Prolonged unconjugated hyperbilirubinaemia is defined as neonatal jaundice persisting beyond 14 d... more Prolonged unconjugated hyperbilirubinaemia is defined as neonatal jaundice persisting beyond 14 days of life. Hereditary Spherocytosis (HS) often remains underdiagnosed and is a notable cause of prolonged neonatal jaundice. Coombs negative haemolytic anaemias are an important cause of unconjugated hyperbilirubinaemia, and HS is one of the most common inherited red cell membrane disorders. Other causes of prolonged unconjugated jaundice include extravasated blood (cephalhaematoma, bruises, intraventricular haemorrhage in preterm infants), haemolysis (blood group incompatibility, red blood cell enzymopathies, and membranopathies), urinary tract infection, congenital hypothyroidism, and rare familial disorders such as Gilbert’s syndrome and Crigler-Najjar syndromes I and II. Herein, the authors present a case report of two male neonates (three week-old and 25dayold) who presented with hyperbilirubinaemia requiring intensive phototherapy, blood transfusion, an exchange transfusion, and ...
Cephalhaematomas and subgaleal haematomas are among the most common birth injuries and are associ... more Cephalhaematomas and subgaleal haematomas are among the most common birth injuries and are associated with birth trauma, forceps, and vacuum-assisted deliveries. They present as scalp swelling and are usually identified shortly after birth. During sonographic examination, if an ultrasound beam scatters off a mirror-like interface, it creates mirror-image artifacts that can cause a diagnostic dilemma. In this case report, a six-day-old neonate presented with a right-side parietal cephalhaematoma that appeared to resemble an epidural haematoma on routine sonographic examination. Gray scale ultrasound revealed an anechoic structure resembling an epidural haematoma in the right parietal region. However, a non-contrast-enhanced computed tomography (NECT) scan of the brain showed a cephalhaematoma without an underlying epidural haematoma. Further evaluation using colour Doppler sonography revealed normal vascular findings within an anechoic space, and gray scale imaging in the sagittal pl...
International Journal of Contemporary Pediatrics, 2018
Hafnia alvei, a Gram negative motile bacillus that belongs to Enterobacteriaceae family is rarely... more Hafnia alvei, a Gram negative motile bacillus that belongs to Enterobacteriaceae family is rarely associated with infection in pediatric patients and is exceptionally rare in the neonatal period. H. alvei is ubiquitous in the environment, causing infections in debilitated and immuno-compromised patients with few cases being reported in neonates. We report two cases of late onset sepsis in term neonates caused by H. alvei that were successfully treated in our unit. To the best of our knowledge, infection due to H. alvei has not been reported in neonates from India. Hafnia alvei causes infection rarely in neonates. Because it can cause nosocomial outbreaks, awareness regarding this uncommon pathogen and initiation of appropriate antibiotic therapy improves the outcome and prevents mortality.
International Journal of Contemporary Pediatrics, 2018
Empedobacter brevis, a gram negative non-motile bacillus that belongs to the family Flavobacteria... more Empedobacter brevis, a gram negative non-motile bacillus that belongs to the family Flavobacteriaceae rarely causes infection in adults and is exceptionally rare in neonates. E. brevis is ubiquitous in the environment, causing nosocomial infections especially in debilitated and immuno-compromised patients with only one case being reported in a neonate. We report a case of early onset sepsis and pneumonia in a term neonate caused by E. brevis that was successfully treated in our unit. Awareness regarding this uncommon pathogen and initiation of appropriate antibiotic therapy improves the outcome and prevents mortality. To the best of our knowledge, this is the second case of E. brevis sepsis reported in a neonate.
Campomelic dysplasia (CD) is a rare form of skeletal dysplasia (incidence 1:200,000 births) which... more Campomelic dysplasia (CD) is a rare form of skeletal dysplasia (incidence 1:200,000 births) which is associated with characteristic phenotypes including bowing of the limbs, a narrow thoracic cage, 11 pairs of ribs, hypoplastic scapulae, macrocephaly, flattened supraorbital ridges and nasal bridge, cleft palate, and micrognathia. In addition to the skeletal abnormalities, hydrocephalus, hydronephrosis, and congenital heart disease have been reported. We describe a preterm neonate who presented with respiratory failure and clinical features of CD. Our case had only 10 pairs of ribs, and to the best of our knowledge this is the first case report of CD with 10 pairs of ribs.
