European Journal of Molecular & Clinical Medicine

The advancement of modern Neonatology has led to more and more survival of babies at lower gestation age. Late preterm babies (born between 33 completed weeks of gestation and before beginning of 38 week of gestation) are the largest growing set of babies among premature babies. They look developmentally and physically more mature and hence often overlooked. They constitute one of the largest subsets of babies requiring hospitalization. This study was conducted to look at the readmission rates of late and early preterm babies in the first month of life with aim to look at various determinants of readmissions.
Aim: A study on readmission of late-preterm and early-term neonates in the first month of life following normal hospital discharge
Materials: Hospital based prospective observational study from Apr 2016 to Oct 2017 in a tertiary care hospital in western India to study the readmission rate of late-preterm and early-term neonates in the first month of life following normal hospital discharge.
Result: There were total 22 (7.1%) admissions among the study population, of which 13 (9.3%) were late preterm neonates and 9 (5.3%) early term neonates. Common causes of readmission were Neonatal hyperbilirubinemia in 12(55%) followed by feeding issues in 8 (36%), hypernatremic dehydration in 5 (23%) and late onset sepsis in 2 (9%) neonates.
Conclusion: Late preterm babies are vulnerable group of population as highlighted by their high rates of readmission. Jaundice and feeding problems were the most common diagnoses associated with readmission.

Background: Birth weight is an important determinant of child survival and development. Low birth weight (LBW) is an index of our status of public health, maternal health and nutrition. The major challenge in the field of public health is to identify the factors influencing low birth weight and to institute remedial measures.
Aim: The aim of this study was attempted to assess incidence of low birth weight and its risk factors affecting low birth weight.
Materials and methods: A cross sectional study design was carried out in a tertiary care government hospital.A total of 1120 postnatal mothers who delivered in the hospital during study period were included in the study except still births. All babies were weighted on standard beam balance within 24 hours of delivery and mother’s height was measured by height measuring stand. The collected data was analyzed using statistical package for the social sciences (SPSS) version 22.
Results and analysis:incidence of LBW neo-born babies was 240/1120 (21.4%)where 104 (43.3%) were males and 136 (56.7%) were female babies. Mean age of the mothers was 23.52±3.16 years; mean weight noted was 58.94±10.09 kg and mean height was 159.1±7.15 cm. The study showed associations between birth weight and mother’s age, weight, height, hemoglobin (Hb) %, birth interval, income, bad obstetric history and complications
Discussion and conclusion: The incidence of low birth weight was found to be very high and it was associated with many risk factors related to maternal health and services. Hence it is recommended to improve maternal health through strengthening the existing maternal services at the basic level of community.

To study hypertension induced by pregnancy and neonatal outcomes.
Materials & methods: A total of 200 premature newborns of gestational age (GA) between 20 and 35 weeks and 5 days, born alive were included. In total, 90 infants were born to hypertensive mothers (G1) and 110 to normotensive mothers (G2). The data was recorded. The results were analysed using SPSS software.
Results: The anthropometric measurements of birth weight were significantly lower in G1. Resuscitation in the delivery room and the need to use surfactant and oxygen dependence at 36 weeks of gestational age did not differ between groups.
Conclusion: There was no difference in weight and survival at 18 months of chronological age.

