Lalitha Krishnan

Perinatal mortality in a rural district of South India

Perinatal mortality is one of the most sensitive indices of maternal and child health. The perinatal mortality rate is an indicator of the extent of pregnancy wastage as well as of the quality and quantity of health care available to the mother and the newborn. A community based prospective study carried out on 13,214 births in South Kanara district between Oct. 1991 – Sept. 1992 revealed a perinatal mortality rate (PNMR) of 44.65/1000 births. Among the various factors influencing perinatal mortality, breech deliveries and babies of multiple pregnancies had a very high perinatal mortality rate of 180.81/1000 births (adjusted odd’s ratio : 4.90) and 128/1000 births (adjusted odd’s ratio : 2.64). The previous bad obstetric history of the mother, parity and sex of the newborn were among the other important factors influencing the PNMR.

Perinatal chikungunya in twins

We report a case of vertically transmitted chikungunya infection in heterozygous twin neonates presenting as seizures, encephalopathy, midfacial hyperpigmentation, anemia, and thrombocytopenia. This could be considered as a rare cause of neonatal seizure and identification would help in appropriate management.

Chikungunya in a newborn

Vertical transmission of Chikungunya has been described in neonates but postnatal chikungunya has rarely been reported. We report a neonate from South India, who presented with apnea, seizures and hypotonia followed by typical visceral and peri-oral skin hyperpigmentation. Chikungunya infection was suspected and confirmed by serology (IgM) which was positive in the baby and negative in mother. It is important to remember viral infections in the differential diagnosis of neonatal seizures and apnea.

Early versus late parenteral nutrition in very low birthweight neonates, a retrospective study from oman

OBJECTIVES The aim of this study was to compare the biochemical parameters, weight gain, osteopenia and phosphate supplementation in very low birth weight (VLBW) neonates receiving early versus late parenteral nutrition (EPN versus LPN). METHODS A RETROSPECTIVE STUDY WAS UNDERTAKEN IN THE LEVEL III NEONATAL INTENSIVE CARE UNIT AT SULTAN QABOOS UNIVERSITY HOSPITAL, OMAN: from January 2007 to October 2008 (LPN group, n = 47) and from January 2009 to June 2010 (EPN group, n = 44). Demographic data, anthropometric and laboratory parameters were extracted from the electronic record system. RESULTS The mean age of PN initiation was LPN = 47.3 hours versus EPN = 14.3 hours. Biochemical parameters analysed during the first week of life revealed a reduction in hypernatraemia (12.7% versus 6.8%) and non-oliguric hyperkalemia (12.7% versus 6.8%) in EPN, with no significant differences in acidosis and urea levels between the two groups. Hyperglycemia >12 mmol/L in <1000g was higher in EPN. Nutritional parameters in 81 babies who survived/stayed in the unit up to a corrected gestational age (CGA) of 34 weeks (40 in LPN and 41 in EPN), revealed a reduction in metabolic bone disease (osteopenia of prematurity [OOP], 17.5% versus 7.3%) and the need for phosphate supplementation (22.5% versus 7.3%) in the EPN group. There was no increase in acidosis or cholestasis. No difference was noted in albumin levels, time to full feeds, time to regain birthweight and mean weight gain per day till 34 weeks corrected CGA. CONCLUSION EPN in VLBW newborns is well tolerated and reduces hypernatraemia, non-oliguric hyperkalemia, OOP and the need for phosphate supplementation.

Malpositioned Central Line in A Neonate Presenting as Superficial Abdominal Abscess

Peripherally inserted central catheters (PICC) have become a routine in intensive care units. Although very effective, they can have life threatening complications like migration, breakage, thrombosis and colonisation [1]. The tip position of PICC lines must always be confirmed. Fluoroscopic placement is ideal, but cannot be done at the bedside and is costly [2]. Single antero-posterior radiograph is the most commonly used and convenient method. Malposition can lead to grave consequences like extravasations and sepsis. Central line migration and extravasation leading to superficial abscess is rare [3,4]. We report a neonate who developed a superficial abdominal collection following surgery due to extravasation through the PICC line.

Elizabethkingia meningoseptica bacteremia in a neonate: A case report and mini-review of the literature

Elizabethkingia meningoseptica is a nonfermentative Gram-negative bacillus that is ubiquitously found in hospital environments, and it has been associated with various nosocomial infections. Immunocompromised individuals are particularly at increased risk for developing severe infections due to E. meningoseptica, including bacteremia. E. meningoseptica is resistant to multiple antimicrobials commonly used for Gram-negative bacteria. Rapid diagnosis and early institution of appropriate therapy for prolonged period are essential in management of such infections. We report a case of bacteremia due to E. meningoseptica in a neonate who presented with clinical findings suggestive of epidermolysis bullosa. Based on the clinical diagnosis and preliminary blood culture report, baby was started on syrup cefixime, topical fucidin cream along with fluid correction for electrolyte imbalance. As baby′s general and systemic status were stable, the baby was discharged with the advice to review after 3 days. Awareness among clinicians along with correct identification by the diagnostic microbiology laboratory is required to reduce the fatal outcome associated with E. meningoseptica infections.

Should delayed cord clamping be the standard of care in term low risk deliveries? A randomized controlled trial from a medical college hospital in south India

Objective: The objective was to compare the effects of early versus delayed cord clamping (ECC vs. DCC) on immediate neonatal adverse outcomes and delayed benefits. Methodology: Prospective randomized controlled trial in mother-infant pairs who were term, singleton with uneventful pregnancies and normal vaginal deliveries. Intervention: ECC done at 10 s after birth. DCC done at 180 s after complete delivery of the fetus. Results: A sample size of 86 mothers were included, but 10 infant blood samples were discarded because they were hemolyzed. Hence final analysis was done on 76 mother-infant pairs (ECC = 39; DCC = 37). Mean serum ferritin level was 299.7 ng/ml in the ECC group versus 399.9 ng/ml in the DCC group with no significant complications in either group. Multiple regression analysis confirmed a clear relationship between DCC and serum ferritin levels after accounting for the effect of secondary variables. Conclusion: DCC should become the standard of care in all low risk singleton pregnancies.

Reverse vertical transmission of hepatitis-B from transfusion-infected children to biological mothers

BackgroundPerinatal and horizontal are the common modes of transmission of hepatitis-B virus in children.Case characteristicsTwo mother-child pairs with children having received multiple blood transfusions in past.ObservationBoth the mothers developed acute hepatitis-B infection whereas children were demonstrated to be having chronic infection with hepatitis-B.OutcomeOne mother cleared her hepatitis-B in fection whereas it persisted in the other. Both children required anti-viral treatment.MessageHepatitis-B virus may rarely get transmitted from infected children to their mothers causing acute infection.