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A woman presented with polyhydramnios at 22 weeks of gestation with a structurally normal fetus and placenta. Biochemical analysis of amniotic fluid detected a very high level of chloride (582 mmol/L), which led to the diagnosis of Bartter syndrome. With serial amniocentesis and indomethacin therapy, the pregnancy continued to 36 weeks. Neonatal and subsequent investigations further supported the diagnosis of Bartter syndrome. The infant was well at birth and now, at 5 months of age, is gaining weight normally on indomethacin.

Outcome of neonates with congenital diaphragmatic hernia (CDH) varies widely and the data from developing countries is scanty. We aimed to study the management and outcome of CDH. We also aimed to ascertain prenatal and postnatal factors affecting the outcome.A retrospective review of neonates with CDH admitted to a teaching hospital was conducted. Demographical data, prenatal and postnatal factors, birth details, management and outcomes were studied. Survival was the primary outcome.16 live-born neonates with diaphragmatic hernia were admitted during the study period. All neonates had hernia on the left side. Mean (standard deviation) gestational age and birth weight were 38.6 (1.5) weeks and 2,616.6 (457) g, respectively. Polyhydramnios was associated in one patient, and additional anomalies in five patients (31.3 percent). Overall survival was 56.3 percent. The CDH was detected prenatally in four and postnatally in 12 patients. 12 neonates underwent surgery and nine survived. Prenatally-detected cases had significantly reduced survival to surgery, overall survival and lower Apgar scores at one minute (p-value is less than 0.04). Median age at surgery was 48 hours. Average duration of mechanical ventilation among survivors was 91.5 hours. Neonatal intensive care unit stay ranged from five to 27 (median nine) days. Six of seven deaths occurred within 72 hours of life. Non-survivors had significantly low Apgar scores and were symptomatic within 12 hours of life (p-value is less than 0.03).Greater than 50 percent survival of neonates with CDH was observed in a centre with conventional ventilation. Poor outcome is likely in neonates who present within 12 hours of life.

Continuous noninvasive monitoring of the partial pressure of arterial carbon dioxide (PaCO2) in ventilated neonates would help clinicians to reduce arterial blood sampling. Our objective was to determine the correlation and agreement between end-tidal carbon dioxide (EtCO2) and PaCO2 in newborns ventilated for various clinical situations.This prospective study was undertaken over 15 months in a teaching hospital. Simultaneous end-tidal and arterial CO2 pairs were obtained from ventilated neonates who were monitored by mainstream capnography and had indwelling arterial catheter. The correlation coefficient and degree of bias between EtCO2 and PaCO2 were assessed for various clinical situations.A total of 133 end-tidal and arterial CO2 pairs were analysed from 32 ventilated newborns. The mean gestational age was 34.6 +/- 3.8 weeks and birth weight was 2,200 +/- 780 g. The overall coefficient of correlation (r) was 0.73 (p-value is less than 0.001). The EtCO2 value was lower than the corresponding PaCO2 value in 86.5 percent pairs, with a mean bias of -6.65 +/- 7.54 mmHg (95 percent CI, - 7.9 to - 5.35). The r-value was more than or equal to 0.92 in neonates ventilated for sepsis, asphyxia and apnoea of prematurity, 0.67 in hyaline membrane disease (HMD) and 0.69 in meconium-aspiration syndrome. In HMD, neonates who received surfactant had a better r-value than those who did not (0.76 vs. 0.6).The correlation between mainstream EtCO2 and PaCO2 is good. Neonates with pulmonary disease will have a lower correlation. Surfactant therapy improves the correlation. EtCO2 monitoring is helpful in trending or screening for abnormal PaCO2 values.