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Aim: Neonatal gastric perforation (NGP) is a rare, perplexing, life-threatening entity affecting neonates. We share our experience of operating upon cases of NGP s and highlight important points observed which may aid in further improving care of neonates, diagnosed with this entity. Materials and Methods: A retrospective analysis of all consecutive patients with NGP operated by the author, at various centers between January 2015 and December 2018, was carried out. We analyzed different variables for these and reached logical conclusions. Results: Between January 2015 and December 2018, we treated ten patients with gastric perforation. All the neonates were preterm, except one. Mean birth weight in our series was 1745 g (range 1300–2400 g). Deterioration in activity, worsening of sepsis, metabolic acidosis, increased ventilator requirements, and abdominal distension were prominent clinical features identified in all patients. All patients subsequently had massive pneumoperitoneum before surgery. Six patients had perforation along the greater curvature, two had perforation at the posterior wall, and two had near total gastric necrosis. We had four mortalities out of ten patients operated. Conclusion: NGP is associated with high mortality, especially in premature and low birth weight neonates. Severity of contributing factors in a premature predisposed neonate determines the severity of gastric necrosis, which in turn is an important prognostic factor. Certain preoperative signs can be useful and can aid in initiating preventive measures to curtail severity of the pathology. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 9‑month‑old girl was referred from the Department of Pediatrics with asymptomatic, congenital skin folds affecting the distal parts of upper and lower extremities, progressively increasing with age; the child was born out of nonconsanguineous parentage, at term by normal vaginal delivery; and he birth weight was 2.7 kg and her growth and developmental milestones were delayed for age.

Background: In the developing countries, neonatal sepsis (NNS) contributes significantly to neonatal admissions and deaths. Its symptoms are usually nonspecific, and definitive laboratory diagnosis can be challenging in a resource-limited setting. Therefore, early empirical antibiotic therapy antibiotics are important in these localities, and this makes it important to document local organisms and their antibiotic sensitivity pattern. Unfortunately, no previous study in our setting has documented these. Methods: This study involved newborns (inborn and outborn) admitted with sepsis (cases) within the 1st month of life at the Enugu State University Teaching Hospital (ESUTH), Enugu, Southeast Nigeria. Controls were included for the analysis, and data were collected over a 4-year period from January 2013 to December 2016. Results: In all, 1920 newborns were admitted to the Special Care Baby Unit of ESUTH during the study period. Fifty-seven were managed for culture-proven sepsis, resulting in an in-hospital incidence rate of 29.7 per 1000 admitted newborns (95% confidence interval 21.9–37.4). A total 228 newborns were recruited (57 cases and 171 controls; ratio of 1:3). The most common presenting symptom and sign were fever (84.2%) and depressed primitive reflexes (50.9%), respectively. A case-fatality rate of 7.4% was observed. Newborn's place of birth (P = 0.02) and the final outcome (P = 0.004) were significantly associated with the development of sepsis, while gender (P = 0.12), birth weight (P = 0.33), gestational age (P = 0.53), and mode of delivery (P = 0.74) were not. Nearly 60% of the organisms implicated were coliforms, while one-quarter were Staphylococcus aureus. The most sensitive antibiotics were the fluoroquinolones, particularly ciprofloxacin, while amoxicillin, ampicillin, and clindamycin were generally not effective. Conclusion: NNS in our environment is commonly caused by coliforms and S. aureus and being outborn is a significant determinant. Antibiotic resistance follows recognized patterns, but the quinolones, despite their inconclusive safety profile in children, are most sensitive. [ABSTRACT FROM AUTHOR]

Background: Despite the advancements in antenatal diagnostic and postnatal management in neonates with esophageal atresia (EA)/tracheoesophageal fistula (TEF) resulting in better survival rates in the developed world, the outcome still remains poor in developing countries. Materials and Methods: Retrospective analysis of medical records of neonates who were operated for EA/TEF from 1991 to 2015 at our center was done. Results: A total of 693 neonates were operated during the study period with male-to-female ratio 1.9:1. Mean birth weight was 2300 ± 840 g and mean gestational age was 36 ± 4 weeks. Prenatal diagnosis with ultrasonography screening was done in only 9% cases. Mean age of neonates at referral was 4.3 ± 1.5 days. Frothing from mouth and tachypnea were the most common presenting features seen in 94% and 78% neonates, respectively. Type III EA was the most common variety seen. Incidence of associated anomalies was 52% with congenital heart disease being most common. Overall postoperative survival rate of 57% was observed. In the past 10 years of study, survival improved to 64% in comparison to 48% during initial 15 years. Poor prenatal supervision, aspiration pneumonia, prematurity, low birth weight, delayed referral and inadequate transport facilities, associated congenital anomalies, and lack of advanced Neonatal Intensive Care Units (NICUs) facilities were the important contributing factors for high mortality. Conclusion: In developing countries, only improving the NICUs and surgical techniques will not deliver a better outcome in neonates with EA/TEF. Emphasis should be on the strengthening of peripheral health services and transport facilities to achieve good survival rates. [ABSTRACT FROM AUTHOR]

