Publications by authors named "Arti Maria"

34 Publications

Clinico-epidemiological profile and outcomes of babies with neural tube defects in a tertiary care center in Northern India.

J Matern Fetal Neonatal Med 2021 Jun 13:1-6. Epub 2021 Jun 13.

Department of Neonatology, Dr Ram Manohar Lohia Hospital and Post Graduate Institute of Medical Education and Research, New Delhi, India, Atal Bihari Vajpayi Institute of Medical Sciences (ABVIMS) and Dr Ram Manohar Lohia Hospital, New Delhi, India.

Introduction: Neural tube defects constitute a major source of disability among children. Proper management requires accurate diagnosis, an assessment of the severity of the lesion, a decision whether intervention is warranted, the nature of the intervention, and educating the family of the need for lifelong medical care. But to do so, reliable data regarding presentation and outcome is very crucial.

Aim Of The Study: To discuss the clinical epidemiological profile and outcome of babies admitted with neural tube defects (NTDs).

Material And Methods: Retrospective observational study was done by extracting data from case notes and follow-up files in Department of Neonatology, PGIMER and Dr. RML Hospital, New Delhi over a period from March 2015 to July 2020.

Results: A total of 25 babies were included in the study. Majority of babies were born to mother at a median age group of 24 (19-36) yrs and nearly one-third of them were illiterate. The history of maternal periconceptional folic acid intake was seen in only five babies (21%). Two third of babies were male (64%) and the median age at admission was at 9 (1-27) days of life. Majority of the cases were open types of NTDs with most common type being meningomyelocele (88%) followed by occipital encephalocele (12%) and there was one case of closed type of neural tube defect having lipomeningomyelocele (4%). The most common associated anomaly was hydrocephalus (76%) followed by Arnold chiari malformation (56%). Motor weakness in form of paraparesis or paraplegia was present in 21 (84%) babies and sensory deficit was present in 44% babies. Bowel and bladder dysfuntion was present in 48% of cases. Ventriculitis was the most common associated morbidity (38%). Meningomyelocele (MMC) repair was the most commonly performed primary surgery (33%) followed by Ventriculo-peritoneal (VP) shunt repair (24%). Twelve babies (48%) were discharged while 2 (8%) expired and 11 (44%) babies left against medical advice.

Conclusion: Neural tube defect is a congenital disorder with significant morbidity. The clinical severity of the NTDs and the uncertainty in their cause makes this a priority for further research. National policies for prevention, in utero diagnosis, and early surgical intervention are required for a better prognosis.
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http://dx.doi.org/10.1080/14767058.2021.1937102DOI Listing
June 2021

Assessment of feasibility and acceptability of family-centered care implemented at a neonatal intensive care unit in India.

BMC Pediatr 2021 04 13;21(1):171. Epub 2021 Apr 13.

Vridhi Project, New Delhi, India.

Background: A family-centered care (FCC) parent participation program that ensures an infant is not separated from parents against their will was developed for the caring of their small or sick newborn at a neonatal intensive care unit (NICU) in Delhi, India. Healthcare provider sensitization training directed at psychosocial and tangible support and an audio-visual training tool for parent-attendants were developed that included: 1) handwashing, infection prevention, protocol for entry; 2) developmentally supportive care, breastfeeding, expression of breastmilk and assisted feeding; 3) kangaroo mother care; and 4) preparation for discharge and care at home. The study aimed to examine the feasibility and acceptability of the FCC model in a NICU in India.

Methods: A prospective cohort design collected quantitative data on each parent-attendant/infant dyad at enrollment, during the NICU stay, and at discharge. Feasibility of the FCC program was measured by assessing the participation of parent-attendants and healthcare providers, and whether training components were implemented as intended. Acceptability was measured by the proportion of parent-attendants who participated in the trainings and their ability to accurately complete program activities.

Results: Of 395 NICU admissions during the study period, eligible participants included 333 parent-attendant/infant dyads, 24 doctors, and 21 nurses. Of the 1242 planned parent-attendant training sessions, 939 (75.6%) were held, indicating that program fidelity was high, and the majority of trainings were implemented as intended. While 50% of parent-attendants completed all 4 FCC training sessions, 95% completed sessions 1 and 2; 60% of the total participating parent-attendants completed session 3, and 75% completed session 4. Compliance rates were over 96% for 5 of 10 FCC parent-attendant activities, and 60 to 78% for the remaining 5 activities.

Conclusions: FCC was feasible to implement in this setting and was acceptable to participating parent-attendants and healthcare providers. Parents participated in trainings conducted by NICU providers and engaged in essential care to their infants in the NICU. A standard care approach and behavior norms for healthcare providers directed psychosocial and tangible support to parent-attendants so that a child is not separated from his or her parents against their will while receiving advanced care in the NICU.
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http://dx.doi.org/10.1186/s12887-021-02644-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8042842PMC
April 2021

Microvillous inclusion disease as a cause of severe congenital diarrhea in a newborn.

