American Academy of Pediatrics AAP has included the LMA in their 2015 neonatal resuscitation Guidelines. However, limited studies have evaluated LMA efficacy in severely depressed newborns. In this case report, we present the successful resuscitation a severely asphyxiated (pH 6.89, ABE-15.4) vacuum extracted neonate who required prolonged positive pressure ventilation (15 minutes) via a Supreme Laryngeal Mask Airway™. In the current case, a neonatal LMA Supreme use, allowing prolonged ventilation and ultimately stabilization, contributed to successful resuscitation.

Purpose: Hirschsprungs disease is common cause of intestinal obstruction in neonate and trans-anal pull through has drastically changed the treatment of Hirschsprungs disease. The aim of this study was to evaluate the short and long-term outcome of single-stage trans-anal pull through in neonates and infants. Material and methods: It was a prospective study of new-born’s and young infants with features of Hirschsprungs disease. Patients with weight more than 3 kg, transition zone at recto sigmoid and distal sigmoid region were included in the study. Patients with more dilated proximal colon, bowel obstruction not responding to washes and long segment Hirschsprungs disease were excluded from the study. Single-stage trans-anal pull through was done in all cases and short term variables include wound infection, leak, peri-anal excoriation and long term outcome variables included continence, constipation, stricture, enterocolitis and need of redo pull-through procedure were evaluated. Results: 24 patients were included in the study. There were 15 males and 9 females. Age of the patients ranged from 26 days to 4.5 months with mean age of 1.3 months. Weight of the patients ranged from 3 kg to 5.3 kg with mean weight of 4.8 kg. Wound infection and perianal excoriation was seen in 8.3% and 45.8% respectively. Enterocolitis, stricture, constipation and minor soiling were seen in 12.5%, 4.2%, 8.3% and 12.5% respectively. Follow-up period ranged from 10 to 120 months. Conclusion: Trans-anal pull through is feasible and safe option with excellent results in neonates and infants with short segment Hirschsprungs disease.

Background: Evidence shows that neonates in the Neonatal Intensive Care Unit (NICUs) experience a significantly higher potential for medication errors and adverse events rate than do patients in other wards of the hospital. This necessitates the assessment of the safety culture in the (NICU) which can help to identify areas that can lead to errors in the unit. Methods: This was cross sectional study done in the Neonatal unit, where the pediatric postgraduates resident doctors (PGs) and nurses were surveyed regarding the safety practices. The Safety Attitude Questionnaire (SAQ) which is validated and has good psychometric properties was used. Mean and Standard deviations for the six domains (job satisfaction, safety climate, teamwork climate, working conditions, perception of management and stress recognition) was analysed and unpaired t test was used to compare the means. Results: Total of 31 responses was obtained (12 PGs and 19 nurses). Overall mean scores for the SAQ were 70.2 for PGs and 63.8 for nurses, suggesting an overall negative response. Mean scores for PGs ranged from 63 (working condition) to 82.8 (stress recognition) and for nurses 48.6 (working conditions) to 82.8 (job satisfaction). There was statistically significant difference between the PGs and nurses in the domain of job satisfaction with p value of 0.03. Rest of the domains showed no significant difference. Conclusion: The scores suggest an overall negative response regarding safety culture in NICU. The variations among the Postgraduates and nurses suggest that we need customise the policies for both groups when we attempt to improve the safety culture in the unit while focussing on promoting teamwork.

Introduction: Pre-term birth is the main determinant of neonatal morbidity and mortality with long-term adverse health consequences. Infants born pre-term compared to term infants experience more difficulty with temperature instability, feeding intolerance, blood glucose regulation, jaundice, apnea, respiratory distress (RDS) and sepsis. Aim: To study the early neonatal morbidities of all pre-term neonates admitted in NICU and to know the immediate outcome during their stay. Also to compare rate of early morbidities and mortality among SGA and AGA pre-term neonates. Material and methods: It’s a prospective observational study carried out in a NICU of a Medical college in South India, for a period of 18 months. Preterm babies (less than 37 weeks gestation using Modified Ballard score) divided into SGA and AGA using growth charts. Total 100 preterm babies included of which SGA and AGA were 50 each. Neonates with TTN (Transient Tachypnea of the Newborn), Birth asphyxia, Neonatal sepsis, Hypoglycemia, Hypothermia, Neonatal hyperbilirubinemia, Respiratory insufficiency, Feed intolerance were included in present study. Results: Hyperbilirubinemia constituted 61% of morbidities, among which 47.5% are AGA neonates and 52.5% are SGA neonates. 24 newborns presented with sepsis, 15 newborns with feed intolerance. 80 newborns had hypoxia at admission. RDS was commonly seen in AGA neonates when compared to SGA neonates. 6 babies among AGA and 8 among SGA had mortality. One baby was discharged AGAinst medical advice. Conclusion: Most common morbidities among the SGA neonates were sepsis, hyperbilirubinemia, feed intolerance, hypoglycemia, Apnea, PDA, hypoxia. AGA neonates had metabolic disorders and RDS.

Background: We hypothesized that in the presence of an intrapartum hypoxic ischemic insult, redistribution of cardiac output away from the hepatic circulation will result in unique patterns of hepatic dysfunction dependent on the degree and duration of the hypoxic ischemic insult. We evaluated the rise and clearance of Aspartate Aminotransferase (AST) and Alanine Aminotransferase (ALT) in term newborns with three common patterns of hypoxic ischemic encephalopathy as an adjunct biomarker in timing of fetal neurologic injury. Methods: We identified 230 term newborns with image proven hypoxic ischemic encephalopathy with profound neurologic impairment over a 30 year period from multiple institutions. Eighty four had liver transaminases in the first 72 hours of life to evaluate patterns of rise and clearance. Results: A total of 215 AST, 220 ALT and 204 NRBC values were collected. Similar to NRBC’s, the general trend was the more chronic asphyxia, the more elevated transaminases are shortly after birth with delayed clearance often beyond 48 hours of life. In acute profound intrapartum injury, liver transaminases demonstrated minimal rise with rapid normalization. There was no difference between groups regarding gender, gestational age and birthweight. Conclusion: No single proven biomarker is diagnostic of neonatal encephalopathy but newborn AST/ALT measured shortly after birth and daily for three days can provide additional evidence based medicine to confirm or refute allegation of acute intrapartum asphyxia.

Neonatal hypocalcemia can result from numerous etiologies and is commonly seen in premature neonates. We describe a late preterm neonate with asymptomatic hypocalcemia whose mother took topiramate throughout the entire pregnancy. Other factors that may contribute to hypocalcemia, including infant of a diabetic mother, were ruled out in our patient. The patient we are reporting on required calcium supplementation for persistent hypocalcemia most likely due to fetal topiramate exposure.

Breastfeeding (BF) neonates generally lose weight after birth. Diurnal and nocturnal factors as well as season may affect BF. The aim of this study was to determine the effect of birth time and seasonal variations on weight loss in BF new-borns. In this retrospective study, two sets of groups were evaluated. Birth time groups (night time: 7 pm-7 am and day time: 7 am-7 pm) and seasonal variations groups (summer, autumn, winter and spring). Weight loss of more than 5%, 7%, 10% at 5% of birth weight at 7% weight at 10% at 12 h were significant contributing factors. Seasonal variations were not associated with weight loss in new-borns. Conclusion: BF babies born at night time lose significant weight during the first two days of life. Seasonal variations did not affect weight loss.