Objective: Despite the presence of hand washing material and the training given to medical staff regarding hygiene measures and health care procedures in October 2015, the prevalence of nosocomial infections in the ne...Objective: Despite the presence of hand washing material and the training given to medical staff regarding hygiene measures and health care procedures in October 2015, the prevalence of nosocomial infections in the neonatal unit of the National University Teaching Hospital of Cotonou (CNHU-Cotonou) was estimated at 8% in January 2016. To determine the factors that contribute to these infections, this study assessed medical staff compliance with hand hygiene measures and procedures. Method: This research was a cross-sectional and observational study conducted from February 15 to March 31, 2016 through direct and cautious observation of 47 members of the medical and paramedical staff. The study variables were hand washing before entering the neonatal unit and before entering each treatment room, hand washing before and after seeing each patient, compliance with hand washing steps, the use of hydroalcoholic solutions and adhering to the ban on mobile phone use inside the treatment room. Results: Only 15% of the medical staff followed all of the rules and measures governing hand hygiene. The result showed that 76.6% of them did not wash their hands before entering the unit;32% washed their hands before each care session;95.7% washed their hands after each care session;and 85% did not comply with the hand washing steps. Only 21.3% of the personnel used hydroalcoholic solution, and only 85% of the personnel adhered to the ban on mobile phone use within the treatment room. Conclusion: Compliance with hand hygiene measures is insufficient. These low compliance rates facilitate the occurrence of nosocomial infections. Nosocomial infections could be prevented by identifying the reasons that medical personnel do not wash their hands and by implementing a program for education/awareness on hygiene measures based on an analysis of errors and care procedures and sustained by regular evaluations.展开更多
AIM:To investigate the frequency,etiology,and current management strategies for diarrhea in newborn.METHODS:Retrospective,nationwide study involving 5801 subjects observed in neonatal intensive care units during 3 yea...AIM:To investigate the frequency,etiology,and current management strategies for diarrhea in newborn.METHODS:Retrospective,nationwide study involving 5801 subjects observed in neonatal intensive care units during 3 years.The main anamnesis and demographic characteristics,etiology and characteristics of diarrhea,nutritional and therapeutic management,clinical outcomes were evaluated.RESULTS:Thirty-nine cases of diarrhea(36 acute,3 chronic) were identified.The occurrence rate of diarrhea was 6.72 per 1000 hospitalized newborn.Etiology was defined in 29 of 39 newborn(74.3%):food allergy(20.5%),gastrointestinal infections(17.9%),antibiotic-associated diarrhea(12.8%),congenital defects of ion transport(5.1%),withdrawal syndrome(5.1%),Hirschsprung's disease(2.5%),parenteral diarrhea(2.5%),cystic fibrosis(2.5%),and metabolic disorders(2.5%).Three patients died due to complications related to diarrhea(7.7%).In 19 of 39 patients(48.7%),rehydration was performed exclusively by the enteral route.CONCLUSION:Diarrhea in neonates is a challenging clinical condition due to the possible heterogeneous etiologies and severe outcomes.Specific guidelines are advocated in order to optimize management of diarrhea in this particular setting.展开更多
Several clinical guidelines for the management of infants with severe neonatal hyperbilirubinemia recommend immediate exchange transfusion(ET) when the risk or presence of acute bilirubin encephalopathy is established...Several clinical guidelines for the management of infants with severe neonatal hyperbilirubinemia recommend immediate exchange transfusion(ET) when the risk or presence of acute bilirubin encephalopathy is established in order to prevent chronic bilirubin encephalopathy or kernicterus. However, the literature is sparse concerning the interval between the time the decision for ET is made and the actual initiation of ET, especially in low- and middle-income countries(LMICs) with significant resource constraints but high rates of ET. This paper explores the various stages and potential delays during this interval in complying with the requirement for immediate ET for the affected infants, based on the available evidence from LMICs. The vital role of intensive phototherapy, efficient laboratory and logistical support, and clinical expertise for ET are highlighted. The challenges in securing informed parental consent, especially on religious grounds, and meeting the financial burden of this emergency procedure to facilitate timely ET are examined. Secondary delays arising from posttreatment bilirubin rebound with intensive phototherapy or ET are also discussed. These potential delays can compromise the effectiveness of ET and should provide additional impetus to curtail avoidable ET in LMICs.展开更多
Simulation training in medical education allows multidisciplinary teams to train in a realistic clinical environment. It helps reduce clinical errors and addresses patient safety issues. Multiple areas can be covered ...Simulation training in medical education allows multidisciplinary teams to train in a realistic clinical environment. It helps reduce clinical errors and addresses patient safety issues. Multiple areas can be covered including procedural skills training, communication, teamwork and human factors training. We present a “model of simulation” in education, which is based onRoyalCollegeof Paediatrics and Child HealthUnited Kingdomgeneral paediatric curriculum. Simulation complements the existing neonatal education programme both for doctors and nurses. It has the long-term purpose of achieving higher standards in neonatal care through the training of staff in a structured, multidisciplinary environment. Its quality and impact are subject to feedback from the participants. This has helped in its evolution and development as a multidisciplinary programme.展开更多
The management and prognostic implications of neonatal encephalopathy(NE)-an altered level of consciousness and abnormal tone and reflexes in term and near-term infants in the first days of life-depends on the underly...The management and prognostic implications of neonatal encephalopathy(NE)-an altered level of consciousness and abnormal tone and reflexes in term and near-term infants in the first days of life-depends on the underlying etiology[1].Since the most common cause of NE in the context of intrapartum hypoxia-ischemia(HI)is hypoxic-ischemic encephalopathy(HIE),the initial management.展开更多
