N. Mohsen, Osama Mohamed El Aziz, I. E. EL Sayed, Mohamed Farouk Ibarhim
Background Adenotonsillar hypertrophy (ATH) is the most common cause of upper airway obstruction in pediatric patients. Aim To study the prevalence of arrhythmias and heart rate variability in children with ATH. Patients and methods A cross-sectional study was conducted that included 40 children with ATH, comprising 26 (65%) males and 14 (35%) females, with a mean age of 4.7±1.07 years (range, 3–6 years), who attended pediatric outpatient clinics, Children’s Hospital, Cairo University, Egypt. Included children were subjected to 12-lead ECG and 24-h Holter ECG. Results ECG examination showed that the mean heart rate of our patients was 96.5±8.7 beats/min, and 100% of patients had regular rhythm. Premature atrial contractions more than five of the total QRS in 24-h Holter were found in 9/40 (22.5%) patients and less than 1% of the total QRS in 24-h Holter in 31/40 (77.5%) patients. Premature ventricular contractions less than 1% of the total QRS in 24-h Holter were found in all patients. Conclusion Arrhythmia is prevalent among patients with ATH; the presence of arrhythmia is significantly associated with the grade of adenoid hypertrophy, platelet count, and pulmonary artery systolic pressure. Further studies on a larger scale and more investigations like pulse oximetry and polysomnography are recommended in patients with ATH.
{"title":"Evaluation of cardiac arrhythmias in Egyptian children with adenotonsillar hypertrophy","authors":"N. Mohsen, Osama Mohamed El Aziz, I. E. EL Sayed, Mohamed Farouk Ibarhim","doi":"10.4103/ajop.ajop_40_20","DOIUrl":"https://doi.org/10.4103/ajop.ajop_40_20","url":null,"abstract":"Background Adenotonsillar hypertrophy (ATH) is the most common cause of upper airway obstruction in pediatric patients. Aim To study the prevalence of arrhythmias and heart rate variability in children with ATH. Patients and methods A cross-sectional study was conducted that included 40 children with ATH, comprising 26 (65%) males and 14 (35%) females, with a mean age of 4.7±1.07 years (range, 3–6 years), who attended pediatric outpatient clinics, Children’s Hospital, Cairo University, Egypt. Included children were subjected to 12-lead ECG and 24-h Holter ECG. Results ECG examination showed that the mean heart rate of our patients was 96.5±8.7 beats/min, and 100% of patients had regular rhythm. Premature atrial contractions more than five of the total QRS in 24-h Holter were found in 9/40 (22.5%) patients and less than 1% of the total QRS in 24-h Holter in 31/40 (77.5%) patients. Premature ventricular contractions less than 1% of the total QRS in 24-h Holter were found in all patients. Conclusion Arrhythmia is prevalent among patients with ATH; the presence of arrhythmia is significantly associated with the grade of adenoid hypertrophy, platelet count, and pulmonary artery systolic pressure. Further studies on a larger scale and more investigations like pulse oximetry and polysomnography are recommended in patients with ATH.","PeriodicalId":7866,"journal":{"name":"Alexandria Journal of Pediatrics","volume":"26 1","pages":"122 - 130"},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72787106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Taha, Mohamed Eltallawy, Emad Eldaly, Amal M Abdel Aal, Enas A. Hamed
Background Neonatal sepsis (NS) is a common neonatal disorder associated with high mortality and morbidity. Objective The present work aims to assess diagnostic value of hepcidin and presepsin in NS detection and their roles in associated morbidity (especially neurological defects) and mortality. Patients and methods A case–control study was conducted at the neonatal intensive care unit of University Children’s Hospital, Assiut, Egypt, in the period between June 2018 and June 2019. A total of 120 neonates with NS and 40 healthy neonates as control group were enrolled. Neonates were subjected to full history taking and thorough clinical evaluation. Blood picture, C-reactive protein (CRP), blood culture, and hepcidin and presepsin serum levels were measured. Only survivors were subjected to electroencephalography (EEG) and brain computed tomography (CT) evaluations. Results Neonates in NS group had significantly higher CRP, as well as hepcidin and presepsin serum levels versus control. Hepcidin and presepsin were significantly higher among nonsurvivors versus survivors and in neonates with neurological deficits versus