RESUMEN

Duplication cyst is a rare congenital malformation. Enterogenous cyst are foregut duplication cyst with or without a vertebral defect. We report a case of a 36hr old neonate with mediastinal enterogenous cyst associated with vertebral defects. The embryology, differentials, and management of enterogenous cyst in the newborn have been discussed.

RESUMEN

OBJECTIVE: To determine the time to normalization of procalcitonin (PCT) levels and duration of antibiotics in neonatal sepsis. METHODS: A prospective observational study design was used. The participants included were neonates with sepsis. The primary outcome measure was time to normalization of PCT levels and duration of antibiotics following clinical resolution. RESULTS: Time to normalization of PCT levels was 9.6 ± 4.2 days in neonates with septic shock, 6.2 ± 2.5 days in neonates without shock, 9.6 ± 3.1 days in neonates with culture-positive sepsis and 6.4 ± 3.1 days in neonates with culture-negative sepsis. Time to normalization of PCT levels according to the stage of systemic inflammatory response syndrome was 5.8 ± 2.8 days in neonates with sepsis, 6.1 ± 3.1 days in those with sepsis syndrome, 6.3 ± 3.3 days in those with early septic shock and 9.4 ± 3.6 days in those with multiorgan dysfunction syndrome. There was no morbidity and mortality in any neonate in the 4-week follow-up. CONCLUSION: The duration of antibiotics can be determined by observing the time to normalization of PCT following clinical resolution of sepsis.

Asunto(s)

RESUMEN

OBJECTIVE: To compare the effect of 4 day course (study group) with 7 day course (control group) of antibiotic treatment in neonatal pneumonia, on treatment success rate. METHODS: This randomized controlled trial was conducted in a tertiary teaching hospital. Seventy, term and near-term neonates with pneumonia who had clinical remission by 48 h of antibiotic therapy were included. The neonates were randomized to receive a total of 4 d of antibiotics (Group 1) or 7 d of antibiotics (Group 2). The outcome measure was treatment failure in each group within 3 d of discharge. RESULTS: The treatment success rate of both the groups was 100%. There was a significant reduction in the duration of hospital stay (p < 0.001), antibiotic usage (p < 0.001), and cost (p < 0.001) in the 4 d group. On follow up till 28 d of enrollment, no infective morbidity was found in either group. CONCLUSIONS: For term and near-term neonates who become clinically asymptomatic within 48 h of antibiotic therapy, 4 d of antibiotic therapy is as effective and safe as 7 d of antibiotic therapy, with significant reduction in hospital stay, antibiotic usage and cost.

Asunto(s)

RESUMEN

BACKGROUND: An estimated 2.7 of the 5.9 million deaths in children under 5 years of age occur in the neonatal period. Severe infections contribute to almost a quarter of these deaths. Mortality due to severe infections in developing country settings is substantial despite antibiotic therapy. Effective interventions that can be added to standard therapy for severe infections are required to reduce case fatality. METHODS/DESIGN: This is a double-blind randomized placebo-controlled parallel group superiority trial to investigate the effect of zinc administered orally as an adjunct to standard therapy to infants aged 3 days up to 2 months (59 days) hospitalized with clinical severe infection, that will be undertaken in seven hospitals in Delhi, India and Kathmandu, Nepal. In a 1:1 ratio, we will randomly assign young infants to receive 10 mg of elemental zinc or placebo orally in addition to the standard therapy for a total of 14 days. The primary outcomes hospital case fatality, which is death due to any cause and at any time after enrolment while hospitalized for the illness episode, and extended case fatality, which encompasses the period until 12 weeks after enrolment. DISCUSSION: A previous study showed a beneficial effect of zinc in reducing the risk of treatment failure, as well as a non-significant effect on case fatality. This study was not powered to detect an effect on case fatality, which this current study is. If the results are consistent with this earlier trial, we would have provided strong evidence for recommending zinc as an adjunct to standard therapy for clinical severe infection in young infants. TRIAL REGISTRATION: Universal Trial Number: U1111-1187-6479, Clinical Trials Registry - India: CTRI/2017/02/007966 : Registered on February 27, 2017.

