Late-onset pubic-phallic idiopathic edema in premature recovering infants

2018 ◽  
Vol 7 (2) ◽  
Author(s):  
Bengt-Ola S. Bengtsson ◽  
John P. van Houten
Keyword(s):  
Neonatal Intensive Care ◽  
Chart Review ◽  
Late Onset ◽  
Expectant Management ◽  
Retrospective Chart Review ◽  
Extremely Low Birth Weight ◽  
Genital Area ◽  
Level 3 ◽  
Prolonged Observation ◽  
Idiopathic Edema

AbstractObjectiveSeveral cases of isolated localized edema of the genital area in extremely low birth weight (ELBW) infants within the last 5 years prompted a search for possible explanations and a search of the literature.Study designA retrospective chart review of all cases of localized genital area edema in our 16-bed community level-3 neonatal intensive care unit (NICU) between January 2007 and December 2017.ResultsA total of six patients with localized edema of the genital area were found. Among the six cases, five provided descriptions of time of onset. Only one case had a plausible etiology [inguinal hernia (IH)].ConclusionsTo our knowledge, this entity is not well described in the literature. Etiologies are speculative. Prolonged observation in the NICU by virtue of ELBW-status suggests that there are no detrimental effects, the condition does not appear to preclude discharge and cautious expectant management and reassurance are therefore in order.

Central edema in critically ill neonates

2019 ◽  
Vol 8 (2) ◽  
Author(s):  
Bengt-Ola S. Bengtsson ◽  
John P. van Houten
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Prognostic Factors ◽  
Neonatal Intensive Care ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Case Presentation ◽  
Level 3 ◽  
Critically Ill Neonates ◽  
Neonatal Population

Abstract Background We reviewed our cases of central edema defined as scalp/facial- and/or truncal edema or anasarca (Ana) hoping to identify prognostic factors that could aid in discussions of futility of care. Case presentation This study was a retrospective chart review of all cases of central edema in our community level-3 neonatal intensive care unit (NICU) between 2006 and 2019. A total of 19 patients with central edema were found. In 6/19 the etiology was due to chylous losses and in 13/19 inflammation was believed to be the major cause. Outcome was known in 17 cases and only 41% survived. Among the survivors, 86% had a gestational age greater than 34 weeks and the edema resolved in less than 2 weeks in the majority. Fifty-nine percent of the patients expired. In those that expired, 80% were born at 30 weeks’ gestation or less and the duration of edema exceeded 2 weeks in all cases and 4 weeks in 60% of the subjects. Conclusion To the best of our knowledge, this is the first retrospective study of the outcome of central edema in a neonatal population and the results can be useful when discussing futility of care in cases of severe and long-standing or worsening edema not responding to medical management.

Reticulocyte Count: The Forgotten Factor in Transfusion Decisions for Extremely Low Birth Weight Infants

2021 ◽  
Author(s):  
Daniel Nakhla ◽  
Alla Kushnir ◽  
Rafat Ahmed ◽  
Vineet Bhandari ◽  
Krystal Hunter ◽  
...  
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Neonatal Intensive Care ◽  
Reticulocyte Count ◽  
Retrospective Chart Review ◽  
Extremely Low Birth Weight ◽  
Positive Trend ◽  
Reference Ranges ◽  
Low Birth Weight Infants ◽  
Packed Red Blood Cells

Objective Extremely low birth weight (ELBW) infants often receive transfusions of packed red blood cells (PRBCs). Long-term outcomes of infants treated with liberal versus restricted transfusion criteria have been evaluated with conflicting results. Clinicians incorporate a reticulocyte count (RC) in their transfusion decisions. There is a lack of information on reference ranges for RCs in growing ELBW infants and whether infant's chronologic age or corrected gestational age (GA) generates a specific trend in the RCs. Our aim was to evaluate the levels of RCs obtained from ELBW infants over the course of the initial hospitalization. Study Design A retrospective chart review of ELBW infants treated in the neonatal intensive care unit (NICU) and had RCs performed. We analyzed the RCs to observe trends based on the chronologic age and corrected GA. Results A total of 738 RCs were analyzed. A positive trend in RCs that reached a peak at 32 to 34 weeks' corrected GA and then experienced a downward trend was observed. Conclusion Our report examines a very common hematologic test that is theoretically helpful but is in need of guidelines concerning the appropriate frequency of testing and its utility in making transfusion decisions in ELBW infants. Key Points

scholarly journals Late-onset psychosis in older outpatients: a retrospective chart review

