Users Online: 67
About us
Editorial board
Search
Ahead of print
Current issue
Archives
Submit article
Instructions
Subscribe
Contacts
Advertise
Reader Login
Export selected to
Endnote
Reference Manager
Procite
Medlars Format
RefWorks Format
BibTex Format
Most cited articles *
Archives
Most popular articles
Most cited articles
Show all abstracts
Show selected abstracts
Export selected to
Cited
Viewed
PDF
REVIEW ARTICLE
Oxidative stress and bronchopulmonary dysplasia
Serafina Perrone, Maria Luisa Tataranno, Giuseppe Buonocore
July-September 2012, 1(3):109-114
DOI
:10.4103/2249-4847.101683
PMID
:24027702
Bronchopulmonary dysplasia (BPD) is the major cause of pulmonary disease in infants. The pathophysiology and management of BPD changed with the improvement of neonatal intensive care unit (NICU) management and with the increase of survival rates. Despite the improvements made, BPD is still a public health concern, resulting in frequent hospitalizations with high rates of mortality, impaired weight and height growth, and neurodevelopmental disorders. Lung injury in the neonatal period has multiple etiologic factors - genetic, hemodynamic, metabolic, nutritional, mechanical, and infectious mechanisms - act in a cumulative and synergic way. Free radical (FR) generation is largely recognized as the major cause of lung damage. Oxidative stress (OS) is the final common endpoint for a complex convergence of events, some genetically determined and some triggered by
in utero
stressors. Inflammatory placental disorders and chorioamnionitis also play an important role due to the coexistence of inflammatory and oxidative lesions. In addition, the contribution of airway inflammation has been extensively studied. The link between inflammation and OS injury involves the direct activation of inflammatory cells, especially granulocytes, which potentiates the inflammatory reaction. Individualized interventions to support ventilation, minimize oxygen exposure, minimize apnea, and encourage growth should decrease both the frequency and severity of BPD. Future perspectives suggest supplementation with enzymatic and/or non-enzymatic antioxidants. The use of antioxidants in preterm newborns particularly exposed to OS and at risk for BPD represents a logical strategy to ameliorate FRs injury, but further studies are needed to support this hypothesis.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
[PubMed]
45
4,354
757
BRIEF REPORT
An interesting observation of PDA closure with oral paracetamol in preterm neonates
Rahul Sinha, Vandana Negi, SS Dalal
January-March 2013, 2(1):30-32
DOI
:10.4103/2249-4847.109245
PMID
:24027742
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.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
[PubMed]
34
5,329
906
ORIGINAL ARTICLES
Prevalence of congenital anomalies in neonates and associated risk factors in a tertiary care hospital in eastern India
Shatanik Sarkar, Chaitali Patra, Malay Kumar Dasgupta, Kaustav Nayek, Prasanta Ray Karmakar
July-September 2013, 2(3):131-134
DOI
:10.4103/2249-4847.119998
PMID
:24251257
Background:
Congenital anomalies are a major cause of stillbirths and neonatal mortality. The pattern and prevalence of congenital anomalies may vary over time or with geographical location.
Aims and Objectives:
The aim of this study is to determine the proportion and types of congenital anomalies in live newborns and to study maternal and perinatal risk factors.
Materials and Methods:
This cross-sectional descriptive study was carried out in the neonatal care unit of R. G. Kar Medical College and Hospital during the period of September 2011 to August 2012. All the live born babies born in this hospital during this period were included. The newborns were examined for the presence of congenital anomalies and mothers were interviewed for socio-demographic variables.
Results:
During the study period, 12,896 babies were born, of which 286 had congenital malformations, making the prevalence 2.22%. Most of the women (55.7%) belonged to the age group between 21 and 30 years. Congenital anomalies were seen more commonly (3.3%) in the multiparas in comparison with primiparas (1.8%). The predominant system involved was Musculo-skeletal system (33.2%) followed by gastro-intestinal (GI) system (15%). Talipes (17.1%) was the most common one in musculoskeletal group and likewise cleft lip and cleft palate in GI system. Congenital anomalies were more likely to be associated with low birth weight, prematurity, multiparity, consanguinity and cesarean delivery.
