Background: Phototherapy despite being very safe is found to be associated with various untoward effects. The objective of this article was to study the changes in various hematological parameters as a result of phototherapy in neonates treated for unconjugated hyperbilirubinemia. Methods: A cross sectional study was conducted in 120 neonates with unconjugated hyperbilirubinemia to determine the changes in the blood cell counts. We compared the complete blood counts at the time of admission and after 48 hours of phototherapy. The data was analyzed in SPSS 25 using paired t test. Results: We observed that there was an increase in the lymphocyte counts from 5,650 cells/mm3 before phototherapy to 6,360 cells/mm3 after phototherapy with a p-value 0.028. MCH increased from 32.22 pg before phototherapy to 33.34 pg after phototherapy with a p-value of 0.018. The mean monocyte counts decreased from 730 cells/mm3 before phototherapy to 530 cells/mm3 after phototherapy with a p-value of 0.016. The mean platelet count also decreased from 241×103 cells/mm3 to 258×103 cells/mm3 with a p-value of 0.041 which was significant. Rest of the blood cell counts seem to be unaltered by phototherapy. Conclusions: Phototherapy was found to be associated with significant decrease in the absolute monocyte count and platelet counts and caused an increase in the lymphocyte count and MCH. However, it does not cause significant changes in the total count and hemoglobin levels.

Neonatal intensive care is associated with high costs world-wide and remains a matter of financial stress for families. This is an issue of great importance in a developing country like ours as financial burden may have a negative impact in the overall outcome of a newborn. The objective of this study was to evaluate the direct cost of treating newborns by family members in a neonatal intensive care unit (NICU). This was a prospective cross sectional study carried out in the NICU of Manipal Teaching Hospital, Pokhara, Nepal. There were 96 neonates included in this study over a period of 3 months from September to November 2020. The average cost per neonate per day was NRs. 5858 (USD 50). The highest health expenditure was incurred in neonates of gestational age of 32 to less than 37 weeks, and it was also significantly higher in neonates having birth weights less than 1.5kg. Preterms with hyaline membrane disease, followed by newborns with meconium aspiration syndrome resulted in maximum health costs. Maximum expenditure of the total bill was due to the cost of the bed charges. The median length of stay in the study was 5 days and the length of stay was directly and significantly related to the treatment costs.

VACTERL is used to denote vertebral abnormalities (V), anal atresia (A), cardiac defects (C), tracheoesophageal fistula (TE), renal or radial abnormalities (R), and limb abnormalities (L). This is a case report of a neonate delivered at Manipal Teaching Hospital, Pokhara with features suggestive of VACTERL association.