Department of Neonatology

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    Small Beginnings, Complex Outcomes: Understanding Birth Size and Health Consequences
    (PUBMED, 2024-07-01) Ashish Jain; Shoham Majumder
    The neonatal period is a critical phase characterized by rapid growth and development, yet it is also a time of heightened vulnerability. Neonatal mortality, defined as death within the first 28 days of life, remains a pressing public health concern globally, with an estimated 2.3 million neonatal deaths occurring annually [1]. In India, despite notable improvements in maternal and child health in recent years, neonatal mortality rates remain high at 25/1000 live births, accounting for more than half of under-five deaths [2]. The intrauterine course and the point of transition to extrauterine life are the most critical determinants of immediate neonatal course as well as long term health. Within this context, birth size and gestational age play the most pivotal roles in shaping the trajectory of neonatal health outcomes. Low birth weight (LBW), typically defined as weighing less than 2500 grams at birth, and preterm birth, occurring before 37 weeks of gestation, are two key statistical thresholds.
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    Yellow Fibrous Cord‑Like Penile Discharge in a Preterm Neonate — Fungal Balanoposthitis
    (PUBMED, 2024-03-01) Chinmay Chetan; Saikat Patra; Brajendra Singh; Girish Gupta
    A 1785 g male neonate was born at 31 wk gestation, to an inadequately treated syphilitic mother. The neonate was diagnosed with congenital neurosyphilis. Injection benzathine penicillin G stat dose along with injection ceftriaxone was started through peripherally inserted central catheter. At DOL 24 he developed thick yellowish cord-like gelatinous odourless discharge from the penis, measuring 9 mm×4 mm (Fig. 1). Physiological phimosis was present, with no signs of inflammation and urinary retention. No perianal rashes were noted. Oral thrush was present. Histopathological examination of discharge and suprapubic urine KOH mount revealed budding yeast cells with pseudohyphae. Local clotrimazole cream and injection fluconazole was started. Local hygiene was maintained. The discharge culture grew Candida albicans sensitive to fluconazole.
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    Correlation of Point-of-Care Lung Ultrasound Scoring System with Clinical Score and Chest X-ray Score for Newborns with Respiratory Distress
    (PUBMED, 2025-07-07) Brajendra Singh; Chinmay Chetan; Saikat Patra; Girish Gupta; Vinayak Madhukar Jedhe; Shoham Majumder
    Objectives To determine correlation between the lung ultrasound score with the chest X-ray score and the Downes score in neonates with respiratory distress. Methods All consecutive neonates admitted in the neonatal intensive care unit (NICU) with respiratory distress were checked for eligibility at admission. Clinical scoring was done using Downes score immediately. 12 area lung ultrasound scoring was done using Brat Score by trained experts. Chest X-ray scoring was done from high quality anteroposterior images. The findings of the three scores were then compared and correlated using Pearson correlation coefficient. Results One hundred neonates were enrolled with mean gestational age of 34.8 ± 3.6 wk and mean birth weight of 2063.7 ± 722 g. A positive correlation was found between Downes score and lung ultrasound score (Pearson correlation coefficient 0.712, p-value < 0.001) but not between lung ultrasound score and chest X-ray score. In the subgroup analysis, a statistically significant correlation was found between lung ultrasound score and Downes score for babies > 32 wk gestation but not for those < 32 wk gestation. Conclusions In neonates admitted to NICU with respiratory distress, lung ultrasound score correlates well with Downes score, especially in babies with gestational age > 32 wk.
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    Effectiveness of Probiotics and Phototherapy Compared to Phototherapy Alone in Treating Hyperbilirubinemia in Neonates ≥35 Weeks Gestation: A Comparative Observational Study
    (SCOPUS, 2023-06-01) Suraj Kumar Singh; Girish Gupta; Sanober Wasim; Rakesh Kumar; Saikat Patra; Chetan Chinmay
    Introduction Neonatal jaundice is a common condition in neonatal practice. Phototherapy is accepted first line of therapy in its treatment. Probiotics can be an addition as it decreases enterohepatic circulation and improves gut function. Materials and Methods The observational study was conducted in 40 neonates. Participants were divided into 2 groups, phototherapy alone (PA) and probiotics plus phototherapy (PP). The mean difference in total serum bilirubin (mg/dL) levels, total duration of phototherapy, incidence of rebound hyperbilirubinemia, frequency of stooling after initiation of therapy, feed intolerance, and occurrence of new onset sepsis was compared. Results The mean difference in serum bilirubin level was not statistically significant after 12 hours (p = .321), 24 hours (p = .544) and 48 hours (p = .863) after initiation of phototherapy. An increase in frequency of stool in the first 24 hours was observed in PP group (p = .003). The total duration of phototherapy was less in PP group although not statistically significant (25 hours vs 38 hours, p = .054). Rebound hyperbilirubinemia was significantly higher in PA (p = .023). There were no cases of feed intolerance and sepsis. Conclusion The addition of probiotics did not alter the clinical course of jaundice. However, probiotics can reduce the rebound hyperbilirubinemia and is safe as it did not increase incidence of new onset sepsis or feed intolerance.
