Fetus and Newborn

Keep Scientific Temper, Transform Society..

2022-05-24T04:14:42-07:00

Early detection of anomalies and interventions will definitely benefit patients and society at large. In this issue, we discuss 2 different scenarios one of which is regarding the modern scientific advancements which aids in the early detection of Down’s syndrome while the other discusses the neonatal issues and problems leading to increased IMR in a section of marginalised population in Kerala.

Soft Markers of Down Syndrome

2022-05-24T05:27:53-07:00

Down syndrome is the most common congenital cause for mental disability. It is an aneuploidy that is potentially detectable in the prenatal period by biochemical and ultrasound markers. The ultrasound findings (soft markers) are not structural anomalies per se and are usually clinically insignificant except for their association with aneuploidy. However, these soft markers are particularly important in screening for trisomy 21 fetuses as majority of them will not have any major congenital anomalies detectable on ultrasound.

Study of the Morbidity and Mortality Pattern in Neonatal Intensive Care Unit at a Tertiary Care among The Under Privileged Population in Attapadi, Kerala

2022-05-24T05:32:40-07:00

Background: Newborns are one among the most vulnerable group and those from the under privileged area are especially so, because of the resource poor social settings, poor health infrastructure, poor transport facilities for sick babies and poor maternal nutritional status.
Giving proper care both antenatal and in neonatal period can definitely improve the morbidity and mortality among one of the most vulnerable set of social group and also awareness of morbidity and mortality rate will aid to provide proper planning, channeling and utilization of resources appropriately.
Aim: Study the morbidity and mortality patterns of under privileged patients from Attapadi admitted in to NICU of a tertiary care hospital in Kerala.
Materials and Methods: This hospital based retrospective study was carried out in the NICU of a tertiary care hospital in Malappuram district for a period of 2 years (April 2018- March 2020). After taking ethical permission from Institutional Ethical Committee and administrative permission from medical superintendent, medical files of the under privileged neonates from Attapadi were retrospectively reviewed. Inclusion criteria: All under privileged newborns(<28 days of life) from Attapadi admitted in to NICU for a period of 2 years (April 2018- March 2020). Exclusion criteria: (a) Babies who left the hospital against medical advice. (b) Neonates whose medical records were incomplete.
Results: Male (31) to female (33) ratio was 1:1.06, of the sixty four babies who were admitted in this hospital among the tribal population. Among the total number of admission 47 of them were preterm neonates and 17 were term neonates. The chief causes of admission in NICU were Low birth weight (87.50%), Prematurity with Respiratory distress syndrome (43.75%) followed by Hypoglycemia (18.75%), sepsis(18.75%), Birth asphyxia (12.50%), Seizures (6.25%), Meconium aspiration syndrome (1.57%) and others (9.38%). Out of the 4 deaths, 3 deaths occurred in babies weighing less than 1000g and one death was in less than 1500g. Mortality was noted only among preterm babies.

Brachytelephalangic Type Chondrodysplasia Punctata - An Under Diagnosed Entity

2022-05-24T05:40:37-07:00

Brachytelephalangic type chondrodysplasia punctata is a rareX linked recessive type of congenital disorder affecting cartilage and bone development with typical findings of binder phenotype, stippled epiphysis and short distal phalanges in male child.1
This occurs due to loss of arylsulfatase E (ARSE) activity. Hypoplastic midface is an important prenatal clue for the diagnosis of chondrodysplasia punctata. Genetic confirmation can be done by detection of deletion of ARSE gene. Even though prevalence of this condition is stated as 1 in 500000, only 55 patients with genetically confirmed disease has been reported so far.2 According to latest literature, genetically confirmed cases were not reported from India so far.
We report the case of a newborn baby in our hospital, resident of South Kerala, with typical clinical findings of brachytelephalangic type of chondrodysplasia punctata and genetically confirmed later.

“Where the Body Forgets to Breathe” Congenital Central Hypoventilation Syndrome

2022-05-24T05:47:46-07:00

Congenital central hypoventilation syndrome (CCHS), also referred to as Ondine’s curse, is a rare, life-threatening disorder characterized by autonomic nervous system dysfunction, which mostly manifests as failure to maintain ventilatory homeostasis during sleep.1,2 Infants with CCHS have inadequate sensitivity to hypoxia and hypercapnia during sleep and in some cases during wakefulness, leading to persistent apnea. Until recently, this has been a diagnosis of exclusion; however recent literature has implicated a genetic etiology.1-5
We report a case of CCHS who presented on day D4 of life with persistent apnea. Diagnosis of primary pulmonary, cardiac, metabolic, neurologic disease, or injury was excluded before the diagnosis of CCHS was made. The diagnosis could be confirmed by a PHOX2B sequence analysis.

What is POCLUS ? - Point of Care Lung Ultrasound

2022-05-24T05:52:43-07:00

Lung ultrasonography (LUS) is becoming a bedside point of care technique in critical care. Lung ultrasound recently has seen an explosion of interest in neonatal care and the evidence about its usefulness is constantly growing. And the added advantage is, it is non-invasive, radiation free, bedside and ideal for the extreme low birth weight neonates and can be interpreted by the neonatologist himself with a little training. Neonatal lung diseases often cause confusion for clinicians due to the non-specific nature of respiratory distress in neonates. Lung ultrasound is a new tool for detecting lung diseases in clinical practice and exhibits high sensitivity and specificity. The various lung ultrasound findings and their interpretation in relation to common neonatal lung conditions like transient tachypnea of newborn (TTN), Respiratory distress syndrome (RDS), Pneumonia, Pleural effusion and Pneumothorax are discussed. Lung ultrasound provides valuable real-time information, which makes it particularly promising for further applications in NICUs. The usefulness of the new Lung Ultrasound (LUS) score in relation to RDS and decision taking on surfactant administration is being delineated. Lung ultrasound scores can be used to guide early surfactant replacement in extremely preterm neonates with RDS & avoid unnecessary harmful x-rays. However, lung ultrasound should not to be performed in isolation; it should be combined with the clinical findings.

Write Up- Science, Technical Components of Fisher & Paykel BCPAP System

2022-05-25T01:39:53-07:00

Continuous positive airway pressure (CPAP) is one of the most accepted noninvasive mode of respiratory support used in neonatal units. It is used both as a primary mode of respiratory support and following extubation from mechanical ventilation. In this review, we present the components of typical CPAP circuit (air – oxygen blender, heated humidifier BCPAP Circuit System, Dual Heated BCPAP Breathing Circuit, Pressure Manifold) and patient interface devices (Nasal prong, Nasal Mask, Nasal tubing, Infant Bonnet, Bubble CPAP generator)