neonates without neurological deficit. Sensitivity and specificity were 88.33 and 82.50%, respectively, for CRP; 93.33 and 90.00%, respectively, for hepcidin; and 91.67 and 90.00%, respectively, for presepsin. Of NS group, 66.7% had late-onset sepsis, 20.0% had neurological deficits, and 45.0% were survivors. Among survivors, the most frequent findings in EEG were focal epileptic discharge (57.4%) followed by continuous normal voltage (46.3%), and generalized periodic discharge with triphasic waves (42.6%), whereas in CT, the most frequent findings were mild hypoxia (37.0%) followed by periventricular hypoxia (33.3%). Conclusions Hepcidin and presepsin have an important role in prediction and diagnosis of NS with neurological sequelae and death. Moreover, brain CT and EEG must be performed in all survivor neonates following NS.
{"title":"The use of hepcidin and presepsin in diagnosis of neonatal sepsis and its neurological sequelae in a tertiary neonatal intensive care unit, Assiut, Egypt","authors":"S. Taha, Mohamed Eltallawy, Emad Eldaly, Amal M Abdel Aal, Enas A. Hamed","doi":"10.4103/ajop.ajop_37_20","DOIUrl":"https://doi.org/10.4103/ajop.ajop_37_20","url":null,"abstract":"Background Neonatal sepsis (NS) is a common neonatal disorder associated with high mortality and morbidity. Objective The present work aims to assess diagnostic value of hepcidin and presepsin in NS detection and their roles in associated morbidity (especially neurological defects) and mortality. Patients and methods A case–control study was conducted at the neonatal intensive care unit of University Children’s Hospital, Assiut, Egypt, in the period between June 2018 and June 2019. A total of 120 neonates with NS and 40 healthy neonates as control group were enrolled. Neonates were subjected to full history taking and thorough clinical evaluation. Blood picture, C-reactive protein (CRP), blood culture, and hepcidin and presepsin serum levels were measured. Only survivors were subjected to electroencephalography (EEG) and brain computed tomography (CT) evaluations. Results Neonates in NS group had significantly higher CRP, as well as hepcidin and presepsin serum levels versus control. Hepcidin and presepsin were significantly higher among nonsurvivors versus survivors and in neonates with neurological deficits versus neonates without neurological deficit. Sensitivity and specificity were 88.33 and 82.50%, respectively, for CRP; 93.33 and 90.00%, respectively, for hepcidin; and 91.67 and 90.00%, respectively, for presepsin. Of NS group, 66.7% had late-onset sepsis, 20.0% had neurological deficits, and 45.0% were survivors. Among survivors, the most frequent findings in EEG were focal epileptic discharge (57.4%) followed by continuous normal voltage (46.3%), and generalized periodic discharge with triphasic waves (42.6%), whereas in CT, the most frequent findings were mild hypoxia (37.0%) followed by periventricular hypoxia (33.3%). Conclusions Hepcidin and presepsin have an important role in prediction and diagnosis of NS with neurological sequelae and death. Moreover, brain CT and EEG must be performed in all survivor neonates following NS.","PeriodicalId":7866,"journal":{"name":"Alexandria Journal of Pediatrics","volume":"14 1","pages":"107 - 116"},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77849720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-09-01DOI: 10.4103/1687-9945.290282
{"title":"Erratum: Efficacy of steroids in childhood drug-resistant epilepsy","authors":"","doi":"10.4103/1687-9945.290282","DOIUrl":"https://doi.org/10.4103/1687-9945.290282","url":null,"abstract":"","PeriodicalId":7866,"journal":{"name":"Alexandria Journal of Pediatrics","volume":"25 1","pages":"172 - 172"},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90105115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dina Aly Fawzy, M. Abdel-Moneim, Shaymaa Elsayed Elmeguid