Neisseria meningitidis is a rare cause of meningitis and septicemia in neonates. There are few pu... more Neisseria meningitidis is a rare cause of meningitis and septicemia in neonates. There are few published case reports of neonatal meningococcal meningitis complicated by subdural empyema, cerebral abscess and hydrocephalus. Few cases of neonatal meningococcal meningitis have been reported in the literature with none of them having the complication of multiple cerebral abscesses in early neonatal period (<seven days of life). We report a case of meningococcal meningitis with multiple cerebral abscesses which presented on fifth day of life and developed hydrocephalus at five weeks of life requiring a Ventriculo Peritoneal (VP) shunt. To the best of our knowledge, this is the first documented case of neonatal meningococcal meningitis with multiple cerebral abscesses.
Journal of Clinical Ophthalmology and Research, 2016
Aims: To evaluate the incidence of retinopathy of prematurity (ROP), prevalence of pre-and postna... more Aims: To evaluate the incidence of retinopathy of prematurity (ROP), prevalence of pre-and postnatal risk factors for development of ROP, and treatment outcomes among preterm infants admitted to the Neonatal Intensive Care Unit (NICU) of a tertiary care hospital located in Hyderabad. Materials and Methods: Retrospective chart review of all infants admitted to the NICU between 2008 and 2013, who met the criteria for ROP screening: (a) ≤34 weeks of gestation, (b) ≤1750 g of birth weight, (c) infants with significant risk factors including sepsis, respiratory distress syndrome, or long-term oxygen use. Treatment was offered to infants with Stage III ROP disease or Stage II in Zone II with plus disease. Qualified infants were treated with argon laser photocoagulation within 48 h of diagnosis. They were followed until the disease was successfully treated. Results: A total of 2910 infants were admitted to the NICU. Incidence of ROP was found to be 2.3% (n = 66), the majority of whom (71%) had Stage I ROP. Seventeen percent of the infants weighed <1000 g. The most prevalent prenatal risk factor was multiple gestations (17%). Prevalent postnatal risk factors included oxygen treatment (71%) and respiratory distress syndrome (58%). Twelve percent (8/66) of infants met the treatment threshold. Following argon laser, regression was observed in 100% of infants, with no recurrence with follow-up between 1 and 4 years after treatment. Conclusions: This is the first study to evaluate the incidence of ROP in Telangana. Argon laser photocoagulation appears to be effective in the treatment of infants in this population. We recommend screening infants ≤32 weeks of gestation and infants born ≤1700 g birth weight.
International Journal of Contemporary Pediatrics, 2016
Leukocyte adhesion deficiency (LAD) is a rare primary immunodeficiency disorder of leukocyte func... more Leukocyte adhesion deficiency (LAD) is a rare primary immunodeficiency disorder of leukocyte function characterized by marked leucocytosis secondary to lack of leukocyte recruitment at the site of infection. LAD type I results from lack of expression of leukocyte cell surface β2 integrins (CD 11 and CD 18) that are essential for leukocyte adhesion to endothelial cells and chemotaxis. LAD I is characterized by delayed separation of the umbilical cord, recurrent life-threatening infections of oral and genital mucosa, skin, intestine and respiratory tract. There is impaired pus formation and delayed wound healing despite extreme neutrophilia. Children with severe form of LAD I (<1% expression of CD18) have the worst prognosis and succumb to infections by 2 years of age. Study reports a case of LAD I in a term neonate who presented with sepsis and the diagnosis was confirmed by flow cytometry. Around 400 cases of LAD I were diagnosed worldwide so far, with very few cases reported fro...
