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Volume 5, No. 1, Jan., 2004
Assessment of Splanchnic Hemodynamics in Neonates at Risk of Necrotizing Enterocolitis
Hesham Awad, Nayera I. Attia*, Nivan T. Ismail**,
Pediatric Department, Institute of Postgraduate Childhood Studies (Medical Department), NICU* and Radiology Department** Ain Shams University, Cairo, Egypt.Abstract
It has been suggested that either acute or chronic intestinal ischemia may play a primary role in the initiation of mucosol injury and subsequently the development of necrotizing enterocolitis (NEC) . Hence, this study aimed at assessment of gut blood flow in neonates at risk of developing NEC and to determine whether a disturbance in splanchnic perfusion could provide not only a pathophysiological basis for the development of NEC but also a mechanism linking a variety of seemingly disparate risk factors. Addingly, changes in splanchnic circulation with increasing postnatal age were evaluated.
Duplex pulsed Doppler ultrasound was used to study changes in gut blood flow velocities during the first week of life in neonates at risk of developing NEC admitted to NICU of Obsteric and Gynecology Department, Ain Shams University Hospitals. This case-control study comprised 127 neonates (61 males and 66 females), their mean gestational age was 35.0± 4.3 weeks and their mean birth weight was 2.35± 0.63 kg. They were classified into 4 groups : 2 control groups [preterms (n=21) and fullterms (n=41)] and 2 patient groups recognized as being at risk of developing NEC [at risk preterms (n=30) and at risk fullterms (n=35)]. They were subjected to history taking, clinical examination, laboratory investigations relevant to the diagonosis on admission, radiological evaluation including chest and abdominal x-rays and echocardiography. Duplex pulsed Doppler ultrasound was used to determine blood flow velocities in coeliac axis (CA) and superior mesentric aretry (SMA) in all studied groups. Subjects were studied on the first, second, third, and seventh days of life.
The results of the current study showed that the mean peak systolic velocities (PSVs) in the SMA were lower in the at risk groups than in the control groups on all 4 days of measurments (p < 0.001). In contrast to the SMA, PSVs of CA increased signifcantly in the at risk groups compared to their controls (p < 0.001). The ratio of PSV in the CA to that in the SMA, an index of relative downstream resistance in the SMA, was significantly greater in the at risk groups than in the control groups on day 1,2 and 3 (p < 0.001). PSVs of SMA tended to increase over the first week of life in control groups. On the other hand, the increase in PSVs of SMA was delayed in the at risk groups .
In conclusion, these data demonstarte that neonates at risk of developing NEC have abnormal gut blood flow velocities and splanchnic perfusion is severely compromised. Hence, alteration in the splanchnic circulation may be an important factor in the final common pathway of different risk factors of NEC and the liver could be considered as the fourth preferential organ for arterial blood supply in the compromised neonate, besides heart, brain and adrenals. Therefore, serial Doppler measurements are mandatory for early detection and prediction of NEC.SIMPLE TECHNIQUE FOR CORRECTION OF WEBBED PENIS DURING RITUAL NEONATAL CIRCUMCISION.
Mahmoud El Sabei**, Ashraf A. Kabesh* and Safwat Abu Al-Maati*, * Pediatric surgery unit. Ain Shams University, Cairo, Egypt. ** General surgery Consultant,
Jeddah -Saudi Arabia.Abstract
Background: Webbed penis is a well known anomaly that can be dealt with while doing the circumcision. Various methods for correction of such anomaly was described and are preferably done under general anaethesia when the infant gets older. A simple technique that can be done under local anaesthesia while doing the circumcision in the neonatal period was described.
Patients and methods: over a period of 5 years, 104 cases of penile webbing were treated in Ain shams university hospital and Jeddah Hospital during ritual neonatal circumcision. Their age ranged from 4 to 6 weeks and the technique was performed in the outpatient clinic under local infiltrating anesthesia using the Gomco circumcision clamp.