J Matern Fetal Neonatal Med 2021 Apr 11:1-3. Epub 2021 Apr 11.

Department of Pathology, Dr. RML Hospital, New Delhi, India.

Microvillous inclusion disease (MVID), also known as congenital microvillus atrophy remains an important differential diagnosis of intractable secretory diarrhea in neonatal period. The condition is inherited as an autosomal recessive disorder with no sex predilection and more commonly reported in those tribes with consanguineous marriages. The pathognomonic electron microscopic findings includes villous atrophy with the formation of intracellular microvillous inclusions. Definite treatment includes either isolated small bowel or combined small bowel and liver transplantation. Herein, we are describing a case of intractable diarrhea in a preterm neonate with MVID phenotype presented on second day of life with intractable diarrhea. The diagnosis was established by classical electron microscopic findings in the intestinal biopsy sample.
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http://dx.doi.org/10.1080/14767058.2021.1910656DOI Listing
April 2021

An Assessment of Implementation of Family Participatory Care in Special Newborn Care Units in Three States of India.

Indian Pediatr 2021 Apr 2;58(4):349-353. Epub 2021 Jan 2.

Child Health Division, Ministry of Health and Family Welfare, Government of India, New Delhi, India.

Objective: To study special newborn care units (SNCUs) in terms of family participatory care (FPC) quality initiative as per Government of India guidelines in select public health facilities, and to document the perspectives of the doctors and mothers.

Design: Cross-sectional.

Settings: SNCUs with functional FPC units in the states of Odisha, Madhya Pradesh and Rajasthan.

Participants: 38 SNCUs; doctors and nurses in-charge of the unit; and two eligible mothers per unit, one inside the step-down unit and second outside the step-down unit whose newborns were admitted to special new-born care unit, having a stable baby weighing above 1500 g.

Intervention: The states implemented FPC as per Government of India guidelines using National Health Mission funds across special newborn care units. This assessment involved onsite observation and interviews of key providers.

Outcome: Proportion of facilities providing regular counselling sessions, enabling support to mothers, recording FPC information; perspectives of health providers on improvement of breastfeeding and kangaroo mother care; proportion of eligible mothers practicing FPC, exclusively breastfeeding, and providing kangaroo mother care services.

Results: Out of 38 SNCUs, we found that FPC sessions for mothers were happening in 36 (95%) facilities. SNCUs provided enabling support to mothers on FPC (74.2%), held regular sessions for the families (70.6%), nurses assisted mothers and family members for breastfeeding and kangaroo mother care (76.4%) and FPC information were recorded (70.6%).

Conclusions: The assessment of facilities where FPC was implemented showed that SNCUs were equipped to implement FPC in public health settings.
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April 2021

Possible Early Vertical Transmission of COVID-19 from an Infected Pregnant Female to Her Neonate: A Case Report.

J Trop Pediatr 2021 01;67(1)

Department of Neonatology, ABVIMS and Dr. RML Hospital, New Delhi 110001, India.

Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-19) has emerged as a public health emergency in recent times. The reported data on the mode of transmission of coronavirus disease 2019 (COVID-19) are largely through contact, droplet, airborne and fomite transmission methods with vertical transmission being a rare entity. We hereby report a case of a probable vertical transmission of SARS-CoV-19 from an infected pregnant female to her neonate. The transmission has been confirmed by a positive RT-PCR at 16 h of life along with a positive IgG antibody test for SARS-CoV-19 in the baby and after excluding the possible environmental contamination of the sample. The baby was asymptomatic during the course of hospital stay and was discharged from the facility on Day 9 of life.
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http://dx.doi.org/10.1093/tropej/fmaa094DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7717437PMC
January 2021

Long-Term Neurodevelopmental Outcomes of Neonatal Chikungunya: Follow-Up of a Series of Cases Till 1 Year.

J Trop Pediatr 2020 Aug 5. Epub 2020 Aug 5.

Department of Neonatology, ABVIMS and Dr RML Hospital, New Delhi 110001, India.

Objectives: Short- or long-term neurodevelopmental outcomes of Neonatal Chikungunya infection haven't been well described. In this study, we describe neurodevelopmental outcomes of a series of 13 infants.

Methods: Study was conducted over a period of 1 year in high-risk follow-up clinic. Follow-up visits were conducted at 3, 6, 9, 12 ± 3 months.

Primary Outcome: Development Quotient by Developmental Assessment Scales for Indian Infants. Secondary outcome: growth/anthropometric assessment, neuromotor/neurosensory and re-hospitalization rate.