Background Despite the advances in treatment of type 1 diabetes mellitus (T1DM), diabetic complications constitute the main cause of morbidity and mortality. Moreover, T1DM is often associated with other autoimmune diseases. Aim To study children with T1DM of long duration, attending the diabetes clinic of Alexandria University Children’s Hospital, regarding the glycemic control and presence of complications and associated autoimmune diseases. Patients and methods A total of 50 children and adolescents with T1DM of more than or equal to 5-year duration were assessed for the presence of diabetic complications and their relation to the glycemic control and duration of diabetes. The investigations included glycosylated hemoglobin, estimated glomerular filtration rate, microalbuminuria, complete liver profile, lipid profile, thyroid profile, tests for celiac disease, abdominal ultrasound, fundus examination, and echocardiography. Results The majority (70%) of the patients had poor glycemic control, and 64% of them were receiving premixed insulin. Lipohypertrophy, fatty liver, dyslipidemia, and nephropathy were very prevalent complications. Hypothyroidism, neuropathy, and celiac disease were less common complications. Conclusion All our diabetic patients should be treated with basal-bolus insulin, with emphasis on education about proper comprehensive management of the disease.
{"title":"Study of children with type 1 diabetes mellitus of long duration attending the Alexandria University Children’s Hospital","authors":"Dina Aly Fawzy, M. Abdel-Moneim, Shaymaa Elsayed Elmeguid","doi":"10.4103/ajop.ajop_38_20","DOIUrl":"https://doi.org/10.4103/ajop.ajop_38_20","url":null,"abstract":"Background Despite the advances in treatment of type 1 diabetes mellitus (T1DM), diabetic complications constitute the main cause of morbidity and mortality. Moreover, T1DM is often associated with other autoimmune diseases. Aim To study children with T1DM of long duration, attending the diabetes clinic of Alexandria University Children’s Hospital, regarding the glycemic control and presence of complications and associated autoimmune diseases. Patients and methods A total of 50 children and adolescents with T1DM of more than or equal to 5-year duration were assessed for the presence of diabetic complications and their relation to the glycemic control and duration of diabetes. The investigations included glycosylated hemoglobin, estimated glomerular filtration rate, microalbuminuria, complete liver profile, lipid profile, thyroid profile, tests for celiac disease, abdominal ultrasound, fundus examination, and echocardiography. Results The majority (70%) of the patients had poor glycemic control, and 64% of them were receiving premixed insulin. Lipohypertrophy, fatty liver, dyslipidemia, and nephropathy were very prevalent complications. Hypothyroidism, neuropathy, and celiac disease were less common complications. Conclusion All our diabetic patients should be treated with basal-bolus insulin, with emphasis on education about proper comprehensive management of the disease.","PeriodicalId":7866,"journal":{"name":"Alexandria Journal of Pediatrics","volume":"33 1","pages":"117 - 121"},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84165157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Badib, Magdy El-Din, A. A. Hamed, Hassan Hassan
Objective Heated, humidified high-flow nasal cannula (HHHFNC) is commonly used as a noninvasive mode of respiratory support in the Neonatal Intensive Care Unit. The safety and efficacy of HHHFNC have not been compared with other modes of noninvasive support in large randomized trials. Aim The objective was to assess the efficacy and safety of HHHFNC compared with nasal continuous positive airway pressure (NCPAP) as a primary mode for noninvasive respiratory support in the Neonatal Intensive Care Unit. Patients and methods This prospective comparative study was conducted on 100 late preterm neonates with gestational age 34–37 weeks with respiratory distress developed within 6 h of age. Patients were categorized into two groups: 50 received NCPAP and 50 received HHHFNC as a primary mode of respiratory support. The primary outcome was requirement for mechanical ventilation within 72 h of age. Secondary outcomes included need for mechanical ventilation beyond 72 h of age, occurrence of complications including nasal trauma, effect on feeding, and length of hospital stay. Results There was no difference in early failure for HHHFNC [1/50 (2.0%)] versus NCPAP [7/50 (14.0%); P=0.059], subsequent need for any intubation [6/50 vs. 8/50 (16%); P=0.564], or in any of several adverse outcomes analyzed, including air leak. NCPAP group had more cases that developed nasal trauma [18/50 (36.0%) vs. HHHFNC 0/50 (0.0%)]. No difference was found between both groups regarding the duration of hospital stay. Conclusion Among infants 34–37 weeks of gestational age, HHHFNC appears to have similar efficacy and safety to NCPAP when applied as a primary mode of respiratory support.
