Background There are few reports of COVID-19 in neonates and most are suspected to be due to postnatal transmission. Vertical transmission has been proven in only a couple of cases so far. Methods We describe early-onset, severe COVID-19 disease in a neonate with very strong evidence of vertical transmission of SARS-CoV-2. Results A COVID-19 suspected mother, who tested negative by RT-PCR for COVID, but tested positive for SARS-CoV-2 by serology, delivered a term baby. The neonate was kept in strict isolation. Molecular tests for SARS-CoV-2 on umbilical stump, placenta, and nasopharyngeal aspirate of the neonate, collected at birth were positive. On day 2, the neonate developed clinical features of COVID in the form of fever, poor feeding, and hyperbilirubenemia along with elevated inflammatory markers. Antibiotics were started empirically pending cultures. Blood, CSF, and urine cultures were sterile. Baby tested RT-PCR positive for SARS-CoV-2 on two more occasions before testing positive for antibodies and was discharged on day 21 of life. Conclusion This report highlights a very strong possibility of vertical transmission of COVID-19 from a mildly symptomatic, RT-PCR negative but antibody-positive mother with significant symptomatic, early-onset neonatal infection.

Background Antimicrobial resistance (AMR) is a growing threat to newborns in low and middle income countries (LMIC). Methods We performed a prospective cohort study in three tertiary Neonatal Intensive Care Units (NICUs) in Pune, India, to describe the epidemiology of neonatal bloodstream infections (BSI). All neonates admitted to the NICU were enrolled. The primary outcome was BSI, defined as positive blood culture. Early onset BSI was defined as BSI on day of life (DOL) 0-2 and late onset BSI on DOL 3 or later. Results From May 1, 2017, until April 30, 2018, 4073 neonates were enrolled. Among at risk neonates, 55 (1.6%) developed early onset BSI and 176 (5.5%) developed late onset BSI. The majority of BSI were caused by Gram-negative bacteria (GNB) (58%); among GNB, 61 (45%) were resistant to carbapenems. Klebsiella spp. (n=53, 23%) were the most common cause of BSI. Compared with neonates without BSI, all-cause mortality was higher among neonates with early onset BSI (31% vs. 10%, p<0.001) and late onset BSI (24% vs. 7%, p<0.001). Non-low birth weight neonates with late onset BSI had the greatest excess in mortality, (22% vs. 3%, p<0.001). Conclusions In our cohort, neonatal BSI were most commonly caused by GNB, with a high prevalence of AMR, and were associated with high mortality, even in term neonates. Effective interventions are urgently needed to reduce the burden of BSI and death due to AMR GNB in hospitalized neonates in LMIC.

Background COVID-19 is uncommon and less severe in children than adults. It is thought that infants may be at higher risk for severe disease than older children. There is a paucity of literature on infants with COVID, particularly those with severe disease. Objective We describe demographic, epidemiologic, clinical, radiological, laboratory features and outcomes of infants with confirmed SARS-CoV-2 infection admitted to a tertiary care teaching hospital in Pune, India Methodology Infants who tested positive for SARS-CoV-2 and were admitted between 1 April 2020 and 7 August 2020 were included in the study. Results A total of 13 infants were admitted during the study period. The median age was 8 months (IQR 6) and nine were male. Common presenting features were fever ( n = 8, 62%), poor feeding, irritability, and runny nose ( n = 3, 23%). Comorbidities noted were severe acute malnutrition (SAM) in three cases (23%) and nutritional megaloblastic anemia, iron deficiency anemia, sickle thalassemia and renal calculi in one case (8%) each. There was a history of low birth weight in two cases (15%). Pallor was noted in three cases (23%), SAM in three cases (23%) and tachypnea and respiratory distress in four cases (30%). Severe anemia, thrombocytopenia, elevated ferritin, abnormal procalcitonin, abnormal C Reactive Protein and deranged D-dimer was noted in three cases (23%) each. Neutrophil–lymphocyte ratio was normal in all cases. Three infants (43%) had evidence of pneumonia on the chest radiograph, of which one had adult respiratory distress syndrome (ARDS) like pattern, one infant had cardiomegaly and perihilar infiltrates. Hydroxychloroquine and azithromycin were given to five patients (38%), Intravenous Immunoglobulin and methylprednisolone were administered to one patient (8%). One infant died of ARDS with multi-organ dysfunction with refractory shock and hemophagocytic lymphohistiocytosis. Conclusion SAM and anemia may be associated with severe COVID in infants.

