The study was aimed to evaluate the performance of a newly developed non-invasive and noncontact bilirubin measurement device (AJo-neo) as an alternative to the conventional invasive biochemical method of total serum bilirubin (TSB) estimation in preterm and term neonates suffering from hyperbilirubinemia associated with risk factors, and/or undergoing phototherapy. The safety and efficacy of the device were assessed in 1968 neonates with gestational ages ranging from 28 to 41 weeks and suffering from incidences of hyperbilirubinemia. Linear regression analysis showed a good correlation between AJO-Neo and the conventional method of TSB (Pearson's coefficient, r = 0.79). The small bias (0.27 mg/dL) and limits of agreements (− 3.44 to 3.99 mg/dL) were within the range of clinical acceptance. The device was also precise in the measurement of bilirubin levels in all subgroups of the study. The receiver operator curve (ROC), that takes account of both sensitivity and specificity of a device showed high efficacy of the device (area under the curve, AUC = 0.83) in the detection of bilirubin. While monitoring the bilirubin level during phototherapy, the device indicated promising results showing good agreement with TSB. Specificities and sensitivities of the device indicated a much higher accuracy in neonates with associated risk factors for hyperbilirubinemia. Hence, the newly developed device (AJO-Neo) is reliable in measuring bilirubin level in preterm, and term neonates irrespective of gestational or postnatal age, sex, risk factors, feeding behavior or skin color. Neonatal jaundice or Icterus neonatorum affects more than 60% of the term and 80% of preterm newborns in the first week of life 1-3 due to excessive production of bilirubin, and the inability of the newly developed liver to excrete it 4. Although benign at low concentrations, persistently elevated levels of bilirubin can cause severe neurotoxicity termed as kernicterus, which may lead to significant morbidity and mortality 5,6. Thus, proper monitoring of the bilirubin level in newborns is mandatory as per the guideline of American Academy of Pediatrics (AAP) to ensure appropriate management 7. The contemporary method of detection of serum bilirubin

Congenital candidiasis is an extremely rare disease with less than 100 cases being reported in the literature. It presents within six days of life with manifestations ranging from localized skin disease to systemic involvement in the form of respiratory distress, sepsis with hepatosplenomegaly, and death. Intrauterine infection by candida may give rise to this condition and it differs from neonatal candidiasis, which manifests as thrush or diaper dermatitis. We report a neonate who presented with diffuse pustular eruption on erythematous background involving head, face, trunk, and palms at birth. Candida albicans was identified on blood culture and budding yeast cells were seen on 10% potassium hydroxide (KOH) preparation on the pus drained from the pustules. Intravenous fluconazole and topical ketoconazole were given and the condition improved completely in two weeks.

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Aim: To determine risk factors of hearing impairment in high risk neonatal intensive care unit (NICU) graduates. Methods and Material:This hospital-based prospective observational study was conducted in the NICU graduates of a tertiary center of eastern India from June 2014 to May 2015. Our study population included 130 infants of which 65 were with high-risk factors (hypoxic-ischemic encephalopathy stage II and III, neonatal hyperbilirubinemia, neonatal sepsis/meningitis, and prematurity) and another 65 normal term infants, who had no adverse perinatal clinical events. Brainstem Evoked Response Audiometry (BERA) was performed by Auditory Evoked Potential Machine before one month of age. Those infants who failed to pass the test were asked for repeat testing after 3 weeks of their initial testing. Follow up of the high-risk babies was done at 1 month, 3 months, 6 months, 9 months and at one year. Factors such as birth weight, gender, days of neonatal intensive care unit (NICU) stay and effects on BERA were analyzed.Results: Out of 65 cases, 15 (23.07%) had birth asphyxia, 20 (30.76%) had hyperbilirubinemia, 10 (15.38%) cases were neonatal sepsis/ meningitis and 20 (30.76%) were of gestational age <37 weeks. On initial BERA screening, 8 (53.33%) cases of birth asphyxia, 9 (45%) cases of hyperbilirubinemia, 2 (20%) cases of sepsis/meningitis and 6 (30%) premature babies had abnormal BERA results of which 3 (4.61%) cases had persistent BERA abnormality after a period of 1 year of follow up of which 3 (4.61%) cases had persistent BERA abnormality after a period of 1 year of follow up. Out of those 3 babies, 2 had severe birth asphyxia with encephalopathy and one had gestational age <37 weeks with other risk factors. Out of 65 controls, no BERA abnormality was detected. In patients with hyperbilirubinemia who had received only one exchange transfusion, abnormal BERA was seen in 3 (23%) on initial screening whereas those who had received 2 exchange transfusion, abnormal BERA was seen in 6 (85.7%) (p=0.03). Similarly, in 15 premature babies with associated risk factors (apnea, hypoglycemia, hypocalcemia, prolonged oxygen use), abnormal BERA was seen in 5 (33.33%) and in 5 premature babies without other risk factors,1 (20%) had abnormal BERA (p=0.001) on initial screening. Conclusion:Neonates with high-risk factors should have their hearing screening done by the age of one month and confirmation by 3 months and intervention by 6 months of age.