{"title":"Evaluation of the use of high-flow nasal cannula as primary respiratory support in late preterms","authors":"A. Badib, Magdy El-Din, A. A. Hamed, Hassan Hassan","doi":"10.4103/ajop.ajop_44_20","DOIUrl":"https://doi.org/10.4103/ajop.ajop_44_20","url":null,"abstract":"Objective Heated, humidified high-flow nasal cannula (HHHFNC) is commonly used as a noninvasive mode of respiratory support in the Neonatal Intensive Care Unit. The safety and efficacy of HHHFNC have not been compared with other modes of noninvasive support in large randomized trials. Aim The objective was to assess the efficacy and safety of HHHFNC compared with nasal continuous positive airway pressure (NCPAP) as a primary mode for noninvasive respiratory support in the Neonatal Intensive Care Unit. Patients and methods This prospective comparative study was conducted on 100 late preterm neonates with gestational age 34–37 weeks with respiratory distress developed within 6 h of age. Patients were categorized into two groups: 50 received NCPAP and 50 received HHHFNC as a primary mode of respiratory support. The primary outcome was requirement for mechanical ventilation within 72 h of age. Secondary outcomes included need for mechanical ventilation beyond 72 h of age, occurrence of complications including nasal trauma, effect on feeding, and length of hospital stay. Results There was no difference in early failure for HHHFNC [1/50 (2.0%)] versus NCPAP [7/50 (14.0%); P=0.059], subsequent need for any intubation [6/50 vs. 8/50 (16%); P=0.564], or in any of several adverse outcomes analyzed, including air leak. NCPAP group had more cases that developed nasal trauma [18/50 (36.0%) vs. HHHFNC 0/50 (0.0%)]. No difference was found between both groups regarding the duration of hospital stay. Conclusion Among infants 34–37 weeks of gestational age, HHHFNC appears to have similar efficacy and safety to NCPAP when applied as a primary mode of respiratory support.","PeriodicalId":7866,"journal":{"name":"Alexandria Journal of Pediatrics","volume":"91 1","pages":"152 - 158"},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91501464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background A febrile seizure (FS) is defined as seizure associated with fever during infancy or childhood. Trace elements such as zinc, copper, selenium, and magnesium are described in association with FS. Aim The present work aimed to study the relation between FSs and serum zinc level, and it evaluated the potential role of zinc supplementation to decrease the frequency of FSs. Patients and methods The study included 40 children diagnosed as having FS for the first time, with an age between 6 months and 5 years old. It included another group with 40 febrile children but without seizures. Overall, 3 ml of peripheral blood was collected from each patient during the first 24 h of attack for measurement of serum zinc levels. The normal level is considered 0.46–1.2 mg/l, and zinc level less than 0.3 mg/l is defined as zinc deficiency. In cases with decreased zinc level, intervention was done by zinc supplementation in dose of 22.5-mg elemental zinc daily in divided doses for 3 months and were reassessed by frequency of seizures and serum zinc level. Results We found a low level of serum zinc in patients with FS. Among 28 children who had low zinc level, mean level of serum zinc (mg/l) was 0.89±0.15, with P value less than or equal to 0.001 after zinc supplementation. Conclusion A significant decrease in level of serum zinc was found in patients with FS, and zinc supplements could be used as a prophylaxis against recurrence of FS.
