Background: Vitamin K deficiency can cause severe haemorrhage in the newborn and is an important cause of infant morbidity and mortality. HDN can be classified according to the time of presentation after birth into early (0–24 hours), classical (1–14 days) and late (2–12 weeks) HDN. Late HDN, which presents after the first week of life, mainly manifests as intracranial haemorrhage, depending upon the site and amount of bleeding, it either results in mortality or life long sequelae in the form of cerebral palsy and scar epilepsy with or without cognitive impairment. Objective: To determine the frequency of ICH about vitamin K deficiency and outcome in infants aged 2 to 24 weeks. Materials and Methods: From 1 September 2017 to 30 September 2019 we retrieved the retrospective data of 8 patients with late HDN admitted to Bapuji Child Health Institute and Chigateri Government General Hospital, Davangere. Results: Six of eight cases with late HDN had an intracranial haemorrhage, of whom 5 patients died (62%), one ended up with neurological sequelae (12%) and 2 cases had an extracranial bleed. Out of these 8 cases, 5 had not received vitamin K at birth. Conclusion: For neonates on strict breastfeeding, despite some with vitamin K prophylaxis, some patients still may suffer from intracranial and extracranial bleeding due to late HDN. Therefore, a change in strategy in the form of making the paediatricians and Anganwadi workers working in subcenters to give vitamin K, who have been vaccinating the babies after birth, would increase the vitamin K coverage.

Introduction: Central nervous system (CNS) manifestations in children with rickettsial diseases are increasingly being reported from various parts of India but still rickettsial disease, as a cause of central nervous system (CNS) infections are underdiagnosed because of lack of freely available rapid and cheap diagnostic tests and varied clinical spectrum of rickettsial fever. Objective: To report CNS manifestations in probable cases of rickettsial diseases so as to increase awareness amongst pediatricians. Materials and Methods: A retrospective analysis of children (birth to 18 years) hospitalized in Bapuji Child Health Institute, which is secondary referral centre catering to children from five districts of Karnataka, with diagnosis of rickettsial disease from January 2016 to December 2018. The diagnosis of rickettsial infections was made by scoring system proposed by Rathi Goodman Aghai (RGA), weil felix test, prompt response to doxycycline within 48 hours and exclusion of differential diagnoses. Results: Out of 278 patients, who were diagnosed as probable case of rickettsia, 172 patients had neurological involvement. Out of 172 patients with diagnosis of rickettsial disease having symptomatic neurological involvement, 148 (86%) had neurological manifestation as the main presenting feature while remaining presented with non-neurological manifestations of rickettsial diseases too, along with neurological manifestations. The youngest patient was 3 month old infant. The various neurological manifestations seen were altered mental status (76%), irritability (61%), headache (48%), meningeal signs (32%), seizures (31%), papilloedema (26%), focal neurological deficits (18%), cerebrospinal fluid (CSF) abnormalities (76%) and neuroimaging abnormalities (28%). Conclusions: The myriads of neurological manifestations were seen with varying range of severity. Pediatricians should be aware of neurological manifestations seen in rickettsial infections and should have high index of suspicion for rickettsial diseases in febrile patients having neurological features specially in endemic areas.

Background: Diphtheria is a fatal bacterial infection which affects the mucous membranes of oropharyngeal and nasal cavity, caused by aerobic gram-positive bacteria Corynebacterium diphtheriae. With the advent of universal immunization against diphtheria the incidence of this infectious disease has declined dramatically with few developed nations having eradicated the disease. No large outbreaks have been reported in India in recent times.Methods: In present study, authors reviewed an outbreak of diphtheria in Davangere between the months of June 2017 and July 2018. Case records of children suspected to have diphtheria, admitted to hospitals affiliated to JJM Medical College, Davangere were retrospectively analysed.Results: 15 cases were suspected to have diphtheria on clinical examination. The mean age of presentation was 7.5 years. Fever, sore throat, difficulty in swallowing, neck swelling and patch in oral cavity were the common signs and symptoms. Airway compromise, myocarditis and neurological complications were noted. Antidiphtheritic serum (ADS) was tried in all 15 cases. Case fatality rate was 40%.Conclusions: Diphtheria is a resurgent problem in India. Prompt identification and early appropriate treatment is essential to prevent morbidity and mortality. Strict adherence to the national immunisation schedule should also be emphasized.

Background: A congenital anomaly may be defined in terms of physical structure as a malformation, an abnormality of physical structure or form usually found at birth or during the first few weeks of life. Congenital anomalies affect approximately 1 in 33 infants and result in approximately 3.2 million birth defect-related disabilities every year. Congenital anomalies or birth defects are relatively common, affecting 3% to 5% of live births in the United States (US) and 2.1% in Europe. Congenital anomalies account for 8% to 15% of perinatal deaths and 13% to 16% of neonatal deaths in India. Objectives: To provide an insight on the burden and types of surgical problems encountered in our NICU of Bapuji Child Health Institute & Research Center, JJM Medical College, Davangere, Karnataka, India and to study the incidence, clinical profile and outcome of surgical condition. Methodology: A total of 3820 babies were examined over a period of 2 years. The relevant information was documented on a semi-structured proforma and analysed. Results: Overall incidence of congenital malformations at birth was 24.8 per 1000 births. The GIT system (51.58%) was most commonly involved followed by respiratory system (26.32%). The incidence of congenital malformation was more in male babies than female babies. Increased frequency was seen in babies born to mothers between 26–30 years & primigravida. The factors which significantly increased the rate of congenital malformations were consanguinity in parents & bad obstetric history. Out of 95 cases, 72% got discharged normally, 18% died in NICU and 10% got discharged against medical advise. Conclusion: With emphasis on “small family” norms and population control it is necessary to identify malformations so that interventional programmes can be planned. Systematic clinical examination of newborns for early detection of anomalies that may warrant medical or surgical intervention. Accurate antenatal anomaly scan need to be done to identify major malformations and terminate the pregnancy.