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    Facial Scalds due to Steam Inhalation in a Neonate – A Case Report
    (Journal of Nepal Paediatric Society, 2024-08-01) Chinmay Chetan; Saikat Patra; Aisha Naaz; Girish Gupta
    Steam inhalation is a traditional remedy used in all age groups for treating respiratory problems like cough, coryza, pharyngitis, bronchiolitis, etc. Though equivocally beneficial, should be avoided in neonates, due to the risk of burns if not used correctly. We present a case of a term neonate with scalds on his face due to steam inhalation, given by his mother, to treat cough and coryza. First and second-degree burns were present on the face. Oral, nasal cavities, and eyes were unaffected. This case highlights the probable side effects of steam inhalation, a therapeutic approach lacking proven advantages. This reemphasizes the need to avoid such treatment strategy, especially in neonates who are predisposed to such injuries.
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    A pilot randomized controlled trial comparing noradrenaline and adrenaline as a first-line vasopressor for fluid-refractory septic shock in neonates
    (PUBMED, 2024-10-13) Reema Garegrat1 ,; Suprabha Patnaik; Sonali Suryawanshi; Chinmay Chetan; Nishant Banait; Pari Singh; Aditya Kallimath; Naharmal B. Soni; Yogen Singh; Pradeep Suryawanshi
    Background and study design: Limited data exists on noradrenaline therapy in neonatal septic shock. We compared the efficacy of noradrenaline with adrenaline in neonatal septic shock. This single center, open label, pilot randomized controlled trial included neonates with clinical evidence of sepsis and shock. Study outcomes: Primary outcomes were: 1) resolution of shock one hour after treatment, and 2) mortality during hospital stay. Secondary outcomes included: need for additional vasopressors; hemodynamic stability without further administration of vasopressors for ≥2 h; changes in blood pressure and heart rate after 1 h of vasopressor treatment; and morbidities during the hospital stay. Results: Of 65 eligible neonates, 42 were randomized (21 each in adrenaline and noradrenaline treatment arms) between August 2020 and January 2022, at level III neonatal intensive care unit (NICU) of Bharati Vidyapeeth Deemed University Medical College and Hospital (BVDUMCH). The mean (SD) gestational age and mean (SD) birth weight were 36.1(4.2) weeks and 1.8 (0.2) kilograms birth weight for noradrenaline and 36.9 (4.1) weeks and 1.7 (0.7) kilograms for adrenaline. Shock resolved within 1 h of vasopressor therapy in 76.2% neonates in the noradrenaline arm and 61.9% in adrenaline arm (p value-0.53). Mortality during hospital stay was 28.6% (6/21) in noradrenaline group and 33.3% (7/21) in adrenaline group (p value- 0.58). Additional vasopressors were required in 23.8% neonates of the noradrenaline group compared to 38.1% neonates in adrenaline arm (p value-0.53). Median (SD) duration of intensive care stay was 6 (SD) days in the noradrenaline group and 10 (SD) days in the adrenaline group (p value-0.045). Conclusion: Among neonates with septic shock, the efficacy of noradrenaline was comparable to adrenaline in resolving septic shock after one hour of infusion and on the mortality during hospital stay
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    Dual fluid silhouette in X-ray of the abdomen: a diagnostic flag for neurogenic bladder with urinary ascites
    (PUBMED, 2024-06-04) Brajendra Singh; Chinmay Chetan; Aisha Naaz; Girish Gupta
    A neonate presented with abdominal distension and decreased urinary output. X-ray revealed dual abdominal fluid condition-ascites with a distended bladder, along with vertebral anomalies. The possibility of urinary ascites and neurogenic bladder was kept, which was further confirmed on evaluation. Here, we emphasise the crucial role of abdominal X-ray as a diagnostic tool in uncovering this intricate medical puzzle. By detailing the clinical presentation, diagnostic approach and treatment strategy, the report contributes insights into the rare and complex abdominal condition.
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    Assessment of Central Catheter Tip Position in Neonates by Ultrasonography Versus X-ray
    (SCOPUS, 2024-06-01) Prachi Patwal; Chinmay Chetan; Brajendra Singh; Vinayak Madhukar Jedhe; Girish Gupta
    Central catheters are frequently inserted in neonatal intensive care units. The tip of these catheters should be in the correct position; otherwise, it may lead to life-threatening complications. X-ray has been universally used as a standard imaging modality to localize the position of central lines. Ultrasonography is an upcoming promising modality. We compared the catheter tip localization using ultrasonography versus X-ray.