{"title":"Serum zinc level in children presenting with febrile seizures","authors":"Dr Nikhil Achanta, Megha Sharma, A. Sharma","doi":"10.4103/ajop.ajop_43_20","DOIUrl":"https://doi.org/10.4103/ajop.ajop_43_20","url":null,"abstract":"Background A febrile seizure (FS) is defined as seizure associated with fever during infancy or childhood. Trace elements such as zinc, copper, selenium, and magnesium are described in association with FS. Aim The present work aimed to study the relation between FSs and serum zinc level, and it evaluated the potential role of zinc supplementation to decrease the frequency of FSs. Patients and methods The study included 40 children diagnosed as having FS for the first time, with an age between 6 months and 5 years old. It included another group with 40 febrile children but without seizures. Overall, 3 ml of peripheral blood was collected from each patient during the first 24 h of attack for measurement of serum zinc levels. The normal level is considered 0.46–1.2 mg/l, and zinc level less than 0.3 mg/l is defined as zinc deficiency. In cases with decreased zinc level, intervention was done by zinc supplementation in dose of 22.5-mg elemental zinc daily in divided doses for 3 months and were reassessed by frequency of seizures and serum zinc level. Results We found a low level of serum zinc in patients with FS. Among 28 children who had low zinc level, mean level of serum zinc (mg/l) was 0.89±0.15, with P value less than or equal to 0.001 after zinc supplementation. Conclusion A significant decrease in level of serum zinc was found in patients with FS, and zinc supplements could be used as a prophylaxis against recurrence of FS.","PeriodicalId":7866,"journal":{"name":"Alexandria Journal of Pediatrics","volume":"102 1","pages":"144 - 151"},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75874586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background Matrix metalloproteinases-9 (MMP-9) is a member of a large group of zinc-dependent endopeptidases and is essential in immune response. It plays an imperative function in pneumonia pathogenesis. We aimed to evaluate the role of MMP-9 in pediatric patients with congenital heart diseases (CHD) who gained ventilator-acquired pneumonia. Patients and methods A total of 80 children were included, who were further divided into 30 cardiac patients with ventilator-associated pneumonia (VAP), 30 cardiac patients with pneumonias either hospital acquired or community acquired, and 20 age-matched and sex-matched cardiac patients without chest infection as the control group. Assessments of white blood cell count, neutrophil count, serum C-reactive protein (CRP), and MMP-9 were done in all studied children. Results Comparison among the studied groups regarding laboratory data revealed high significant difference regarding white blood cell, neutrophil count, CRP, and MMP-9, as they were elevated among cardiac children with VAP than other groups (P=0.0001, 0.0001, 0.0001, and 0.0001, respectively). There was no significant difference between cases with acyanotic CHD and those with cyanotic CHD either with increased pulmonary blood flow or with decreased pulmonary blood flow regarding MMP-9 (P=0.2446). Conclusion MMP-9 level was significantly elevated in cardiac patients with VAP than other groups. Serum MMP-9 was more elevated among cyanotic CHD with increased pulmonary blood flow as hypoxia can lead to increased expression of MMP-9. MMP-9 was correlated with other inflammatory markers, including CRP, neutrophils count, and white blood cells, which offers it as a marker in assessing severity of pediatric pneumonia in cardiac patients.
