Journal of Neonatology

Congenital hypothyroidism (CH) is seen more often in preterm and low birthweight infants. However, very few studies exist that explore the epidemiology and risk factors associated with CH, especially from the Indian subcontinent.

A cross-sectional screening study was carried out on 240 low birthweight (<2.5 kg) and late preterm (34-36.6 weeks) newborns not requiring ventilator support over a period of 18 months. A total of 0.5 mL of venous sample was obtained on day 4 of life for analyzing thyroid stimulating hormone (TSH), tetraiodothyronine (T4), as well as tetraiodothyronine (T3) levels by an architect plus Chemiluminescence microparticle immunosorbent assay. Neonates with TSH values of more than 20 mIU/L were categorized as having elevated TSH.

Elevated TSH was seen in 10 (4.2%) neonates. The presence of maternal anemia (P = .011), gestational diabetes mellitus (GDM) (P < .001), and maternal hypothyroidism (P < .01) was found to be significantly linked to elevated TSH levels. Other maternal comorbidities, gestational age, birthweight, as well as the nature of birth bore no significant relation with CH.

Elevated TSH was found to be common in late preterm and low birthweight newborns. Neonates of mothers suffering from hypothyroidism, advanced maternal age, GDM, and maternal anemia should be serially evaluated for thyroid abnormalities as they possess a significantly higher risk of having elevated TSH levels.

In the context of the COVID-19 pandemic, studies on perinatal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection play an essential role in the understanding of the disease which in turn is necessary for optimal management of affected neonates.

To determine the clinical outcomes in neonates born to mothers with SARS-CoV-2 infection and to identify possible risk factors in perinatal transmission.

This was a retrospective cohort study performed at level-3 teaching Neonatal Intensive Care Unit (NICU) in South India. Medical records of all mothers who delivered in the COVID-19 facility and neonates born to COVID-19 confirmed mothers from April 15, 2020, to September 15, 2021, were collected and analyzed.

Of 15,720 deliveries, 556 mothers who tested positive for COVID-19 delivered 563 babies (7 twins), of which 6.3% were positive for SARS-CoV-2. Out of 563 babies, 14.5% were preterm and 95% were asymptomatic. Among COVID-19 positive mothers, cesarean was the most common mode of delivery (73.5% and 88% in COVID-19 positive and negative neonates respectively; P value = .01) and most of the babies were roomed-in (85.2% in COVID-19 positive and 94.6% in COVID-19 negative neonates; P value = .02). COVID-19 positive neonates had significantly high probability of pneumonia (P value = .003), sepsis (P value = .03), septic shock (P value = .01), and abnormal CXR (P value = .01). There was no significant difference in the mortality rate.

COVID-19 positive status of the mother is not associated with increased risk of preterm birth, neonatal admission, morbidity, or mortality. The risk of transmission was not found to be associated with direct breastfeeding or rooming-in.

Studies on factors affecting mortality in neonatal tetanus (NNT) are mostly from other developing countries. Although NNT has been eliminated from India, cases are still occasionally reported from rural areas. Moreover, there is paucity of such studies from India. Hence, this study was aimed to identify risk factors affecting NNT mortality so that case fatality can be minimized especially in resource-limited settings.

The records of the 32 neonates diagnosed as NNT over a period of 8 years (2013-2020) were reviewed, and a statistical comparison of various variables between survivors and nonsurvivors was made.

The overall case fatality rate in our study was 75%. Determinants of mortality in these cases were low birthweight, short incubation period, short period of onset, delay in seeking medical attention, presence of comorbidity, dose of tetanus immunoglobulin < 250 IU, and an unknown entry site of infection. Gender and place of delivery were not associated with increased mortality.

Improved maternal antenatal care (birthweight and gestation), recognition of the disease at onset of symptoms, and early hospital contact are important, in addition to optimum supportive care, to reduce NNT mortality.

(a) Utility of neonatal sequential organ failure assessment (SOFA) score for predicting mortality in neonatal sepsis. (b) Determining a cut-off score of neonatal sequential organ failure assessment (nSOFA) score in relation to mortality.

Prospective pilot study in neonatal intensive care unit (ICU) for 1 year (January-December 2021).

All neonates (inborn and outborn) admitted to neonatal ICU with the diagnosis of presumed or proven sepsis.

Neonates with critical congenital heart disease, congenital malformations, congenital immunodeficiency syndromes, inborn errors of metabolism, and neonates with birth asphyxia. All neonates admitted in neonatal ICU with the diagnosis of presumed or proven sepsis were included in the study. Variables required for nSOFA were assessed along with general demographic like age, gestational age, and so on. The nSOFA score was documented twice, once at the time of admission (initial evaluation) for sepsis and later at 24 h. The final outcome (survivor/nonsurvivor) was recorded. Data was analyzed to see the correlation of nSOFA to outcome and also to see the predictive value of cut-off nSOFA score to outcome.