To find out the incidence, neonatal outcome and associated maternal antepartum & intrapartum risk factors of meconium stained amniotic fluid (MSAF). DESIGN: Prospective Study. SETTINGS: Neonatal Unit of Hospital and PNC Ward. SUBJECTS & METHODS: Prospective Study was conducted including 100 babies born with meconium stained amniotic fluid who are admitted in NICU and with mother in PNC ward in a period of six months (April 2012-October 2012) excluding those who born with congenital abnormalities. Detail history of babies and mother with MSAF noted with emphasis on antepartum and intrapartum risk factors and outcome in terms of morbidity and mortality. RESULTS: Incidence of MSAF in the study was 8. 98%. Out of 100, 24 babies were admitted to NICU with most common indications being birth asphyxia (16%) and Meconium Aspiration Syndrome (MAS) (6%). Majority babies were delivered through thin Meconium Stained Liquor (MSL) (44%) followed by thick (35%) and moderate (21%). Total number of deaths were 9 and all these babies had thick meconium with severe birth asphyxia. Ninety one babies were born at >37 weeks of gestation and 57 had birth weight over 2. 5 Kg. Nineteen percent were non vigorous requiring tracheal suctioning and positive pressure ventilation at birth. Common mode of delivery was emergency Cesarean in 83% patients. Common maternal and fetal risk factors were fetal distress (30%) followed by Oligohydramnios (30%), Pregnancy induced hypertension (PIH) (24%), anemia (14%), severe anemia (5%), Antepartum hemorrhage (4%) and Antepartum eclampsia (4%). CONCLUSIONS: Oligohydramnios, PIH, anemia and fetal distress were common antenatal and intranatal factors associated with MSAF. Major morbidity and indication for NICU admission was Birth asphyxia and non vigorous babies. Mortality rate was 9% which is commonly associated with thick meconium and severe birth asphyxia. KEY WORDS: Meconium stained amniotic fluid, meconium aspiration syndrome, early neonatal outcome INTRODUCTION: Meconium Aspiration Syndrome (MAS) continues to be threat to many newborns throughout the world with a case fatality rate of 5% (as much as 40%), in addition to short and long term pulmonary and neurodevelopmental sequelae (1) India has the unfortunate distinction of claiming more than a quarter of the total newborn deaths in the world (2). One such attribute is meconium stained amniotic fluid (MSAF) which complicates delivery in approximately 8% to 15% of live births (3). In a large series, MSAF was found in 12% of 1,77,000 live births. MAS occurs in 1-3% of all cases of MSAF and in 10-30% of neonates with meconium aspiration (4). Various risk factors are associated with increased mortality and morbidity in MAS like postterm babies, primipara and grand multipara, unbooked mothers, mothers with toxemia of pregnancy or prolonged rupture of the membranes, infants with moderate or severe birth asphyxia and

Background Pediatric tuberculous meningitis (TBM) commonly causes death or disability. . In adults, high-dose rifampicin may reduce mortality. Fluoroquinolones’ role remains unclear. There have been no antimicrobial treatment trials for pediatric TBM. Methods TBM-KIDS (NCT02958709) was a Phase II open-label randomized trial among children with TBM in India and Malawi. Participants received isoniazid and pyrazinamide plus: (a) high-dose rifampicin (30 mg/kg) and ethambutol (R30HZE, Arm 1); (b) high-dose rifampicin and levofloxacin (R30HZL, Arm 2); or (c) standard-dose rifampicin and ethambutol (R15HZE, Arm 3) for 8 weeks, followed by 10 months of standard treatment. Functional and neurocognitive outcomes were measured longitudinally using Modified Rankin Scale (MRS) and Mullen Scales of Early Learning (MSEL). Results Of 2487 children pre-screened, 79 were screened, and 37 enrolled. Median age was 72 months. 49%, 43%, and 8% had Stage I, II, and III disease. Grade 3 or higher adverse events occurred in 58%, 55%, and 36% of children in Arms 1, 2, and 3, with one death (Arm 1) and six early treatment discontinuations (4 in Arm 1, 1 each in Arms 2 and 3). By Week 8, all children recovered to MRS score of 0 or 1. Average MSEL scores were significantly better in Arm 1 than Arm 3 in fine motor, receptive language, and expressive language domains (p<0.01). Conclusions In a pediatric TBM trial, functional outcomes were excellent overall. The trend towards higher frequency of adverse events but better neurocognitive outcomes in children receiving high-dose rifampicin requires confirmation in a larger trial.