A Rare and Unusual Case of Hypernatremic Dehydration in a Newborn Presenting With Adrenal Haemorrhage and Leading to Acute Kidney Injury.

Adrenal haemorrhage, although a rare entity in the neonatal period, is a known complication of birth asphyxia. Adrenal haemorrhage progresses differently depending on the type and extent of the glands involved. Adrenal haemorrhage can cause persistent jaundice, fever, dehydration, scrotal swelling, abdominal wall discolouration, septicemia, and a shock-like state. Here, we report the case of a four-day-old male infant who presented with jaundice, poor feeding, and hypernatremic dehydration. The patient developed acute kidney injury and, eventually, renal failure due to adrenal haemorrhage. He had an abdominal lump with deranged renal parameters along with hyperbilirubinemia. Abdominal ultrasonography and contrast computed tomography scan showed left suprarenal enlargement with evidence of adrenal haemorrhage. The patient was managed well with ventilatory support and peritoneal dialysis and discharged successfully. A subsequent follow-up showed complete resolution of the adrenal haemorrhage. Single ultrasonography is a good modality for diagnosis but not sufficient, so serial ultrasonography at subsequent follow-up is a must.

Navigating Complexity: A Rare Case of Down Syndrome With Dural Venous Thrombosis in a Neonate.

This case report presents a unique clinical scenario of a 2 kg male neonate with Down syndrome complicated by dural venous thrombosis. Born via normal vaginal delivery, the infant exhibited syndromic features characteristic of Down syndrome, necessitating admission to the neonatal intensive care unit (NICU) for respiratory distress. Confirmatory karyotyping established the diagnosis. Subsequent complications included germinal matrix haemorrhage, hypoxic-ischemic encephalopathy, and aspiration pneumonia. An MRI revealed dural venous thrombosis in the left transverse sinus, an uncommon manifestation in neonates with Down syndrome. Multidisciplinary management involved respiratory support, antibiotic therapy, and neurophysiotherapy. Infectious complications, including Klebsiella pneumoniae growth, required tailored antibiotic intervention. Despite intubation and CO2 retention challenges, the neonate improved and was ultimately discharged with favourable anthropometric measurements. This case underscores the importance of a comprehensive approach to neonatal care in the context of Down syndrome, emphasising the need for early recognition and management of rare complications such as venous thrombosis. The positive outcome highlights the efficacy of a multidisciplinary strategy in addressing complex neonatal conditions.

A Rare Case of Persistent COVID-19 Infection With Aspergillosis in a 12-Year-Old Child.

At the end of 2019, coronavirus disease 2019 (COVID-19) was first detected in Wuhan. In March 2020, COVID-19 became a global pandemic. Saudi Arabia registered the first case of COVID-19 on March 2, 2020. COVID-19 can affect any organ in the body. It affects the respiratory system predominantly. Reverse transcriptase-polymerase chain reaction (RT-PCR) is used to diagnose COVID-19, and the preferred swab is the nasopharyngeal swab. The shedding of the virus continues for about 20 days after the onset of the symptoms. There may be prolonged shedding in a few cases without any symptoms. Viral cultures are used for the confirmation of the shedding. Although the preferred mode of diagnosis is RT-PCR, enzyme-linked immunosorbent assay helps in the diagnosis of antibodies. Here, we report a rare case of prolonged viral shedding for more than 14 weeks. The patient had a prolonged COVID-19 infection, which caused immunosuppression, following which the patient presented with an infection.

To study ultrasound and chest X-ray findings and their role in the diagnosis of dengue fever in children.

Introduction: Dengue fever is a fatal viral illness affecting almost all age groups and is seen in almost all tropical countries. Ultrasonography (USG) can be a useful tool for the assessment and diagnosis of dengue fever. Objectives: The study aimed to evaluate X-ray and ultrasound findings in children with dengue fever. Material and Methods: This was a prospective and cross-sectional study that was carried out in a hospital in Mumbai for over one year. All relevant data were collected, validated, and analyzed statistically on the software Epi Info 7. Results: Abnormal X-ray findings noticed were pleural effusion, pneumonia, and bilateral nodular opacities. Pleural effusion and respiratory complications were more common in severe dengue (P < 0.05). Out of the 37 patients on whom USG was done, 33 (89.18%) had abnormal and 4 (10.81%) had normal USG findings. Of the 17 patients with dengue who showed warning signs, 16 (89.9%) had abnormal USG findings. Plasma leakage in the form of ascites and effusion was commonly seen. One hundred percent of patients with severe dengue had abnormal USG findings. The abnormal USG findings were more commonly detected between 5-7 days and were more commonly associated with IgG + IgM-positive serology. Conclusion: Ultrasonography is a good modality for the diagnosis and evaluation of dengue patients. Serial ultrasound should be done for the assessment and evaluation of said patients.

A Rare Variant and Unusual Presentation of Holt Oram Syndrome in a Child.

