Bashir Ahmed Charoo

Klebsiella brain abscess in a neonate

Klebsiella pneumoniae is rarely associated with neonatal cerebral abscess. A case of Klebsiella brain abscess in a neonate is described. Diagnosis of abscess was confirmed by magnetic resonance imaging and ultrasound-guided aspiration.

Shoshin beriberi-thiamine responsive pulmonary hypertension in exclusively breastfed infants: A study from northern India

Objective To study the effect of thiamine administration on the resolution of pulmonary hypertension in exclusively breastfed infants. Design Prospective cohort study. Setting Hospital based study of a tertiary care hospital. Patients A total of 29 infants with 17 males (58.6%) and 12 females (41.4%) were included in the study. Intervention In addition to the management of shock, right heart failure and renal failure, patients received intravenous thiamine 100 mg/kg IV followed by 10 mg/day till introduction of supplementary feeds. Main outcomes measures Resolution of shock, metabolic complications and pulmonary hypertension. Results Mean age at presentation was 78.45 ± 30.7 days. All infants were exclusively breastfed. 86.2% of mothers were on customary dietary restrictions. Biventricular failure and tachycardia was commonly present. There were four deaths in our series. Acute metabolic acidosis was a universal feature with a mean pH of 7.21 ± 0.15. Pulmonary hypertension was present in all patients on admission. Intravenous thiamine 100 mg/kg IV stat was given immediately after documenting pulmonary hypertension. Repeat echocardiography showed complete resolution of pulmonary hypertension. Conclusion Many infants present to us with Shoshin beriberi with unusually high pulmonary pressures. These patients respond to thiamine challenge with prompt resolution of metabolic complications and reversal of pulmonary hypertension. We believe this is first of its kind from the region, which is reported.

Maternal overt hypothyroidism and neurobehavioral outcome of neonates: A cohort study from an iodine-deficient area of Northern India

ObjectiveTo study the relation between maternal overt hypothyroidism and neurodevelopmental outcome of neonates in iodine-deficient region of Northern India (Kashmir Valley).DesignProspective cohort study.SettingEndocrinology department of a tertiary-care hospital.Participants82 hypothyroid pregnant women were enrolled and followed up till delivery. The neonates born to this group represented the case neonates. 51 euthyroid healthy pregnant women were selected as control group. The neonates born to these mothers served as controls.Main outcome measuresEarly neonatal behavioral assessment at 3-4 weeks of age.ResultsThe mean TSH and free T4 in neonates of mothers with well controlled hypothyroidism was significantly different from those born to mothers with poorly controlled hypothyroidism and controls in 1st trimester, but the difference was statistically insignificant for 2nd and 3rd trimester values.ConclusionOvert maternal hypothyroidism in iodine-deficient area constitutes a risk factor for an abnormal neurobehavioral development of affected child.

Prevalence of Depression among Caregivers of Indian Children with Cystic Fibrosis

ObjectiveTo study the prevalence of depression among caregivers of children with cystic fibrosis and its impact on the health and well being of these children.MethodsThis cross-sectional study was conducted in a tertiary care hospital from September 2015 through August 2016. Forty one parents of children receiving treatment at the Cystic fibrosis (CF) clinic were approached to be part of the study. Six families declined the request resulting in 85% recruitment rate. The Centre for Epidemiological Studies Depression Scale (CES-D) was used to assess depression score among caregivers. The CES-D provides clinical cut-off scores of ≥16 that help in identifying persons at risk for depression. CES-D was completed by the parent closely associated with care of the affected child. Main outcome measure was to find the number of caregivers of patients who has score of ≥16 on CES-D scale, and its effect on growth and respiratory exacerbations of the affected child.ResultsA total of 23 fathers and 12 mothers participated in the study. The mean age of male and female caregivers was 30.9 ± 5.4 and 27.8 ± 4.7 y respectively. Eighteen (51.4%) caregivers scored above the clinical cut-off on the CES-D in the index study with mean score of 22.0 ± 4.0. The mean CES-D score among non-depressive caregivers was 7.76 ± 4.2. Significant negative association was found between parental depression and child’s health. Children with high parental CES-D score suffered significantly more respiratory exacerbations (3.83 ± 1.2 episodes) in last six months than parents with low CES-D score (2.18 ± 1.28 episodes) (p value = 0.00). Similarly, stunting was more commonly seen in patients with high caregiver CES-D score (15 vs. 7; P value = 0.01).ConclusionsA very high prevalence of caregiver depression was found in cystic fibrosis, which negatively impacted care and well being of the affected patients. Depression was more common in families with poor economic and education level.