A total of 60 neonates with presumed or proven sepsis (30 each in term and preterm) were admitted, of which 10 (16.7%) were nonsurvivors (6 preterms and 4 term), P value .731. Four deaths were observed in outborn (n = 38) and 6 in inborn (n = 22) babies, P value .149. The mean (±standard deviation [SD]) of age (days) and weight (kg) among survivors was 11.24 (9.47) and 2.23 (0.69) and for nonsurvivors was 11.2 (11.9) and 1.9 (1.1), respectively, P value >.05. There was no statistical significance observed between survivors and nonsurvivors in relation to blood culture positivity, P value .17. Mean (±SD) nSOFA score among survivors at the time of admission (initial evaluation) was 1.96 (1.69) and at 24 h was 1.16 (1.48). Among nonsurvivors mean (±SD), admission (initial evaluation) nSOFA score was 7.6 (2.0) and at 24 h 10 (2) was observed, P value of <.001. The mean (±SD) of nSOFA changes (at the time of admission and at 24 h) for survivors (–)0.8(1.14) and for nonsurvivors 2.4 (1.17) was observed, P value <.001. Outcome in relation to nSOFA score, 90.0% mortality was observed with the score of ≥6 at the time of admission (initial evaluation) and score of ≥5 at 24 h. Based on these cut-off values, receiver operating characteristic curve for mortality prediction was calculated. Area under curve (AUC) for admission (initial) was 0.972 (sensitivity 90%, specificity 98%, positive predictive value 90%, negative predictive value 98, with accuracy of 96.7%). At 24 h, AUC was 0.999 (sensitivity 100%, specificity 98%, positive predictive value 90.9%, negative predictive value 100, with accuracy of 98.3%).

nSOFA can predict neonatal mortality due to sepsis. Admission nSOFA score of ≥6 and ≥5 at 24 h correlate well with mortality.

Neurosonography has been commonly used for screening in neonatal intensive care unit (NICU), for early detection of defects in the central nervous system (CNS) which include findings like intracranial hemorrhage, hydrocephalus, cerebral edema, and other structural abnormalities.

To detect the CNS abnormality in critically ill neonates by neurosonography.

This was a cross-sectional study done in the NICU of AVBR Hospital, Sawangi Meghe, Wardha. Neonates were defined as “critically ill” after taking their detailed history and performing a complete physical examination. Following this, the newborns who fulfilled the studies’ inclusion criteria were subjected to neurosonogram. The following factors were considered: gestational age, clinical examination, investigations, neurosonography findings, and outcomes.

A total of 150 critically ill newborns were subjected to neurosonography, 24 of them had abnormal findings. There was a significant correlation of gestational weeks, mode of delivery, and diagnosis of critically ill neonates with abnormal neurosonography (P = .000, P = .000, and P = .000). Prematurity was the most common diagnosis followed by meningitis. A total of 16% of the newborns had abnormal results in neurosonography. About 6.67% of these had hydrocephalus, 5.34% had an intraventricular hemorrhage (IVH), 1.34% had periventricular echogenicity, 0.66% had cerebral edema, 0.67% had germinal matrix hemorrhage, and 0.66% had brain abscess. A total of 109 (72.67%) participants in the study had a positive outcome at the time of discharge from NICU; whereas, 27 (18%) unfortunately did not survive.

Neurosonography is thus a valuable, safe, and effective diagnostic tool used for screening critically ill neonates for abnormalities of the brain.

Down syndrome (DS) is associated with high mortality in India, due to nondiagnosis/late-diagnosis caused by unavailability of qualified doctors and/or lack of access to expensive medical/diagnostic facilities, especially in rural India. Using artificial intelligence/machine learning graphical pattern recognition tools, relevant facial points can be extracted from children’s photographs, facial anomalies can be identified, and probability of DS affliction can be predicted.

Trained Google’s Cloud Vision AutoML Image Classification model was employed with ~2,000 photographs of DS positive children and ~3,000 photographs of DS negative children. A subset of 300 images, 100 each of Asian, Caucasian, and Other-Race children, was used to train and test 3 race-specific models. These results were compared against a unified model trained and tested with same 300 images.

The CloudML model trained with ~5,000 images initially achieved: Sensitivity—94.6%, specificity—96.9%, and accuracy—96.0%. Upon optimizing confidence threshold to 0.1, model maximized sensitivity at 99.6%, specificity dropped to 93.8%, and accuracy maintained at 96.0%. Each of the race-specific models trained with 100 images each, after optimization, yielded perfect scores on sensitivity, specificity, and accuracy of 100% each. Against this, the unified model with 300 images yielded overall accuracy of 98% (100% sensitivity, 83% specificity for Caucasian children, and 100% sensitivity, 100% specificity for Asian/Other children).