Conclusion:
Public awareness about preventable risk factors is to be created and early prenatal diagnosis and management of common anomalies is strongly recommended.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
[PubMed]
29
5,119
835
REVIEW ARTICLE
Bilirubin neurotoxicity in preterm infants: Risk and prevention
Vinod K Bhutani, Ronald J Wong
April-June 2013, 2(2):61-69
DOI
:10.4103/2249-4847.116402
PMID
:24049745
Hemolytic conditions in preterm neonates, including Rhesus (Rh) disease, can lead to mortality and long-term impairments due to bilirubin neurotoxicity. Universal access to Rh immunoprophylaxis, coordinated perinatal-neonatal care, and effective phototherapy has virtually eliminated the risk of kernicterus in many countries. In the absence of jaundice due to isoimmunization and without access to phototherapy or exchange transfusion (in 1955), kernicterus was reported at 10.1%, 5.5%, and 1.2% in babies <30, 31-32, and 33-34 wks gestational age, respectively. Phototherapy initiated at 24±12 hr effectively prevented hyperbilirubinemia in infants <2,000 g even in the presence of hemolysis. This approach (in 1985) reduced exchange transfusions from 23.9% to 4.8%. Now with 3 decades of experience in implementing effective phototherapy, the need for exchange transfusions has virtually been eliminated. However, bilirubin neurotoxicity continues to be associated with prematurity alone. The ability to better predict this risk, other than birthweight and gestation, has been elusive. Objective tests such as total bilirubin, unbound or free bilirubin, albumin levels, and albumin-bilirubin binding, together with observations of concurrent hemolysis, sepsis, and rapid rate of bilirubin rise have been considered, but their individual or combined predictive utility has yet to be refined. The disruptive effects of immaturity, concurrent neonatal disease, cholestasis, use of total parenteral nutrition or drugs that alter bilirubin-binding abilities augment the clinical risk of neurotoxicity. Current management options rely on the "fine-tuning" of each infant's exposure to beneficial antioxidants and avoidance of silent neurotoxic properties of bilirubin navigated within the safe spectrum of operational thresholds demarcated by experts.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
[PubMed]
28
8,606
1,882
REVIEW ARTICLES
Patent ductus arteriosus ligation and adverse outcomes: Causality or bias?
Dany E Weisz, Patrick J McNamara
April-June 2014, 3(2):67-75
DOI
:10.4103/2249-4847.134670
PMID
:25024972
Observational studies have associated patent ductus arteriosus (PDA) ligation in preterm infants with increased chronic lung disease (CLD), retinopathy of prematurity, and neurodevelopmental impairment at long-term follow-up. Although the biological rationale for this association is incompletely understood, there is an emerging secular trend toward a permissive approach to the PDA. However, insufficient adjustment for postnatal, pre-ligation confounders, such as intraventricular hemorrhage and the duration and intensity of mechanical ventilation, suggests the presence of residual bias due to confounding by indication, and obliges caution in interpreting the ligation-morbidity relationship. A period of conservative management after failure of medical PDA closure may be considered to reduce the number of infants treated with surgery. Increased mortality and CLD in infants with persistent symptomatic PDA suggests that surgical ligation remains an important treatment modality for preterm infants.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
[PubMed]
26
8,837
1,433
ORIGINAL ARTICLES
Neonatal sepsis: High antibiotic resistance of the bacterial pathogens in a neonatal intensive care unit of a tertiary Care hospital
Arpita Jigar Shah, Summaiya A Mulla, Sangita B Revdiwala
April-June 2012, 1(2):72-75
DOI
:10.4103/2249-4847.96753
PMID
:24027694
Objective:
To study the bacterial pathogens causing neonatal sepsis and their sensitivity pattern so that guidelines can be prepared for empirical antibiotic therapy.
Materials and Methods:
We conducted a prospective analysis of all the cases admitted to the neonatal intensive care unit (NICU) of a tertiary care hospital and studied the culture and sensitivity pattern of organisms isolated. The neonates who presented with signs and symptoms of septicemia, with/without pneumonia and/or meningitis were studied and a detailed record of the maturity, age at onset, sex, birth weight (weight on admission for home deliveries), symptoms and signs along with the maternal risk factors was made. The cases with suspect sepsis were screened using various screening markers. Blood culture was done in all the cases, while cerebrospinal fluid was analysed only in those indicated. Sensitivity of the isolated organism was tested by Kirby Bauer disc diffusion techniques and various drug resistance mechanisms were studied.
Result:
Out of the 190 neonates (M:F=1.22:1) admitted to the NICU, 60 (31.57%) shows blood culture positive. Ninety-five percent cases were due to early onset septicemia. Thirty one neonates had Gram negative, twenty seven had Gram positive septicemia and two had candidial infection. Seventy percent Gram-positive isolates were resistant to penicillin. Ninety percent Gram negative isolates were resistant to gentamycin and ampicillin. Carbapenem resistance mechanisms such as ESBL.
