Predictors of Mortality in Neonatal Pneumonia: An INCLEN Childhood Pneumonia Study.

BACKGROUND: Neonatal pneumonia contributes significantly to mortality due to pneumonia in the under-five age group, but the predictors of mortality are largely unknown. OBJECTIVES: To evaluate the clinical and microbiological characteristics and other risk factors that predict mortality in neonates admitted with pneumonia in tertiary care centres. STUDY DESIGN: Prospective observational cohort study. PARTICIPANTS: Term and preterm (32 weeks to 36 6/7 weeks) neonates (<28 days of life) admitted with clinical and radiological features suggestive of pneumonia. INTERVENTION: Baseline sociodemographic data, clinical details, blood culture and nasopharyngeal swabs for virologic assay (RT PCR for RSV, Influenza) were collected at admission and the neonates were observed throughout their hospital stay. OUTCOME: The primary outcome was predictors of mortality in neonatal pneumonia. RESULTS: Five hundred neonates were enrolled in the study. Out of 476 neonates with known outcomes, 39 (8.2%) died. On multivariate analysis, blood culture positive sepsis was independently associated with mortality (adjusted OR 2.51, 95% CI1.23 to 5.11; P-0.01). CONCLUSIONS: Neonates with blood culture positive pneumonia positive are at a higher risk of death.

Symptomatic west syndrome secondary to glucose transporter-1(GLUT1) deficiency with complete response to 4:1 ketogenic diet.

Glucose transporter type 1 (GLUT-1) deficiency is a rare cause of preventable intellectual disability. Intellectual disability is due to refractory seizures in infancy and reduced supply of glucose to the brain. The authors report a third born male child of consanguineous parentage who presented with infantile spasms. Initially, he had refractory convulsions of focal, generalised, and myoclonic jerks, not responding to multiple anticonvulsants. He also had choreoathetoid movements. On examination he had microcephaly. MRI of brain was normal and EEG showing diffuse slowing. CSF glucose was low compared to blood glucose, with normal lactate and without any cells, hence diagnosed as Glucose transporter-1 deficiency and started on ketogenic diet. With ketogenic diet, child was seizure free, anticonvulsants decreased to 2 from 5, and improvements in development were noted.