To the Editor: Polymyxin B is a polypeptide antibiotic. It has bactericidal activity against aerobic gram negative bacteria. Side effects of intravenous polymyxin B are anaphylactic reactions, dyspnea, tachycardia, eosinophilia, fever, nephrotoxicity and neurotoxicity. Skin exanthemata and urticarial rash are known acute dermatological side effects but gradual skin hyperpigmentation is not well documented. We report 3 babies who had progressive skin hyperpigmentation after intravenous polymyxin B.Out of the three neonates, one baby was term and two were preterm. All these newborns had culture proven late onset sepsis. Polymyxin B was started with normal therapeutic doses (25,000-40,000 units/kg/d). Photographs was taken by digital camera since beginning to at least 2 wk of treatment and difference in skin color was compared (Figs. 1a, b and c); the skin color progressively darkened. Reversal of skin color to baseline was noticed in one infant at 45 d. Other two infants were lost follow up.Polymyxin B is derived from Bacillus polymyxa. Common acute dermatological side effects are well known [1], but progressive generalized skin hyperpigmentation is not well described. Shih et al. reported generalized skin hyperpigmentation in premature infants receiving polymyxin B [2]. Skin hyperpigmentation has also been observed in adult patients receiving polymyxin B alone [3,4] or in combination therapy [5].We noted generalized skin hyperpigmentation among neonates receiving IV polymyxin B. None of the baby received phototherapy. Concomitant antibiotics were vancomycin, ceftazidime and amikacin and none of them has been reported to cause hyperpigmentation and thus concomitant antibiotics and phototherapy were excluded as cause for skin hyperpigmentation.As polymyxin B is excreted through the kidney, the drug level may be higher in newborns due to functional immaturity of the kidneys. Cumulative effect is likely to be exaggerated among premature babies.The exact mechanism of skin hyperpigmentation due to polymyxin B is unknown. It could be due to the release of histamine and increased tyrosinase activity by polymyxin B. Histamine can induce melanogenesis by its metabolite imidazoles. Further studies are needed to document this additional adverse effect of intravenous polymyxin B more evidently.
Transcutaneous measurement of bilirubin is being used for neonatal jaundice. Its utility during phototherapy in preterm babies is not established. Objective of our study was to assess the e cacy of transcutaneous bilirubin (TcB) measurement in comparison to total serum bilirubin in preterm newborns at admission and during phototherapy at covered skin area (glabella). It was a prospective observational study and conducted at neonatal intensive care unit of a tertiary care hospital from January 2017 to January 2019. One hundred eligible preterm neonates were enrolled. Babies who were very sick, with poor peripheral circulation, edematous, having conjugated hyperbilirubinemia, with major congenital malformations, already received phototherapy or exchange transfusion were excluded. Paired total serum bilirubin and transcutaneous bilirubin were measured at admission, at 6 hours and 24 hours during phototherapy. TcB was measured from area (glabella) covered by eye protector during phototherapy.Sample for TsB was taken within 10 minutes of TcB measurement. The mean difference between TsB and TcB values at admission, 6 hours and 24 hours of phototherapy were -0.005 (0.353), --0.350 (0.611), and -0.592 (0.353) respectively. At admission or before starting of phototherapy the difference (TsB-TcB) was statistically not signi cant (p=.125), while the difference in these values were statistically signi cant at 6 hours and 24 hours of phototherapy. Conclusion: TcB measurements from covered skin area in jaundiced preterm infants during phototherapy were not correlated with TsB and cannot be used as an alternate of serum bilirubin levels. What Is KnownTotal serum bilirubin (TB) measurement in jaundiced neonates by high performance liquid chromatography is a "gold standard".There is evidence for use of transcutaneous bilirubinometry for assessment of bilirubin in term newborn. What is NewTcB measurements from a covered skin area in jaundiced preterm newborns under phototherapy were not correlated signi cantly at 6 hours and 24 hours of phototherapy, but correlated before phototherapy.TcB cannot be used as an alternate of serum bilirubin levels however, it reduces the frequency of blood sampling, iatrogenic blood loss, pain associated with prick and improves quality of neonatal care.