Background: Deficiency of pulmonary surfactant is one of the most important factors contributing to the development of respiratory RDS [1]. In immature lungs, the elevated surface tension resulting from surfactant deficiency leads to alveolar collapse at the end of expiration, atelectasis, uneven inflation and regional alveolar over distension. Improved use of antenatal steroids, labour room CPAP, trial of CPAP before intubation and caffeine have changed the way a preterm baby with RDS is managed in the last decade. Many babies with RDS who used to receive prophylactic or early rescue surfactant are now managed with CPAP alone, others are administered surfactant only if they fail CPAP. But, in this process of trial of CPAP, a few babies receive surfactant as “late rescue” after few hours of trial of CPAP. Objective: To evaluate factors determining long duration of respiratory support (CPAP/ventilation > 120 hours) in VLBW babies in Indian NICU.
Aims and Objectives: To evaluate factors determining long duration of respiratory support (CPAP/ventilation > 120 hours) in VLBW babies in Indian NICU.
Material and Methods: A prospective longitudinal study was conducted at RDJM Medical College, Muzaffarpur, Bihar, India from October 2021 to September 2022. All legally viable preterm babies < 32 weeks and < 1500 grams (inborn or out born admitted within 2 hours of birth) were included in the study. A total of 50 Babies were included in the study.
Results and Observations: Out of 50 babies 9 babies were excluded from analysis due to major malformation in 6 and referral of 3 cases. A definite association was noted between gestation (86% of<28 weeks 46% of 29-30, 18% of 31-32 weeks babies, p=0.02) and long duration of respiratory support. Boys vs girls (61% vs 32%, p=0.06), babies born after spontaneous labor vs delivery for maternal/fetal reasons (67% vs 32%, P0.06) were likely to require long duration of respiratory support

Neonatal period is the most susceptible period of life as diseases occurring during this period are majorly preventable. Nearly two third of infant deaths occur within first 28 days of life¹, out of which maximum deaths occur within first week of life ². Nearly 98% of total deaths in neonatal period are mainly caused by infection, asphyxia, LBW and prematuriy².
Objectives:
1)     To study the morbidity patterns and treatment outcomes in neonates managed in Sick Newborn Care Units of Lucknow.
2)     To suggest measures (if, any) to improve the services provided for management of neonates in Sick Newborn Care Units.
Methods: A descriptive cross-sectional study was conducted among 360 neonates managed in Sick Newborn Care Units of district Lucknow. Out of 5 government SNCUs in Lucknow, 3 were randomly chosen. The schedule was pretested on 10 percent of the total sample of neonates admitted to SNCU.
Results: Out of 360 neonates, 65.8% were directly admitted with presenting complain of low birth weight. Majority (88.1%) of neonates were successfully discharged, while 3.1% got expired. Most of the deaths were reported due to respiratory distress syndrome.
Conclusions: The results of the study indicated that all health care providers need to be extensively trained on sick newborn care. Women need to be educated more on neonatal and early neonatal care. The community needs to be informed and made aware of Sick Newborn Care Units.

Background:Neonatal septicemia is a clinical syndrome characterized by signs and symptoms of infection with accompanying bacteremia in the first month of life. Despite continuing advances in diagnosis and treatment, it remains one of the important causes of higher mortality and morbidity.Aim of our study is to evaluate the changes of platelet count and indices (MPV, PDW) in neonatal sepsis.
Materials and Methods: It is a prospective crossectional study conducted in Tertiary health center (PRATHIMA INSTITUTE OF MEDICAL SCIENCES) in the DEPARTMENT OF PATHOLOGY in colloboration with neonatology section over a time period of 7 months from January to August 2019.Using convenient sampling method, 100 neonates with sepsis and 100 normal neonates without any medical problems, as the control group were selected. Weight and gestational age matched healthy neonates without any infectious disease served as control. The groups were compared for age, WBC count, neutrophil count, platelet count, PDW AND MPV.
Results: In our study out of 100 cases, early onset sepsis was present in 30 cases, while late onset neonatal sepsis was present in 70 cases.40 neonates showed culture positivity and the remaining 60 showed culture negative sepsis. Statistically significant correlation of MPV with platelet count(high MPV in thrombocytopenic neonates) and outcome. Significant difference in PDW in thrombocytopenic neonates and non-thrombocytopenic neonates. Neonates with sepsis have significantly increased MPV, PDW compared to healthy neonates.
Conclusion: Platelet count and indices can be used as early diagnostic markers in neonatal sepsis. Neonates with sepsis have significantly increased MPV, PDW compared to healthy neonates. Platelet indices are inexpensive and easily available tests can be routinely performed for all neonates suspected to be in sepsis.

