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Volume 6, No. 3, September, 2005
Ionized serum Calcium Not Serum Total Magnesium Predicts outcome in neonatal hypoxic-Ischemic Encephalopathy
Hoda A Atwa *, Hesham I. Elshal* Amal S ahmed **,Mohamed A Metawie***
Department of Pediatrics ,** Department of Clinical Pathology,***Department of* Gynecology and Obstatric, faculty of medicine, suez canal university
ABSTRACT
Perinatal hypoxic-ischemic encephalopathy (HIE) is a significant cause of neonatal mortality and neurodevelopment impairments. Previous works have attempted to find a sensitive parameter that will accurately predict outcome in infants with perinatal asphyxia. The aim of this study was to whether or not the serum total magnesium (Mg),ionized Ca (iCa), and other electrolytes concentrations in neonate with(HIE) in umbilical cord blood and 48 hours serum samples could be used to predict their outcome. METHODS: Hospital-based prospective study of admission to newborn intensive care unit between 2001-2004.A total of 60 term neonates fulfilling the criteria for HIE were included in the study. HIE was classified according to the criteria of Sarnat and Sarnat, mild moderate and sever. Twenty full term healthy newborns were chosen as control. Umbilical cord blood on delivery and after 48 hours was collected for the measurement of total Mg, iCa, and Na.
Infants was followed by a pediatrician and neurological examination
Was done at the age of 6 and 12 month . RESULT: In the group of normal infants there was a significant increase in serum total Mg and Na concentrations and decrease in iCa concentration by the second day of life compared with umbilical cord blood values. Infant with mild HIE had significantly higher umbilical cord blood total Mg concentrations compared with moderate and severe HIE groups. Infant with severe HIE had significantly lower mean umbilical cord blood total Mg concentration compared with other groups. On the second day of life infants with severe HIE had significantly higher serum concentration of total Mg and lower concentrations of iCa and Na compared with other groups. The serum cord and 48 hour ionized calcium concentrations were significantly lower in HIE group who had a poor outcome . cord serum and 48 hours level of ionized calcium and 48hr Na were predicting variable for poor outcome in HIE group.
RISING RATIO OF MATRIX METALLOPROTEINASE 9/ TISSUE INHIBITOR METALLOPROTEINASE 1 IN TRACHEOALVEOLAR FLUID: A PREDICTOR FOR DEVELOPMENT OF CHRONIC LUNG DISEASE IN VENTILATED PRETERM NEONATES
Heba Hany Abou Hussein and Dina Mohamed El Abd*
Pediatric Department, Chemical Pathology Department*, Faculty of Medicine, Cairo UniversityABSTRACT
Bronchopulmonary dysplasia (BPD) or chronic lung disease (CLD) is a disorder of lung injury and repair originally ascribed to positive pressure mechanical ventilation and oxygen toxicity. Matrix metalloproteinases (MMPs) including MMP9 act in remodeling and destruction of extracelluar lung matrix and basement membranes. Tissue inhibitor metalloproteinase 1 (TIMP1) is the specific tissue inhibitor of MMP9. Imbalance in the level of MMP9 relative to its inhibitor TIMP1 has been implicated in matrix disruption and remodeling with further development of (CLD).
Aim: to study the value of rising ratio MMP9/ TIMP1 in serial TAF samples in prediction of CLD in neonates needing mechanical ventilation for a long duration.
Patients and Methods: A prospective study conducted on 48 preterm neonates having respiratory distress syndrome (RDS) recruited from NICU of Kasr El Eini Hospital. They were all receiving mechanical ventilation. Their mean gestational age (GA) was 32.03±1.07 weeks and mean birth weight (BW) was 1118±93.38 gm. They were subjected to 3 serial tracheal aspirate fluid collections (TAF) during the routine tracheal lavage. 1st sample was collected during the 1st 24 hours of life, 2nd sample during the period from the 8th to the 11th day postnatal and the 3rd sample during the period from the 12th to the 16th day postnatal. Levels of MMP9 and TIMP1, were measured using ELISA technique. Ratio MMP9/TIMP1 was calculated. Patients who completed the 3 serial samples were subdivided into 2 groups: Group I: including patients who developed CLD and Group II including patients who did not develop CLD. Ratio of MMP9/TIMP1 was compared in the 3 serial samples in both groups.