Context: Neonatal sepsis is one of the common reasons for admission to neonatal units in developing countries. Resistance to antibiotics is increasing in neonatal sepsis. Aims: To evaluate the antibiotic resistant pattern of pathogens associated with early‑onset and late‑onset neonatal sepsis. Settings and Design: This cross‑sectional study was done at special care baby unit of a tertiary care hospital from January 2008 to June 2009. Subjects and Methods: All neonates with risk factors or clinical features of sepsis were enrolled and samples for blood cultures were taken. Neonates whose blood culture yielded growth of bacteria were included in this study. Standard data collection form was used to collect all demographic data, pathogen, and resistant to antibiotics. Statistical Analysis Used: Chi‑square test and Fisher’s exact test were used for compare the variables. The value P < 0.05 was considered statistically significant. Statistical analysis was done using EpiInfo 7. Results: Sixty‑five blood culture positive neonates were included in this study. Early‑onset neonatal sepsis and late‑onset neonatal sepsis were 35.4% and 54.6%, respectively, and 98.5% sepsis was caused by Gram‑negative organism. Common organisms isolated were Klebsiella and Enterobacter. Organisms isolated were resistant to first- and second-line antibiotics and quinolone derivatives. In about 15% cases, bacteria showed resistance to third line of antibiotics used in neonatal sepsis. Conclusion: Gram‑negative bacteria and in particular Klebsiella and Enterobacter species are the leading causes of early‑onset and late‑onset neonatal sepsis. All organisms were resistant to ampicillin, gentamicin, and third generation cephalosporin but resistant to imipenem and meropenem were low. [ABSTRACT FROM AUTHOR]

Introduction: A variety of lesions which may be transient, physiological, or pathological may be present during the neonatal period. However, most of these conditions are benign and self-limiting. Objective: To study the hospital-based incidence and clinical pattern of dermatoses during the early neonatal period. Methods: A hospital-based, cross-sectional study was conducted in a government hospital. A total of 1260 consecutive live babies delivered over a period of 1 year at the Department of Obstetrics and Gynecology were examined up to 7 days of extrauterine life. Results: Among 1260 newborns, 1242 (98.5%) had cutaneous lesions. Among them, 700 (55.5%) were males and 560 (44.4%) were females. Of these, 1119 (88.1%) weighed >2.5 kg, whereas 141 (11.9%) weighed <2.50 kg. 1176 (93.3) were born at term, 66 (5.3%) were preterm, and 18 (1.4%) were postterm. History of consanguinity was present in 211 (16.7%) cases. 817 (64.8%) newborns were delivered by normal vaginal route and 443 (35.1%) by cesarean section. Majority, i.e., 764 (60.6%) mothers were in the age group of 21-25 years, 318 (25.23%) below 20 years, 162 between 26 and 30 years (12.86%), and 16 (1.26) were more than 30 years. Mongolian spot, milia, sebaceous hyperplasia, erythema toxicum, and physiological scaling were the common physiological and transient dermatoses seen. A few pathological conditions such as Waardenburg syndrome and bathing trunk nevus were seen. Conclusion: The hospital-based incidence of neonatal dermatoses was 98.5% with no sexual predilection. Although common, most of the skin lesions in newborn are self-limiting requiring no treatment. Correct diagnosis and counseling the parents may relieve the anxiety and mental trauma. [ABSTRACT FROM AUTHOR]

Purpose: To determine the incidence of intraretinal hemorrhage in newborns at the Hospital de San José, Bogotá, Colombia from September 2009 to September 2010. Design: Cohort study. Methodology: Live newborns were examined at the San José Hospital for a year (September 2009 to 2010), analyzing neonatal and maternal factors associated with the presence of intraretinal hemorrhages. A simple random cluster sampling was used, excluding newborns with a compromised general status, as well as those whose parents or legal guardians did not sign the informed consent form. Patients with the presence of intraretinal hemorrhages were examined every 2 weeks until resolution was observed. Results: A total of 190 newborns were examined, finding an incidence of intraretinal hemorrhages of 22.6% (95% CI 16.6 to 28.6). Most of the mothers were nulliparous (55.8%) and deliveries were eutocic (65.1%). From newborns with hemorrhages, 81.3% were born at term, and hemorrhages in most patients (93.0%) were resolved by the second week of monitoring. Associations between hemorrhages and cesarean section (RR 0.42, CI 0.22 to 0.79) and episiotomy (RR 1.73, CI 1.02 to 2.94) were observed. Conclusions: Newborns who presented intraretinal hemorrhages were children of nulliparous mothers on whom episiotomy was performed, and some with eutocic and instrumented Intraretinal hemorrhages in newborns: Incidence and associated factors deliveries. The first two variables had statistical significance for the development of intraretinal hemorrhages. [ABSTRACT FROM AUTHOR]