Background: Neonates pose a challenge in Neonatal intensive care unit (NICU) for central vascular access, which represents a daily practice. We have reported our experience with Central venous cut down through long saphenous vein (LSV) at sapheno-femoral junction (SF), its indications, feasibility and complications.
Objective: To assess the feasibility of insertion of central line by Sapheno-femoral (SF) cut down.
Methods: This is a retrospective study carried out in a Tertiary care hospital in a Metropolitan city of India. All the neonates who required Central venous access were included in the study.
Results: In our setting 176 neonates required LSV cut down for vascular access over a period of 3 years (2019-2022). The mean weight of the neonates was 1980 grams (range 680-4.1kg). The mean day at which the catheter was inserted was 7.1 days. Out of 176 neonates 8 neonates required vascular access for surgical condition and remaining 168 for medical condition. In 10 neonates the central line was inserted in operation theatre under general anesthesia. In the remaining 166 neonates the catheter was inserted in NICU under local anaesthesia. The mean time required for insertion of catheter was 14.2 minutes. The most common indications for Central line insertion included Sepsis, Respiratory distress syndrome, prematurity. The complications of CVL in our setting were central line induced sepsis followed by limb oedema.
Conclusion: Open surgical cut down of long Saphenous vein is feasible and a safe procedure, It can be performed as a bedside procedure without the need for General anaesthesia.

Introduction: Hyperbilirubinemia is the most common morbidity in normal term healthy
newborn. There is evidence that cord blood albumin (CBA) level can act as a potential marker
for the prediction of hyperbilirubinemia in neonates. The present study was therefore designed
to establish a correlation between the level of cord blood albumin (CBA) and total serum
bilirubin (TSB) so that albumin level could be standardized as a prediction marker for the
neonatal hyperbilirubinemia.
Methods: CBA and TSB levels were analysed in 500 normal term healthy newborns with birth
weight ≥2500 grams and APGAR score ≥ 7/10 at 1 min and 5 mins, after obtaining consent
from their parents. Albumin levels were analysed from the cord blood at the time of birth and
TSB levels were analysed from venous blood. Pearson’s correlation coefficient was used to
analyse the correlation between CBA and TSB levels.
Results: The mean CBA was 2.94 ± 0.34 g/dl and mean TSB was 11.17 ± 2.52 mg/dl. The
relationship between CBA and TSB values was statistically significant on further analysis of
CBA with the modality of treatment, the results were again statistically significant. The
correlation between CBA and TSB was also observed with negative correlation of r = - 0.43
with p value of <0.0001 which was highly significant.
Conclusion: Newborns with high CBA levels have low risk of developing neonatal
hyperbilirubinemia and can be discharged early from hospital. Whereas low CBA is an
indicator for developing neonatal hyperbilirubinemia in the first week of life.

Background:Early diagnosis and treatment are very important to reduce the rates
of morbidity and mortality related to Inborn errors of metabolism .The present
study aimedto detect the inborn errors of metabolism early among neonates.This
was a cross sectional study was carried out at neonatal intensive care unit in
pediatric department at Zagazig university children hospital. This study involved
114 neonates who were subjected to full medical history, thorough clinical
examination and laboratory investigations which included Complete blood count,
Coagulation profile ,C-reactive protein ,procalcitonin, Liver and renal function
tests , Serum levels of electrolytes, Plasma ammonia and lactate, Urine organic acid
analysis, Extended metabolic screening, Blood gas and serum anion gab and Blood
glucose level. Results:About 53.5% of the studied groups were males and 46.5%
were females. As regards mode of delivery 74.6% were by CS and 25.4% by NVD.
Also, 30.7% had positive consanguinity, 12.3% had sibling death, and 3.5% have
similar condition. History of abortion was found in 22.8% and genetic disease was
in 2.6% of the studied group. The main clinical presentations among the studied
group were RD, Encephalopathy and hypotonia. Only 6.1% of the studied group
had positive culture metabolic acidosis was detected only in 9.6% of the studied
group. About 90.4% of the studied group was alive and 9.6% were died.
Conclusion: IEM disorders are not rare disease in high-risk neonates with
attentions to consanguinity which is a common tradition in our country. The
manifestations of metabolic disorders are common, and many physicians
misdiagnose them as they are unaware about these disorders.