Results: DASII was <85 in three infants. Two other had expressive speech delay. Two, three and four babies had head circumference, length and weight below third centile, respectively. Two infants had persistent hypertonia and one had hypotonia. Two infants developed strabismus. Two infants had seizures persisting at 12 months requiring re-hospitalization.

Conclusion: Neonatal Chikungunya infection portends a poor neurodevelopmental outcome at 1 year of age. Careful neurodevelopmental follow-up is required for identification and management of sequelae.
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http://dx.doi.org/10.1093/tropej/fmaa053DOI Listing
August 2020

Periviable Birth - The Ethical Conundrum: Few concerns.

Indian Pediatr 2019 08;56(8):695-696

Department of Neonatology, PGIMER and Dr RML Hospital, New Delhi, India.

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August 2019

Congenital scars: a rare presentation of neonatal lupus.

Arch Dis Child Fetal Neonatal Ed 2019 Nov 30;104(6):F630. Epub 2019 Jul 30.

Department of Dermatology, Postgraduate Institute of Medical Education and Research and Dr Ram Manohar Lohia Hospital, New Delhi, India.

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http://dx.doi.org/10.1136/archdischild-2019-317141DOI Listing
November 2019

Case 1: Oral Burns as a Presentation of Accidental Organophosphorus Poisoning in a Neonate.

Neoreviews 2019 01;20(1):e37-e40

Department of Endocrinology, King George's Medical University, Lucknow, India.

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http://dx.doi.org/10.1542/neo.20-1-e37DOI Listing
January 2019

Facilitating Behavior Modification of 'Problem Resident': A Paradigm Shift in Approach.

Indian Pediatr 2019 04;56(4):339-340

Independent Consultant, New Delhi, India.

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April 2019

Acceptability of a family-centered newborn care model among providers and receivers of care in a Public Health Setting: a qualitative study from India.

BMC Health Serv Res 2019 Mar 21;19(1):184. Epub 2019 Mar 21.

Department of Neonatology, PGIMER & assoc. Dr. RML Hospital, New Delhi, India.

Background: Family-centered care (FCC), based on collaborative participation of the family along with a team of health care providers, is found to increase the well-being of sick infants in neonatal critical care units. Over the last 4 years, the neonatal unit of Dr. Ram Manohar Lohia Hospital in Delhi has innovated and developed an implementation framework for FCC. This qualitative study assessed the acceptability of family-centered care among providers and family members of neonates to identify gaps and challenges in implementation.

Methods: In-depth interviews were conducted among a purposive sample of twelve family members of admitted neonates and six providers to examine their perceptions and experiences regarding FCC.

Results: Family members and providers expressed a positive perception and acceptance of FCC based on the competencies and knowledge acquired by parents and other caregivers of essential newborn care. Family members reported being satisfied with the overall health care experience due to the transparency of care and allowing them to be by their baby's bedside. Limitations in the infrastructure or lack of facilities at the public hospital did not seem to dilute these positive perceptions. Providers also perceived FCC as a good practice to be continued in spite of concerns around sharing of nursery space with parents, the need for constant vigilance of parents' practices in handling of their newborns, and the need for separate, designated nursing staff for FCC.

Conclusion: Both providers and receivers of neonatal care found FCC to be an acceptable form of care. Providers identified challenges and suggested possible solutions, such as need of periodic provider sensitization on FCC, improved staff organization, and provision of mother-friendly facilities to enable her to provide around-the-clock care by her baby's bedside. Overcoming these challenges would allow for better integration of FCC within general clinical care in neonatal care units.
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http://dx.doi.org/10.1186/s12913-019-4017-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6427855PMC
March 2019

Resurgence of Chikungunya: A New Threat to Public Health: Authors' Reply.

Indian Pediatr 2018 11;55(11):1009

Department of Neonatology, PGIMER and Dr RML Hospital, New Delhi, India.

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November 2018

Achieving Early Mother-baby Skin-to-skin Contact in Caesarean Section: A Quality Improvement Initiative.

Indian Pediatr 2018 Sep;55(9):765-767

Department of Anaesthesia, Postgraduate Institute of Medical Education and Research and Dr RML Hospital, New Delhi, India.

Objective: To improve rate of skin-to-skin contact for early initiation of breastfeeding at birth on operation table among healthy term and late pretem babies born by caesarean sections from 0% to 80% in eight weeks.

Methods: A quality improvement initiative was undertaken at maternity-newborn care unit of a tertiary-care hospital. A team involving Neonatologists/Pediatricians, Obstetricians, Anaesthesiologists, and Nurses in concerned areas identified problem areas using Fish bone analysis. Situational analysis was done through process flow mapping. Three Plan-do-study-act cyles were undertaken. Firstly, sensitization of personnel was done and a written policy was made. Secondly, maternal counselling and procedural modifications were done. Lastly, efforts were made to improve duration of contact.