Conclusion:
There is an increasing trend of antibiotic resistance to the commonly used and available drugs. Continuous surveillance for antibiotic susceptibility should be done to look for resistance pattern.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
[PubMed]
25
7,322
1,535
REVIEW ARTICLES
A systematic review and meta-analysis of the timing of early intraventricular hemorrhage in preterm neonates: Clinical and research implications
Sameer Yaseen Al-Abdi, Maryam Ali Al-Aamri
April-June 2014, 3(2):76-88
DOI
:10.4103/2249-4847.134674
PMID
:25024973
A considerable number of intraventricular hemorrhages (IVH) occur within the first hours of life (HOL). Temporality between IVH and its antecedents as well as a consistent definition of "early IVH" is lacking in a large and growing body of literature. We performed a systematic review of prospective studies that reported onset of IVH in preterm neonates within the first HOL and afterwards. The English literature was searched using three databases up to March 2013. Four timing periods of IVH can be compared in 16 identified studies: 0-6; 7-12; 13-24; after 24 HOL. The 0-6 and after 24 HOL were the major modes of IVH timing. Pooled IVH proportions were estimated through a meta-analysis of studies that were conducted after antenatal steroid and surfactant era. In neonates weighing ≤1500 g at birth: 48% of IVH (95% CI: 42-58%, 5 studies, 279 IVH cases) occurred during 0-6 HOL and 38% (95% CI: 19-57%, 4 studies, 241 IVH cases) after 24 HOL. The 0-6 HOL is the shortest, most vulnerable period for IVH, thus, an early IVH is an IVH occurs in it. Such early IVH had prognostic, etiological/preventive and medicolegal implications. Accordingly, preterm neonates at risk of IVH should have their first routine screening head ultrasound at about 6 HOL. Future research exploring the antecedents of IVH should guaranty the temporality between these antecedents and IVH. Additional research will be required to determine whether the long term neurological outcomes of early and late IVH are the same.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
[PubMed]
25
5,027
1,611
ORIGINAL ARTICLES
The main etiologies of acute Kidney injury in the newborns hospitalized in the neonatal intensive care unit
Hossein Emad Momtaz, Mohammad Kazem Sabzehei, Bahman Rasuli, Saadat Torabian
April-June 2014, 3(2):99-102
DOI
:10.4103/2249-4847.134691
PMID
:25024976
Introduction:
Acute kidney injury (AKI) is one of the most common diseases among the newborns hospitalized in the neonatal intensive care units (NICUs), which is usually resulted from predisposing factors including sepsis, hypovolemia, asphyxia, respiratory distress syndrome (RDS), and heart failure. The goal of this study was to assess main etiologies, relevant risk factors, and early outcome of neonatal AKI.
Materials and Methods:
In a cross- sectional study, 49 consecutive neonates hospitalized in NICU of Besat hospital with diagnosis of AKI from October 2009 to October 2011 were investigated through census sampling method. AKI was diagnosed based on urine output and serum creatinine levels.
Results:
The prevalence of AKI was 1.54% (49 out of 3166 newborns hospitalized in NICU) with the female: male was 7:1. Thirty-nine patients (79.5%) were full-term neonates. Oliguria was observed in 38 (77.5%) patients. Sepsis was the most common predisposing factor for AKI in 77.5% of patients (
n
= 38) accompanied with the highest mortality rate among other factors (30.5%). Other leading causes of AKI included hypovolemia secondary to dehydration, followed by hypoxia secondary to RDS, patent ductus arteriosus, posterior urethral valve, asphyxia, and renal venous thrombosis. A positive relationship was observed between neonates' age, sex, urine output, and also between serum creatinine levels with initiation of dialysis. The mortality rate among the newborns hospitalized with AKI was 36.7%. Eighteen (36.7%) newborns were treated with peritoneal dialysis (PD) of whom 10 patients (55.6%) died, 31 patients were managed conservatively of whom five neonate died (25.9%).
Discussion:
Prognosis of AKI in the oliguric neonates requiring PD is very poor. It is thus recommended to prevent AKI by predicting and rapid diagnosis of AKI in patients with potential risk factors and also by early and effective treatment of such factors in individuals with AKI.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
[PubMed]
23
4,970
1,122
CASE REPORTS
Pentalogy of cantrell: An extremely rare congenital anomaly
Suresh Chandran, Dinesh Ari
April-June 2013, 2(2):95-97
DOI
:10.4103/2249-4847.116410
PMID
:24049753
A baby with the complete form of pentalogy of Cantrell was delivered at 33 weeks of gestation. The hallmark of this syndrome is ectopia cordis (EC) with omphalocele. Even though a fetal diagnosis was made at 14 weeks, parents have decided to continue with the pregnancy. Early antenatal ultrasonographic diagnosis is essential as survival depends mostly on the EC, associated cardiac anomalies and degree of thoraco-abdominal defect. Fetal diagnosis of this lethal anomaly before viability gives the parents an option of termination.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
[PubMed]
21
9,280
638
ORIGINAL ARTICLES
Performance evaluation of hematologic scoring system in early diagnosis of neonatal sepsis
Manisha Makkar, Chinki Gupta, Rambha Pathak, Sunal Garg, NC Mahajan
January-March 2013, 2(1):25-29
DOI
:10.4103/2249-4847.109243
PMID
:24027741
Objectives:
The present study was undertaken to evaluate and highlight the importance of hematological scoring system (HSS) in the early detection of neonatal sepsis.
Materials and Methods:
The cross-sectional study enrolled 110 neonates who were clinically suspected of infection (study group) and normal neonates for comparison (controls), during the 1
st
week of life. All peripheral blood smears were analyzed using HSS of Rodwell
et
al
., by pathologists blinded to the infection status of the newborns. HSS assigns a score of 1 for each of seven findings significantly associated with sepsis: Abnormal total leukocyte count, abnormal total polymorphonuclear neutrophils (PMN) count, elevated immature PMN count, elevated immature: Total (I:T) PMN ratio, immature: Mature (I:M) PMN ratio ≥0.3, platelet count ≤150,000/mm
3
, and pronounced degenerative or toxic changes in PMNs. Score of ≤2 was interpreted as sepsis unlikely; score 3-4: Sepsis is possible and ≥5 sepsis or infection is very likely. Blood culture was taken as a standard indicator for septicemia. The perinatal history, clinical profile and laboratory data were recorded and correlated in each case. Each hematological parameter was assessed for its individual performance and also with the culture-proven sepsis. Sensitivity, specificity, positive and negative predictive values (NPVs) were calculated for each parameter and for different gestational ages.
