Correlation of cardiac troponin T level, clinical parameters and myocardial ischaemia in perinatal asphyxia

Introduction: Resource limitation in developing countries may preclude access to cardiac troponin-T assay thereby necessitating reliance on clinical judgment for identification of hypoxic myocardial cellular injury.Objectives: To relate selected clinical signs with elevated serum cardiactroponin-T in asphyxiated term neonates.Methods: Asphyxia was identified by low umbilical arterial blood pH . 7.20 and low five minute Apgar score . 6 while controls were term, non.asphyxiated neonates. All babies were examined for heart rate,heart rhythm irregularities, peripheral pulse volume, respiratory rate,pallor, cyanosis, heart murmur and sensorium.Results: Thirty term, asphyxiated neonates and their matched controlswere studied. Central cyanosis, reduced pulse volume, pallor, depressedsensorium; tachycardia and tachypnea were all associated with increased odds ratios for abnormal cardiac troponin.T levels.Conclusion: Clinicians working in resource.limited health facilitiesshould have a high index of suspicion for myocardial cellular injurywhen these signs are elicited.Keywords: neonates, asphyxia, troponin-T, myocardial injur

Time to full enteral feeds in hospitalised preterm and very low birth weight infants in Nigeria and Kenya

\ua9 2024 Imam et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Background Preterm (born < 37 weeks’ gestation) and very low birthweight (VLBW; <1.5kg) infants are at the greatest risk of morbidity and mortality within the first 28 days of life. Establishing full enteral feeds is a vital aspect of their clinical care. Evidence predominantly from high income countries shows that early and rapid advancement of feeds is safe and reduces length of hospital stay and adverse health outcomes. However, there are limited data on feeding practices and factors that influence the attainment of full enteral feeds among these vulnerable infants in sub-Saharan Africa. Aim To identify factors that influence the time to full enteral feeds, defined as tolerance of 120ml/ kg/day, in hospitalised preterm and VLBW infants in neonatal units in two sub-Saharan African countries. Methods Demographic and clinical variables were collected for newborns admitted to 7 neonatal units in Nigeria and Kenya over 6-months. Multiple linear regression analysis was conducted to identify factors independently associated with time to full enteral feeds. Results Of the 2280 newborn infants admitted, 484 were preterm and VLBW. Overall, 222/484 (45.8%) infants died with over half of the deaths (136/222; 61.7%) occurring before the first feed. The median (inter-quartile range) time to first feed was 46 (27, 72) hours of life and time to full enteral feeds (tFEF) was 8 (4.5,12) days with marked variation between neonatal units. Independent predictors of tFEF were time to first feed (unstandardised coefficient B 1.69; 95% CI 1.11 to 2.26; p value <0.001), gestational age (1.77; 0.72 to 2.81; <0.001), the occurrence of respiratory distress (-1.89; -3.50 to -0.79; <0.002) and necrotising enterocolitis (4.31; 1.00 to 7.62; <0.011). Conclusion The use of standardised feeding guidelines may decrease variations in clinical practice, shorten tFEF and thereby improve preterm and VLBW outcomes