The neonatal skin microbiome consists of all the genomes and genetic products of micro-organisms harbouring the skin of babies. Host and the microbiota develop a harmonious environment resulting in symbiosis. Any disruption of this environment could lead to pathological disease. Our study was conducted to explore the neonatal skin fungal microbiome of very preterm neonates admitted to Neonatal Intensive Care Unit at a tertiary health care setting using Next Generation Sequencing of the18S rRNA gene. The most abundant genera found in 22/30 samples were Candida followed by Bipolaris & Cladosporium on the skin microbiome of these neonates. The presence of these fungi, whether just as commensals or as potential pathogens, is currently under research, owing to the risk of early exposure and incidence of infection right from birth.
The neonatal skin microbiome consists of all the genomes and genetic products of microorganisms harboring on an infant’s skin. Host and the microbiota develop a harmonious environment resulting in symbiosis. Any disruption of this environment could lead to pathological disease. This study was conducted to understand the neonatal skin microbiome of very preterm neonates (under 32 weeks) admitted to the Neonatal Intensive Care Unit(NICU) at a tertiary healthcare setting before and after kangaroo mother care (KMC), using next-generation sequencing (NGS). Skin swabs were collected on two different occasions and analyzed using the NGS technique after amplification via polymerase chain reaction. The results showed relative abundance for Mycobacterium tuberculosis in 83.33% and 66.67% (p = 0.29) and Mycobacteroides abscessus in 100% and 93.33% (p = 0.30) of the very preterm neonates on the skin microbiome before and after KMC, respectively as an incidental finding. The mere presence of these bacilli as commensals or as potential pathogens is alarming due to the risk of early exposure and incidence of tuberculosis from birth. These findings, in our view, are the first findings to be established in such a setting.
Background: Cornelia de Lange syndrome is a genetic syndrome characterized by intellectual disability, facial features with synorphrys or fused eyebrows, upper limb anomalies and atypical growth. It is caused by spontaneous mutations in genes responsible for structural or regulatory function of cohesin complex.
Report: We present two newborns cases admitted to our NICU with characteristic dysmorphic features of microcephaly, ectrodactyly and thick eyebrows. One baby also had associated congenital heart defect and sensorineural hearing loss. Both babies are under followup with developmental early intervention programs. Parents were offered genetic counselling for future pregnancies.
Conclusion: Cornelia de Lange is predominantly a clinical diagnosis by identifying typical dysmorphic features. Labelling a syndromic diagnosis helps to provide genetic counselling to the parents, identify associated co-morbidities at earlier stages and improve the quality of living of such children.
Children with COVID-19 largely remain asymptomatic or mildly symptomatic with gastroenteritis or influenza like presentation. However, few of them go on to develop features of multi-system inflammatory syndrome secondary to dysregulated cytokine release, resulting even in death. We report a 45 days old infant who presented to us with fluid unresponsive shock following protracted vomiting few hours prior to arrival. Eight days prior, child was admitted in COVID Isolation centre with mild illness, after testing positive on rapid Antigen Test and discharged 3 days later. Child when brought was severely acidotic and hence electively intubated. Shock did not improve even following multiple boluses and inotropic support on mechanical ventilation. Encephalopathy, myocardial dysfunction and acute kidney injury, with elevated inflammatory markers post COVID-19 suggested multi-system inflammation syndrome in him. The infant deteriorated rapidly and succumbed even before targeted therapy could be initiated. MIS-C presenting with refractory shock is increasingly being reported in pediatric age group and these children rapidly deteriorate without early recognition and treatment. Clinicians need a heightened suspicion for cytokine storm related complications and institute early immune-modulative therapy, especially during the present COVID-19 pandemic.
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