P
value was also calculated for different parameters.
Results:
Out of the 110 infants, based on clinical findings and laboratory data were classified into three categories: Sepsis (
n
=42), probable infection (
n
=22) and normal (
n
=46). Out of these, 42 (38.2%) newborns had positive blood culture. 63 (57%) neonates were preterm and 47 (43%) term. Male: female ratio was 0.96:1. The
P
value was significant for the different gestational ages (0.0002) and sex ratio (0.003). Immature polymorphonuclear neutrophils (PMN) count was the most sensitive and I:M PMN ratio, the most specific indicator of sepsis. For sepsis and probable sepsis, I:T PMN count and immature PMN count have highest sensitivity whereas I:T and I:M PMN ratio have highest specificity. HSS has much higher sensitivity and specificity in preterms than in term neonates. Positive predictive value and NPV is also higher in preterm than term for HSS. It was also seen that with increasing scores, the likelihood of sepsis also increased.
Conclusion:
The sensitivities of the various screening parameters were found to be satisfactory in identifying early onset neonatal sepsis. It is a simple and feasible diagnostic tool to guide towards the decision-making for a rationale treatment.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
[PubMed]
20
8,088
1,653
Stool calprotectin in necrotizing enterocolitis
Ehab AM Albanna, Hanan S Ahmed, Hanan Abdelaziz Awad
January-March 2014, 3(1):16-19
DOI
:10.4103/2249-4847.128721
PMID
:24741535
Background:
Calprotectin is a 36 kDa protein present in the cytoplasm of the neutrophil has antimicrobial and apoptosis inducing activities.
In vitro
studies have shown that calprotectin inhibits the growth of various microorganisms. Necrotizing enterocolitis (NEC) remains one of the leading causes of morbidity and mortality in neonatal intensive care units (NICU), affecting up to 5% of premature infants. Fecal calprotectin is resistant to degradation and has been proposed as a useful marker of gastrointestinal inflammation.
Objective:
The objective of the present study is to evaluate fecal calprotectin concentrations in NEC.
Study Design:
Fifteen neonates with a clinical diagnosis of NEC were studied; they admitted at NICU of Zagazig University Hospital. In addition, 20 age sex matched neonates fed all caloric requirement served as the control group. All neonates were subjected to history taking, clinical examination, laboratory investigations (complete blood count, C-reactive protein) and determination of stool calprotectin.
Results:
There was a highly significant increase in fecal calprotectin in patients than control and there was a highly significant increase in its fecal level in died patients than living one. Also significant increase in fecal calprotectin level with increasing severity of NEC.
Conclusion:
Fecal calprotectin measurements could be a valuable tool for the investigation of preterm and full term infants suspected of having NEC.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
[PubMed]
18
3,763
779
REVIEW ARTICLE
Predicting disease severity of necrotizing enterocolitis: How to identify infants for future novel therapies
Troy A Markel, Holly Engelstad, Brenda B Poindexter
January-March 2014, 3(1):1-9
DOI
:10.4103/2249-4847.128717
PMID
:24741531
Necrotizing enterocolitis (NEC) remains a very devastating problem within the very low birth weight neonatal population. Several experimental therapies are being tested in animal models and soon may be ready for human trials. Despite this progress, we currently have no way to identify infants who would be optimal targets for therapy. Specifically, we are unable to predict which infants will progress to the more severe Bell's stage of disease that may necessitate surgery. Ideally, an algorithm could be constructed that would encompass multiple neonatal and maternal risk factors as well as potential biologic markers of disease so that these infants could be identified in a more timely fashion. This review summarizes the known risk factors and biomarkers of disease in hopes of stimulating clinical research to identify such an "early warning" NEC algorithm.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
[PubMed]
18
5,933
1,382
Stem cell therapy for neonatal diseases associated with preterm birth
Alessandro Borghesi, Claudia Cova, Diego Gazzolo, Mauro Stronati
January-March 2013, 2(1):1-7
DOI
:10.4103/2249-4847.109230
PMID
:24027735
In the last decades, the prevention and treatment of neonatal respiratory distress syndrome with antenatal steroids and surfactant replacement allowed the survival of infants born at extremely low gestational ages. These extremely preterm infants are highly vulnerable to the detrimental effects of oxidative stress and infection, and are prone to develop lung and brain diseases that eventually evolve in severe sequelae: The so-called new bronchopulmonary dysplasia (BPD) and the noncystic, diffuse form of periventricular leukomalacia (PVL). Tissue simplification and developmental arrest (larger and fewer alveoli and hypomyelination in the lungs and brain, respectively) appears to be the hallmark of these emerging sequelae, while fibrosis is usually mild and contributes to a lesser extent to their pathogenesis. New data suggest that loss of stem/progenitor cell populations in the developing brain and lungs may underlie tissue simplification. These observations constitute the basis for the application of stem cell-based protocols following extremely preterm birth. Transplantation of different cell types (including, but not limited to, mesenchymal stromal cells, endothelial progenitor cells, human amnion epithelial cells) could be beneficial in preterm infants for the prevention and/or treatment of BPD, PVL and other major sequelae of prematurity. However, before this new knowledge can be translated into clinical practice, several issues still need to be addressed in preclinical
in vitro
and
in vivo
models.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
[PubMed]
15
5,294
1,018
ORIGINAL ARTICLES
Correlation of EEG, CT, and MRI brain with neurological outcome at 12 months in term newborns with hypoxic ischemic encephalopathy
Annu Jose, John Matthai, Sarah Paul
July-September 2013, 2(3):125-130
DOI
:10.4103/2249-4847.119996
PMID
:24251256
Objective:
To correlate electroencephalogram (EEG), computed tomography (CT), and magnetic resonance imaging (MRI) brain with neurological outcome at 12 months in term neonates with hypoxic ischemic encephalopathy.