Background Neonatal encephalopathy(NE)due to suspected hypoxic-ischemic encephalopathy(HIE),referred to as NESHIE,is a clinical diagnosis in late preterm and term newborns.It occurs as a result of impaired cerebral bl...Background Neonatal encephalopathy(NE)due to suspected hypoxic-ischemic encephalopathy(HIE),referred to as NESHIE,is a clinical diagnosis in late preterm and term newborns.It occurs as a result of impaired cerebral blood flow and oxygen delivery during the peripartum period and is used until other causes of NE have been discounted and HIE is confirmed.Therapeutic hypothermia(TH)is the only evidence-based and clinically approved treatment modality for HIE.However,the limited efficacy and uncertain benefits of TH in some low-to middle-income countries(LMICs)and the associated need for intensive monitoring have prompted investigations into more accessible and effective stand-alone or additive treatment options.Data sources This review describes the rationale and current evidence for alternative treatments in the context of the pathophysiology of HIE based on literatures from Pubmed and other online sources of published data.Results The underlining mechanisms of neurotoxic effect,current clinically approved treatment,various categories of emerging treatments and clinical trials for NE are summarized in this review.Melatonin,caffeine citrate,autologous cord blood stem cells,Epoetin alfa and Allopurinal are being tested as potential neuroprotective agents currently.Conclusion This review describes the rationale and current evidence for alternative treatments in the context of the pathophysiology of HIE.Neuroprotective agents are currently only being investigated in high-and middle-income settings.Results from these trials will need to be interpreted and validated in LMIC settings.The focus of future research should therefore be on the development of inexpensive,accessible monotherapies and should include LMICs,where the highest burden of NESHIE exists.展开更多
Background: Despite improvements in clinical management, mortality of congenital diaphragmatic hernia (CDH) remains high. Early prediction of mortality risk helps in comparing strategies and/or performances of differe...Background: Despite improvements in clinical management, mortality of congenital diaphragmatic hernia (CDH) remains high. Early prediction of mortality risk helps in comparing strategies and/or performances of different centers. Birth weight (BW), Apgar Score at 5 minutes, and modified McGoon Index (MGI) calculated by the ratio between the diameters of pulmonary arteries and the descending aorta have been used to determine mortality of CDH. Aim: The purpose of this study is to evaluate the relationship between early detectable variables and survival in newborns with CDH intubated at birth, managed with “gentle”ventilation and delayed surgery. Methods: All medical records of patients affected by highrisk CDH and treated with a standardized protocol at Bambino GesúChildren’s Hospital, Rome, Italy, between January 2002 and September 2004 were reviewed. Prenatal diagnosis, gestational age, BW, sex, side of hernia, and MGI were recorded on admission. The relationship with mortality of each variable was evaluated by univariate analysis. Subsequently, a predictive model of mortality was developed using a logistic regression: the explanatory variables, BW, and MGI were dichotomized in high (HBW and HMGI) and low (LBW and LMGI) according to the best cutoff found with receiver-operating characteristic curves. Results: Thirty-four newborns with CDH, treated with a standardized protocol, were studied. The main characteristics of the 34 patients were BW, 2886 g (1500-3620 g); gestational age, 37.7 weeks (32-42 weeks); male/female, 22/12; right/left, 8/26; prenatal diagnosis, 29; MGI, 1.31 (0.9-1.85). Only BW and MGI were significantly (P < .05) associated with mortality at the univariate analysis. The best cutoff values were 2755 g for BW (sensitivity, 70%; specificity, 74%) and 1.25 for MGI (sensitivity, 73%; specificity, 78%). Using these limits, BW and MGI resulted independently associated with mortality in the multivariate analysis. Using the 4 possible combinations, the LBW associated with the LMGI presented the highest prediction of mortality (80%). Conclusions: Birth weight and MGI, variously combined,were predictive of mortality. Because they are not influenced by subsequent modalities of care, they can be considered as valid early severity scores in CDH and used for comparing strategies and/or performances of different centers.展开更多
Breastfeeding and human milk are the normative standards for feeding and nutrition of both term and pre-term infants. Fresh mother’s own milk is recognized as the optimal choice for feeding all newborns, including pr...Breastfeeding and human milk are the normative standards for feeding and nutrition of both term and pre-term infants. Fresh mother’s own milk is recognized as the optimal choice for feeding all newborns, including preterm and very low birth weight infants. Evidence documents short and long-term metabolic, immunologic and neurodevelopmental advantages of breastfeeding when compared to formula. Moreover, benefits of breastfeeding on psychological and relational aspects have to be considered. Currently, human milk supplementation is usually performed to meet the specific nutritional requirements of preterm infants. When mother’s milk is unavailable or in short supply, donor milk represents the best alternative, although some nutritional elements are inactivated by the necessary pasteurization process. Aim of this review is to briefly summarize the main biological and nutritional factors that contribute to the beneficial effects of human milk feeding for preterm infants.展开更多
Introduction: Partial liquid ventilation may benefit the lung disease in preterm neonates but intratracheal instillation of perfluorocarbon increases cerebral blood flow and may cause brain injury. We aimed to determi...Introduction: Partial liquid ventilation may benefit the lung disease in preterm neonates but intratracheal instillation of perfluorocarbon increases cerebral blood flow and may cause brain injury. We aimed to determine if the effects of perfluorocarbon administration on cerebral blood flow vary by dose-volume, rate of administration, endotracheal tube portal of entry, or closely targeting PaCO2. Methods: Forty-two dosing events (in eleven rabbits) were randomised to different dosing strategies, including a sham (i.e., placebo/control) dose of air over 20 min, 20 mL/kg of perfluorocarbon slowly over 20 min, 10 mL/kg of perfluorocarbon slowly over 20 min, 10 mL/kg of perfluorocarbon moderately fast over 10 min, 10 mL/kg of perfluorocarbon rapidly over 5 min, 10 mL/kg of perfluorocarbon slowly over 20 min via the endotracheal tube tip lumen (as opposed to the proximal end of the tube used in all other groups), or 10 mL/kg of perfluorocarbon slowly over 20 min whilst targeting a PaCO2 of 45 - 50 mmHg. Blood gases, haemodynamics, cortical cerebral blood flow and carotid flow were recorded continuously for 30 minutes from the start of each dose. Results: Carotid flow increased with 20 mL/kg perfluorocarbon and cortical cerebral blood flow was significantly more variable. Carotid and cortical cerebral blood flow increased using 10 mL/kg or 20 mL/kg with no difference between the two dose-volumes. There was no difference in cerebral blood flow by rate of administration, but carotid blood flow was more variable during slow administration. There were no differences in the increase in cerebral blood flow by portal of entry. If PaCO2 was maintained between 45 - 50 mmHg there was no increase in cerebral blood flow and there was less variable carotid flow. Conclusions: Cerebral blood flow increases with perfluorocarbon dosing. This occurs regardless of the dose-volume of perfluorocarbon. These effects were mitigated by closely targeting PaCO2.展开更多
