Renal injury due to perinatal asphyxia has not been systematically evaluated. The available studies have used variable definitions, incomplete investigations and none had a control group. The aim of this study was to evaluate systematically the renal functions in severely asphyxiated newborns and to find if abnormal renal function tests can predict adverse outcome (death or neurologic abnormality at discharge). In a prospective case-control design, 25 inborn babies>or=34 weeks gestation having asphyxia (5 min Apgaror=5 min) were enrolled as 'cases'. Simultaneously 25 gestation and weight matched babies with no asphyxia were enrolled as 'controls'. Renal function tests, calculated renal indices using timed urine collections and excretion of beta2-microglobulin and N-acetyl-beta-D-glucosaminidase (NAG) were monitored in both the groups for first 4 days of life. Fourteen (56 per cent) asphyxiated babies had acute renal failure (ARF) as compared to 1 (4 per cent) control (p=0.002). Blood urea and serum creatinine values were significantly higher in asphyxiated babies on day 4 but not on day 2. Renal failure index and FeNa were higher in asphyxiated babies on both day 2 and day 4, but creatinine clearance was not different. Urinary excretion of both beta2-microglobulin and NAG was higher in the asphyxiated babies on day 2 as well as day 4. Five minute Apgar1.5 mg/dl alone had the best specificity and positive predictive value. The renal parameters were however poorer predictors of adverse outcome in comparison to clinical markers like 5 min Apgar

There are no evidence-based guidelines available regarding the duration of antibiotics in neonatal septicemia. We compared the effectiveness of a 7-day intravenous antibiotic regimen with the standard 14-day regime in blood-culture-proven sepsis in neonates. This was a controlled, blinded, randomized trial with stratification (for birth weight). Blood-culture-positive septic babies > or =32 weeks and/or > or =1500 g were enrolled if meningitis and other deep-seated focal infections were ruled out. Parental consent was obtained. Randomization to either 7-day or 14-day therapy was done on day 7 of antibiotics if the baby had clinically remitted by day 5. Blood culture was repeated 24 h after antibiotic completion. Subjects were observed in the hospital for at least 72 h, and followed-up for 28 days by weekly visits and telephonic contacts. The primary outcome was treatment failure within 28 days defined as a positive blood culture, or clinical signs accompanied by either positive CRP or adjudicated to be a relapse by an expert committee. A total of 120 babies were eligible, 51 were excluded (no consent: 12; non-remission: 39), and 69 were randomized to receive either a 7-day course (n = 34) or a 14-day course (n = 35) of antibiotics. Baselines variables were comparable in the two groups. Primary outcome assessment could be done in 33 cases in either group. There was a trend to greater treatment failures in the 7-day group compared with 14-day group (5 vs. 1, respectively; P = 0.19). On subgroup analysis of subjects with Staphylococcus aureus infection, those who received 7-day therapy (n = 7) had significantly more treatment failure than 14-day therapy (n = 7) (four and zero, respectively; P = 0.022), whereas on sub-group analysis of babies with non-S. aureus infections, treatment failure rates were identical (3.8% in both groups). On comparing the organisms isolated in the group of subjects which was not randomized by virtue of being symptomatic (n = 39) vs. the group which was randomized (n = 69), it was found that S. aureus infections were significantly commoner in the former group (61.5 vs. 21.3%, respectively; P < 0.001). Neonates > or =32 weeks and/or > or =1500 g with S. aureus sepsis require 14 days of antibiotics. S. aureus infection is also associated with failure to achieve clinical remission by the 5th day of antibiotic therapy. Larger trials are required to confirm whether neonates with non-S. aureus sepsis, whose symptoms remit by 5 days, can be treated with 7 days of antibiotics.

The aim of the study was to determine the neurodevelopmental outcome of acute bilirubin encephalopathy (ABE) in children who underwent double volume exchange transfusion (DVET). The 25 referred newborns of ≥ 35 weeks gestation with total serum bilirubin >20 mg dl(-1) and signs of ABE were enrolled and followed up at 3, 6, 9 and 12 months. Denver Development Screening Test (DDST), Neurological examination along with MRI at discharge and brain stem evoked response audiometry (BERA) at 3 months were done. Abnormal neurodevelopment was defined as either (i) cerebral palsy or (ii) abnormal DDST or (iii) abnormal BERA. The mean bilirubin at admission was 37 mg dl(-1). MRI and BERA were abnormal in 61% and 76%. At 1 year, DDST and neurological abnormality were seen in 60% and 27% and 80% had combined abnormal neurodevelopment. MRI had no relation (P = 0.183) but abnormal BERA had a significant association (P = 0.004) with abnormal outcome. Intermediate and advanced stages of ABE associated with significant adverse outcome in spite of DVET.

