Browsing by Author "Dutta, Sourabh"

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    Clinical characteristics & outcome of SARS-CoV-2 infected neonates presenting to paediatric emergency
    (Wolters Kluwer – Medknow, 2022-03) Kumar, Jogender; Kumar, Praveen; Saini, Shiv Sajan; Sundaram, Venkataseshan; Mukhopadhyay, Kanya; Dutta, Sourabh; Paulpandian, Raja Rajan; Mittal, Piyush; Das, Swati; Rameshbabu, Monisha; Mandula, Phani Priya; Ranjan, Ankit; Tiwari, Deepika; Taneja, Manish; Garg, Ashok; Jayashree, Murlidharan; Goyal, Kapil; Singh, Mini; Puri, Goverdhan Dutt; Lakshmi, P.V.M.; Guru, Rashmi Ranjan
    Background & objectives: Data on neonatal COVID-19 are limited to the immediate postnatal period, with a primary focus on vertical transmission in inborn infants. This study was aimed to assess the characteristics and outcome of COVID-19 in outborn neonates. Methods: All neonates admitted to the paediatric emergency from August 1 to December 31, 2020, were included in the study. SARS-CoV-2 reverse transcription- (RT)-PCR test was done on oro/nasopharyngeal specimens obtained at admission. The clinical characteristics and outcomes of SARS-CoV-2 positive and negative neonates were compared and the diagnostic accuracy of a selective testing policy was assessed. Results: A total of 1225 neonates were admitted during the study period, of whom SARS-CoV-2 RT-PCR was performed in 969. The RT-PCR test was positive in 17 (1.8%). Mean (standard deviation) gestation and birth weight of SARS-CoV-2-infected neonates were 35.5 (3.2) wk and 2274 (695) g, respectively. Most neonates (11/17) with confirmed COVID-19 reported in the first two weeks of life. Respiratory distress (14/17) was the predominant manifestation. Five (5/17, 29.4%) SARS-CoV-2 infected neonates died. Neonates with COVID-19 were at a higher risk for all-cause mortality [odds ratio (OR): 3.1; 95% confidence interval (CI): 1.1-8.9, P=0.03]; however, mortality did not differ after adjusting for lethal malformation (OR: 2.4; 95% CI: 0.7-8.7). Sensitivity, specificity, accuracy, positive and negative likelihood ratios (95% CI) of selective testing policy for SARS-CoV-2 infection at admission was 52.9 (28.5-76.1), 83.3 (80.7-85.6), 82.8 (80.3-85.1), 3.17 (1.98-5.07), and 0.56 (0.34-0.93) per cent, respectively. Interpretation & conclusions: SARS-CoV-2 positivity rate among the outborn neonates reporting to the paediatric emergency and tested for COVID-19 was observed to be low. The selective testing policy had poor diagnostic accuracy in distinguishing COVID-19 from non-COVID illness.
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    Cutaneous Aspergillus flavus infection in a neonate.
    (2004-04-27) Singh, S Amuchou; Dutta, Sourabh; Narang, Anil; Vaiphei, Kim
    A premature newborn infant born at 30 weeks gestation developed erythematous papular skin lesions that coalesced to form a necrotic plaque with black eschar. Skin histopathology and culture demonstrated infection with Aspergillus flavus. There was no evidence of Aspergillus flavus infection elsewhere.
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    Drug resistant neonatal Candida tropicalis septicemia. Did it cause diaphragmatic hernia?
    (2003-03-27) Dutta, Sourabh; Narang, Anil
    A full-term, 3 kg baby girl developed early onset Candida tropicalis septicemia. The fungus was resistant to amphotericin B, fluconazole and itraconazole. She developed an acquired diaphragmatic hernia during the course of the infection. The possible association of the hernia with the fungal sepsis is discussed. She improved on treatment with 4-flucytosine and after being operated for the hernia.
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    Early onset neonatal sepsis due to Morganella morganii.
    (2004-11-14) Dutta, Sourabh; Narang, Anil
    Two neonates, both 32-weekers, developed Morganella morganii sepsis on the first day of life. They presented within a day of each other, primarily with respiratory signs. In both cases there was a history of spontaneous premature rupture of membranes, exposure to a single dose of ampicillin ante-partum, and similar antibiograms. No common source could be identified.
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    Effects of cessation of a policy of neonatal fluconazole prophylaxis on fungal resurgence.