97%) Candida isolates were found among 167 NICU patients. Candida albicans (35%) was the most common isolate followed by Candida parapsilosis (30%), Candida tropicalis (15%), Candida krusei (15%), and Candida glabrata (5%). Among the 20 Candida isolates, resistance to the Fluconazole was 35%, to Ketoconazole 25%, to Miconazole 20%, and
Aim: To find out association between vitamin D level and early onset neonatal sepsis (EONS). Methods: This case control study was conducted at a tertiary care center in Northern India during June 2018 to May 2019. Neonates with culture-proven EONS were included as case and neonates without EONS were enrolled as control. 25OH-D levels were evaluated with other routine blood samples. Statistical analysis was done by using unpaired t test and chi-square test. Results: Sixty-two infants were enrolled in each group; baseline characteristics were comparable in both groups. Risk of EONS increased 8 times in neonates with 25OH-D level <30 ng/mL (odds ratio = 8.2; 95% confidence interval [CI]: 3.08-21.82; P = .000). The 25OH-D level was significantly lower in EONS group than control group. Optimal cut-off for 25OH-D was 25 ng/mL to predict EONS with a sensitivity and specificity of 88.7% and 79%, respectively (area under the curve: 0.84; 95% CI: 0.76-0.92; P = .000). Conclusions: Vitamin D insufficiency is significantly associated with EONS. Vitamin D deficiency significantly increases risk of EONS. Maternal vitamin D supplementation may improve neonatal vitamin D levels and may decreases risk of EONS. Further studies including maternal vitamin D level are required for implementation.
Transcutaneous measurement of bilirubin is being used for neonatal jaundice. Its utility during phototherapy in preterm babies is not established. Objective of our study was to assess the efficacy of transcutaneous bilirubin (TcB) measurement in comparison to total serum bilirubin in preterm newborns at admission and during phototherapy at covered skin area (glabella). It was a prospective observational study and conducted at neonatal intensive care unit of a tertiary care hospital from January 2017 to January 2019. One hundred eligible preterm neonates were enrolled. Babies who were very sick, with poor peripheral circulation, edematous, having conjugated hyperbilirubinemia, with major congenital malformations, already received phototherapy or exchange transfusion were excluded. Paired total serum bilirubin and transcutaneous bilirubin were measured at admission, at 6 hours and 24 hours during phototherapy. TcB was measured from area (glabella) covered by eye protector during phototherapy. Sample for TsB was taken within 10 minutes of TcB measurement. The mean difference between TsB and TcB values at admission, 6 hours and 24 hours of phototherapy were -0.005 (0.353), --0.350 (0.611), and -0.592 (0.353) respectively. At admission or before starting of phototherapy the difference (TsB-TcB) was statistically not significant (p=.125), while the difference in these values were statistically significant at 6 hours and 24 hours of phototherapy. Conclusion: TcB measurements from covered skin area in jaundiced preterm infants during phototherapy were not correlated with TsB and cannot be used as an alternate of serum bilirubin levels.
Background: To study the clinical profile of dengue in children Methods: The hospital based study was conducted on patients presenting to paediatric hospital, who fulfilled inclusion and exclusion criteria. Results: Based on the symptoms, the most common symptoms noticed were fever 94.00% followed by myalgia 85.00% decreased appetite 83%, retroorbital pain in 84.0% and vomiting 81.00% Conclusion: It concluded that common symptoms observed were fever, myalgia, decreased appetite and headache The common complications presented were hepatic dysfunction and shock with no mortality indicating the presence of less virulent organisms.. Keywords: Dengue, Complication, Shock
Introduction: Sepsis is the most common cause of mortality in infants and children. A hormonal disorder that often affected in sepsis is thyroid hormones which occur in the form of euthyroid sick syndrome (ESS) or nonthyroidal illness syndrome (NTIS). The aim of study was to evaluate thyroid hormones changes and the outcome in children with sepsis. Materials and Methods: Present study is hospital based observational cohort study.70 children with diagnosed sepsis were required in sample size. Serum free T3, free T4 and TSH was measured on day one and also on follow up (7th day). Result: on day one Serum FT3 level was low in 40 (57.2%) subjects and Serum FT4 level was low in 12 (17.2%) subjects. TSH was normal in most 66 (94.2%) of subjects. Mortality was more in children with low serum FT3 (22.5%) as compared to those with normal FT3 (3.4%). Mortality was also more in children with low serum FT4 level (41.6%) as compared to those with normal FT4 level (8.7%), (p=0.002). Mortality was more in children with low serum FT3 (29%) on follow up as compared to those with normal FT3 (2.5%) (p=0.001). Conclusion: Thyroid hormones dysfunctions are common in children with sepsis. Mortality is significantly associated with low levels of serum FT3 & FT4. So Thyroid hormones dysfunctions could be an indicator of disease severity with possible need for hormone supplementation. Keywords: Thyroid hormones, Serum free T3, free T4, TSH, sepsis, children
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