Gastroschisis: Impact of Bedside Closure on Ventilator-Associated Outcomes

Author(s):  
Alison Morag Campbell ◽  
Mahmoud Motawea ◽  
Wayne Fradley ◽  
Sean Marven

Abstract Aim In our practice, preformed silos are routine rather than reserved for difficult cases. We aimed to identify whether silo and bedside closure can minimize: general anesthetic (GA) exposure, need for intubation and ventilation, or days intubated for neonates with simple gastroschisis (SG). Methods After approval, patients were identified via the neonatal discharge log (April 2010 to April 2019). Data were collected by case-note review and analyzed with respect to GA, ventilation, and core outcomes. Results Of 104 patients (50 female, mean birth weight 2.43 kg, mean gestational age 36 + 2 weeks), 85 were SG and 19 complex. Silo application was initial management in 70 SG, 57 completed successful bedside closure (by day 4 of life—median). Fifteen SG had initial operative closure.Of the 70 SG managed with silo, 46 (66%) had no GA as neonates. Twelve required GA for line insertion. Thirteen patients with initial silo had closure in theater (7 opportunistic at time of GA for line). Nine required intubation and ventilation out-with the operating theater during neonatal management. Seven had already been intubated at delivery; 3 because of meconium aspiration.One-hundred percent of those treated with operative closure had GA, 1 patient subsequently required surgery for subglottic stenosis. Time to full feeds did not differ between groups. Conclusion Silo and bedside closure allow the majority of SG neonates to avoid GA or intubation in the neonatal period, without increased risk of complication. However, it is important that the nursing expertise required to manage these patients safely is not underestimated.

2021 ◽  
pp. 097321792110076
Author(s):  
Abdah Hrfi ◽  
Mohammed H.A. Mohammed ◽  
Omar Tamimi

Cardiac tamponade as a result of pericardial effusion (PE) is a serious uncommon condition in the neonatal period. PE in such cases could be associated with hydrops fetalis, neonatal sepsis, metabolic diseases, or as a complication of percutaneous indwelling central catheter. 1 We are reporting a preterm baby, with low birth weight who developed large PE as a complication of total parenteral nutrition via a peripherally inserted central catheter, managed successfully with pericardiocentesis.


2021 ◽  
pp. 1-4
Author(s):  
Josef Jackson ◽  
Eumenia Castro ◽  
Michael A. Belfort ◽  
Alireza A. Shamsirshaz ◽  
Ahmed A. Nassr ◽  
...  

Umbilical vein varices are rare umbilical cord anomalies that typically occur intra-abdominally. Extra-abdominal umbilical vein varices are exceedingly rare and usually diagnosed postnatally on gross pathologic examination. Umbilical vein varices have been associated with increased risk of fetal anemia, cardiac abnormalities, and intrauterine fetal demise. This case report discusses a patient who presented with a massive extra-abdominal umbilical vein varix, whose infant was ultimately delivered due to fetal distress and died in the neonatal period. This report also discusses associated fetal conditions and guidelines for antenatal testing and surveillance of known umbilical vein varices.


Author(s):  
Jennifer Knuth ◽  
Lindsay Gennari ◽  
John Cagino

Awareness following general anesthesia is a rare event; however, it may have significant impact on patient satisfaction and long-term morbidity. Detecting intraoperative awareness during a general anesthetic is difficult due to the fact that the signs and symptoms are often absent in documented cases of awareness. Often, intraoperative awareness goes unnoticed until a patient reports the experience. Anesthesiologists should be cognizant of the risk factors associated with an increased risk of intraoperative awareness. Cesarean section performed under general anesthesia, cardiac surgery, and trauma surgery all carry an increased risk. Anesthesiologists should consider patient specific risk factors involving a higher than expected anesthetic requirement in developing their anesthetic plan. In the event of intraoperative awareness, the anesthesiologist’s actions and interactions with the patient are critical in improving the patient’s’ outcome and minimizing long-term psychological stress. Anesthesiologists should acknowledge the event and create a supportive relationship with the patient.


