Purpura fulminans is a hemorrhagic condition associated predominantly with meningococcal and other gram negative septicemias. It occurs mainly in infants and younger children. Features include tissue necrosis, small vessel thrombosis, disseminated intravascular coagulation, multi-organ failure and death. Other causes include clotting factor deficiencies and idiopathic varieties. The condition is uncommon due to gram positive bacterial sepsis. We report one such case with gram positive bacterial infection

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Background: One of the most frequent illnesses in the rst 48 to 72 hours of neonatal life is respiratory distress. The most frequent reason for NICU hospitalization and the leading cause of morbidity in newborn is respiratory distress. The present study is aimed to determine and correlate the incidence, risk factors, causes and outcomes of respiratory distress in neonates in a neonatal intensive care unit of a tertiary care facility. Impressive outcomes are achieved when neonatal respiratory illness is diagnosed early and managed with appropriate interventions. Material & Methods: A prospective observational study was conducted for a period of 18 months in the inborn & outborn NICU of Department of Pediatrics, Index Medical College Hospital & Research Centre, Indore after valid approval from Institutional ethics committee on. 100 babies who presented with respiratory distress irrespective of their status at time of delivery (preterm, term or post term) and qualied the inclusion criteria were enrolled after taking written informed consent from the parents/caretakers. Following the admission of the newborn, data were recorded in the predesigned proforma. Statistical analysis was done with P value <0.05 signicant. Out Results: of 100 babies included in the study, 62 were males while 38 were females. Pulmonary cause was the most frequent cause of respiratory distress in newborn out of which TTNB (33%) was the commonest followed by RDS (20%). Prematurity (37%), MSAF (18%), Caesarean section against precipitous labour (9.5%), obstruction/non progression of labour (8%) were the major risk factors to develop. 58% of babies were born via LSCS with MSAF (24.1%), previous Caesarean section (20.7%) and obstructed labour (13.8%) as the main indications. Under treatment intervention,62 (62%) babies required only Oxygen while 20 babies (20%) required CPAP and 18 babies (18%) required mechanical ventilation. Morbidity was seen in 34% of newborns with RD which included sepsis, ROP, IVH, HIE, BPD. Out of 20 deaths,14 babies (70%) were males, and 6 babies (30%) were females. In Conclusion: cidence of respiratory distress was 9.8% among live births. Transient tachypnea of the newborn is the most common cause of respiratory distress in newborn. Antenatal risk factors increase the incidence of RD. Risk factors like Prematurity, meconium-stained liquor, cesarean delivered newborns, obstructed labour, Oligo/polyhydramnios, foetal distress, PROM was associated with respiratory distress in newborns. Prematurity is the most common and most important risk factor for the development of RD in newborn. There was male predominance & most of the babies were delivered via caesarean section. Frequency and severity of RD is inversely related to gestational age and birth weight. Early term and preterm babies constituted majority of the babies with respiratory distress. Most of the babies had mild to moderate respiratory distress with Downe's score between 2-6. RDS was the most common cause for CPAP and ventilation. The mortality rate was 20% among the respiratory distress cases admitted in NICU, rest 80% survived. The most common cause of death was RDS. Early diagnosis and identication of causes of respiratory distress in neonate is critical in the management. The neonatal outcome will improve with efforts made to prevent preterm birth, identify various maternal risk factors and intervene early with appropriate interventions.

The congenital melanocytic nevi which are formed by the overgrowth of melanocytes occur in about 1% of the newborns. Giant Congenital Melanocytic Nevi (GCMN) which are of sizes larger than 20 cm diameter are rare and they occur in 1/500,000 newborns. Primary diagnosis of congenital giant nevus is clinical. Here, we report a case of full-term infant born with extensive black patch having smooth surfaces, irregular margins, and covering 45% of the skin surface.

Introduction: Malaria is a disease of global health importance and currently, 95% of the Indian population lives in malaria endemic area. Malaria parasite profile has been changing significantly over the years and is responsible for significant mortality and morbidity. Objective: To study the clinic-hematological profile and mortality in plasmodium vivax and falciparum malaria. Methodology: Hospital based observational study in a tertiary care centre for a period of 4 years including children <14 years of age who were tested positive for plasmodium vivax/falciparum. Results: A total of 230 confirmed cases of malaria were taken up, of which 141 were P. falciparum (61.30%) and 69 were P. vivax (30%) positive. 20 patients were positive for both Pf and Pv (8.70%). Fever with chills and/or rigor was most common symptom and pallor followed by splenomegaly was the most common physical signs. The most common hematological abnormality noted was anemia followed by thrombocytopenia. Anemia was more common in p. falciparum and in children below 5 years of age. Mortality was highest in p. falciparum malaria (5.67%) followed by mixed infection (5%) and Pv (2.89%). Cerebral malaria was most common cause of mortality (6 cases) followed by acute renal failure and shock. Complications were more common with Pf group, though they were also seen in Pv group. Conclusion: Cerebral malaria is the most lethal entity of severe malaria and children are more prone than other susceptible groups. Encephalopathy, shock and renal failure at the time of presentation were poor prognostic factors, while anemia and thrombocytopenia were not found to be associated with adverse outcome.