Perinatal Transmission and Outcomes of SARS-CoV-2 Infection

Maternal SARS-CoV-2 infection can adversely afect the birth and neonatal outcomes. The authors prospectively enrolled 196 neonates born to 193 SARS-CoV-2–positive mothers to determine the rate of mother-to-baby transmission of SARSCoV-2 and its efect on short-term neonatal outcomes in Indian population. Nineteen babies turned out to be RT-PCR– positive for SARS-CoV-2, carrying a perinatal transmission rate of 9.8%. Rates of prematurity and low birth weight were 12.8% and 18.9% in the neonatal group, respectively. On comparing SARS-CoV-2–positive (n=19) and negative (n=177) neonatal groups, rate of prematurity, hospital admission rate, and death rate were higher in the former group. The placental positivity rate for SARS-CoV-2 was 8.1%, but no relation was found between placental and neonatal infection.

Pattern of congenital heart diseases in Western Rajasthan: an echocardiographic study

Background: Congenital heart disease (CHD) accounts for nearly one third of all major congenital anomalies. Globally the prevalence of CHD is 1.01 to 17.5 per 1000 live births. In India it is 1.3 to 26.4 per 1000 study population. CHD is an important cause of mortality and morbidity representing a global health burden. Early diagnosis and treatment may lead to improved prognosis in patients suffering from CHD. The aim of this study was to assess the pattern of CHD in Western Rajasthan, India by echocardiography.Methods: This was a retrospective study carried out at Dr. S. N. Medical College and attached group of hospitals in Jodhpur, Rajasthan, India. The study period was from July 2014 to June 2017. Records of all patients undergoing transthoracic echocardiography from newborn to 25 years of age were analyzed for age, sex and CHD findings.Results: In the study period, a total of 24,914 patients underwent echocardiography, of which 877 patients were identified as having CHD. Prevalence of CHD was 35.20 per 1000 study population. Amongst the total diagnosed CHD cases, 489 (55.76%) patients were male, with male to female ratio of 1.2:1. CHDs were diagnosed more commonly between 1 month and 1 year of age (41.28%). The commonest type of acyanotic CHD in the present study was ventricular septal defect (21.44%) and cyanotic CHD was tetralogy of Fallot (18.24%).Conclusions: Prevalence of CHD in Western Rajasthan, India was 35.20 per 1000 study population. Profile of CHDs in the present study was similar to that in published literature.

Experience with Holter monitoring for evaluation of infant arrhythmia

Background: Arrhythmia is defined as abnormal heart rates. Sometimes they are intermittent and difficult to diagnose on routine ECG. Neonatologist and Pediatrician needs to rapidly establish accurate diagnosis and management for infants suspected to have arrhythmia. Hence Holter monitoring of the infants presenting with symptoms suggestive of arrhythmia is necessary as it provides a continuous record of heart's electrical activity. The aim of this paper is to find out the role of continuous ambulatory electrocardiographic monitoring in daily clinical practice of Pediatrics.Methods: All infants including neonates, either inborn or brought to the paediatric emergency with risk factors, between January 2016 to January 2018, were included in this prospectively study. Evaluation including chest X-ray, standard 12-lead electrocardiography, 24 hours continuous ECG monitoring using Mortara holter, echocardiography, biochemical and haematological analysis.Results: A total of 73 babies were enrolled in present study. In this study arrhythmia was found in 29 (39.72%) new-borns. The most common arrhythmia observed was supraventricular tachycardia (SVT) (41.3%). Other arrhythmia observed were ventricular tachycardia (VT), AV block (34.4%), atria premature beats (3.4%) and ventricular premature beats (6.89%), tachy-bradyarrhythmia (3.4%) and junctional rhythm (3.4%). Of 29 arrhythmia patients four were diagnosed solely by Holter monitoring. None of the babies had long QT syndrome on Holter monitoring.Conclusions: Cardiac arrhythmias are important causes of infant morbidity, and mortality if undiagnosed and untreated. It is important for the neonatologist and paediatrician to be aware of these of arrhythmias and the various diagnostic modalities available for them. A Holter electrocardiogram may be of value in identification of these transient arrhythmic events.

Renal failure in asphyxiated neonates.