Congenital transmesenteric hernia in neonates is a rare cause of intestinal obstruction with devastating outcomes and still remains a challenge to diagnose pre-operatively. Patients are often managed with emergency surgical exploration and may need bowel resection. We present 2 neonates with small bowel obstruction secondary to strangulated transmesenteric hernia through a congenital defect in the small bowel mesentery, which were managed successfully. We have also reviewed the literature about congenital transmesenteric hernia in neonates. [ABSTRACT FROM AUTHOR]

Orbital abscess generally occurs in older children but it can rarely affect infants and neonates too. We report a case of community acquired methicillin resistant staphylococcus aureus (CA-MRSA) neonatal orbital abscess in a 12-day-old term female neonate with no significant past medical history or risk factor for developing the infection. The case highlights the importance of consideration of CA-MRSA as a causative agent of neonatal orbital cellulitis even in a neonate without any obvious predisposing condition. Prompt initiation of appropriate medical therapy against MRSA and surgical drainage of the abscess prevents life threatening complications of orbital cellulitis which more often tend to be fatal in neonates. [ABSTRACT FROM AUTHOR]

Aims: To evaluate the hearing threshold and find the incidence of hearing loss in infants and children belonging to high-risk category and analyze the common risk factors. Subjects and Methods: Totally, 125 infants and children belonging to high-risk category were subjected to brainstem evoked response audiometry. Clicks were given at the rate of 11.1 clicks/s. Totally, 2000 responses were averaged. The intensity at which wave V just disappears was established as hearing the threshold. Degree of impairment and risk factors were analyzed. Results: Totally, 44 (35.2%) were found to have sensorineural hearing loss. Totally, 30 children with hearing loss (68%) belonged to age group 1-5 years. Consanguineous marriage was the most commonly associated risk factor. Majority (34) had profound hearing loss. Conclusion: Newborn screening is mandatory to identify hearing loss in the prelinguistic period to reduce the burden of handicap in the community. The need of the hour is health education and genetic counseling to decrease the hereditary hearing loss, as hearing impairment due to perinatal factors has reduced due to recent medical advancements. [ABSTRACT FROM AUTHOR]

Background: Classical duplications may present along any part of gastrointestinal tract (GIT) from mouth to anus. Atypical or unusual rare varieties of GIT duplications may also occur, but with different anatomical features. Materials and Methods: We reviewed our 5-year record (February 2008-January 2013) to describe clinical profile of unusual GIT duplications in neonates and small infants. Results: Three patients with atypical variety of GIT duplications were managed in our department during this tenure. Two were females and one male. Age was ranged between 11 days and 2 months. All patients presented with massive abdominal distension causing respiratory embarrassment in two of them. In all patients, the pre-operative differential diagnoses also included GIT duplication cysts. Computerized tomography (CT) scan showed single huge cyst in one and multiple cysts in two patients. In one patient the CT scan also depicted a thoracic cyst in relation to posterior mediastinum. At operation, one patient had colonic tubular duplication cyst along with another isolated duplication cyst, the second case had a tubular duplication cyst of ileum with its segmental dilatation, and in the third case two isolated duplications were found. Duplication cysts were excised along with mucosal stripping in one patient, cyst excision and intestinal resection and anastomosis in one patient, and only cysts excision in one. All patients did well post-operatively. Conclusion: We presented unusual GIT duplications. These duplications are managed on similar lines as classical duplications with good prognosis when dealt early. [ABSTRACT FROM AUTHOR]

Genitopatellar syndrome is an extremely rare, autosomal dominant disorder characterized by the association of absent patellae, genital anomalies, dysmorphic features (coarse face, large nose, microcephaly), renal anomalies (multicystic kidneys or hydronephrosis), cardiac defects, and intellectual deficit. Constant skeletal manifestations include flexion deformities of the knees and hips with club feet. It is caused by mutations in KAT6B which encodes for histone acetyltransferase 6B enzyme involved in gene regulation. [ABSTRACT FROM AUTHOR]

Anorectal malformation (ARM) is a common neonatal anomaly. Gastrointestinal perforation in a neonate with this anomaly is uncommon. Much rarer, there is a perforation complicating a low ARM with anocutaneous fistula discharging meconium and gas. We present a case of colonic perforation in a neonate with low ARM and an anocutaneous fistula. [ABSTRACT FROM AUTHOR]

