Validation of modified sick neonatal score, a simple clinical score for assessment of severity of illness and outcome in new-borns for resource poor settings

Background: India contributes to 25% of the neonatal deaths worldwide each year. Neonatal disease severity scoring systems are needed to make standardized comparison between performances of different units and also give prognostic information. Existing scoring systems are unsuitable for resource-limited settings which lack investigations like pH, pO2/FiO2 ratio and base excess. Modified sick neonatal score (MSNS) is based on eight routinely measured clinical variables in NICUs namely respiratory effort, heart rate, axillary temperature, capillary refill time, random blood sugar, pulse oximeter saturation, gestational age and birth weight found to be useful in resource poor settings. The aim of the study was to validate MSNS score for its clinical utility in predicting mortality.Methods: This was a cross sectional study done at NICU of Mamata Medical College Hospital. The parameters required for the score were recorded immediately at admission in NICU from 1 January 2020 to 1 January 2021 and scored using Modified sick neonatal score (MSNS). The total score was calculated and outcome was noted. The data collected were coded and analzed using SPSS Statistics for Windows, v21.0 Chi square test, Mann-Whitney U test and ROC analysis.Results: Total of 355 neonates got discharged, while 45 neonates expired. For a cutoff score of ≤10, sensitivity and specificity were 85.9% and 51.1%, respectively. Positive predictive value and negative predictive value were 93.3% and 31.5%, respectively. The Area under the curve (AUC) was 0.811 (95%CI: 0.788-0.835), which indicates the accuracy of 81.1%.Conclusions: MSNS is a better suited neonatal disease severity score for resource poor settings.

Perceptions of undergraduate medical students regarding e-learning during COVID-19 pandemic

Background: The unprecedented COVID-19 pandemic has caused a sudden shift towards the exclusive adoption of online teaching, forming the primary source of medical education and enabling students to continue to learn remotely. The role in the academic arena has gained importance furthermore considering the ongoing COVID-19 pandemic causing educational institutions around the world over to close down and thus giving rise to multiple challenges at all stages and levels of education in particular for students, due to the lockdown situation. Hence the present study was carried out to assess the perceptions of undergraduate medical students regarding e-learning during COVID-19 pandemic.Methods: A cross-sectional study was carried out from April 2021 to June 2021 among 404 undergraduate medical students of IIMSR Medical College, Badnapur, Jalna, Maharashtra. The questionnaire had eliciting information about socio-demographic profile, knowledge and perception regarding advantages and challenges of e-learning was administered to them. Data was entered in Microsoft excel and analyzed using statistical package for the social sciences (SPSS) version-13.0.Results: About 87% students were of opinion that e-learning was not useful and not motivated to use it and 38% students’ think it’s beneficial as has interactive mode, but 62% students think otherwise. Only 36% are of opinion that e-learning will improve their performance. Majority 78% students think e-learning will not help in better understanding then formal teaching methods.Conclusions: Undergraduate medical students were still more inclined towards traditional teaching rather than e-learning. Faculty members should take necessary measures for improving e-learning facility and quality to help with better learning.

Clinical profile, etiology, type and outcome of neonatal seizures: a hospital-based study

Background: Our study was undertaken to study the etiological factor, clinical profile, types and outcome of newborn with neonatal seizures (NNS).Methods: Our study was hospital based prospective study was done in Sheri Kashmir institute of medical sciences (SKIMS) Bemina from April 2013 to April 2015 in NICU, after obtaining ethical clearance from institutional ethical committee. All neonates fulfilling inclusion criteria were included in our study.Results: In our study, 80 neonates with seizures were included in our study, among them 48 were males and 32 were females. Majority of neonates (57.5%) developed seizures during first 72 hours of life due to birth asphyxia. Commonest types of neonatal seizures observed in our study were subtle observed in 46 cases, followed by tonic (21.2 %), clonic (14.9 %) and mixed (6.2%) seizures. Birth asphyxia was commonest cause (57.5%) of NNS, sepsis with meningitis (18.7%) followed by hypoglycemia (13.7%) and hypocalcemia (5%). Cases of birth asphyxia were associated with higher mortality (58.3%) as compared to cases with metabolic seizures.Conclusions: From our study we conclude that commonest cause of neonatal seizure was birth asphyxia occurring within 72 hours of birth. Sepsis and meningitis were also common infections resulting in neonatal seizure, while as hypoglycaemia and hypocalcemia were common biochemical abnormalities leading to NNS. Early identification and treatment are likely important for long-term outcomes in acute symptomatic seizure.

