Patent ductus arteriosus (PDA), in which there is a persistent communication between the descending thoracic aorta and the pulmonary artery that results from failure of normal physiologic closure of the fetal ductus, is one of the more common congenital heart defects in preterm neonates. The closure of PDA can be done with either Indomethacin or Brufen which are cyclooxygenase 1, 2 inhibitor; however these drugs are associated with side effects. We report an interesting findings of ductal closure in 10 preterm neonates (gestational age 27-33 wks) presenting with significant large PDA who had failed or had absolute contraindication with Brufen. These preterm neonates were treated with oral paracetamol in the dose of 15 mg/kg 8 hourly. The PDA closure was achieved within 48 h and there was no complication.

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Background: Neonates being nonverbal are unable to express their pain leading to underestimation of their pain and hence insufficient pain relief. Neonatal pain is assessed by pain scales based on the behavioural and physiological changes that occur in response to painful stimuli. This cross sectional study was conducted at a tertiary care centre using Premature Infant Pain Profile (PIPP) score with 4% lidocaine as local anaesthetic agent to produce surface anaesthesia of skin prior to intravenous cannulation. Methods: Sample size was collected by simple randomisation method. Our study groups included 50 term and 50 preterm neonates with POG of 28-40 weeks requiring IV cannulation. Heart rate (HR), SpO 2 , facial expressions and behavioural state were noted before venipuncture and after venipuncture using PIPP scale. Same cohort of patients was assessed for pain response after applying 4% lidocaine cream during future venipuncture with help of PIPP score. Results: The PIPP score in preterm group before and after anesthesia was 11.28 AE 3.72 and 9.58 AE 3.39. PIPP score in term group before and after anesthesia was 11.54 AE 2.84 and 9.04 AE 2.97. There was reduction in mean PIPP score after using topical anesthetic agent in both study groups and the results were statistically significant. Conclusion: This study found that topical anesthetic agents were effective in reducing pain during venipuncture. Based on the facts of the study, it is recommended that pain scoring should be a part of routine monitoring in neonatal intensive care units and appropriate measures should be used to reduce pain.

Segmental dilatation of the ileum is one of the uncommon causes of intestinal obstruction in neonates. We present a case of slow transit of bowel contents leading to suspicion of functional bowel obstruction in a new born, which on exploration turned out to be a case of segmental dilatation of the jejuno-ileal region. The clinical and radiological evaluation was suggestive of hypomotility disorder of gut, resulting in diagnostic dilemma and delayed surgical intervention.