Design:
Prospective observational study.
Setting:
Neonatal intensive care unit (NICU) in a tertiary care teaching hospital.
Materials and Methods:
The study was conducted between June 2010 and November 2011. Consecutive term neonates with perinatal asphyxia and hypoxic ischemic encephalopathy were the subjects. All babies were managed as per standard protocol. EEG was done as soon as the baby was stable and CT brain within 7 days. MRI was done at 3 months. Neurodevelpmental assessment was done at 12 months.
Results:
Of the 31 babies, four died and one was lost to follow-up. Neurodevelopmental at 12 months of age was normal in 15 babies. EEG was normal in six babies and all of them had a normal neurodevelopment. Thirteen of the 14 babies with burst suppression pattern were abnormal (
P
<0.001). CT brain was normal in 14 and all of them had normal neurodevelopment (
P
<0.001), while 11 of the 12 with cerebral edema had abnormal outcome (
P
<0.001). Of the 16 babies with normal MRI, 14 were normal, while all six babies with abnormal signals in the cortex and thalamus had abnormal outcome (
P
=0.002).
Conclusions:
A normal EEG and CT brain in a term newborn with hypoxic ischemic encephalopathy (HIE) is associated with good neurological outcome. Burst suppression pattern in EEG, bleeds, or hypodensities in the CT and involvement of basal ganglia/thalamus in the MRI are predictors of abnormal outcome.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
[PubMed]
14
4,663
673
Outcome of exchange blood transfusions done for neonatal jaundice in Abakaliki, South Eastern Nigeria
Roland C Ibekwe, MaryAnn U Ibekwe, Vivian U Muoneke
January-March 2012, 1(1):34-37
DOI
:10.4103/2249-4847.92239
PMID
:24027683
Background:
Neonatal jaundice (NNJ) is a major cause of morbidity and mortality among neonates in Nigeria and exchange blood transfusion (EBT) is a common modality of its treatment in Ebonyi State University Teaching Hospital (EBSUTH), Abakaliki. This communication aims to audit this service.
Materials and Methods:
A 3-year retrospective review of the case files of all neonates that had EBT for NNJ at the new born special care unit of EBSUTH.
Result:
Two hundred and thirty seven (17.25%) out of 1374 neonatal admissions had NNJ. EBT was performed for 40 (16.9%) of them. The commonest indications for EBT were low birth weight/prematurity, ABO blood group incompatibility, sepsis and glucose 6 phosphate deficiencies. The mean serum bilirubin at which EBT was done was 28.3 mg/dl. The EBT was uneventful in 36 cases while in four (10%) cases there were reported adverse events. Seven neonates (17.5%) died after the procedure and documented causes of death include bilirubin encephalopathy, respiratory failure, and septic shock and disseminated intravascular coagulopathy.
Conclusion:
There is high rate of EBT use in the management of severe neonatal hyperbilirubinemia with significant morbidity and mortality in this study site. There is need to review the contribution of factors such as late presentation in the hospital to this and proffer solutions to it.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
[PubMed]
13
8,405
744
Trends in incidence of neonatal sepsis and antibiotic susceptibility of causative agents in two neonatal intensive care units in Tehran, I.R Iran
Shahla Afsharpaiman, Mohammad Torkaman, Amin Saburi, Amir Farzaampur, Susan Amirsalari, Zohreh Kavehmanesh
July-September 2012, 1(3):124-130
DOI
:10.4103/2249-4847.101692
PMID
:24027707
Background:
Neonatal sepsis is a worldwide problem that presents a management challenge to care groups for neonates and infants. Early diagnosis and management can considerably decrease the risk of sepsis, and improve the outcome.
Aim:
The aim of the present study was to determine the incidence, causative pathogens, and the antibiotic sensitivity pattern for neonatal sepsis in Iran.
Materials and Methods:
A historical cohort study was conducted on 84 patients with neonatal sepsis who were admitted to the neonatal intensive care unit (NICU) wards of Baqiyatallah and Najmieh University hospitals in Tehran, between 2003 and 2006. Clinical, demographic and laboratory data was collected from medical records.
