Cerebral function monitoring in term or near term neonates at MDH : preliminary experience and proposal of a guideline

Introduction: Cerebral function monitoring (CFM) is a simplified EEG device that is used to monitor cerebral function at the cot-side. Various studies have shown its value in detecting neonatal encephalopathy and electrographic seizures, prognostication of neonatal cerebral insults, assessment of response to anticonvulsant therapy and in selecting encephalopathic infants for therapeutic hypothermia. This paper describes our preliminary experience with this monitoring device at Mater Dei Hospital, and a draft of a protocol for its clinical application. Methods: Fourteen recordings were performed on neurologically normal and abnormal term neonates. The quality of the records and their correlation with other imaging and standard EEG findings was assessed. A dataset including technical and clinical particulars of these cases was then compiled, analyzed and discussed. Results: Amplitude aEEG traces were recorded from a total of 14 patients, 4 of whom were normal term or near term infants, and 10 were infants with a neurological abnormality. All records were of satisfactory quality, and all showed very high impedance levels. Five out of 11 neurologically-abnormal patients had signs of seizure activity on CFM. A technical fault caused high impedance level in the first 2 traces. Annotations were generally lacking. Five out of 10 infants with CNS problems had clinical seizures of which 4 had electrographic seizures on CFM, 4 had electrographic seizures on formal EEG, and 3 had abnormal MRI findings. Conclusion: Our local experience has confirmed the usefulness of CFM monitoring in the setting of a neonatal intensive care unit. Despite some initial problems with high impedance levels and electrode attachment, the tracings obtained were reproducible and of good quality. Almost half of the neurologically-abnormal neonates showed signs of seizure activity on CFM with good correlation with clinical and standard EEG. The timely diagnosis enabled the clinicians to confirm seizure activity, initiate anticonvulsant therapy and monitor the response. Staff training is vital in order to improve utilisation of CFM in neonatal practice.peer-reviewe

Audit in practice : surveillance for hypoglycaemia in the neonatal paediatric intensive care unit

Hypoglycaemia in neonates is defined as a blood glucose ≤ 2.6 mmol/1. Certain categories of babies are at particularly high risk of developing hypoglycaemia in the first few days of life, and are routinely monitored in the Neonatal Paediatric Intensive Care Unit by reagent strips using a reflectance meter. This study shows that the current glucose meter, in use in the entire Department of Health, is unreliable in the detection of hypoglycaemia in neonates, but is accurate for values of blood glucose >3 mmol/1. For this reason, laboratory blood glucose estimation should be used for screening of neonatal hypoglycaemia until such time that a more reliable technique for bedside assay of blood glucose becomes available in the Neonatal Paediatric Intensive Care Unit.peer-reviewe

Overview of the blood transfusion policy in preterms on the Neonatal Intensive Care Unit

Preterm infants on the Neonatal Intensive Care Unit receive a greater number of red cell transfusions than any other hospitalised group. Over the past twenty years research has focused on setting standards to determine when it is necessary to transfuse packed cells in this cohort, whilst exploring the use of red cell growth factors and other substrates judiciously in order to reduce and/or avoid red cell transfusions and limit donor exposure. One hundred and eighty-one blood transfusions were administered to 106 preterms less than 35 weeks gestation on the NICU during 2009 in Malta. The median (range) volume of blood used from each bag supplied by the Blood Transfusion Department was 25.8mls (10-50mls), the rest of which was discarded. Risk factors for transfusion included Extremely Low Birth Weight (less than 1kg) and a gestation of less than 30 weeks. The blood transfusion guidelines presently in use on the local NICU were reviewed and compared with more restrictive guidelines on other units and suggestions made to reduce transfusions in line with these guidelines. A reduction in transfusion aliquots provided for neonates to just 50mls from the customary 250mls in a dedicated single-donor programme will safeguard limited health resources and minimise donor exposure.peer-reviewe

Recent results from MICE on multiple coulomb scattering and energy loss

Multiple coulomb scattering and energy loss are well known phenomena experienced by charged particles as they traverse a material. However, from recent measurements by the MuScat collaboration, it is known that the available simulation codes (GEANT4, for example) overestimate the scattering of muons in low Z materials. This is of particular interest to the Muon Ionization Cooling Experiment (MICE) collaboration which has the goal of measuring the reduction of the emittance of a muon beam induced by energy loss in low Z absorbers. MICE took data without magnetic field suitable for multiple scattering measurements in the spring of 2016 using a lithium hydride absorber. The scattering data are compared with the predictions of various models, in- cluding the default GEANT4 model

Controlled trial with brinerdin : a new antihypertensive

A double-blind study on 40 ambulant, mild to moderate hypertensive patients aged from 35-67 years is presented. After a dose-adjustment period and a 3-week wash-out the patients were randomized into 2 groups each on active drug and placebo respectively. Regular physical and laboratory examinations were made. The Brinerdin group showed a highly significant fall in blood pressure. In all cases the fall was gradual without sudden fluctuation. By comparison the placebo group showed only insignificant changes in blood pressure. At the effective dosage of 1-3 tablets daily there were no untoward side-effects. As with all saluretic drugs some patients tended to have slightly raised uric acid levels. The study demonstrates that at a dosage of 1-3 tablets per day Brinerdin is an effective anti-hypertensive agent. In all cases comparison with placebo showed a highly significant difference in favour of Brinerdin.peer-reviewe

Sarcoidosis

Sarcoidosis is a multisystemic disorder of unknown cause characterized by the formation of immune granulomas in involved organs. It is an ubiquitous disease with incidence (varying according to age, sex, race and geographic origin) estimated at around 16.5/100,000 in men and 19/100,000 in women. The lung and the lymphatic system are predominantly affected but virtually every organ may be involved. Other severe manifestations result from cardiac, neurological, ocular, kidney or laryngeal localizations. In most cases, sarcoidosis is revealed by persistent dry cough, eye or skin manifestations, peripheral lymph nodes, fatigue, weight loss, fever or night sweats, and erythema nodosum. Abnormal metabolism of vitamin D3 within granulomatous lesions and hypercalcemia are possible. Chest radiography is abnormal in about 90% of cases and shows lymphadenopathy and/or pulmonary infiltrates (without or with fibrosis), defining sarcoidosis stages from I to IV. The etiology remains unknown but the prevailing hypothesis is that various unidentified, likely poorly degradable antigens of either infectious or environmental origin could trigger an exaggerated immune reaction in genetically susceptible hosts. Diagnosis relies on compatible clinical and radiographic manifestations, evidence of non-caseating granulomas obtained by biopsy through tracheobronchial endoscopy or at other sites, and exclusion of all other granulomatous diseases. The evolution and severity of sarcoidosis are highly variable. Mortality is estimated at between 0.5–5%. In most benign cases (spontaneous resolution within 24–36 months), no treatment is required but a regular follow-up until recovery is necessary. In more serious cases, a medical treatment has to be prescribed either initially or at some point during follow-up according to clinical manifestations and their evolution. Systemic corticosteroids are the mainstay of treatment of sarcoidosis. The minimal duration of treatment is 12 months. Some patients experience repeated relapses and may require long-term low-dose corticosteroid therapy during years. Other treatments (immunosuppressive drugs and aminoquinolins) may be useful in case of unsatisfactory response to corticosteroids, poor tolerance and as sparing agents when high doses of corticosteroids are needed for a long time. In some strictly selected cases refractory to standard therapy, specific antiTNF-α agents may offer precious improvement. Some patients benefit from topical corticosteroids