns for both probable and culture-positive sepsis. Results: Among the infants with sepsis 24% had early-onset sepsis. The incidence of ESBL of early-onset Gram-negative sepsis (EOGNS) was 44.7% (n = 17 of 38) and it was 65% in late-onset Gram-negative sepsis (n = 84 of 129). The predominant ESBL-producing microbe responsible for neonatal sepsis was Klebsiella sp. Among newborns with EOGNS, the risk factors for the production of ESBL were preterm PROM (p = 0.004) and maternal exposure to antibiotics (p = 0.05). Conclusion: ESBL Gram-negative sepsis is a substantial problem in neonatal infections. Maternal exposure to cephalosporins and maternal PPROM are important risk factors for ESBL Gram-negative EOS.

An infant with aphallia and its associated complication: A rare case report and review of literature

Complete penile agenesis (aphallia) is a very rare congenital anomaly. Around 80 cases have been reported to date. Diagnosis of this rare anomaly is made by clinical examination, but treatment options and parental counselling for gender assignment is difficult and challenging for the treating doctor. We report a case of an infant with complete penile agenesis with recto-urethral fistula, who was referred on day 6 of life. This baby developed obstructive uropathy which required vesicostomy. Surgical management consists of gender assignment after discussing in detail the pertinent situation with the parents and accepting their final decision.

Thrombocytopenia absent radius syndrome with Tetralogy of Fallot: a rare association

Thrombocytopenia absent radius (TAR) syndrome is a very rare and infrequently seen congenital disorder with an approximate frequency of 0.42/100,000 live births. It is associated with bilateral absence of radii, hypo-megakaryocytic thrombocytopenia, and presence of both thumbs. The other systems which are affected by TAR syndrome include skeletal, hematologic, and cardiac systems. Intracranial hemorrhages due to thrombocytopenia and cardiac disorders are a common association usually seen with this syndrome and are usual cause of death. We describe a 3-month-old infant who was diagnosed with TAR syndrome on the basis of clinical features (thrombocytopenia and bilateral absent radius bone and confirmed by genetic analysis). The patient was diagnosed to have Tetralogy of Fallot, for which the infant was managed with definitive repair and thrombocytopenia was managed with platelet transfusion. Infants with TAR syndrome should be assessed for other associated malformations of various systems and followed up regularly and parents should be counseled for associated expected complications in these patients. We report an infant with TAR syndrome with Tetralogy of Fallot, which has not been reported in medical literature until now and this is the first case of its type.

Ectrodactyly, Ectodermal Dysplasia, Cleft Lip, and Palate (EEC Syndrome) with Tetralogy of Fallot: A Very Rare Combination

Ectrodactyly, ectodermal dysplasia, and cleft lip/palate syndrome (EEC) syndrome is a rare genetic disorder with an incidence of around 1 in 90,000 in population. It is known with various names including split hand–split foot–ectodermal dysplasia–cleft syndrome or split hand, cleft hand, or lobster claw hand/foot. We report first case of EEC with associated heart disease (Tetralogy of Fallot) who was diagnosed as EEC on the basis of clinical features and EEC was confirmed with genetic analysis.

Neonatal Hypertension: An Underdiagnosed Condition, A Review Article

Advances in neonatology and intensive monitoring has increased our ability to identify and measure blood pressure in sick premature and term infants and this has contributed to an increased awareness of hypertension in the NICU. A few recent studies done by Zubrow and others have offered many new information on blood pressure values over the first month after birth and on other many intrinsic and extrinsic factors that can cause effects on the blood pressure in the neonatal period. There are no definite cut off for labelling hypertension in newborn period and also doubts are there on the pharmacological treatment. This is a field in neonatology which is least studied hence requires further inquiry. This review article will cover several aspects of neonatal hypertension like definition, normotensive data, etiology, clinical characteristics, diagnostic modalities, treatment choices and long term effect of these newborns.

Lobster Claw Hand Foot Syndrome: Rare Congenital Orthopedic Disorder

A term male infant was born to 28 year old primigravida mother, non-consanguineous marriage, with birth weight of 2.8 kg and with normal Apgar score 8/8/9. At birth baby was noted to have deformed left foot with syndactyly of the lateral two toes with median cleft of the left foot with associated hypoplasia of nails (Figures 1 and 2). There were no other facial and limb abnormalities noted in infant. The infant was diagnosed as case of diagnosed with a case of cleft foot (lobster foot). The lower limb x-ray showed presence of tibia as these patients are known to have tibial agenesis. The infant was evaluated with echocardiography and brain ultrasound which was normal. There was no orthopedic abnormality in the parents or their relatives. The baby was discharged and now in regular orthopedician follow up.