Congenital diaphragmatic hernia (CDH) is a common developmental anomaly that usually presents in ... more Congenital diaphragmatic hernia (CDH) is a common developmental anomaly that usually presents in the neonatal period. It is known to be associated with cardiac, renal, genital and chromosomal anomalies. Late presentation of CDH (beyond 1-month of age) is seen in 13% of the cases. Malrotation is reported in 42% of CDH cases. We report a case of a 3-month-old infant with concurrent CDH, Meckel's diverticulum and malrotation. This is the first case report of such an association in an infant.
Macroglossia is a clinical condition in which the tongue protrudes beyond the teeth or alveolar r... more Macroglossia is a clinical condition in which the tongue protrudes beyond the teeth or alveolar ridge during resting posture, or there is an impression of a tooth on the lingual border with the mouth open. True macroglossia occurs in hypothyroidism, Beckwith-Wiedemann syndrome, and storage disorders. Apparent or pseudo macroglossia may result from neurological impairment of the tongue or a relatively small buccal cavity as in Pierre Robin syndrome and Down's syndrome. Rarely, macroglossia is inherited as an autosomal dominant condition. A wide variety of primary conditions of the tongue can cause tongue enlargement, e.g., lingual thyroid, cysts, tumors, hemangioma, lymphatic malformations, and myositis. Symptoms associated with macroglossia include noisy breathing, stridor, snoring, and feeding difficulties. Although macroglossia is described in hypothyroidism, there are few publications on macroglossia presenting in the neonatal period. We report a case of congenital hypothyroidism presenting as isolated macroglossia at birth in a term neonate.
This is an open-access article distributed under the terms of the Creative Commons Attribution Li... more This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
This is an open-access article distributed under the terms of the Creative Commons Attribution Li... more This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
International Journal of Contemporary Pediatrics, 2015
Stenotrophomonas maltophilia, a multi-drug resistant non fermenting gram negative bacillus is an ... more Stenotrophomonas maltophilia, a multi-drug resistant non fermenting gram negative bacillus is an increasingly common nosocomial pathogen, especially in intensive care units. Comparatively few cases of S. maltophilia infection have been reported in neonatal population. We report a case of early onset sepsis with pneumonia in a full term neonate due to S. maltophilia treated successfully.
Prolonged unconjugated hyperbilirubinaemia is defined as neonatal jaundice persisting beyond 14 d... more Prolonged unconjugated hyperbilirubinaemia is defined as neonatal jaundice persisting beyond 14 days of life. Hereditary Spherocytosis (HS) often remains underdiagnosed and is a notable cause of prolonged neonatal jaundice. Coombs negative haemolytic anaemias are an important cause of unconjugated hyperbilirubinaemia, and HS is one of the most common inherited red cell membrane disorders. Other causes of prolonged unconjugated jaundice include extravasated blood (cephalhaematoma, bruises, intraventricular haemorrhage in preterm infants), haemolysis (blood group incompatibility, red blood cell enzymopathies, and membranopathies), urinary tract infection, congenital hypothyroidism, and rare familial disorders such as Gilbert’s syndrome and Crigler-Najjar syndromes I and II. Herein, the authors present a case report of two male neonates (three week-old and 25dayold) who presented with hyperbilirubinaemia requiring intensive phototherapy, blood transfusion, an exchange transfusion, and ...
Cephalhaematomas and subgaleal haematomas are among the most common birth injuries and are associ... more Cephalhaematomas and subgaleal haematomas are among the most common birth injuries and are associated with birth trauma, forceps, and vacuum-assisted deliveries. They present as scalp swelling and are usually identified shortly after birth. During sonographic examination, if an ultrasound beam scatters off a mirror-like interface, it creates mirror-image artifacts that can cause a diagnostic dilemma. In this case report, a six-day-old neonate presented with a right-side parietal cephalhaematoma that appeared to resemble an epidural haematoma on routine sonographic examination. Gray scale ultrasound revealed an anechoic structure resembling an epidural haematoma in the right parietal region. However, a non-contrast-enhanced computed tomography (NECT) scan of the brain showed a cephalhaematoma without an underlying epidural haematoma. Further evaluation using colour Doppler sonography revealed normal vascular findings within an anechoic space, and gray scale imaging in the sagittal pl...