Results: The overall results were satisfactory both cosmetically and functionally. Two patients developed subcutaneous hematoma, three had minor form of skin infection and four patients required re-correction due to residual webbing.
Prevalence of Clinically Significant Neonatal Jaundice and its Relation to Some Risk Factors In Minoufyia GovernorateFathia M El Nemr, Ali El Shafie, Taghrid Farahat*, Rabea El Bahnasi* and Sameh Abdel Rahman**.
Pediatrics, Community & Environmental Medicine *, and Family Medicine **, Minoufyia University
Abstract
Hyperbilirubinemia is one of the most common problems encountered in newborns. Nowadays it was noticed to be seen more than before, representing an important medical, social, and economic health problem. A number of epidemiologic factors may exert their influence on increasing the occurrence of neonatal jaundice.
Objective : To estimate the prevalence of neonatal jaundice in Minoufyia governorate using the judgment of Integrated Management of Childhood Illness (IMCI) project for the detection of clinically significant jaundice and to identify some of its risk factors with spotting light on the role of family physician in the management.
Study design : This study was carried out on 300 fullterm and preterm neonates (153 males, and 147 females), selected from three hospitals and two Maternal and Child Health Centers in Shebin El Kom City and districts The study design composed of two main parts: A cross sectional study (200 cases), to estimate the prevalence of jaundice among neonates (group I), and: A case control study (100 cases), to identify the important risk factors for occurrence of neonatal jaundice ( group IIA,B).
Results: The prevalence of clinically significant neonatal jaundice was 17%. Some neonatal risk factors were found to be significantly increased among jaundiced babies compared to controls: {low birth weight, prematurity, and infection (P values 0.02, 0.01,and 0.001 respectively).
However in comparing, sex, breast feeding, cephalhematoma, the difference was found to be insignificant. As regard maternal factors, the use of oxytocin during first stage of labor, was the only significant risk factor (P value 0.01), however, maternal age, education, consanguinity, jaundice of previous sibling, intake of iron & tonics, abdominal ultrasound, and mode of delivery were insignificant factors. The most common cause of pathological jaundice was infection, and the most commonly used treatment was phototherapy. More cases were referred from primary health physicians (PHP) compared to specialists with a significantly earlier age at referral ( 3.7+ 0.21 days in cases referred from PHP and 5.45 + 0.31 days in those of specialists). However the outcome of cases didn’t differ significantly between cases referred from PHP compared to specialists.
Conclusion: The prevalence of neonatal jaundice is high in Minoufyia. A significant relation was found between the occurrence of neonatal jaundice and some maternal and neonatal risk factors which need to be reevaluated on a larger scale. The clinical criteria of the IMCI project for diagnosis and referral of jaundiced newborn are very beneficial and need to be generalized and supported by a scheduled neonatal follow up early after birth.
A NEW MODALITY FOR EARLY DIAGNOSIS AND SEVERITY PREDICTION IN NECROTIZING ENTEROCOLITIS
Safaa S Imam*, Hatem A Saafan**, Sherine K Amin***
*Pediatric department, **Pediatric surgery department, ***Radiology department ; Ain-Shams UniversityAbstract
Purpose: To develop a new method for diagnosing necrotizing enterocolitis and prediction of severity with the use of computed tomography (CT).
Methods: Urine specimens from 63 premature neonates were obtained at 4-hours interval for 24 hours duration after administration of iodinated water-soluble contrast material (Iohexol) entrally for 45 neonates from them. Twelve neonates had definite necrotizing enterocolitis (NEC) (group I) and 10 neonates had suspected NEC (group II). Urine from another two groups without any clinical evidence of NEC (at the time these studies were performed) was collected, 23 neonates (group III) received Iohexol (who underwent upper gastrointestinal study), and 18 neonates (group IV) did not receive Iohexol. The attenuation coefficient of each urine specimen was determined with CT(equivalent to concentration of the Iohexol in urine).