Results: Rate of early skin-to-skin contact after Plan-do-study-act cycle 1, 2 and 3, respectively was 87.5%, 90% and 83.3%. It was 100% after sustainability phase after four months.

Conclusion: Early skin-to-skin contact was achievable through sensitization of all persons involved and simple procedural changes. Prolonging duration of contact remained a challenge.
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September 2018

Encephalitic presentation of Neonatal Chikungunya: A Case Series.

Indian Pediatr 2018 Aug;55(8):671-674

Department of Radiology, Postgraduate Institute of Medical Education and Research and Dr RML Hospital, New Delhi, India.

Objective: To describe clinical features and early neurological outcomes in neonatal Chikungunya.

Methods: Clinical, pathological and radiological details of neonates with acute encephalitic features and typical rash, later diagnosed as Chikungunya, are presented. Neurodevelopmental evaluation and imaging was done at discharge/three months.

Results: Abnormal neurological examination with fever was typical presentation in all 13 babies with/without seizures/peri-oral rashes; 12 had persistent neurological abnormalities at discharge. A follow-up at three months revealed continued neurodevelopmental deficits. Neuroimaging abnormalities were seen in eight out of ten cases.

Conclusions: Perinatal Chikungunya should be considered in neonates presenting within first week with fever, encephalopathy and perioral rashes with/without seizures with history of maternal Chikungunya within last week before delivery.
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August 2018

Neurodevelopmental disorders in children aged 2-9 years: Population-based burden estimates across five regions in India.

PLoS Med 2018 07 24;15(7):e1002615. Epub 2018 Jul 24.

Department of Neurology, Paras Hospital, Gurugram, Haryana, India.

Background: Neurodevelopmental disorders (NDDs) compromise the development and attainment of full social and economic potential at individual, family, community, and country levels. Paucity of data on NDDs slows down policy and programmatic action in most developing countries despite perceived high burden.

Methods And Findings: We assessed 3,964 children (with almost equal number of boys and girls distributed in 2-<6 and 6-9 year age categories) identified from five geographically diverse populations in India using cluster sampling technique (probability proportionate to population size). These were from the North-Central, i.e., Palwal (N = 998; all rural, 16.4% non-Hindu, 25.3% from scheduled caste/tribe [SC-ST] [these are considered underserved communities who are eligible for affirmative action]); North, i.e., Kangra (N = 997; 91.6% rural, 3.7% non-Hindu, 25.3% SC-ST); East, i.e., Dhenkanal (N = 981; 89.8% rural, 1.2% non-Hindu, 38.0% SC-ST); South, i.e., Hyderabad (N = 495; all urban, 25.7% non-Hindu, 27.3% SC-ST) and West, i.e., North Goa (N = 493; 68.0% rural, 11.4% non-Hindu, 18.5% SC-ST). All children were assessed for vision impairment (VI), epilepsy (Epi), neuromotor impairments including cerebral palsy (NMI-CP), hearing impairment (HI), speech and language disorders, autism spectrum disorders (ASDs), and intellectual disability (ID). Furthermore, 6-9-year-old children were also assessed for attention deficit hyperactivity disorder (ADHD) and learning disorders (LDs). We standardized sample characteristics as per Census of India 2011 to arrive at district level and all-sites-pooled estimates. Site-specific prevalence of any of seven NDDs in 2-<6 year olds ranged from 2.9% (95% CI 1.6-5.5) to 18.7% (95% CI 14.7-23.6), and for any of nine NDDs in the 6-9-year-old children, from 6.5% (95% CI 4.6-9.1) to 18.5% (95% CI 15.3-22.3). Two or more NDDs were present in 0.4% (95% CI 0.1-1.7) to 4.3% (95% CI 2.2-8.2) in the younger age category and 0.7% (95% CI 0.2-2.0) to 5.3% (95% CI 3.3-8.2) in the older age category. All-site-pooled estimates for NDDs were 9.2% (95% CI 7.5-11.2) and 13.6% (95% CI 11.3-16.2) in children of 2-<6 and 6-9 year age categories, respectively, without significant difference according to gender, rural/urban residence, or religion; almost one-fifth of these children had more than one NDD. The pooled estimates for prevalence increased by up to three percentage points when these were adjusted for national rates of stunting or low birth weight (LBW). HI, ID, speech and language disorders, Epi, and LDs were the common NDDs across sites. Upon risk modelling, noninstitutional delivery, history of perinatal asphyxia, neonatal illness, postnatal neurological/brain infections, stunting, LBW/prematurity, and older age category (6-9 year) were significantly associated with NDDs. The study sample was underrepresentative of stunting and LBW and had a 15.6% refusal. These factors could be contributing to underestimation of the true NDD burden in our population.