Background and objective:Hearing impairment is often associated with pregnancy
infections such as Toxoplasma, Rubella, Cytomegalovirus (TORC). The aimswere to
determine the prevalence of hearing impairment using Otoacoustic Emissions (OAE) and
analyze the associated risk factors in neonates with dual/multiple TORC infections.
Materials and Methods:This cross-sectionalstudy was conducted from
SeptemberuntilNovember 2019. Infants admitted in the intermediate room during the
period were included in the study and underwent OAE to evaluate the presence of hearing
impairment.Infants with OAE refer tested with TORC examination. Prevalence of hearing
impairment with dual/multiple TORC infections was calculated and the Odds Ratio for
specific risk factors was measured using Fisher’s exact test.
Results: Over the period, 50 babies were screened. Forty-three babies (86%) presented
normal hearing at OAE. Seven babies (14%) response OAE refer. Out of 7 infants, one
infant classified OAE refer had early discharged, the six of them undergo TORC
examination. Out of 6 infants, 5 of them represented dual/multiple TORC infections. By
univariant analysis,the most higher risk factor for hearing impairment and dual/multiple
TORC infection was the premature rupture of membrane OR 41; 95% CI 3,65 – 46,03.
Correlation between dual/multiple TORC infection and hearing impairment was
significant statistically, p=0.001, R = 0.826.

Background: Inborn errors of metabolism (IEMs) make up a large group of rare
disorders caused by an inherited deficiency or absence of proteins that have
enzymatic, carrier, receptor, or structural roles. This study is aimed to early
detection, diagnosis, and intervention to improve outcome.
Patients and methods: This cross-sectional study was done in Pediatrics
Department, Zagazig University Hospitals. It included 65 cases with suspected
inborn errors of metabolism. All the studied cases were subjected to full history
taking, clinical examination and Laboratory investigations.
Results: The age of neonates, infant and children were 35 (54.6%), 22 (34.37%), 8
(10.93%) cases respectively, 34 cases were females and 30 males. The most common
complaint was poor suckling in 14 cases (21.8%) then lethargy as well as fever in 6
cases (9.37%). Disturbed consciousness and hepatosplenomegaly were present in 11
cases (17.18%). Metabolic disorders including metabolic acidosis (25%),
hypoglycemia (3.12%), raise lactate level (4.68%), hyperammonemia (14) and
presence of ketonuria in (4.68%) of cases, respectively. The different disease types
of the studied cases after routine and specific laboratory finding, our results showed
that, 18 cases Suspected IEM (not diagnosed), 11 cases Diagnosed metabolic (non
PKU), 36 cases Diagnosed Phenylketonuria (PKU).
Conclusion: Early diagnosis of inborn errors of metabolism (IEMs) during
neonatal period or infancy for starting its proper treatment will improve outcomes,
control complications of metabolic diseases and decrease the mortality rates.