Results: The mean CT attenuation coefficient of urine from neonates who did not receive Iohexol (group IV) was 5.2 ± 3.5 HU (Hounsfield unit), and that from neonates without NEC (group III) (who underwent upper gastrointestinal study) was 6.8± 3.0 HU. The mean CT attenuation coefficient of urine from patients with suspected necrotizing enterocolitis (group II) was 28.0 ± 3.8 HU, and that from patients with definite necrotizing enterocolitis (group I) was 73.0 ± 19.8 HU. The mean CT attenuation coefficient in neonates with NEC were significantly higher than that from suspected group and than that from patients without NEC whether received the Iohexol or not (P<0.01). Follow up samples revealed significant reduction in the CT attenuation coefficient after treatment.
Conclusion: Urine from neonates with necrotizing enterocolitis show significantly higher CT attenuation coefficients than those from patients without necrotizing enterocolitis. CT examination of urine may allow early diagnosis of necrotizing enterocolitis, effect of treatment as well as severity prediction.
CLINICAL SIGNIFICANCE OF SERUM PROLACTIN LEVEL IN NEONATAL SEIZURES
Nayera I. Attia and Heba S. Ali*
Institute of Postgraduate Childhood Studies (Medical Department), NICU and Biochemistry Department*, Faculty of Medicine Ain Shams University, Cairo, Egypt.Abstract
Researches on more economical and practical methods for the differential diagnosis of seizures are required. Prolactin is the most specific neurohormone that is elevated after seizures in adults and children. The possibility that serum prolactin could be used as an epileptic marker in neonates is attractive because an ictal EEG recording is not always available. Therefore, this study aimed at determination of the clinical usefulness of serum prolactin as a diagnostic aid in neonatal convulsions and its relation to etiology, type and duration of seizures.
The present study was conducted on 35 term neonates with neonatal convulsions (patient group) recruited from the NICU of Obstetric and Gynecology Department, Ain Shams University. Their mean birth weight was 3.45± 0.42 kg and their mean gestational age was 38.63±1.29 weeks. Thirty-five healthy neonates were chosen to serve as a control group. Each neonate in the patient group had at least one clinically observed seizure. Seizures were diagnosed clinically and EEG confirmation was not required. Postictal serum prolactin levels were obtained at 30 minutes, 24 hours and 72 hour (recovery level) after the seizures using ELISA technique. The ratio of 30 minutes postictal prolactin level to recovery level (prolactin ratio) was used as an indicator of postictal prolactin increase.
The results of the current study showed that etiologic diagnoses included were hypoxic-ischemic encephalopathy (HIE) (40%) followed by neonatal sepsis (31%), intracranial hemorrhage (ICH) (14%), hypoglycemia (8%) and hypocalcemia (5%). Serum prolactin level was significantly higher (P<0.01) at 30 minutes postictally in the patients with seizures than in control group and this value started to decline after 24 hours and became insignificant at 72 hours postictally. Additionally, postictal serum prolactin levels were significantly higher in tonic and clonic convulsions and in seizures due to hypoxia as compared to controls. Moreover, 24 hours postictal serum prolactin level was significantly higher than 30 minutes postictal level in both tonic and myoclonic convulsions. Postictal serum prolactin levels correlated negatively with Apgar score at 5 minutes and the mean prolactin ratio in the patient group was 2.41±1.80 denoting a marked postictal prolactin elevation.
In conclusion, postictal serum prolactin levels increased significantly during the 24 hours following seizures in neonatal seizures especially with tonic and clonic types and mostly due to hypoxia. Therefore, postictal serum prolactin level may be helpful in the differentiation of seizures as well as providing important information about their etiology particularly when continuous EEG monitoring is not possible. In addition, prolactin ratios may be used to assess more accurately the phenomenon of postictal hyperprolactinemia.
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