Srikanta Basu

Oxidative stress in term small for gestational age neonates born to undernourished mothers: a case control study

BackgroundThe objective of this study was to assess the status of oxidative stress in term small for gestational age (SGA) newborn infants born to undernourished mothers by estimating levels of erythrocyte superoxide dismutase (SOD), catalase, reduced glutathione, and serum malondialdehyde (MDA) in cord blood and comparing them to healthy appropriate for gestational age (AGA) controls. This was done in a case control design at a tertiary level teaching hospital.MethodsWe included 20 singleton healthy SGA newborn infants born between 38–40 weeks to undernourished mothers with a) post-pregnancy weight < 50 kg or height < 145 cm AND b) hemoglobin < 8.0 g/dL or serum albumin < 2.5 g/dL. An equal number of age and sex matched AGA newborn infants born to healthy mothers served as Controls. Mothers with other risk factors and newborns with complications during delivery or immediate newborn period were excluded. MDA, SOD, catalase and reduced glutathione were measured in the cord blood of all neonates and compared between the groups (unpaired t test); levels were also correlated to maternal weight, height, hemoglobin, and albumin by both univariate (pearsonian correlation) and multivariate (multiple regression) analysis.ResultsThe activity of MDA was increased (5.33 ± 0.72 vs 2.55 ± 0.22 nmol/mL; P < 0.0001) while levels of superoxide dismutase (493.6 ± 54.9 vs. 786.8 ± 79.1 U/g Hb; P < 0.0001), catalase (1.48 ± 0.24 vs. 2.31 ± 0.20 U/g Hb; P < 0.0001) and reduced glutathione (2.84 ± 0.37 vs 6.42 ± 0.23 Umol/g Hb, P < 0.0001) were decreased in term SGA born to undernourished mothers as compared to term AGA born to healthy mothers. On univariate analysis, all the markers of oxidative stress correlated significantly with maternal parameters (P < 0.005). On multivariate analysis, maternal albumin and hemoglobin accounted for maximum correlation with the markers of oxidative stress.ConclusionsIntrauterine malnutrition is associated with significant oxidative stress in small for gestational age neonates born at term to malnourished mothers.

COMPARISION OF NEEDLE AUTOPSY WITH CONVENTIONAL AUTOPSY IN NEONATES

Tru-cut needle biopsy postmortems were compared with the standard conventional autopsy in neonates. Twenty-five fresh deceased neonates between 33 weeks of gestation to below 28 days of life were examined by both the techniques. Tissue collection by needle biopsy varied from 92% for liver to 20% for spleen while lung, brain, and kidney gave intermediate results. The cause of death could be determined in 17 cases (68%) by needle biopsy and in 24 cases (96%) by conventional postmortem. In 14 of the 17 cases (56%) cause of death could be determined by biopsy which was in full concordance with the findings of the full autopsy, whereas 3 (12%) cases showed only partial concordance and the diagnosis were discrepant in 32% cases. Needle autopsy missed diagnosis of various congenital malformations, which can be discerned only after meticulous gross examination. Needle autopsy is of value when permission for a complete autopsy cannot be obtained.

Approach to a child with a heart murmur.

The vast majority of children with heart murmurs have an ‘innocent’ murmur. Differentiation of such murmurs from those due to structural cardiac disease, so called ‘pathological’ murmurs, is largely clinical. Pediatricians are capable of differentiating one from the other, provided a detailed evaluation is done. This article outlines the salient features of innocent murmurs that help us recognize them clinically.

An unusual case of neonatal brain abscess following Klebsiella pneumoniae septicemia

A case of solitary brain abscess in a term neonate caused by Klebsiella pneumoniae is described: K. pneumoniae, although a common cause of neonatal septicemia, is rarely implicated as an etiological agent for cerebral abscess in this age-group. The interest of this case lies in the rarity of the causative organism and atypical features. In the absence of predisposing factors in the neonate, we suspect that the infection was transmitted vertically from the mother before or at the time of delivery since there was evidence of asymtpomatic urinary tract infection in the antenatal period.

Unusually severe ABO hemolytic disease of newborn.

ABO-hemolytic disease of newborn (ABO-HDN) is a common cause of neonatal hyperbilirubinemia. Most of the cases are however mild. We desribe a neonate with ABO-HDN with unusually severe course.

Hypernatremic dehydration in term and near-term neonates

We present a series of 30 cases of apparently healthy neonates, >34wk of gastation age and or 1.8 Kg of birthweight, discharged by day 2 in case of vaginal delivery and by day 4 to 5 in cesarean section. Thus presented over a period of one year with features quite similar to that of sepsis but on investigations finally diagnosed and managed as hypernatremic dehydration without sepsis. They were considered to have NHD only if weight loss was >10% of the birth weight and or >5% in 24 hours and serum sodium concentration was >149 meq/l at presentation. Babies who were sick looking, had respiratory distress, shock, received special medical treatment or had major congenital malformations were not included. Sepsis was ruled out in all the babies with laboratory investigations.

Pseudohypoparathyroidism in a mother and son: Phenotypic variability and associated disorder

A 2-month-old infant with clinical features of hypothyroidism presented with hypocalcemic seizures. The maternal phenotypic features aroused the suspicion of pseudohypoparathyroidism which was confirmed in both by biochemical and endocrinological investigations. Though the child had clinical and radiological features to suggest hypothyroidism he had normal free thyroxine and only slightly elevated thyroid stimulating hormone levels. Special note is made of the intra and interpatient variability of this rare inherited disorder.