International Journal of Contemporary Pediatrics, 2018
Hafnia alvei, a Gram negative motile bacillus that belongs to Enterobacteriaceae family is rarely... more Hafnia alvei, a Gram negative motile bacillus that belongs to Enterobacteriaceae family is rarely associated with infection in pediatric patients and is exceptionally rare in the neonatal period. H. alvei is ubiquitous in the environment, causing infections in debilitated and immuno-compromised patients with few cases being reported in neonates. We report two cases of late onset sepsis in term neonates caused by H. alvei that were successfully treated in our unit. To the best of our knowledge, infection due to H. alvei has not been reported in neonates from India. Hafnia alvei causes infection rarely in neonates. Because it can cause nosocomial outbreaks, awareness regarding this uncommon pathogen and initiation of appropriate antibiotic therapy improves the outcome and prevents mortality.
International Journal of Contemporary Pediatrics, 2018
Empedobacter brevis, a gram negative non-motile bacillus that belongs to the family Flavobacteria... more Empedobacter brevis, a gram negative non-motile bacillus that belongs to the family Flavobacteriaceae rarely causes infection in adults and is exceptionally rare in neonates. E. brevis is ubiquitous in the environment, causing nosocomial infections especially in debilitated and immuno-compromised patients with only one case being reported in a neonate. We report a case of early onset sepsis and pneumonia in a term neonate caused by E. brevis that was successfully treated in our unit. Awareness regarding this uncommon pathogen and initiation of appropriate antibiotic therapy improves the outcome and prevents mortality. To the best of our knowledge, this is the second case of E. brevis sepsis reported in a neonate.
Campomelic dysplasia (CD) is a rare form of skeletal dysplasia (incidence 1:200,000 births) which... more Campomelic dysplasia (CD) is a rare form of skeletal dysplasia (incidence 1:200,000 births) which is associated with characteristic phenotypes including bowing of the limbs, a narrow thoracic cage, 11 pairs of ribs, hypoplastic scapulae, macrocephaly, flattened supraorbital ridges and nasal bridge, cleft palate, and micrognathia. In addition to the skeletal abnormalities, hydrocephalus, hydronephrosis, and congenital heart disease have been reported. We describe a preterm neonate who presented with respiratory failure and clinical features of CD. Our case had only 10 pairs of ribs, and to the best of our knowledge this is the first case report of CD with 10 pairs of ribs.
Neisseria meningitidis is a rare cause of meningitis and septicemia in neonates. There are few pu... more Neisseria meningitidis is a rare cause of meningitis and septicemia in neonates. There are few published case reports of neonatal meningococcal meningitis complicated by subdural empyema, cerebral abscess and hydrocephalus. Few cases of neonatal meningococcal meningitis have been reported in the literature with none of them having the complication of multiple cerebral abscesses in early neonatal period (<seven days of life). We report a case of meningococcal meningitis with multiple cerebral abscesses which presented on fifth day of life and developed hydrocephalus at five weeks of life requiring a Ventriculo Peritoneal (VP) shunt. To the best of our knowledge, this is the first documented case of neonatal meningococcal meningitis with multiple cerebral abscesses.
Journal of Clinical Ophthalmology and Research, 2016
Aims: To evaluate the incidence of retinopathy of prematurity (ROP), prevalence of pre-and postna... more Aims: To evaluate the incidence of retinopathy of prematurity (ROP), prevalence of pre-and postnatal risk factors for development of ROP, and treatment outcomes among preterm infants admitted to the Neonatal Intensive Care Unit (NICU) of a tertiary care hospital located in Hyderabad. Materials and Methods: Retrospective chart review of all infants admitted to the NICU between 2008 and 2013, who met the criteria for ROP screening: (a) ≤34 weeks of gestation, (b) ≤1750 g of birth weight, (c) infants with significant risk factors including sepsis, respiratory distress syndrome, or long-term oxygen use. Treatment was offered to infants with Stage III ROP disease or Stage II in Zone II with plus disease. Qualified infants were treated with argon laser photocoagulation within 48 h of diagnosis. They were followed until the disease was successfully treated. Results: A total of 2910 infants were admitted to the NICU. Incidence of ROP was found to be 2.3% (n = 66), the majority of whom (71%) had Stage I ROP. Seventeen percent of the infants weighed <1000 g. The most prevalent prenatal risk factor was multiple gestations (17%). Prevalent postnatal risk factors included oxygen treatment (71%) and respiratory distress syndrome (58%). Twelve percent (8/66) of infants met the treatment threshold. Following argon laser, regression was observed in 100% of infants, with no recurrence with follow-up between 1 and 4 years after treatment. Conclusions: This is the first study to evaluate the incidence of ROP in Telangana. Argon laser photocoagulation appears to be effective in the treatment of infants in this population. We recommend screening infants ≤32 weeks of gestation and infants born ≤1700 g birth weight.