Post optimization, this model can be used as an effective postnatal screening tool for DS detection. Preliminary results indicate that race-specific models can achieve even higher accuracy, sensitivity, and specificity.

Clinical competency of nurses has been identified to be vital in making the difference between survival and death of neonates. Continuing education (CE) is essential to enhance the competency of nurses. This study aims to evaluate the effect of an educational intervention on nurses’ competency as regards their knowledge, attitude, and practices of neonatal care in a teaching hospital in Ogun State.

A quasi experimental one (1) group pre- and postintervention design was used. Purposive sampling of all registered nurses working in the neonatal unit of Olabisi Onabanjo University Teaching Hospital (OOUTH), Sagamu Ogun State was utilized. Two tools were used for data collection: a semi-structured questionnaire and nurses’ clinical performance observational checklist. Data were collected before and 2 weeks after educational intervention. Data collected was managed using Statistical Package for Social Sciences (SPSS), version 20 software. Descriptive statistics was used to analyze and present variables. Inferential statistics of student t test was employed for hypotheses testing at P ≤ .05.

Nurses’ knowledge and practice improved at postintervention. Knowledge mean score at pretest was 35.21 (±6.33) which increased to 43.74 (±3.30) in the posttest (t = −7.33, P = .000). Practice mean score at pretest was 32.7 (±6.04) which increased to 44.8 (±7.22) postintervention (t = 7.26, P = .000). However, no significant difference was observed between the attitude of nurses regarding care of neonates pretest 71.0 (±7.15) and posttest 71.1 (±13.5) (t = 0.04, P = .968). Overall, there is a significant difference in the nurses’ competency score at pretest 192.21 (±20.23) and posttest 203.79 (±4.78) (t = −2.21, P = .040). Majority (94.7%) of the nurses agreed that CE would facilitate their competent in the care of neonates in neonatal units while 31.6% established that financial constraint was a barrier to attending CE to improve themselves.

Implementation of educational program for nurses working in the neonatal unit improved their competency toward neonatal care. It is recommended that CE and training programs should be organized for nurses on a regular basis to sustain their competency.

Single application of chlorhexidine soon after birth reduces skin colonization. The benefit is not sustained after 72 h and multiple repeated cleansing is suggested. Such interventions especially in preterm infants need evaluation.

To evaluate efficacy and safety of multiple whole-body cleansing with aqueous 0.5% chlorhexidine during first week in preterm infants.

Randomized controlled trial with superiority design and triple blinding.

Level-III neonatal intensive care unit of teaching hospital in India.

A total of 120 hemodynamically stable preterm (28-34 weeks) infants without encephalopathy weighing ≥ 1,000 g admitted within 6 h of life.

Following stratified randomization (28-31 weeks n = 31; 32-34 weeks n = 89), 59 and 61 infants were cleansed with identically looking aqueous 0.5% chlorhexidine wipes and placebo (sterile-water wipes) respectively at 0, 48, and 96 h after recruitment and followed up until neonatal period.

Primary outcome was skin colonization rate on day 7. Secondary outcomes include neonatal mortality, incidence of sepsis, adverse skin reactions, and hypothermic episodes and colony counts during first week.

We used intention to treat analysis. After multiple cleansings, skin colonization on day 7 with chlorhexidine was 50.9% (28/55) and sterile water was 92.8% (52/56). Risk reduction with chlorhexidine cleansing was 45% compared with sterile water (relative risk = 0.55; 95% confidence interval [CI]: 0.42,0.72). Absolute risk reduction = 41.95% (95% CI: 27.1, 56.78) and number needed to treat = 2.4 persons (95% CI: 1.8, 3.7). Neonatal mortality (10.1% vs 16.3%, P = .539), sepsis (10.1% vs 19.6%, P = .229) was not significant. None had adverse skin reactions. Temperature loss after wet cleansing was not different between chlorhexidine and water.

Multiple whole-body cleansing with aqueous 0.5% chlorhexidine at 48 h interval during first week of life reduces skin colonization in preterm infants.

Rhizobium radiobacter, a gram-negative organism, rarely infects newborn infants, and the literature on the outcome of infants and treatment options is sparse.

We present a healthy preterm neonate infected with R. radiobacter and treated successfully. As the literature is limited in neonates, we performed the literature review of studies that reported R. radiobacter infection in the neonatal population. The systematic search on April 15, 2020, across PubMed, Web of Science, and Medline identified 5 case reports to date. The neonates in those reports were otherwise healthy without underlying risk factors, had infection limited to the bloodstream, treated successfully with cephalosporins, and aminoglycosides without any sequelae.

R. radiobacter sepsis infection in newborn infants can occur without underlying risk factors and can be treated with common antibiotics, and the outcome of the infected neonates is favorable.