Background: Of the 2.8 million neonatal deaths, worldwide, 0.43 million is contributed by sepsis alone. The objective of this study was to determine the levels of umbilical cord C-reactive protein and assess the suitability of this test in diagnosing early onset sepsis in newborns born to mothers with no risk factors for intrapartum infection. To determine the influence of other factors such as parity, birth weight and mode of delivery on the levels of cord CRP.Methods: CRP levels in cord blood were estimated for 103 consecutive newborns delivered at a tertiary care teaching hospital. These babies were monitored for signs of sepsis for 72 hours and were later followed up with serum CRP and blood cultures.Results: A prospective cohort study of 103 consecutive newborns were taken of which 53.4% were male babies. Comparison of cord CRP levels of baseline characteristics revealed significant elevation in babies born to multipara mothers (p = 0.0028) and in low birth weight babies (p = 0.05), while there were no significant changes in different modes of delivery. The mean cord CRP of the study group was 0.694±0.2979. Out of 104 babies, 16 had elevated cord CRP (above 1.1mg/l) of these, 12 babies were later confirmed to have sepsis. The mean cord CRP level in babies with EOS was 1.3±0.255 (p = 0.001). A sensitivity of 100%, specificity of 90.9%, positive predictive value of 75% and negative predictive value of 100% was determined.Conclusions: This study confirms that cord CRP is an effective marker to predict EONS. An optimal concentration of cord CRP > 1.1 mg/L has maximal sensitivity and specificity to predict EONS.

Sir, A normal 2-yr-old girl presented with loose motions and vomiting followed by drowsiness. History revealed that the patient had developed these symptoms within 30 min of consumption of a yellow funnel shaped flower. Examination revealed an irregularly irregular heart rate with ST segment elevation on electrocardiogram with intermittent bradycardia. Blood pressure was 60/42 mm Hg in the right arm in supine position and the respiratory rate was 45/min with acidotic breathing. On central nervous system examination, the child was drowsy but arousable. Pupils were bilaterally equal and reacting to light. There was no cranial nerve palsy or focal neurological deficit. Gastric lavage yielded a yellow colored fluid. Activated charcoal was administered after the lavage in the casualty, which was approximately after 45 min of consumption of the flower. The sensorium rapidly deteriorated and patient became comatose. Intravenous fluids and antibiotic coverage was given. Patient had decreased perfusion and hypotension, for which a dopamine drip was started. Bradycardia was treated with intravenous atropine. Elective endotracheal intubation was undertaken and patient was mechanically ventilated. Serum potassium was 7 mmol/dl and an arterial blood gas revealed compensated metabolic acidosis which were treated as per standard guidelines. Later, the child developed an episode of generalized tonic-clonic convulsion for which she required injection midazolam and injection phenytoin intravenously. As signs of II degree heart block were seen on ECG, temporary pacing was planned, but patient developed asystole and did not respond to resuscitative measures. The flower ingested was confirmed by the father as yellow oleander from the photograph in the textbook of toxicology.

Background: An efficacious, reliable, and non-invasive route of administration for midazolam, a drug used for sedation and pre-anesthetic medication, would have obvious advantages. This study compares the sedation achieved by nebulized route and intravenous route as procedural sedation.Methods: A randomized double-blinded interventional study was designed to compare the effect of nebulized midazolam with intravenous midazolam as a sedative medication in 86 children undergoing imaging procedures like CT scan, MRI scan, EEG. Ramsay sedation scores and parameters of cardiovascular and respiratory function were measured over 20 min and summarized Results: The mean sedation score in both groups was comparable at baseline, 10 minutes and 20 minutes with p values of 0.1, 0.1, 0.09 respectively. Parameters of cardiovascular and respiratory function were comparable in both the groups. Conclusion: Present study showed that nebulized midazolam when given at a higher dose of 1 mg/kg was found to be as potent as intravenous midazolam, opening up a door for a sedative which is easier to administer, has better acceptance with lesser complication.