Premature Rupture of Membranes (PROM) with the resulting prematurity remains a major public health issue in the Democratic Republic of Congo (DRC). This study aimed to assess expectant management of PPROM before 34 we...Premature Rupture of Membranes (PROM) with the resulting prematurity remains a major public health issue in the Democratic Republic of Congo (DRC). This study aimed to assess expectant management of PPROM before 34 weeks at the university hospital of Kinshasa. We conducted a retrospective analysis of expectantly managed PROM before 34 weeks between January 2008 and December 2018. Maternal and fetal outcomes were collected, and all data were analyzed using the SPSS 23.0 software. Of the 113 patients included in the study, 2.6% were diagnosed with PROM before 34 weeks. We observed prolongation of the pregnancy duration;the median latency period was eight days, and the average gestational age at delivery of 32.85 ± 2.5 weeks. Chorioamnionitis (23%), severe oligoamnios (7%), and acute fetal distress (4%) were complications observed during the latency period. In the postpartum period, endometritis (6.2%), neonatal jaundice (39.8%), anemia (25.7%), ulcerative necrotizing enterocolitis (6.2%), cerebromeningeal hemorrhage (5.3%), and acute respiratory distress syndrome (4.4%) were complications observed. The risk of infection during the latency period was significantly associated with irregular (P = 0.045) or lack (P = 0.006) antenatal care (ANC) attendances and C-Reactive Protein (CRP) results 6 (P = 0.013). The risk of neonatal death was significantly associated to infection during the latency period (P = 0.011), irregular (P = 0.009) or lack of ANC (P = 0.000) attendances, Birth weight g (P = 0.039) as well as Gestational age at birth between 28 to 30 Weeks (S) (P = 0.021). These findings report first-time pregnancy outcomes related to the management of PPROM before 34 weeks in our setting. We found that the conservative attitude adopted allowed the prolongation of pregnancies, reducing the risks associated with prematurity. Nevertheless, attendance in good quality ANC could reduce the frequency of PROM and related adverse outcomes.展开更多
Objective: High-frequency ventilation (HFV) is an effective means to achieve gas exchange in neonates. Adequate carbon dioxide (pCO<sub>2</sub>) levels are best achieved immediately after starting HFV, avo...Objective: High-frequency ventilation (HFV) is an effective means to achieve gas exchange in neonates. Adequate carbon dioxide (pCO<sub>2</sub>) levels are best achieved immediately after starting HFV, avoiding either hypercapnia or hypocapnia. We aimed to determine the initial pCO<sub>2</sub> levels after starting HFV, and the time taken to obtain the initial blood gas. Methods: We conducted an observational retrospective study on neonates that required their first episode of HFV. Data included the first blood gas result after starting HFV and when the gas was taken after starting HFV. Results: This study included 112 neonates with a median birth weight of 938 (IQR: 692 - 1549) grams and gestational age of 27.2 (24.6 - 30.7) weeks. The first pCO<sub>2</sub> after starting HFV (mean (SD)) was 53.7 (22) mmHg. Of 112, 15 (13.4%) showed initial hypocapnia (pCO<sub>2</sub> 35 mmHg), and 17 (15.2%) showed hypercapnia (pCO<sub>2</sub> > 65 mmHg)—a total of 28.6% unacceptable pCO<sub>2</sub> levels. Of 112, the first blood gas was obtained within 30 minutes in 47 (42%) and within one hour in 85 (76%), with a significant delay of two or more hours in eight (7.1%). Conclusion: Many neonates had unacceptable pCO<sub>2</sub> levels upon starting first-time HFV. There were significant delays in obtaining the initial gas.展开更多
Objective: To determine the outcome of antenatally suspected congenital cystic adenomatoid malformation of the lung (CCAM) over a 10 year period. Methods: Thi s is a retrospective study of all babies diagnosed antenat...Objective: To determine the outcome of antenatally suspected congenital cystic adenomatoid malformation of the lung (CCAM) over a 10 year period. Methods: Thi s is a retrospective study of all babies diagnosed antenatally in the Prenatal D iagnosis Unit and delivered in Oxford between 1991 and 2001. Data were obtained from the Oxford Congenital Anomaly Register, theatre records, and histopathology reports. Results: Twenty eight cases of CCAM were diagnosed antenatally. Five p regnancies were terminated. Data are available on all 23 of the pregnancies that continued and resulted in two neonatal deaths and 21 surviving babies. Eleven o f the 23 cases (48%) showed some regression of the lesion antenatally, and four of these cases appeared to resolve completely on prenatal ultrasound. Three of the 23 babies (13%) were symptomatic in the early neonatal period, and three de veloped symptoms shortly afterwards. Seventeen of the 23 babies (74%) were asym ptomatic, of whom 12 had abnormalities on chest radiograph or computed tomograph y scan and had elective surgery. Two babies (8%) had completely normal postnata l imaging, and three had abnormalities which resolved in the first year of life. Seventeen of the 23 babies (74%) had surgery. Histology at surgery was heterog eneous. Of the 23 live births, all 21 survivors (91%) are well at follow up or have been discharged. Conclusions: All babies diagnosed antenatally with CCAM re quire postnatal imaging with computed tomography irrespective of signs of antena tal resolution. In asymptomatic infants, the recommendations are close follow up and elective surgery for persistent lesions within the first year of life. Hist ology at surgery was heterogeneous, and this should be considered when counselli ng parents.展开更多
To determine whether social deprivation is associated with neonatal unit admission. Setting: English district general hospital. Method: Retrospective review of neonatal unit admission records between 1990 and 2002. Re...To determine whether social deprivation is associated with neonatal unit admission. Setting: English district general hospital. Method: Retrospective review of neonatal unit admission records between 1990 and 2002. Results: There was a linear increase in admission rates with increasing deprivation. The admission rate was 6.1% of live births for infants in the most affluent quartile compared with 11.1% for those in the most deprived quartile. Admission rates for all indications except jaundice and feeding problems increased with increasing deprivation. Conclusion: Social deprivation correlates strongly with neonatal morbidity and the need for neonatal unit admission. This finding has implications for professionals in public health and primary and secondary care.展开更多