Wernicke’s encephalopathy in exclusive breastfed infants

BackgroundKashmir has a population that largely consumes polished rice which is deficient in thiamine. Furthermore, lactating women in this region are prone to severe thiamine deficiency because of their traditional food avoidance practices. Infantile beriberi is common in exclusively breastfed infants of thiamine deficient mothers in Kashmir.MethodsThis was a one year prospective hospital-based study. We included 50 exclusively breastfed infants in our study. All patients were evaluated as per unit protocol including complete septic workup and metabolic workup. Most of our patients belonged to low and middle income group families, and mothers were on customary dietary restriction. Demographic and anthropometric data were collected from all the study participants. In addition, data regarding the treatments received by the study population and overall mortality were collected.ResultsThe mean age, male:female ratio, and mean weight of the study population were 3.15±0.97 months, 1.5:1, and 5.1±1.1 kg, respectively. Traditional food avoidance practices were followed by 80% of the mothers. Irritability was observed in 40 (80%) patients. Blepharoptosis was observed in 30 (60%). Septic workup including cerebro spinal fluid analysis was normal in all patients. Predominant magnetic resonance imaging finding was bilateral basal ganglia hyperintensity. Whole blood thiamine diphosphate levels showed a drastic decrease (10-49 nmol/L). Ten percent of the study infants died.ConclusionIn exclusively breastfed infants, we observed acute infantile encephalopathy with epidemiological, clinical, biochemical, and radiological features suggestive of infantile Wernicke’s encephalopathy and a favourable therapeutic response to thiamine supplementation during the acute stage.

Complications due to breastfeeding associated hypernatremic dehydration

Objective: The aim was to assess the incidence, presenting features, and complications of breastfeeding associated hypernatremic dehydration among hospitalized neonates. Materials and Methods: A retrospective study over a period of 18 months to identify term and near term (≥35 weeks of gestation) breastfed neonates, who were admitted with serum sodium concentration of ≥150 mEq/l and no apparent explanation for their hypernatremia other than inadequate breastmilk intake. Results: The incidence of breastfeeding associated hypernatremic dehydration among 2100 term and near term neonates was 1.38%. The median serum sodium at presentation was 164 mEq/l (range: 151-191 mEq/l). The mean weight loss in these patients was 10.16% ±6.6%. The reasons for seeking medical attention were refusal of feeds (72.41%), lethargy (68.96%), decreased urine output (44.82%), jaundice (27.58%) and fever (24.13%). Five patients (17.24%) had seizures and three (10.34%) had coagulopathy. Other complications included hypoglycemia, hypocalcemia, acute kidney injury (AKI) (37.93%) and intraventricular hemorrhage. The mean serum creatinine was 1.82 ± 2.5 mg/dl (range: 0.19-9.6). A statistically significant association was seen between serum sodium concentration at presentation and AKI. It was also found that those patients who had AKI had a higher weight loss and had presented later to the hospital than those without AKI. One patient died within 12 h of admission. This child had disseminated intravascular coagulopathy, AKI, and hypoglycemia. Conclusions: Breastfeeding associated hypernatremic dehydration is a serious condition with many serious complications and even results in death if detected late. Health care providers have increasing responsibilities of promoting proper breastfeeding techniques and taking measures for early diagnosis and treatment of this problem.

Efficacy of different types of phototherapy devices: A 3-year prospective study from Northern India

Objective: To evaluate the efficacy of light-emitting diode (LED) over conventional phototherapy in near-term and term Rh-compatible otherwise healthy neonates in resource-constrained settings. Design: This was a 3-year prospective observational study. Setting: The study was conducted in the neonatal unit of a teaching hospital. Patients: Near-term and term (≥35 weeks of gestation) Rh-compatible, otherwise healthy, newborns were included in the study. Interventions: Single surface LED or conventional phototherapy was performed. Main Outcome Measures: The primary outcome variable was the duration of phototherapy, and the secondary outcome variables were a rate of fall in the total serum bilirubin (TSB) and need for exchange transfusion. Results: A total of 406 patients constituted the study population. Two hundred and thirty patients received LED phototherapy, and 176 patients received conventional phototherapy. The birth weight, gestational age, gender, mean TSB, and other baseline laboratory parameters were similar in both groups. The median duration of phototherapy in the LED group (22.0 h [95% confidence interval: 20.47, 23.53]) was significantly less than that in the conventional phototherapy group (32.0 h [95% confidence interval: 29.8, 34.1]). Similarly, the rate of fall of TSB at 6, 12, and 18 h was significantly higher in LED group than in the conventional group. Fifteen patients (6.5%) received double volume exchange transfusion in LED group and twenty patients (11.4%) in the conventional group. Conclusions: LED phototherapy was found more efficacious than conventional phototherapy in resource-constrained settings, where the majority of jaundiced patients are managed with latter one and because of limited resources irradiance is never checked or checked inappropriately, which can be a source of serious error.

Neonatal sepsis with atypical presentations

Sepsis in neonatal intensive care units throws formidable challenges in homoeostasis, be in metabolic, nutritional or hematological. Newborn sepsis results in considerable morbidity and mortality among neonates. Due to inability on part of the neonate to develop adequate inflammatory response to localize the infection they commonly develop disseminated systemic infection, pneumonia and/or meningitis. We have described 4 cases of neonatal sepsis with localization at unusual sites. Our first case presented as a Fourniers gangrene, an infective necrotizing fasciitis of the perineal, genital or perianal regions. We also present a very rare entity of acute digital gangrene in a newborn baby as a sole manifestation of neonatal septicemia.