Background: The prevalence of hearing loss is higher in neonates admitted to NICU compared to the general population. Preterm babies are more vulnerable to the hearing damage due to their immature inner ear exposing them to various high frequency noises in the NICU to which they were not accustomed. Most NICU in India exceed the recommended sound levels. In order to reduce damage to the ears, foam-based earplugs are used to reduce the sound intensity reaching the ears of these premature babies.Methods: Babies admitted to NICU are allocated alternatively to receive earplugs or not. Cases are preterm babies with earplugs and controls are the ones without earplugs. The incidence of hearing loss is found by OAE testing of the ears at the end of NICU stay.Results: Out of 40 in each group, 6 babies in control group failed the OAE compared the 3 in the earplug group. Babies who did wear earplugs had longer period of NICU stay.Conclusions: Use of earplugs in babies admitted to NICU reduced the incidence of hearing loss and also length of NICU stay.

Background Modified Sick Neonatal Score (MSNS) is a modification of the Sick Neonatal Score (SNS) by adding perinatal factors such as birth weight and gestational age to the scoring. A significantly higher sensitivity and specificity were obtained by adding the above parameters to SNS. The parameters in MSNS were simple and easy to score, but the scoring was done only once, and the utility of the score to assess the response to treatment was not analysed. In this study, we aimed to determine the role of MSNS as a prognostic indicator in the neonatal intensive care unit (NICU) and to study the correlation of the change in the MSNS (Delta-MSNS) 24 hours after admission with the outcomes and as a measure of response to treatment. Methodology A cross-sectional study was conducted for six months on all neonates admitted to the NICU during the study period. All babies were scored using MSNS containing eight basic clinical parameters, namely, respiratory rate, heart rate, axillary temperature, peripheral capillary refill time, random blood sugar, oxygen saturation, gestational age, and birth weight. Scoring by MSNS was done on the following two occasions: first score at admission, and second score 24 hours later. A change in the score during the first 24 hours of NICU stay (Delta-MSNS) was analysed for babies with an initial score of less than or equal to 12. All babies were followed up for analysis of outcomes, and outcomes were documented as discharge from the hospital or death. Length of hospital stay was documented for the babies that were discharged. Statistical analysis was done using the software RStudio v1.1.456. Kruskal-Wallis rank sum test was used to compare individual parameters of the score as well as the mean score between the expired and discharged groups. Spearman rank-order correlation coefficient was used to correlate the scores with length of hospital stay. Results A total of 248 neonates were considered for inclusion in the study. The mean score at admission was 7.94 (SD = 1.89) in the expired group and 14.46 (SD = 1.84) in the discharged group. The p-value for each of these was <0.001. Using MSNS as a test variable, a receiver operating characteristic (ROC) curve was generated, and as measured by the area under the curve was 0.98. A cut-off score of 10 was obtained that had a sensitivity of 88.24%, specificity of 95.2%, positive predictive value of 57.69%, and negative predictive value of 99%. A significant negative correlation was observed with a Spearman correlation coefficient of -0.67 when the initial MSNS was correlated with length of hospital stay in patients who were discharged. A significant negative correlation with a coefficient of -0.39 and p-value of 0.017 was determined when delta MSNS score was correlated with the discharged babies who had an initial score of less than 12. Conclusions MSNS is an easy-to-use bedside scoring system that requires minimal training and no invasive procedures. It has shown a h...

