Multisystem inflammatory syndrome in children (MIS-C) is a post-infectious immune-mediated condition, seen 3–5 weeks after COVID-19. Maternal SARS-CoV-2 may potentially cause a similar hyperinflammatory syndrome in neonates due to transplacental transfer of antibodies. We reviewed the perinatal history, clinical features, and outcomes of 20 neonates with features consistent with MIS-C related to maternal SARS-CoV-2 in Kolhapur, India, from 1 September 2020 to 30 April 2021. Anti-SARS-CoV-2 IgG and IgM antibodies were tested in all neonates. Fifteen singletons and five twins born to eighteen mothers with a history of COVID-19 disease or exposure during pregnancy presented with features consistent with MIS-C during the first 5 days after birth. Nineteen were positive for anti-SARS-CoV-2 IgG and all were negative for IgM antibodies. All mothers were asymptomatic and therefore not tested by RTPCR-SARS-CoV-2 at delivery. Eighteen neonates (90%) had cardiac involvement with prolonged QTc, 2:1 AV block, cardiogenic shock, or coronary dilatation. Other findings included respiratory failure (40%), fever (10%), feeding intolerance (30%), melena (10%), and renal failure (5%). All infants had elevated inflammatory biomarkers and received steroids and IVIG. Two infants died. We speculate that maternal SARS-CoV-2 and transplacental antibodies cause multisystem inflammatory syndrome in neonates (MIS-N). Immunomodulation may be beneficial in some cases, but further studies are needed.

Human milk is a dynamic physiological fluid. The short term and long term benefits of breast feeding are already very well established. Apart from the nutritional components, the human milk contains many growth factors & different kinds of live cells. Present study is an observational study of the cytological evaluation of the 100 samples of human milk collected in the first post partum week of Indian women. The interesting observation of the present study is the rising counts of the immune cells in the human milk which peak on day 5. This finding probably correlates with the greater immunological needs of the neonate in the first week. These cells help the neonate in providing cell mediated immune responses and protection against respiratory and gut infections. They also help in the process of the neonatal gut maturation. The counts of the epithelial cells in the human milk are observed to be steady throughout the, first post partum week. The mesenchymal stem cells observed in the human milk could be myoepithelial in origin. The higher levels of the growth factors like hepotocyte growth factor and vascular endothelial growth factor in the human milk when compared with the umbilical cord or the maternal serum could be attributed to the paracrine secretions by the stem cells. The observations of the present study are correlating with the physiological needs of the neonate in the most important period of the first week after the birth. The study further strengthens the concept of exclusive breast feeding.

Introduction: Diabetic Ketoacidosis (DKA) presents with spectrum of clinical manifestations and awareness regarding this amongst physicians is crucial. The study aimed to chronicle the clinical profile of DKA in type 1 diabetes mellitus (T1DM) children. Methods: The study was conducted at a tertiary care hospital including patients with signs and symptoms of DKA with either debut or established T1DM (n = 38). Detailed clinical history, examination and laboratory investigations were carried out. Differences in frequency distribution concerning demographics and clinical data were analysed in R-studio software (v.1.2.5001). Results: Kussmaul breathing (49.97%) was the commonest presentation. Infection (39.46%) and poor compliance due to inadvertent omission of insulin therapy (50%) were the commonest precipitating factors. Mild, moderate and severe dehydration was present in 44.74%, 39.47% and 15.79% respectively. Forty-five percent patients had moderate while 34.21% and 21.05% had mild and severe DKA respectively. Seventy-five percent and 52% patients were below 3rd percentile for height and weight respectively. High number of patients had past history of viral infections, were diagnosed in winter, belonged to 2nd or 3rd birth order and from lower middle class. Patients with poor compliance to insulin belonged to lower middle (40%), upper lower (53.33%) and lower class (6.67%). Conclusions: DKA can be diagnosed early by identifying dehydration, Kussmaul breathing, polyuria and altered sensorium. Infection and poor compliance due to omission of insulin therapy were the commonest and preventable precipitating factor for DKA. Poor compliance to insulin can be attributed to lower socioeconomic class. Awareness among physicians concerning clinical profile of DKA is crucial.

Background: Microalbuminuria is thought to be an early predictor of impending diabetic nephropathy, while glycosylated hemoglobin (HbA1c) is a biochemical marker of long-term glycemic control in children with type 1 diabetes mellitus (T1DM). Objectives: The study aimed to evaluate the prevalence of microalbuminuria and its association with HbA1c on admission and duration of diabetes. Also, changes in HbA1c level on admission and three months after admission were studied to assess diabetes control in children with T1DM. Methods: This prospective study was conducted among 38 children (< 18 years) diagnosed with TIDM presenting with clinical signs, symptoms, and biochemical parameters of DKA. The presence of microalbuminuria, HbA1c level, and the number of past episodes of DKA were recorded. HbA1c level was again estimated after three months. The resultant data was tabulated and analyzed statistically (P < 0.05). Results: Microalbuminuria and poor HbA1c control were observed in 18% and 60% of the sample population, respectively. A significant association was found between HbA1c > 9% (P = 0.032) and the duration of diabetes > 4 years (P = 0.032) and microalbuminuria. Significant improvement in glycemic control was noted from the time of admission to three months after admission (9.76 ± 2.77 vs. 7.75 ± 1.28; P = 0.00012). A significant difference was observed between past DKA episodes according to HbA1c control (P < 0.001). Conclusions: Microalbuminuria assessment is needed in T1DM children, especially those with HbA1c > 9% and duration of diabetes > four years, to evaluate diabetic nephropathy. Good glycemic control can be achieved with effective insulin therapy accompanied by appropriate counseling and regular follow-up.

Worm infestation issue is a common health condition observed mostly in Asian countries. The prevalence of worms in children is higher due to the habit of playing in mud or outdoors which is not found in the case of an infant. Very rarely worm infestation is observed in infants. There is a need for an investigation to be carried out for live worms in the stool. Sometimes the change in the diet of the infant, irregular bowel movements, and worm-like things in stool makes an alarming situation. We report the original case of a 6-month-old infant camouflaging for worm infestation due to the presence of the thread-like parasite in stool. The routine stool and chemical analysis of black thread thing from stool revealed solid diet fibers of banana and not any parasitic infection.

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In twin pregnancies, usually the delivery of both the babies occur together with a difference of few minutes. However, in very rare situations the first fetus gets aborted during second trimester and the cervix gets reformed. In such rare situations after the abortion (vaginal expulsion) of the first fetus, prolonging pregnancy is a real challenge. The risks of haemorrhage, chorioamnionitis, coagulopathies and immediate abortion of the second fetus are very high. In such event, if the pregnancy is prolonged, preterm delivery of the second twin within next few weeks is very common.We report a case of diamniotic, dichorionic pregnancy achieved through In Vitro Fertilisation (I.V.F.) in a 43 years old woman who also had diabetes mellitus. This patient had spontaneous onset of uterine contractions and leaking which resulted into expulsion of the first fetus at 17 weeks of gestation. The placenta of the first fetus and intact gestational sac of the other twin, were left in utero.The management included vigilant maternal monitoring, use of tocolytics antibiotics and delayed cervical cerclage. The pregnancy was prolonged for 115 days. The patient required caesarean section at 34 weeks for the development of severe pre-eclampsia and delivered a healthy male baby of 2.1 kg who required a brief stay of twelve days in NICU. Placentas of both the fetuses were removed during caesarean section. This case is exceptional and there are no validated medical protocols for the management; the scientific evidence is still controversial.Our care supports the prolongation of the pregnancy of the second twin with high medical vigilance.