Otoacoutic Emission Testing in Preterm and Term Sick Newborns: A Comparative Analysis.

In newborns, both term and preterm, cochlear hearing loss is common due to different pathologies. Currently accepted methods for hearing screening in newborns are otoacoustic emission (OAE) and auditory brainstem responses. Among these two, OAE is quicker, economical and more accessible. In the present study we assessed OAEs in sick newborns, both term and preterm, having different pathological conditions. This descriptive study was conducted over 3 months in sick newborn care unit (SNCU) in a tertiary care hospital. All sick newborns admitted to SNCU in the study period were tested for otoacoustic emission. The results were subjected to the Chi square test (test of independence). Among 640 sick newborns, 184 were preterm; the rest being term newborns. Among the term sick newborns, 4.8% of those with birth asphyxia, 8.6% of those having septicaemia, 25% of those with hyperbilirubinemia needing exchange transfusion, 22.9% of those having meningitis and 33.3% of those with major congenital anomalies, had "refer" on OAE. Among preterm sick newborns, 30.8% of those with birth asphyxia, 32.5% of those having septicaemia, 75% of those with hyperbilirubinemia needing exchange transfusion, 41.7% of those having meningitis, 40% of those with major congenital anomalies and 8.7% of those with no co-morbidity had "refer" on OAE. Upon computing the p value of Chi square test performed on the results, the results were not significant (p = 0.85). Hence we didn't find any statistically significant difference between term and preterm sick newborns on OAE. The incidence of "refer" result in OAE increases with co-morbidities in both term and preterm sick newborns, somewhat more in preterm newborns. But preterm sick newborns do not seem to have an increased incidence of hearing impairment.

Influence of Sub-Inhibitory Dosage of Cefotaxime on Multidrug Resistant Staphylococcus haemolyticus Isolated from Sick Neonatal Care Unit.

Staphylococcus haemolyticus has emerged to be a frequently encountered late-onset sepsis pathogen among newborn infants. Critical care of neonates involves substantial usage of antibiotics and these pathogens are often exposed to sub-optimal doses of antibiotics which can augment maintenance of selection determinants and a range of physiological effects, prime among them being biofilm formation. Therefore, in this study, the outcome of a sub-inhibitory dosage of a commonly prescribed third-generation antibiotic, cefotaxime (CTX), on multidrug resistant (MDR) S. haemolyticus, was investigated. A total of 19 CTX-resistant, MDR and 5 CTX-susceptible strains isolated from neonates were included. Biofilm-forming abilities of S. haemolyticus isolates in the presence of sub-optimal CTX (30 µg/mL) were determined by crystal violet assays and extracellular DNA (eDNA) quantitation. CTX was found to significantly enhance biofilm production among the non-susceptible isolates (p-valueWilcoxintest­0.000008) with an increase in eDNA levels (p-valueWilcoxintest­0.000004). Further, in the absence of antibiotic selection in vitro, populations of MDR isolates, JNM56C1 and JNM60C2 remained antibiotic non-susceptible after >500 generations of growth. These findings demonstrate that sub-optimal concentration of CTX induces biofilm formation and short-term non-exposure to antibiotics does not alter non-susceptibility among S. haemolyticus isolates under the tested conditions.

Clinical Characteristics of Paediatric Hyperinflammatory Syndrome in the Era of Corona Virus Disease 2019 (COVID-19).

The pandemic of COVID-19 initially appeared to cause only a mild illness in children. However, it is now apparent that a small percentage of children can develop a hyperinflammatory syndrome labeled as Pediatric inflammatory multisystem syndrome-temporally associated with SARS-CoV-2 (PIMS-TS) with a phenotype resembling Kawasaki disease (KD) ('Kawa-COVID-19'). Features of this newly recognized condition may include fever, hypotension, severe abdominal pain and cardiac dysfunction, evidence of inflammation, and single or multi organ dysfunction in the absence of other known infections. Children emerge to have mild symptoms compared to adults, perhaps due to reduced expression of the angiotensin converting enzyme (ACE)-2 receptor (the target of SARS-CoV-2) gene, trained innate immunity, and a young and fit immune system. Some of these children may share features of Kawasaki disease, toxic shock syndrome or cytokine storm syndrome. They can deteriorate rapidly and may need intensive care support as well. The PCR test is more often negative although most of the children have antibodies to SARS-CoV-2. Although the pathogenesis is not clearly known, immune-mediated injury has been implicated.