Study of hemoglobin and red blood cell indices during first week of life in normal term neonates

Background: Transition from foetal to neonatal life is associated with major changes in hemogram due to homeostatic control. There are very wide ranges of hemogram levels that seem to be abnormally high or low in healthy term neonate at birth and during first week of life but these were actually normal for that neonatal period depending upon gestational and post-natal age.Method: Hemogram was studied in 100 normal term neonates born in RNT medical college during June 2009 to Dec 2009.Results: The ranges of various hemogram indices at birth, 24 hours, 48 hours and 7 days are as follows: Hemoglobin 12.2-23.2 gm/dl, 11.6-22.8 gm/dl, 11.5-21.3 gm/dl and 11.3-21.3 gm/dl respectively. Hematocrit 36.8-64.3%, 35.2-61.3%, 34.4-60.6% and 32.2-60.1% respectively. Mean corpuscular volume (MCV) 82.2-126.5 fl, 82.5-126.1 fl, 82.1-126.3 fl and 80.5-126.4 fl respectively. Mean corpuscular hemoglobin (MCH) 26.2-40.9 pg, 26.0-39.7 pg, 26-40.5 pg and 25.4-39.4 pg respectively. MCH concentration (MCHC) 29.6-38 g/dl, 28.5-37.7 g/dl, 28.4-38.6 g/dl and 28.4-38.5 g/dl respectively. Total red blood cell count (TRBC) 3.7-6.9×106/µl, 3.3-6.9×106/µl, 3.3-6.7×106/µl and 3.3-6.3×106/µl respectively.Conclusions: Hemoglobin level falls in early life in healthy term neonate. Also, there is wide range of RBC parameters in healthy term neonates. The normal values of hemogram in neonates are different from other age groups and it varies with postnatal age and gestational age. A reference range derived from large neonatal datasets of varied gestational and postnatal age should be used such as those presented here for healthy term neonates.

Clinical characteristics and outcome of neonates with neonatal mastitis: a hospital based study

Background: Neonatal mastitis is not an uncommon condition, mostly occurs due to Staphylococcus aureus (S. aureus), sometimes leading to breast abscess with detrimental effects.Methods: Our study was retrospective, hospital based observational study carried out at Government Medical College, Baramulla from August 2017 to August 2019, all cases with features of neonatal mastitis were included in the study and also admitted in hospital. Clinical and laboratory data along with demographic data was recorded and analysed.Results: 23 cases were included with age of presentation 8 to 28 days. Babies particularly male babies received breast massage (N=10), besides this pain (15) and redness (N=23) was most common clinical characteristics purulent discharge seen in 2 cases and 7 cases were febrile. Laboratory findings include decreased total leucocyte count (TLC) and positive C-reactive protein (CRP), pus culture from samples revealed S. aureus in 11 cases, coagulase-negative staphylococci (CONS) in 3 cases, E. coli in 2 cases and sterile in 7 cases. Most of cases were sensitive to penicillin (N=14) and in two cases were methicillin resistant S. aureus (MRSA) strains resistant to methicillin. All patients responded well to intravenous (IV) antibiotics while as 8 cases required (I and D), blood cultured showed growth in 19 cases while cerebrospinal fluid (CSF) analysis was sterile in all patients. Above all babies were discharged successfully without any complications.Conclusions: We concluded from our study that neonatal mastitis if treated early has better outcome rather than practicing misbeliefs like breast massage to express so called witch’s milk, in addition we conclude that neonatal mastitis is not an uncommon problem.

