Congenital Lingual Melanotic Macule : Rare entity in infants

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Comparison of breastfeeding practices among different social groups: Experience from North India

Background: Breastfeeding is one of the most important determinants for neonatal survival, and the prevention of childhood infections. Breastfeeding practices vary among different professional and non-professional working mothers and also among different strata of society. Objectives: To assess the comparative prevalence of exclusive breastfeeding in various health professionals (Group 1), other professional women (Group 2), non-working housewives (Group 3), and laborer women (Group 4). Materials and Methods: This prospective study was conducted in the form of an interview of all above mentioned four groups of mothers using preplanned questionnaires. The mothers attending to our routine outpatient department and immunization section were randomly interviewed after taking proper informed consent. The study was conducted over a period of 1 year from January 2016 to December 2016. A total of 800 women (200 in each group) who had delivered within the past 1 year were interviewed. Results: Breastfeeding was delayed by more than 4 h in only 26% (52/200) in Group 1 (doctors/nurses/other health professionals) in comparison to 47.5%, 54.5%, and 43% of infants in Group 2, Group 3 and Group 4, respectively. Exclusive breastfeeding for ≥6 months as per the WHO recommendation was not given to any of the baby among health professional group (Group 1) where it was given to only 4.5% of Group 2 mothers, 3.5% of mothers in Group 3 and around 34.5% of laborer mothers. All mothers in Group 1 started with top/formula feeds before 6 months in comparison to 95.5%, 76.5%, and 66.5% of infants in Groups 2–4, respectively. Conclusion: Despite higher rates of early initiation of breastfeeding among all the groups and particularly in health professionals, awareness of exclusive breastfeeding (EBF), the benefits of EBF was the low depicted biyearly introduction of supplementary feeding. Maternal employment was observed as a major factor for early initiation of supplementary feeding, among health and other professionals whereas hungry baby and excessive crying were major contributory factors in early initiation of supplementary feeding in urban housewives and laborer mothers. This indicates the need to further promote and create awareness about the advantages of EBF and avoid early introduction of complementary foods

Diagnosis and Genetic Analysis of Glutaric Acidaemia Type I : Very rarely seen inborn error of metabolism

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Reducing infiltration rates of peripheral intravenous cannula: A quality improvement initiative in a neonatal intensive care unit of tertiary care hospital in Northern India

Background: Peripheral venous access is used for infusion of fluids, medications, and blood products. Penetration of these products through an intravenous (IV) access to surrounding tissues causes infiltration or extravasations injuries. Objective: The objective of the study was to measure the incidence of peripheral IV cannula (PIV) infiltration in neonates and reduce infiltration rate by at least 30 % from baseline rate. Methods: This was a quality improvement (QI) study, conducted in the neonatal intensive care unit from March 2018 to June 2018. All the neonates with PIV cannula irrespective of gestational age, postnatal age, and weight were included in the study. The baseline rate of PIV infiltration was determined. A team of doctors and nurses performed root cause analysis of factors responsible for PIV cannula infiltration using fishbone analysis. Various change ideas were tested through sequential Plan-Do-Study-Act cycles. Results: Infiltration rate of PIV cannula after intervention decreased from a baseline incidence rate of 60.8/100 IV–21.4/100 IV days over the study period. Conclusions: A QI approach was able to accomplish a reduction in the infiltration rates of PIV cannula in our unit

Ectrodactyly, Ectodermal Dysplasia, Cleft Lip, and Palate (EEC Syndrome) with Tetralogy of Fallot: A Very Rare Combination

Ectrodactyly, ectodermal dysplasia, and cleft lip/palate syndrome (EEC) syndrome is a rare genetic disorder with an incidence of around 1:90,000 live births. It is known with various names which includes split hand–split foot–ectodermal dysplasia–cleft syndrome or split hand, cleft hand or lobster claw hand/foot. We report first case of EEC with associated heart disease (Tetralogy of Fallot) who was diagnosed as EEC on the basis of clinical features and EEC was confirmed with genetic analysis

