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Volume 2, No. 1, Jan., 2001
NEONATAL ADRENAL HEMORRHAGE: CLINCAL AND RADIOLOGICAL ASPECTS
ABDEL-WAHED M A*, AIDA EL-SHIBINY**, HASSAN A T***
DEPARTMENTS OF PEDIATRICS*, DIAGNOSTIC RADIOLOGY**, AND SURGERY***, FACULTY OF MEDICINE, AIN SHAMS UNIVERSITYAbstract
Neonatal adrenal hemorrhage (NAH) is not uncommon, often clinically subtle condition that may associate perinatal hypoxia, birth trauma, and neonatal sepsis. We investigated the rate, and diagnostic characteristics of NAH among 280 sick neonates at NICU, Maternity Hospital, Ain Shams University. Twelve neonates (4.28%) were diagnosed as having NAH. There was a male predominance (7:5). The mean birth weight of neonates with NAH was 3.16 kg, mean gestational age was 38.67 weeks. The major predisposing factors were; perinatal hypoxia, traumatic delivery because of large birth weight or breech presentation, as well as neonatal septicemia. The condition was unilateral in the majority of cases (11/12), the right gland being affected mostly (10 cases), whereas the left gland was affected only once. The only bilateral case developed adrenocortical insufficiency with shock and prerenal failure that required blood transfusion, fluid adjustment, steroid treatment, and inotropic measures. Later, the condition was complicated by bilateral adrenal suppuration that justified sonography guided aspiration. The sole presentation in one case was right sided inguinoscrotal hematoma. Five cases (about 42%) within this study were asymptomatic. On the other hand, common symptoms were poor feeding and vomiting, anemia, abdominal mass, and jaundice.
Diagnosis was feasible in most cases with conventional sonography. Doppler and/or CT examinations were required in cases with abdominal mass as conventional sonography was inconclusive in ruling out the possibility of neonatal neuroblastoma.
In conclusion, NAH can be detected early by abdominal sonography in vulnerable neonates and most cases recover with conservative measures. Thus, unnecessary surgery and life threatening sequelae because of late recognition are preventable.REAPPRAISAL OF A SIMPLE METHOD FOR DIAGNOSIS AND LEVELING OF ISOLATED TRACHEOESOPHAGEAL FISTULA
Sherif M. Soliman, Gamal S. Ali*, Sameh A. Hay
Pediatric Surgery department, *Children’s Hospital Institute of postgraduate childhood study- Ain Shams University Cairo – Egypt.Abstract
Purpose:The diagnosis of isolated (N-type) tracheoesophageal fistula (TEF) remains a challenging problem, requiring in most instances a combination of various diagnostic modalities to establish its presence as well as its level. With paucity of bronchoscopic facilities, we adopted a simple technique for diagnosing and leveling of isolated TEF.
Methods:From 1990 through 1999, 11 patients with clinically suspicious isolated TEF were subjected to esophagoscopy with simultaneous endotracheal injection of Methylene Blue and application of positive pressure. The efflux of the dye to the esophagus was noted and its level was recorded. All patients with TEF underwent surgical correction.
Results:Among 11 patients (age range 3weeks – 9 months) with clinically suspicious isolated TEF, esophagography / cineradiography detected the presence of the fistula in 4 patients. Endotracheal injection of Methylene blue with simultaneous esophagoscopy confirmed the presence of the fistula and its level in 8 and 3 were negative. In positive cases, fistulae were located in the cervical esophagus. With a Left Cervical approach, fistulae in all patients were identified, divided and closed with seven survivors. One had a recurrent fistula necessitating re-operation and closure with an intervening muscle flap.
Conclusion:This technique is simple and effective in diagnosing and leveling of isolated TEF. In our experience it is found to be a suitable alternative when bronchoscopic facilities are not available.SERUM LEPTIN AND SOME MINERALS CONCENTRATIONS IN CORD BLOOD: RELATIONSHIP TO BIRTH WEIGHT
USAMA R. EL-Safy , Mervat A. Hesham , Hanan A. Abd El-Rahman , Somia H. Abd-Alla*, Mohammad A. Abd EL-Hady Pediatric and Clinical Biochemistry *Departments Faculty of Medicine - Zagazig University
Abstract
Leptin is a hormone secreted by adipocytes. It regulates body weight and its levels correlate with body fat content. Also, optimal mineral intake is crucial, especially during the period of rapid growth that occurs during infancy and childhood. So this work was done to study the levels and effects of leptin and some minerals (calcium, phosphorous, zinc and copper) on foetal growth and to evaluate their relationship to birth weight .This study conducted on sixty neonates immediately after birth and they were categorized into 4 groups :appropriate for gestational age (FT-AGA) , full term large for gestational age (F.T. – LGA) , full term small for gestational age(FT-SGA) , preterm appropriate for gestational age (Pre-AGA). All groups were subjected to full maternal history and thorough clinical examination , anthropometeric measurements and laboratory investigations for measurements of serum levels of leptin by Immunoradiometric assay and minerals (calcium – phosphorus – zinc -copper )by plasma emmission spectrometer.