Conclusions: The study identifies NDDs in children aged 2-9 years as a significant public health burden for India. HI was higher than and ASD prevalence comparable to the published global literature. Most risk factors of NDDs were modifiable and amenable to public health interventions.
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http://dx.doi.org/10.1371/journal.pmed.1002615DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6057634PMC
July 2018

Diffuse neonatal hemangiomatosis presenting as congestive heart failure.

Dermatol Pract Concept 2017 Jul 31;7(3):66-69. Epub 2017 Jul 31.

Department of Neonatology, PGIMER and Dr RML Hospital, Delhi India.

Diffuse neonatal hemangiomatosis is a rare condition with a very high mortality rate if left untreated. We report a neonate having around 490 cutaneous and multiple diffuse liver hemangiomas presenting as congestive heart failure. Prompt treatment was instituted with decongestive drugs and prednisolone for anticipated life threatening complications due to hepatic hemangiomas. Propranolol was added later as it is known to precipitate congestive failure and also to avoid long-term complications of steroids. The child responded well. However, there is no consensus regarding the initial line of management, which needs to be individualized keeping in mind the efficacy, long-term side effects of the drug and the clinical presentation.
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http://dx.doi.org/10.5826/dpc.0703a15DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5661156PMC
July 2017

Family-Centered Care: Beginning of a New Era in India: Authors Reply.

Indian Pediatr 2017 09;54(9):788-789

Department of Neonatology, PGIMER RML Hospital, and #Department of Pediatrics, HIMSR and HAH Centenary Hospital; New Delhi, India.

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September 2017

Acute respiratory distress syndrome in a neonate due to possible transfusion-related acute lung injury.

Asian J Transfus Sci 2017 Jul-Dec;11(2):203-205

Department of Pediatrics, PGIMER and RML Hospital, New Delhi, India.

Transfusion-related acute lung injury (TRALI) is a potentially life-threatening complication of blood component transfusion. It is relatively underdiagnosed entity in neonates with scant literature. We report a case of TRALI in a preterm neonate developing acute respiratory distress within 6 h of blood product transfusion in the absence of preexisting lung disease. Prompt ventilator and supportive management were instituted. The baby showed clinical and radiological improvement within 12 h; however, he succumbed to death due to acute massive pulmonary hemorrhage 36 h later. Possibility of TRALI should be kept if there is sudden deterioration of lung function after blood transfusion.
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http://dx.doi.org/10.4103/ajts.AJTS_120_16DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5613432PMC
October 2017

Family-Centered Care to Complement Care of Sick Newborns: A Randomized Controlled Trial.

Indian Pediatr 2017 Jun;54(6):455-459

Departments of Pediatrics and $Microbiology, PGIMER and Dr. RML Hospital; *Biostatistics, AIIMS; and #Management Studies, IIT; New Delhi, India. Correspondence to: Dr Arti Maria, Neonatal Division, Department of Pediatrics, PGIMER and Dr. RML Hospital, Baba Kharak Singh Marg, New Delhi, India 110 001.

Objective: To assess the impact of family-centered care in delivery of care to sick newborns, on nosocomial infection rate.

Design: Randomized controlled trial.

Setting: Tertiary referral nursery (October 2010 to March 2012).

Participants: 295 neonates randomized at the time of hospitalization in neonatal intensive care unit.

Intervention: Parent-attendant of intervention group were trained using an indigenously developed and pretested, culturally sensitive, simple audio-video tool that covered domains of personal hygiene, hand washing, danger signs recognition and feeding of sick neonate. Control group received routine care by nurses and doctors.

Outcome Measure: Primary: culture positive nosocomial infection rate. Secondary: culture negative nosocomial infection rate, duration of hospitalization, mortality and breastfeeding rate.

Results: Two-thirds of family caregivers were fathers/ mothers and about 20% were grandparents. About 60% of family care givers were either illiterate (25%) or primary/middle pass (34%). Incidence of nosocomial episodes of sepsis was not different between groups (incidence rate difference 0.74, 95 % CI -4.21, 5.6, P = 0.76). Pre-discharge exclusive breastfeeding rates were significantly higher in intervention group [80.4% vs 66.7% (P=0.007)].

Conclusion: There was no significant difference in nosocomial infection rate between the two groups. Translating and adapting principles of family-centered care was feasible, and improved the pre-discharge exclusive breastfeeding rates.
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http://dx.doi.org/10.1007/s13312-017-1047-9DOI Listing
June 2017

Vancomycin-induced thrombocytopenia in a newborn.

