A Micro-costing Model of Neonatal Intensive Care from a Tertiary Indian Unit: Feasibility and Implications for Insurance.

Objective: To calculate and compare costs of neonatal intensive care by micro-costing and gross-costing methods. Methods: The costs of resources of a tertiary care neonatal intensive care unit were estimated by the two methods to arrive at specific costs per diagnosis related categories for 33 neonates followed-up prospectively. Results: Grosscosting as compared to micro-costing resulted in higher cost per bed (Rs 6315 vs. Rs 4969) and wide variations of costs (-34.8% to +13.4%). Intensity of interventions, relative stay in neonatal intensive care unit compared to the step-down nursery, and total length of hospital admission accounted for these variations. Conclusions: Estimates based on micro-costing arrived in this study may be used as a starting point in developing assumptions for insurance models covering neonatal intensive care.

Management of Neonatal Seizures.

Seizures in the newborn period constitute a medical emergency. Subtle seizures are the commonest type of seizures occurring in the neonatal period. Myoclonic seizures carry the worst prognosis in terms of long-term neurodevelopmental outcome. Hypoxic-ischemic encephalopathy is the most common cause of neonatal seizures. Multiple etiologies often co-exist in neonates and hence it is essential to rule out common causes such as hypoglycaemia, hypocalcemia, and meningitis before initiating specific therapy. A comprehensive evidence based approach for management of neonatal seizures has been described in this protocol.

HIV infection mimicking autoimmune disorder.

A 13-yr-old girl born to healthy parents presented with cough, fever, easy fatiguability, photosensitivity and alopecia. She had clubbing and diffuse crackles in the chest on examination. Her CT scan of the chest showed evidence of bronchiectasis with consolidation. Investigations for tuberculosis and collagen vascular disease were negative. In due course she developed features of raised intracranial tension. Her blood for HIV ELISA was positive with CD4 counts of 17/ microL. Her CSF, sputum, blood and urine specimen were all positive for Cryptococcus neoformans on culture. HIV was not considered initially because of her atypical presentation. There was no history of sexual abuse, her parents were healthy and she did not receive any blood transfusion in the past.