Holt Oram syndrome is a rare genetically inherited disorder characterized by various skeletal abnormalities of the upper limb with an underlying structural heart defect. Family history and conduction defects may or may not be there. The diagnosis is often clinical; if the criteria are not fulfilled, then genetic studies may be required. This syndrome can also occur with complex congenital heart defects, heart blocks, and arrhythmias. The correlation between the severity of cardiac and skeletal manifestations was not studied, and in severe conditions and acute presentation, the patient may have atrial, supraventricular, and ventricular fibrillation. The association of radius with hand deformity and the cardiac defect is well reported, but this disease's involvement of the humerus and Supraventricular tachycardia (SVT) is rare. Here, we are reporting a case of Holt Oram syndrome in a five-year male child with unusual skeletal hypoplastic humerus who presented with breathlessness, palpitations, and supraventricular tachycardia and suffered a total of three episodes which were managed with adenosine and cardioversion successfully. The involvement of the humerus, along with symmetrical bilateral radial defect with Atrial septal defect (ASD) and Supraventricular tachycardia (SVT), is a unique feature of Holt Oram syndrome seen in our case.

An Unusual Presentation of Neonatal Sepsis as Hyperleukocytosis With Firm Lymphadenopathy: A Diagnostic Challenge.

The neonatal leukemoid reaction is an acute response of the body to stress. Any inflammatory processes in the newborn period may lead to an increase in the white blood cell (WBC) count. Hyperleukocytosis refers to an extremely elevated leukocyte count beyond 100,000/cubic millimeter (cumm). Here, we report a case of a leukemoid reaction in a newborn who presented with fever, swelling over the neck, and failure to thrive. Peripheral smear showed the presence of all precursors of white blood cells, but no blast cells were seen. Fine needle aspiration cytology (FNAC) did not show any abnormal cells or any evidence of leukemia. Hence, the diagnosis of a leukemoid reaction was made. Hyperleukocytosis presenting as palpable lymphadenopathy in a neonate is a rare finding that was seen in this case secondary to septicemia.

Femoral Artery Thrombosis: Rare Sequelae of a Common Entity.

Neonatal hypernatremic dehydration (NHD) is a common complication in breastfed neonates which if not recognized early can lead to life-threatening complications. Only a few cases of NHD leading to peripheral gangrene have been reported in the literature. We report a case of a 14-day-old neonate with complaints of dyspnoea, poor oral intake, and gangrenous changes in the left leg. There was a 28% weight loss since birth due to inadequate feeding. The baby was diagnosed with severe hypernatremic dehydration with Kidney Disease Improving Global Outcomes (KDIGO) stage 4 acute kidney injury requiring peritoneal dialysis. Ultrasonography of the left lower extremity revealed a distal femoral artery thrombus leading to dry gangrene requiring amputation. There were neurological signs like altered sensorium and drug-resistant seizures which were suspicious for intracranial pathology like cerebral venous sinus thrombosis. Prevention and early diagnosis of NHD are essential to prevent the occurrences of such grave complications. It can be easily achieved by improving the vigilance regarding the adequacy of feeds subjectively by the mother if the baby is at home and objectively by physicians in the hospital setting. These simple interventions have the potential to prevent readmissions due to not only simple feeding complications but grave complications as mentioned above as well and save precious lives.

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.

Comparison of Continuous versus Pulsed Mode in Accelerated Corneal Collagen Cross-linking for Keratoconus.

PURPOSE: To compare efficacy and safety between the two modes of energy delivery-pulsed and continuous, in accelerated corneal collagen cross-linking (KXL) to stop the keratoconus advancement through topographical, visual, and refractive endpoints. METHODS: It was a prospective, comparative, randomized, interventional trial. Patients with bilateral progressive keratoconus were subjected to pulsed mode KXL (P-KXL) in the right and continuous mode KXL (C-KXL) treatment in the left eye. In both methods, additional supplemental oxygen was delivered to corneal surface using a nasal cannula connected to an oxygen supply. Uncorrected distance visual acuity (UDVA) and corrected distance visual acuity, posttreatment manifest spherical equivalent and astigmatism, and corneal topography were studied. The deformation amplitude index (DAI) was measured by Corvis-ST. Postoperative follow-up was done. RESULTS: One hundred eyes of 50 patients underwent P-KXL in the right eye and C-KXL in the left eye. The average follow-up was 12.1 ± 1.2 months. At 1 year posttreatment, the UDVA had a mean change of 0.11 ± 0.14 logMAR in P-KXL and 0.18 ± 0.14 logMAR in C-KXL groups. The line of demarcation was observed at 251.13 ± 18.28 µ and 245.28 ± 28.26 µ deep, respectively, in P-KXL- and C-KXL-treated eyes at 6 months' follow-up. The DAI as measured by Corvis-ST showed a significant decrease from pretreatment values of 1.12 ± 0.13 mm to 0.84 ± 0.14 mm (P < 0.01) in P-KXL eyes and from 1.04 ± 0.14 mm to 0.85 ± 0.15 mm (P = 0.03) in C-KXL eyes. Both the groups did not show any statistically significant endothelial cell loss posttreatment. CONCLUSION: C-KXL can give similar functional outcomes as P-KXL with the help of supplemental oxygen delivery with the added advantage of a shortened procedure time in comparison to pulsed mode.