Drug Metab Pers Ther 2016 12;31(4):235-237

Neonatal thrombocytopenia is common and is frequently seen in neonatal sepsis. Drug-induced thrombocytopenia is likely to be missed unless a high index of suspicion is present. Changing of antibiotics for assumed nonresolution of sepsis may lead to persistent thrombocytopenia in a neonate if drug-induced thrombocytopenia is missed. Vancomycin-induced neonatal thrombocytopenia is rarely described in scientific literature. We describe a newborn who was diagnosed with early onset sepsis and vancomycin-induced thrombocytopenia. Other causes of thrombocytopenia such as sepsis, alloimmune thrombocytopenia, thrombosis etc. were excluded. The platelet counts normalized within 72 h of stopping vancomycin. Vancomycin-induced IgM platelet antibodies could not be done in our case (due to financial constraints), but their absence does not exclude the diagnosis of vancomycin-induced thrombocytopenia.
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http://dx.doi.org/10.1515/dmpt-2016-0021DOI Listing
December 2016

A Randomized Trial Comparing Efficacy of Bubble and Ventilator Derived Nasal CPAP in Very Low Birth Weight Neonates with Respiratory Distress.

J Clin Diagn Res 2016 Sep 1;10(9):SC09-SC12. Epub 2016 Sep 1.

Senior Resident, Department of Pediatrics, PGIMER and Dr. RML Hospital , Delhi, India .

Introduction: Continuous Positive Airway Pressure (CPAP) has an established role in the care of Very Low Birth Weight (VLBW) babies with respiratory distress. Bubble CPAP (BCPAP) is a cheap alternative for countries where resources are limited. However, data comparing efficacy of BCPAP with conventional ventilator derived (VCPAP) is limited.

Aim: To compare CPAP failure rates between BCPAP and VCPAP among VLBW, with moderate respiratory distress. Secondary objectives were to compare the rates of Intraventricular Haemorrhage (IVH), pulmonary air leaks and deaths between the two groups and determine the predictors of CPAP failure.

Materials And Methods: VLBW babies with moderate respiratory distress (Silverman Anderson score 4-7), born or admitted in Neonatal Intensive Care Unit (NICU) within 28 days of life were randomized to receive either BCPAP (n=34) or VCPAP (n=34). CPAP failure rate in both the groups was compared.

Results: The baseline characteristics were similar in both the groups. Five out of 34 (14.70%) babies in BCPAP group and 11 out of 34 (32.35%) in VCPAP failed CPAP (p=0.08). IVH (BCPAP group 24% and VCPAP group 9%, p= 0.10) and mortality (BCPAP group 6% and VCPAP group 9%, p=0.642) were comparable in both the groups. Factors such as gestational age <30 weeks, weight <1000 grams, Respiratory Distress Syndrome (RDS), shock, pulmonary haemorrhage, Disseminated Intravascular Coagulation (DIC) and multi-organ dysfunction were significantly associated with CPAP failure in our study.

Conclusion: The CPAP failure rates in VLBW babies with moderate respiratory distress were found to be similar whether bubble CPAP or ventilator CPAP was used. There was no difference in complication rates of IVH or mortality with either method of CPAP.
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http://dx.doi.org/10.7860/JCDR/2016/20584.8572DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5072040PMC
September 2016

Family-centered Care for Sick Newborns: A Thumbnail View.

Indian J Community Med 2016 Jan-Mar;41(1):11-5

Centre of Social Medicine and Community Health, Jawaharlal Nehru University, New Delhi, India.

Family-centered care (FCC) for sick newborns is emerging as a paradigmatic shift in the practice of facility-based newborn care. It seeks to transforming a provider-centered model into a client-centered one and thus build a new therapeutic alliance. FCC is the cornerstone of continuum of care, imparting caregiving competencies to parents/caregivers both within institutions as well as after the discharge. This has potential gains for the newborn, family members, and facility-level staff. The initial model piloted in tertiary-care settings is now undergoing translation at five sites across the country; the outcomes are keenly awaited.
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http://dx.doi.org/10.4103/0970-0218.170957DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4746947PMC
February 2016

Maternal anti-M induced hemolytic disease of newborn followed by prolonged anemia in newborn twins.

Asian J Transfus Sci 2015 Jan-Jun;9(1):98-101

Department of Paediatrics, Dr. Ram Manohar Lohia Hospital, New Delhi, India.