Results:
Among all the comprised neonates, 44 patients were diagnosed with early-onset sepsis, 23 cases with late-onset sepsis and others with nosocomial sepsis. The most common isolated pathogen in all groups was
Enterobacter
, and was responsible for 31.4%, 47.8% and 41.2% of the episodes of sepsis, according to the sepsis type mentioned above, respectively. Susceptibility of common sepsis related pathogens to imipenem and gentamycin gradually reduced over the years between 2003 and 2006. Total mortality and morbidity rates due to neonatal sepsis were estimated at 27.4% and 89.3%, respectively. Mortality following sepsis was found more in boys (Odds Ratio (OR)=4.897, Conifdence Interval (CI)=95%,
P
=0.031), and those with low birth weight (OR=4.406, CI: 95%,
P
=0.011). Higher sepsis related co-morbidity was found in neonates following cesarean delivery (OR=6.280, CI: 95%,
P
=0.025).
Conclusion:
It seems that the mortality rate in this study was lower than similar studies in Iran and other developing countries. This difference between the mortality rates of the centers in our study and others could be due to the high occurrence of
Enterobacter
infections in the latter and also high resistance of these pathogens to commonly used antibiotics such as β-lactams and aminoglycosides reported in other studies.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
[PubMed]
12
6,408
1,124
Retinopathy of prematurity: A study of incidence and risk factors in NICU of Al-Minya University Hospital in Egypt
AHA Abdel Hakeem, GB Mohamed, MF Othman
April-June 2012, 1(2):76-81
DOI
:10.4103/2249-4847.96755
PMID
:24027695
Background:
Retinopathy of prematurity (ROP) is a serious complication of prematurity treatment and can lead to blindness unless recognized and treated early.
Objective:
To estimate the incidence of ROP in preterm infants in our NICU, to identify the risk factors which predispose to ROP, and to assess the outcome of these cases.
Materials and Methods:
ROP prospective screening survey was performed enrolling all prematures admitted to the NICU from January 2009 to December 2010, with a gestational age of 32 weeks or less at birth and a birth weight of 1500 g or less. Infants whom gestational age was >32 weeks or birth weight was >1500 g were included if they exposed to oxygen therapy for more than 7 days. Also infants who were born between 32 and 34 weeks gestational age were examined if they had a course of instability (like sepsis, asphyxia or ventilation). A total of 172 infants (88 females) had retinal evaluation by indirect ophthalmoscopy from the 4
th
postnatal week and followed up periodically. Perinatal risk factors for ROP were assessed using univariate and multivariate analysis. Infants who progressed to stage 3 ROP with plus disease were given laser therapy.
Results:
Out of the studied 172 infants, 33 infants (19.2%) developed ROP in one or both eyes; 18 (54.5%) cases stage 1, 9 (27.3%) cases stage 2 and 6 (18.2%) cases stage 3 with plus disease. None of the studied neonates presented ROP at stages 4 or 5. The six cases diagnosed as ROP stage 3 with plus disease underwent laser ablative therapy. Laser was effective in treatment and decreasing the progression of ROP. Univariate analysis showed that there was a significant relationship between the occurrence of ROP and gestational age (
P
=0.000), sepsis (
P
=0.004), oxygen therapy (
P
=0.018), and frequency of blood transfusions (
P
=0.030). However, nonsignificant relationship was found between the occurrence of ROP and sex, mode of delivery, birth weight, respiratory distress syndrome, patent ductus arteriosus, intraventricular hemorrhage, hypotension, phototherapy, duration of oxygen therapy, mechanical ventilation, and CPAP (all
P
>0.05). Gestational age, sepsis, oxygen therapy and frequency of blood transfusions remained significant variables after logistic regression analysis.
Conclusion:
The incidence of ROP in this study was 19.2%; low gestational age, sepsis, oxygen therapy and frequent blood transfusions were significant risk factors for ROP. Laser was effective in treatment and decreasing the progression of ROP. As this is a unit-based study, a comprehensive countrywide survey on ROP in Egypt is recommended to determine any regional differences in disease incidence.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
[PubMed]
12
3,646
604
Multicenter randomized controlled trial of therapeutic hypothermia plus magnesium sulfate versus therapeutic hypothermia plus placebo in the management of term and near-term infants with hypoxic ischemic encephalopathy (The Mag Cool study): A pilot study
Sajjad Ur Rahman, Fuat Emre Canpolat, Mehmet Yekta Oncel, Abdurrahman Evli, Ugur Dilmen, Hussain Parappil, Jasim Anabrees, Khalid Hassan, Mohammed Khashaba, Islam Ayman Noor, Lucy Chai See Lum, Anis Siham, Melek Akar, Heybet Tuzun, Aiman Rahmani, Moghis Rahman, Lina Haboub, Mohammed Rijims, Rohana Jaafar, Lai Yin Key, Mohammad Tagin
July-September 2015, 4(3):158-163
DOI
:10.4103/2249-4847.159863
Background:
Therapeutic hypothermia provides up to 30% neuroprotection in moderate to severe hypoxic ischemic encephalopathy (HIE). Additional neuroprotection may be achieved by using concomitant pharmacologic neuroprotective agents.
