Clinicoetiological profile, immediate outcome and short-term follow-up of term babies with hyperbilirubinemia

Background: Neonatal jaundice is a common cause of admission of newborns. Since bilirubin is potentially toxic to the central nervous system, early detection and appropriate management is of paramount importance. We therefore undertook this study with an objective to assess the causes, clinical correlation, immediate outcome and short term follow up for hearing and neurodevelopmental assessment in term babies with jaundice admitted in our NICU.Methods: This study was done in NICU in Bapuji Child Health Institute and Research center attached to JJMMC, Davangere. This study included 100 term infants admitted for jaundice during November 2013 to May 2015 and 6 months follow up of these infants for hearing and neurodevelopmental outcome was done. A proforma was used to collect relevant information.Results: Physiological jaundice (50%) and Blood group incompatibility (36%) were the most common causes of hyperbilirubinemia in the study. During a short term follow up i.e. 6 months, majority (97%) of the jaundiced infants had normal hearing and neurodevelopmental outcome except for 3 infants who had sensorineural hearing loss and BIND. In severe group the percentage of abnormal BERA and unfavourable neurological outcome was more when compared to moderate group, which was statistically significant. All the 3 infants who had abnormal BERA had developmental delay.Conclusions: Neonatal jaundice is a common cause of admission of newborns. Physiological jaundice was the commonest cause of neonatal hyperbilirubinaemia followed by blood group incompatability. Majority of the infants had normal BERA and normal neurodevelopmental outcome on short term follow up. A close association was found between BERA and neurodevelopmental outcome in the study. BERA is an useful neurophysiological tool for monitoring neurological complications, however it is not a useful tool to predict final neurological outcome

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Levels of Neonatal Thyroid Hormone in Preterm Infants and Neurodevelopmental Outcome at 5½ Years: Millennium Cohort Study

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2010-0743 ◽

2010 ◽

Vol 95 (11) ◽

pp. 4898-4908 ◽

Cited By ~ 49

Author(s):

Caroline Delahunty ◽

Shona Falconer ◽

Robert Hume ◽

Lesley Jackson ◽

Paula Midgley ◽

...

Keyword(s):

Preterm Infants ◽

Home Environment ◽

Premature Infants ◽

Thyroid Dysfunction ◽

Neurodevelopmental Outcome ◽

Millennium Cohort Study ◽

Term Infants ◽

Follow Up Study ◽

Serum T4

Context: Transient hypothyroxinemia is the commonest thyroid dysfunction of premature infants, and recent studies have found adverse associations with neurodevelopment. The validity of these associations is unclear because the studies adjusted for a differing range of factors likely to influence neurodevelopment. Objective: The aim was to describe the association of transient hypothyroxinemia with neurodevelopment at 5.5 yr corrected age. Design: We conducted a follow-up study of a cohort of infants born in Scotland from 1999 to 2001 ≤34 wk gestation. Main Outcome Measures: We measured scores on the McCarthy scale adjusted for 26 influences of neurodevelopment including parental intellect, home environment, breast or formula fed, growth retardation, and use of postnatal drugs. Results: A total of 442 infants ≤34 wk gestation who had serum T4 measurements on postnatal d 7, 14, or 28 and 100 term infants who had serum T4 measured in cord blood were followed up at 5.5 yr. Infants with hypothyroxinemia (T4 level ≤ 10th percentile on d 7, 14, or 28 corrected for gestational age) scored significantly lower than euthyroid infants (T4 level greater than the 10th percentile and less than the 90th percentile on all days) on all McCarthy scales, except the quantitative. After adjustment for confounders of neurodevelopment, hypothyroxinemic infants scored significantly lower than euthyroid infants on the general cognitive and verbal scales. Conclusions: Our findings do not support the view that the hypothyroxinemic state, in the context of this analysis, is harmless in preterm infants. Many factors contribute both to the etiology of hypothyroxinemia and neurodevelopment; strategies for correction of hypothyroxinemia should acknowledge its complex etiology and not rely solely on one approach.