{"title":"Role of serum matrix metalloproteinases-9 in pediatric cardiac patients with pneumonia","authors":"Khaled Elhessy, M. Hafez, N. Abousamra, E. Ahmed","doi":"10.4103/ajop.ajop_41_20","DOIUrl":"https://doi.org/10.4103/ajop.ajop_41_20","url":null,"abstract":"Background Matrix metalloproteinases-9 (MMP-9) is a member of a large group of zinc-dependent endopeptidases and is essential in immune response. It plays an imperative function in pneumonia pathogenesis. We aimed to evaluate the role of MMP-9 in pediatric patients with congenital heart diseases (CHD) who gained ventilator-acquired pneumonia. Patients and methods A total of 80 children were included, who were further divided into 30 cardiac patients with ventilator-associated pneumonia (VAP), 30 cardiac patients with pneumonias either hospital acquired or community acquired, and 20 age-matched and sex-matched cardiac patients without chest infection as the control group. Assessments of white blood cell count, neutrophil count, serum C-reactive protein (CRP), and MMP-9 were done in all studied children. Results Comparison among the studied groups regarding laboratory data revealed high significant difference regarding white blood cell, neutrophil count, CRP, and MMP-9, as they were elevated among cardiac children with VAP than other groups (P=0.0001, 0.0001, 0.0001, and 0.0001, respectively). There was no significant difference between cases with acyanotic CHD and those with cyanotic CHD either with increased pulmonary blood flow or with decreased pulmonary blood flow regarding MMP-9 (P=0.2446). Conclusion MMP-9 level was significantly elevated in cardiac patients with VAP than other groups. Serum MMP-9 was more elevated among cyanotic CHD with increased pulmonary blood flow as hypoxia can lead to increased expression of MMP-9. MMP-9 was correlated with other inflammatory markers, including CRP, neutrophils count, and white blood cells, which offers it as a marker in assessing severity of pediatric pneumonia in cardiac patients.","PeriodicalId":7866,"journal":{"name":"Alexandria Journal of Pediatrics","volume":"84 1","pages":"131 - 135"},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81176590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-09-01DOI: 10.4103/1687-9945.290283
{"title":"Erratum: Assessment of the preoperative classification for computed tomography predictability of round window niche visibility through posterior tympanotomy during cochlear implant surgery","authors":"","doi":"10.4103/1687-9945.290283","DOIUrl":"https://doi.org/10.4103/1687-9945.290283","url":null,"abstract":"","PeriodicalId":7866,"journal":{"name":"Alexandria Journal of Pediatrics","volume":"214 1","pages":"173 - 173"},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85535244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background Neonatal jaundice remains a very common presentation in newborn babies, especially during the first week of life. Serious morbidities and long-term sequelae are seen in babies with delayed diagnosis and intervention. A timely and early decision-making workout would make the outcome better. First-hour-of-life presenting icterus is a worrisome sign, and hence, a swift intervention is much needed. Aim To compare the auditory brain stem response results between healthy newborns and newborns managed from pathological unconjugated hyperbilirubinemia started in the first day of life. Patients and methods A case–control study was conducted at the neonatal intensive care unit of Alexandria University Maternity Hospital on 55 full-term newborns; 30 were cases who had pathological unconjugated hyperbilirubinemia in the first day of life using Queensland Clinical Guideline: neonatal jaundice 2017, and 25 were controls who had no pathological jaundice and were healthy. The exclusion criteria were considered. Diagnostic auditory brain stem response tests were done at the Audiology Unit in Outpatient clinics at Alexandria Main University Hospital by an audiologist for each ear of the case group within 7 days of complete management and were made for each ear of the controls group from 7 to 15 days of age. Results The study found no significant difference between both studied groups regarding latency, amplitude of waves I, III, and V, V/I amplitude ratio, and interpeak interval between waves I–III, III–V, and I–V at intensity of 70 dBnHL on both right and left ears. Conclusions Early identification and management of newborns with early-onset pathological hyperbilirubinemia using Queensland Clinical Guidelines: Neonatal jaundice 2017 can protect them from the acute bilirubin encephalopathy and auditory neuropathy spectrum disorder.
