We assessed the effect of vitamin D supplementation on related biochemistry, infection and dentition of the infant. In a double-blind, placebo-controlled trial conducted in Lucknow, India (latitude 26°N), 230 mother -newborn pairs were randomised to receive, for 9 months, 3000 µg/month oral vitamin D 3 by the mother (group A) or 10 µg/d by the infant (group B) or double placebo (group C). All babies received 15 min of sun exposure (unclothed) during massage. Infants' median 25-hydroxyvitamin D (25(OH)D) was lower in group C (median 45·3; interquartile range (IQR) 22-59·5 nmol/l) than in groups A (median 60·8; IQR 41·3-80·5 nmol/l (P < 0·01)) and B (median 61·3; IQR 41·3-75·3 nmol/l (P < 0·05)) at 3·5 months. Infant 25(OH)D correlated negatively with infant parathyroid hormone (r −0·46, P < 0·01). Elevated alkaline phosphatase (>7.5 µkat/l) was significantly more frequent in group C babies (16 %) than in group A (4 %) or group B (0 %) babies. The number of days with respiratory or diarrhoeal infection by 9 months of age was higher in group C (median 46·5; IQR 14·8-73·3 d) than in group A (median 18·5; IQR 8·8-31·0 d (P < 0·01)) or group B (median 13·0; IQR 7·0-28·5 (P < 0·05)). We conclude that monthly maternal or daily infant supplementation with vitamin D along with sun exposure is superior to sun exposure alone in maintaining normal infant 25(OH)D at 3·5 months, and provide protection from elevated alkaline phosphatase and infectious morbidity.Key words: Vitamin D: Lactation: Infants: Sunshine Hypovitaminosis D is highly prevalent in India despite adequate sunshine. Factors responsible for this include inadequate exposure to sunshine, atmospheric pollution and skin pigmentation. Serious consequences of vitamin D deficiency include cardiac failure and hypocalcaemic seizures (1) . Transplacental transfer and breast milk concentration of vitamin D are low in mothers with poor vitamin D status during pregnancy and lactation (2)(3)(4) . Studies from India have shown 84-96 % of mothers and infants at birth and at 3 months to have serum 25-hydroxyvitamin D (25(OH)D) < 20 ng/ml (50 nmol/l), with winter mean 25(OH)D in women being as low as 5·9 ng/ml (14·75 nmol/l) (2,5) . High-dose (160 µg or 6400 IU/d) vitamin D 3 administered to the lactating mother was found to safely and significantly improve maternal 25(OH)D and mean milk antirachitic activity (6) . Ala-Houhala et al. (7) showed that a regimen of 50 (but not 25) μg/d to the mother improved the nursing infant's serum 25(OH) D significantly. In the only study from India on postnatal supplementation of term infants, Kumar et al. (8) did not find any differences between the placebo and supplemented groups (receiving 35 µg vitamin D 3 /week) in mortality or hospital admissions (their primary outcomes) or referral to the outpatient clinic for moderate morbidity, although serum 25(OH)D was higher in the treated group. Current international recommendations mention 10 µg/d as routine supplementation for breastfeeding infants (3,4,9) . However, no study from tropic...

A male term neonate, at day 23 of life, presented with vesicular lesions over the trunk, which spread to allover the body on the next day. Five days later, he started developing blistering of the skin over the trunk and extremities, which subsequently ruptured, leaving erythematous, tender raw areas with peeling of the skin. The mother had vesicular eruptions, which started on the second day of delivery and progressed over the next 3 days. Subsequently, similar eruptions were noticed in two of the siblings before affecting the neonate. On the basis of the exposure history and clinical picture, a diagnosis was made of varicella infection with staphylococcal scalded skin syndrome (SSSS). The blood culture and the wound surface culture grew Staphylococcus aureus. Treatment included intravenous fluid, antibiotics, acyclovir and wound care. However, after 72 h of hospitalisation, the neonate first developed shock, refractory to fluid boluses, vasopressors and catecholamine along with other supports; and he then succumbed. In all neonates, staphylococcal infection with varicella can be fatal due to SSSS, the toxic shock syndrome or septicaemia.

COVID-19 infection in children is relatively mild and is associated with fewer complications compared with adults. Here we report the case of a previously healthy preteen girl who presented with active COVID-19 and shock. On day 1, ultrasound of the thorax revealed a right-sided pleural effusion with haemorrhagic pus on diagnostic tap, which improved clinically with appropriate hospital treatment. Even at discharge, the chest X-ray barely changed, indicating a fibrotic area and a collapsed lung. The patient had persistent thrombocytosis, her inflammatory markers (C reactive protein, ESR, interleukin 6, serum ferritin, D-dimer and procalcitonin) were elevated, and a high-resolution CT scan of the thorax at discharge revealed fibro-infiltrative patches with cavitary lesions in COVID-19 pneumonia, which are unusual findings. The patient was discharged on clinical improvement and was doing fine on follow-up after 2 weeks.

Background: Mother's milk is the best milk for neonates. Preterm very low birthweight (VLBW) neonates face many challenges leading to low rates of breastfeeding at discharge. Aims: (i) To determine the proportion of <32 weeks preterm VLBW neonates who are exclusively breastfed (EB) at discharge and (ii) determinants of exclusive breastfeeding (EBF) at discharge. Methods: An observational study was conducted for a duration of 1 year, from May 2019 to April 2020 in a tertiary care neonatal intensive care unit (NICU) in North India. Consecutive <32 weeks preterm VLBW neonates admitted within 72 h of birth and on full enteral feeds (FEF) within 10 days of birth were included in this study and followed up till discharge. Results: Forty-four of 97 (45.4%) preterm VLBW neonates were exclusively breastfed and 31/97 (32%) received more than 80% mother's own milk (MOM) at discharge. Male sex (P = 0.03), those whose first feed had any amount of MOM (P = 0.038) or exclusive MOM in their first feed or when initiated on first FEF (P = 0.002), and neonates with longer duration of hospital stay (P = 0.035) had an increased chance of being exclusively breastfed at discharge. Conclusion: Preterm VLBW neonates who receive any amount of MOM in their first feed or first FEF, male infants and those who stay longer in hospital are more likely to be exclusively breastfed at discharge.

Question: The primary objective was to determine the role of Vitamin D in severe pneumonia and secondarily with duration of hospitalization, time of resolution of tachypnea, chest retraction and inability to drink water.