Aim: To assess the reproducibility of, and determine normative data for, flow volume measurements from the right common carotid artery (CCA) and its relation to left ventricular output (LVO) in stable term and preterm...Aim: To assess the reproducibility of, and determine normative data for, flow volume measurements from the right common carotid artery (CCA) and its relation to left ventricular output (LVO) in stable term and preterm babies using Doppler ultrasound. Methods: Right CCA flow volume was measured using a near focus, hig h frequency transducer by obtaining intensity weighted mean velocity and right C CA diameter. LVO was determined using standard Doppler techniques. Reproducibili ty studies were performed on 30 newborn infants by two observers. Normative data were obtained from 40 spontaneously bre athing preterm babies and 21 term babies. Results: The intraobserver coefficient of variation for CCA flow measurements was 10.5%for observer 1 and 15.4%for o bserver 2, whereas the interobserver coefficient of variation was 16.4%. In ter m and preterm infants, right CCA flow was about 20 ml/kg/min, accounting for 11 %of cardiac output. Among the preterm infants, there was a positive correlation of right CCA flow with gestation (r = 0.61, p < 0.001), weight (r = 0.64, p < 0 .001), and LVO (r = 0.59, p < 0.001). Right CCA diameter also increased with wei ght (r = 0.63, p < 0.001) and gestation (r = 0.58, p < 0.001). The proportion of LVO distributed to the right CCA did not increase with gestation, nor did the r ight CCA flow per kg body weight. Conclusions: It is possible to perform reprodu cible measurements of flow volume in the CCA of newborn infants. In stable, spon taneously breathing babies, both cardiac output and carotid flow increased with gestation and body weight. The proportion of cardiac output distributed to the r ight CCA remained relatively constant across gestation.展开更多
Aim: To assess the intelligence quotient (IQ) and academic achievement in earl y adulthood of a cohort of extremely-low birthweight (ELBW ≤1000 g) subjects. Methods: All 82 ELBW survivors consecutively born in or ref...Aim: To assess the intelligence quotient (IQ) and academic achievement in earl y adulthood of a cohort of extremely-low birthweight (ELBW ≤1000 g) subjects. Methods: All 82 ELBW survivors consecutively born in or referred to a single ter tiary center in 1976-1981 were traced at a mean age of 18 y. Three disabled chi ldren had died. Fifty-nine subjects (75%)-had their IQ tested and 69 (87%) r esponded to a questionnaire. They were compared to 44 term, normal birthweight ( NBW)-matched controls. Outcome measures were: IQ (Wechsler Adult Intelligence S cale) and educational outcome. The main outcome variables were compared between groups and analyzed for neonatal and demographic data and in the ELBWgroup for c hildhood data. Results: There was a strong relationship (r2 = 0.55, p < 0.0001) between childhood and adult IQ for the 41 ELBW subjects tested at both ages (6.1 ±1.3 and 18.4 ±1.9 y). Differences were significant between ELBW and NBW grou ps: in mean full-scale IQ (94 ±12 vs 108 ±14), verbal IQ (93 ±12 vs 106 ±14 ) and performance IQ (97 ±14 vs 109 ±16) (p < 0.0001). Differences between ELB W and NBW groups in prevalence of IQ < 85 (19 vs 2%, p = 0.012), of schooling i n a regular curriculum for age (36 vs 68%, p = 0.0011), of requirement for spec ial classes or schools (33 vs 9%, p = 0.0032), and of obtainment of secondary s chool diploma for those 18 y or older (56 vs 85%, p = 0.018) were largely due t o fathers’socioeconomic score. Conclusion: ELBW subjects had a mean adult IQ in the normal range; however, it was one standard deviation below that of NBW subj ects and they had more school failures. Despite this, more than half of ELBW sub jects aged 18 y or more had obtained their secondary school diploma.展开更多
Objectives: (1) To determine a normal range for urinary citrate for term babi es. (2) To compare urinary citrate measured in ex preterm babies at term with th is normal range. (3) To evaluate whether urinary citrate w...Objectives: (1) To determine a normal range for urinary citrate for term babi es. (2) To compare urinary citrate measured in ex preterm babies at term with th is normal range. (3) To evaluate whether urinary citrate was related to presence of nephrocalcinosis (NC) and chronic Lung Disease (CLD) in these ex preterm bab ies. Study design: Urinary citrate was measured in 38 healthy term babies (mean birth weight 3.52 kg, mean gestation 41weeks) at amean postnatal age of 3 days ( 1- 5 days) and in 53 ex preterm babies ( < 32 weeks gestation at birth) at term . These preterm babies were part of a larger study on NC in which two renal ultr asound scans were performed at 1 month and term. Results: The normal range for u rinary citrate in term babies was 0.025- 2.97 (mean 1.03) mmol/l and citrate/cr eatinine ratio 0.0011- 0.852 (mean 0.27). In the ex- preterm urinary citrate w as not significantly different (mean 1.1 vs. 1.03, p=0.7232)- but urine citrate /creatinine ratio was significantly higher (mean 1.27 vs. 0.27, p=0.0005). There was no significant difference in urinary citrate or ratios of citrate/creatinin e and calcium/citrate in the 11 (20.7% ) with NC or in the 17 (32% ) babies wi th CLD. There was no significant relationship found between duration of TPN and urinary citrate measured at term. Conclusion: We have determined a normal range for urinary citrate in healthy term babies in the first week of life. The range was very wide. Ex preterm babies had similar values at term and there was no ass ociation between urinary citrate and NC or CLD.展开更多
Objectives: (1) To determine a normal range for urinary citrate for term babies.(2) To compare urinary citrate measured in ex preterm babies at term with this normal range.(3) To evaluate whether urinary citrate was r...Objectives: (1) To determine a normal range for urinary citrate for term babies.(2) To compare urinary citrate measured in ex preterm babies at term with this normal range.(3) To evaluate whether urinary citrate was related to presence of nephrocalcinosis (NC) and chronicLung Disease (CLD) in these ex preterm babies.Study design: Urinary citrate was measured in 38 healthy term babies (mean birth weight 3.52 kg, mean gestation 41weeks) at amean postnatal age of 3 days (1-5 days) and in 53 ex preterm babies ( < 32 weeks gestation at birth) at term.These preterm babies were part of a larger study on NC in which two renal ultrasound scans were performed at 1 month and term.Results: The normal range for urinary citrate in term babies was 0.025-2.97 (mean 1.03) mmol/l and citrate/creatinine ratio 0.0011-0.852 (mean 0.27).In the ex-preterm urinary citrate was not significantly different (mean 1.1 vs.1.03, p=0.7232)-but urine citrate /creatinine ratio was significantly higher (mean 1.27 vs.0.27, p=0.0005).There was no significant difference in urinary citrate or ratios of citrate/creatinine and calcium/citrate in the 11 (20.7%) with NC or in the 17 (32%) babies with CLD.There was no significant relationship found between duration of TPN and urinary citrate measured at term.Conclusion: We have determined a normal range for urinary citrate in healthy term babies in the first week of life.The range was very wide.Ex preterm babies had similar values at term and there was no association between urinary citrate and NC or CLD.展开更多
