Red baby syndrome a new disease due to parvovirus B-19 observed in Kerala.

Red Baby Syndrome is a new disease seen in infants and young children. Dramatic onset of clinical symptoms with high intensity, short duration and lack of similarity with other cutaneous lesions makes it distinct. Of 50 such patients studied over a period of 5 years, half were below one year of age. Abrupt onset of high fever and generalized erythema involving the entire skin, which is swollen and tender is characteristic. These children were highly irritable and had paradoxical cry when cuddled. Rapid resolution of symptoms occurred in 7-10 days with extensive desquamation. Routine investigations were normal, C-reactive protein was raised only in 10 patients. Human Parvo virus B-19 IgM antibodies were positive in 15 out of 24 patients. Real time polymerase chain reaction was positive for human parvovirus B 19 DNA in one. Histopathological changes in the skin biopsy showed post infectious vascular injury pattern.

Benefits of maternal participation in newborn nurseries.

OBJECTIVE: To evaluate the outcome of active involvement of mothers/mother substitutes in day-to-day care of high risk neonates admitted in a level II newborn care unit. METHODS: An observational study was carried out over a period of eleven years incorporating active participation of mothers/substitute in the day to day care of their sick neonates. The outcome is assessed in terms of mortality due to the three major illnesses (asphyxia, sepsis and prematurity) during this phase. The data is compared with that of a similar level II care centre where conventional neonatal care is practised. RESULTS: There is a significant and sustainable reduction in neonatal mortality due to the three major illnesses when the mothers are also involved in the neonatal care, in spite of a considerable increase in the number of admissions during this period. CONCLUSION: The concept of active participation of mother/substitute in neonatal nursery ensures 1:1 care at all times. It is a cheap and effective alternative to inadequacy of bed:nurse ratio (BNR).

Hand-foot-and-mouth disease in Calicut.

OBJECTIVE: Hand-Foot-and-Mouth Disease (HFMD) is a mild exanthematous illness seen worldwide, affecting mainly children under ten years of age. The causative agents were initially Coxsackie virus type A 16 and related serotypes. The situation changed drastically about thirty years ago with the advent of a new aetiological agent, Enterovirus type 71 (EV 71), which has caused very large outbreaks with severe complications and many deaths. METHODS: The authors report an outbreak of papulovesicular lesions on the skin and oral mucosa compatible with the diagnosis of HFMD in children in and around Calicut in October 2003. Clinical and laboratory study in collaboration with the National Institute of Communicable Diseases, Delhi. Eighty one children with the syndrome were examined and followed up from October 2003 to February 2004, when the outbreak subsided. RESULT: The outbreak was mild and all children recovered within 1 to 2 weeks. CONCLUSION: Acute and convalescent paired serum samples collected from 19 patients were examined at the NICD for IgM antibody against EV 71 by microneutralisation test in cell culture. All the paired samples tested showed significant rise in titre of antibodies, confirming the diagnosis of EV 71 infection in each of them.

Spectrum of clinical presentations of vein of galen aneurysm.

Aneurysm of the vein of Galen is a rare intracranial vascular malformation. It is known to have diverse manifestations and varying severity. Four cases with different modes of presentation and outcome are reported. A mortality of 50 per cent was encountered. Among the survivors, one had neurologic sequelae whereas the other had attained age-appropriate developmental milestones. The former was a rare case of spontaneous thrombosis of the aneurysm while the latter was a boy who underwent therapeutic embolization.

Popliteal pterygium syndrome with unusual features.

Popliteal pterygium syndrome is a well defined complex that consists of popliteal pterygium, intercrural pterygium, various digital anomalies that include hypoplasia or agenesis of digits, syndactyly, valgus or varus deformities of the feet and oral anomalies such as cleft lip-palate. A baby with the typical anomalies as well as a few unusual features such as mongloid slant, hypertelorism, malformed alae nasi and elbow joint contractures is reported.

Incidence and risk factors for neonatal hypoglycaemia in Kerala, India.

OBJECTIVES: To detect the incidence and risk factors that predicted the occurrence of neonatal hypoglycaemia and to identify neonates who require mandatory blood glucose screening during the first 48 h of life. DESIGN: Hospital based prospective study in a maternity centre in south India. SETTING: Labour room, postnatal wards and newborn nursery of the Institute of Maternal and Child Health, Medical College, Kozhikode, India. PATIENTS: Six hundred and four neonates were enrolled in the study by a systematic random sampling method from 1 August to 1 November 2002. INTERVENTION/MEASUREMENT: Random blood glucose levels were estimated by the standard glucose oxidase--peroxidase method on two occasions 24 h apart, during the first 2 days of life. Nineteen clinical characteristics of the mother-baby pair were analysed statistically in relation to the occurrence of hypoglycaemia. RESULTS: The incidence of neonatal hypoglycaemia in the present study group was 41/1000 live births. Eight variables strongly and independently predicted the risk of neonatal hypoglycaemia, at least one being present in 89.1% of the hypoglycaemic neonates. They included prematurity, low birthweight, maternal diabetes mellitus, delay in initiation of breastfeeding for more than 2 h postnatally, maternal pre-eclampsia and eclampsia, birth asphyxia, cold stress or hypothermia, and maternal oligohydramnios. CONCLUSIONS: Hypoglycaemia was a common problem in apparently normal asymptomatic babies. Apart from the classic 'text book risk factors', maternal oligohydramnios and a breastfeeding delay of more than 2 h after delivery predicted the risk of neonatal hypoglycaemia in this group. Mandatory blood glucose screening in babies with any one of the above mentioned risk factors serves as an easy and cost effective measure for the prompt identification of this condition.

Congenital varicella syndrome.

The fetal consequences of chickenpox complicating pregnancy depends on the period of gestation at which the infection is contracted. The extremely rare classical form of congenital varicella syndrome, resulting from maternal varicella infection in the first trimester of pregnancy, is being reported here. The unusual features in this baby are bilateral hypoplastic lower extremities, fracture of bones, a normal electroencephalogram and phantom hernias of the anterior abdominal wall.

Anencephaly with placental attachment.

Anencephaly is a severe defect of development of the neuraxis that is incompatible with survival. This particular neural tube defect is characterised by the absence of large portions of the cranium. The peculiar feature in this baby is the abnormal attachment of the placenta to the site of the skull defect.

Baller-Gerold syndrome.

Craniosynostosis is known to be associated with a large number of inherited disorders of childhood. Its presence along with absent thumbs and ectopic anus is the characteristic feature of one such extremely rare disorder, described as the Baller Gerold syndrome. The typical features are being reported here.

Effect of phenytoin sodium in reducing blistering of epidermolysis bullosa report of four cases.

To evaluate the effect of phenytoin in reducing of patients with epidermolysis bullosa four newborn babies were studied after thorough clinical evaluation including detailed history and relevant investigations. All of them were put on oral phenytoin sodium, in the usual antiepileptic dose and were followed up. All of the babies had significant reduction in the number of lesions.

Fetal intracranial hemorrhage due to antenatal low dose aspirin intake.

Antenatal intake of low dose aspirin is advised for prevention of pregnancy induced hypertension, intrauterine growth retardation and pre-term labour. Aspirin has an anticoagulant effect due to its action on Cyclo-oxygenase and vitamin K dependent coagulation factors. It can readily cross the placental barrier and be a potential cause for bleeding tendency in the fetus. Fetal intracranial hemorrhage, following low dose aspirin administration in a mother and subsequent effect after delivery is being reported.