University Publications

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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
Alarming medication error with prostaglandin E1 (PGE1) in a term neonate with critical congenital heart disease
(BMJ case report, 2024-04-08) Saikat Patra; Prachi Patwal; Chinmay Chetan; Girish Gupta
An outborn full-term female newborn with birth weight 2.45kg was admitted to our centre at 24 hours of life with respiratory distress and cyanosis. The baby had tachycardia and oxygen saturation (SpO2 ) 40% at admission to neonatal intensive care unit (NICU). She was mechanically ventilated on synchronized intermittent mandatory ventilation (SIMV) mode. Clinical evaluation raised suspicion of critical congenital heart disease; echocardiogram revealed transposition of the great arteries with 6mm ostium secundum atrial septal defect and small patent ductus arteriosus. The baby was started only on intravenous prostaglandin E1 (PGE1) as per unit protocol, where 1 ampoule (500 µg) of PGE1 is mixed in 49mL of 5% dextrose yielding a concentration of 10 µg/mL and is then started using an infusion pump at a rate of 0.6mL/kg/hour to provide a dose of 0.1 µg/kg/min. She developed tachycardia along with confluent erythematous macules over the scalp, face, neck and trunk, 10 hours after starting PGE1 infusion (figure 1). There was no associated fever or hypertension, while lowest blood pressure recorded was 52/30mm Hg. The skin rash, characterised by bright erythematous macular lesions, rapidly spread to the extremities. It was noticed that PGE1 was wrongly administered at 10 times the expected dose for the last 2hours prior to the cutaneous manifestation. The infusion was immediately stopped, and the baby was given
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.
Biotinidase deficiency-masquerade of primary immunodeficiency disease in neonate
(PUBMED, 2024-12-15) Chinmay Chetan; Brajendra Singh; Saikat Patra; Girish Gupta
Biotinidase deficiency, a rare metabolic disorder characterised by abnormal biotin metabolism, affects the biotin-dependent carboxylase functions. Primarily characterised by neurological and skin disorder, it may present with myriad features. Early recognition is important for preventing long-term morbidities. Here, we describe a case of a neonate presenting with seizures and a clinical picture suggestive of immunodeficiency. Multiple superficial abscesses along with septic arthritis of the left knee and left hip led to suspicion of primary immunodeficiency disorder. On evaluation, there was severe biotinidase deficiency. The neonate was supplemented with biotin, after which there were no further episodes of severe infection requiring hospitalisation, seizures or skin manifestation. This case report highlights the wide spectrum of clinical picture these disorders may present with and the low threshold for their evaluation and treatment.
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.
Double BCG vaccination in a neonate: implications, management and prevention
(PUBMED, 2023-12-01) Chinmay Chetan; Saikat Patra; Shailendra Kumar Singh; Girish Gupta
Tuberculosis is a common cause of morbidity and mortality especially in low-income and middle-income countries like India. BCG vaccination is recommended for all neonates after birth in areas with a high tuberculosis disease burden. Here, we describe a case where a neonate received two doses of the BCG (Chennai strain) vaccine within a span of 4 days after birth due to a vaccination error. Parents were informed about the event. The infant was managed conservatively and followed up till 12 months of life for any possible complication. There were no serious adverse effects apart from the localised reaction and a double scar on the left arm. Measures to avoid any such error in the future and the need for reporting medication error has been highlighted. Parental concerns are frequent in such scenarios and should be actively addressed.
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.
Effect of Recorded Chants of the “OM” Mantra as an Interventional Music Therapy on Reducing Stress in Newborns Admitted to the Neonatal Intensive Care Unit: An Observational Study
(SAGE Publications, 2023-05-31) Shailendra Kumar Singh; Saikat Patra; Chinmay Chetan; Girish Gupta
Introduction Newborns admitted to the neonatal intensive care unit (NICU) are under tremendous stress. The “OM” sound is known to have a calming effect on adults. The effect of administering chants of “OM” to newborns is unknown. Objectives Primary Objective To evaluate the effect of the “OM” sound on vital parameters in newborns admitted to the NICU. Secondary Objectives To observe the duration of the effect of the “OM” sound on vital parameters after the music therapy and to observe its effect at various gestational ages. Methods Prospective observational study was carried out over 4 months. 57 newborns enrolled were administered music therapy by playing recorded chants of “OM” mantra (MTOM). Vitals were recorded before, during, and after MTOM. Results The heart rate (HR) before and with MTOM was 142 ± 7 and 130 ± 11 bpm (p = .001). The decrease in HR persisted even after 1 h of stoppage of MTOM (p = .001). A significant decrease in HR was observed in all gestations (p = .001). There was no significant difference in respiratory rate (RR) and SpO2 before and with MTOM. Conclusion MTOM significantly reduces HR in newborns of all gestational ages, and its effect persists for at least 1 h after stopping MTOM.