Our results showed highly significant differences between the four studied groups as regard leptin concentrations. FT-LGA group had higher leptin level than FT-AGA and FT-SGA while the preterm had the lowest level . There was positive correlation between leptin levels in cord blood and gestational age(GA), birth weight (BW),length(LT) and body mass index ( BMI). As regard minerals, there were statistical significant difference between the studied groups when compared regarding calcium, zinc, copper but not with phosphorus. Zinc showed positive correlation with B.M.I and calcium was positively correlated with all clinical parameters (GA, BW, LT, BMI, H.C). We can conclude that there is a strong correlation between body weight and leptin concentration suggests that adipose tissue is the major determinant of leptin secretion in utero. Also calcium and zinc are essential elements for fetal growth.Renal Function Changes in Preterm Infants Receiving Theophylline for Apnea of Prematurity
El-M.F. El-Badrawy, Nehal M. El-Raggal, Mona M. Zaki* and A.A. El-Gallad
Pediatric and Clinical Pathology* Departments, Ain Shams UniversityAbstract:
This study was conducted to evaluate the possible effects of a short course (3 days) of theophylline on the developing kidney of the preterm infant. It comprised 30 preterms (gestational age: 30-35 weeks) who were assigned to two groups: a group of infants suffering repeated episodes of apnea of prematurity for which they were treated with theophylline (n=15) and an untreated control group (n=15). The study design included a pretreatment period (period I) and a subsequent post-treatment period (period II) of theophylline administration in a loading dose of 5 mg/kg followed by a maintenance dose of 2 mg/kg/24h. Both groups were studied comparatively in both periods. Timed collection of urine and blood samples at midpoint of each collection period were done in the two periods of the study to evaluate urine flow, serum and urinary levels of creatinine (Cr), sodium (Na), potassium (K), calcium (Ca) and phosphate (P). Cr clearance (CCr) and fractional excretion (Fe) of Na and Ca were calculated accordingly. The results demonstrated significant diuresis following theophylline therapy (urine flow increased from 2.96?0.44 to 3.7?0.80 ml/kg/hr, p<0.001). From period I to period II significant drop in serum Cr level (p<0.001) and increase in urinary Cr excretion (p<0.05) with a resultant rise of CCr (from 0.96?0.56 to 2.58?1.70 ml/kg/min, p<0.001) were demonstrated in theophylline treated preterms. There was also significant post- treatment rise in serum Na concentration and decrease in its Fe as well as enhanced Ca excretion with increased urinary Ca/Cr ratio (p<0.05, respectively). No significant changes in each of these parameters were detected between the same periods in the untreated control group (p>0.05). It is concluded that a short course of theophylline probably has predictable effects on the developing kidney of the preterm newborn through improvement of renal function and enhancement of Ca excretion. Hence, prospective studies are needed to assess the beneficial effects of the drug in treating infants with renal insufficiency. It is also advised to monitor blood levels in treated preterms to adjust dose and time related renal effects and possible risk of development of osteopenia and nephrocalcinosis later on.
LEPTIN CONCENTRATION IN CORD BLOOD: RELATIONSHIP TO INSULIN LEVEL, BIRTH WEIGHT, GENDER AND PREMATURITY
MOHSEN EL-KAFRAWY* (M.D.); TAREK KHATAB* (M.D.); MOHAMMED ALLOUSH** (M.D.); AMAL ABOU AL-FADLE***
Pediatric*, Obstetric & Gynecology** and Biochemistry*** Departments
Benha Faculty of MedicineAbstract
Leptin is an adipocyte derived peptide hormone regulating energy balance in experimental animals. To investigate whether fetal leptin level correlate with insulin level, birth weight, body mass index (BMI), ponderal index (PI), gender and prematurity, serum leptin and insulin levels were determined by quantitative enzyme immunoassay and radio-immunoassay (RIA) techniques respectively in cord blood of 81 full-term with a mean age of 39.48 ? 1.24 weeks and 27 pre-term with a mean age of 33.3 ? 1.52 weeks neonates born from uncomplicated pregnancies. All the newborns were healthy and were delivered normally. Leptin and insulin levels were significantly higher in full term than in preterm (4.87 ? 2.09 ng/ml and 7.92 ? 2.95 ?U/ml versus 2.67 ? 0.54 ng/ml and 5.65 ? 1.08 ?U/ml) respectively (P< 0.001) and we did not find any significant difference between males and females regarding age, length, birth weight, BMI, PI, insulin and leptin levels neither in full-term nor in pre-term groups, also we found a positive correlation between leptin concentration and insulin levels, gestational age, birth weight, BMI and PI, in both groups which suggests that adipose tissue mass is a major determinant of leptin secretion in utero. The correlation of cord blood insulin and leptin may suggest that in addition to the direct anabolic action of insulin part of its effect on birth weight is mediated by leptin secretion. The gender effect on serum leptin is still controversial as we did not find any significant correlation between leptin and gender in both groups. Further studies on leptin concentration in premature and dysmature infants may provide important information regarding the regulation of the leptin concentration in the fetus and may lead to the discovery of some novel physiological actions of leptin on fetal growth.