Asunto(s)

RESUMEN

OBJECTIVES: To compare the effect of 400 IU and 1000 IU vitamin D for 6 weeks in very low birth weight preterm neonates. DESIGN: Randomized, double-blinded controlled trial in a teaching hospital. PARTICIPANTS: Fifty very low birth weight preterm neonates. INTERVENTION: Vitamin D 400 IU/day (Group 1) or 1000 IU/day (Group 2). OUTCOME MEASURES: Change in serum calcium, phosphate, alkaline phosphatase (ALP), 25-hydroxy vitamin D (25-OHD), parathormone, incidence of skeletal hypomineralization and growth. RESULTS: After 6 weeks of supplementation, the mean serum calcium and 25-OHD levels were significantly higher (p < 0.001 each), while ALP and parathormone levels significantly lower (p < 0.001 each) in group 2. Skeletal hypomineralization was lesser and growth better in group 2. CONCLUSION: Vitamin D supplementation in a dose of 1000 IU/day is more effective in maintaining serum calcium, phosphate, ALP, 25-OHD and parathormone levels with lower incidence of skeletal hypomineralization and better growth.

Asunto(s)

RESUMEN

OBJECTIVE: To assess the effect of zinc supplementation on neuro-development and growth of preterm neonates. SETTING: Referral neonatal unit of a teaching hospital. DESIGN: Open-labeled Randomized controlled trial. PARTICIPANTS: 100 preterm neonates. INTERVENTION: Participants randomized to receive oral zinc (study group) or not (controls). MAIN OUTCOME MEASURES: Primary: Neuro-development status at 40 weeks post conceptional age and at 3 month corrected age using Amiel-Tison neurologic assessment. Secondary: anthropometry and serum alkaline phosphatase at 3 months corrected age. RESULTS: At 40 weeks post-conceptional age, greater number of zinc supplemented infants demonstrated alertness and attention pattern normal for their age (P=0.02). Higher number of controls showed signs of hyper-excitability at 40 week post-conceptional age (P=0.001) and 3 months corrected age (P=0.003). At 3 month corrected age, mean serum alkaline phosphatase level was significantly higher in the study group compared to controls. CONCLUSION: Zinc supplementation till 3 month corrected age in preterm breastfed infants improves alertness and attention pattern; and decreases signs of hyperexcitability, and proportion with abnormal reflexes.

Asunto(s)

RESUMEN

OBJECTIVE: To evaluate pulse oximetry for detection of congenital cyanotic heart disease in sick neonates using echocardiography as gold standard. METHODS: Pulse oximetry readings were taken at admission from 950 neonates from right upper limb and either foot with infant breathing room air. Pulse oximetry was considered abnormal if oxygen saturation at room air measured <90% or difference between right hand and foot was more than 3%. Persistent abnormality was considered positive result. Echocardiography was performed on all neonates with positive pulse oximetry (study group) and on one subsequent neonate with negative screen for each neonate with positive screen (controls). RESULTS: Pulse oximetry was positive in 210 neonates. It detected 20 out of 21 (95.2%) true positives. The sensitivity, specificity, positive predictive value, negative predictive value and odds ratio (95% CI) of pulse oximetry was 95.2%, 52.4%, 9.5, 99.5 and 22 (5.3, 91.4), respectively. CONCLUSION: Pulse oximetry screening is useful in detecting cyanotic heart diseases in sick newborns.

Asunto(s)

RESUMEN

OBJECTIVES: To compare the effect of 10 days versus 14 days of antibiotic therapy in neonatal meningitis on treatment failure rate. METHODS: The study was a randomized controlled trial conducted at a referral neonatal unit. The participants were 70 neonates with meningitis randomized to receive 10 days (study group) or 14 days (control group) of antibiotics. The primary outcome measure studied was treatment failure in each group within 28 days of enrolment. RESULTS: None of the neonates among either of the groups had occurrence of meningitis during follow-up. Occurrence of sepsis was observed after discharge in three neonates in the control group and none in the study group. Brainstem-evoked response audiometry was abnormal in one neonate in the study group. Adverse effects of drugs and neurological deficits were not observed in the study population. CONCLUSIONS: Short course of antibiotic therapy (10 days) is effective, with potential benefits of shorter hospital stay.

Asunto(s)

RESUMEN

The benefits of breastfeeding for the infant and nursing mother are well established. The World Health Organisation (WHO) recommends exclusive breastfeeding up to 6 mo and continued breastfeeding up to 2 y. Exclusive breastfeeding is the most effective intervention to reduce infant mortality and is estimated to prevent 13 % of under 5 child mortality in low income countries. However, rate of exclusive breastfeeding is alarmingly low in our country. Mothers who face problems in breastfeeding immediately resort to top feeds. It is the responsibility of the health professionals to identify and manage breastfeeding problems appropriately. UNICEF/World Health Organisation, through Baby Friendly Hospital Initiative (BFHI), have recommended good health care practices that support breastfeeding and increase likelihood of optimum breastfeeding. This paper briefly discusses breastfeeding and related feeding problems seen in clinical practice.

