Symptomatic aortic thrombosis is a devastating condition in the neonatal intensive care unit (NICU), which is now increasingly being diagnosed with the availability of bedside ultrasound. Early intervention can go a long way towards preventing adverse outcomes. In our case, a preterm, very low birth weight, growth-restricted baby developed aortic thrombosis with hypertensive emergency and later limb-threatening ischaemia, which usually requires thrombolysis. However, due to the parents’ reservations, he was given only therapeutic anticoagulation (with closely monitored activated partial thromboplastin time targets), which resulted in complete thrombus resolution. A multidisciplinary team approach was followed, and early detection with frequent monitoring led us to a favourable outcome.
Background With the increasing survival of preterm infants, their nutrition becomes an enormous challenge. Adequate nutrition plays an important role in good neurodevelopmental outcomes. Extrauterine growth retardation (EUGR) is defined as discharge weight below 10th percentile of the weight expected for that gestation after plotting on postnatal growth charts. Aims and Objective This study was conducted to assess the incidence of EUGR in preterm babies and its associated risk factors. Material and Methods This was a retrospective medical chart review of neonates admitted from January 2017 to November 2021 to a level III Neonatal Intensive Care Unit in Delhi, India. Eligible neonates were all preterm babies born at <35 completed weeks’ gestation admitted in NICU within 24 hours of birth and survived for at least 7 days. Neonates who died during hospitalization or were born with a major congenital anomaly requiring surgery in immediate neonatal period or with any genetic syndrome were excluded. Results A total of 250 babies were enrolled in the study, out of which 45.2% neonates were EUGR. Factors significantly associated with EUGR status were long duration of hospital stay, lower birth weight, small for gestational age (SGA) at birth, male sex, persistent ductus arteriosus, sepsis, broncho-pulmonary dysplasia, use of total parenteral nutrition, long duration of mechanical ventilation, longer time to reach full feeds, and interruption of feeds. SGA was associated with highest odds of developing EUGR [OR-80.45 (16.96-1441.09), P<0.001 followed by use of TPN [OR-2.86 (1.61-5.08), p<0.001]. Risk of EUGR increased manifold as the number of risk factors increased. Future plans Strategies for prevention of EUGR should focus on prevention of various neonatal morbidities and risk factor reduction during the hospital stay.
Respiratory distress is the most common cause of neonatal admission. Cystic lung lesions are rarer cause of the same. These are heterogeneous lesions with varied antenatal and postnatal manifestations. The outcomes of antenatally diagnosed lung malformations have showed more improvement than previously thought of. With advancement in imaging techniques, more definitive diagnosis and timely intervention, even in-utero interventions, can be planned. Overall, survival rates have also improved over the past 2 decades. A majority of infants are asymptomatic and do not require surgery in neonatal period, and the expectant management is usually followed in most centers, but some may have mass effect and require either in-utero or early neonatal intervention. For asymptomatic lesions, the timing of surgery remains controversial as there are propagators of both early and late intervention. A multidisciplinary team approach is required for its optimal management. We present here a set of 3 babies who were diagnosed as having cystic lung lesions antenatally but later these turned out to be completely different entities.
Introduction: Compromised skin barrier increases the susceptibility of high-risk preterm neonates to nosocomial sepsis. Thus, topical oil application may be a promising strategy for improving neonatal outcomes. Objectives: The objectives of the study were to study the effect of topical oil application on the incidence of nosocomial sepsis and skin condition. Materials and Methods: This randomized controlled trial was conducted in a referral neonatal unit. The study included consecutive preterm neonates admitted before 4 days of age with admission weight of 1000–2000 g. Computer-generated random number sequence was used for grouping neonates in sunflower oil (n=39) and control (n=39) groups. Results: 70 neonates (89.7%) completed the trial. At enrollment, baseline characteristics, clinical features, and lab abnormalities for sepsis evaluation were comparable in two groups. The incidence of nosocomial sepsis was 15.4% and 17.9% in oil and control group (p=0.7613). On day 10 of enrolment, in oil group, all 23 babies, and in control group, only 1 of 21 babies had normal skin (p<0.001). On multiple regression analysis, the odds ratio (95% confidence interval) for care practice device usage (v/s. randomized group and skin condition) in the causation of nosocomial sepsis was 1.189 (1.08?1.298, p=0.002). Conclusions: No difference in the incidence of nosocomial sepsis was observed between the oil and control groups. However, each additional day of care practice devices usage increased the risk of nosocomial sepsis by 1.19 times, despite oil application and/or improvement in the skin condition.
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