{"title":"Study of auditory brain stem response in newborns treated from unconjugated hyperbilirubinemia started in the first day of life","authors":"A. Badib, Ahmed Manfy, M. Goda, D. Elmoazen","doi":"10.4103/ajop.ajop_45_20","DOIUrl":"https://doi.org/10.4103/ajop.ajop_45_20","url":null,"abstract":"Background Neonatal jaundice remains a very common presentation in newborn babies, especially during the first week of life. Serious morbidities and long-term sequelae are seen in babies with delayed diagnosis and intervention. A timely and early decision-making workout would make the outcome better. First-hour-of-life presenting icterus is a worrisome sign, and hence, a swift intervention is much needed. Aim To compare the auditory brain stem response results between healthy newborns and newborns managed from pathological unconjugated hyperbilirubinemia started in the first day of life. Patients and methods A case–control study was conducted at the neonatal intensive care unit of Alexandria University Maternity Hospital on 55 full-term newborns; 30 were cases who had pathological unconjugated hyperbilirubinemia in the first day of life using Queensland Clinical Guideline: neonatal jaundice 2017, and 25 were controls who had no pathological jaundice and were healthy. The exclusion criteria were considered. Diagnostic auditory brain stem response tests were done at the Audiology Unit in Outpatient clinics at Alexandria Main University Hospital by an audiologist for each ear of the case group within 7 days of complete management and were made for each ear of the controls group from 7 to 15 days of age. Results The study found no significant difference between both studied groups regarding latency, amplitude of waves I, III, and V, V/I amplitude ratio, and interpeak interval between waves I–III, III–V, and I–V at intensity of 70 dBnHL on both right and left ears. Conclusions Early identification and management of newborns with early-onset pathological hyperbilirubinemia using Queensland Clinical Guidelines: Neonatal jaundice 2017 can protect them from the acute bilirubin encephalopathy and auditory neuropathy spectrum disorder.","PeriodicalId":7866,"journal":{"name":"Alexandria Journal of Pediatrics","volume":"63 1","pages":"159 - 171"},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80582068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background The evidence of routine use of sedatives in mechanically ventilated preterm infants is not established because of adverse effects of commonly used drugs. Dexmedetomidine (DEX) is an emerging alternative. Objective To assess safety and efficacy of DEX use as a sedative in mechanically ventilated preterm neonates. Patients and methods A double-blind, randomized controlled trial was conducted on 40 preterm infants less than or equal to 32 weeks of gestation who required mechanical ventilation (MV) during the first 5 days of life. They were randomly assigned to receive DEX (0.1 μg/kg/h) during the first 5 days or placebo. Time to first extubation was our primary outcome, and secondary outcomes were plasma Krebs von den Lundgen-6 at seventh day, bronchopulmonary dysplasia, total duration of MV, total duration of oxygen supplementation, need for postnatal steroid, pain score, necrotizing enterocolitis, intraventricular hemorrhage, patent ductus arteriosus, need for positive inotropes, retinopathy of prematurity requiring intervention, days to reach 100 ml/kg enteral feeds, adverse effects of DEX, and mortality. Results A total of 40 neonates (20 in each group) were enrolled. DEX use was associated with earlier extubation of mechanically ventilated preterm infants (P=0.001) compared with placebo. Durations of respiratory support and MV were significantly shorter in DEX group compared with placebo. DEX therapy was associated with lower level of serum Krebs von den Lundgen-6 and Echelle de Douleur et d’Inconfort du Nouveau-né pain score compared with placebo. Patients in DEX group have less need to fentanyl dosing and low incidence of sepsis and intraventricular hemorrhage. There was no significant difference between groups regarding other secondary outcomes. There is no significant difference between groups regarding adverse effects. Conclusion We concluded that DEX has beneficial effect on short-term respiratory outcome in mechanically ventilated preterm infants without significant effect on neonatal mortality.