Exchange transfusion in neonates: An experience from a tertiary care center in North India

Background: Blood exchange transfusion (ET) involves replacement of affected neonate’s blood with compatible donor blood. Although the use of ET has decreased over years, it still remains a popular emergency rescue procedure for newborns with severe jaundice. Objective: The study was done to describe the indications and complications associated with ET in a 20 bedded neonatal unit of a tertiary care center in North India. Materials and Methods: This was a retrospective observational cohort study of neonates who underwent ET from July 2014 to May 2019. Demographic profile, indications and etiology, details of ET procedure, and related adverse events were noted from medical records and chart review. Results: Of 2310 admitted neonates, 77 (3.3%) underwent 103 ETs during the study period with an average rate of 23.3 ETs per year. Hyperbilirubinemia was the most common indication for ET in 53 (68.8%) neonates. Rhesus (Rh) hemolytic disease was the single most frequent etiology for hyperbilirubinemia seen in 43 (55.8%) neonates. A total of 77 adverse events related to ET were seen in 53 (68.8%) neonates whereas 17 (22%) had more than one adverse event. The most common complication was thrombocytopenia in 40 (51.9%) neonates. Overall, mortality was 7 (9.1%); none were attributable to ET. Conclusion: The study identifies Rh hemolytic disease of newborn as the most common etiology leading to ET in newborns. Although ET is a relatively safe procedure, the high incidence of adverse events suggests vigilant monitoring and in-depth expertise for performing and managing complications of the procedure

Neonatal Cholestasis: A Pandora’s Box

Neonatal cholestasis (NC) is a diagnostic dilemma frequently countered in a neonatal care unit. Early diagnosis is vital for achieving an optimal patient outcome as many causes of cholestasis such as biliary atresia are time-sensitive and amenable to treatment if analyzed and treated early. Nonetheless, it is not generally simple to analyze these cases right on time as some of them are regularly missed due to the presence of pigmented stools, lack of newborn metabolic screening, and named as instances of prolonged jaundice. In this manner, we prescribe to explore all reasons for prolonged jaundice stretching out past 14 days in neonates. Besides, we suggest that stool card ought to be a piece of release rundown for all newborn children being released from the nursery. This is of most extreme significance in the nation like India where guaranteeing customary follow-up is as yet a tough assignment. These stool cards will help in the early determination of patients with NC particularly biliary atresia and guarantee their auspicious cure. Another reason which needs exceptional say is parenteral nutrition–associated liver illness, as the proportion of preterm babies is getting greater and greater with better neonatal care. These extreme preterm infants are in the requirement for prolonged (>14 days) total parenteral nourishment because of which they are at high hazard for NC contrasted with their more developed peers. In this survey, we will give an understanding of clinical approach, differential diagnosis, and clinical review of NC

Transillumination test: A bedside aid for differentiating meningocele from myelomeningocele: Point of care testing

Transillumination test is a bedside and simple technique to illuminate the body cavity by transmission of light through the cavity. Transillumination test is used in a variety of conditions like hydrocele, Hydrocephalus, pneumoperitonium and pneumothorax in neonatology. We describe use of transillumination for differentiating meningocele and myelomeningocele

Hypoglycemia: When to Treat?

Hypoglycemia is the most common metabolic disorder encountered in neonates. The definition of hypoglycemia as well as its clinical significance and management remain controversial. Most cases of neonatal hypoglycemia are transient, respond readily to treatment, and are associated with an excellent prognosis. Persistent hypoglycemia is more likely to be associated with abnormal endocrine conditions, such as hyperinsulinemia, as well as possible neurologic sequelae. Manifestations of hypoglycemia include seizures which can result in noteworthy neuromorbidity in the long haul. Thus, hypoglycemia constitutes a neonatal emergency which requires earnest analytic assessment and prompt treatment. In this review, we have tried to cover the pathophysiology, the screening protocol for high-risk babies, management, long-term neurologic sequelae associated with neonatal hypoglycemia, with evidence-based answers wherever possible, and our own practices