There is limited information whether the use of ciprofloxacin in the neonatal period affects the linear growth of very low birth weight (VLBW) babies in infancy. This was a retrospective cohort study on VLBW babies followed up until 12 months corrected age (12-mCA). Exclusions were: infants with no length record taken at 12-mCA, who received ciprofloxacin after neonatal period, were neurologically abnormal, growth retarded in utero or congenitally malformed, had chronic systemic illnesses or endocrinopathies in infancy. Cases were defined as those who received intravenous ciprofloxacin (10 mg/kg/dose 12-hourly) for at least 3 days in the neonatal period, whereas controls were those not exposed to ciprofloxacin during neonatal life. Of 205 babies included in the study, there were 61 cases and 144 controls. Length at 12-mCA was similar in both groups [71.9 +/- 3.0 cm and 71.7 +/- 3.3 cm; p = 0.95]. On multi-variate linear regression analysis, length at a post-conceptional age of 40 weeks and sex emerged as independent predictors of length at 12-mCA. Ciprofloxacin administered at a dose of 10 mg/kg/dose 12-hourly for 3 days or more to VLBW babies does not affect their linear growth until 12 months corrected age.

Hyperammonemic encephalopathy with normal liver function is an uncommon serious adverse effect of valproate therapy. We retrospectively analyzed the case records of 5 patients of epilepsy on valproate with hyperammonemic encephalopathy. Of the 5 patients, 3 were on monotherapy. The mean valproate dose was 1250 mg/day and the duration of therapy ranged between 4 and 90 days. Alteration in the sensorium was the presenting clinical feature. The risk factors included high initial dose (2), long-term valproate therapy (1), and long-term valproate therapy with concomitant topiramate (1). There was good correlation between the fall in serum ammonia levels and clinical improvement. Hyperammonemic encephalopathy should be suspected in patients on valproate with altered sensorium. Response to treatment is rewarding.

This prospective cohort study was conducted to evaluate variability in mortality of very low birth weight (VLBW) neonates during their birth hospitalization in different hospitals of India. A liveborn neonate was eligible for inclusion in the study if it was born or admitted in a participating hospital between 1st January and 31st December 2012 and weighed 1500g or less at birth. Neonates were given clinical care as per standard protocols. Standardized neonatal mortality ratio (SNMR) was calculated as the ratio of the observed mortality to the expected mortality. Expected mortality rate for each unit was calculated by adjusting for various prognostic factors at the time of birth or admission in the participating unit. Among 1345 neonates [mean birth weight: 1168 ± 240g, median gestation: 30wk (IQR: 28-32)] enrolled in the study 199 (14.8%) died before hospital discharge. Although variation in inter-hospital SNMR was statistically insignificant (P 0.49), 95% CI of SNMR of most hospitals was broad reaching level of clinical significance on both sides of line of equivalence. This indicates the need to establish an ongoing quality-improvement collaborative network to identify and adopt clinical practices associated with decreased mortality.

Objective To estimate the levels of perceived stress and determine the professional quality of life domains namely, compassion satisfaction, burnout, and secondary trauma and their associated factors in neonatal intensive care unit (NICU) nurses. Methods A multicenter cross-sectional study was carried out across a number of NICUs in North India from May to June 2022. A total of 223 nurses included in the study were given a self-administered questionnaire consisting of their sociodemographic profile, work profile, PSS 14 scale, and ProQol 5 scale. Data was analyzed using descriptive statistics, correlation coefficient, and multiple regression. Results Based on PSS 14, 52(23.3%), 132(59.2%), and 39(17.5%) nurses experienced mild, moderate, and severe stress, respectively. Burnout and secondary trauma were found to be average in the majority of nurses (178[79.8%] and 175 [78.5%], respectively) in regard to professional quality of life domains. A sizable portion of the nurses was found to have average to high compassion satisfaction. Factors such as more number of night duties, alarms and lights in NICU, lesser professional experience, high workload, being unmarried, and having no children were found to be significant in association with perceived stress and professional quality of life. Conclusion According to this study, the majority of nurses who work in NICUs experience moderate levels of stress, which negatively impacts their professional quality of life. Therefore, it is important to consider various stress management programs based on the stressors.

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