A prospective case controlled study was conducted in the NICU of a tertiary level referral teaching hospital to determine the incidence of renal failure in asphyxiated neonates and to correlate severity and type of renal failure with Apgar score and hypoxic ischemic encephalopathy (HIE) grading of the neonates. Ninety-eight neonates were enrolled 70 asphyxiated babies and 28 healthy controls. Renal functions were assessed using urinary output, urine microscopy, biochemical parameters and sonographic findings. Babies having renal failure were managed on a protocolised plan and followed up till 6 months of age to detect any residual impairment. Blood urea and serum creatinine were significantly higher in asphyxiated babies compared to the control group. Biochemical derangements correlated well with HIE staging and Apgar scores. There was no significant difference in urine output in the control and the study group as significant oliguria was seen in only 7 of the 70 asphyxiated babies and the output did not correlate with severity of asphyxia. Serum sodium level and fractional excretion of sodium showed significantly different values in the asphyxiated babies compared to control. Of the 70 asphyxiated babies 33 (47.1 %) had renal failure, which was of the non-oliguric type in 78 % cases and oliguric type in 22 % cases. Sonographic abnormalities were seen more often in oliguric babies and was associated with a bad prognosis. Renal parameters normalized in all neonates by 6 months of age. Mortality was higher in babies with oliguric renal failure. We conclude that renal failure is a significant problem in asphyxiated neonates with majority of babies having nonoliguric failure. Severity of renal function abnormality correlates well with degree of asphyxia. Oliguria, hyponatremia and abnormal sonographic scan are bad prognostic signs in renal failure secondary to birth asphyxia.

Engelmann's disease with optic atrophy.

Engelman-Camurati disease is a rare Diaphyseal dysplasia, characterized by endosteal and periostal thickness of cortex of shaft of tubular bone sparing metaphysis and epiphysis. The bone of the hand, feet, ribs, scapulae and pubis are not affected.

Normal parameters of ventricular system in healthy infants.

Six hundred healthy inborn newborns and infants upto the age of 18 months were studied. Cranial sonography was performed by real time 2D scanner with 5 MHz transducer and images were obtained through anterior fontanelle and temporo-squamal suture. Various parameters related to ventricular system were measured for different ages till the fontanelle remained open. These values will prove useful for diagnosing hydrocephalus at an early stage of the disease and also to find out the blocks at various levels in ventricular system.

Ultrasonic diagnosis of intracranial hemorrhage in high risk neonates.

One hundred and eleven high risk neonates were subjected to (cranial ultrasound (CR-USG) Caranial sonography was performed by 2D realtime scanner with 5 MHz transducer through anterior and posterior fontanelle and temporo-squamal suture. One quarter of these neonates developed intracranial hemorrhage (ICH) within 120 hours of birth. Of them 42.8% neonates recovered completely, 21.4% developed ventriculomegaly, 21.4% neonates expired, 10.4% developed pseudo-porencephalic cysts and 3.5% developed aqueductal block. It is concluded that CR-USG is a useful technique for detection and monitoring of complications of ICH and at least one screening sonogram is essential in the first week of life of all high risk neonates.

Cranial ultrasonic assessment of infants with acute bacterial meningitis.

A prospective study was performed on 44 patients (newborn to one year old) with acute bacterial meningitis. Sonograms were obtained within 72 hours of diagnosis, and repeated on 7th, 14th or at an early date, if required. The spectrum of sonographic features of meningitis included normal scan (35.4%), echogenic sulci (63.7%) and parenchyma (29.5%), ventriculomegaly (59%), ventriculitis (35%), pseudo-porencephalic cyst (4.4%), extra axial fluid collection (4.4%), encephalomalacia (2.2%) and cerebral abscess (2.2%) in patients.

Measurement of ventricular size in term and preterm infants.

Real time ultrasonography was done in neonates to establish the norms for ventricular size and to see if there is a correlation between ventricle size and gestational age. A total of 153 normal infants admitted to our nursery after September, 1989 were taken up for the study. First ultrasound was performed within six days of birth. Sonography was done with 3.5 MHz transducer through anterior and lateral fontanelle. Results revealed that there is a significant difference in the mean value of falx to lateral wall of the cortex, ventricular index and ratio (VI/FC) of preterm and term infants. The ventricular size of small for gestational age infants is significantly different from appropriate gestational age infant of corresponding gestational ages. The percentile chart of VI for Indian infants is comparable to that of western infants.