Introduction: Pneumothorax occur most during neonatal age than other age of life in
human being, this more related to high morbidity and death rate. It started form damage
to alveoli that more distended. The air seepages lengthways of the perivascular sheath of
connective tissue inside to the pleural space, The aim of our study is to assessment of
prevalence, recognize the danger factors and to define the clinical features, treatment and
consequence of neonates that have pneumothorax and determine the fate of neonates
after treatments.
Method: Prospectively collected data from newborn infants with pneumothorax observed
and treated at the Neonatal Intensive Care Unit (NICU) in al immamian alkadhomain
medical city, Sociodemographic data of neonates, clinical features of pneumothorax and
treatment of pneumothorax. Finally, assessment the fate of neonate assessed.
Results: A cross section descriptive study on 41 neonates mean age (34.6 ± 3) weeks
most age group 31 – 40 weeks 85% and weight (2 ± 0.7) kg most neonates (49%) with
2.1 – 3 kg, 34% females and 66% males, 61% of neonates are single parity, 71% of
neonates not need to antenatal steroid, while 56% of neonates delivered by CS, 71% of
neonates with Apgar score less than 7 in first 1 min., Significant association between
sociodemographic variables and clinical features as show in table 4; 52% of right
pneumothorax occur in male, 88% of left pneumothorax occur in male and 100% of
bilateral pneumothorax occur in male. 57% of RDS occur females while 43% of RDS in
male. 100% of TTN occur in single parity. 67% of pneumonia occur at age group 21- 30
week. Significant association between sociodemographic variables and treatment and fate
as show in table 5; 56% of neonate’s need C-pap were females and 44% were males.
56% of neonates need O2 therapy with weight 2.1-3kg, 26% of them that need O2 therapy
with weight 1-2 kg. 55% of alive neonates are males and 45% are females, 72% of single
parity neonates still alive.
Conclusion: Pneumothorax is moderately common in the NICU. The fate of neonates are
71% still alive and 29% dead. Pneumothorax itself was not a factor of death, probably due
to the sufficient and rapid therapy used in the NICU.

Introduction:The neonatal period comprising the first 4 weeks (28 days) of a child's life after birth is critical and dangerous events might occur. Structural, functional changes occur rapidly in this period. It is very important for mothers to be aware of the danger signs in neonates during this period. This study was done to find the prevalence of knowledge and awareness of danger signs among mothers of children aged less than 1 year.
Methods: A Community based cross-sectional study was carried out in United Arab Emirates from June 2020 to August 2020. Simple random sampling method was used and the sample size was calculated as 150. Mothers of children aged below 1 year were included in the study. A semi-structured pre-tested questionnaire was used in this study for interview purposes. Informed oral consent in common languages- English, Hindi, Tamil, Telugu, and Malayalam was obtained.
Results: The prevalence of good knowledge of danger signs among mothers of children aged less than 1 year in this study was found out to be 28.6%. 91.2% of the mothers have reported having sought medical care when any of the mentioned Danger signs occurred whereas 8.7% of them had opted to treat at home.
Conclusion:In spite of extensive coverage of maternal and child health services, the knowledge and awareness of the danger signs in neonates are fairly low in the mothers. Therefore more awareness and health education campaigns need to be implemented.

Congenital anomalies are the structural and functional irregularities at birth. In this progressive study, all the neonates who are admitted to the Neonatal Intensive Care Unit during the three year period from 1st June 2017 to 31 May 2020.
Aim: The study aims to examine the prevalence, type, and epidemiological factors of congenital anomalies among the population of Ladakh India.
Subject and methods: All the neonates during the study period were examined by pediatrics and questionnaire filled by the consent of the family. A total of 936 parents of neonates was agreed to participate in this study and among them, 524 are male neonate and 412 was female.
Results: Four and a half percent were diagnosed as being congenital malformed and the common system affected by congenital anomalies in the digestive system followed by the mucso-skeletal system. In this study, based on the logistic regression consanguineous marriage with OR of 9.862 (4.221; 23.041), P= <0.001, familial congenital anomalies in the family with OR of 17.008 (4.343; 66.606), P=0.001, an anaemic mother with OR of .124 (.029; .538). P = .005, Apgar score with .033 (.016: .067), P-value of <0.001 and paternal smoking with OR of 13.305 (5.558: 31.854) with P value of <0.001 had shown a very good significant correlation with the congenital anomalies.
Conclusion: The occurrence and distribution of congenital anomalies in Ladakh were reported. More active prenatal screening and the possible role of genomics study are major importance to uncovering the susceptibilities.