Mortality and Morbidity of Extreme Preterm Neonates

Extremely preterm babies (22–27+6 weeks gestation) are at increased risk of death and morbidity. In recent years, more babies born between 22 and 25 weeks gestation are being resuscitated and requiring prolonged treatment instead of receiving comfort care only. Therefore, the present study was designed to evaluate the morbidity and mortality of extremely premature babies born between 22 weeks and 27weeks+6 days gestation during their hospital stay. Methods: The study was conducted at Rajagiri Hospital in Aluva, a tertiary care hospital in Kerala. This was a retrospective study that included all extremely preterm births between 22 weeks and 27weeks+6 days gestation over a period of 3 years. Results: Forty five extreme preterm neonates were born during the study period out of 2598 NICU admissions (1.7 %). Thirty of those forty five neonates (67 %) survived. The rate of survival of extreme preterms increases with gestational age. Moderate and severe bronchopulmonary dysplasia (BPD) were seen in 7 cases (16 %), grade 3 and 4 intraventricular hemorrhage (IVH) were seen in 6 cases (13 %), necrotizing enterocolitis (NEC) were seen in 8 cases (18%) and retinopathy of prematurity (ROP) requiring treatment were seen in 9 cases (20%). Higher incidence of mortality was seen in neonates who were small for gestational age (SGA) and whose mothers had chorioamnionitis. The average length of hospital stay was 76 days. The mean average duration of mechanical ventilation and non invasive ventilation were 19 days and 32 days respectively. Conclusion: Extremely preterm neonates remain at risk for mortality and major morbidity, with those between 22 to 25 weeks gestation having the highest risk. Survival is feasible in a tertiary care centre where adequate facilities are available. This data can be useful for patient counseling regarding preterm outcomes and NICU stay.

Septic Arthritis –A Case Series

Septic arthritis is a pyogenic infection of a joint. Blood culture findings are positive in only 50% of patients. Cultures of synovial aspirates are positive in only 30% of cases. Ultrasound examination is the preferred radiologic method of examination. Septic arthritis requires surgical debridement and is managed with appropriate antibiotic therapy. This is a retrospective analysis of neonates with septic arthritis who were admitted to the neonatal intensive care unit of a tertiary care hospital over a period of 3 years. Follow up data was available for all neonates. On follow up at 2 years, four neonates had good outcome with normal gait and no restriction of movements. Three neonates had bad outcome (restriction of movements in two and abnormal gait in one) with associated DDH. One neonate had associated liver abscess and portal vein thrombosis while another case was associated with osteomyelitis.