Impact of maternal thyroid disorders on maternal and neonatal outcomes in women delivering after 34 weeks of gestation

Introduction: The association of altered thyroid regulation during pregnancy can lead to the development of hypothyroidism or hyperthyroidism, and the resultant thyroid dysfunction ultimately leads to pregnancy-related complications. Objective: The objective of this study was to determine the impact of maternal thyroid disorders on maternal and neonatal outcomes in women delivering at/after 34 weeks of gestation. Methods: The current study was a prospective observational case–control study done over 6 months. Comparisons were made between the pregnancy-related complications and the neonatal outcomes in 100 dysthyroid mothers with those of 100 euthyroid mothers, delivering at/after 34 weeks of gestation. Results: Enrollment of 200 mother-infant dyads, 100 in each group were done. The need for cesarean delivery was higher in hypothyroid patients as they failed induction oflabor (36.1%). Among the neonatal outcomes, the hypothyroid patients had a significantly higher incidence of late preterm delivery (31%) and had a higher incidence of small for gestational age infants (32%). Infants of such dysthyroid mothers did not show any significant abnormalities in their thyroid function tests. Conclusion: Abnormalities in thyroid function tests remain uncommon in infants born to dysthyroid mothers. Early screening and optimum treatment of thyroid disorders are extremely vital for optimum maternal and neonatal health outcomes. Knowledge of the associated comorbidities such as gestational diabetes, prematurity, growth retardation, and greater need for cesarean births can help to provide better medical care

Clinical profile of late-preterm infants admitted to a tertiary care hospital

Background: Late-preterm babies account for nearly 10% of the total births. Understanding clinical profile of late-preterm infants is important for helping newborn care providers to anticipate and manage potential morbidity during the birth hospitalization and early follow-up. Objective: The objective of this study is to study the clinical profile of late-preterm newborns (340/7 to 366/7 weeks of gestation). Methods: This was a prospective observational study conducted in the neonatal unit of a tertiary care public hospital. All late-preterm babies delivered in the hospital from July 2016 to December 2016, who met the inclusion criteria, were enrolled after taking consent from parents. Detailed antenatal and natal history were noted along with neonatal morbidities and mortality, and the interventions and treatment required by the infants were noted in a structured pro forma. These late-preterm infants were followed up till death/discharge and readmission to hospital and reasons for readmission were evaluated. Results: We enrolled 110 late-preterm babies delivered in our center. The most common morbidity was jaundice requiring phototherapy (63.63%) followed by respiratory distress (24.54%). 25.45% of infants required respiratory support in the form of continuous positive airway pressure or mechanical ventilation. Hypocalcemia and sepsis were observed in 10% of the babies. Feed intolerance was also observed in 16.36% of the babies. The mortality in this group of late preterms was 4.54%. Conclusions: Late-preterm infants show a considerably high rate of medical complications, including need for respiratory support and prolonged hospital stay. Awareness about the neonatal morbidities in late-preterm newborns will facilitate better management of these neonates

Neonatal bartter syndrome in an extremely low birth weight baby

Early diagnosis of Bartter syndrome (BS) in the neonatal period is a clinical challenge, more so in an extremely low birth weight (ELBW) baby because of the inherent renal immaturity and the associated difficulty in fluid management. However, once a diagnosis is made, the disorder is known to respond well to fluid and electrolyte management, prostaglandin inhibitors, and potassium-sparing diuretics. Herein, we report a case of neonatal BS in a very premature ELBW infant

Hypernatremic dehydration due to lactation failure in an exclusively breastfed neonate

We report a 13-day-old exclusively breastfed neonate, admitted with a history of fever, poor feeding, lethargy and decreased urine output. The mother had history of lactation failure. The neonate had severe hypernatremia, acute renal failure and metabolic acidosis. Renal ultrasound was normal, but the sodium level in mother′s milk was 96 mEq/L (normal 7 ± 2 mEq/L). The neonate required peritoneal dialysis on the second day of admission. The biochemical investigations gradually returned to normal and the neonate was discharged on day 12 of admission. We highlight the importance of lactation management and supportive counseling to prevent complications like hypernatremic dehydration due to lactation failure

Parental and professional perceptions of informed consent and participation in a time-critical neonatal trial: a mixed-methods study in India, Sri Lanka and Bangladesh

Introduction Time-critical neonatal trials in low-and-middle-income countries (LMICs) raise several ethical issues. Using a qualitative-dominant mixed-methods design, we explored informed consent process in Hypothermia for encephalopathy in low and middle-income countries (HELIX) trial conducted in India, Sri Lanka and Bangladesh.Methods Term infants with neonatal encephalopathy, aged less than 6 hours, were randomly allocated to cooling therapy or usual care, following informed parental consent. The consenting process was audio-video (A-V) recorded in all cases. We analysed A-V records of the consent process using a 5-point Likert scale on three parameters—empathy, information and autonomy. In addition, we used exploratory observation method to capture relevant aspects of consent process and discussions between parents and professionals. Finally, we conducted in-depth interviews with a subgroup of 20 parents and 15 healthcare professionals. A thematic analysis was performed on the observations of A-V records and on the interview transcripts.Results A total of 294 A-V records of the HELIX trial were analysed. Median (IQR) score for empathy, information and autonomy was 5 (0), 5 (1) and 5 (1), respectively. However, thematic analysis suggested that the consenting was a ceremonial process; and parental decision to participate was based on unreserved trust in the treating doctors, therapeutic misconception and access to an expensive treatment free of cost. Most parents did not understand the concept of a clinical trial nor the nature of the intervention. Professionals showed a strong bias towards cooling therapy and reported time constraints and explaining to multiple family members as key challenges.Conclusion Despite rigorous research governance and consent process, parental decisions were heavily influenced by situational incapacity and a trust in doctors to make the right decision on their behalf. Further research is required to identify culturally and context-appropriate strategies for informed trial participation

Additional file 4: of Hypothermia for encephalopathy in low and middle-income countries (HELIX): study protocol for a randomised controlled trial

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Hypothermia for moderate or severe neonatal encephalopathy in low-income and middle-income countries (HELIX): a randomised controlled trial in India, Sri Lanka, and Bangladesh

Copyright (c) 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license