    (2005-12-21) Dutta, Sourabh; Murki, Srinivas; Varma, Sanjeev; Narang, Anil; Chakrabarti, Arunaloke
    Fluconazole has been used as prophylaxis against systemic fungal infections in preterm neonates. We conducted a study to determine whether cessation of a policy of prophylactic fluconazole results in a resurgence of fungal infections in a unit. Neonates born in the 3 epoches: A 36-month pre-Fluconazole prophylaxis epoch (Group 1), a 21-month Fluconazole prophylaxis epoch (Group 2) and a 39-month post Fluconazole prophylaxis epoch (Group 3) were compared for incidence and onset of fungal sepsis and resistance patterns. There was a decline in the incidence of fungal sepsis from Group 1 to Group 2, and it remained stable from Group 2 to Group 3. There was no significant difference in resistance to Fluconazole and to any of the azoles in Groups 1, 2 and 3 respectively.
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    Effects of tactile-kinesthetic stimulation in preterms.
    (2002-04-27) Dutta, Sourabh
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    Epidemiology, Clinical Profile, Intensive Care Needs and Outcome in Children with SARS-CoV-2 Infection Admitted to a Tertiary Hospital During the First and Second Waves of the COVID-19 Pandemic in India
    (Dr. K C Chaudhuri Foundation, 2023-02) C.R., Vishwa; Sharma, Raman; Jayashree, Muralidharan; Nallasamy, Karthi; Bansal, Arun; Angurana, Suresh Kumar; Mathew, Joseph L.; Sankhyan, Naveen; Dutta, Sourabh; Verma, Sanjay; Kumar, Rakesh; Devnanai, Mahesh; Vaidya, Pankaj C.; Samujh, Ram; Singh, Mini P.; Goyal, Kapil; Lakshmi, P. V. M.; Saxena, Akshay K.
    Objectives To compare the epidemiological, clinical profle, intensive care needs and outcome of children hospitalized with SARS-CoV-2 infection during the frst and second waves of the pandemic. Methods This was a retrospective study of all children between 1 mo and 14 y, admitted to a dedicated COVID-19 hospital (DCH) during the frst (1st June to 31st December 2020) and second waves (1st March to 30th June 2021). Results Of 217 children, 104 (48%) and 113 (52%) were admitted during the frst and second waves respectively. One hundred ffty-two (70%) had incidentally detected SARS-CoV-2 infection, while 65 (30%) had symptomatic COVID-19. Comorbidities were noted in 137 (63%) children. Fifty-nine (27%) and 66 (30%) children required high-dependency unit (HDU) and ICU care respectively. Severity of infection and ICU needs were similar during both waves. High-fow oxygen (n=5, 2%), noninvasive ventilation [CPAP (n=34, 16%) and BiPAP (n=8, 5%)] and invasive ventilation (n=45, 21%) were respiratory support therapies needed. NIV use was more during the second wave (26% vs. 13%; p=0.02). The median (IQR) length (days) of DCH stay among survivors was longer during the frst wave [8 (6–10) vs. 5.5 (3–8); p=0.0001]. Conclusions Disease severity, associated comorbidities, PICU and organ support need and mortality were similar in the frst and second waves of the pandemic. Children admitted during the second wave were younger, had higher proportion of NIV use and shorter length of COVID-19 hospital stay.
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    Evaluation of lactate dehydrogenase, creatine kinase and hepatic enzymes for the retrospective diagnosis of perinatal asphyxia among sick neonates.
    (2008-02-04) Reddy, Sanath; Dutta, Sourabh; Narang, Anil
    It is difficult to make a retrospective diagnosis of perinatal asphyxia in symptomatic neonates delivered non-institutionally. We studied serum creatine kinase muscle-brain fraction (CK-MB), lactate dehydrogenase (LDH), glutamic oxaloacetic transaminase (SGOT) and glutamic pyruvate transaminase (SGPT) for differentiating asphyxiated (n=25) from non-asphyxiated (n=20) neonates who present with non-specific signs of sickness. CK-MB was assayed at 8 and 24 h; and LDH, SGOT and SGPT at 72 h of life. On comparing cases and controls, median 8-hr CK-MB [80 U/L vs. 26 U/L respectively, P< 0.001], median 24-hr CK-MB [33.5 U/L vs. 21.5 U/L respectively, P=0.009] and median LDH [965 U/L vs. 168 U/L respectively, P< 0.001] were higher in asphyxiated neonates. Raised LDH had 100% sensitivity, while CK-MB had 100% specificity for asphyxia. LDH had the highest area under ROC curve (0.998). We conclude that LDH at 72 hr of life is most accurate at differentiating asphyxiated from non-asphyxiated symptomatic neonates.