Aim:
The aim was to evaluate the safety of concomitant neuroprotective therapy of therapeutic hypothermia and magnesium sulfate (MgSO
4
) in the management of moderate and severe HIE in term and near-term infants.
Study
Design:
Multicenter double-blind randomized controlled trial.
Methodology:
Term and near-term newborn infants (≥35 weeks) with a clinical diagnosis of moderate or severe HIE were randomized to either Arm A (therapeutic hypothermia plus MgSO
4
) or Arm B (therapeutic hypothermia plus placebo) using a net-based randomization system. Both groups received, within 6 h of birth, standard hypothermia therapy (72 h of cooling to 33.5°C followed by slow rewarming over a period of 8 h) plus either MgSO
4
(250 mg/kg/dose ×3 doses) or placebo (normal saline). The groups were compared for short-term predischarge adverse outcomes.
Results:
A total of 60 patients were randomized (29 in Arm A and 31 in Arm B). Both groups had similar baseline characteristics (
P
> 0.05) including severity of HIE. There were no differences in the short-term adverse outcomes (death, seizures, thrombocytopenia, coagulopathy, renal failure, elevated liver function test's, hypotension, intracranial hemorrhage, necrotizing enterocolitis, pulmonary hemorrhage, persistent pulmonary hypertension, and pulmonary air leak syndromes) between the two groups (
P
> 0.05).
Conclusions:
The combined use of therapeutic hypothermia and MgSO
4
appears to be safe particularly with respect to maintaining normal blood pressure and coagulopathy. Long-term survival and neurodevelopmental outcomes remain to be evaluated.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
12
5,362
947
CASE REPORTS
Congenital chikungunya
Hariharan Gopakumar, Sivji Ramachandran
July-September 2012, 1(3):155-156
DOI
:10.4103/2249-4847.101704
PMID
:24027715
Chikungunya virus (CHIKV) infection manifesting in neonates is very rare. The prevalence of the entity was described only recently. We describe a neonate with chikungunya who presented with severe thrombocytopenia and features of multisytem involvement. Identification of this entity based on clinical and epidemiological background helps in appropriate management and aids in prognostication of the affected neonate.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
[PubMed]
11
2,860
564
ORIGINAL ARTICLES
Oral nystatin versus intravenous fluconazole as neonatal antifungal prophylaxis: Non-inferiority trial
Ali Mersal, Ibrahim Alzahrani, Mahasen Azzouz, Adel Alsubhi, Heba Alsawaigh, Nouf Albshri, Manal Bajammal, Ghazal Avand, Abdulmajid Almahbosh
April-June 2013, 2(2):88-92
DOI
:10.4103/2249-4847.116408
PMID
:24049751
Background:
Fluconazole has shown to be effective in reducing both colonization and invasive Candida infection (ICI) in ELBW neonates; we conducted a randomized trial to compare oral nystatin with intravenous fluconazole for prophylaxis against invasive Candidiasis in high risk neonates.
Materials and Methods:
By using SPSS, preterm less than 30 weeks gestation and/or birth weight 1200 grams or less assigned to receive either intravenous Fluconazole (6 mg/kg q72 hr for 1
st
week then q48 h for 6 wks) or oral Nystatin (100,000 unit q8 hr for 6 wks). The medications commenced at one week of age after obtaining the base line investigations and check for Candida colonization by urine culture and rectal swab; subsequently all lab work and the clinical data were monitered regularly. Risk factors were assessed. The data collected prospectively looking for primary end point the invasive Candida infection (ICI) and 2 ndry outcomes include medication safety, tolerance and cost.
Results:
65 neonate randomly assigned however only 57 neonates comleted the study 33/57 (57%) to intravenous fluconazole group and 24/57 (42%) to oral nystatin group. No differences in birth weights Nystatin (1.15 Kg) Fluconazole (1.01 Kg), gender males (26/57), female (32/57), Gestational age (29.28 vs l28.22) or risk factors between the two groups. Rectal swab Colonization occurred in 2/24 (8%) in Nystatin group and 4/33 (12%) in the Fluconazole group, but none of the neonates developed ICI or side effects, although in the Fluconazole group transient transaminase elevation 2SD standard deviation above the mean was observed. Central line duration was 2 SD above the mean for fluconazole group, The cost of the Fluconazole treated group (7,581 SAR) 106.4 US/pt double the cost of Nystatin treated group (3,375 SAR) 50 US/pt.
Conclusion:
Intravenous Fluconazole and oral Nystatin at the prophylactic doses are equally effective and safe in preventing (ICI) in preterm neonates, however oral Nystatin is readily available, easily administered with lower cost per neonate.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
[PubMed]
11
4,198
607
EBN SYNOPSIS
Oxygen saturation and outcomes in preterm infants the boost ii United Kingdom, Australia, and New Zealand collaborative groups
Emad Khadawardi, Fahad Al Hazzani
April-June 2013, 2(2):73-75
DOI
:10.4103/2249-4847.116404
PMID
:24049747
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
[PubMed]
10
2,764
456
ORIGINAL ARTICLES
NT-proBNP levels improve the ability of predicting a hemodynamically significant patent ductus arteriosus in very low-birth-weight infants
Sujatha Buddhe, Sarita Dhuper, Roger Kim, Laya Weichbrod, Eman Mahdi, Nishant Shah, Sashi Kona, Myron Sokal
April-June 2012, 1(2):82-86
DOI
:10.4103/2249-4847.96758
PMID
:24027696
Purpose:
A hemodynamically significant Patent ductus arteriosus (HsPDA) in premature infants is known to be associated with significant morbidity. Recently brain natriuretic peptides and superior mesenteric artery (SMA)-resistive indices have been used to effectively diagnose HsPDA.