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Microsurgical Lumbar Discectomy

Neurosurgery ◽

10.1227/00006123-197902000-00005 ◽

1979 ◽

Vol 4 (2) ◽

pp. 137-140 ◽

Cited By ~ 50

Author(s):

Donald H. Wilson ◽

James Kenning

Keyword(s):

Nerve Root ◽

Lumbar Disc ◽

Lumbar Discectomy ◽

Normal Anatomy ◽

Short Term ◽

Common Cause ◽

Microsurgical Technique ◽

Epidural Fat

Abstract The application of microsurgical technique to lumbar discectomy may be of dual value: minimal disruption of the integrity of normal anatomy and meticulous hemostasis may help to speed the process of convalescence, and the retention of epidural fat around the nerve root may help to prevent adhesions, a common cause of the late, “failed disc” syndrome. The authors report their experience with 83 consecutive microdiscectomies for lumbar disc protrusions. The results must be considered as tentative because the follow-up period has been short and the authors found it difficult to quantify the quality of health during the convalescent phase, although this seemed to be excellent. Their short term results are similar to those of the larger series reported by Williams, whose experience with microsurgical lumbar discectomies began 6 years ago. No other series have been reported. The authors describe their technique and compare it to that of Williams.

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New Recommendations Not Very Different from Current Practice

PEDIATRICS ◽

10.1542/peds.91.1.167 ◽

1993 ◽

Vol 91 (1) ◽

pp. 167-168

Author(s):

RICHARD J. ALLEN

Keyword(s):

Differential Diagnosis ◽

Neonatal Jaundice ◽

Current Practice ◽

Cost Effective ◽

Term Infants ◽

Specific Test ◽

Benefit Cost ◽

Unnecessary Testing ◽

Effective Analysis

To the Editor.— In the "Evaluation and Treatment of Jaundice in the Term Newborn: A Kinder, Gentler Approach," Newman and Maisels1 focus on "unnecessary testing and treatment of many jaundiced term infants."1,p809 Although "routine screening with a more specific test" was suggested for galactosemia, none was mentioned in any of the five tables. In the follow-up commentaries only one other author mentioned galactosemia in the differential diagnosis of neonatal jaundice.2 After reading these several interesting papers it is still unclear to me whether reducing the frequency of tests for neonatal jaundice or excluding individual specific tests (ie, direct bilirubin) will benefit cost-effective analysis or be "a kinder, gentler approach" for babies.

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Abstract 352: Predictive Value of Discharge Neurological Outcome Scores Following Out-of-Hospital Cardiac Arrest for Long-term Neurological Status: A Systematic Review

Circulation ◽

10.1161/circ.138.suppl_2.352 ◽

2018 ◽

Vol 138 (Suppl_2) ◽

Author(s):

Wen Yu Wu ◽

Amit Chopra ◽

Shelley McLeod ◽

Carolyn Ziegler ◽

Steve Lin

Keyword(s):

Systematic Review ◽

Cardiac Arrest ◽

Neurological Outcome ◽

Observational Studies ◽

Neurological Status ◽

Short Term ◽

Outcome Scores ◽

Hospital Cardiac Arrest

Introduction: Neurological outcomes following out-of-hospital cardiac arrest are commonly assessed using clinically validated outcome measures such as the Cerebral Performance Category (CPC) score, and are mainstay for evaluating neurological status at discharge. However, it remains unclear if these measures accurately reflect long-term neurological status after discharge. The primary objective of this systematic review was to better understand the predictive value of discharge neurological outcome scores for long-term neurological status. Methods: Comprehensive electronic searches of Medline, Embase and The Cochrane Library from inception to September 2016 were conducted and reference lists were hand-searched.Randomized controlled trials (RCT) and prospective observational studies were included. Our primary outcome was the correlation between discharge or 30 days post-arrest neurologic status and long-term ( > 3 month) neurological outcome score. Preliminary Results: After screening 4,265 titles and abstracts independently and in duplicate, 6 studies including 5 prospective observational studies and 1 RCT were included. Four studies reported long-term follow-up at 6 months post-arrest and 2 studies reported follow-up at 1 year. In the studies with 6-month follow-up, 368/450 patients (82.7%) had favourable short-term neurological scores (CPC 1-2) at discharge or 30 days post-arrest, and 352/445 patients (79.1%) had favourable scores at 6 months post-arrest. In the studies with 1-year follow-up, 67/80 patients (83.8%) had favourable neurological scores at discharge or 30 days post-arrest, and 60/80 patients (75%) patients had favourable neurological scores at 1 year. Conclusion: Long-term neurological outcome scores following OHCA were consistent with short-term outcome at hospital discharge or 30 days post-arrest. Further studies are needed to elucidate more comprehensive prognostic factors for predicting long-term neurological outcome.

