Effect of iron supplementation from neonatal period on the iron status of6-month-old infants at-risk for early iron deficiency: a randomized interventional trial.

OBJECTIVE: To investigate the effects of iron supplementation from the second day after birth on 6-month hemoglobin (Hb), serum ferritin and motor development in infants at risk of early iron deficiency. STUDY DESIGN: Term (37-41 weeks) infants of anemic (Hb ≤ 100 g L-1; N = 100) and non-anemic (Hb > 100 g L-1; N = 100) mothers were randomized to daily iron supplementation at a dose of 2 mg kg-1 from 36 h of age (N = 50, each of anemic and non-anemic mothers) or no iron-supplementation (N = 50 each of anemic and non-anemic mothers). Hb, serum ferritin and motor development at 6 months were compared in the two groups. RESULTS: Iron-supplemented infants had higher Hb (103.7 ± 9.3 g L-1 versus 97.0 ± 9.4 g L-1, p < .0001) and serum ferritin (133.93 ± 52.41 ng mL-1 versus 78.09 ± 42.03 ng mL-1, p < .001) concentrations, compared with the no iron-supplementation group. Their motor development was closer to age-appropriate norms than the no iron-supplementation group (5.83 ± 0.69 versus 5.18 ± 1.35, p < .01). CONCLUSION: Early Iron supplementation is effective for improving iron status and motor development at 6 months in infants at risk for early iron deficiency.

Transitional Hypoglycaemia Management in Small for Gestational Age Neonates with Sucrose Enriched Expressed Breastmilk in Resource Poor Setting.

AIM: To find out if oral sucrose is as efficacious as intravenous dextrose (IVDx) in treating hypoglycaemia in small for gestational age (SGA) neonates and to compare risk of feed intolerance (FI) and necrotizing enterocolitis (NEC) in oral therapy with IVDx therapy. METHODS: Eighty SGA haemodynamically stable hypoglycaemic [blood sugar (BS) < 40 mg/dl] neonates of ≥32 to ≤36 week gestational age were randomized to receive oral sugar enriched expressed breastmilk (EBM; Group A) or IV dextrose therapy (Group B; 40 in each group) in similar calculated doses. BS at 6 h after treatment, incidence of recurrence of hypoglycaemia, FI and NEC were compared. RESULTS: Mean BS level at 6 h after treatment in oral supplementation group was 63.53 ± 22.12 mg/dl [3.52 ± 1.22 mmol/l (IQR 49.2-82 mg/dl, 2.7-4.5 mmol/l) vs. 71.28 ± 31.76 mg/dl [3.96 ± 1.76 mmol/l (IQR 48.5-73 mg/dl, 2.69-4 mmol/l) in IVDx group, p = 0.209. Relative risk (RR) of recurrence of hypoglycaemia in oral vs. IV treatment was 1.5 with 95% CI 0.4578-4.9151. Incidence of FI (p = 0.49, RR 1, 95%CI 0.3-3.1) and NEC (p = 0.4, RR 0.2, 95%CI 0.01-4.2) was comparable. CONCLUSION: In resource poor setting in haemodynamically stable hypoglycaemic SGA neonates, EBM enriched with calculated dose of sucrose given orally maintains euglycaemia (BS 40-125mg/dl, 2.2-6.9 mmol/l) without increased incidence of FI and NEC. This method also prevents lactational failure.

Bacillus cereus-Attributable Primary Cutaneous Anthrax-Like Infection in Newborn Infants, India.

During March 13-June 23, 2018, anthrax-like cutaneous lesions attributed to the Bacillus cereus group of organisms developed in 12 newborns in India. We traced the source of infection to the healthcare kits used for newborn care. We used multilocus sequence typing to characterize the 19 selected strains from various sources in hospital settings, including the healthcare kits. This analysis revealed the existence of a genetically diverse population comprising mostly new sequence types. Phylogenetic analysis clustered most strains into the previously defined clade I, composed primarily of pathogenic bacilli. We suggest that the synergistic interaction of nonhemolytic enterotoxin and sphingomyelinase might have a role in the development of cutaneous lesions. The infection was controlled by removing the healthcare kits and by implementing an ideal housekeeping program. All the newborns recovered after treatment with ciprofloxacin and amikacin.

In resource limited areas complete enteral feed in stable very low birth weight infants (1000-1500 g) started within 24 h of life can improve nutritional outcome.

OBJECTIVE: To evaluate feasibility of complete enteral feed (CEF) in stable very low birth weight neonates weighing 1000-1500 g. SUBJECTS AND INTERVENTIONS: One hundred and three stable very low birth weight (vlbw) neonates (1000-1500 g) irrespective of gestational age (GA) were randomized to receive either CEF with expressed breast milk (EBM) (n = 51) or minimal enteral feed (MEF) supplemented with intravenous fluid (IVF). (MEF) (n = 52). Feed volume was increased progressively. Primary outcome measures were feed intolerance (FI) and necrotizing enterocolitis (NEC) in first 21 days of life or discharge from NICU, whichever was earlier. Secondary outcome measures were the time taken to reach calorie intake of 110 kcal/kg/D and regain of birthweight. RESULTS: FI was observed in n = 12 (23.53%) in CEF group versus n = 6 (11.53%) in MEF group (p = 0.1264). NEC was observed in 4 (7.8%) in CEF group versus 1(1.9%) in MEF group (p = 0.16) and results were comparable in both groups. Birthweight regain (10.6 ± 1.6 days versus 11.8 ± 1.6 days, p = 0.038), NICU discharge (11.7 ± 2.6 days versus 13.0 ± 3.45 days, p = 0.038) and time to reach 110 kcal/kg/day (9.571 ± 1.458 days versus 10.833 ± 1.655 days, p = 0.001) were significantly earlier in CEF compared to MEF group. CONCLUSION: Complete enteral feeds started within 24 h of life is feasible in vlbw neonates.