2020 ◽  
Vol 5 (4) ◽  
pp. 129-138
Author(s):  
Rosemary A. deShazo ◽  
Aaron M. Secrest ◽  
April W. Armstrong ◽  
Kristina Callis Duffin

Importance: Patients with psoriasis are at an increased risk of hypertension, and when present, hypertension is more severe in patients with psoriasis. However, hypertension often goes underdiagnosed and undertreated in this population, which can contribute to increased overall morbidity and mortality. Objective: To review the relationship between psoriasis and hypertension and provide practical screening and treatment recommendations for dermatologists to address hypertension in patients with psoriasis. Evidence Review: PubMed and MEDLINE databases were searched for hypertension and psoriasis. Consensus was reached by the authors based on published work and clinical experience for recommendations on screening, monitoring, diagnosis, and treatment of hypertension in patients with psoriasis. Findings: Hypertension is more prevalent, and often more severe, in the psoriasis population. This review summarizes recommendations for annual hypertension screening in patients with psoriasis, as well as diagnostic cutoffs and initial therapies for dermatologists to consider. Referral to primary care for continued hypertension management and additional referral recommendations based on comorbidities are described. Conclusions and Relevance: Psoriasis is a common dermatologic diagnosis in the United States. Dermatologists should be fully aware of appropriate screening, diagnosis, and initial management of hypertension in this population to help improve morbidity and mortality.


2016 ◽  
Vol 125 (4) ◽  
pp. 667-677 ◽  
Author(s):  
M. Ruth Graham ◽  
Marni Brownell ◽  
Daniel G. Chateau ◽  
Roxana D. Dragan ◽  
Charles Burchill ◽  
...  

Abstract Background Animal studies demonstrate general anesthetic (GA) toxicity in the developing brain. Clinical reports raise concern, but the risk of GA exposure to neurodevelopment in children remains uncertain. Methods The authors undertook a retrospective matched cohort study comparing children less than 4 yr of age exposed to GA to those with no GA exposure. The authors used the Early Development Instrument (EDI), a 104-component questionnaire, encompassing five developmental domains, completed in kindergarten as the outcome measure. Mixed-effect logistic regression models generated EDI estimates for single versus multiple GA exposure and compared both single and multiple exposures by the age of 0 to 2 or 2 to 4 yr. Known sociodemographic and physical confounders were incorporated as covariates in the models. Results A total of 18,056 children were studied: 3,850 exposed to a single GA and 620 exposed to two or more GA, who were matched to 13,586 nonexposed children. In children less than 2 yr of age, there was no independent association between single or multiple GA exposure and EDI results. Paradoxically, single exposure between 2 and 4 yr of age was associated with deficits, most significant for communication/general knowledge (estimate, −0.7; 95% CI, −0.93 to −0.47; P < 0.0001) and language/cognition (estimate, −0.34; 95% CI, −0.52 to −0.16; P < 0.0001) domains. Multiple GA exposure at the age of 2 to 4 yr did not confer greater risk than single GA exposure. Conclusions These findings refute the assumption that the earlier the GA exposure in children, the greater the likelihood of long-term neurocognitive risk. The authors cannot confirm an association between multiple GA exposure and increased risk of neurocognitive impairment, increasing the probability of confounding to explain the results.


2012 ◽  
Vol 11 (2) ◽  
pp. 134-136
Author(s):  
Safia Rana ◽  
Zeeba Shamim Jairajpuri ◽  
Sonia Garg

Congenital leukemia is a rare disorder presenting in the immediate neonatal period & diagnosed at or within few days of birth.1 Because of the doubling time of leukemic cells, the disease becomes clinically evident after birth or shortly thereafter.2 Neonates with Down’s syndrome have an increased risk for congenital leukemia particularly acute megakaryoblastic leukemia (FAB M7).3 The incidence of acute megakaryoblastic leukemia in Down’s syndrome is estimated to be 400 times than in normal children.4 We present a case of congenital leukemia in a 22 day old female child with Down’s syndrome who had cyanosis and skin rashes for 2 days. Diagnosis was established on the basis of hematological investigations and cytochemistry of the cells. DOI: http://dx.doi.org/10.3329/bjms.v11i2.9656 Bangladesh Journal of Medical Science Vol. 11 No. 02 April 2012: 134-136


2019 ◽  
Vol 72 (3-4) ◽  
pp. 123-130
Author(s):  
Milanka Tatic ◽  
Skeledzija Miskovic ◽  
Ranko Zdravkovic ◽  
Milica Gojkovic ◽  
Aleksandra Kovac ◽  
...  

Introduction. Sedation is the reduction of irritability or agitation by the use of certain drugs mostly to facilitate therapeutic or diagnostic procedures. Scales for evaluation of the depth of sedation. Riker Sedation-Agitation Scale and Richmond Agitation-Sedation Scale are the most commonly used scales. Drugs. Sedation is generally produced by using medications from the group of opioids, benzodiazepines, intravenous and inhalation general anesthetic agents, neuroleptics, phenothiazines, ?-agonists and barbiturates. Adverse effects of sedatives. Sedation is often associated with hypotension, prolonged mechanical ventilation and longer time on respiratory support, higher frequency of delirium, immunosuppression, deep vein thrombosis, increased risk for development of nosocomial pneumonia, all of which leads to the prolonged recovery time. Conclusion. Sedatives currently used in intensive care units are widely used, but they have limitations. The goal is to get the desired level of sedation with as few side effects as possible.