2014 ◽  
Vol 27 (4) ◽  
pp. 694-696 ◽  
Author(s):  
Teruyuki Matsuoka ◽  
Hiroshi Fujimoto ◽  
Yuka Kato ◽  
Kenji Fukui ◽  
Jin Narumoto
Keyword(s):  
Differential Diagnosis ◽  
Older People ◽  
Mood Disorders ◽  
Clinical Setting ◽  
Chart Review ◽  
Late Onset ◽  
Retrospective Chart Review ◽  
Aged Society

Late-onset psychosis (LOP) has become increasingly prevalent in the clinical setting, especially in the highly aged society, due to the increasing numbers of older people and its disruptive impact on the lives of patients and caregivers. Although previous studies have identified some of the features of LOP (Webster and Grossberg, 1998; Mitford et al., 2010; Tan and Seng, 2012), some of the previous studies did not include patients with dementia and mood disorders. This study addresses the features of LOP in consecutive outpatients to provide information that supports the differential diagnosis.

Nurses' Finnegan Scoring of Newborns with Neonatal Abstinence Syndrome Not Affected by Time or Day of the Week

2019 ◽  
Vol 37 (02) ◽  
pp. 224-230 ◽  
Author(s):  
Alla Kushnir ◽  
Jennifer L. Bleznak ◽  
Judy G. Saslow ◽  
Gary Stahl
Keyword(s):  
Neonatal Intensive Care ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Time Of Day ◽  
Behavioral Changes ◽  
Neonatal Abstinence Syndrome ◽  
Abstinence Syndrome ◽  
Institutional Review ◽  
Day Of The Week ◽  
Scoring Tool

Abstract Objective Newborns exposed to drugs in utero are at risk of developing neonatal abstinence syndrome (NAS), characterized by behavioral changes and physiologic instability. Finnegan scoring tool quantifies severity of symptoms and guides treatment. This article evaluates whether time of day and the number of shift hours affects modified Finnegan scores, and the subjective component of these scores. Study Design Institutional review board-approved, retrospective chart review of newborns admitted to neonatal intensive care or transitional nursery from 2011 to 2014. Inclusion criteria: > 35 weeks' gestation, known maternal substance use, positive maternal or newborn urine, or meconium drug screen, NAS treatment. Results A total of 101 charts were evaluated. Mean treatment duration was 31.8 days (standard deviation ±18.3). There was no significant relationship between observer shift hour and high scores (> 8) (p = 0.83). Highest scores occurred in the afternoon, decreased at night (p = 0.03), and throughout admission (p < 0.0001). Weekend and weekday scores were similar (p = 0.4). The objective component of the scores remained similar throughout the day (p = 0.91) and week (p = 0.52). Conclusion Finnegan scores given by nurses were not influenced by shift hour. Time of day did not influence overall high scores or the proportion of objective to total Finnegan score. Inter-rater reliability was maintained regardless of time of day or day of the week.

Ectopic pregnancy outcomes in patients discharged from the emergency department

CJEM ◽  
2018 ◽  
Vol 21 (1) ◽  
pp. 71-74
Author(s):  
Krista Hawrylyshyn ◽  
Shelley L. McLeod ◽  
Jackie Thomas ◽  
Catherine Varner
Keyword(s):  
Emergency Department ◽  
Ectopic Pregnancy ◽  
Chart Review ◽  
Transvaginal Ultrasound ◽  
Tertiary Care ◽  
Expectant Management ◽  
Retrospective Chart Review ◽  
Missed Abortion ◽  
Ectopic Pregnancies ◽  
Rule Out

