Prevalence and Immediate Outcomes of Hypoxic Ischaemic Encephalopathy (HIE) Among Infants with Birth Asphyxia Admitted at the Neonatal ward of Muhimbili National Hospital in Dar es Salaam, Tanzania

\ud To determine the prevalence and immediate outcome of infant with hypoxic ischemic encephalopathy (HIE) admitted at the Neonatal ward [ward 36] of Muhimbili National Hospital. Prospective cohort hospital based study at the neonatal unit of Muhimbili National Hospital (MNH). It involved neonates with either low apgar score (score≤ 7 at 5 minutes) and/or those young infants that were found to have symptoms and signs suggestive of HIE. Data were collected using a checklist, and analysed using Epi-info computer program. The study showed the prevalence of birth asphyxia at neonatal ward MNH to be 30.9% and among these, 92 neonates (82.1%) had HIE. Mortality due to HIE was 27.2%. Majority of neonates with mild HIE (92.3%) was discharged to their mothers while majority of those with severe HIE (51.6%) died. A total of 92 neonates were recruited in the study. The prevalence of birth asphyxia at the Neonatal ward MNH from 13th may to 31st may 2007 was 30.9%.h 27.2%. 92.3% of neonates with Mild HIE discharged within seven (7) days while more than half those with severe HIE (51.3%) died and 72% of deaths occurred within first three (3) days of life. Also the less the severity of HIE the less time of stay in the ward and the earlier the neonates started breastfeeding while the vise versa is true. HIE score chart is simple to use and its correct use can predict the prognosis of the neonates with HIE\u

Is 24 hour observation in hospital after stopping intravenous antibiotics in neonates justified?

Background: Antibiotics are given empirically for suspected sepsis in up to 75% of neonates on the Neonatal and Paediatric Intensive Care Unit (NPICU), after completion of a septic screen. Treatment is discontinued on day 3 if cultures remain negative or after 7-14 days with proven sepsis and, until recently, these neonates are then observed for an additional period of 24 hours before being discharged from hospital. Aim: To assess whether the 24 hour observation period after stopping antibiotics is clinically justified and, if not, whether neonates can be discharged safely on the same day when antibiotics are stopped. Methods: A consecutive sample of 95 babies admitted to NPICU, and who received antibiotics, from December 2006 to January 2008 were analysed prospectively. Their clinical presentation, predisposing risk factors for neonatal sepsis, investigations, antibiotic details and medical management including respiratory support were recorded, and correlated with all events that may have occurred during the observation period after stopping antibiotics. Results: No adverse events were documented in the 24 hour period after antibiotics in all 95 neonates in this study and, therefore, there was no association with any potential predisposing risk factors. Conclusion: The need to observe neonates for a period prior to discharge after stopping antibiotics is not supported on clinical grounds and, as a result of this study, has been discontinued. Neonates can be discharged from hospital safely and immediately on stopping antibiotics, thus reducing hospital stay and an estimated cost saving of approximately €18,000 to the service provider per annum.peer-reviewe

New architectural design of delivery room reduces morbidity in preterm neonates: a prospective cohort study

Background: A multidisciplinary committee composed of a panel of experts, including a member of the American Academy of Pediatrics and American Institute of Architects, has suggested that the delivery room (DR) and the neonatal intensive care units (NICU) room should be directly interconnected. We aimed to investigate the impact of the architectural design of the DR and the NICU on neonatal outcome. Methods: Two cohorts of preterm neonates born at < 32weeks of gestational age, consecutively observed during 2years, were compared prospectively before (Cohort 1: "conventional DR") and after architectural renovation of the DR realized in accordance with specific standards (Cohort 2: "new concept of DR"). In Cohort 1, neonates were initially cared for a conventional resuscitation area, situated in the DR, and then transferred to the NICU, located on a separate floor of the same hospital. In Cohort 2 neonates were assisted at birth directly in the NICU room, which was directly connected to the DR via a pass-through door. The primary outcome of the study was morbidity, defined by the proportion of neonates with at least one complication of prematurity (i.e., late-onset sepsis, patent ductus arteriosus, intraventricular hemorrhage, periventricular leukomalacia, bronchopulmonary dysplasia, retinopathy of prematurity and necrotizing enterocolitis). Secondary outcomes were mortality and duration of hospitalization. Statistical analysis was performed using standard methods by SPSS software. Results: We enrolled 106 neonates (56 in Cohort 1 and 50 in Cohort 2). The main clinical and demographic characteristics of the 2cohorts were similar. Moderate hypothermia (body temperature ≤ 35.9° C) was more frequent in Cohort 1 (57%) compared with Cohort 2 (24%, p = 0.001). Morbidity was increased in Cohort 1 (73%) compared with Cohort 2 (44%, p = 0.002). No statistically significant differences in mortality and median duration of hospitalization were observed between the 2 cohorts of the study. Conclusions: If realized according to the proposed architectural standards, renovation of DR and NICU may represent an opportunity to reduce morbidity in preterm neonates