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.
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.
Neonatal evaluation by extended (12 area) vs. traditional (6 area) lung ultrasound scoring (NEXT-LUS): a prospective observational study
(Forntieres, 2025-08-13) Chinmay Chetan; Shoham Majumder; Aninda Debnath; Ravleen Kaur; Deepak Jaybhaye; Arshpuneet Kaur; Saikat Patra
Background: Lung ultrasound (LUS) offers a safe, repeatable, radiation-free tool in management of respiratory distress in neonates. Despite wide use, limited data exists on optimal scoring approaches. Methodology: A prospective observational study was conducted over 6 months in a tertiary neonatal intensive care unit (NICU) enrolling neonates with respiratory distress within 2 h of admission after consent. LUS was performed using both 6-area and 12-area scanning approaches. Scores were assigned per Brat’s criteria. Primary outcome was prediction of need for invasive ventilation within 72 h. Secondary outcomes included optimal cut-off scores, correlation with clinical outcomes and procedural safety. Results: Among 73 neonates enrolled, the 6-area LUS score (cut-off ≥5) predicted invasive mechanical ventilation within 72 h with 75% sensitivity and 67% specificity (AUC = 0.76). The 12-area score (cut-off ≥13) had similar accuracy (sensitivity 75%, specificity 73%; AUC = 0.77). Both 6-area and 12-area scores performed better in neonates <34 weeks (AUCs: 0.83 vs. 0.86). In neonates presenting after 24 h of life (n = 19), both scores maintained good accuracy (AUCs: 0.80 for 6-area, 0.83 for 12-area). Multivariate analysis identified partial pressure of carbon dioxide (pCO2) and duration of stay as independent predictors. The 12-area score required reattempts (in 9% cases) unlike the 6-area score. Conclusion: In neonates presenting with respiratory distress, 6-area and 12-area LUS scores done within 2 h of admission show good and comparable predictive value regarding need for invasive ventilation by 72 h.
Neonatal nephrotic syndrome: all is not gloomy
(BMJ Publishing Group, 2024-01-02) Chinmay Chetan; Shailendra Kumar Singh; Saikat Patra; Girish Gupta
Congenital nephrotic syndrome (CNS) is a rare clinical syndrome with a constellation of proteinuria, hypoalbuminemia and oedema, presenting within 3 months of birth. We present a rare case of neonatal nephrotic syndrome with a probable sepsis induced aetiology. The neonate was referred at day of life 15 with Klebsiella pneumonia sepsis and anasarca. On investigation, the patient had nephrotic range proteinuria, hypoalbuminemia, generalized anasarca and ascites. The neonate was started on broad-spectrum antibiotics and furosemide. Genetic and other secondary causes of CNS were ruled out. With supportive management and resolution of sepsis, the neonate improved. This case highlights the rare cause of sepsis-induced nephrotic syndrome (NS), which required only supportive treatment without the need for aggressive management of CNS.
Role of point-of-care ultrasound in the management of congenital diaphragmatic palsy
(PUBMED, 2025-06-27) Ravleen Kaur; Kanishka Bahuguna; Chinmay Chetan; Saikat Patra
In newborns, brachial plexus injury is the most common peripheral nerve injury during the delivery. It may also lead to phrenic nerve injury causing diaphragmatic palsy. Conservative management remains the mainstay of treatment for congenital diaphragmatic palsies. Surgical plication is a potential management strategy for the persistent cases, but the timing and outcomes are not clear. Here, we present a case where diaphragmatic palsy was diagnosed and monitored using point-of-care ultrasound. The surgical intervention was avoided by serial monitoring of diaphragmatic excursion on ultrasound, which revealed improvement despite persistent requirement of respiratory support.