AbstractObjectiveThe objective of this study was to determine the proportion of women who had a ruptured ectopic pregnancy after being discharged from the emergency department (ED) where ectopic pregnancy had not yet been excluded.MethodsThis was a retrospective chart review of pregnant (<12-week gestational age) women discharged home from an academic tertiary care ED with a diagnosis of ectopic pregnancy, rule-out ectopic pregnancy, or pregnancy of unknown location over a 7-year period.ResultsOf the 550 included patients, 83 (15.1%) had a viable pregnancy, 94 (17.1%) had a spontaneous or missed abortion, 230 (41.8%) had an ectopic pregnancy, 72 (13.1%) had unknown outcomes, and 71 (12.9%) had other outcomes that included therapeutic abortion, molar pregnancy, or resolution of βHCG with no location documented. Of the 230 ectopic pregnancies, 42 (7.6%) underwent expectant management, 131 (23.8%) were managed medically with methotrexate, 29 (5.3%) were managed with surgical intervention, and 28 (5.1%) patients had a ruptured ectopic pregnancy after their index ED visit. Of the 550 included patients, 221 (40.2%) did not have a transvaginal ultrasound during their index ED visit, and 73 (33.0%) were subsequently diagnosed with an ectopic pregnancy.ConclusionThese results may be useful for ED physicians counselling women with symptomatic early pregnancies about the risk of ectopic pregnancy after they are discharged from the ED.

scholarly journals Appropriate Use of Vancomycin in NICU Despite Free-for-All Policy

2016 ◽  
Vol 21 (3) ◽  
pp. 207-212
Author(s):  
Benjamin M. Hammer ◽  
Allison B. Lardieri ◽  
Jill A. Morgan
Keyword(s):  
Therapeutic Drug Monitoring ◽  
Drug Monitoring ◽  
Neonatal Intensive Care ◽  
Late Onset ◽  
Retrospective Chart Review ◽  
Therapeutic Drug ◽  
Appropriate Use ◽  
Renal Outcomes ◽  
Late Onset Sepsis ◽  
Significant Difference

OBJECTIVES: Because of increases in antimicrobial resistance, the use of vancomycin in late-onset sepsis has come under scrutiny. The primary outcome of this study was to determine if vancomycin for the treatment of late-onset sepsis in the neonatal intensive care unit (NICU) was being discontinued within 72 hours according to the existing protocol. Secondary outcomes included the appropriateness of therapeutic drug monitoring associated with vancomycin, and renal dysfunction associated with the use of vancomycin in the NICU outside of the 72-hour policy. METHODS: A retrospective chart review was completed for patients in the NICU who received vancomycin for the treatment of late-onset sepsis between the dates of January 1, 2014, and July 1, 2014. RESULTS: There were 125 vancomycin treatment courses, of which 97 were included. Appropriate use of vancomycin, per policy, occurred in a total of 87 of 97 courses (89.6%). Therapeutic drug monitoring was evaluated by the number of appropriate troughs, determined using renal function and previous trough concentrations. There was not a statistically significant difference in the number of inappropriate troughs drawn between those that were continued on vancomycin appropriately (n = 17 courses; 4 of 44 inappropriate troughs) versus inappropriately (n = 10 courses; 1 of 22 inappropriate troughs; p = 0.66), despite the large number of troughs drawn. Adverse renal outcomes were not statistically significant in patients continued inappropriately on vancomycin (p = 1.0). CONCLUSIONS: Vancomycin use in the NICU for late-onset sepsis is appropriate per the existing antibiotic policy. Therapeutic drug monitoring could be improved, and adverse renal outcomes due to inappropriate continuation of vancomycin are rare.

How Aggressive Should Delivery Room Cardiopulmonary Resuscitation Be for Extremely Low Birth Weight Neonates?

PEDIATRICS ◽  
1993 ◽  
Vol 92 (3) ◽  
pp. 447-450
Author(s):  
DEBORAH J. DAVIS
Keyword(s):  
Birth Weight ◽  
Cardiopulmonary Resuscitation ◽  
Low Birth Weight ◽  
Neonatal Intensive Care ◽  
Chart Review ◽  
Medical Literature ◽  
Delivery Room ◽  
Extremely Low Birth Weight ◽  
Ethical Decisions ◽  
Birth Weight Neonate

The neonatology staff attending high-risk deliveries are often faced with difficult ethical decisions. One of these is whether or not to perform cardiopulmonary resuscitation on extremely low birth weight neonates in the delivery room. Unfortunately, there is a paucity of information in the medical literature addressing this dilemma. To determine whether guidelines for resuscitation of the extremely low birth weight neonate could be set, I undertook a chart review of all neonates born with a birth weight of 1000 g or less in our institution. METHODS All babies born at the Ottawa General Hospital who weighed 1000 g or less at birth were identified through the neonatal intensive care unit logbook, which records all births at which a neonatal physician is in attendance.