Background: Neonatal jaundice or icterus neonatrum has been observed in newborn babies for many centuries. The objective of this study was to determine the correlation between cord albumin levels and development of hyperbilirubinemia in term healthy neonates.Methods: A prospective study was conducted on 165 term healthy neonates. Gender, gestational age, anthropometric measurements were taken into consideration. It was ascertained that there was no other risk factor for hyperbilirubinemia amongst the neonates. The neonates were divided into two groups A and B based on the cord albumin levels of <2.8 gm/dl and >2.8 gm/dl.Results: Of the 165 babies included in the study, 126 babies were under Group 1 and 39 under Group 2. 44 babies (34%) in group 1 and 28 babies (71.7%) in group 2 (p<0.0005) developed clinical icterus of which 16 in group 1 and 19 in group 2 required phototherapy (p<0.05). 1 baby in group required exchange transfusion. The sensitivity and specificity of cord albumin in detecting neonatal hyperbilirubinemia in this study was determined to be 71.8% and 65.1% respectively.Conclusions: Cord albumin levels help to determine and predict the possibility of hyperbilirubinemia among neonates. Hence this can help to identify the at-risk neonates. So, routine determination of cord albumin can be advocated to keep a track on at risk neonates.

Background: Neonatal sepsis accounts for early-half of all neonatal death in India. Although the gold standard for the diagnosis of neonatal sepsis is by blood culture, there is a need for a test that is cheap, accurate, easily performed with quick availability of reports so that prompt and appropriate treatment is ensured. In this study we try to analyse the diagnostic value of I/T2ratio in comparison to I/T ratio and absolute neutrophil count (ANC) independently to correctly predict neonatal sepsis. Subjects and Methods: A time bound, prospective comparative study was done on neonates with suspected neonatal sepsis for a 2 year period. Neonates were then analysed in three groups depending on their blood culture results as no sepsis, probable sepsis and proven sepsis. I/T2was calculated for all the babies and an optimum cut off was found for the same. The diagnostic accuracy of I/T2 ratio with septic screen positivity and blood cultures were assessed. Results: 245 neonates included in the study were divided into three groups depending on whether they were blood culture positive sepsis, probable or clinical sepsis. The means of septic screen parameters including I/T2 were highly significant when compared between the three groups (p value <0.001). ROC curve created showed the AUC for I/T, I/T2 and ANC was 0.822, 0.809, 0.610 (p value <0.001) and a higher specificity. Conclusion: I/T2 shows promise as a parameter to screen for sepsis in neonates. Calculating the I/T2 ratio in conjunction with established septic screen parameters could enhance prediction of sepsis in newborns.

Introduction: Sick newborns often require central venous catheters for prolonged periods of time when admitted to the Neonatal Intensive Care Unit (NICU). These central lines, hence, raise the problems of sepsis, thrombus and other potential linerelated complications. In-line endotoxin filters are found to be an effective intervention to remove potential sepsis causing bacteria, endotoxins and other particulates there by reducing the mortality and morbidity of these newborns. Aim: To determine the effect of in-line endotoxin filters on mortality and occurrence of venous thrombosis, sepsis and Necrotising Enterocolitis (NEC) in sick newborns with central venous catheters. Materials and Methods: This single-centre, prospective interventional study was conducted over a period of 12 months, where, all sick babies admitted to the NICU for more than 24 hours with a central venous catheter were eligible for the study. They were grouped into those which received the in-line filters (study group) and those with standard care without filters (control group). The primary outcome variables studied were sepsis, thrombus formation, NEC, ventilator days and death. Secondary outcomes were days of hospital stay, line days, and length of ICU stay. Results: Out of 137 eligible neonates, 127 were finally included in the study; 66 were in the control group while 61 in the study group, seven were excluded and a total of 54 in the study group were included. A total of 20 cases developed NEC in the control group while only six in the study group (p-value=0.03). Thrombus formation was lesser in the study group 3 (5.6%) compared to the control group 14 (21.2%). Thrombus formation was also found to be less likely to occur when an in-line filter is attached as compared to not using one (OR 0.232; 95% CI 0.628-0.858; p-value=0.02). The odds of occurrence of NEC (OR: 0.307 95 % CI: 0.113 - 0.834) also were found to be significantly less in the study group. Conclusion: A simple intervention like addition of in-line endotoxin filters to the central venous catheters in sick newborns in NICU decreases the risk of thrombosis, risk of NEC and overall complications in critically ill NICU patients.