Reactive infectious mucocutaneous eruptions associated with SARS-CoV-2 infection

Several dermatological manifestations are described in COVID-19. A 3-year-old boy presented with fever, painful oral ulcers with COVID-19 infection. A diagnosis of reactive infectious mucocutaneous eruptions (RIME) was made. He was worked up for the usual causes of RIME but were all negative. His severe acute respiratory syndrome corona virus-2 immunoglobulin M (SARS-CoV-2 IgM) was positive and he was managed with Intravenous hydrocortisone with which he improved dramatically. RIME might be the first/only manifestation of COVID-19 and it should be kept in mind.

How safe is soy in infancy? Case report of thelarche in an infant

Soy protein based formulas are commonly used in infant nutrition for various indications like lactose intolerance and cow’s milk protein allergy. There are concerns regarding phytoestrogen related and other side effects of these formulas. We are describing a case of possible soy formula induced thelarche in a 7 months infant. There was normalization of estradiol levels with some clinical improvement after stopping soy formula over a follow-up of 12 months duration. We suggest further studies to evaluate hormone levels in infants on soy formulas and to consider it only for appropriate clinical indication and age group.

Early infantile form of Krabbe disease: a case report

A 7-month-old female child, born to 2nd degree consanguineous marriage brought with complaints of gross developmental delay. Her examination revealed spasticity in all 4 limbs with brisk deep tendon reflexes with intact primitive reflexes and exaggerated startle reflex. Her MRI brain showed demyelination signs in bilateral thalami, dentate hila, and thickened optic chaisma. Age of presentation, clinico-radiological findings were suggestive of early infantile form of Krabbe disease.

A study on effect of phototherapy in term new-born in a tertiary care centre in south Rajasthan

Background: Phototherapy is a safe and effective method for management of neonatal hyperbilirubinemia with no serious untoward side effects. Hypocalcemia is a common and lesser observed adverse effect of phototherapy.Methods: This study was a prospective observational study done in department of pediatrics, RNT Medical College, Udaipur (Rajasthan). Serum calcium level was observed in term neonates admitted for phototherapy.Results: Out of total 80 neonates included in study 40 received phototherapy and 40 were control. Neonates receiving phototherapy had significantly lower level of serum calcium. Other complication were rashes, loose stool, fever and dehydration.Conclusions: We can conclude from this study that hypocalcemia is a significant complication of phototherapy in newborn and probably monitoring of serum calcium level in babies under phototherapy is warranted.

A cross sectional study on assessment of nutritional status and factors affecting anemia in children in tertiary care teaching hospital

Background: Earlier many studies were conducted to assess the prevalence of anemia in adults, pregnant women, and children under 5 years of age. Despite all the reasons, there is an immense need to assess the nutrition status and prevalence of anemia in a pediatric population. Therefore, the purpose of the present study was to assess the nutritional status and prevalence of anemia in the pediatric population of age group 1-12 years.Methods: The present study was a cross-sectional study with a sample size of 100 with age group 1-12 year, was conducted in Government general hospital, Guntur. The study was carried for a period of 6 months (October to March). Data were collected by using the NACS assessment guide tool for nutritional status and tallquist hemoglobin scale was used to measure hemoglobin.Results: Age group of 1-6 years had 26% severe stunting whereas in the age group lo 7-12 years, 5% of the people had severe stunting. Age group of 1-6 yr and 7-12 years had 16% of severe wasting and 13% of severe wasting respectively. The prevalence of anemia in children had a significant impact with maternal education (p<0.05), socioeconomic status of the family (p<0.05), birth order of the child (p<0.05) and doesn’t have any significant impact with father education (p>0.05), past medical history (p>0.05).Conclusions: From our study, we conclude that moderate anemia was more noticeable than mild and severe anemia in people of rural areas in and around Guntur. Severe stunting and moderate wasting was observed more in the age group of 1-6 years of children in both sexes.