Varied presentations of congenital dengue infection in neonates.

Dengue fever is a common viral infection in the tropics and is prevalent in Southeast Asia. Dengue infection is associated with increased morbidity and mortality in the perinatal period. Transplacental transfer of dengue infection is rare. Here we report of four such cases.

Acute liver failure in tropical infections- thinking beyond viral hepatitis!

Acute liver failure is characterised by the presence of jaundice and encephalopathy with or without coagulopathy in a patient with a previously normal liver.1 A variety of tropical infections can lead to this clinical presentation. Hepatosplenomegaly and bleeding manifestations are common in such patients. Deranged liver biochemistry and poor outcomes are hallmarks of viral hepatitis inducing liver failure.

Perinatal transmission of dengue infection in a preterm neonate: a case report.

Dengue infection during pregnancy carries the risk of vertical transmission to the fetus and newborn. This is higher if the infection occurs late in pregnancy and the mother delivers at the height of viremia. In such a scenario, both mother and neonate are at risk of life-threatening complications. We present an interesting case of dengue infection in a preterm neonate managed at our unit.

Profile of extrahepatic portal venous obstruction among children in Central India.

INTRODUCTION: There is a paucity of data regarding the clinical profile of children with extrahepatic portal venous obstruction (EHPVO) from Central India. MATERIAL AND METHODS: Retrospective analysis of 30 children with EHPVO treated between 2002 and 2012. RESULTS: The median age of presentation was 12.5 years (range 5-14 years) and median duration of symptoms was 3.2 years (range 0.3-10 years). Home delivery was noted in 30 cases (100%), umbilical sepsis in 8 (27%) and history of cow dung application over the umbilical cord in 2 cases (6.7%). Twenty-two cases (73.4%) presented with upper gastrointestinal (GI) bleeding while 18 (60%) were referred for pancytopenia and/or hypersplenism. The patients underwent a median of 3.2 sessions of endoscopic therapy for varices. Most patients (19/30, 63.4%) dropped out of serial endotherapy due to the paucity of funds. Shunt surgery was performed in 7 patients. CONCLUSIONS: Home delivery and umbilical sepsis are significant risk factors for EHPVO. Most patients present with GI bleeding and do well on endoscopic treatment/shunt surgery.

Neonatal Cholestasis - Single Centre Experience in Central India.

BACKGROUND: Neonatal cholestasis syndrome (NCS) is a major cause of morbidity and mortality in infants. The disorder has rarely been studied in centers from Central India. OBJECTIVES: To study the prevalence, clinical presentation and etiology of NCS at a tertiary referral center in Central India. MATERIALS AND METHODS: The study was carried out at a tertiary referral center in Central India. The study is a descriptive study. The records of all patients with suspected NCS treated in the Department of Pediatrics from 2007-2012 were analyzed. RESULTS: One hundred and sixty-eight children had a provisional diagnosis of NCS. The complete records of 100 children were available for the study. The median age of presentation was 78 days (range 15-270 days). The male: female ratio was 1.17:1. The clinical features noted were- jaundice (100/100,100%), failure to thrive (73,73%), organomegaly (68, 68%), acholic stools (38,38%), abdominal distention (52,52%) and poor feeding (29, 29%). The etiology as confirmed by investigations is as follows- neonatal hepatitis (20,20%), idiopathic neonatal hepatitis (18,18%), biliary atresia (41,41%), sepsis (14,14%) and others (7,7%). CONCLUSIONS: The proportion of NCS in our group of patients was 1.2 per 1000 patients. Jaundice, organomegaly and failure to thrive are the common presentations. Biliary atresia, neonatal hepatitis and idiopathic neonatal hepatitis were the common etiological factors at our center.

Atypical manifestations of viral hepatitis A and E.

Acute viral hepatitis A and E (HAV/HEV) are usually self-limiting illnesses. However, they can have atypical presentations which lead to increased morbidity and mortality. We studied 81 patients from all age groups admitted with these infections at our centre over a 1 year period. Acute liver failure, prolonged cholestasis, ascites and haemolysis are common atypical manifestations of acute viral HAV and HEV. Relapsing hepatitis, ascites and double peak jaundice were seen more often in the paediatric age group.