Ralstonia mannitolilytica, an unusual pathogen in the Neonatal Intensive Care Unit: a case of neonatal sepsis and literature review

2020 ◽  
Vol 20 ◽  
Author(s):  
Panagiotis Lampropoulos ◽  
Despoina Gkentzi ◽  
Sotirios Tzifas ◽  
Georgia Kapnisi ◽  
Ageliki Karatza ◽  
...  
Keyword(s):  
Premature Infant ◽  
Neonatal Sepsis ◽  
Neonatal Intensive Care ◽  
Antimicrobial Agents ◽  
Late Onset ◽  
Extremely Low Birth Weight ◽  
Respiratory Impairment ◽  
Gram Negative ◽  
Sensitivity Pattern ◽  
Resistance Patterns

Background: Premature infants are considered high-risk subgroup for neonatal sepsis due to yet defective immune system, interventions practised and synergy of factors favoring multiple resistance of Gram-positive and Gram-negative pathogens to antimicrobial agents. Case presentation: We present a case of late-onset neonatal sepsis in a premature infant caused by an uncommon pathogen; a premature infant of extremely low birth weight had in his 4th week of life severe clinical deterioration with lethargy, fever, pallor, 1 mottling, abdominal distention, tachycardia, and worsening respiratory impairment. Full septic screen was performed, broad-spectrum antibiotic therapy was initiated and supportive care per needs was provided. Blood cultures (and endotracheal tube tip cultures) isolated meropenem- and gentamicin-resistant strain of rare pathogen Ralstonia mannitolilytica. Ralstonia spp are aerobic, Gram-negative, lactose nonfermenting, oxidase- and catalase-positive bacilli, thriving in water and soil. Ralstonia spp are identified only sporadically as causative agents of neonatal sepsis; to our knowledge this is the second report of neonatal sepsis due to R. mannitolilytica in the literature so far. Our patient was eventually treated (per sensitivity pattern) with intravenous ciprofloxacin, and recovered well from the infection. Conclusion: We intend to raise awareness among neonatologists with regards to early detection of unusual pathogens, emergence of antibiotic resistance patterns, and obligation for adherence to infection control policies.

Central versus Low-Lying Umbilical Venous Catheters: A Multicenter Study of Practices and Complications

2018 ◽  
Vol 36 (11) ◽  
pp. 1198-1204 ◽  
Author(s):  
Nathalie El Ters ◽  
Colleen Claassen ◽  
Thomas Lancaster ◽  
Alan Barnette ◽  
Whitney Eldridge ◽  
...  
Keyword(s):  
Neonatal Intensive Care ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Neonatal Intensive Care Units ◽  
Central Position ◽  
Complication Rates ◽  
Conventional Teaching ◽  
Significant Difference ◽  
Hyperosmolar Solutions

Objectives Conventional neonatology practice is to place umbilical venous catheters (UVCs) in central position and to limit the use of low-lying catheters. Our objectives were to describe the practices and complications associated with UVCs and to evaluate the type of infusates used with either UVC position. Study Design A retrospective chart review was performed at four neonatal intensive care units to identify neonates who underwent UVC placement over a 2-year period. Infant demographics, UVC position, catheter days, fluid and medication characteristics, and specific complications were extracted. Results A total of 2,011 neonates who underwent UVC placement were identified during the 2-year period. Of these, 641 UVCs (31.9%) were identified in the low-lying position. Centrally positioned UVCs were associated with lower gestational age and were left in situ for a longer duration than low-lying UVCs. Infusions of hyperosmolar solutions and vasopressors were significantly higher in central UVCs, though they were used in a significant number of low-lying UVCs. Complications, while not statistically different, were three times higher in low-lying UVCs. Conclusion Despite conventional teaching, low-lying UVCs were used in nearly one-third of infants in this cohort. Parenteral nutrition, antibiotics, and vasopressors were infused through central and low-lying UVCs. There was no statistically significant difference in complication rates between UVC positions.

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