Assessment of the incidence of sensorineural hearing loss among infants admitted to neonatal intensive care unit in health centers of Golestan University of Medical Sciences, Iran

Materials and methods: In this prospective cohort study, 870 neonates were recruited by nonrandom sampling method. After filling in the demographic and clinical check lists, automated auditory brainstem response (AABR) was performed for neonates at the beginning of hospitalization; then they were followed-up and again they were assessed with AABR and for those babies who had abnormal AABR, auditory brainstem response (ABR) was performed before discharge at the same day

Endocardial Pacemaker Implantation in Neonates and Infants

Transvenous pacemaker lead implantation is the preferred method of pacing in adult patients. Lead performance and longevity are superior and the implantation approach can be performed under local anaesthetic with a very low morbidity. In children, and especially in neonates and infants, the epicardial route was traditionally chosen until the advent of smaller generators and lead implantation techniques that allowed growth of the child without lead displacement. Endocardial implantation is not universally accepted, however, as there is an incidence of venous occlusion of the smaller veins of neonates and infants with concerns for loss of venous access in the future. Growing experience with lower profile leads, however, reveals that endocardial pacing too can be performed with low morbidity and good long-term results in neonates and infants

Serum Hsp70 antigen: Early diagnosis marker in perinatal asphyxia

BACKGROUND: Perinatal asphyxia is an important cause of mortality and permanent neurological and developmental deficit. Early and accurate diagnosis would help to establish the likely prognosis and may also help in determining the most appropriate treatment. Studies in experimental animal models suggest that a protein called Hsp70 may be a good and potentially useful marker of cellular stress that may be clinically useful in determining the presence of neonatal asphyxia. OBJECTIVES: Regarding the importance of early and accurate diagnosis of asphyxia, we conducted this study, which is the first investigation of the comparison of the serum Hsp70 antigen level between asphyxiated and healthy infants. PATIENTS AND METHODS: In this observational study, the serum concentrations of Hsp70 antigen were compared between neonates suffering from perinatal asphyxia (n = 50) and normal neonates (n = 51). The inclusion criteria for the cases were neonates who had reached term and had at least two clinical criteria of asphyxia. Exclusion criteria were babies with gestational age < 37 weeks, infants with congenital abnormalities or positive blood culture. Exclusion criteria in this group were the requirement to hospital stay during first week of the life or babies whose mothers had difficulties during pregnancy or delivery. Term neonates without major anomalies who had asphyxia during delivery were enrolled in the first six hours after delivery, and control group consisted of healthy term neonates without problems and normal delivery process in the first week of life. The cord blood was taken during labor to measure Hsp70 antigen level by using an in-house ELISA (The enzyme-linked immunosorbent assay). RESULTS: The median values of serum anti Hsp70 titers were significantly higher in asphyxiated neonates compared with non-asphyxiated neonates (0.36 [0.04 - 1.14] vs 0.24 [0.01 - 0.63]). At cutoff point = 0.3125 ng/mL, sensitivity was 58% and specificity 76% based on ROC curve. CONCLUSIONS: A significant difference between the serum concentrations of Hsp70 of the control and patient group was observed in this study. It is inferred serum concentrations of Hsp70 antigen may be a useful marker for the early diagnosis of that prenatal hypoxia

