Effect of Antenatal Dexamethasone in Late Preterm Period on Neonatal Hypoglycemia: A Prospective Cohort Study from a Developing Country.

OBJECTIVES: This study compared the risk of hypoglycemia within 72 h of life in infants with and without exposure to antenatal dexamethasone in the late preterm period (34-366/7 week's gestational age). METHODS: This prospective cohort study was conducted in a tertiary care neonatal unit of Eastern India from May 2021 to November 2021. Babies in the exposed group received at least one dose of antenatal dexamethasone in the late preterm period between 7 days before delivery and birth. 'Complete course' of antenatal steroid was defined as four doses of injection dexamethasone at 12 h intervals and <4 doses were considered as 'Partial course'. Primary outcome was incidence of hypoglycemia within 72 h of life, defined as whole blood glucose <45 mg/dl. RESULTS: Total 298 infants (98 in control, 134 in partial and 66 in complete group) were assessed for final outcome. No significant difference in outcomes were seen in the exposed group compared to unexposed group. However, incidence of hypoglycemia within 72 h (complete vs. partial p= 0.008, complete vs. control p=0.005) and 12 h of life (complete vs. partial p=0.013, complete vs. control p=0.013) was significantly less in complete steroid group. Logistic regression analysis revealed complete course of antenatal corticosteroid significantly decreased the risk of hypoglycemia [adjusted odds ratio, 95% confidence interval (CI) 0.15 (0.03-0.69), p=0.015]. Number needed to be exposed for one additional benefit was 7 (95% CI, 6.35-22.14). CONCLUSION: Complete course of dexamethasone administered to mothers at risk of late preterm delivery reduces risk of neonatal hypoglycemia within 72 h of life.

Cholinergic crisis, intermediate syndrome and delayed polyneuropathy following malathion poisoning.

Organophosphate poisoning is common in developing countries, more so in India. A 7-year-old boy with history of ingestion of unquantified amounts of malathion, presented to the pediatric emergency of Calcutta National Medical College, Kolkata in acute cholinergic crisis. He was treated with atropine and pralidoxime. The acute cholinergic crisis persisted for four days after admission, and as it subsided, the child developed respiratory distress, bulbar palsy, cyanosis, hypoxemia and hypercarbia. A diagnosis of intermediate syndrome was made and patient needed prolonged ventilation for 21 days for type II respiratory failure. Five days after discharge, the child developed distal weakness of both lower limbs, which later involved the hands. There was associated gross sensory loss. Nerve conduction velocity study and sural nerve biopsy predominantly showed evidence of sensory-motor axonopathy with associated demyelination. The child was treated with physiotherapy, but was left with disabilities like claw hand, foot drop and the inability to walk.

Changes in biochemical contents of expressed breast milk on refrigerator storage.

To determine the biochemical integrity of refrigerated breast milk for 96 hours at 4C, a longitudinal observational study done with fresh milk samples. It is found that there were significant changes in pH, serum albumin and lactose concentrations in breast milk though within normal range.

Glycogen storage disease 1a with piebaldism.

A 3 and half years old male child born by consanguineous marriage presented with white forelock and symmetric hypopigmented areas present since birth, similar to his mother and elder sister. Hepatomegaly was noticed at one year of age. Liver biopsy revealed enlarged pale hepatocytes distended with glycogen. Skin biopsy revealed absence of melanin pigment in white depigmented skin. G727T gene splice mutation was diagnosed in exon 5 of 17q21 chromosome.