Long distance neonatal transport on road is feasible and with a qualified team results can be comparable to those transported from shorter distances.

Persistent pulmonary hypertension of the newborn (PPHN) is a syndrome of high pulmonary vascular resistance (PVR) commonly seen all over the world in the immediate newborn period. Several case reports from India have recently described severe pulmonary hypertension among infants in the postneonatal period. These cases typically present with respiratory distress in 1–6-month-old infants, breastfed by mothers on a polished rice-based diet. Predisposing factors include respiratory tract infection such as acute laryngotracheobronchitis with change in voice, leading to pulmonary hypertension, right atrial and ventricular dilation, pulmonary edema and hepatomegaly. Mortality is high without specific therapy. Respiratory support, pulmonary vasodilator therapy, inotropes, diuretics and thiamine infusion have improved the outcome of these infants. This review outlines four typical patients with thiamine-responsive acute pulmonary hypertension of early infancy (TRAPHEI) due to thiamine deficiency and discusses pathophysiology, clinical features, diagnostic criteria and therapeutic options.

The study was designed to compare the biochemical characteristics of neonates transported by qualified transport team, before and after stabilization, interventions required and setbacks during these transports. Prospective cohort study of all neonatal transports during a period of 13 months from various maternity and pediatric centers was conducted; 151 babies who fulfilled the criteria were included in the study. 58% of babies < 32 wks were hypothermic, 21% of the total babies were hypotensive and a total of 25% of the babies were hypoxic at the referral hospital. Intubation was done by the transport team in 23% of babies and 25 % of the babies were transported on a ventilator. There was a significant improvement in the clinical condition of all these babies in relation to temperature control, sugar control, oxygenation and blood pressure after stabilization.

Severe malaria causes multiorgan dysfunction, which is the predominant reason for mortality in these children. Cardiac enzymes have been elevated and cardiac involvement has been suspected in some of these children, however, clear cut echocardiographic evidence for it was not possible. There were isolated reports of myocardial dysfunction in malaria in adults but none in children. We present two such children with cardiac involvement and myocardial dysfunction.

Colistimethate sodium is effective against carbapenem-resistant Gram-negative bacteria, and is safe in children.

Objective: The study was aimed at comparing the accuracy in length of insertion of umbilical arterial catheter in all new born groups stratified according to weight, by using two different methods, that is, Wright et al./ Case (Group I): (4 Â Body wt (BW) (kg)) þ 7; Shukla et al./Control (Group II): (3 Â BW (kg)) þ 9.Study Design: It was a randomized open label case control study in a Level III tertiary level Neonatal Intensive Care Unit over 9 months.Result: The babies in both the groups were similar in relation to weight, gender, prematurity and weight subgroups. Under insertion was seen in 8% (4/50) of babies in group I and over insertion was seen in group II where it was 32.6% (16/49). There was a reduction of 82% abnormal insertions and repositioning by using the Wright's formula as compared with the Shukla's formula in preterm babies. Statistically significant reduction in repositioning was seen in all babies <1500 g in Group I and under insertion seen in 8% of babies in group I did not attain statistical significance (P ¼ 0.34).Conclusions: There is no universal formula, which gives the accurate length of placement of an umbilical arterial catheter, but Wright's formula comes closer in neonates with different weight sub groups.

Respiratory flutter or diaphragmatic flutter is a rare disorder characterized by involuntary, high frequency contractions of the diaphragm. Only 7 cases are reported in infants till date. The present case presented with life threatening respiratory distress immediately after birth. In view of high respiratory rate of 120-154 per minute, clinical and fluoroscopic evidence of diaphragmatic contraction and absence of any obvious CNS, cardiovascular and respiratory pathology, respiratory flutter was diagnosed. It was also associated with dysphagia and laryngomalacia. The patient was managed with prolonged continuous positive airway pressures (CPAP) with partial success, but symptoms improved with use of chlorpromazine.

La hipertensión pulmonar persistente del neonato (PPHN) es un síndrome de alta resistencia vascular pulmonar (RVP), observado comúnmente en todo el mundo durante el periodo neonatal inmediato. Recientemente, varios reportes de casos en la India han descrito la ocurrencia de hipertensión pulmonar grave en infantes en el periodo posneonatal. Típicamente, en estos casos se presenta dificultad respiratoria en infantes de 1–6 meses de edad, amamantados por madres con una dieta basada en arroz blanco. Los factores predisponentes incluyen infecciones del tracto respiratorio, como laringotraqueobronquitis con cambio en la voz, que conducen a hipertensión pulmonar, dilatación de la aurícula y el ventrículo derechos, edema pulmonar y hepatomegalia. La mortalidad es alta si no se aplica una terapia específica. La asistencia respiratoria, tratamiento con vasodilatadores pulmonares, inotrópicos, diuréticos y la infusión de tiamina han mejorado el pronóstico de estos infantes. En esta revisión se describen cuatro pacientes típicos con hipertensión pulmonar aguda de la primera infancia, sensible a la tiamina (TRAPHEI), debida a la deficiencia de esta vitamina, y se discute su fisiopatología, sus características clínicas, sus criterios diagnósticos y las opciones terapéuticas disponibles.