Neonatal encephalopathy is a common entity encountered by treating physicians in any neonatal intensive care unit. Though hypoxic ischaemic encephalopathy is the most frequent cause in developing countries, metabolic causes should also be looked for in refractory neonatal seizures with sibling death and parental consanguinity. Early myoclonic infantile encephalopathy, considered under the broad spectrum of infantile encephalopathy, is a rare syndrome in infants with onset within 3 months of age. It is characterized by myoclonic seizures, features of encephalopathy and caused by underlying metabolic diseases, nonketotic hyperglycinemia being the most common cause. On contrary its close mimicker, Ohtahara syndrome or early infantile epileptic encephalopathy is most likely associated with structural neurological lesions. We report a 12-day term Indian male neonate, born of second degree consanguinity with multiple sibling death history, presented with refractory myoclonic seizures in spite of uneventful birth history. Myoclonic seizures, refractory to intravenous phenobarbitone, phenytoin and infusion Midazolam, persisted after ruling out hypoglycemia, dyselectrolytemia, and neonatal sepsis. EEG showed typical burst suppression pattern pointing towards diagnosis of early myoclonic infantile encephalopathy. Further metabolic causes were looked for but tandem mass spectrometry for dried blood sample was normal. Lastly, urinary GCMS revealed 5-oxoprolinuria, an autosomal recessive condition, characterized by acidosis, jaundice, and severe hemolytic anemia among neonates, primarily due to glutathione synthetase enzyme deficiency. In severe form of 5-oxoprolinuria, neurological complications in form of seizures, ataxia have been documented in earlier studies; however, its association with myoclonic encephalopathy is yet to be reported in the literature and this report may be the first of its kind.

BackgroundMedication errors are an emerging problem in various hospital settings, especially in neonates. A study conducted in the neonatal care unit of a tertiary institute in Kolkata as baseline over 3 months, revealed total error to be around 71.1/100 prescriptions (median medication error percentage: 63%).PurposeTo assess the occurrences of medication errors and determine efficacy of Point-of-Care Quality improvement (POCQI) model in reducing the same from baseline 63% to less than 10%, in the above setting within next 9 months.Materials and methodsThis quality improvement initiative of quasi-experimental design comprised randomly selected prescriptions and monitoring sheets of neonates admitted in the neonatal care unit, obeying inclusion and exclusion criteria. Medication errors were assessed and categorised using a predesigned and pretested checklist. Interventions were planned after forming a quality improvement team in four plan–do–study–act (PDSA) cycles spanning over 6 weeks each (including training of doctors and nurses, signature and countersignatures of respective healthcare personnel, computer-generated prescriptions and newly designed software-generated prescriptions) as per POCQI model of the WHO and results in post-intervention phase (3 months) were compared.ResultsA total of 552 prescriptions and monitoring sheets of 124 neonates were studied. Median medication error percentages in first, second, third and fourth PDSA cycle were, respectively, 48%, 42%, 30% and 14%. Total error reduced to 10.4/100 prescriptions (p<0.005), with significant reduction in erred dosage, timing, interval, preparation and rate of infusion of drugs in prescriptions of the post-intervention phase.ConclusionImplementation of change ideas via PDSA cycles, as per the POCQI model with technological aid, significantly decreased the percentage of medication errors in neonates, which was also sustained in the post-intervention phase and facilitated error-free prescriptions.

In this paper we propose a new clustering based data gathering mechanism for large scale wireless sensor networks. Our proposed mechanism first stores the locations of the sensors by GPS information and then sends a mobile data-collector (which can be an autonomous robot or a vehicle equipped with a transceiver and battery) which can move into the whole sensing field like a movable base station and collect data from the static sensors. Here at first our algorithm divides the region into a number of compact regions according to the range of the mobile collector and then determines a geometrical routing path along which the mobile collector can move and collect data from the sensors all in single hop data transmission technique and in minimal time. In wireless sensor networks, the data packets are directly gathered without relays and collisions. As a result, the lifetime of the sensors are prolonged. In our algorithm we have focused mainly on the facts like maximizing the network coverage, minimizing the overlapping of the regions , maximizing the number of nodes getting attended in one poll by the mobile collector and minimizing the path length so that the collector can cover the whole region in minimum time. The simulation results show a significant improved performance of proposed model.