Results: During the study period: 18 neonates died before they completed the 3 successive samples and were excluded from the final analysis of the study. The results of the present study showed that MMP9/TIMP1 ratio was rising over the 3 successive samples in CLD group. In 1st sample ratio in CLD group was 3.6±0.92 versus 3.32±0.8 in no CLD group P Value 0.426 non significant but ratio rises in 2nd samples to reach 5.12±1.44 in CLD group versus 3.30 ± 0.82 in no CLD group p value 0.002 highly significant. In the 3rd sample the ratio rises more to be 6.50±1.79 in CLD group versus 3.09 ± 0.78 in no CLD group P Value 0.001 very highly significant.
Conclusion: A rising ratio MMP9/ TIMP1 in TAF in early life might be of use as a predictor for the development of CLD in ventilated neonates. Supplementation of tissue inhibitor (TIMP1) when available could be an effective strategy in the prophylaxis and treatment of CLD.
Laparoscopic Management of Chronic Intermittent Gastric Volvulus in Children
Ashraf A. Kabesh* and Karima Maher**
Pediatric Surgery* and Radiology** Departments - Ain Shams UniversityABSTRACT
Purpose: The aim of the study was to review the infants who presented with chronic intermittent gastric volvulus in the past 5 years, analyze pitfalls in the diagnosis and define the role of laparoscopy in the evaluation and treatment of this condition. Background: Gastric volvulus (GV) is an abnormal rotation of the stomach around its axis.[1] It has traditionally been considered a rare entity in children, and standard texts on paediatrics typically make scant reference to it.[2] In our experience, however, a detailed medical history and a careful radiographic study of children with digestive symptoms reveals gastric volvulus to be more frequent than is commonly thought. Patients and Methods: We performed this study on all children treated for chronic intermittent gastric volvulus who presented to the Department of Pediatric Surgery, Ain Shams University School of Medicine since 2001. Results: All the patients (10 boys, 5 girls) were term infants, mean age 11 months at diagnosis. The principal symptoms were upper abdominal pain, colic, distension and non-bilious vomiting. The mean age at onset of symptoms was 2 months. Diagnosis was in all cases on the basis of upper intestinal transit studies. All patients underwent conservative treatment; 7 of these patients showed no significant improvement and thus underwent surgery. We performed simple laparoscopic anterior gastropexy in 3 patients and laparoscopic gastrostomy in four. All patients showed good recovery after surgery. Conclusion: Careful examination of patients with gastrointestinal problems, and even repeated respiratory infections may reveal chronic gastric volvulus with greater frequency than has traditionally been thought. We believe that this entity is often undetected, and is often inappropriately treated. We also showed that laparoscopy is feasible, safe and efficient in the management of these cases.Keywords: gastric volvulus, non-bilious vomiting, laparoscopic gastrostomy, laparoscopic gastropexy
C-REACTIVE PROTEIN AS A MARKER FOR EARLY ONSET NEONATAL SEPSIS: THE GOOD, THE BETTER AND THE BEST
Heba Hany Abou Hussein, Azza Mohamed El-Khawaga*, Amal Abdel Wahab* and Shahenaz EL Sabbahei Abdou*
Pediatric and Chemical pathology* departments, Cairo University
ABSTRACT
Introduction: C-reactive protein (CRP) analysis is a simple, established and widely available test to identify an evidence of plasma acute phase response to infection and tissue injury. Standard CRP assays such as: latex agglutination and quantitative assays lack sensitivity at the early onset of neonatal sepsis. They can detect CRP concentrations. The development of the new high sensitivity immunoassay technique for CRP (HSCRP) has enabled its detection at lower concentrations. In HSCRP immunoassay, anti CRP antibodies react with antigen in the serum to form antigen antibody complex measured turbidimetrically.
