Study protocol: 'a large cohort study of postnatal events in a not-for-profit referral centre in Vellore, South India'.

INTRODUCTION: In a large developing country, with diverse population characteristics and differential access to healthcare, it is important to identify factors that influence postnatal health. This knowledge will help frame recommendations to enhance universal postnatal care. METHODS AND ANALYSIS: A prospective cohort study will be conducted by recruiting all participants who deliver in a referral centre in South India during a 1-year period after written consent is obtained from them. In addition to clinical information pertaining to their delivery and demographics, details of physical health, mental health socioeconomic status and emotional support will also be collected. Every participant will be followed up physically and/or by telephonic consultation at 3, 9 and 18 months of their postnatal period to reassess their status and that of their babies. As there are several independent and dependent variables requiring multivariate analysis, a sample size of 10 000 is considered adequate. Any unplanned visits to a health facility will be enquired into and documented for analysis.During data analysis, the effect of Caesarean section, high-risk characteristics and gestational age of the baby at delivery on various outcome measures and postnatal status will be evaluated. Interpretation of the large volume of collected data will help frame recommendations to improve postnatal care ETHICS AND DISSEMINATION: The study is approved by the Institutional Review Boards (Research and Ethics Committees) of Christian Medical College, Vellore, Tamil Nadu, India (IRB 12178 date 24 June 2020).Women are provided with a detailed information sheet and written consent is obtained. They are reassured that their care will not be compromised if they do not consent to the study. Data will be available on the clinical trial portal to assist in the dissemination of results after the project is published. TRIAL REGISTRATION NUMBER: CTRI/2022/03/041343.

Torn between two worlds: parental experiences of neonatal follow-up for infants with hypoxic ischaemic encephalopathy in India-a qualitative study using interpretative phenomenological analysis.

OBJECTIVE: This study aimed to understand the barriers and facilitators of a neonatal follow-up programme, as perceived by parents of infants born with hypoxic ischaemic encephalopathy (HIE). DESIGN: This study applied a qualitative study design using interpretative phenomenological analysis. It included focus group discussions, face-to-face in-depth interviews and telephonic interviews. Data were analysed using thematic content analysis. SETTING: Neonatal follow-up clinic of a tertiary hospital in South India. The study was conducted between March and December 2020. PARTICIPANTS: Five fathers and eight mothers of infants with HIE. RESULTS: Parents of children with HIE are torn between two worlds-an atmosphere of support and one of criticism. Three main themes were identified: (1) neonatal intensive care unit (NICU) stay: distressful versus reassuring experiences; (2) parenthood: supportive versus unsupportive environments; and (3) neonatal follow-up: adherence versus non-adherence. CONCLUSION: Parents of children with HIE experience sociocultural barriers in the NICU, after discharge and during the follow-up period. These lead to a complex array of emotional and physical consequences that affect parenting and follow-up care.

Severe neonatal autoimmune thrombocytopenia secondary to maternal Evans syndrome.

Evans syndrome is a rare and chronic autoimmune disease seen in both paediatric and adult age groups. We present a case of severe thrombocytopenia in a neonate born to a mother with Evans syndrome who showed no response to intravenous immunoglobulin therapy initially and improved after treatment with methylprednisolone.

Natal and Neonatal Teeth: A Tertiary Care Experience.

BACKGROUND: Presence of teeth in a neonate is a rare occurrence due to the disturbance in the biological chronology of teeth. Although uncommon, these teeth if present are found to have several clinical implications. AIMS: This study aimed to describe the clinical characteristics and the treatment outcome of natal and neonatal teeth from a hospital setting. MATERIALS AND METHODS: This retrospective study was carried out by reviewing the hospital records of babies with natal or neonatal teeth in a tertiary hospital in Tamil Nadu between January 1, 2012, and December 31, 2014. Babies with complete clinical data along with their follow-up records were selected and results were analyzed. RESULTS: Complete clinical data of 33 babies with a total of 52 teeth were included, of which 28 teeth were natal and 24 teeth were neonatal. All the teeth were located in the mandibular primary incisor region and majority were in pairs. A positive family history was present in eight cases. Extractions were carried out only in cases where the teeth were found to be extremely loose or interfering with feeding. The only local complication noted in this study was Riga-Fede disease. CONCLUSIONS: The findings of this study suggest that natal and neonatal teeth may have a possible hereditary basis. All the teeth were noted to be prematurely erupted primary teeth rather than supernumerary teeth. Both dentists and pediatricians need to be aware of the clinical implications of these teeth and that they should be retained unless they are symptomatic.

Malignant rhabdoid tumour of the neck in a neonate.

Fetal neck masses are rare, and present a challenge antenatally, during delivery and in making a diagnosis. In this report, we detail the presentation of a neonate with a neck mass diagnosed in the third trimester. The baby was delivered by ex utero intrapartum therapy (EXIT). Investigations sent included an MRI with limited CT cuts, and a biopsy, which lead to the diagnosis of a malignant rhabdoid tumour. This is rare and the overall survival is low.

Mediastinal bronchogenic cyst mimicking congenital lobar emphysema.

Bronchogenic cyst (BC) is a rare congenital malformation of the lung. Most patients remain asymptomatic until adulthood while some are symptomatic in the first few years of life. However, symptoms in newborn period are rare. We report a case of a 3-day-old preterm baby with respiratory distress diagnosed as congenital lobar emphysema on chest X-ray. A CT scan revealed a mediastinal cyst causing obstructive lobar emphysema. The cyst was excised and pathological examination was suggestive of BC.