Author(s):  
Lisa J. Krain ◽  
Kenrad E. Nelson

Hepatitis E virus (HEV) poses serious risks to pregnant women and their developing fetuses, including increased risk of pregnancy loss, stillbirth, preterm delivery, and early infant death. Supportive care is currently the standard treatment for pregnant women with HEV infection, but in some cases, ribavirin treatment or early delivery may be indicated. Infants born with acute HEV infection face increased risk of complications and death. Intensive monitoring and support may be required in the neonatal period, particularly for preterm infants. Infants who survive the early neonatal period are likely to recover fully and clear the virus. Immunoassays and molecular methods for diagnosis of HEV have improved markedly over the past decade. New HEV vaccines may provide an opportunity to prevent both maternal illness and mother-to-child transmission (vertical transmission) (MTCT).


2021 ◽  
Vol 14 (1) ◽  
pp. e239143
Author(s):  
Ankush Gupta ◽  
Sanya Chhikara ◽  
Navreet Singh ◽  
Krishna Prasad

Calcified lesions often result in undilatable lesions, balloon dog-boning, poor device delivery as well as underexpanded stents (UES). This leads to an increased risk of acute and chronic stent failure. A 49-year-old man was admitted with anterior wall myocardial infarction and angiogram showed a diffuse calcific left anterior descending artery/diagonal lesion, which was stented with two overlapping drug-eluting stents. Angiogram after post-dilatation showed UES. Optical coherence tomography (OCT) confirmed UES with 58% expansion, minimum stent area (MSA) of 2.91 mm2 and 360° calcium arc around the stent. This UES was dilated with a ultra high-pressure balloon (UHPB) at 40 atmosphere, that led to calcium fracture and increased MSA to 7.42 mm2 and stent expansion to 97%. While OCT-guided lesion modification prior to stenting is ideal, OCT-guided assessment and management is also invaluable post-percutaneous coronary intervention. In the event of stent underexpansion, UHPB may be used as an initial management strategy.


Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Mohammad Ibrahim ◽  
Ravjot Sodhi ◽  
Aaron Nizam ◽  
Nabiha Khakoo ◽  
Siddhart Mehta ◽  
...  

Introduction: A peripherally inserted central catheter (PICC line) is a form of intravenous access that can be used for a prolonged period, which lowers the rate of infection. Our study aims to prove that PICC line insertion predicts a higher rate of Deep Vein Thrombosis (DVT), especially in those receiving the PICC line in a weaker arm. Methods: We conducted a retrospective analysis of stroke patients admitted to NeuroICU between September 2010 and October 2011 at a community teaching hospital. Patient records were evaluated for PICC line placement, DVT, Pulmonary Embolism (PE) development, and anticoagulant status. Odds ratios were calculated for the development of DVT and PE for PICC patients, as well as the outcomes for PICC line patients based on arm strength as defined with motor strength scale using SPSS software version 20. Results: The study included a total of 307 patients (mean age = 62.5 +/- 17.2, 51% female). Ninety-nine patients had a PICC line inserted, 22 of which developed DVT, including 10 patients who appeared to have PICC Line Related Large Venous Thrombosis. The presence of a PICC line conferred an increased risk (OR= 5.18, 95% CI, 2.40-11.2) for the development of a DVT. Patients who had a PICC line placed in a weaker arm (mean strength = 2.17) were more likely to develop a DVT than patients with a PICC line in a stronger arm (mean strength = 3.07) p<0.05. Patients given DVT prophylaxis were less likely to develop a DVT (OR = 0.32, 95% CI, .004 - .252) p < 0.05. Twenty-one patients had a CT chest angiogram performed, including six patients who had evidence of a PE. Of these six patients, one patient had a PICC line placement with subsequent development of DVT followed by PE. PICC line placement and DVT had no predictive value on the development of PE due to the small sample size. Conclusions: Our data suggests that patients who had a PICC line placed into a weaker strength arm had an increased risk of DVT in the same arm and that DVT prophylaxis significantly decreases this risk. Further studies should evaluate the predictive value of PICC line insertion with the risk of developing PE in stroke patients.


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