Allo-anti-M often has an immunoglobulin G (IgG) component but is rarely clinically significant. We report a case of hemolytic disease of the fetus and newborn along with prolonged anemia in newborn twins that persisted for up to 70 days postbirth. The aim was to diagnose and successfully manage hemolytic disease of newborn (HDN) due to maternal alloimmunization. Direct antiglobulin test (DAT), antigen typing, irregular antibody screening and identification were done by polyspecific antihuman globulin cards and standard tube method. At presentation, the newborn twins (T1, T2) had HDN with resultant low reticulocyte count and prolonged anemia, which continued for up to 70 days of life. Blood group of the twins and the mother was O RhD positive. DAT of the both newborns at birth was negative. Anti-M was detected in mothers as well as newborns. Type of antibody in mother was IgG and IgM type whereas in twins it was IgG type only. M antigen negative blood was transfused thrice to twin-1 and twice to twin-2. Recurring reduction of the hematocrit along with low reticulocyte count and normal other cell line indicated a pure red cell aplastic state. Anti-M is capable of causing HDN as well as prolonged anemia (red cell aplasia) due to its ability to destroy the erythroid precursor cells. Newborns with anemia should be evaluated for all the possible causes to establish a diagnosis and its efficient management. Mother should be closely monitored for future pregnancies as well.
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http://dx.doi.org/10.4103/0973-6247.150968DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4339947PMC
February 2015

An unusual association of microcephalic osteodysplastic primordial dwarfism type I with cardiac and brain anomalies.

J Clin Neonatol 2014 Jan;3(1):53-4

Department of Pediatrics, PGIMER and Dr. Ram Manohar Lohia Hospital, New Delhi, India.

Less than 100 cases of primordial dwarfism have been reported worldwide out of which Microcephalic osteodysplastic primordial dwarfism type I comprise about <30 cases. We report a rare case of extreme growth failure in a neonate with primordial dwarfism of antenatal onset due to Microcephalic osteodysplastic primordial dwarfism type I. Our case is also unique in being associated with hitertho unreported association of subpulmonic ventricular septal defect and a dorsal interhemispheric cyst in the brain.
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http://dx.doi.org/10.4103/2249-4847.128743DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3982344PMC
January 2014

Lethal progressive thoracic insufficiency in a neonate due to jarcho levin syndrome.

J Clin Neonatol 2014 Jan;3(1):49-50

Department of Pediatrics, Medanta Medicity Hospital, New Delhi, India.

A rare case of Jarcho Levin syndrome (JLS) presenting as a lethal progressive respiratory insufficiency in early neonatal period is reported. The neonate had classical features of this syndrome including vertebral segmentation defects, typical costo-vertebral fusion defects and scoliosis resulting in small thoracic volume and limited chest expansion; all consistent with a clinical diagnosis of JLS with thoracic insufficiency. In addition, our case had a rare association of dextrocardia and acyanotic congenital heart disease.
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http://dx.doi.org/10.4103/2249-4847.128739DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3982342PMC
January 2014

Comparison of oral ibuprofen with oral indomethacin for PDA closure in Indian preterm neonates: a randomized controlled trial.

Pediatr Cardiol 2014 Jun 17;35(5):824-30. Epub 2014 Jan 17.

Department of Pediatrics, PGIMER & Associated Dr RML Hospital, New Delhi, India.

Oral ibuprofen is being used as an alternative to indomethacin in medical management of patent ductus arteriosus (PDA), but limited data exist on oral efficacy of these drugs for PDA closure in India. To assess and compare the efficacy of oral ibuprofen and oral indomethacin for PDA closure in preterm Indian neonates, we designed a randomized controlled study on clinically diagnosed and echocardiographically confirmed hemodynamically significant PDA in preterm neonates. Patients were assigned to receive either oral ibuprofen at a dosage of 10, 5, 5 mg/kg every 24 h or three doses of oral indomethacin (0.20-0.25 mg/kg every 24 h) starting on the third day of life or when diagnosed. A second course of ibuprofen/indomethacin was given, if PDA failed to close within 48 h after the first course. Patients were monitored for complications like oliguria, bleeding, necrotizing enterocolitis, intraventricular hemorrhage, oxygen dependency, and gastrointestinal side effects. The baseline characteristics were comparable in both groups. Of the 83 children enrolled, 57.8 % received oral ibuprofen and 42.1 % received oral indomethacin. The overall closure rate of PDA was 60 and 65.7 % in the ibuprofen and indomethacin groups, respectively. Closure rate was significantly higher when the drugs were administered at an early postnatal age (<8 days) (83.3 % [p = 0.02] in the indomethacin group and 75 % [p = 0.03] in the ibuprofen group) in neonates >28 weeks (ibuprofen group 66.7 % [p = 0.02]; indomethacin group 65.5 % [p = 0.04]) and in babies with birth weight >1,000 g (ibuprofen group 62.2 %; indomethacin group 70 % [p = 0.04 in both groups]). Complications were similar in both groups. The efficacy of both drugs was similar. Poor closure in our study could be because of genetic differences in pharmacokinetics of drug metabolism in the Indian population. Regimens with higher doses or increased duration of treatment may increase the frequency of closure. Studies with larger numbers of subjects with evaluation of pharmacokinetic parameters are therefore required.
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http://dx.doi.org/10.1007/s00246-014-0861-2DOI Listing
June 2014

Frequency and characteristics of infections caused by extended-spectrum beta-lactamase-producing organisms in neonates: a prospective cohort study.

