Level of Stress and Coping Strategies Seen Among Parents of Neonates Admitted in NICU

Aim To assess the level of stress and coping strategies in parents of neonates admitted in Neonatal Intensive Care Unit (NICU) at a tertiary care centre in North India. Materials and methods It was a descriptive/observational cross-sectional study of 3 year duration with a sample size of 224. All parents willing to participate and who could understand English or Hindi were included in the study after the informed consent. Stress levels and coping strategies were assessed using a validated questionnaire between 2nd to 7th day of admission. Demographic data was collected and parental stress and coping was quantified using likert scale. The data was analyzed using SPSS Version 20.0. Results Most of the parents were moderately stressed (93.3%). The most impactful stress domain was ‘Emotional’ and the most impactful question out of that domain was ‘constant fear of child’s recovery’. Of all the coping strategies, cognitive strategy was mostly used by parents. There was a negative correlation between stress and coping strategies (r = –0.09) but the result was statistically insignificant (p-value = 0.16). Of all the demographic variables, the birth order of the baby was significantly related to stress (p-value < 0.05), while parent’s education, monthly family income and area of residence were significantly related to coping (p-value < 0.05, <0.05 and <0.001, respectively). Conclusion Most of the parents were moderately stressed, with cognitive strategy being the most used by parents as the coping mechanism.

Salbutamol Toxicity in a Newborn Due to Unintentional Oral Ingestion of Inhalation Respules—A Case Report

Cases of salbutamol toxicity by oral ingestion and inhalation are rarely reported in the pediatric age group and have never been reported in neonates. We report a case of salbutamol toxicity by unintentional oral ingestion of inhalation respules in a newborn, which led to tachycardia and QT prolongation requiring medical management. The importance of breastfeeding, identifying similar looking medications, and keeping them separately at home are discussed.

Antenatal Care Predicts Neonatal Mortality in Eastern Africa: A Systematic Review and Meta-analysis of Observational Studies

Background Sub-Saharan African countries, especially the Eastern region, present the dismal picture of neonatal mortality (NM) in the globe. The majority of these deaths could be avoided if effective health measures are provided throughout pregnancy and childbirth. Although antenatal care (ANC) is assumed as one of the viable interventions that contribute to neonatal survival, the effect of ANC on NM was not systematically analyzed in Eastern Africa. Thus, the study aimed to determine the pooled effect of ANC on NM in Eastern Africa. Methods PubMed, EMBASE, CINAHL, and HINARI databases were searched using appropriate keywords from January 1, 1990 to February 12, 2021. Independent authors selected eligible articles and extracted data. The risk of a bias assessment tool for nonrandomized studies was used to assess the quality of the study. Comprehensive meta-analysis version 2 was used for meta-analysis. The random-effect model was employed, and the outcome is expressed as a risk ratio with 95% confidence interval (CI). Results In total, 1149 studies were identified through database search, and only 27 studies were included in the meta-analysis. Having at least 1 ANC visit during pregnancy reduced the risk of neonatal death by 42% compared to their counterparts (RR = 0.58, 95% CI [0.47, 0.71]). The pooled prevalence of NM was 8.5% (95% CI [7.3, 9.6]), with NM rate of 46.3/1000 live births. Conclusion The study indicated that NM might be decreased even with a single ANC visit when compared to no visits. Scaling up ANC services through ANC promotion and tackling service-related barriers could potentially reduce NM in Eastern Africa.

Intrafamilial Variability of the R694C Variant in BICD2 Presenting with Lethal Severe Arthrogryposis

Arthrogryposis multiplex congenita (AMC) is a heterogeneous condition comprising congenital multiple joint contractures, and it is secondary to decreased fetal mobility following environmental/genetic abnormalities. BICD2 pathogenic variants have been associated with autosomal dominant spinal muscular atrophy with lower extremity predominance (SMALED2). We report the case of a newborn with decreased fetal movements and ventriculomegaly diagnosed in utero, born with severe AMC, multiple bone fractures, congenital hip dislocation, and respiratory insufficiency that led to neonatal death. His mother had AMC diagnosis without established etiology. Her phenotype characterization was key to guide the genetic investigation. A BICD 2 heterozygous variant (NM_001003800.1; c.2080C > T; p. [Arg694Cys]) was detected both in the mother and the newborn. This variant had previously been reported in 3 cases, all having de novo severe SMALED-type 2B (MIM#618291) phenotype. This is the first report of this variant (p. [Arg694Cys]) presenting with an inherited, severe, and lethal phenotype associated to intrafamilial variability, suggesting a more complex phenotype-genotype correlation than previously stated.