Objective:
To assess the sensitivity and specificity of N-terminal proBNP (NT-proBNP) in predicting an HsPDA diagnosed by clinical and echocardiographic criteria including pulsatility index (PI) of SMA.
Materials and Methods:
All preterm neonates <1500 g were evaluated with echocardiograms and NT-proBNP levels on the 3
rd
to 5
th
day of life and then every week until the echo showed either a closed PDA or non-HsPDA.
Results:
Sixty-nine babies with mean gestational age of 27 weeks were included in the study. NT-proBNP levels were significantly higher in the HsPDA group (
n
=22) with a mean±SEM of 24420±3190 compared to 3072±332 in the non-HsPDA group (
n
=47) (
P
<0.001). NT-pro BNP level of 5900 pg/ml had 96% sensitivity and 90% specificity of predicting HsPDA.
Conclusions:
With frequently changing hemodynamics in low-birth weight infants, including NT-proBNP and PI of SMA improve the ability of assessing the effects of a HsPDA and will help timing of intervention.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
[PubMed]
10
3,638
481
REVIEW ARTICLE
Non-invasive ventilation in premature infants: Based on evidence or habit
Shalabh Garg, Sunil Sinha
October-December 2013, 2(4):155-159
DOI
:10.4103/2249-4847.123082
PMID
:24404523
Despite surfactant and mechanical ventilation being the standard of care for preterm infants with respiratory failure, non-invasive respiratory support is increasingly being employed in neonatal units. The latter can be accomplished in a variety of ways but none of them have been proven so far to be superior to intubation and mechanical ventilation. Nonetheless, they appear to be safe and effective in experienced hands. This article relates to the use of non-invasive forms of respiratory support and evidence is reviewed from the clinical trials which have evaluated the use of these techniques.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
[PubMed]
10
5,425
10,170
SNS CLINICAL PRACTICE GUIDELINES
Whole body cooling for infants with hypoxic-ischemic encephalopathy
Rafat Mosalli
April-June 2012, 1(2):101-106
DOI
:10.4103/2249-4847.96777
PMID
:24027701
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
[PubMed]
10
6,503
1,348
ORIGINAL ARTICLES
Jejunoileal atresia: Factors affecting the outcome and long-term sequelae
Alessandro Calisti, Claudio Olivieri, Riccardo Coletta, Vito Briganti, Lucia Oriolo, Giuseppina Giannino
January-March 2012, 1(1):38-41
DOI
:10.4103/2249-4847.92237
PMID
:24027684
Context:
Jejunoileal atresia (JIA) is a common abnormality. The outcome is conditioned by several variables. Nutritional problems, and long-term sequelae are described among those who survive.
Aim:
To correlate the type of JIA and its management to the outcome and long-term quality of life.
Settings and Design:
Forty-three cases over a 17-year period (1992-2009). Perinatal data, management, and outcome were extracted from the clinical notes. The cases that had survived were contacted to get information about their present condition.
Materials and Methods:
Morbidity and mortality were matched to maturity, birth weight, mode of diagnosis, type of JIA, associated anomalies, and management and duration of parenteral nutrition. Growth and quality of life in 34 cases were evaluated via a telephone interview at a minimum of one year from surgery.
Statistical analysis:
Fisher test, Linear regression test, Kruskal-Wallis test, Dunn's comparison test.
Results:
Male/Female ratio was 25/18 and median birth weight was 2.644 g. Prenatal diagnosis was recorded in 34%. Six patients (14%) had associated anomalies. Primary surgery was resection and anastomosis in 88% and temporary stoma in 12%. Length of the resected bowel ranged from 3 to 65 cm. Whenever multiple atresia was found, the bowel length was saved by multiple anastomosis. Three dehiscences and three adhesive obstructions required a reoperation. Two patients (4%) died due to a central catheter-related sepsis. Prenatal diagnosis did not influence the outcome and was associated with a higher rate of Cesarean deliveries. Interview, at a median of nine years, showed normal growth in 85%. One case of short bowel syndrome is still on parenteral support at 22 months.
Conclusions:
Preserving bowel length and reducing the recourse to stoma is the key to good outcome and growth. Sequelae are correlated with the type of atresia and length of residual bowel; however, they decrease their severity with time.
[ABSTRACT]
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[CITATIONS]
[PubMed]
9
5,279
761
* Source: CrossRef
Feedback
Subscribe
Sitemap
|
What's New
|
Feedback
|
Disclaimer
|
© Journal of Clinical Neonatology | Published by Wolters Kluwer -
Medknow
Online since 30 April, 2011