Journal of Neonatology

Objective: To study the influence of antenatal and perinatal factors on umbilical cord blood thyroid-stimulating hormone (CB TSH) levels.

Design: Cross-sectional study.

Setting: Private Medical College.

Methods: CB TSH levels were measured in 1147 neonates using chemiluminescence immunoassay. The effect of antenatal and perinatal factors on CB TSH values was analyzed statistically.

Results: The mean TSH value was 6.811 mIu/mL. A total of 44 neonates (3.83%) had a CB TSH value greater than 20 mIu/mL and had to be recalled for a repeat workup. CB TSH was significantly raised in first-order births, those born via normal vaginal delivery, and in those whom the lower section caesarean section (LSCS) was done for fetal distress (all P value <.05). Male babies had a significantly higher CB TSH value as compared to the females. Babies having Apgar < 7 at 1 min also had a significantly higher CB TSH value. Maternal hypothyroidism did not have any significant effect. On multivariate analysis, we found a positive correlation between birth weight, Apgar, and gestational age with CB TSH values.

Conclusion: The incidence of neonates having a CB TSH greater than 20 mIu/mL was 3.83%. Male children, those delivered via normal delivery, those delivered via LSCS where fetal distress was an indication, and those requiring resuscitation, were significant factors affecting CB TSH values.

Background and Objectives: Hemodynamics in neonatal sepsis is complex and poorly understood. Several studies have reported conflicting findings on cerebral blood flow (CBF) in sepsis from severely increased flow to severely decreased flow. The objective of our study was to study CBF by measuring the resistive index (RI) of the anterior cerebral artery in late-onset neonatal sepsis (LONS).

Methods: All newborn infants admitted in our neonatal intensive care unit with suspected LONS during the period from January 2017 to December 2017 underwent point-of-care transcranial Doppler ultrasonography to measure the RI of the anterior cerebral artery within 24 h of clinical presentation before starting inotropes if at all required. Infants with congenital heart disease, perinatal asphyxia, major congenital malformations, and genetic syndromes were excluded. Neonates with positive culture were included in the final analysis.

Results: Of 89 suspected LONS, 33 were culture positive and were analyzed. The mean admission weight was 2.33 ± 0.76 kg. The mean gestational age was 33.5 ± 3.4 wk. Most common organism isolated was Klebsiella pneumoniae (82%). The RI was high in 54.5% (17 of 33) and normal in 45.5% (15 of 33) cases.

Conclusions: LONS is a unique and complex hemodynamic state and we found it associated with the high RI indicating decreased CBF. A larger study may help in more understanding of this unique hemodynamic association.

Background: In the United States (USA), kratom has become popular for controlling withdrawal symptoms from opioid cessation. Case studies have alluded to the occurrence of features of neonatal abstinence syndrome (NAS) in infants born to mothers who regularly used kratom.

Materials and Methods: A comprehensive literature was conducted using Pubmed and Google Scholar with a combination of keywords. A total of 8 unique abstracts were identified and reviewed.

Results: The reviewed papers suggest that infants exposed to kratom via the transplacental route exhibit symptoms such as breathing difficulties, irritability, jitteriness, muscle hypertonicity, and a high-pitched inconsolable cry, which are features of NAS. Though no treatment protocols exist for managing kratom withdrawal, the studies suggested symptomatic management of a hyper-adrenergic state. Some studies recommended using methadone, whereas others recommend the use of morphine, rooming-in, and close contact with the mother.

Objectives: To assess the morbidity, mortality, operation time, and postoperative complications in the present modified transpleural (MTP) approach with the conventional extrapleural (EP) approach in esophageal atresia (EA) with tracheoesophageal fistula (TEF).

Design: Longitudinal randomized case control study.

Setting: Pediatrics Surgery Department of a tertiary care hospital.

Study period: November 2009 to December 2011.

Participants: Neonates above 1.5 kg body weight with EA and TEF.

Results: Sex ratio is 7:3 (male and female). In total, 40% had associate anomalies. Duration of operation in MTP approach from 90 to 110 min (mean duration 98.6 min) where as in EP approach from 120 to 130 min (mean duration 121.4 min). All 3(15% wound infections were in EP group. A total of 3 develops right sided pneumothorax with 2 in MTP and 1 in EP approach group. In total, 10% (2) in MTP approach group and 5% (1) in EP group expired. Leakage in anastomotic site was seen in 2(10%) each in both the groups. Six developed stricture, out of which 4 in EP group, 2 in MTP group.

Conclusion: MTP approach is less time consuming, possess less hindrance during operation. Postoperative complications are comparable. Mortality is higher in MTP group than EP group, may be because of associated lethal co morbidity.

Background: Cerebrospinal fluid C-reactive protein (CSF-CRP) in adults and children has been shown to be useful for the diagnosis of bacterial meningitis; however, it has not been evaluated in neonates.

Objective: To study the role of CSF-CRP as a diagnostic marker in neonatal meningitis and determine optimal cut-offs for diagnosis.

Study Design: Prospective observational study from June 2017 to December 2017.

Methodology: Routine CSF analysis along with CSF-CRP was performed in neonates who qualified for lumbar puncture.

Results: At a cut-off value of 3.8 mg/L, CSF-CRP had a sensitivity of 0.96 and a specificity of 0.44, with positive and negative predictive values of 0.63 and 0.91, respectively.

Conclusion: CSF-CRP has higher diagnostic efficiency than other CSF markers. At a value of 3.8 mg/L, it has a high sensitivity and a negative predictive value to rule out meningitis.

We briefly review the current trend in handling the neonatal baby weight, gestational age, and other related categorical and continuous variable data, through both robust and outlier-based methods. Graphs are generally presented as smooth curves which give a wrong visual impression and totally hide the actual variability of the data, robust methods are applied without considering that they may certainly be affected by asymmetrical contamination, and the outlier-based methods are incorrectly applied without ascertaining if the individual data arrays are normally distributed, free from discordant observations.

Aim: To demonstrate our new procedure for handling of neonatal baby data from two case studies.

Methodology: The univariate data were handled through the application of discordancy tests in the light of new precise and accurate critical values, and significance tests were applied to both original and discordant outlier-free data arrays. The bivariate data were also handled from identifying and separating discordant outliers and reporting the quality of the coefficients in terms of standard errors. Finally, the supervised multivariate technique of linear discriminant and canonical analysis is successfully applied.

Results: The results of significance tests for some cases varied from the use of all data versus censored data. The identification and separation of bivariate discordant outliers drastically improved the quality of regression lines. Linear discriminant and canonical analysis provided high success values for laboratory-controlled experiments.

Conclusion: The need of obtaining both central tendency and dispersion parameters in all medical data is established. The reporting of regression coefficients with individual errors is recommended.

Hyperleukocytosis with a variable degree of immature precursors defines a leukemoid reaction (LR) with cause other than leukemia. We report a 25-week preterm with LR, without any features suggestive of leukemia. The LR was transient, and leucocytes followed a decreasing trend with no obvious LR-related complications.