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Background: Acute kidney injury (AKI) is a significant problem in neonates, but the evidence is sparse. Neonatal AKI is an independent risk factor for increased mortality and prolonged hospital stay. There are stark differences in the epidemiology of AKI in neonates amongst the developing and the developed world. Increased prevalence of neonatal sepsis, lack of awareness about neonatal AKI and poor access to pediatric nephrologists add to the improper management of neonatal AKI in the developing countries.Methods: This study is a multicentric, national, prospective cohort study [The Indian iconic Neonatal Kidney Educational Registry (TINKER)] conducted in level 2–3 NICUs in 11 centers across India. We have enrolled nearly 2,000 neonates over the study period. Neonates (≤ 28 days) who were admitted in NICU and those who received intravenous (IV) fluids for at least 48 h for hydration and/or nutrition have been included. Data collection included: (1) baseline demographics (2) daily physiologic and laboratory parameters (3) discharge data. KDIGO workgroup AKI definition modified for neonates was used for defining AKI. Data entry was carried out by individual participating centers using a web-based database (akiregistry.org). De-identified data has been maintained and handled by the principal investigator (PI). This collaboration plans to disseminate data through peer-reviewed publications and through presentations at educational conferences.Conclusions: The purpose of this study is to create the first prospective neonatal all-cause AKI data repository and describe the incidence of neonatal AKI in NICUs in the country and determine the risk factors as well as the outcomes of such neonates—both short-term and long-term outcomes. This will eventually spur therapeutic advancements, facilitate decipherment of epidemiological trends, risk factors as well as outcomes and identify disparities in management across the nation.

Zinc deficiency, common in children of developing countries, leads to susceptibility to infections. Relapses in nephrotic syndrome are precipitated mostly by infections. Most of morbidity and mortality in nephrotic patients is during nephrotic range proteinuria. Management of factors which reduce duration of relapse, can decrease morbidity in pediatric nephrotic patients. We aimed to study serum zinc levels, in patients of nephrotic syndrome, at onset/relapse and at remission and tried to find out correlation between serum zinc levels and time to achieve remission.Observational study was conducted in tertiary centre of North India over 12 months. Consecutive pediatric patients, with initial episode/relapse of NS were enrolled. Patients were treated as per standard protocol. Time taken for remission was noted. Serum zinc level was estimated first at confirmation of initial episode/relapse and then at remission. Data were summarized as mean ± standard deviation. Groups were compared by paired t test. Pearson correlation analysis was done to assess association between initial zinc level and time to attain remission.68 patients were screened for inclusion in the study but only 49 qualified for final analysis. Serum zinc level was statistically different in all patients at enrolment and at remission. Pearson correlation analysis showed an insignificant and inverse correlation between time to remission and serum zinc level (r=0.14, p>0.05) suggesting that, as serum zinc level at enrolment decreases, the time to remission lengthens.Zinc level at initial episode/relapse was found to have negative correlation with time to attain remission.

Caffey disease is a rare and self-limiting condition characterised by cortical hyperostosis with inflammation of adjacent fascia and muscles. It usually presents in infancy and clinical features include hyperirritability, acute inflammation with swelling of overlying soft tissues and subperiosteal new bone formation. Awareness of the existence of this rare condition and its typical clinical and radiological profile will avoid unnecessary investigations and treatment and help the physician to explain its good prognosis to parents of affected children. We report a three-month-old male infant who presented to the Outpatient Paediatrics Department at Moti Lal Nehru Medical College, Allahabad, India, in 2018 with a right shoulder mass, decreased upper limb movements and irritability. The patient was treated with ibuprofen and paracetamol. Irritability and limitation of movement improved over a treatment period of two weeks.Keywords: Caffey Disease; Infant; Prostaglandin E1; Thrombocytosis; Case Report; India.

Background: Acute kidney injury (AKI) is common in neonates admitted to neonatal intensive care units (NICUs). There is a need to have prospective data on the risk factors and outcomes of acute peritoneal dialysis (PD) in neonates. The use of kidney replacement therapy in this population compared to older populations has been associated with worse outcomes (mortality rates 17–24%) along with a longer stay in the NICU and/or hospital. Methods: The following multicentre, prospective study was derived from the TINKER (The Indian PCRRT-ICONIC Neonatal Kidney Educational Registry) database, assessing all admitted neonates ≤28 days who received intravenous fluids for at least 48 h. The following neonates were excluded: death within 48 h, presence of any lethal chromosomal anomaly, requirement of congenital heart surgery within the first 7 days of life and those receiving only routine care in nursery. Demographic data (maternal and neonatal) and daily clinical and laboratory parameters were recorded. AKI was defined according to the Neonatal Kidney Disease: Improving Global Outcomes criteria. Results: Of the included 1600 neonates, a total of 491 (30.7%) had AKI. Of these 491 neonates with AKI, 44 (9%) required PD. Among neonates with AKI, the odds of needing PD was significantly higher among those with significant cardiac disease (odds ratio (95% confidence interval): 4.95 (2.39–10.27); p < 0.001), inotropes usage (4.77 (1.98–11.51); p < 0.001), severe peripartum event (4.37 (1.31–14.57); p = 0.02), requirement of respiratory support in NICU (4.17 (1.00–17.59); p = 0.04), necrotising enterocolitis (3.96 (1.21–13.02); p = 0.03), any grade of intraventricular haemorrhage (3.71 (1.63–8.45); p = 0.001), evidence of fluid overload during the first 12 h in NICU (3.69 (1.27–10.70); p = 0.02) and requirement of resuscitation in the delivery room (2.72 (1.45–5.12); p = 0.001). AKI neonates with PD as compared to those without PD had a significantly lower median (interquartile range) duration of stay in NICU (7 (4–14) vs. 11 (6–21) days; p = 0.004), but significantly higher mortality (31 (70.5%) vs. 50 (3.2%); p < 0.001). This discrepancy is likely attributable to the critical state of the neonates with AKI. Conclusions: This is the largest prospective, multicentre study specifically looking at neonatal AKI and need for dialysis in neonates. AKI was seen in 30.7% of neonates (with the need for acute PD in 9% of the AKI group). The odds of needing acute PD were significantly higher among those with significant cardiac disease, inotropes usage, severe peripartum event, requirement of respiratory support in NICU, necrotising enterocolitis, any grade of intraventricular haemorrhage, evidence of fluid overload more than 10% during the first 12 h in NICU and requirement of resuscitation in the delivery room. AKI neonates with PD as compared to AKI neonates without PD had a significantly higher mortality. There is a need to keep a vigilant watch in neonates with risk factors for the development of AKI and need for PD.