Cw is a low frequency red cell antigen that belongs to the Rh blood groups system. While not uncommon, anti-Cw is rarely associated with clinically significant haemolytic disease of the newborn (HDN). When it does occ...Cw is a low frequency red cell antigen that belongs to the Rh blood groups system. While not uncommon, anti-Cw is rarely associated with clinically significant haemolytic disease of the newborn (HDN). When it does occur, it is often subclinical or of mild to moderate clinical severity. In the majority of pregnancies it is considered to be a naturally occurring antibody and has not been reported to cause hydrops fetalis or stillbirth. We report a case of anti-Cw alloimmunization, which was associated with significant anaemia and hydrops fetalis, presenting at 35 wk gestation. Conclusion: Pregnancies affected by anti-Cw merit closer scrutiny. Consideration should be given to performing more frequent antenatal ultrasound assessments to detect hydrops fetalis. This may help to support the need for more invasive procedures (cordocentesis and intrauterine transfusions).展开更多
文摘Objective: Despite the presence of hand washing material and the training given to medical staff regarding hygiene measures and health care procedures in October 2015, the prevalence of nosocomial infections in the neonatal unit of the National University Teaching Hospital of Cotonou (CNHU-Cotonou) was estimated at 8% in January 2016. To determine the factors that contribute to these infections, this study assessed medical staff compliance with hand hygiene measures and procedures. Method: This research was a cross-sectional and observational study conducted from February 15 to March 31, 2016 through direct and cautious observation of 47 members of the medical and paramedical staff. The study variables were hand washing before entering the neonatal unit and before entering each treatment room, hand washing before and after seeing each patient, compliance with hand washing steps, the use of hydroalcoholic solutions and adhering to the ban on mobile phone use inside the treatment room. Results: Only 15% of the medical staff followed all of the rules and measures governing hand hygiene. The result showed that 76.6% of them did not wash their hands before entering the unit;32% washed their hands before each care session;95.7% washed their hands after each care session;and 85% did not comply with the hand washing steps. Only 21.3% of the personnel used hydroalcoholic solution, and only 85% of the personnel adhered to the ban on mobile phone use within the treatment room. Conclusion: Compliance with hand hygiene measures is insufficient. These low compliance rates facilitate the occurrence of nosocomial infections. Nosocomial infections could be prevented by identifying the reasons that medical personnel do not wash their hands and by implementing a program for education/awareness on hygiene measures based on an analysis of errors and care procedures and sustained by regular evaluations.
文摘AIM:To investigate the frequency,etiology,and current management strategies for diarrhea in newborn.METHODS:Retrospective,nationwide study involving 5801 subjects observed in neonatal intensive care units during 3 years.The main anamnesis and demographic characteristics,etiology and characteristics of diarrhea,nutritional and therapeutic management,clinical outcomes were evaluated.RESULTS:Thirty-nine cases of diarrhea(36 acute,3 chronic) were identified.The occurrence rate of diarrhea was 6.72 per 1000 hospitalized newborn.Etiology was defined in 29 of 39 newborn(74.3%):food allergy(20.5%),gastrointestinal infections(17.9%),antibiotic-associated diarrhea(12.8%),congenital defects of ion transport(5.1%),withdrawal syndrome(5.1%),Hirschsprung's disease(2.5%),parenteral diarrhea(2.5%),cystic fibrosis(2.5%),and metabolic disorders(2.5%).Three patients died due to complications related to diarrhea(7.7%).In 19 of 39 patients(48.7%),rehydration was performed exclusively by the enteral route.CONCLUSION:Diarrhea in neonates is a challenging clinical condition due to the possible heterogeneous etiologies and severe outcomes.Specific guidelines are advocated in order to optimize management of diarrhea in this particular setting.
文摘Several clinical guidelines for the management of infants with severe neonatal hyperbilirubinemia recommend immediate exchange transfusion(ET) when the risk or presence of acute bilirubin encephalopathy is established in order to prevent chronic bilirubin encephalopathy or kernicterus. However, the literature is sparse concerning the interval between the time the decision for ET is made and the actual initiation of ET, especially in low- and middle-income countries(LMICs) with significant resource constraints but high rates of ET. This paper explores the various stages and potential delays during this interval in complying with the requirement for immediate ET for the affected infants, based on the available evidence from LMICs. The vital role of intensive phototherapy, efficient laboratory and logistical support, and clinical expertise for ET are highlighted. The challenges in securing informed parental consent, especially on religious grounds, and meeting the financial burden of this emergency procedure to facilitate timely ET are examined. Secondary delays arising from posttreatment bilirubin rebound with intensive phototherapy or ET are also discussed. These potential delays can compromise the effectiveness of ET and should provide additional impetus to curtail avoidable ET in LMICs.
文摘Simulation training in medical education allows multidisciplinary teams to train in a realistic clinical environment. It helps reduce clinical errors and addresses patient safety issues. Multiple areas can be covered including procedural skills training, communication, teamwork and human factors training. We present a “model of simulation” in education, which is based onRoyalCollegeof Paediatrics and Child HealthUnited Kingdomgeneral paediatric curriculum. Simulation complements the existing neonatal education programme both for doctors and nurses. It has the long-term purpose of achieving higher standards in neonatal care through the training of staff in a structured, multidisciplinary environment. Its quality and impact are subject to feedback from the participants. This has helped in its evolution and development as a multidisciplinary programme.
基金funded by the Gates Foundation[Grant Nos.INV-022216 and INV-041062]the South African Medical Research Council(SAMRC),and the University of Pretoria through the Institute for Cellular and Molecular Medicine.
文摘The management and prognostic implications of neonatal encephalopathy(NE)-an altered level of consciousness and abnormal tone and reflexes in term and near-term infants in the first days of life-depends on the underlying etiology[1].Since the most common cause of NE in the context of intrapartum hypoxia-ischemia(HI)is hypoxic-ischemic encephalopathy(HIE),the initial management.
