Extended Sick Neonate Score (ESNS) for Clinical Assessment and Mortality Prediction in Sick Newborns referred to Tertiary Care

Objective:To evaluate utility of a new Extended Sick Neonate Score (ESNS). to predict ‘in-hospital mortality’ and compare with Score for Neonatal Acute Physiology – PerinatalExtension II (SNAPPE II) and Sick Neonate Score (SNS). Design:Prospective observationalstudy. Methods:All extramural sick newborns transported to the neonatology unit of a tertiarycare teaching hospitalover a period of one year.Correlation between ESNS, SNAPPE-II andSNS scoring, and sensitivity/specificity of each score to predict mortality were determined.Results:961 newborns were enrolled in the study. ESNS, SNAPPE II and SNS were stronglycorrelated, even when stratified by gestation. ESNS of ≤11 had the best sensitivity (85.9%)and specificity (89.8%). For preterms, ESNS ≤12 had the best sensitivity (92.3%) andspecificity (76.7%). Conclusion:ESNS can predict ‘in-hospital mortality’ outcome withsatisfactory sensitivity and specificity

Hansen’s Chronic Polyarthritis in a Child.

Background: Musculoskeletal manifestations of leprosy are often underdiagnosed and under-reported. Case characteristics: An 11-year old girl with leprosy presented with deforming symmetric polyarthritis with raised inflammatory parameters and erosion on imaging. Observation: The patient was diagnosed to have Hansen’s chronic polyarthritis and treatment started with non-steroidal anti-inflammatory drugs and methotrexate. Message: Hansen’s chronic polyarthritis is a rare differential of juvenile chronic arthritis in children.

Clitoral Length and Anogenital Ratio in Indian Newborn Girls.

Objective: To generate normative data on clitoris length, anogenital distance and anogenital ratio in Indian newborns. Design: Cross-sectional study. Setting: Neonatal unit of a tertiary care teaching hospital in Kolkata. Participants: 378 female neonates, who were hemo-dynamically stable without critical illness or chromosomal anomaly, and without any vulval hematoma or genital abnormalities. Interventions: Measurements were recorded using a digital vernier caliper between 24-72 hours. Infant was held in position by an assistant, while the investigator measured clitoral length by gently retracting the labia majora. Anogenital distance (centre of the anus to posterior convergence of the fourchette) and anogenital ratio (anogenital distance divided by the distance from centre of the anus to base of the clitoris) was also measured. Main outcome measures: Gestational age- and birthweight-wise normative values of clitoral length, anogenital distance and anogenital ratios. Results: Mean clitoral length was 3.1 (1.54) mm for the whole cohort while anogenital distance and anogenital ratio were 10.2 (2.78) mm and 0.34 (0.07) mm, respectively. The gestation age-wise percentile charts of clitoral length, anogenital distance and anogenital ratio have been generated. There was no correlation between clitoral length and gestational age, body length, head circumference and birth weight. Correlations were also weak for anogenital distance. Conclusions: The normative values generated can serve as reference standard in the assessment of clitoromegaly, ambiguous genitalia, virilizing effects and suspected in utero androgen exposure.