To Validate Use of Transmittance Sensor of Peripheral Pulse Oximeter for Forehead Pulse Oximetry in Newborns
(SAGE Publications, 2024-10-01) Talha Rehman; Girish Gupta; Saikat Patra; Chinmay Chetan; Rakesh Kumar; Sanober Wasim
Introduction Peripheral pulse oximeters with continuous monitoring of heart rate and saturation have revolutionized neonatal care. Motion artifacts, hypothermia, and poor perfusion are some of the barriers for reliable reading in the transmittance type of peripheral pulse oximeters. This study was planned to assess the effectiveness of transmittance sensors applied over the forehead for monitoring the heart rate and saturation. Material and Methods An observation study was conducted over a period of 1 month. Two pulse oximeters (Masimo RAD97) were applied simultaneously, one over the periphery (right hand/wrist) and the other over the forehead using an innovative headband. A total of 540 readings of heart rate and saturation (SpO2) from each site were recorded. A difference of more than 5 beats/minute in heart rate and 2% saturation were considered clinically significant. Results Forty-five neonates with mean gestational age of 35.3 ± 3.2 weeks and birth weight of 2109 ± 683 grams were enrolled. Forehead pulse oximeter could pick up the heart rate and SpO2 readings in all the babies. A statistically significant difference of 3.8 beats/minute in heart rate and 2.5% in SpO2 was noted (p-value < 0.0001). The difference in heart rate was not clinically significant. Conclusion We propose that the transmittance type peripheral pulse oximeter sensors can be used over the forehead. It has the potential to avoid erroneous readings due to motion artifacts, hypothermia, or shock. Saturation nomograms for the forehead pulse oximetry need to be established before it can be used to monitor and manage the neonates for the same.
Usefulness of Mean Gastric Emptying Time in Late Preterm and Term AGA and SGA Newborns to Determine Feeding Frequency—An Observational Study
(SAGE Publications, 2023-06-14) Ankit Jain; Saikat Patra; Vinayak Madhukar Jedhe; Chinmay Chetan; Girish Gupta
Objectives The primary objective is to calculate and compare mean gastric emptying time in appropriate for gestational age (AGA) and small for gestational age (SGA) newborns. The secondary objective is to compare mean gastric emptying time in SGA babies with or without antenatal Doppler changes and to measure gastric spheroidal volume at various intervals in AGA and SGA newborns with or without antenatal Doppler changes. Methods This prospective observational study was carried over 3 months from November 2022 to January 2023. A total of 30 newborns were enrolled and their gastric spheroidal volume was calculated by ultrasound pre-feed and post-feed every 30 minutes till it reached within 10% of pre-feed volume which was taken as gastric emptying time. Mean gastric emptying time was compared among AGA and SGA newborns and amongst SGA with or without antenatal Doppler changes. Results Mean gastric emptying time of AGA was 124 ± ± 25.01 minutes and for SGA was 132 ± 29.57 minutes which was statistically nonsignificant. Mean gastric emptying time when compared between SGA neonates with or without antenatal Doppler changes was similar (P value .43). The gastric spheroidal volume was significantly smaller in SGA newborns compared to their AGA counterparts in pre-feed state (P value .01) and it persisted till 60 minutes post feed (P value .028); however, the mean gastric emptying time is similar in both the groups. Conclusion Mean gastric emptying time of AGA and SGA newborns is similar and hence a feeding interval of 1.5 to 2.5 hours is appropriate for these late preterm and term newborns. Antenatal Doppler changes in SGA babies did not alter their gastric emptying time hence similar feeding frequency can be used in both.
Usefulness of skills in point of care ultrasound and simulation-based training as essential competencies in acute management of neonatal cardiac tamponade
(BMJ Publishing Group, 2023-12-29) Ankit Jain; Saikat Patra; Chinmay Chetan; Girish Gupta
Peripherally inserted central catheter (PICC) insertion is a routine procedure in the neonatal intensive care unit required for prolonged intravenous fluid, nutrition and medication support. Neonatal cardiac tamponade is a serious and rare complication of PICC line insertion. Early detection by point of care ultrasound (POCUS) and management by pericardiocentesis improves the chances of survival. Regular simulation-based training sessions on a mannequin, along with knowledge of POCUS, can assist neonatologists and paediatricians for a quick and appropriate response in this emergency condition.
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.