背景:由于常用药物的不良反应，机械通气早产儿常规使用镇静剂的证据尚未建立。右美托咪定(DEX)是一种新兴的替代品。目的评价DEX用于机械通气早产儿镇静的安全性和有效性。患者与方法:对40例出生后5天需要机械通气(MV)的小于或等于妊娠32周的早产儿进行了双盲、随机对照试验。随机分为前5天服用0.1 μg/kg/h的DEX组和安慰剂组。第一次拔管的时间是我们的主要终点，次要终点是第7天的血浆Krebs von den lunden -6、支气管肺发育不良、MV总持续时间、补充氧气总持续时间、产后类固醇的需求、疼痛评分、坏死性小肠结肠炎、脑室内出血、动脉导管未闭、正性肌力的需求、需要干预的早产儿视网膜病变、达到100 ml/kg肠内喂养的天数、DEX的不良反应和死亡率。结果共纳入40例新生儿，每组20例。与安慰剂相比，DEX的使用与机械通气早产儿早期拔管相关(P=0.001)。与安慰剂组相比，DEX组呼吸支持和MV持续时间明显缩短。与安慰剂相比，DEX治疗与血清Krebs von den Lundgen-6和Echelle de Douleur et d ' incomfort du nouveau - naux疼痛评分水平较低相关。DEX组患者对芬太尼剂量的需求较小，败血症和脑室内出血的发生率较低。在其他次要结果方面，两组间无显著差异。两组之间在不良反应方面没有显著差异。结论DEX对机械通气早产儿短期呼吸结局有改善作用，对新生儿死亡率无显著影响。
{"title":"Short-term respiratory outcome of mechanically ventilated preterm infants treated by dexmedetomidine: randomized controlled trial","authors":"M. Zedan, Maged Mostafa, E. Thabet, I. Nour","doi":"10.4103/ajop.ajop_42_20","DOIUrl":"https://doi.org/10.4103/ajop.ajop_42_20","url":null,"abstract":"Background The evidence of routine use of sedatives in mechanically ventilated preterm infants is not established because of adverse effects of commonly used drugs. Dexmedetomidine (DEX) is an emerging alternative. Objective To assess safety and efficacy of DEX use as a sedative in mechanically ventilated preterm neonates. Patients and methods A double-blind, randomized controlled trial was conducted on 40 preterm infants less than or equal to 32 weeks of gestation who required mechanical ventilation (MV) during the first 5 days of life. They were randomly assigned to receive DEX (0.1 μg/kg/h) during the first 5 days or placebo. Time to first extubation was our primary outcome, and secondary outcomes were plasma Krebs von den Lundgen-6 at seventh day, bronchopulmonary dysplasia, total duration of MV, total duration of oxygen supplementation, need for postnatal steroid, pain score, necrotizing enterocolitis, intraventricular hemorrhage, patent ductus arteriosus, need for positive inotropes, retinopathy of prematurity requiring intervention, days to reach 100 ml/kg enteral feeds, adverse effects of DEX, and mortality. Results A total of 40 neonates (20 in each group) were enrolled. DEX use was associated with earlier extubation of mechanically ventilated preterm infants (P=0.001) compared with placebo. Durations of respiratory support and MV were significantly shorter in DEX group compared with placebo. DEX therapy was associated with lower level of serum Krebs von den Lundgen-6 and Echelle de Douleur et d’Inconfort du Nouveau-né pain score compared with placebo. Patients in DEX group have less need to fentanyl dosing and low incidence of sepsis and intraventricular hemorrhage. There was no significant difference between groups regarding other secondary outcomes. There is no significant difference between groups regarding adverse effects. Conclusion We concluded that DEX has beneficial effect on short-term respiratory outcome in mechanically ventilated preterm infants without significant effect on neonatal mortality.","PeriodicalId":7866,"journal":{"name":"Alexandria Journal of Pediatrics","volume":"1 1","pages":"136 - 143"},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84831152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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