Short Term Neurobehavioral Outcomes in Late Preterm Neonates Born to Pre-Eclamptic Mothers

Objective: To study the effect of maternal pre-eclampsia on the short-term neurobehavioraloutcomes in late preterm neonates using Neurobehavioral Assessment of Preterm Infants(NAPI) score. Methods: 30 late preterm neonates born to mothers with preeclampsia, andthirty controls born to mothers without pre-eclampsia were enrolled, and followed up to 40weeks of post-menstrual age. They were evaluated by NAPI score of MDV (Motordevelopment-vigor) and AO (Alertness orientation) at 40 wk. Results: The mean NAPIscore of MDV in cases was 60.1 (9.56) as compared to 70.0 (11.48) in controls (P <0.001).The mean NAPI score of AO in cases was 37.45 (11.04) as compared to 45.6 (13.33) incontrols (P=0.006). Conclusions: Late preterm neonates born to mothers with pre-eclampsia have poor short term neurobehavioral outcomes.

Formation of Quality of Care Network in India: Challenges and Way Forward

India contributes to the largest pool of the global neonatal and under-five mortalities. The current healthcare delivery services have ascope for improvement in terms of the quality of care at the point of delivery. In this era of resource constraints across the low- and middle-income countries (LMIC), quality improvement techniques can be a game changer to positively address the common bottlenecks ofhealth service delivery and increase community participation. Globally, networks of quality of care and collaboratives have demonstratedsignificant impact in improving processes of care and the quality of services delivered to the end user. The Nationwide quality of carenetwork (NQOCN) is a self-sustaining network of quality improvement teams, which have cohesively led the spread and adoption ofsimple quality improvement strategies across the Indian subcontinent. The current perspective apprises the reader about NQOCN, itsrelevance and impact in current times

Congenital hypoplasia of the internal carotid artery.

A newborn presented at 14 hrs of age with right sided clonic seizures and shrill cry. Magnetic Resonance Imaging of the brain showed left cerebral hemiatrophy with cystic changes in left fronto-parietal lobe and parasylvian region. The Magnetic Resonance Angiography revealed hypoplasia of left supraclinoid Internal Carotid Artery and hypoplasia and irregularity of vessel wall affecting the left Middle Cerebral Artery. Such an early presentation of this rare disorder has not been reported previously. Recognition of this anomaly has important implications during carotid and trans-sphenoidal surgery, in thromboembolic disease, and in the surveillance and detection of associated cerebral aneurysms.

Parvovirus B19 nonimmune hydrops in a neonate.

Parvovirus B19 is responsible for approximately 10% of all cases of nonimmune hydrops. An unusual case of perinatally acquired parvovirus infection in a neonate is reported who presented with nonimmune hydrops fetalis at D15 of life.

Paratyphoid sepsis.

A large for gestational age male baby was born to a healthy young primigravida, on L-thyroxime, at 40 weeks by caesarean delivery in a tertiary care hospital. The baby had episodes of hypoglycemia during his immediate four postnatal days in the nursery that were successfully managed with intravenous glucose administration. The baby became unwell on day 5 and had a positive sepsis-screening test. Blood culture revealed a multidrug susceptible S. Paratyphi A strain, which he probably acquired on the first or second postnatal day from the contaminated expressed breast milk or the formula feed.

Bruck syndrome.

The combination of arthrogryposis multiplex congenita and osteogenesis imperfecta is extremely rare. This combination is named Bruck syndrome. A 34 week male baby weighing 1.7 kg at birth was noted to have multiple flexion contractures and pterygia at elbows, wrists and knees, in addition to right foot talipes equinovarus deformity. Postnatally the child developed multiple swellings involving both the upper and lower limbs. A plain radiograph revealed the presence of fractures involving the long bones of the upper and lower limbs. A diagnosis of osteogenesis imperfecta with arthrogryposis multiplex congenita was made, and the patient was labeled as a case of Bruck Syndrome. The aim of this report is to make the readers aware regarding this rare entity and to specifically look for presence of features suggestive of osteogenesis imperfecta when encountered with a neonate born with arthrogryposis multiplex congenita.

Guillain-Barre syndrome as a complication of enteric fever.

The incidence of neurological manifestations in enteric fever varies widely but the predilection of typhoid toxins to nervous system is well known. A case of enteric fever in a 10-year-old girl, who developed Guillain-Barre syndrome subsequently as a complication, is reported below with a brief review of the literature.

Microalbuminuria as a predictor of early glomerular injury in children with sickle cell disease.

OBJECTIVE: A cross sectional study was carried out to determine the prevalence of microalbuminuria in the pediatric patients with sickle cell disease. METHODS: The study was carried out on 64 pediatric patients aged less than 14 years with documented HbSS, HbAS and HbS beta thalassemia, Microalbuminuria was estimated using single radial immuno diffusion technique. Majority of the study subjects were of HbSS type. 38.5% had symptoms for > 2 years. 18.8% of the study population had significant microalbuminuria (19.2% of SS type and 18.8% of Hb AS types). RESULT: Microalbuminuria excretion was significantly more in patients > 9 years of age as compared to young patients (p < 0.05). Mean serum creatinine levels did not show any significant difference in the various study groups. CONCLUSION: Microalbuminuria estimation is a very important clinical marker of preclinical glomerular damage in patients with sickle cell disease. It estimation would help in the early detection of such patients and prompt initiation of therapy.