No abstract

In preterm neonates, umbilical cord milking at birth enhances iron stores at 6 weeks of age. Higher phototherapy rates with this intervention are a matter of concern.

Oil application has a potential to improve weight gain and cause less weight loss in first 7 d in low birth weight neonates.

Delayed cord clamping with milking the cut cord improved iron stores at 6 weeks of age in term infants, then either of the two interventions alone.

• There is no significant difference in ferritin and hemoglobin levels at 6 weeks among term, Indian neonates who had UCM and DCC and that this study may give support to the practice of UCM in term deliveries when DCC is not feasible.

DCC and UCM had similar effect on cerebral blood flow velocities and Doppler indices in MCA, in term neonates.

Paraquat (1,1′-dimethyl-4,4′-dipyridylium) is a broad spectrum liquid herbicide associated with both accidental and intentional ingestion, leading to severe and often fatal toxicity. Despite widespread availability, reports of herbicide poisoning from India are not common. Diagnosis is often difficult in the absence of proper history, nonspecific clinical features, and lack of diagnostic tests. We report two cases of fatal paraquat poisoning from a tertiary care hospital, Kota, Rajasthan, India.

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.