Organophosphorus Poisoning with Homicidal Intention in a Neonate

Organophosphorus Compounds (OPC) are widely used as pesticides, and poisoning due to OPC is very rare in neonates. A 12-dayold female neonate was admitted with gasping respiration, excessive oral secretions and cold extremities. She had frothing from mouth and nose with an offensive odour, was hypothermic, hypotonic, cyanosed and was in mild stupor. Pupils were pin pointed, capillary refill time was 4-5 sec and had bilateral crepitations of lungs on auscultation. The baby was intubated, given 0.1 mg of atropine followed by 0.9% saline bolus and gastric lavage. She was treated with empirical antibiotics, atropine, Pralidoxime (PAM) and respiratory support. The baby responded well to treatment and was discharged on 10th day of admission. This could be the second case of Organophosphorus (OP) poisoning with homicidal intention reported in neonates

Achromobacter xylosoxidans Causing Late-onset Sepsis with Pneumonia in a Term Neonate

Achromobacter xylosoxidans (A. xylosoxidans), is an aerobic gram negative motile bacillus that rarely causes infection in healthy adults and is exceptionally rare in neonates. A. xylosoxidans is ubiquitous in nature, causing nosocomial infections especially in debilitated and immunocompromised patients. Few outbreaks caused by this organism were reported in Neonatal Intensive Care Units (NICU) along with sporadic cases in neonates. A 3-week-old term neonate presented with late-onset sepsis and pneumonia caused by A. xylosoxidans that was successfully treated with antibiotics and supportive care. Awareness regarding this uncommon pathogen and initiation of appropriate antibiotic therapy would improve the outcome and prevent mortalit

Partial Exchange Transfusion in the Management of a Preterm Neonate with Severe Anaemia from Acute Foetomaternal Haemorrhage: A Case Report

Foetomaternal Haemorrhage (FMH) refers to the passage of foetal blood into the maternal circulation. FMH is rarely diagnosed antenatally as clinical findings are subtle and non specific. Massive FMH is suspected when foetal movements are decreased, and Cardiotocographic (CTG) findings are abnormal with decreased heart rate variability, saw-tooth or a sinusoidal pattern. Massive FMH can lead to foetal demise, stillbirth, hydrops, or the birth of a severely anaemic infant with hypovolaemic shock. A 35-week pregnant woman presented with decreased foetal movements, and an emergency caesarean section was performed due to late deceleration on the cardiotocograph. The baby was very pale at birth and in shock. The Kleihauer-Betke (KB) test performed on the mother’s blood shortly after delivery showed 2.7% foetal red cells, suggesting 135 cc of FMH. The clinical features and outcome of FMH depend on the gestational age, volume, and rapidity of FMH, as well as, whether it is acute or chronic. Packed cell transfusion is recommended, but in babies with severe anaemia and cardiac failure, partial exchange transfusion is performed. The baby was managed with a fluid bolus, inotropic support, respiratory support, and partial exchange transfusion, resulting in a successful outcome. A high index of suspicion enables the obstetrician to undertake diagnostic tests, cordocentesis, plan for intrauterine transfusion or delivery, and alert the neonatal team for a better outcome

Cardiac Hypertrophy in an Infant of a Diabetic Mother: A Case of Reversible Cardiomyopathy

Diabetes Mellitus (DM) is a chronic metabolic disorder characterised by insulin deficiency or resistance and/or β-cell defects. High Body Mass Index (BMI) at conception, undiagnosed pregestational diabetes, and poor glycaemic control significantly affect the foetal heart, foetoplacental circulation and foetal growth. Myocardial hypertrophy and cardiac defects are more prevalent in Infants of Diabetic Mothers (IDMs). Cardiac Hypertrophy (CH) is characterised by a significant thickening of the interventricular septum, reduction in the size of the ventricular cavity, systolic and diastolic dysfunction and subaortic stenosis. A term neonate born to a mother with pregestational insulin-dependent Type I Diabetes Mellitus (T1DM) developed respiratory distress soon after birth, and Echocardiography (ECHO) showed Asymmetric Septal Hypertrophy (ASH) and Left Ventricular Outflow Tract (LVOT) obstruction. The baby responded well to oral propranolol, which was continued for four weeks, resulting in the resolution of CH at four months of age on follow-up. The present case underscores the importance of ECHO, even in infants born to mothers with good glycaemic control

Cephalhaematoma Mimicking an Extradural Haematoma due to MirrorImage Artifact on Sonography in a Term Neonate: A Case Report

Cephalhaematomas and subgaleal haematomas are among the most common birth injuries and are associated with birth trauma, forceps, and vacuum-assisted deliveries. They present as scalp swelling and are usually identified shortly after birth. During sonographic examination, if an ultrasound beam scatters off a mirror-like interface, it creates mirror-image artifacts that can cause a diagnostic dilemma. In this case report, a six-day-old neonate presented with a right-side parietal cephalhaematoma that appeared to resemble an epidural haematoma on routine sonographic examination. Gray scale ultrasound revealed an anechoic structure resembling an epidural haematoma in the right parietal region. However, a non-contrast-enhanced computed tomography (NECT) scan of the brain showed a cephalhaematoma without an underlying epidural haematoma. Further evaluation using colour Doppler sonography revealed normal vascular findings within an anechoic space, and gray scale imaging in the sagittal plane showed normal cerebral parenchyma without midline shift. These findings helped identify the observed structure as a mirror-image artifact. It is important to note that these artifacts can lead to diagnostic errors, resulting in additional investigations and causing anxiety for parents. Understanding and being aware of these artifacts can help avoid unnecessary imaging and reduce radiation exposure