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    Fluid Supplementation versus No Fluid Supplementation in Late Preterm and Term Neonates with Asymptomatic Polycythemia: A Randomized Controlled Trial.
    (2016-11) Sundaram, Mangalabharathi; Dutta, Sourabh; Narang, Anil
    Objective: To compare supplemental intravenous fluids with no supplementation in asymptomatic polycythemic late preterm and term neonates. Methods: 55 infants with venous haematocrit of 65-75 were randomly allocated to receive either 25 mL/kg IV normal saline over 6-8 hours or routine fluids. They were followed up for 48 hours. Results: There was no significant difference between fluid supplementation and control groups regarding need for partial exchange transfusion [6/27 (22.2%) vs 8/28 (28.6%); P=0.59]. Conclusions: We did not find any evidence of clinical benefit with IV fluid supplementation in late preterm and term neonates with asymptomatic polycythemia (PCV 65-75).
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    For a Change, May the Hare Defeat the Tortoise
    (Indian Academy of Pediatrics, 2019-04) Dutta, Sourabh
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    Hyperkalemia and ventricular tachycardia in ELBW infant.
    (2003-01-30) Singh, Daljit; Dutta, Sourabh; Narang, Anil
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    Infantile cortical hyperostosis.
    (2005-01-08) Dutta, Sourabh; Jain, Naveen; Bhattacharya, Anish; Mukhopadhyay, Kanya
    Infantile cortical hyperostosis (Caffey disease) is characterized by radiological evidence of cortical hyperostosis, soft tissue swellings, fever and irritability. We report a case of Caffey disease highlighting its presentation as pyrexia of unknown origin, appearance on radionuclide bone scintigraphy and our unsatisfactory experience of treating it with Ibuprofen, a prostaglandin inhibitor.
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    Intestinal Colonization Among Very Low Birth Weight Infants in First Week of Life.
    (2014-10) Dutta, Sourabh; Ganesh, Meenakshi; Ray, Pallab; Narang, Anil
    Objective: To study intestinal colonization patterns in very low birth weight infants in the first week of life in a neonatal intensive care unit. Methods: Meconium/stool specimens were obtained on days 1, 3, 5 and 7 from 38 very lowbirth- weight infants in a level III neonatal intensive care unit. Results: On day 1, 45% had sterile guts, and by day 3, all infants were colonized. E. coli, K. pneumoniae and Enterococcus fecalis were predominant organisms. Lactobacilli was found in one isolate and Bifidobacteria was not detected during the study period. There was an association between formula feeding and E. coli colonization. Conclusions: Very low birth weight infants admitted in neonatal intensive care units have abnormal intestinal colonization patterns.
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    Intravenous immunoglobulins in rhesus hemolytic disease.
    (2003-09-19) Mukhopadhyay, Kanya; Murki, Srinivas; Narang, Anil; Dutta, Sourabh
    OBJECTIVE: To evaluate the role of intravenous immunoglobulins in Rh hemolytic disease of newborn. METHODS: The study included all DCT positive Rh isoimmunized babies admitted in the unit from August 2000 to February 2001. Intravenous immunoglobulins in the dose of 500 mg/kg on day 1 and day 2 of life in addition to the standard therapy. Babies who received IVIG were compared with those who did not receive IVIG for the peak bilirubin levels, duration of phototherapy, number of exchange transfusions, discharge PCV and the need for blood transfusions for late anemia till 1 months of age. RESULTS: A total of 34 babies were eligible for the study. 8 babies received IVIG and 26 babies only standard treatment. The mean maximum bilirubin levels were significantly lower in the IVIG group compared to the group who received NO IVIG (16.52 +/- 2.96 Vs 22.72 +/- 8.84, p=0.004). Five babies in the IVIG group (62.5%) and 23 babies in the NO IVIG group required exchange transfusions (88.5%, p=0.014). 12 of the 26 babies in the NO IVIG group required multiple exchange transfusions while none of the babies in IVIG group required more one exchange transfusion (p=0.03). The mean duration of phototherapy was 165 +/- 109 hours in the IVIG group as against 119 +/- 56 hours in the NO IVIG group (p=0.29). Blood transfusion for anemia was more common in the IVIG group (37.5% Vs 11.5% p=0.126) though the packed cell volumes at discharge were similar in both the groups (39.5 +/- 11 Vs 40 +/- 5.1, P=0.92). CONCLUSION: Intravenous immunoglobulins is effective in decreasing the maximum bilirubin levels and the need for repeated exchange transfusions in Rh hemolytic disease of newborn. There is however an increased need for blood transfusions for late anemia in the babies treated with IVIG.