基金supported by the South African Medical Research Council(GIPD 96783)the Bill and Melinda Gates Foundation(INV-022216 and INV-041062).
文摘Background Neonatal encephalopathy(NE)due to suspected hypoxic-ischemic encephalopathy(HIE),referred to as NESHIE,is a clinical diagnosis in late preterm and term newborns.It occurs as a result of impaired cerebral blood flow and oxygen delivery during the peripartum period and is used until other causes of NE have been discounted and HIE is confirmed.Therapeutic hypothermia(TH)is the only evidence-based and clinically approved treatment modality for HIE.However,the limited efficacy and uncertain benefits of TH in some low-to middle-income countries(LMICs)and the associated need for intensive monitoring have prompted investigations into more accessible and effective stand-alone or additive treatment options.Data sources This review describes the rationale and current evidence for alternative treatments in the context of the pathophysiology of HIE based on literatures from Pubmed and other online sources of published data.Results The underlining mechanisms of neurotoxic effect,current clinically approved treatment,various categories of emerging treatments and clinical trials for NE are summarized in this review.Melatonin,caffeine citrate,autologous cord blood stem cells,Epoetin alfa and Allopurinal are being tested as potential neuroprotective agents currently.Conclusion This review describes the rationale and current evidence for alternative treatments in the context of the pathophysiology of HIE.Neuroprotective agents are currently only being investigated in high-and middle-income settings.Results from these trials will need to be interpreted and validated in LMIC settings.The focus of future research should therefore be on the development of inexpensive,accessible monotherapies and should include LMICs,where the highest burden of NESHIE exists.
文摘Background: Despite improvements in clinical management, mortality of congenital diaphragmatic hernia (CDH) remains high. Early prediction of mortality risk helps in comparing strategies and/or performances of different centers. Birth weight (BW), Apgar Score at 5 minutes, and modified McGoon Index (MGI) calculated by the ratio between the diameters of pulmonary arteries and the descending aorta have been used to determine mortality of CDH. Aim: The purpose of this study is to evaluate the relationship between early detectable variables and survival in newborns with CDH intubated at birth, managed with “gentle”ventilation and delayed surgery. Methods: All medical records of patients affected by highrisk CDH and treated with a standardized protocol at Bambino GesúChildren’s Hospital, Rome, Italy, between January 2002 and September 2004 were reviewed. Prenatal diagnosis, gestational age, BW, sex, side of hernia, and MGI were recorded on admission. The relationship with mortality of each variable was evaluated by univariate analysis. Subsequently, a predictive model of mortality was developed using a logistic regression: the explanatory variables, BW, and MGI were dichotomized in high (HBW and HMGI) and low (LBW and LMGI) according to the best cutoff found with receiver-operating characteristic curves. Results: Thirty-four newborns with CDH, treated with a standardized protocol, were studied. The main characteristics of the 34 patients were BW, 2886 g (1500-3620 g); gestational age, 37.7 weeks (32-42 weeks); male/female, 22/12; right/left, 8/26; prenatal diagnosis, 29; MGI, 1.31 (0.9-1.85). Only BW and MGI were significantly (P < .05) associated with mortality at the univariate analysis. The best cutoff values were 2755 g for BW (sensitivity, 70%; specificity, 74%) and 1.25 for MGI (sensitivity, 73%; specificity, 78%). Using these limits, BW and MGI resulted independently associated with mortality in the multivariate analysis. Using the 4 possible combinations, the LBW associated with the LMGI presented the highest prediction of mortality (80%). Conclusions: Birth weight and MGI, variously combined,were predictive of mortality. Because they are not influenced by subsequent modalities of care, they can be considered as valid early severity scores in CDH and used for comparing strategies and/or performances of different centers.
文摘Breastfeeding and human milk are the normative standards for feeding and nutrition of both term and pre-term infants. Fresh mother’s own milk is recognized as the optimal choice for feeding all newborns, including preterm and very low birth weight infants. Evidence documents short and long-term metabolic, immunologic and neurodevelopmental advantages of breastfeeding when compared to formula. Moreover, benefits of breastfeeding on psychological and relational aspects have to be considered. Currently, human milk supplementation is usually performed to meet the specific nutritional requirements of preterm infants. When mother’s milk is unavailable or in short supply, donor milk represents the best alternative, although some nutritional elements are inactivated by the necessary pasteurization process. Aim of this review is to briefly summarize the main biological and nutritional factors that contribute to the beneficial effects of human milk feeding for preterm infants.
文摘Introduction: Partial liquid ventilation may benefit the lung disease in preterm neonates but intratracheal instillation of perfluorocarbon increases cerebral blood flow and may cause brain injury. We aimed to determine if the effects of perfluorocarbon administration on cerebral blood flow vary by dose-volume, rate of administration, endotracheal tube portal of entry, or closely targeting PaCO2. Methods: Forty-two dosing events (in eleven rabbits) were randomised to different dosing strategies, including a sham (i.e., placebo/control) dose of air over 20 min, 20 mL/kg of perfluorocarbon slowly over 20 min, 10 mL/kg of perfluorocarbon slowly over 20 min, 10 mL/kg of perfluorocarbon moderately fast over 10 min, 10 mL/kg of perfluorocarbon rapidly over 5 min, 10 mL/kg of perfluorocarbon slowly over 20 min via the endotracheal tube tip lumen (as opposed to the proximal end of the tube used in all other groups), or 10 mL/kg of perfluorocarbon slowly over 20 min whilst targeting a PaCO2 of 45 - 50 mmHg. Blood gases, haemodynamics, cortical cerebral blood flow and carotid flow were recorded continuously for 30 minutes from the start of each dose. Results: Carotid flow increased with 20 mL/kg perfluorocarbon and cortical cerebral blood flow was significantly more variable. Carotid and cortical cerebral blood flow increased using 10 mL/kg or 20 mL/kg with no difference between the two dose-volumes. There was no difference in cerebral blood flow by rate of administration, but carotid blood flow was more variable during slow administration. There were no differences in the increase in cerebral blood flow by portal of entry. If PaCO2 was maintained between 45 - 50 mmHg there was no increase in cerebral blood flow and there was less variable carotid flow. Conclusions: Cerebral blood flow increases with perfluorocarbon dosing. This occurs regardless of the dose-volume of perfluorocarbon. These effects were mitigated by closely targeting PaCO2.