The Relation between Blood Lactate and Acid Base Status and the Prognosis in Sick Ventilated Neonates.
Iskander I, El Beleidy A, El Sisy O, Khedr M.
Abstract
Lactic acidosis commonly complicated critical illness. Studies have shown that the degree of increase in blood lactate is proportional to the degree of decrease in oxygen delivery and the severity of oxygen deficiency4. In clinical practice presence of acidosis and particularly negative base, excess is commonly assumed to reflect hyperlactatemia. PH and base excess continue to be used as proxy measures for tissue perfusion. Some studies in adults and children have failed to show the expected correlation between acid base balance and blood lactate6, 7
Aim of this study: to test the relationship between common acid base parameters and blood lactate in sick ventilated neonates and to identify the prognostic accuracy of blood lactate measurement.
Material and method: 41 sick ventilated newborns were included in this prospective study. 3 consecutive samples were drawn at 24-hour intervals for a maximum of 3 samples per infant. Blood gases and blood lactate were analyzed simultaneously. Correlations and comparisons were performed to define the relation between acid base parameters and blood lactate
Results: 97 samples were obtained. Blood lactate ranged from 8.2-128 mg%. Mean blood lactate level was 22.03 mg% in those who survived and 51.2 mg% in those who died. Correlation studies between blood lactate and common acid base parameters failed to show any consistent correlation between blood lactate and pH, base excess and bicarbonate level during the three days of the study.
There was a significant difference in the lactate level between the survivors (22, 19, 14.8 mg%) and nonsurvivors (51,37.9, 40.8) on all 3 days of the study (p value < 0.001), while there was no difference between the two groups in the blood gas values. Comparison between blood gas parameters and blood lactate in relation to outcome showed that changes in the latter were much more predictive of the outcome. While blood gases tended to normalize on days 2 and 3 of the study in the nonsurvivors group, blood lactate remained persistently high. In addition, this study showed that raised blood lactate was associated with increased patient mortality. The trend of lactate was much more valuable that a single reading. While none of the patients with a rising blood lactate level survived, 96% of those with a low or decreasing lactate level survived.
SYNCHRONIZED VERSUS CONVENTIONAL INTERMITTENT MANDATORY VENTILATION IN PREMATURE INFANTS WITH RESPIRATORY DISRESS SYNDROME
A.M.EL-SAWI*, H.A.KAMEL* AND M.A.ABDEL-WAHED**
DEPARTEMENTS OF PEDIATRICS, FACULTY OF MEDICINE,CAIRO UNIVERSITY*,AND AIN SHAMS UNIVERSITY**
Abstract
Between March 1999 and september 2000; a total 42 premature infants suffering respiratory distress syndrome (RDS) who required mechanical ventilation were included in this study which was done in Banha Medical Insurance Hospital. The infants were randomly classified into two groups; 21premature infants each, group A with mean birth weight (1.48+0.3 kg), and group B with mean birth weight (1.39+0.33 kg). Infants in group A received synchronized intermittent mandatory ventilation (SIMV), while infants in group B received conventional intermittent mandatory ventilation (CIMV) therapy. Our data showed that the duration of ventilation was significantly shorter (p<0.05) in synchronized group (161+_98 hr.) compared to conventional group (222+_160 hr.). In addition, significantly fewer patients (p<0.05) required reintubation in synchronized than in conventional groups (4 vs. 13 patients).The incidence of severe intraventricular hemorrhage ( grade 3 and 4) was significantly lower in synchronized compared to the conventional groups (2 vs. 8 patients). On the other hand, no significant difference could be reported (p>0.05) between both groups regarding the incidence of bronchopulmonary dysplasia (2 in each group) or the incidence of pneumothorax (zero vs. 1 patient). Finally, significantly fewer patients died (p<0.05) in synchronized group compared to the conventional group (4 vs. 10 patients). In conclusion, this work reveals that SIMV shorten the duration of mechanical ventilation and reduce the need for reintubation in pretem neonates with RDS. Moreover, it reduces the incidence of some serious complications of mechanical ventilation such as IVH.
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