Fibromatosis colli is a benign swelling involving sternocleidomastoid muscle. It is usually seen in neonatal age group. The history of prolonged labor or difficult delivery may be present in many cases. The presentation usually is asymptomatic neck swelling or mass in neonates. In some cases, torticollis may be present. The diagnosis is usually done by ultrasound which may typically show fusiform and thickened sternocleidomastoid muscle on the affected side. We hereby report four cases of fibromatosis colli presenting in the neonatal period. All of them presented with neck swelling and were diagnosed to be having fibromatosis colli on ultrasound. [ABSTRACT FROM AUTHOR]

Mesenchymal chondrosarcomas are rare malignant tumours in children, especially, in neonates. The authors present a case of congenital mesenchymal chondrosarcoma in a 1-day neonate located in sacrum. According to the authors' literature searches, this case is the first congenital sacral mesenchymal chondrosarcoma. We also reviewed the papers published in English literatures. [ABSTRACT FROM AUTHOR]

BACKGROUND: The aim of this study was to compare the usefulness of ultrasonography and scintigraphy in diagnosing the etiology of primary congenital hypothyroidism (CH). METHODS: The newborns that were examined by both thyroid scintigraphy and ultrasonography during CH screening program in Isfahan were included in this study. The ultrasonographic findings were compared with the scintigraphic findings and the sensitivity and specificity of the ultrasonography was determined. RESULTS: During this study, 102 CH newborns were studied. According to the ultrasonographic results, 61.8%, 26.5%, 2.9% and 8.8% of them had normal thyroid gland, agenesia, ectopia and hypoplasia, respectively, and according to scintigraphic results, 55.9%, 35.3% and 8.8% of them had normal thyroid gland, agenesia and ectopia, respectively. Ultrasound detected sensitivity, specificity, positive predictive value, negative predictive value, and positive and negative likelihood ratio were 77%, 92%, 89%, 84%, 9.6 and 0.25, respectively. The sensitivity and specificity of ultrasonography compared with thyroid scintigraphy in diagnosis of thyroid gland ectopia was 33% and 100%, respectively. CONCLUSIONS: Though thyroid ultrasonography failed to diagnose 67% of ectopic cases and nonfunctioning thyroid gland, it had the ability to determine the anatomy of thyroid gland. So, considering some limitations of scintigraphy, we concluded that ultrasonography is a relatively appropriate imaging tool for diagnosing CH etiologies, especially in the initial phase of CH screening. [ABSTRACT FROM AUTHOR]

Amniotic band syndrome is a rare condition that is associated with various malformations. Its etiology is controversial. The neuroimage shown here is of a newborn with placenta–encephalocele adhesion and other malformations that suggest amniotic band syndrome. [ABSTRACT FROM AUTHOR]

Congenital cutaneous candidiasis is an uncommon and benign infection presenting at birth or within 6 days of life in neonates exposed to candida in utero. It presents with generalized erythematous macules, papules, vesicles and pustules with or without systemic symptoms. We describe a full term newborn child with congenital cutaneous candidiasis born to an asymptomatic mother. Awareness of this condition is necessary to make an early diagnosis and differentiate from other neonatal infections. [ABSTRACT FROM AUTHOR]

We report a 2-month-old child with galactosemia and falsely high glucose readings with a glucometer using mutant variant of quinoprotein glucose dehydrogenase (MutQ-GDH) chemistry. Potentially fatal hypoglycemia could have been induced in the child if insulin infusion had been initiated as per glycemic management protocol. Even though, the product information with the glucometer carries warning regarding interference by high galactose levels, the awareness regarding this interaction is generally poor in many practice settings. Although, false readings have been reported with glucose dehydrogenase pyrroloquinoline quinone (GDH-PQQ) glucometers, to our knowledge this is the first case report of a falsely high glucose reading due to high galactose in a proven case of galactosemia with a glucometer using the MutQ-GDH chemistry (a modified GDH-PQQ chemistry). Our experience has prompted us to write this case report and we suggest avoiding these glucometers in neonates and infants when a metabolic disease is suspected. [ABSTRACT FROM AUTHOR]

The article features a case of a rare genodermatosis called Michelin tire baby syndrome clinically presenting with excessive ring-like skin folds affecting the extremities and trunk. The clinical findings of a 10-month-old male child revealed asymptomatic skin folds on the upper and lower limbs since birth and the mother had a similar presentation when she was born. According to the author, this is the first case of familial Michelin tire baby syndrome in India.

The article presents the results of radiological investigations on a newly born baby boy who had features of fetal alcoholic syndrome (FAS) in the form of facial dysmorphic features, bilateral optic atrophy, and sensorineural hearing loss. It notes that the repeated brain computerized tomography (CT) done two days later showed extensive bihemispherical infarcts. When discharged to the hospital, it says that the child had profound developmental delay and intractable epilepsy.