Background: Postoperative sepsis, which has high morbidity and mortality, is a major problem affecting the outcome of neonatal surgeries. Adequate treatment and preventive measures for sepsis can decrease the morbidity and mortality in neonatal surgeries. Objective: (1) To study the incidence of sepsis in neonatal surgical patients and (2) To study the causative organisms and their sensitivity to antibiotics in such sepsis. Materials and Methods: A prospective, observational study was carried out in the tertiary-care level neonatal intensive care unit of SSG Hospital, Vadodara, Gujarat. Eighty newborns having a major surgery within the first 30 days of life were included in the study. Baseline data of the study participants were collected including antenatal and perinatal histories and evidence of postoperative sepsis. Complete examination and investigations including quantitative C-reactive protein (QCRP), WBC counts, blood culture, and treatment were also included. Conclusion: Incidence of postoperative sepsis in neonates was found to be 73.75%. We found coagulase-negative Staphylococcus aureus to be the most common organism (38%) cultured from blood, followed by Klebsiella (19%) and Acinetobactor (18.2%), which was sensitive to cefotaxime, amikacin, and piperacillin/tazobactam.

Objective Conventional regimen for treating neonatal pyogenic meningitis is parenteral antibiotics for 21 days. We compared efficacy of short-term antibiotic of 14 days to this conventional regimen. Methods A quasi-experimental study was conducted in tertiary care hospital over 11 months. Neonates having birth-weight more than 1.5 kg with pyogenic meningitis were enrolled, and allotted into 2 groups: group A was given antibiotics for 14 days and group B for 21 days. They were monitored during hospital stay, and compared on follow-up on day 28. Primary outcome measure was treatment failure in the form of recurrence of sepsis/meningitis and faltering in growth or developmental milestones. Results The treatment success rate in both groups was 100%, no patient had recurrence. Mean growth in head circumference on day 28 was 1.8 (±0.56) cm in group A and 1.62 (±0.56) cm in group B, P = .15. Mean weight gain was 540 (±230) gm in group A and 470 (±180) gm in group B, P = .13. Mean length gain was 2.51 (±0.95) cm in group A and 2.33 (±0.64) cm in group B, P = .32. On day 28, all patients of group A and B had achieved social smile ( P = 1.0), 34 from group A and 38 from group B achieved gaze fixation ( P = .37), 21 from group A and 18 from group B could hold head steady ( P = 1.0). None developed any sequalae or abnormal otoacoustic emissions. Conclusion Short course of antibiotics for neonatal pyogenic meningitis was as effective as the conventional regimen in neonates with cerebrospinal fluid clearance and clinical improvement by day 7.

Background: Kangaroo mother care (KMC) is routinely practiced in post-natal wards for care of stable low birth weight (LBW) infants. Objectives of the study were conducted to emphasize on the role of KMC in vitals stabilization and weight gain in LBW babies inside neonatal intensive care unit (NICU).Methods: Cross-sectional analytical quantitative study.Results: A total of 80 babies (48 males and 32 females) were enrolled and given KMC inside NICU. Mean birth weight was 1330 grams. Mean gestational age was 33 weeks (range 30-38 weeks). KMC was initiated within 72 hours of life in majority of babies (71%). Though 65% of them required oxygen support via prongs, KMC was started in them, with monitoring of vitals. No episode of apnea was observed during KMC sessions. Mean duration of KMC was 6 days (3-14 days). Heart rate dropped by 3-4 beats per minute (150+2.12 to 146+1.63, Respiratory rate decreased from 53+3.9 to 49+2.7, Oxygen saturation improved by 2-3% (93+0.42 to 96+0.71). Temperature rose from 36.78+0.01 to 37.07+0.02. P value for all vitals was 0.0001, which is considered significant (<0.05). Average weight gain was 76 grams during the average 6 days of KMC inside NICU, (p value=0.0001).  Conclusions: KMC was found to be effective for stabilization of vitals in NICU, early initiation and upgradation of feeding, early achievement of weight gain pattern, and early shift to postnatal ward by mother’s side. Also, no adverse effects were noted on the babies.

Background:Neonatal hyperekplexia is a rare nonepileptiform disorder characterized by an exaggerated startle reflex associated with generalized hypertonia. We report a newborn with mutation in the glycinergic inhibition pathway resulting in hyperekplexia, associated with features of arthrogryposis multiplex congenita.Clinical Description:A 3-day-old newborn born at term vaginally cried immediately after birth and presented with lethargy, poor cry, and abnormal clonic movements of all four limbs. On examination, there was hyperreflexia and hypertonia in all four limbs along with dislocation of the right knee joint. Blood investigations, including tandem mass spectrometry, serum ammonia, serum, and cerebrospinal fluid glycine levels, were normal, ruling out inborn errors of metabolism responsible for hyperekplexia and arthrogryposis. The magnetic resonance imaging (MRI) brain and electroencephalogram were normal, while the MRI spine showed kyphosis. The genetic evaluation showed heterozygous missense mutation in exon 6 of the SLC6A9 gene and homozygous mutation in the TOR1A gene, which explained the hyperekplexia and the arthrogryposis multiplex congenita.Management and Outcome:The patient received supportive care. Oral clonazepam and levetiracetam were started in view of hypertonia and clonic spasms. Feeding was given by intragastric tube as he had poor suck–swallow coordination.Conclusions:This case highlights an interesting and extremely rare combination of hereditary hyperekplexia and arthrogryposis multiplex congenita existing together in the same patient, confirmed by the corroborating genetic mutations. Awareness of such conditions among pediatricians is essential to order appropriate genetic evaluations and treatment accordingly.

Background Intern doctors are often incompetent to perform neonatal resuscitation, which is an essential skill and core competency area of pediatric curriculum. Methods We aimed to analyze the impact of direct observation and supervised “hands-on” component along with standard basic neonatal resuscitation training for intern doctors. An educational interventional study was conducted among interns after being approved by ethics committee. Mannequin based Basic neonatal resuscitation training of intern doctors was demonstrated. After that one week observership for real-life experience in NICU was given, where they observed minimum 5 delivery calls under the supervision of senior resident/faculty. Learning gain of the interns was analyzed by comparing the pre- and post-training test score. Knowledge based questions and objective structured clinical examination (OSCE) stations were used for the assessment. The OSCE was used to check the skills acquisition among intern doctors. Interns post workshop and post observership feedback in the form of reflection were analyzed. Faculty’s feedback in the form of reflection was analyzed. Results A total of 8 interns completed both pre and post training test for the level 2 evaluation-learning gain. Mean test scores of knowledge based questions and OSCE increased significantly from 85% to 97.5% and 33.33% to 100%, respectively. Pre- and post-workshop OSCE revealed 100% achievement of clinical skill of neonatal resuscitation. Intern doctors perceive that NRP training program improved their confidence levels and decreased the fear to perform neonatal resuscitation during first golden hour of life to save life of newborn. BNRP program is one of the core components to impart a clinical skill as an integral part of learning during internships. Conclusion Direct observation and supervised “hands-on” component as an additional teaching-learning method was well perceived and competency of interns for neonatal resuscitation was significantly enhanced. BNRCP competent IMG/intern being the first contact physician will be able to survive the newborn and contribute in decreasing neonatal mortality rate.