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Biomedical subjects

Sourabh Dutta

Publications and source records attributed to Sourabh Dutta.

At least 19 recordsLinked to original sources

Characterization of gut microbiota signatures in Indian preterm infants with necrotizing enterocolitis: a shotgun metagenomic approach.

INTRODUCTION: Necrotizing enterocolitis (NEC) is an inflammatory bowel disease that primarily affects preterm infants. Predisposing risk factors for NEC include prematurity, formula feeding, anemia, and sepsis. To date, no studies have investigated the gut microbiota of preterm infants with NEC in India. METHOD: In the current study, shotgun metagenomic sequencing was performed on fecal samples from premature infants with NEC and healthy preterm infants (n = 24). Sequencing was conducted using the NovaSeq X Plus platform, generating 2 &#xd7; 150 bp paired-end reads. The infants were matched based on gestational age and postnatal age. RESULT: The median time to NEC diagnosis was 9 days (range: 1-30 days). Taxonomic analysis revealed a high prevalence of Enterobacteriaceae at the family level, with the genera Klebsiella and Escherichia particularly prominent in neonates with NEC. No statistically significant differences in alpha or beta diversity were observed between stool samples from infants with and without NEC. Linear regression analysis demonstrated that Enterobacteriaceae were significantly more abundant in stool samples from infants with NEC than without NEC (q < 0.05). Differential abundance analysis using Linear Discriminant Analysis Effect Size (LEfSe) identified Klebsiella pneumoniae and Escherichia coli as enriched in the gut microbiota of preterm infants with NEC. Functional analysis revealed an increase in genes associated with lipopolysaccharide (LPS) O-antigen, the type IV secretion system (T4SS), the L-rhamnose pathway, quorum sensing, and iron transporters, including ABC transporters, in stool samples from infants with NEC. CONCLUSION: The high prevalence of Enterobacteriaceae and enrichment of LPS O-antigen and T4SS genes may be associated with NEC in Indian preterm infants.

Humans↗

Randomized controlled trial of compact fluorescent lamp versus standard phototherapy for the treatment of neonatal hyperbilirubinemia.

BACKGROUND: Special blue tube lights of standard length are used in most neonatal units to deliver phototherapy. Of late, special blue compact fluorescent lamp phototherapy equipments have been introduced in India, which are claimed to be better than standard tube lights. AIM: To compare special blue compact fluorescent lamp (CFL) phototherapy with special blue standard-length tube lights (STL). METHODS: This randomized, controlled trial was conducted in a level III NICU. Neonates, otherwise healthy, of gestation greater than 34 weeks with hyperbilirubinemia requiring phototherapy, were included. Rh iso-immunized babies, those who underwent prior exchange transfusion and whose parents declined to consent were excluded. By stratified block randomization, babies were allocated to receive phototherapy by CFL or STL. CFL and STL were both special blue lights with irradiance maintained above 15 microWatts/nm/cm2. Total serum bilirubin (TSB) was measured 12 hourly till phototherapy was stopped or an exchange transfusion was done. Temperature and clinical and laboratory parameters of dehydration were recorded 12 hourly till 72 hrs. Nursing staff answered an objectivized proforma about the disadvantageous effects on nurses. RESULTS: Fifty babies were enrolled in each group. Baseline characteristics, causes of jaundice, hemolysis, baseline TSB and irradiance were similar in both groups. Mean duration of phototherapy (P = 0.98) was similar in both groups. Kaplan-Meier analysis of phototherapy duration showed no difference in the survival curves of the 2 groups (P = 0.6). Axillary temperature was similar in both groups and no baby was dehydrated. Nursing staff reported no significant differences between CFL and STL visavis glare hurting the eyes, giddiness and headache. CONCLUSIONS: CFL phototherapy has no superiority over STL phototherapy in terms of efficacy and adverse effects on the neonate and effects on nursing staff.

Female↗

Ciprofloxacin administration to very low birth weight babies has no effect on linear growth in infancy.

There is limited information whether the use of ciprofloxacin in the neonatal period affects the linear growth of very low birth weight (VLBW) babies in infancy. This was a retrospective cohort study on VLBW babies followed up until 12 months corrected age (12-mCA). Exclusions were: infants with no length record taken at 12-mCA, who received ciprofloxacin after neonatal period, were neurologically abnormal, growth retarded in utero or congenitally malformed, had chronic systemic illnesses or endocrinopathies in infancy. Cases were defined as those who received intravenous ciprofloxacin (10 mg/kg/dose 12-hourly) for at least 3 days in the neonatal period, whereas controls were those not exposed to ciprofloxacin during neonatal life. Of 205 babies included in the study, there were 61 cases and 144 controls. Length at 12-mCA was similar in both groups [71.9 +/- 3.0 cm and 71.7 +/- 3.3 cm; p = 0.95]. On multi-variate linear regression analysis, length at a post-conceptional age of 40 weeks and sex emerged as independent predictors of length at 12-mCA. Ciprofloxacin administered at a dose of 10 mg/kg/dose 12-hourly for 3 days or more to VLBW babies does not affect their linear growth until 12 months corrected age.

Anti-Infective Agents↗

A randomized, triple-blind, placebo-controlled trial of prophylactic oral phenobarbital to reduce the need for phototherapy in G6PD-deficient neonates.