Asunto(s)

RESUMEN

Zygomycosis is a rare infection in neonates. The clinical presentation is non-specific and diagnosis most often is made at autopsy. Surgical debridement performed early improves survival. We report a case of neonatal zygomycosis with gastric perforation.

Asunto(s)

RESUMEN

OBJECTIVES: To evaluate the role of dexamethasone therapy in neonatal meningitis in a randomized placebo controlled trial. METHODS: The participants were eighty neonates with meningitis randomized to receive dexamethasone or saline placebo. Dexamethasone was started prior to the first dose of antibiotics in the dose of 0.15 mg/kg intravenous 6 hourly for 2 d. Primary outcome measure was mortality. Secondary outcome measures included progression of systemic inflammatory response syndrome (SIRS) up to 48 h, differences in cerebrospinal fluid (CSF) cytokines between baseline levels and 24 h after enrolment and brain stem auditory evoked response (BAER) after 4 to 6 wk of discharge. RESULTS: Baseline variables were comparable in both the groups. Mortality was significantly decreased in dexamethasone group (p = 0.005) and the absolute risk difference was 27.5 % (95 % CI 9.5-45.8 %). There was a significant reduction in cells per mm(3) (62.5 vs. 100) and proteins (162 vs. 217.5 mg/dl) after 24 h of treatment in the dexamethasone group. IL-1ß was significantly reduced after 24 h in dexamethasone group (290 vs 665 pg/ml). TNF- α was significantly lower (157.5 vs 427.5 pg/ml) and sugar significantly higher (50 vs 38 mg/dl) in the dexamethasone group after 24 h. Significant difference was noted between dexamethasone and saline groups in the progression of SIRS. CONCLUSIONS: Dexamethasone significantly reduced fatality, progression of SIRS and CSF inflammatory indices.

Asunto(s)

RESUMEN

Intrapericardial herniation of liver is a rare form of diaphragmatic hernia. We report a 30-hour old baby with right congenital anterior diaphragmatic hernia masquerading as congenital pneumonia with cardiomegaly. It is prudent to consider congenial anterior diaphragmatic hernia in any newborn with unexplained respiratory distress, cardiomegaly and pericardial effusion.

Asunto(s)

RESUMEN

We conducted this study to evaluate the adequacy of breastmilk as a source of vitamin E in exclusively breastfed VLBW infants. Such infants (n=44) were randomly allotted to receive vitamin E supplementation (n = 23); the rest (n = 21) did not receive vitamin E. After 21 days, the vitamin E level in the supplemented group was 0.78 + 0.26 mg/dL as compared to 0.77+ 0.25 mg/dL in the unsupplemented group (P=0.69). The ratio of Vitamin E to lipids was also comparable in the two groups, (P=0.65). We concluded that vitamin E supplementation is not routinely needed in VLBW infants.

Asunto(s)

RESUMEN

We report a case of congenital hyperinsulinism with diffuse pancreatic abnormality diagnosed preoperatively by using [18-F]-L-DOPA positron emission tomography (PET). The infant was referred to us for recurrent hypoglycemia. Critical blood sample revealed increased insulin: glucose ratio. DOPA PET scan revealed diffuse involvement of pancreas. Subtotal (95%;) pancreatectomy was done. Infant remained euglycemic on breast feeds at discharge.

Asunto(s)

RESUMEN

Congenital leukemia (CL) is an extremely rare disorder in the newborn, significant proportion of which is of myeloid origin, primarily of M4 or M5 morphology. As compared to pediatric leukemia, CL is a more aggressive disease. Acute myeloid leukemia (AML-M7) or acute megakaryocytic leukemia is a rare type of AML with an incidence of 0.5 per million per year. Median age of presentation is 6 years, and children may present with a broad variety of symptoms including low-grade fever, diarrhea, easy bruising, failure to gain weight and life-threatening conditions.