Total parenteral nutrition and carnitine supplementation practices in preterm neonates - results of a national survey

Thesis (M.A.)--Boston UniversityBackground: The goal of postnatal total parenteral nutrition (TPN) in premature neonates (PT) is to mimic the intrauterine environment of the fetus. Micronutrients are essential for optimal development. Although carnitine is present in human breast milk and is supplemented in infant formula, very preterm infants primarily receive parenteral nutrition, often devoid of carnitine, shortly after birth. Carnitine plays a critical role in cellular and mitochondrial metabolism. Preterm infants are deficient in carnitine as it is transferred from the placenta to the fetus during late pregnancy. Previously, our group surveyed US neonatologists in 2001 regarding carnitine supplementation practices and found that the majority were not fully familiar with the implications of carnitine deficiency and only 28% of preterm neonates on TPN were receiving carnitine. Since this study, recent research has emphasized the impact of carnitine on early weight gain and its neuroprotective effects. Objective: To determine current TPN carnitine supplementation practices in fasting preterm neonates (< 32 wks and < 1,500g) by conducting a national survey of board- certified neonatologists. [TRUNCATED

Possible role of TORCH agents in congenital malformations in Gorgan, northern Islamic Republic of Iran

This descriptive, cross-sectional study was carried out to explore the frequency of contamination with TORCH agents in neonates with congenital malformations in a referral centre in Gorgan city, Islamic Republic of Iran. Blood samples were taken from 64 neonates and their mothers over a 20-month period in 2003-04. Serologic tests showed that 4/64 infants born with congenital malformations (6%) had positive IgM antibody titres for Toxoplasma gondii (2 cases), rubella virus (1 case) and cytomegalovirus (1 case). IgM was positive in 9/63 mothers (14%), also for T. gondii (3 cases), rubella virus (3 cases) and cytomegalovirus (3 cases). No cases of herpes simplex virus type II or Treponema pallidum were found

Surfactant function in neonates with respiratory distress syndrome

The function of pulmonary surfactant of a group of 14 preterm neonates (birth weight 907 +/- 60 g) who suffered from severe respiratory distress syndrome (RDS) and who had received exogenous bovine lipid extracted surfactant on the first day of life was compared to that in a second group of 8 neonates (birth weight 940 +/- 110 g) with mild RDS who had not received surfactant treatment. Mechanical respiratory support from day 2 on was the same in both groups. The minimal surface tension (gamma(min)) improved steadily, falling from about 30 mN/m initially to less than 20 mN/m before extubation, A consistent but loose correlation was found between gamma(min) and mechanical respiratory support necessary, as quantitated by the oxygenation index. Total protein was about 0.8 +/- 0.2 mg/mg of phospholipids and did not change during the first week of life. There were no correlations between total protein and gamma(min) or the oxygenation index. The data suggest that inhibition of surfactant function by proteins leaked into the airspaces does not play a major role during recovery from RDS, Instead, endogenous remodelling of surfactant might be of greater relevance

Diagnostic Value Parameters Of Acute Phase Reactances Of Infectious-inflammatory Process In Diagnostics Of Early Neonatal Sepsis

An advanced progress of clinical neonatology in recent years has enabled to achieve considerable success in newborn management with due respect to both medical treatment and general care, especially in the group of neonates with low body weight at birth. At the same time, neonatal sepsis in the early period still predetermine sickness and mortality of newborns.Material and methods. Clinical-paraclinical indices with detection of diagnostic value of C-reactive protein and interleukins-6 and 8 were evaluated in 100 neonates with available susceptibility factors to early neonatal infection from mother\u27s side and clinical signs of organ dysfunction in neonates with precautions of generalized infectious-inflammatory process at the end of their first day of life.Results. The data obtained substantiate that low concentrations of IL-6 and IL-8 prevail, and therefore the mentioned mediators hardly can be used to verify early neonatal infection. In the majority of children C-reactive protein elevated the concentration of 10.0 mg/L which is traditionally considered to be a discriminant as to the verification of an infectious process in newborns.Conclusions. None of the clinical signs associated with infectious-inflammatory process in newborns in the first two days of their life enabled to verify reliably availability of systemic bacterial infection