OBJECTIVE: Decreased conjugation is probably more important than hemolysis for causing jaundice in G6PD-deficient neonates. The role of enzyme inducers, like phenobarbital, in G6PD deficiency is unclear. This randomized controlled trial was performed to evaluate Phenobarbital's role in reducing the need for phototherapy among G6PD-deficient neonates. STUDY DESIGN: This stratified, randomized, triple-blinded, placebo-controlled trial was conducted in a level III NICU. Consecutive babies with gestation >/=34 weeks and birth weight >/=1800 g were screened from cord blood. G6PD-deficient neonates, who were otherwise healthy, were enrolled. Rh isoimmunization, maternal Phenobarbital use and lack of parental consent were exclusion criteria. Subjects were randomly allocated to receive 5 mg/kg day of oral phenobarbital/ placebo for first 3 days. They were monitored daily for total serum bilirubin (TSB) until declining TSB was documented twice. The primary outcome was requirement for phototherapy and secondary outcomes were duration of phototherapy, need for exchange transfusion, peak TSB and adverse effects. Sample size of 56 could detect a decline in phototherapy requirement from 40 to 5% with 80% power and 5% error. RESULTS: Of 2370 babies screened, 63 were G6PD-deficient. Of them, 56 eligible babies were allocated to phenobarbital (n=27) or placebo (n=29). The mean age of administration of the first dose was 18.55+/-7.3 h. In total, 44% in phenobarbital group and 41% in placebo group required phototherapy (p=1.0). There was no significant difference in exchange transfusion rates (18.5 vs 10%, p=0.46). No baby had adverse reactions. CONCLUSION: Prophylactic oral phenobarbital does not decrease the need for phototherapy or exchange transfusions in G6PD-deficient neonates.

Administration, Oral↗

Fatal neonatal renal failure due to maternal enalapril ingestion.

UNLABELLED: ACE inhibitors are commonly used drugs in the management of adult hypertension. However their use in pregnant women can have serious effects on the fetus. In this manuscript we report a case of fatal neonatal renal failure associated with maternal intake of enalapril during third trimester and review the related literature. CASE: The index case was born to a mother with PIH which was treated with enalapril (5 mg) once a day for 21 days prior to delivery in addition to other anti-hypertensives. Temporally, use of enalapril was associated with the onset of oligohydramnios. The neonate presented with intrauterine growth retardation, hydrops and oliguric renal failure, which did not respond to furosemide, peritoneal dialysis and exchange transfusion. Autopsy showed macroscopically and microscopically normal kidneys. CONCLUSION: Use of ACE inhibitors during pregnancy should be avoided.

Acute Kidney Injury↗

Infantile cortical hyperostosis.

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.

Fever of Unknown Origin↗

Effects of cessation of a policy of neonatal fluconazole prophylaxis on fungal resurgence.

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.

Antifungal Agents↗

Cutaneous Aspergillus flavus infection in a neonate.

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.

Aspergillosis↗

Subgaleal hematoma and seven exchange transfusions.

A 3 kg baby was delivered by cesarean section after prolonged labor. He had massive subgaleal hematoma. He developed anemia requiring packed cell transfusions and hyperbilirubinemia requiring a total of seven exchange transfusions and highly intensive phototherapy. There were no adverse complications of the hyperbilirubinemia or the exchange transfusion.

Anemia↗

Risk factors of threshold retinopathy of prematurity.

OBJECTIVE: To determine the risk factors which predispose to the development of threshold retinopathy of prematurity among patients of retinopathy of prematurity. METHODS: The ROP clinic records of a 3 year period were retrospectively studied to identify babies with threshold ROP (T-ROP) and sub-threshold ROP (ST-ROP). Various antenatal and perinatal risk factors, neonatal morbidity and therapeutic interventions were compared between the 2 groups. RESULTS: Of the total of 108 babies, 55 had T-ROP and 53 had ST-ROP. On univariate analysis, packed cell transfusions for anemia, double volume exchange transfusions (DVET), number of DVET, ventilation, gestational age <or= 28 weeks and apneic episodes were significantly higher in the T-ROP group. On multivariate analysis, the administration of packed cells [OR 2.8, 95 PERCENT CI 1.2, 6.6; (p = 0.014)] and DVET [OR 2.7, 95 PERCENT CI 1.2, 6.5; (p = 0.022)] emerged as independent risk factors of T-ROP. CONCLUSION: Administration of blood products increases the risk of developing T-ROP among patients who have ROP. There is a need to exercise caution in the use of blood products in premature newborns.

Female↗

Multiple dose pharmacokinetics of ciprofloxacin in preterm babies.

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.

Anti-Infective Agents↗

Early onset neonatal sepsis due to Morganella morganii.

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.

Ampicillin Resistance↗

Enalapril-induced acute renal failure in a newborn infant.

A full-term baby boy developed congestive cardiac failure secondary to left-to-right shunts. He developed acute renal failure following the administration of oral enalapril given for the treatment of cardiac failure. There was no underlying renal disease or renal artery stenosis. He required three peritoneal dialyses, following which he recovered from the renal failure.

Acute Kidney Injury↗

Intravenous immunoglobulins in rhesus hemolytic disease.

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.

Erythroblastosis, Fetal↗

Microcephaly with plate-like cortical calcification.

Congenital malformations of the central nervous system have varied presentations depending on the stage of embryological development when the insult occurred. We report a neonate with microcephaly associated with plate-like cortical calcification, probably secondary to an unidentified insult at around 11-12 weeks post-conceptional age causing an arrest of the proliferative phase. The associated vasculopathy probably caused diffuse cortical calcification.

Brain Diseases↗