Binu Ninan

Grandmothers' perspective on hearing loss in children and newborn hearing screening

Aim: To study the opinions of grandmothers of newborns on hearing loss, Newborn hearing screening (NHS) and intervention options. Materials and Methods: 100 grandmothers were interviewed in a tertiary care hospital, using a questionnaire adapted from Olusanya, Luxon and Wirz (2006). The responses were analyzed using frequency distribution. Results: 63% were aware that hearing loss could be congenital. Among the causes studied, more awareness was present for family history (67%), noise exposure (62%), and ear discharge (61%). Less than 50% of the participants were aware of other causes. Majority knew that bewitchment (72%) and ancestral sins (69%) were not a cause for hearing loss. Only 20% were aware that hearing loss could be identified at birth and 12% knew about availability of NHS. 75% thought that intervention is possible for hearing loss, and 33% believed that hearing-impaired children could attend regular school, if intervened. 86% of grandmothers preferred testing soon after birth. 87% preferred OAE compared to BERA (33%) as a screening tool. Hearing aids (92%) and surgery (89%) was widely accepted as intervention for hearing loss. Conclusion: Grandmothers had good awareness on congenital hearing loss. And limited awareness was present on causes of hearing loss, identification of hearing loss at birth, NHS and intervention. Thus, indicating an urgent need to create awareness in the above areas. A demonstration of positive attitude was shown in the results towards NHS and intervention for hearing loss, which will facilitate early identification and intervention.

Neonate with haemophagocytic lymphohistiocytosis secondary to dengue infection: a case report.

We report the first case of haemophagocytic lymphohistiocytosis (HLH) in a neonate secondary to primary Dengue virus infection. This neonate presented in the third week of life with fever, shock and hepatosplenomegaly and was diagnosed to have Dengue infection by serology and HLH was confirmed on bone marrow.

Pattern and antimicrobial susceptibility of carbapenem resistant organisms in tertiary care neonatal intensive care unit, India

Background: The emergence of carbapenem resistant organism (CRO) in the health care setting has been well-documented recently. CRO is an increasing cause of neonatal infections all over the world especially in developing countries. Objective: The aim was to study pattern, incidence, and antimicrobial sensitivity of CROs in neonatal Intensive Care Unit (NICU). Materials and Methods: We conducted a retrospective observational study between January 2011 and June 2012. The study was conducted at a tertiary level NICU. Blood cultures were done in BACTEC 9120 or brain heart agar. Culture isolates were identified by automated identification or conventional biochemical tests. Microscan 96 and/or disk diffusion method performed antibiotic susceptibility. We studied the entire Gram-negative blood culture positive isolates and also studied their antibiotic sensitivity pattern. CRO was defined by any Gram-negative isolates showing resistant to meropenem and imipenem. Results: One hundred and thirty-four babies had grown microorganisms in their blood culture. Of the 134, 77.6% ( n = 104/134) was due to Gram-negative organism infection. Among culture positive Gram-negative organisms, 14.4% ( n = 15/104) babies had carbapenem resistant Gram-negative organisms infections. Among the CRO, most common was Acinetobacter species ( n = 9), followed by Klebsiella pneumoniae ( n = 4), Escherichia coli ( n = 1), Serratia ( n = 1). CRO showed resistance to our first line, second line drugs and carbapenems. Mortality among CRO babies was 33% ( n = 5/15). Babies with nonCRO infection had 10% mortality ( n = 9/89). All CROs were sensitive to Polymyxin and colistin. Conclusion: The incidence of CRO was surprising. Polymyxin B and E (colistin) is the drug of choice for CRO. Mortality among these CROs was greater than nonCRO. Mortality caused by CRO is knocking and shocking data, indicating the emergence to check the use of antimicrobials in NICUs.

MRI at term equivalent age for predicting long term neuro-developmental outcome in preterm infants - A cohort study

Abstract Purpose: Preterm infants are at increased risk of adverse neurodevelopmental outcome (NDO). Cranial ultrasound has limited predictability. The purpose of the study is to evaluate whether magnetic resonance imaging (MRI) done at term equivalent age (TEA) predicts NDO at 18–22 months of corrected gestational age (CGA). Materials and methods: This cohort study of preterm infants born at ≤32 weeks of gestation and/or birth weight <1500 grams between April 2011 and August 2012 was conducted in a tertiary care institute in India. MRI done at TEA was reported using objective scoring. NDO at 18–22-month CGA was assessed using Bayley Scale of Infant Development (BSID) version III. Composite score (CS) < 85 in motor, language, or cognition domain was taken as adverse NDO. Association between individual MRI subscores and NDO was evaluated using multiple linear regressions by backward elimination method. Validity of MRI abnormality in predicting adverse NDO was assessed. Results: Out of 94 infants who had MRI at TEA, 56 (60%) underwent BSID III. Mean gestational age was 29.8 ± 2.1 weeks. Median CS of all domains was lower with higher total MRI score. Predictive accuracy for various subscores ranged from 55 to 73%. By multiple regression analysis, signal abnormality was associated with motor delay (β −8.4; p .02) and cystic white matter (WM) changes with motor delay (β −7.3; p .003) and cognitive delay (β −6.1; p .005). Conclusions: Although specificity and negative predictive value were moderate to high across all subscores in MRI to predict the NDO, the accuracy has been only low to moderate, which limits its use as sole predictor.