Laryngospasm and neonatal seizure due to hypocalcaemia and vitamin D deficiency: an emergency condition in NICU and challenge to the neonatologist

A term male infant, 8 days old, was admitted to our neonatal intensive care unit with abnormal movements of the upper limbs. The infant was born in our hospital with birth weight of 3.2 kg and had an Apgar score of 8/9/9 at 1, 5 and 10 min, respectively. The infant was breastfed and also formula fed. The physical examination did not reveal any malformation or abnormal facies. The infant was investigated for neonatal seizure, the results of which showed serum sodium of 138 mg/dL, potassium of 3.8 mg/dL, sugar of 87 mg/dL, serum calcium of 4.6 mg/dL (1.15 mmol/dL) and serum magnesium of 1.6 mg/dL (0.65 mmol/L). The ECG showed a prolonged QTc interval (0.52 s). Head ultrasound showed no significant abnormality. The baby was given stat injectable calcium for symptomatic hypocalcaemia and was taken up on a maintenance dosage of calcium at 80 mg/kg/day. On morning rounds he had …

Urine dipstick tests can aid decision-making when treating infants with unexplained fever, but more research is needed.

A recent paper by Herreros et al. (1) in Acta Paediatrica reported, for the first time, that performing a dipstick test on a clean-catch urine sample was an accurate way of diagnosing a urinary tract infection (UTI) in a febrile infant under 90 days of age, without the need for invasive procedures. We have a number of comments on this study. It would have been useful to know how old the youngest infants were and the duration of unexplained fever. In addition, they used low-risk Rochester criteria to select the infants, and one criterion is normal urinalysis, which may have affected the consistency of the study. It was also difficult to understand the sequence used to obtain the samples. The Methods section stated that the aim was to collect a clean-catch sample and a catheterised sample for each subject, but in 35 cases, there were only clean-catch samples, and in 28 patients, there were only catheterised samples. It would have been helpful to know why both sets of samples were not collected for all infants. Furthermore, the microbiological methods could have been more conclusive if they had clearly mentioned how much urine was collected, how they uniformly preserved the samples and the personnel involved in the tests. The results could also have been more valid if they had provided details of the culture media used, and the organisms grown in urine cultures, as nitrate reductase-negative bacteria might lead to negative nitrite dipstick tests (2). Despite these limitations, this excellent study provides guidance on immediate decisionmaking while treating an infant with unexplained fever. Several studies have already established high sensitivity and specificity of urine analysis in diagnosing UTI in infants less than 90 days (3), but what we need now is a change of practice.

Hypoglycemia: When to Treat?:

Hypoglycemia is the most common metabolic disorder encountered in neonates. The definition of hypoglycemia as well as its clinical significance and management remain controversial. Most cases of neonatal hypoglycemia are transient, respond readily to treatment, and are associated with an excellent prognosis. Persistent hypoglycemia is more likely to be associated with abnormal endocrine conditions, such as hyperinsulinemia, as well as possible neurologic sequelae. Manifestations of hypoglycemia include seizures which can result in noteworthy neuromorbidity in the long haul. Thus, hypoglycemia constitutes a neonatal emergency which requires earnest analytic assessment and prompt treatment. In this review, we have tried to cover the pathophysiology, the screening protocol for high-risk babies, management, long-term neurologic sequelae associated with neonatal hypoglycemia, with evidence-based answers wherever possible, and our own practices.

Cayler Cardio-Facial Syndrome: An Uncommon Condition in Newborns.

Introduction: Cayler cardio-facial syndrome is a rare syndrome associated with asymmetric crying faces with congenital heart disease. We report a newborn that was diagnosed as case of Cayler Cardio-facial syndrome based on clinical features and was confirmed with FISH analysis. Case Presentation: A term male baby, born to non-consanguineous couple through normal vaginal delivery was diagnosed to have asymmetric crying faces with deviation of angle of mouth to left side at the time of birth. The baby had normal faces while sleeping or silent. Mother was known case of hypothyroidism and was on treatment. Baby was diagnosed as case of Cayler Cardio-facial Syndrome and was investigated with echocardiogram, brain ultrasound, total body X-ray examination, X-ray of cervico-thoracic vertebral column and fundus examination. Echocardiogram showed muscular VSD, brain ultrasound was normal and fundus examination showed tortuous retinal vessels. Whole body X-ray and lateral X-ray of cervico-thoracic vertebral column were not suggestive of any skeletal abnormalities. The other associated malformation was right ear microtia. Baby FISH karyotype analysis showed deletion of 22q11.2 deletion. Baby was discharged and now on follow-up. Conclusions: Cayler syndrome is a rare syndrome which must be suspected if a baby has asymmetrical cry pattern and normal facies when baby sleeps. Patient must be evaluated with echocardiography to find out associated cardiac malformations. These infants should undergo FISH analysis for 22q11.2 deletion syndrome.