文摘Premature Rupture of Membranes (PROM) with the resulting prematurity remains a major public health issue in the Democratic Republic of Congo (DRC). This study aimed to assess expectant management of PPROM before 34 weeks at the university hospital of Kinshasa. We conducted a retrospective analysis of expectantly managed PROM before 34 weeks between January 2008 and December 2018. Maternal and fetal outcomes were collected, and all data were analyzed using the SPSS 23.0 software. Of the 113 patients included in the study, 2.6% were diagnosed with PROM before 34 weeks. We observed prolongation of the pregnancy duration;the median latency period was eight days, and the average gestational age at delivery of 32.85 ± 2.5 weeks. Chorioamnionitis (23%), severe oligoamnios (7%), and acute fetal distress (4%) were complications observed during the latency period. In the postpartum period, endometritis (6.2%), neonatal jaundice (39.8%), anemia (25.7%), ulcerative necrotizing enterocolitis (6.2%), cerebromeningeal hemorrhage (5.3%), and acute respiratory distress syndrome (4.4%) were complications observed. The risk of infection during the latency period was significantly associated with irregular (P = 0.045) or lack (P = 0.006) antenatal care (ANC) attendances and C-Reactive Protein (CRP) results 6 (P = 0.013). The risk of neonatal death was significantly associated to infection during the latency period (P = 0.011), irregular (P = 0.009) or lack of ANC (P = 0.000) attendances, Birth weight g (P = 0.039) as well as Gestational age at birth between 28 to 30 Weeks (S) (P = 0.021). These findings report first-time pregnancy outcomes related to the management of PPROM before 34 weeks in our setting. We found that the conservative attitude adopted allowed the prolongation of pregnancies, reducing the risks associated with prematurity. Nevertheless, attendance in good quality ANC could reduce the frequency of PROM and related adverse outcomes.
文摘Objective: High-frequency ventilation (HFV) is an effective means to achieve gas exchange in neonates. Adequate carbon dioxide (pCO<sub>2</sub>) levels are best achieved immediately after starting HFV, avoiding either hypercapnia or hypocapnia. We aimed to determine the initial pCO<sub>2</sub> levels after starting HFV, and the time taken to obtain the initial blood gas. Methods: We conducted an observational retrospective study on neonates that required their first episode of HFV. Data included the first blood gas result after starting HFV and when the gas was taken after starting HFV. Results: This study included 112 neonates with a median birth weight of 938 (IQR: 692 - 1549) grams and gestational age of 27.2 (24.6 - 30.7) weeks. The first pCO<sub>2</sub> after starting HFV (mean (SD)) was 53.7 (22) mmHg. Of 112, 15 (13.4%) showed initial hypocapnia (pCO<sub>2</sub> 35 mmHg), and 17 (15.2%) showed hypercapnia (pCO<sub>2</sub> > 65 mmHg)—a total of 28.6% unacceptable pCO<sub>2</sub> levels. Of 112, the first blood gas was obtained within 30 minutes in 47 (42%) and within one hour in 85 (76%), with a significant delay of two or more hours in eight (7.1%). Conclusion: Many neonates had unacceptable pCO<sub>2</sub> levels upon starting first-time HFV. There were significant delays in obtaining the initial gas.
文摘Objective: To determine the outcome of antenatally suspected congenital cystic adenomatoid malformation of the lung (CCAM) over a 10 year period. Methods: Thi s is a retrospective study of all babies diagnosed antenatally in the Prenatal D iagnosis Unit and delivered in Oxford between 1991 and 2001. Data were obtained from the Oxford Congenital Anomaly Register, theatre records, and histopathology reports. Results: Twenty eight cases of CCAM were diagnosed antenatally. Five p regnancies were terminated. Data are available on all 23 of the pregnancies that continued and resulted in two neonatal deaths and 21 surviving babies. Eleven o f the 23 cases (48%) showed some regression of the lesion antenatally, and four of these cases appeared to resolve completely on prenatal ultrasound. Three of the 23 babies (13%) were symptomatic in the early neonatal period, and three de veloped symptoms shortly afterwards. Seventeen of the 23 babies (74%) were asym ptomatic, of whom 12 had abnormalities on chest radiograph or computed tomograph y scan and had elective surgery. Two babies (8%) had completely normal postnata l imaging, and three had abnormalities which resolved in the first year of life. Seventeen of the 23 babies (74%) had surgery. Histology at surgery was heterog eneous. Of the 23 live births, all 21 survivors (91%) are well at follow up or have been discharged. Conclusions: All babies diagnosed antenatally with CCAM re quire postnatal imaging with computed tomography irrespective of signs of antena tal resolution. In asymptomatic infants, the recommendations are close follow up and elective surgery for persistent lesions within the first year of life. Hist ology at surgery was heterogeneous, and this should be considered when counselli ng parents.
文摘To determine whether social deprivation is associated with neonatal unit admission. Setting: English district general hospital. Method: Retrospective review of neonatal unit admission records between 1990 and 2002. Results: There was a linear increase in admission rates with increasing deprivation. The admission rate was 6.1% of live births for infants in the most affluent quartile compared with 11.1% for those in the most deprived quartile. Admission rates for all indications except jaundice and feeding problems increased with increasing deprivation. Conclusion: Social deprivation correlates strongly with neonatal morbidity and the need for neonatal unit admission. This finding has implications for professionals in public health and primary and secondary care.
文摘Aim: To assess the reproducibility of, and determine normative data for, flow volume measurements from the right common carotid artery (CCA) and its relation to left ventricular output (LVO) in stable term and preterm babies using Doppler ultrasound. Methods: Right CCA flow volume was measured using a near focus, hig h frequency transducer by obtaining intensity weighted mean velocity and right C CA diameter. LVO was determined using standard Doppler techniques. Reproducibili ty studies were performed on 30 newborn infants by two observers. Normative data were obtained from 40 spontaneously bre athing preterm babies and 21 term babies. Results: The intraobserver coefficient of variation for CCA flow measurements was 10.5%for observer 1 and 15.4%for o bserver 2, whereas the interobserver coefficient of variation was 16.4%. In ter m and preterm infants, right CCA flow was about 20 ml/kg/min, accounting for 11 %of cardiac output. Among the preterm infants, there was a positive correlation of right CCA flow with gestation (r = 0.61, p < 0.001), weight (r = 0.64, p < 0 .001), and LVO (r = 0.59, p < 0.001). Right CCA diameter also increased with wei ght (r = 0.63, p < 0.001) and gestation (r = 0.58, p < 0.001). The proportion of LVO distributed to the right CCA did not increase with gestation, nor did the r ight CCA flow per kg body weight. Conclusions: It is possible to perform reprodu cible measurements of flow volume in the CCA of newborn infants. In stable, spon taneously breathing babies, both cardiac output and carotid flow increased with gestation and body weight. The proportion of cardiac output distributed to the r ight CCA remained relatively constant across gestation.