RESUMEN

OBJECTIVE: To determine the severity of systemic inflammatory response syndrome (SIRS) at admission, bacteriological profile, antibiotic sensitivity of pathogens and factors associated with fatality in home delivered neonates with sepsis. METHODS: This was a prospective observational study conducted in the referral neonatal unit of a teaching hospital admitting extramural neonates. The subjects comprised of 80 home delivered neonates presenting with systemic inflammatory response syndrome at admission. Skin temperature, oxygen saturation, capillary refill time and blood sugar were recorded in all the neonates at admission. For Blood culture, blood collected by venipuncture was placed in a tryptic soy broth culture bottle. Serum TNF-α was measured by ELISA kit. RESULTS: Early onset sepsis was seen in 27.5%. The commonest clinical feature in the study population was decreased oral acceptance (53.8%). The mean distance traveled to reach the hospital was 19 ± 3 km. At admission, acute physiological derangement in the form of abnormal skin temperature, oxygen saturation, perfusion and blood sugar was present in 53 neonates and 44% had more than one parameter deranged. Only 11% cases had early sepsis while the SIRS was well established in the rest. Klebsiella pneumoniae was the predominant bacteria isolated in 14 cases. Resistance of Klebsiella isolates to Ampicillin was 90% and to Gentamicin 57%. The fatality was higher in presence of advanced stages of SIRS at admission. CONCLUSION: SIRS was well established in 89% cases at admission. Klebsiella resistant to antibiotics was the predominant etiological organism. Fatality was higher in culture positive sepsis and in those associated with meningitis and pneumonia.

Asunto(s)

RESUMEN

Chlamydia trachomatis is considered a major aetiological agent of conjunctivitis in newborns. The objective of the present study was to determine the aetiology of neonatal conjunctivitis and clinico-epidemiological correlates of chlamydial ophthalmia neonatorum. Fifty-eight newborns with signs and symptoms of conjunctivitis were studied. Conjunctival specimens were subjected to Gram staining, routine bacteriological culture, culture for Neisseria gonorrhoeae and direct fluorescent antibody (DFA) staining for diagnosis of C. trachomatis infection. C. trachomatis was detected in 18 (31%) neonates. Findings suggest that since C. trachomatis is the most common cause of neonatal conjunctivitis, routine screening and treatment of genital C. trachomatis infection in pregnant women and early diagnosis and treatment of neonatal Chlamydial conjunctivitis may be considered for its prevention and control.

Asunto(s)

RESUMEN

OBJECTIVE: A) To study the frequency of perceived breast milk insufficiency in mothers of hospitalized neonates. b) To assess subsequent duration of exclusive breast feeding and growth (upto three months) in neonates whose mothers perceived breast milk insufficiency. METHODS: Neonates whose mothers were willing to breastfeed their babies were included in the study. Their breastfeeding status was assessed and the mother's perception of breastfeeding was elicited as per WHO guidelines. In mothers who perceived breast milk insufficiency (crisis group), causes for such a perception were looked into. Mothers were regularly counseled to breastfeed the infant After discharge the mother infant dyad were followed up for three months and babies evaluated for weight, length and head circumference. RESULTS: Three hundred and seven neonates and their mothers fulfilling the inclusion criteria were enrolled in the study. Perceived breast milk insufficiency was present in 208 (68%) mothers. Common reasons for such a perception were irrational. In the crisis group, 35% mothers had preterm babies as compared to 16% in the non crisis group (p =0.001). One hundred and fifty three mothers (73.33%) in the crisis group had breast milk sodium levels>16 mmol/L as compared to 12 mothers (12.12%) in the non crisis group (p 0.001). Micturition <6 times/24 hours was reported in 166 (83%) mothers in crisis group as compared to 18 (18.1%) mothers in non crisis group. All mothers who perceived breast milk insufficiency could be helped by lactation management and exclusively breastfed their babies. All infants were exclusively breastfed at discharge and at three month follow up. The growth of the infants was satisfactory in the crisis group at 3 months follow up. CONCLUSION: The Present study suggests that lactation failure following delayed initiation of breastfeeding can be countered by subsequent intensive counselling. Emphasis is required on counselling for breastfeeding in primary neonatal care.

Asunto(s)

Asunto(s)

RESUMEN

Celiac disease (CD) is being increasingly reported from the wheat-eating population of north India. However, the exact prevalence of CD in children is not known as population screening studies are scarce. Our study aimed to determine the prevalence of CD in 400 children, 6 months to 12 years of age attending pediatrics department of a tertiary care hospital in north India. The study population was screened for antitissue transglutaminase (tTG) antibodies. Endoscopic duodenal biopsy was done in the anti--tTG positive subjects. Four patients were diagnosed with CD as per the modified ESPGHAN criteria. The prevalence of CD thus was 1 %, which was in concordance with screening studies using serological markers conducted in the West.

Asunto(s)