Echocardiographic Evaluation in Neonates Suspected to Congenital Heart Disease in NICU

ABSTRACT Background and Objective: Congenital heart disease (CHD) is the most form of cardiovascular disease in children. CHD have different presentations, from defects that progress asymptomatically to those with significant symptoms and high mortality. This study was performed to highlight the importance of signs and symptoms to diagnosis of CHD neonates. Materials & Methods: This descriptive analytic study was performed on 113 newborns in NICU ward of Mostafa Khomeini hospital from March 2010 to March 2011, referred for cardiac evaluation by echocardiography. Data and echocardiography results were extracted from patients' documents. PDA in preterm newborns was excluded. Results: Echocardiographic findings were normal in 20 newborns and abnormal in 93 cases. Murmur and cyanosis were reasons for referral to cardiologist in 45 (39.82%) newborns, of which 42 (93.33%) newborns had CHD. DM in mothers was the reason for referral in 21 (18.85%) newborns, of which 17 (80.95%) newborns had CHD. Asphyxia was the reason for referral in 17 (15.04%) newborns, of which 14 (82.35%) newborns had CHD. Bradycardia was the reason for referral in 13 (11.50%) newborns, of which 11 (84.62%) newborns had CHD. Arrhythmia, associated congenital malformation, chromosome disorders, tachycardia, RDS and CHF were uncommon reasons for referral. Conclusion: The main reasons for referral were heart murmur and cyanosis. Although other reasons were uncommon, their presence indicated a high probability of diagnosis of heart disease

Physicians’ and nurses’ decision making to encounter neonates with poor prognosis in the neonatal intensive care unit

This is an Accepted Manuscript of an article published by Sage in Clinical Ethics on 03/06/2020. Available online: https://journals.sagepub.com/doi/abs/10.1177/1477750920927173This is an Accepted Manuscript of an article published by Sage in Clinical Ethics on 03/06/2020.Available online: https://journals.sagepub.com/doi/abs/10.1177/1477750920927173acceptedVersio

'Perinatal outcome in preterm premature rupture of membranes with Amniotic fluid index < 5 (AFI < 5)

Abstract Background Our purpose was to determine whether AFI Methods We performed a prospective cohort study of 95 singleton pregnancies complicated by preterm premature rupture of the membranes (PPROM) with delivery between 26 and 34 weeks gestation. Patients were categorized in two groups on the basis of amniotic fluid index2 and Fisher exact tests. Continuous data were evaluated for normal distribution and tested for significance with the student t test. All 2-sided p values Results Both groups were similar with respect to selected demographics, gestational age at rupture of the membranes, gestational age at the delivery, birth weight. Both groups were similar with respect to selected variable, latency until delivery, early onset neonatal sepsis, RDS and neonatal death. Patients with AFI Conclusions An AFI<5 cm after PPROM between 26 and 34 weeks gestation is associated with an increased risk of maternal infections and frequency of C/S.</p

The frequency of clinical and laboratory findings of hypernatremia and factors affecting its severity in term newborns

Background: Hypernatremic dehydration in neonate is a serious potentially life treating can damage the central nervous system. The aim of this study was to determine the clinical and laboratory signs of hypernatremic dehydration in term infant. Methods: A cross sectional study was performed from April 2010 to March 2012 in 111 neonates with sodium>145 mmol/l who were admitted at the Mostafa Khomeini and Hazrat Zainab Hospitals in Tehran, Iran. The incidence of clinical and laboratory findings and relationship between some risk factors influencing the severity of hypernatremia were reviewed. The patients were subdivided in two groups: Na<150 mmol/l (group 1) and Na≥150 mmol/l (group 2). Premature infants less than 37 weeks, congenital malformations, formula fed, sepsis and organic disease were excluded. The Student’s t-test, Mann-Whitney U test and Chi-square test were used for statistical data analysis. P<0.05 were considered significant. Results: One hundred and eleven of 2015 (5.2%) patients had hypernatremia. Fifty eight (52.25%) infants were male and sodium ranging was from 146 to 175 mmol/l with an average of 150.3 mg/dl. The most common clinical findings in both groups 1 and 2 were lethargy (81%, 84.5%), fever (74.1%, 73.6%), poor feeding (67.3%, 73.6%), weight loss (60.2%, 84.9%) and a decrease in urine volume (31%, 52.8%). Oliguria, restlessness, seizures, weight loss, orange urine, pathologic hyperbilirubinemia were significantly higher in group 2 than group 1 (P1.5 mg/dl (P=0.016) and bilirubin level (P=0.01). The relationship between type of nutrition, type of delivery, parity, maternal age, sex, gestational age, discharge, maternal education level were not significant. Conclusion: Sufficient attention to the warning signs of hypernatremia such as lethargy, weight loss, oliguria, poor feeding, fever, restlessness and determination of serum sodium levels in suspected cases can significantly reduce the potential complications of hypernatremic dehydration in neonate