Clinically relevant yeast species identified by sequencing the internal transcribed spacer region of r-RNA gene and Vitek 2 compact (YST card) commercial identification system: Experience in a Tertiary Care Hospital in Assam, Northeast India.

In this retrospective study from 2012 to 2015, 333 clinical isolates of yeasts were identified using Vitek 2 Compact System YST ID card (Biomerieux, France) and internal transcribed spacer (ITS) sequencing. Eighteen species were identified by ITS sequencing. Candida albicans was the most common species (46.5%), followed by Candida tropicalis (27%). The total species supported by Vitek System was 11 (61.11%). The sensitivity of the system in identifying these 11 species was 66.66%-100%; specificity 98.37%-100%; positive predictive value 70%-100%, negative predictive value 96.05%-100%, and diagnostic accuracy 96.99%-100%. Diagnostic accuracy of ITS1 and ITS2 sequences individually was 98.49% and 100% using NCBI Genbank database.

Pattern of Gross Congenital Malformations in a Tertiary Referral Hospital in Northeast India.

OBJECTIVE: To explore the prevalence of structural congenital malformations among newborns and study some of the fetal and maternal characteristics of the malformed babies in North east India where such systematic study on congenital malformation has not been undertaken before. METHODS: A cross sectional study was undertaken from May 2010 through Feb 2013 for estimation of gross congenital malformations among live birth and stillbirth children born in Assam Medical College. All live births were clinically examined for detection of gross congenital malformations and autopsy was carried out on still births and neonates dying within 24 h of birth to detect gross congenital malformations in the internal organs. All malformations were classified as per ICD 10 classification. The mothers of the newborns with congenital malformations were interviewed in a predesigned, pretested proforma. The variables included maternal age, antenatal registration, antenatal history of drug intake, consanguinity and previous history of malformations. Statistical analysis was done using chi square test. RESULTS: A total 18,192 births including live births and still births were examined and 206 cases of structural malformations were observed. Prevalence of congenital malformations was 1.2 % of the total live births. Distribution of malformation was predominant among males than in females (60.67 vs. 37.37 %; p < 0.05). Musculoskeletal system was the most common system involved. Prevalence of malformation of the cardiovascular system was found to be very low. Malformations among stillbirths and newborns born to unregistered mothers were significantly more. Percentage of malformations in babies born to mothers of more than 30 y of age was higher than other age groups (2.2 %). Occurrence of malformations in low birth weight babies were significantly more (p < 0.001). CONCLUSIONS: Prevalence of malformations was 1.2 % of the total live births. Musculoskeletal system was the most common system involved. Congenital malformations were significantly associated with sex of the new born, registration of the mother and birth weight of the newborn.

Prevalence of anemia in pregnant women and its effect on neonatal outcomes in Northeast India.

OBJECTIVES: To determine the prevalence of anemia in pregnant women and characterize its effect on neonatal outcome in Northeast India. PATIENTS AND METHODS: Four hundred and seventy mothers and their newborn infants during a one month period were included. The association between maternal hemoglobin (Hb) at delivery and neonatal outcomes were determined. RESULTS: Anemia (Hb < 110 g/L) was present in 421 (89.6%) mothers with 35 (8.3%) having severe anemia(Hb < 70 g/L). After adjusting for maternal and neonatal variables, each 10 g/L decrease in maternal Hb was associated with 0.18 week decrease in gestational length (p = 0.003) and 21 g decrease in birth weight (p = 0.093). Severe maternal anemia was associated with 0.63 week (95% CI, 0.03-1.23week) shorter gestation, 481 g (95% CI, 305-658 g) lower birth weight and 89% increased risk of small-for-gestation (OR 1.89, 95% CI, 1.25-2.86)in the offspring, compared with those born to mothers without anemia (p < 0.001). CONCLUSION: Maternal anemia was highly prevalentin this population. Lower gestational age and birth weight, and increased risk of small-for-gestation were associated with maternal anemia, especially when maternal Hb was <80 g/L. Maternal anemia needs urgent attention to improve neonatal outcome in this population.

Sneathia species in a case of neonatal meningitis from Northeast India.

Here we report the detection of Sneathia species most closely related to Sneathia sanguinegens, an infrequently reported bacterium, in the cerebrospinal fluid of a neonate by a culture independent method. Even though on rare occasions, this bacterium was isolated previously from the blood of neonatal bacteraemia cases. To the best of our knowledge there exists no previous report of detection of S. sanguinegens in the cerebrospinal fluid even though recently there has been a report of isolation of closely related species, Leptotrichia amnionii. The neonate recovered following antimicrobial therapy for 21 days. We conclude that uncultivable or difficult- to-cultivate bacteria like Sneathia could be an emerging pathogen for neonatal infection.

Acute pulmonary melioidosis in a child: A case report and review of literature.

Melioidosis is a rare potentially fatal infection caused by the bacterium Burkholderia pseudomallei, which is endemic in Southeast Asia and Northern Australia and an emerging pathogen in India. It is a largely under-diagnosed disease and an imitator of tuberculosis, both clinically and radiologically.