Background: Neonatal birth injuries are the third major cause of neonatal mortality in most developing countries. Very few studies have been done in India on birth injuries and its relation to various factors such as undesirable presentations and parity. Aim: The present study was conducted to analyze the birth injuries in our setup to know the various perinatal circumstances leading to birth injuries. Materials and Methods: An observational study was done in which 100 cases of birth trauma were noticed among 850 consecutive viable births during the study period of 2 years. Details of the health status of the mother, antenatal, intra-natal, and postnatal particulars, including the age, sex, weight, mode of delivery, type of presentation, and nature of the birth injury in different modes of delivery and type of presentation of the baby were taken. Results: It was found that of 850 newborn babies, 100 babies were found to have birth injuries, thus giving an incidence of 11.76% per 100 live births. Asphyxia formed the major groups which were noted in 45 babies. Cephalohematoma was the next common injury being noted in 32 cases. A total of 18 babies had soft tissue injuries and 4 babies had neurological injuries. Conclusion: Our findings support to use data on neonatal birth injuries as an indicator to assess the quality and safety of maternity units.

B irth injuries or birth trauma is defined as impairment or injury suffered by the neonate during delivery or during the entire birth process [1]. The predisposing risk factors for birth injuries can be classified into maternal, fetal, or birth attendants associated. The common risk factors of birth injuries are usually identified early in pregnancy or at an early stage of labor by trained health professionals, however, either due to lack of experience or poor facility setting, newborn incur a severe form of birth injury. The common risk factors for birth injuries are lack of supervision of pregnancy, maternal medical conditions, difficult labor, short or prolonged labor, obstructed labor, higher birth weight >4000 g, instrumental delivery, malpresentation, and maternal age <16 years or >35 years [2-5]. Injury may occur during labor, delivery, or after delivery, especially in neonates who require resuscitation in the delivery room. It can occur during both vaginal and cesarean deliveries [6]. Varied incidence has been reported in literature. It may be associated with increased morbidity and mortality [7]. There is a wide spectrum of birth injuries ranging from minor and self-limited problems (e.g., laceration or bruising) to severe injuries that may ABSTRACT Background: Neonatal birth injuries are the third major cause of neonatal mortality in most developing countries. Very few studies have been done in India on birth injuries and its relation to various factors such as undesirable presentations and parity. Aim: The present study was conducted to analyze the birth injuries in our setup to know the various perinatal circumstances leading to birth injuries. Materials and Methods: An observational study was done in which 100 cases of birth trauma were noticed among 850 consecutive viable births during the study period of 2 years. Details of the health status of the mother, antenatal, intra-natal, and postnatal particulars, including the age, sex, weight, mode of delivery, type of presentation, and nature of the birth injury in different modes of delivery and type of presentation of the baby were taken. Results: It was found that of 850 newborn babies, 100 babies were found to have birth injuries, thus giving an incidence of 11.76% per 100 live births. Asphyxia formed the major groups which were noted in 45 babies. Cephalohematoma was the next common injury being noted in 32 cases. A total of 18 babies had soft tissue injuries and 4 babies had neurological injuries. Conclusion: Our findings support to use data on neonatal birth injuries as an indicator to assess the quality and safety of maternity units.

Background: Approximately 3–4% of neonates with meconium-stained amniotic fluid (MSAF) develop meconium aspiration syndrome (MAS), of which nearly 30–50% need continuous positive airway pressure (CPAP) or mechanical ventilation (MV). Objective: The objective of the study was to evaluate the usefulness of bubble CPAP as a respiratory support in neonates admitted with MAS and to enumerate factors affecting the CPAP failure. Materials and Methods: A prospective study was conducted, involving all the neonates born with a history of MSAF with respiratory distress within 6 h of life (Downe’s score 4–7), SpO2 <90% with chest X-ray suggestive of MAS. Bubble CPAP was started with pressure and FiO2 adjusted to maintain a SpO2 between 89% and 95%, maximum pressure limit of 6 cm, and FiO2 of 100%, respectively. CPAP was removed when SpO2 was >90% with FiO2 requirement <25% and when respiratory distress was passive (Respiatory rate <60/min, no or mild retractions and no grunt). The primary outcome was measured in terms of improvement in Downe’s score and clinical condition of neonates. CPAP failure was defined as the need for MV, pulmonary leak syndrome, persistent pulmonary hypertension, and progression of Downe’s score. Results: Downe’s score at the start of CPAP was 6 which decreased to 4, 6 h post-CPAP. There was an improvement in FiO2, RR, and heart rate from 68%, 76/min, and 181/min to 84%, 48/min, and 123/min post-CPAP, respectively. The success rate of CPAP was 77% and failure rate was 23%. Conclusion: Early initiation of CPAP in MAS neonates decreases the need for MV and improves outcomes.

Proximal femoral focal deficiency (PFFD) is a rare congenital anomaly. We present a case of an isolated unilateral congenital femoral deficiency that was born locally. A full-term male baby was brought to us with a complaint of short left lower limb. Examination revealed short left lower limb with absence of thigh. Detailed history was obtained and he was examined clinically as well as radiologically. He was diagnosed as a case of PFFD of type C. Proper evaluation and its management accordingly can help the patient to lead a socially and economically productive life.

Background: Hepatic involvement is not an uncommon in dengue viral infection, which presents with elevation in serum aminotransferases due to reactive hepatitis. The study is aimed to know the pattern of changes in hepatic enzyme levels in dengue infection in pediatric patients and to assess it with clinical presentation of dengue in particularly patients without and with shock.Methods: Pediatric patients with serologically confirmed Dengue viral infection were enrolled in the study and divided clinically into a shock group and a non-shock group. SGPT and SGOT levels were measured from day one of fever onset till 7 days and within 3 days after shock in the shock group. Student t-test was used to analyze the statistical data.Results: 100 patients with a mean age of 8±2.6 years were included in the study. The incidence of abnormal SGOT and SGPT levels were 96.9% and 51.1% in the shock group, and 92.2% and 45% in the non-shock group respectively. 30% and 17.9% of the patients in shock group and only 9.9% and 4.2% in non-shock group had the respective SGOT and SGPT levels > 200 U/L. Patients in shock group had statistically higher levels of Serum aminotransferase compared to the non-shock group. SGOT tended to increase starting from one day before shock and continued to increase within a few days whereas SGPT was less likely to be affected.Conclusions: Pediatric patients with Dengue infection have raised Aminotransferases in particular SGOT, which is higher than SGPT level. Aminotransferase levels in shock patients are significantly high and increases up to 3 days.