Severe Neonatal COVID Pneumonia With Cytokine Storm

COVID infection is not as common in children as in adults. In the first wave, symptomatic SARS-CoV-2 infection was less common with mild symptoms in children and neonates. But in the second wave, more children and neonates were affected with severe manifestations. COVID infection in neonates is mostly asymptomatic and published data from various neonatal units of India shows that most COVID positive newborns have good prognosis; poor outcomes are due to perinatal complications and rarely due to COVID. 1 However, in the second wave, newborns too were affected. We are presenting the case of a preterm neonate who developed severe COVID pneumonia on day 10 of life with cytokine storm and succumbed to death.

A Case of Congenital Adrenal Hyperplasia due to 3-Beta-Hydroxysteroid Dehydrogenase Deficiency Presented With Acute Liver Failure

Congenital adrenal hyperplasia (CAH) is a group of rare autosomal disorders characterized by a variety of defects in adrenal steroidogenesis. Most cases of CAH are due to an enzyme deficiency in either 21-hydroxylase or 11-beta-hydroxylase. A much rarer form of CAH due to 3-betahydroxysteroid dehydrogenase (3B-HSD) deficiency results in impaired synthesis of all steroid hormones. The clinical presentation of undervirilization in 46 XY patients, hyponatremia, hyperkalemia, and recurrent hypoglycemia in 3B-HSD deficiency cases is well described in the literature. We describe a neonate with 3B-HSD deficiency that presented with ambiguous genitalia and hypoglycemia and was found to have comorbid coagulopathy, cholestasis, and direct hyperbilirubinemia with liver failure that resolved with glucocorticoid and mineralocorticoid treatment. Prompt recognition of this disease is imperative for timely intervention.

Survival Rate, Postdischarge Readmission Rate, Its Causes and Outcomes Among the Preterm Neonates Admitted in a Tertiary Care Centre, Northern India

Objective: To assess the survival rate, readmission rate, its causes, and outcomes among the preterm neonates that were discharged from the neonatal units of a tertiary care center of northern India. Methods: A retrospective study was conducted in neonatal units of a tertiary care center in northern India. Preterm neonates (<=35 weeks) were admitted in these neonatal units, and their parents were included as participants by total enumeration sampling between July–December 2018. The data was collected from the admission records for the last 6 months from neonatal intensive care unit and from the parents whose babies were discharged. The parents were telephonically interviewed regarding readmissions and mortality. The data relating to the sociodemographic profile of parents, clinical profile of preterm neonates, readmission profile of discharged preterm neonates, and risk predictors for readmission of preterm neonates was collected. Results: A total of 249 preterm neonates were admitted in 6 months. It was found that the survival rate was 197 (79.1%); the readmission rate was 23 (16.4%). Out of total readmitted, majority 22 (95.7) had low maternal education as risk predictor of readmissions, followed by habitats of rural area. Conclusion: Preterm neonates are at more risk for getting multiple readmissions as compared to other neonates. Thus, there is a need to find out the strategies to overcome the burden of readmissions.

Congenital Lung Abnormalities: Experience of a Tertiary Care NICU in Delhi, A Case Series

Respiratory distress is the most common cause of neonatal admission. Cystic lung lesions are rarer cause of the same. These are heterogeneous lesions with varied antenatal and postnatal manifestations. The outcomes of antenatally diagnosed lung malformations have showed more improvement than previously thought of. With advancement in imaging techniques, more definitive diagnosis and timely intervention, even in-utero interventions, can be planned. Overall, survival rates have also improved over the past 2 decades. A majority of infants are asymptomatic and do not require surgery in neonatal period, and the expectant management is usually followed in most centers, but some may have mass effect and require either in-utero or early neonatal intervention. For asymptomatic lesions, the timing of surgery remains controversial as there are propagators of both early and late intervention. A multidisciplinary team approach is required for its optimal management. We present here a set of 3 babies who were diagnosed as having cystic lung lesions antenatally but later these turned out to be completely different entities.

Neonatal Atrial Flutter: Case Report

Neonatal atrial flutter is a rare entity seen in the newborn period. With prompt treatment, they mostly revert to normal rhythm, with good long-term prognosis. But prolonged untreated atrial flutter can result in heart failure. This necessitates prompt diagnosis and treatment of the condition. However, all available treatment modalities are not effective in all patients. Here, we report 2 newborns with atrial flutter who did not respond initially to medical management, but eventually responded to cardioversion, with good outcome.

Prolonged Viral Shedding in Vertically Acquired SARS-CoV-2 Infection in Preterm Infants–Shedding Versus Infectivity

The reported median duration of viral shedding after infection with SARS-CoV2 is between 12 and 20 days. It is now established that infected individuals can continue to shed viral ribonucleic acid (RNA) without shedding live virus. This has implications for quarantine and infection control practices. COVID in the acute phase seems to be milder in children, and the duration of viral RNA shedding is shorter in children compared to adults. SARS-CoV-2 infections in the newborn period is rare. Little is known about the duration of viral shedding in preterm infants with vertically acquired SARS-CoV-2. 3 of the 4 preterm infants cared for at our center had prolonged shedding up to 34 days with live viral shedding not seen beyond the second week when tested in 3 of them.