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    Unraveling Patterns of Congenital Structural Malformations in Infants: A Hospital-Based Descriptive Study
    (PUBMED, 2024-05-15) Savita Pandey; Yasir A. Lone; Saikat Patra; Braham P. Kalra; Sanyam Modi
    Introduction Congenital malformation studies serve several purposes, including establishing baseline rates, monitoring changes over time, exploring the origins of these defects, and helping in planning health services. Increasing public awareness about pediatric surgical interventions is another goal of these studies. However, the impact of congenital malformations is often underestimated in developing countries due to insufficient healthcare data and diagnostic facilities, particularly in rural areas. Families affected by the birth of a child with congenital malformations face significant stress and hardship. Methods The main aims of this study were to evaluate the clinical pattern of congenital structural malformations in our region (Uttarakhand, India), identify possibly associated factors of congenital malformations, and find out the immediate outcome of congenital malformations in enrolled participants. Results Among a total of 150 cases, 73 (48.7%) cases were inborn, whereas 77 (51.3%) cases were outborn. Investigation of congenital malformation revealed cleft lip or palate in 37 (24.7%) cases, congenital heart disease (CHD) in 33 (22%) cases, meningomyelocele (MMC) in 18 (12.0%) cases, anorectal malformation (ARM) in 11 (7.3%) cases, hypospadias in 10 (6.7%) cases, congenital talipes equinovarus (CTEV) in nine (6.0%) cases, tracheoesophageal fistula (TEF) in nine (6.0%) cases, polydactyly in seven (4.7%) cases, pelviureteric junction obstruction (PUJO) in four (2.7%) cases, duodenal atresia in three (2.0%) cases, midgut volvulus in three (2.0%) cases, umbilical sinus in two (1.3%) cases, sacrococcygeal teratoma (SCT) in one (0.7%) case, phimosis in one (0.7%) case, microtia in one (0.7%) case, and micrognathia in one (0.7%) case. Mortality was observed in 11 (7.3%) cases, whereas 105 (70%) cases were successfully discharged. Among 11 mortality cases, the cause of death was CHD in seven (63.2%) cases, TEF+CHD in two (18.1%) cases, MMC in one (9%) case, and duodenal atresia in one (9%) case. Conclusion Contrary to the common belief that advanced maternal age of greater than 35 years is a major cause, 86.6% of the congenital structural anomalies in our hospital-based study in Uttarakhand occurred in babies of mothers belonging to the age group of 18-30 years. Also, consanguineous marriage was observed in only 3.3% of cases, indicating that it may not be a major contributing factor causing congenital structural malformations in our region. External congenital anomalies are most commonly observed (60.7%), with cleft lip and cleft palate being the most common. The most frequently observed internal congenital anomaly is CHD (22%) followed by gastrointestinal (GI) (18.6%) and urinary anomalies (10.1%). Death and referral are commonly seen in CHD.
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    Infective Endocarditis due to Unusual Pathogens Complicated with Pulmonary Thromboembolism: A Rare Occurrence in a Premature Infant
    (SCOPUS, 2024-05-13) Saikat Patra; Prachi Patwal; Chinmay Chetan; Girish Gupta
    Background: Survival of low birth weight preterm neonates has increased with the availability of better neonatal care, however, the use of central lines for longer duration increases the risk of bacterial and fungal sepsis. Neonatal infective endocarditis (IE) is a rare presentation of neonatal sepsis and is often associated with complications and high mortality. Clinical Description: A 36 weeker, premature baby, hospitalized for early onset sepsis, was transferred to our hospital on day 15 of life, with an umbilical catheter in situ, with fever, respiratory distress, and persistent thrombocytopenia. Clinical examination revealed decreased oxygen saturation, crepitations in the right lung field, systolic murmur, and hepatomegaly. Management and Outcome: Baseline investigations revealed positive septic screen with thrombocytopenia with meningitis, neonatal cholestasis, and right sided consolidation on chest X ray. A two dimensional echocardiography (ECHO) revealed vegetation on the tricuspid valve, and blood culture from two sites revealed growth of Candida tropicalis and Serratia marcescens. Colistin, tigecycline, and amphotericin B therapy were initiated as per sensitivity along with low molecular weight heparin for prevention of embolization. The baby developed acute worsening in respiratory distress after 4 weeks of therapy. Repeat ECHO revealed increased size of cardiac vegetation and computed tomography of thorax with pulmonary angiography revealed pulmonary thromboembolism. Unfortunately, the baby succumbed to complications of IE. Conclusion: Invasive instrumentations such as umbilical catheterization and prolonged hospitalizations of premature newborns predispose them to develop IE, especially with unusual organisms. Such infections have a complicated course and may be fatal.