Biomed Res Int 2013 24;2013:756209. Epub 2013 Sep 24.

Department of Paediatrics & Neonatology, PGIMER & Associated Dr. Ram Manohar Lohia Hospital, Baba Kharag Singh Marg, New Delhi 110001, India.

This prospective cohort study was conducted to determine the frequency of infections caused by extended-spectrum beta-lactamase- (ESBL-) producing organisms, various bacteria producing ESBL, antibiotic susceptibility of these organisms, and the risk factors associated with these infections in a neonatal intensive care unit in a tertiary care hospital in North India. Of the 150 neonates enrolled in the study, 47 culture-positive neonates were included in the study cohort and were divided into two groups: ESBL-positive (8 neonates) and ESBL-negative (39 neonates) cohorts. Various organisms were isolated from 72 culture samples in these 47 neonates. Of these, 10 culture samples grew ESBL-positive organisms and 62 samples grew ESBL-negative organisms. The frequency of ESBL-producing organisms was found to be 5.3%. ESBL infection incidence densities were found to be 3.4 per 1000 patient-days. Klebsiella (60%) was the most common organism producing ESBL followed by Escherichia coli (30%) and Pseudomonas (10%). Eighty percent of the ESBL-producing organisms were sensitive to piperacillin-tazobactam. Risk factors found significant by univariate analysis (P < 0.05) were preterm, low birthweight, perinatal asphyxia, respiratory distress syndrome, anaemia, metabolic acidosis, prolonged mechanical ventilation (>7 days), length of hospitalization, length of level 3 stay, prior antibiotic use, central venous catheter duration, peripherally inserted central venous catheter duration, and total parenteral nutrition duration. Factors that retained significance in the logistic regression model were duration of hospital stay (adjusted OR: 0.958, CI: 0.920-0.997, and P value = 0.037) and gestational age (adjusted OR: 1.39, CI: 1.037-1.865, and P value = 0.028). There was no significant difference in the mortality between the two groups.
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http://dx.doi.org/10.1155/2013/756209DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3794505PMC
June 2014

Intractable diarrhoea caused by cytomegalovirus enterocolitis in an immunocompetent term neonate.

J Trop Pediatr 2013 Dec 18;59(6):509-11. Epub 2013 Jun 18.

Department of Pediatrics, PGIMER & Dr RML Hospital, New Delhi 110001, India.

Symptomatic cytomegalovirus (CMV) infection mainly affects preterm and immunocompromised infants and usually manifest as rash, pneumonia, hepatospleenomegaly or encephalitis. To our knowledge intractable diarrhoea at two weeks of age caused by postnatally acquired CMV in immunocompetent term neonate is not reported. An unusual case of postnatally acquired CMV enterocolitis manifesting as protracted diarrhoea in an immunocompetent baby in neonatal period is reported. We conclude that CMV should be considered in the differential diagnosis of intractable diarrhoea in neonatal period and treatment with intravenous ganciclovir for CMV enterocolitis is not only indicated but is therapeutic.
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http://dx.doi.org/10.1093/tropej/fmt052DOI Listing
December 2013

Pharyngoesophagoplasty, posterior laryngotracheoplasty, and esophagotracheoplasty for Type III laryngotracheoesophageal cleft with a distal tracheobronchoesophageal cleft.

Eur J Pediatr Surg 2012 Jun 10;22(3):260-3. Epub 2012 May 10.

Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research, Dr RML Hospital, New Delhi, India.

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http://dx.doi.org/10.1055/s-0032-1308708DOI Listing
June 2012

Mycoplasma pneumoniae as a cause of non-resolving pneumonia in a neonate.

J Med Microbiol 2010 Jun 25;59(Pt 6):731-732. Epub 2010 Feb 25.

Department of Microbiology, Maulana Azad Medical College, New Delhi 110002, India.

Mycoplasma pneumoniae is known to be the chief causative organism for community-acquired non-lobar pneumonia in children of 5-15 years of age. M. pneumoniae as an aetiological agent for pneumonia among neonates and infants has rarely been reported. We report here a case of persistent pneumonia due to M. pneumoniae in a 3-week-old neonate.
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http://dx.doi.org/10.1099/jmm.0.017491-0DOI Listing
June 2010