Auditory brainstem response in very preterm, moderately preterm and late preterm infants

BACKGROUND Auditory brainstem response across preterm infants help in understanding difference if any in auditory maturation. OBJECTIVE To analyze and compare absolute and interpeak latencies of ABR in very preterm, moderate preterm and late preterm infants at term age. METHOD ABR traces were obtained from 148 ears of preterm infants (52 of very preterm, 44 of moderately preterm & 52 of late preterm) at term age. ABR was recorded with 11.1/s clicks at different intensity levels. RESULTS Absolute latencies of peak I, III, V and interpeak latencies of peak I-V, I-III and III-V were analyzed and compared between three preterm groups. One way ANOVA was used to compare ABR parameters between three groups of preterm infants and also to compare ABR parameters across various gestation ages. There were no overall differences in absolute latencies, interpeak latencies and amplitude of ABR between preterm groups and across various gestation ages (P>0.05). Pearson correlation was used to find the correlation between gestation age and ABR parameters. However, no correlation was found. ABRs were similar among preterm groups at term age which reflects that the brainstem maturation is similar among preterm groups. CONCLUSION Gestational age at birth does not seem to influence absolute and interpeak latencies of ABR at term age. In preterm neonates, the findings lead to suggest that maturation of auditory pathway occurs in a similar manner in preterm infants regardless of gestational age at birth. We conclude that preterm birth alone as a risk factor does not appear to have any marked effect on the development of ABR at term age.

Spectrum of magnetic resonance imaging abnormalities in neonatal seizures in a tertiary care hospital in India

Background: Seizure is the most common neurological presentation during the first month of life and can lead to adverse long term outcome. The aim of the study was to describe the spectrum of brain lesions identified by magnetic resonance imaging (MRI) in term babies presenting with neonatal seizures. Methods: This retrospective descriptive study was done in a tertiary care hospital. The study subjects included term neonates presenting with neonatal seizures admitted in neonatal intensive care unit over a 5 year period, who underwent MRI brain. Data was collected from the medical records and radiology department. Results: Out of 189 neonates presenting with seizures, 155 underwent MRI brain. Brain lesions were identified in 122 (79%) babies. The most common etiological diagnosis was hypoxic ischemic encephalopathy (HIE) which was noted in 43 (28%) neonates. The other findings in the decreasing order were encephalitis in 35 (23%), metabolic disorder in 16 (10%), haemorrhage in 15 (9.7%) vascular in 12 (8%) and cortical dysplasia in 1 (

Does diffusion restriction changes in magnetic resonance imaging predict neurological outcome in neonatal seizures

Background: Neonatal seizures are a common manifestation of brain dysfunction. Neonatal magnetic resonance imaging (MRI) has rapidly become the study of choice for the evaluation of central nervous systems disorders in newborns. According to a study conducted in Wilhelmina Childrens Hospital, University Medical Center Utrecht, diffusion Restriction (DR) changes in the MRI is a good indicator of cell dysfunction (reversible or irreversible) within one week of insult. Objectives: The main aim of this study was to find the association of DR changes in MRI of brain for neonatal seizures with long term neurodevelopment outcome. Methods: This is a retrospective observational study conducted in Sri Ramachandra University. Retrospective data was collected for the time period of January 2010 to December 2011 from medical records department (MRD) for patient data, neonatal intensive care unit and reports from PACS for MRI images and the Karthikeyan child development unit for their developmental follow up reports. Results: Comparison of composite score for various domains with DR changes was done with a t-test and comparison of babies with developmental delay and DR changes with Chi-square test. MRI DR changes with developmental outcome in different domains namely cognition, language-receptive/expressive, fine and gross motor was studied. There is no statistical significance among those who have DR changes and with those who do not have DR changes. Conclusion: Though diffusion restriction changes in MRI may not predict adverse long term neuro developmental outcome, they can be of use with regards to individual etiological profile as in stroke. Larger group study and long term follow up is required to substantiate these findings.