文摘Aim: To assess the intelligence quotient (IQ) and academic achievement in earl y adulthood of a cohort of extremely-low birthweight (ELBW ≤1000 g) subjects. Methods: All 82 ELBW survivors consecutively born in or referred to a single ter tiary center in 1976-1981 were traced at a mean age of 18 y. Three disabled chi ldren had died. Fifty-nine subjects (75%)-had their IQ tested and 69 (87%) r esponded to a questionnaire. They were compared to 44 term, normal birthweight ( NBW)-matched controls. Outcome measures were: IQ (Wechsler Adult Intelligence S cale) and educational outcome. The main outcome variables were compared between groups and analyzed for neonatal and demographic data and in the ELBWgroup for c hildhood data. Results: There was a strong relationship (r2 = 0.55, p < 0.0001) between childhood and adult IQ for the 41 ELBW subjects tested at both ages (6.1 ±1.3 and 18.4 ±1.9 y). Differences were significant between ELBW and NBW grou ps: in mean full-scale IQ (94 ±12 vs 108 ±14), verbal IQ (93 ±12 vs 106 ±14 ) and performance IQ (97 ±14 vs 109 ±16) (p < 0.0001). Differences between ELB W and NBW groups in prevalence of IQ < 85 (19 vs 2%, p = 0.012), of schooling i n a regular curriculum for age (36 vs 68%, p = 0.0011), of requirement for spec ial classes or schools (33 vs 9%, p = 0.0032), and of obtainment of secondary s chool diploma for those 18 y or older (56 vs 85%, p = 0.018) were largely due t o fathers’socioeconomic score. Conclusion: ELBW subjects had a mean adult IQ in the normal range; however, it was one standard deviation below that of NBW subj ects and they had more school failures. Despite this, more than half of ELBW sub jects aged 18 y or more had obtained their secondary school diploma.
文摘Objectives: (1) To determine a normal range for urinary citrate for term babi es. (2) To compare urinary citrate measured in ex preterm babies at term with th is normal range. (3) To evaluate whether urinary citrate was related to presence of nephrocalcinosis (NC) and chronic Lung Disease (CLD) in these ex preterm bab ies. Study design: Urinary citrate was measured in 38 healthy term babies (mean birth weight 3.52 kg, mean gestation 41weeks) at amean postnatal age of 3 days ( 1- 5 days) and in 53 ex preterm babies ( < 32 weeks gestation at birth) at term . These preterm babies were part of a larger study on NC in which two renal ultr asound scans were performed at 1 month and term. Results: The normal range for u rinary citrate in term babies was 0.025- 2.97 (mean 1.03) mmol/l and citrate/cr eatinine ratio 0.0011- 0.852 (mean 0.27). In the ex- preterm urinary citrate w as not significantly different (mean 1.1 vs. 1.03, p=0.7232)- but urine citrate /creatinine ratio was significantly higher (mean 1.27 vs. 0.27, p=0.0005). There was no significant difference in urinary citrate or ratios of citrate/creatinin e and calcium/citrate in the 11 (20.7% ) with NC or in the 17 (32% ) babies wi th CLD. There was no significant relationship found between duration of TPN and urinary citrate measured at term. Conclusion: We have determined a normal range for urinary citrate in healthy term babies in the first week of life. The range was very wide. Ex preterm babies had similar values at term and there was no ass ociation between urinary citrate and NC or CLD.
文摘Objectives: (1) To determine a normal range for urinary citrate for term babies.(2) To compare urinary citrate measured in ex preterm babies at term with this normal range.(3) To evaluate whether urinary citrate was related to presence of nephrocalcinosis (NC) and chronicLung Disease (CLD) in these ex preterm babies.Study design: Urinary citrate was measured in 38 healthy term babies (mean birth weight 3.52 kg, mean gestation 41weeks) at amean postnatal age of 3 days (1-5 days) and in 53 ex preterm babies ( < 32 weeks gestation at birth) at term.These preterm babies were part of a larger study on NC in which two renal ultrasound scans were performed at 1 month and term.Results: The normal range for urinary citrate in term babies was 0.025-2.97 (mean 1.03) mmol/l and citrate/creatinine ratio 0.0011-0.852 (mean 0.27).In the ex-preterm urinary citrate was not significantly different (mean 1.1 vs.1.03, p=0.7232)-but urine citrate /creatinine ratio was significantly higher (mean 1.27 vs.0.27, p=0.0005).There was no significant difference in urinary citrate or ratios of citrate/creatinine and calcium/citrate in the 11 (20.7%) with NC or in the 17 (32%) babies with CLD.There was no significant relationship found between duration of TPN and urinary citrate measured at term.Conclusion: We have determined a normal range for urinary citrate in healthy term babies in the first week of life.The range was very wide.Ex preterm babies had similar values at term and there was no association between urinary citrate and NC or CLD.
文摘Cw is a low frequency red cell antigen that belongs to the Rh blood groups system. While not uncommon, anti-Cw is rarely associated with clinically significant haemolytic disease of the newborn (HDN). When it does occur, it is often subclinical or of mild to moderate clinical severity. In the majority of pregnancies it is considered to be a naturally occurring antibody and has not been reported to cause hydrops fetalis or stillbirth. We report a case of anti-Cw alloimmunization, which was associated with significant anaemia and hydrops fetalis, presenting at 35 wk gestation. Conclusion: Pregnancies affected by anti-Cw merit closer scrutiny. Consideration should be given to performing more frequent antenatal ultrasound assessments to detect hydrops fetalis. This may help to support the need for more invasive procedures (cordocentesis and intrauterine transfusions).
