Perinatal hypoxic–ischemic brain injury results in neonatal hypoxic–ischemic encephalopathy and serious long-term neurodevelopmental sequelae. Magnetic resonance imaging (MRI) of the brain is an ideal and safe imaging modality for suspected hypoxic–ischemic injury. The pattern of injury depends on brain maturity at the time of insult, severity of hypotension, and duration of insult. Time of imaging after the insult influences the imaging findings. Mild to moderate hypoperfusion results in germinal matrix hemorrhages and periventricular leukomalacia in preterm neonates and parasagittal watershed territory infarcts in full-term neonates. Severe insult preferentially damages the deep gray matter in both term and preterm infants. However, associated frequent perirolandic injury is seen in term neonates. MRI is useful in establishing the clinical diagnosis, assessing the severity of injury, and thereby prognosticating the outcome. Familiarity with imaging spectrum and insight into factors affecting the injury will enlighten the radiologist to provide an appropriate diagnosis.

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Original Research ArticleBecause of improved survival rate of low birth weight infants (LBW), there is increasing need of safe ventilation. Conventional ventilation is associated with ventilation induced lung injury (VILI). High frequency oscillatory ventilation (HFO) reduces VILI as it uses subphysiological tidal volume. Preclinical studies have shown that more effective stabilization of DCO2 can be achieved by combining volume guarantee to high frequency ventilation, as in HFO VG tidal volume can be directly controlled. This study is done to evaluate the clinical applicability of this finding of preclinical studies by analyzing the ventilation parameters and physiological parameters of those newborns who are ventilated on HFO or on HFO VG. In this retrospective study neonates ventilated on HFO or HFO VG in the year 2018 were identified and data collected from medical records. Twelve neonates were included in the study. Six of them received high frequency ventilation and other 6 were ventilated on HFO VG mode. VThf (tidal volume in high frequency) were almost same in both groups (1.94 in HFO and 1.9 in HFO VG). It is found that fluctuations in DCO2 (diffusion coefficient of CO2) was less in HFO VG group (SD 43.44 & 92.58 P value0.015). Also babies on HFO VG had better SpO2 values (95.67, 85.83 p value 0.05) and lesser fluctuations in SpO2 (SD 7.0 & 13.64) indicating better oxygenation and lesser hypoxia in HFO VG group. This pilot study suggests VG combined with HFO reduces fluctuations in DCO2 and SpO2.

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Background: Neonatal sepsis related mortality is preventable with timely recognition, rational antimicrobial therapy and aggressive supportive care. The objective of this study was to study the maternal and neonatal risk factors in new-borns with early onset sepsis and to ascertain commonest pathogen responsible.Methods: This study was done in the neonatal intensive care unit tertiary care hospital, Thrissur. Data collected after clinical examination and from the records of new-borns diagnosed with early onset sepsis were analyzed. All neonates suspected to have sepsis had a septic screen to corroborate the diagnosis. Blood culture was performed in all cases of suspected sepsis prior to starting antibiotics. The risk factors for sepsis, both maternal and neonatal were analysed. Their clinical features and bacteriological profile were studied. Data analysis was done using their mean±standard deviation (SD), percentage analysis, chi-square test or fischer’s test.Results: Fifty newborns with diagnosed early onset sepsis (EOS) were studied. Results suggest that maternal screening is prudent, interventions like vaginal examination were causative of sepsis than meconium stained liquor or prolonged rupture of membranes. A coincidental finding suggests that sepsis is more common in males and term babies. Blood culture showed predominant pathogen to be Klebsiella.Conclusions: Among the maternal factors, increased frequency of vaginal examination was most prevalent in the study group. Prematurity and asphyxia were not strong pre-runners for sepsis. EOS cases presenting with respiratory distress were 50%. Fever and tachycardia were the next common clinical features. The cases yielded blood culture positive were 20% and Klebsiella pneumonia (40%) was the commonest organism isolated.