Multisystem inflammatory syndrome in children (MIS-C) is a post-infectious immune-mediated condition, seen 3–5 weeks after COVID-19. Maternal SARS-CoV-2 may potentially cause a similar hyperinflammatory syndrome in neonates due to transplacental transfer of antibodies. We reviewed the perinatal history, clinical features, and outcomes of 20 neonates with features consistent with MIS-C related to maternal SARS-CoV-2 in Kolhapur, India, from 1 September 2020 to 30 April 2021. Anti-SARS-CoV-2 IgG and IgM antibodies were tested in all neonates. Fifteen singletons and five twins born to eighteen mothers with a history of COVID-19 disease or exposure during pregnancy presented with features consistent with MIS-C during the first 5 days after birth. Nineteen were positive for anti-SARS-CoV-2 IgG and all were negative for IgM antibodies. All mothers were asymptomatic and therefore not tested by RTPCR-SARS-CoV-2 at delivery. Eighteen neonates (90%) had cardiac involvement with prolonged QTc, 2:1 AV block, cardiogenic shock, or coronary dilatation. Other findings included respiratory failure (40%), fever (10%), feeding intolerance (30%), melena (10%), and renal failure (5%). All infants had elevated inflammatory biomarkers and received steroids and IVIG. Two infants died. We speculate that maternal SARS-CoV-2 and transplacental antibodies cause multisystem inflammatory syndrome in neonates (MIS-N). Immunomodulation may be beneficial in some cases, but further studies are needed.

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Worm infestation issue is a common health condition observed mostly in Asian countries. The prevalence of worms in children is higher due to the habit of playing in mud or outdoors which is not found in the case of an infant. Very rarely worm infestation is observed in infants. There is a need for an investigation to be carried out for live worms in the stool. Sometimes the change in the diet of the infant, irregular bowel movements, and worm-like things in stool makes an alarming situation. We report the original case of a 6-month-old infant camouflaging for worm infestation due to the presence of the thread-like parasite in stool. The routine stool and chemical analysis of black thread thing from stool revealed solid diet fibers of banana and not any parasitic infection.

Human milk is a dynamic physiological fluid. The short term and long term benefits of breast feeding are already very well established. Apart from the nutritional components, the human milk contains many growth factors & different kinds of live cells. Present study is an observational study of the cytological evaluation of the 100 samples of human milk collected in the first post partum week of Indian women. The interesting observation of the present study is the rising counts of the immune cells in the human milk which peak on day 5. This finding probably correlates with the greater immunological needs of the neonate in the first week. These cells help the neonate in providing cell mediated immune responses and protection against respiratory and gut infections. They also help in the process of the neonatal gut maturation. The counts of the epithelial cells in the human milk are observed to be steady throughout the, first post partum week. The mesenchymal stem cells observed in the human milk could be myoepithelial in origin. The higher levels of the growth factors like hepotocyte growth factor and vascular endothelial growth factor in the human milk when compared with the umbilical cord or the maternal serum could be attributed to the paracrine secretions by the stem cells. The observations of the present study are correlating with the physiological needs of the neonate in the most important period of the first week after the birth. The study further strengthens the concept of exclusive breast feeding.

In twin pregnancies, usually the delivery of both the babies occur together with a difference of few minutes. However, in very rare situations the first fetus gets aborted during second trimester and the cervix gets reformed. In such rare situations after the abortion (vaginal expulsion) of the first fetus, prolonging pregnancy is a real challenge. The risks of haemorrhage, chorioamnionitis, coagulopathies and immediate abortion of the second fetus are very high. In such event, if the pregnancy is prolonged, preterm delivery of the second twin within next few weeks is very common.We report a case of diamniotic, dichorionic pregnancy achieved through In Vitro Fertilisation (I.V.F.) in a 43 years old woman who also had diabetes mellitus. This patient had spontaneous onset of uterine contractions and leaking which resulted into expulsion of the first fetus at 17 weeks of gestation. The placenta of the first fetus and intact gestational sac of the other twin, were left in utero.The management included vigilant maternal monitoring, use of tocolytics antibiotics and delayed cervical cerclage. The pregnancy was prolonged for 115 days. The patient required caesarean section at 34 weeks for the development of severe pre-eclampsia and delivered a healthy male baby of 2.1 kg who required a brief stay of twelve days in NICU. Placentas of both the fetuses were removed during caesarean section. This case is exceptional and there are no validated medical protocols for the management; the scientific evidence is still controversial.Our care supports the prolongation of the pregnancy of the second twin with high medical vigilance.