Objectives: Evaluation of the diagnostic value of highly sensitivity CRP immunoassay in comparison to standard CRP latex agglutination and quantitative assays in early onset neonatal sepsis.
Study design: A prospective controlled study including 51 neonates with culture proven bacterial sepsis. Ten healthy neonates served as control group. All neonates were subjected to full clinical examination, and laboratory investigations including: CBC with differential leukocytic count, blood culture and sensitivity. CRP analysis was performed using 3 techniques for each patient: CRP latex agglutination, CRP quantitative assay where values ? 6mg/L were considered abnormal, and HSCRP immunoassay where values ? 2mg/L were considered abnormal.
Results: CRP latex agglutination was positive in 8/51 (15.68%) and had sensitivity of 15.68%, specificity 100%, positive predictive value 100%, negative predictive value 18.86% and diagnostic accuracy 29.5%. CRP quantitative assay was positive in 12/51 (23.52%). At cut of level 6mg/L: sensitivity was 23.5%, specificity 100%, positive predictive value 100%, negative predictive value 20.4% and diagnostic accuracy 36.06%. HSCRP immunoassay was positive in 34/51 (66.66%). At cut off level 2mg/L: sensitivity was 66.6%, specificity 100%, positive predicative value 100%, negative predictive value 37.03% and diagnostic accuracy 72.13%.
Conclusion: CRP analysis using high sensitivity immunoassay is likely to improve the diagnostic accuracy of CRP in detection of early onset neonatal sepsis. It allows detection of CRP at low concentrations. Only 40µl of serum is needed, and results are available within 15 minutes.
EVALUATION OF SEIZURES IN THE TERM NEWBORN
El Maraghy S, Belal A, Iskander I, Adly N
Pediatric and Radiology Departments, Cairo UniversityABSTRACT
Background: Seizures occurring in the neonate are not uncommon and usually indicate an underlying neurological disorder. In many cases the occurrence of seizures is followed later by other neurological sequelae and sometimes handicapping.
Objective: To study the use of MRI in the newborn for the diagnosis of the etiology of seizures in comparison to Cranial US and CT scans and its possible prognostic value regarding neurodevelopmental outcome.
Methods: In this study 20 term neonates 8 girls and 12 boys presenting with seizures with or without evidence of HIE were prospectively studied to identify cause of the seizures comparatively using US, CT and MRI as well as EEG and laboratory testing. Follow up neurological and developmental examination of these infants was done at 6months, 1 and 2 years.
Results: Based on MRI findings the causes of seizures in these patients were hypoxic ischemic encephalopathy (HIE) (70%), intracranial hemorrhage (ICH) (15%), cerebral dysgenesis (10%) and acute fulminating inflammatory process (5%). The cause was unknown in 20% of the cases until magnetic resonance imaging (MRI) was performed. Cranial ultrasonography failed to show any basal ganglia lesions seen by MRI.
Regarding follow up, infants with diffuse MRI lesions had higher mortality and morbidity compared to infants with focal MRI and normal MRI findings.
Conclusion: The combined use of various imaging techniques to detect the etiology of neonatal seizures with precise anatomical definition is of great importance for the management of neonatal seizures as well for the alleviation of parental distress.
Key Words: CT, MRI, Neonatal seizures
The proper use of drugs during the perinatal period
Review Article
Vassilios Fanos, Alessandra Atzei, Ada Ximenes, Alessandra Reali, Laura Cuzzolin*
Neonatal Intensive Care Unit, University of Cagliari,
*Public Health Department-Section of Pharmacology, University of Verona
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