Evaluating the Clinical Risk Index for Babies (CRIB) II Score for Mortality Prediction in Preterm Newborns: A Prospective Observational Study at a Tertiary Care Hospital.

INTRODUCTION: Neonatal mortality is an issue that affects both the developed and developing world. It is very important in the neonatal intensive care unit (NICU) to do the assessment of the severity of neonatal illness, which in turn helps in estimating and preventing mortality in the NICU by improving healthcare control and by rational use of resources. This research was carried out to evaluate how effectively the Clinical Risk Index for Babies (CRIB) II score can predict mortality rates among newborns treated in our NICU.  Methodology: This prospective observational study spanned one year, commencing in October 2021 and concluding in September 2022, within the confines of our NICU. The CRIB II score calculation was performed for included newborns, and the outcomes of the newborns were compared. A receiver operating characteristic (ROC) curve was obtained to ascertain the optimal CRIB II cut-off score for predicting mortality. RESULTS: Within the designated research timeframe, 292 neonates were admitted to the NICU. Forty-four newborns were enrolled in the study. Preterm neonates who died had higher CRIB II scores than those who survived, and their median (IQR) was 6 (1-12) vs. 9.5 (5-14) (p=0.0003). The estimate for the area under the curve was 0.83 (95% CI 0.68-0.92), and the odds ratio of 2.56 suggests neonates with a higher CRIB II score have higher chances of mortality. CONCLUSION: The CRIB II score is very good at predicting mortality in preterm newborns.

Neonatal hypernatremic dehydration in breastfed neonates: a prospective study unmasking the influences of breastfeeding practices and early weight monitoring.

Introduction: Hypernatremic dehydration in neonates is an uncommon but serious reason for re-hospitalization, especially in exclusively breastfed neonates. The aim was to study the incidence, associated maternal and neonatal characteristics and risk factors, and presenting features of neonatal hypernatremic dehydration (NHD). Methods: A prospective study design was employed to enroll full-term newborns admitted with serum sodium concentrations of ≥145 mEq/L from April 2022 to March 2023 at a tertiary care rural hospital. Maternal and neonatal characteristics and breastfeeding practices of these mother-baby pairs were recorded and observed. Healthy control for every mother-baby pair was taken. Ethical clearance and informed consent were obtained from mothers. Result: 34 newborns out of total 672 NICU admissions were admitted due to NHD, with an incidence of 4.7%. Primiparous mothers were 23 (67.6%) in the cases and 10 (29.4%) in the control group (p = 0.0017). Disparity in maternal breastfeeding practices of cases, such as delayed initiation time 2.3 h vs. 1.27 h (p < 0.0001), less frequency of breastfeeding 6.5 times vs. 9.3 times (p < 0.0001), and duration of breastfeeding sessions 23.3 min vs. 32 min (p = 0.0014) respectively in cases and controls were found to be potential contributing factors. 61.7% of mothers had breast issues in the cases and 17.6% in the control group (p = 0.0002) with average LATCH score of 4.29 in cases as compared to 8.08 in controls (p < 0.0001) at time of baby's admission to NICU. The average neonatal age at presentation was six days and average weight loss was 11.4% in cases vs. 2.8% in controls (p < 0.0001). The main presenting features were excessive weight loss 30 (88.2%), lethargy 20 (58.8%), jaundice 18 (52.9%) and fever 14 (41.1%). Conclusion: Neonatal hypernatremic dehydration (NHD) poses a significant clinical challenge, particularly in full-term, exclusively breastfed healthy neonates. We found an incidence of 4.7%. Delayed initiation of breastfeeding, inadequate breastfeeding techniques, and maternal breast-related issues were significant contributors to NHD. Primiparous mothers were found to be at higher risk, emphasizing the need for targeted breastfeeding education and support for primiparous mothers. The study reaffirmed the critical role of frequent and effective duration of breastfeeding and daily weight monitoring for preventing NHD.

The Etiological Profile of Neonatal Thrombocytopenia in Neonates in Neonatal Intensive Care Unit: A Cross-Sectional Study.

Background Neonatal thrombocytopenia is one of the most common clinical entities encountered in the neonatal intensive care unit (NICU); if not identified early, it can lead to significant morbidity and mortality. The aim of this study was to find out the etiological profile of neonatal thrombocytopenia in the NICU and to study the association between the etiology and onset of thrombocytopenia. Methods It was a single-center, cross-sectional, descriptive study of neonates having thrombocytopenia. The study was carried out in the NICU of the department of pediatrics in a tertiary care center over a period of one year. The study population included neonates admitted to the NICU having thrombocytopenia (platelet count: <150×109/L). The demographic data such as name, sex, gestational age, age at the onset of thrombocytopenia, and birth weight was recorded. Data was collected based on laboratory investigations. Results Early-onset thrombocytopenia was present in 34% of neonates, and late onset was seen in (66%). A statistically significant result was found in disseminated intravascular coagulation (DIC); the p value was 0.02. The majority of neonates had late-onset sepsis (LOS) (57%). In both early-onset sepsis (EOS) and LOS, 36.84% each, the majority of neonates had moderate thrombocytopenia. Statistically significant results were found in respiratory distress syndrome (RDS) and necrotizing enterocolitis (NEC); the p value was 0.004 and 0.03, respectively. Conclusion Thrombocytopenia is a universal finding in neonates in the NICU, and it is an important prognostic marker of various disease conditions in neonates. Thus, the timely recognition and management of thrombocytopenia is essential to reduce neonatal morbidity and mortality.

Filling the Gaps for Feeding Difficulties in Neonates With Hypoxic-Ischemic Encephalopathy.

Hypoxic-ischemic encephalopathy (HIE) in neonates poses long-term feeding difficulties and abnormalities of swallowing, the sequel of which is growth impairment. Such infants are also at risk of impaired self-feeding in the grown-up stage along with other motor and tone abnormalities leading to malnutrition and multiple aspiration pneumonia episodes. The lack of evidence-based and pragmatic feeding strategies in such neonates is because of varied unrecognized symptoms and lacking validated diagnostic approaches. This article approaches evidence related to the pathophysiologic basis of feeding difficulties in neonates with HIE as well as standardizing measures and techniques to improve the feeding abilities of such babies and, in turn, their long-term development. The present review provides a scaffold for putting importance on this less taken care issue of feeding problems and emphasizes that more objective and evidence-based studies are required to be added to the literature for early interventions and management of this issue so that caregivers and neonatologists are not misguided by crude subjective opinions.

Traumatic peripheral neuropraxias in neonates: a case series.

Traumatic peripheral nerve palsies in the newborn are uncommon but are a cause of severe anxiety in parents. Erb's palsy, brachial plexus, radial nerve and facial nerve are the common nerves affected. Perinatal injuries are the most frequent cause of traumatic peripheral neuropraxias / nerve palsies. Usually these neuropraxias are self-limited with good recovery with conservative management in majority of cases.Ten neonates with peripheral neuropraxias were included in this retrospective study based on a review of these cases over a period of three and a half years. Their clinical profile, presenting symptoms, predisposing factors and management were analyzed. We encountered five neonates with erb's palsy, three with facial palsy and two had radial nerve affection. Risk factors in our series included large babies, prolonged or difficult labour, instrumental delivery and shoulder dystocia. All cases of peripheral nerve involvement were managed conservatively with physiotherapy. Nine neonates were discharged and showed gradual improvement and one patient unfortunately succumbed due to severe birth asphyxia. Parental counseling and rehabilitation play an important part in management of these cases.