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    Multiple courses of antenatal steroids.
    (2007-05-29) Sandesh Kiran, P S; Dutta, Sourabh; Narang, Anil; Bhansali, Anil; Malhi, Prahbhjot
    The benefits and risks of multiple courses of antenatal steroids (ANS) are still unresolved issues. This was a prospective cohort study in a level III neonatal unit. Preterm babies < or = 35 wk gestation were included. Malformations, chronic maternal steroid intake, exchange transfusions prior to cortisol sampling and incomplete ANS courses were exclusion criteria. Subjects were classified into: No course (Group 0), 1 course (group 1), 2 courses (Group 2), > 2 courses (Group 3) of antenatal dexamethasone. The key outcome was adrenal function assessed by basal and post-ACTH cortisol on day 3. Other outcomes were neonatal morbidity, mortality, growth parameters at birth, long term growth and neuro-development. Of 210 eligible babies, 124 were enrolled. 38, 51, 10 and 25 babies belonged to groups 0, 1, 2 and 3 respectively. Basal and post-ACTH serum cortisol did not show any significant difference between groups (p=0.5 and p=0.9 respectively). Incidence of severe HMD requiring ventilation was significantly lower (p=0.02) in multiple course group (combined groups 2 and 3) compared to single course group. There were no differences in other neonatal morbidity, birth OFC and weight between single and multiple ANS groups. Follow up data at a mean age of 22 mth was available in 59 subjects (69%) belonging to groups 1-3. No differences were noted in the proportion of patients with abnormal neurological examination (p=0.1), abnormal PDI (p=0.9), abnormal MDI (p=0.9) and physical growth between multiple and single course groups. Multiple courses of antenatal dexamethasone resulted in a significant decrease in severe forms of RDS and they did not cause adrenal suppression, decreased growth or impaired neuro-development.
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    Multiple dose pharmacokinetics of ciprofloxacin in preterm babies.
    (2004-10-04) Aggarwal, Poonam; Dutta, Sourabh; Garg, S K; Narang, Anil
    BACKGROUND: Ciprofloxacin is increasingly used in preterm neonates to treat multi-drug resistant infections, however the pharmacokinetics of this drug in preterm newborns is not well studied. OBJECTIVES: To determine the multi-dose pharmacokinetics of intravenous ciprofloxacin in pre-term infants. DESIGN: Prospective, cohort study. SETTING: Level III Neonatal Intensive Care Unit in a tertiary Care hospital in North India. METHODS: 24 preterm neonates with age < 28 days, who received intravenous ciprofloxacin 10 mg/kg/dose 12 hourly for clinical and/or culture proven sepsis, were enrolled. Serum levels of ciprofloxacin were analyzed after first dose on day 1 and at the end of days 3 and 7. Results: Of 24 babies included in the study [mean gestation (SD) 32 wks (2.4 wks)], 3 died and 1 dropped out in the initial few days, leaving 20 patients whose data on serum ciprofloxacin were available. Peak values on days 1, 3 and 7 were [mean +/- SEM] 2.3 +/- 0.39 microg/mL, 3.0 +/- 0.44 microg/mL and 2.7 +/- 0.39 microg/mL respectively (P >0.05). Trough values on these days were 0.7 +/- 0.14 microg/mL 0.8 +/- 0.14 microg/mL and 1.0 +/- 0.21 microg/mL respectively (P > 0.05). There were no differences between the <1500 g and > 1500 g sub-groups and the < 7 days and >7 days sub-groups with respect to the corresponding peak and trough values on days 1, 3 and 7. The 95% C.I. of serum concentrations were above the MIC90 for most Enterobacteriaceae species, however the lower bound of the 95% C.I. of the mean trough levels was lower than MIC90 for Pseudomonas aeruginosa and Staphylococcus aureus. No adverse effects were observed. CONCLUSIONS: Intravenous ciprofloxacin in a dose of 10 mg/kg/dose 12 hourly is an effective treatment of neonatal sepsis, but higher doses may be required for treating Staphylococcus aureus and Pseudomonas.
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    Onset of bilirubin rise in G6PD deficient neonates prenatal or postnatal.
    (2005-10-05) Murki, Srinivas; Dutta, Sourabh