International Journal of Contemporary Pediatrics, 2016
Leukocyte adhesion deficiency (LAD) is a rare primary immunodeficiency disorder of leukocyte func... more Leukocyte adhesion deficiency (LAD) is a rare primary immunodeficiency disorder of leukocyte function characterized by marked leucocytosis secondary to lack of leukocyte recruitment at the site of infection. LAD type I results from lack of expression of leukocyte cell surface β2 integrins (CD 11 and CD 18) that are essential for leukocyte adhesion to endothelial cells and chemotaxis. LAD I is characterized by delayed separation of the umbilical cord, recurrent life-threatening infections of oral and genital mucosa, skin, intestine and respiratory tract. There is impaired pus formation and delayed wound healing despite extreme neutrophilia. Children with severe form of LAD I (<1% expression of CD18) have the worst prognosis and succumb to infections by 2 years of age. Study reports a case of LAD I in a term neonate who presented with sepsis and the diagnosis was confirmed by flow cytometry. Around 400 cases of LAD I were diagnosed worldwide so far, with very few cases reported fro...
Congenital diaphragmatic hernia (CDH) is a common developmental anomaly that usually presents in ... more Congenital diaphragmatic hernia (CDH) is a common developmental anomaly that usually presents in the neonatal period. It is known to be associated with cardiac, renal, genital and chromosomal anomalies. Late presentation of CDH (beyond 1-month of age) is seen in 13% of the cases. Malrotation is reported in 42% of CDH cases. We report a case of a 3-month-old infant with concurrent CDH, Meckel's diverticulum and malrotation. This is the first case report of such an association in an infant.
Macroglossia is a clinical condition in which the tongue protrudes beyond the teeth or alveolar r... more Macroglossia is a clinical condition in which the tongue protrudes beyond the teeth or alveolar ridge during resting posture, or there is an impression of a tooth on the lingual border with the mouth open. True macroglossia occurs in hypothyroidism, Beckwith-Wiedemann syndrome, and storage disorders. Apparent or pseudo macroglossia may result from neurological impairment of the tongue or a relatively small buccal cavity as in Pierre Robin syndrome and Down's syndrome. Rarely, macroglossia is inherited as an autosomal dominant condition. A wide variety of primary conditions of the tongue can cause tongue enlargement, e.g., lingual thyroid, cysts, tumors, hemangioma, lymphatic malformations, and myositis. Symptoms associated with macroglossia include noisy breathing, stridor, snoring, and feeding difficulties. Although macroglossia is described in hypothyroidism, there are few publications on macroglossia presenting in the neonatal period. We report a case of congenital hypothyroidism presenting as isolated macroglossia at birth in a term neonate.
This is an open-access article distributed under the terms of the Creative Commons Attribution Li... more This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
This is an open-access article distributed under the terms of the Creative Commons Attribution Li... more This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
International Journal of Contemporary Pediatrics, 2015
Stenotrophomonas maltophilia, a multi-drug resistant non fermenting gram negative bacillus is an ... more Stenotrophomonas maltophilia, a multi-drug resistant non fermenting gram negative bacillus is an increasingly common nosocomial pathogen, especially in intensive care units. Comparatively few cases of S. maltophilia infection have been reported in neonatal population. We report a case of early onset sepsis with pneumonia in a full term neonate due to S. maltophilia treated successfully.
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