Effect of progesterone as maintenance tocolytic therapy on the prevention of recurrent preterm labor: a randomized clinical trial

Objective: The study evaluated the efficacy and safety of vaginal rogesterone on prevention of recurrent preterm labor. Materials and methods: Total number of 70 patients with preterm labor treated with intravenous magnesium sulfate in perinatology department of valiasr hospital entered to a randomized clinical trial. Treatment group after inhibition of preterm labor with magnesium sulfate received progesterone suppository (400 mg) daily until delivery and control group received no treatment. Latency until delivery, recurrence of preterm labor and neonatal outcomes were studied. Statistical significance was defined as p< 0.05. Results: Mean latency until delivery (p< 0.05), low birth weight (p< 0.05), birth weight (p< 0.01) were significantly different between the two groups. Recurrence of preterm labor was not significantly different between the groups. Conclusions: The use of vaginal progesterone suppository after successful parenteral tocolysis associated with a longer latency preceding delivery but failed to reduce the incidence of recurrent preterm labor

The prevalence and assessment of blood transfusions in newborns

Background: Blood transfusion is common in infants. Due to the weakened immune system of newborns and the risk of blood transfusion complications, it is necessary to pay more attention following or after to blood transfusion. The aim of this study was to evaluate the frequency and risk factors of blood transfusions in hospitalized neonates. Methods: A cross-sectional study was performed on 1106 infants admitted in the neonatal intensive care unit (NICU) of Mustafa Khomeini University Hospital, Tehran, Iran, from spring 2009 to 2012. Frequency and the reason for of blood components transfusion including fresh frozen plasma, platelets, whole blood, packed red blood cells, cryoprecipitate and relationship with gestational age, sex, birth weight, Apgar score, duration of hospitalization, use of mechanical ventilation were assessed. Statistical analysis was performed with SPSS statistical software, version 16 (IBM, Armonk, NY, USA) and statistical test, chi-square test, independent t-test and analysis of variance (ANOVA). Results: Among 1106 infants admitted to the neonatal intensive care unit, 221 infants (%19.98) received blood products. 82 of all (37%) were female and 139 (%63) were female. 113 (51%) of neonate were preterm and 108 (48%) were term. From 361 times of blood transfusions, 121 infant (54.75%) received at least one blood product. The frequency of blood transfusion was between 39 and 1 times, with an average of 3.65 times per infant. Frequency of fresh frozen plasma infusion was 173 (47.9%), packed cell 122 (33%), platelet 32 (8.8%), cryoprecipitate 20 (5.1%) and whole blood 3 unit (0.83%). The most common causes for fresh frozen plasma transfusion was replacement therapy 140 (80%), for packed cell, to correct symptomatic anemia 68 (55.6%), for platelet transfusions was to prevent bleeding in&nbsp; neonates with thrombocytopenia 20 (62.5%) and cryoprecipitate for bleeding caused by DIC in 18 infant (90%). There was significant relation between frequency of blood transfusions with gestational age (P=0.002), birth weight (P=0.01), cause of hospitalization (P=0.001) using of ventilator (P=0.002), and length of hospital stay (P=0.001). Conclusion: With attention to the guidelines of blood transfusions and controlling factors affecting premature birth and low weight infants, reducing length of hospital stay and duration of mechanical ventilation, frequency and complications of blood transfusion can be effectively decreased