Severe neonatal autoimmune thrombocytopenia secondary to maternal Evans syndrome.

Evans syndrome is a rare and chronic autoimmune disease seen in both paediatric and adult age groups. We present a case of severe thrombocytopenia in a neonate born to a mother with Evans syndrome who showed no response to intravenous immunoglobulin therapy initially and improved after treatment with methylprednisolone.

Foot Length for Gestational Age Assessment and Identification of High-Risk Infants: A Hospital-Based Cross-Sectional Study.

The knowledge of the gestational age of the newborn is essential for management. In the absence of a dating scan, the postnatal assessment scores have drawbacks of being difficult to learn and administer in the community. The measurement of the foot length is easy, reproducible and offers an objective assessment. The objective of this study was to determine the correlation of postnatal (<48 h) foot length measurement (with calipers) with gestational age as determined by antenatal dating ultrasound, create a predictive model for the same and propose foot length measurement cutoffs for <37 and <34 weeks of gestation. Secondary objectives were to assess the correlation between foot length as measured with calipers and that measured with a ruler and a paper footprint. This was a hospital-based cross-sectional study. Among the 520 babies assessed, the correlation of foot length with gestational age was 0.89. Operational cutoffs for the categories of <37 and <34 weeks at a sensitivity of 95% were <70 and <65 mm, respectively. The Pearson's correlation between foot length as measured by caliper and ruler was 0.95 and between caliper and paper footprint was 0.87. This study correlating foot length and gestational age has the potential to help neonatal care providers make informed management decisions, particularly in resource-limited settings.

Effects of Antenatal Magnesium Sulfate on the Gut Function of Preterm (<32 weeks) Very Low Birth Weight Neonates: Experience from a Tertiary Institute in South India.

OBJECTIVE: Antenatal magnesium sulfate (MgSO4) is found to have various adverse effects in newborn, but the effect on preterm gut is still unclear. This study aimed to evaluate the effects of antenatal MgSO4 on preterm gut function by assessing the clinical outcomes and mesenteric blood flow. METHODS: This was a prospective cohort study on all preterm very low birth weight (VLBW) neonates born at a tertiary care center in South India from November 2016 to August 2017. Neonates with antenatal magnesium (Mg) exposure were compared with those with no exposure for various neonatal outcome variables like time to reach full feeds, feed intolerance, necrotizing enterocolitis (NEC) and other preterm complications, serial serum Mg levels and superior mesenteric artery (SMA) Doppler velocity measurements at two time points (24-48 h and 4-5 days after birth). RESULTS: Out of 84 neonates, 56 neonates were exposed to antenatal Mg with a median cumulative maternal dose of 28 g and the rest 28 neonates had no exposure. The mean time to reach full feeds was the same in both groups (10.5 days). Feed intolerance episodes were similar in the first week of life between the exposed and unexposed groups (48.2% vs. 46.4%; p = 0.88). Univariate analysis revealed no difference between groups concerning rates of NEC (p = 0.17) or mortality (p = 0.39). There was no significant difference in SMA Doppler parameters and hypermagnesemia between the two groups. CONCLUSION: Our study found no significant impact on postnatal feed tolerance and mesenteric blood flow among preterm VLBW neonates with antenatal MgSO4 exposure.

Malignant rhabdoid tumour of the neck in a neonate.

Fetal neck masses are rare, and present a challenge antenatally, during delivery and in making a diagnosis. In this report, we detail the presentation of a neonate with a neck mass diagnosed in the third trimester. The baby was delivered by ex utero intrapartum therapy (EXIT). Investigations sent included an MRI with limited CT cuts, and a biopsy, which lead to the diagnosis of a malignant rhabdoid tumour. This is rare and the overall survival is low.

Vitamin D status and adequacy of standard supplementation in preterm neonates from South India.

OBJECTIVE: The aim of this study was to assess vitamin D status of preterm babies at birth and adequacy of daily supplementation with vitamin D. METHODS: This prospective cohort study recruited 111 preterm babies, 25 to 32 weeks' gestation from a tertiary care perinatal center in south India. Cord blood was assayed for serum calcium, phosphate, alkaline phosphatase, and 25-hydroxyvitamin D (25(OH)D). All of the babies were fed unfortified breast-milk and supplemented daily with calcium, phosphate, and 400 IU of vitamin D. At 6 weeks serum calcium, phosphate, alkaline phosphatase, parathyroid hormone, and 25(OH)D levels were estimated. RESULTS: Of 111 preterm babies recruited, a total of 90 (81%) of the preterm babies were followed up until 6 weeks. The median (interquartile range) vitamin D level in the preterm group was 34.7 (25.6-50.1) and 19.3 (13.9-27.1) ng/mL at birth and 6 weeks, respectively. Using a cutoff value of <20 ng/mL to determine vitamin D insufficiency (VDI), it was observed that 12.6% of the babies were vitamin D insufficient at birth. This increased to 52.2% at 6 weeks despite the recommended supplementation with vitamin D (P < 0.001). CONCLUSIONS: The prevalence of VDI was not high at birth; however, a large proportion of preterm babies were vitamin D insufficient at 6 weeks despite being supplemented with vitamin D 400 IU/day. The recommended vitamin D supplementation of 400 IU appears to be inadequate to prevent VDI, and hence randomized controlled trials looking at higher doses of vitamin D supplementation are needed.

Isolated pulmonary Langerhans cell histiocytosis.

Isolated pulmonary involvement in Langerhans Cell Histiocytosis (LCH) is rare in childhood. The authors report a 6-y- old boy presenting with recurrent pneumothorax, whose CT thorax showed diffuse pulmonary cystic lucencies bilaterally. Biopsy of the lesions confirmed pulmonary LCH with Cd1a and S 100 positivity.