WMS is a rare but clearly identifiable syndrome with significant morbidity, predominantly affecting infants below 1,500 g birth weight. The earliest pathology appears to be alveolar air leak. Inflammatory activation induced by cystic interstitial air may cause the subsequent progressive respiratory disease. Management is supportive but should include investigation for pulmonary hypertension.

This observational study was done to discover the prevalence of fetal malnutrition (FM) in term newborns using clinical assessment of nutritional status (CANS score) and to identify associated risk factors. All term babies born in a referral teaching hospital during the 1-year study period were included in the sample. Gestational age and weight-for-gestational-age were assessed, and babies were classified as appropriate-for-gestational-age (AGA), small-for-gestational-age (SGA) or large-for-gestational-age (LGA). Maternal risk factors were recorded in each case. Fetal malnutrition was present in 19.6% of babies, of whom 40.7% had intrauterine growth retardation. Of the babies with FM, 59.9% were AGA and 1.9% were SGA even though they had no signs of FM. FM was evident in 84.2% of SGA babies, and 12.9% of AGA babies showed FM. The weights of babies with FM were significantly lower than of those without FM. Maternal risk factors for FM included adverse age, primiparity, low pre-pregnancy weight and height, a bad obstetric history and pregnancy-induced hypertension. Malnutrition in the newborn might be missed if intrauterine growth curves only are used for assessment. The CANS score is a simple and rapid clinical scoring system for diagnosing fetal malnutrition. Not all SGA babies are malnourished and those without FM have a better outcome and faster catch-up growth.

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During an 18-month study period, teleconsultations were conducted by email between a neonatal intensive care unit at an urban teaching hospital in western India and a rural primary care centre 40 km away. There were email consultations about 182 newborn babies; these consultations comprised 309 messages sent from the primary care centre and 272 messages from the teaching hospital. The average reply time was 11.3 h. Thirty-eight babies were referred to the intensive care unit at the teaching hospital after these consultations. The remaining 144 babies were managed at the primary care centre. Telemedicine helped in the diagnosis, referral, treatment and follow-up of patients. The cost of the email service was estimated to be Rs12,000 and the savings in avoided transfer were estimated to be Rs546,000, a cost-benefit ratio of 1:45.

Multidrug resistant (MDR) Klebsiella pneumoniae an increasing cause of neonatal sepsis in India. This observational study was designed to monitor temporal change in prevalence of K. pneumoniae as a causative organism for neonatal sepsis and its sensitivity pattern. The time period was divided into four time frames of six months each [designated A (1/10/2006?31/03/2007) to D (1/04/2008?30/09/2008)]. K. pneumoniae isolation in all cultures sent from neonatal intensive care units doubled in time frame D (6.3%) compared to time frame A (3.0). Similarly, the percentage of total positive cultures in the neonatal intensive care unit that were K. pneumoniae also doubled (27.8% in A to 55.6% in D). K. pneumoniae sepsis tripled in inborn neonates (15.4% in A to 47.1% in D). Incidence of MDR K. pneumoniae increased from 0% in time frame A to 76.5% in time frame D. Resistance against ampicillin and third generation cephalosporins (cefotaxime and ceftazidime) remained 100% in all time frames. Carbapenem (meropenem and imipenem) resistance increased from 0% in time frame A and B to 41.2% in time frame D. Death due to K. pneumoniae sepsis showed brisk resurgence in time frame D (17.6%) compared to time frame C (10%). Lower gestational age and birth weight were associated with higher mortality. MDR K. pneumoniae is emerging as a more frequent cause of neonatal sepsis. There is an dincreasing threat of combined quinolone and carbapenem resistant MDR K. pneumoniae.