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Prospective, interdisciplinary follow-up of children with prenatally diagnosed giant omphalocele: short-term neurodevelopmental outcome

Journal of Pediatric Surgery ◽

10.1016/j.jpedsurg.2009.09.004 ◽

2010 ◽

Vol 45 (4) ◽

pp. 718-723 ◽

Cited By ~ 25

Author(s):

Enrico Danzer ◽

Marsha Gerdes ◽

Jo Ann D'Agostino ◽

Judy Bernbaum ◽

Jennifer Siegle ◽

...

Keyword(s):

Neurodevelopmental Outcome ◽

Short Term ◽

Giant Omphalocele

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Short-term neurological improvement in neonates with hypoxic-ischemic encephalopathy predicts neurodevelopmental outcome at 18–24 months

Journal of Perinatal Medicine ◽

10.1515/jpm-2019-0391 ◽

2020 ◽

Vol 48 (3) ◽

pp. 296-303

Author(s):

Beate Grass ◽

Simone Scheidegger ◽

Beatrice Latal ◽

Cornelia Hagmann ◽

Ulrike Held ◽

...

Keyword(s):

Neonatal Period ◽

Comprehensive Evaluation ◽

Neurodevelopmental Outcome ◽

Unfavorable Outcome ◽

Hypoxic Ischemic Encephalopathy ◽

National Guidelines ◽

Short Term ◽

Neurological Improvement ◽

Ischemic Encephalopathy

AbstractObjectivesTo evaluate the association of short-term neurological improvement until day of life 4 in neonates with hypoxic-ischemic encephalopathy (HIE) receiving therapeutic hypothermia (TH) with neurodevelopmental outcome at 18–24 months.MethodsThis is a retrospective analysis of prospectively collected data of 174 neonates with HIE registered in the Swiss National Asphyxia and Cooling Register between 2011 and 2013. TH was initiated according to national guidelines, and Sarnat staging was performed daily. Short-term neurological improvement was defined if Sarnat stage improved from admission until day 4 of life. Standardized neurodevelopmental assessments were performed at 18–24 months. Unfavorable outcome was defined as death before 2 years of age or severe or moderate disability at follow-up.ResultsOne hundred and sixty-four of 174 neonates (94%) received TH, of those 30 (18%) died in the neonatal period (no late mortality). Eighty-one percent of the survivors (109/134) were seen at 18–24 months. Of the 164 cooled neonates, 62% had a short-term neurological improvement, and the Sarnat score remained unchanged in 33%. Short-term neurological improvement was associated with an odds ratio (OR) of 0.118 [95% confidence interval (CI) 0.051–0.271] for an unfavorable outcome at 18–24 months.ConclusionShort-term neurological improvement predicts neurodevelopmental outcome at 18–24 months in the era of TH. Clinical examination must be part of a comprehensive evaluation for prognostication in HIE.

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A Novel Aneurysm Clip Design for Atheromatous, Thrombotic, or Previously Coiled Lesions: Preliminary Experience With the “Compression Clip” in 6 Cases

Operative Neurosurgery ◽

10.1227/neu.0b013e3181f7451b ◽

2010 ◽

Vol 67 (suppl_2) ◽

pp. ons333-ons341 ◽

Cited By ~ 1

Author(s):

Eric S. Nussbaum ◽

Leslie A. Nussbaum

Keyword(s):

Endovascular Therapy ◽

Vascular Occlusion ◽

Neurological Complications ◽

Short Term ◽

Intraoperative Angiography ◽

Aneurysm Clip ◽

Complex Aneurysms ◽

Complex Lesions

Abstract BACKGROUND: Large and giant lesions often have thicker, atheromatous walls as well as intra-aneurysmal thrombus that combine to prevent traditional clips from closing properly in some cases. OBJECTIVE: To report the development and use of a novel clip design specifically tailored to treat atheromatous, thrombotic, or previously coiled aneurysms. METHODS: We retrospectively reviewed the records of 6 patients with complex aneurysms not amenable to simple neck clipping and not considered appropriate for endovascular therapy who were treated using a novel “compression” clip design. We describe the development and use of a novel aneurysm clip design with blades that are not opposed at rest to allow direct clipping of atheromatous, thrombotic, and previously coiled aneurysms. RESULTS: Four patients had recurrent, previously coiled aneurysms; one of these also had a large thrombotic component. Two patients had complex lesions with heavy atheroma involving a portion of their aneurysms. There were no complications related to the use of the clip, and all patients did well without neurological complications. In every case, the clip allowed straightforward obliteration of the aneurysm without the need for temporary vascular occlusion, aneurysmorrhaphy, or removal of an intra-aneurysmal coil mass. All patients underwent intraoperative angiography to confirm obliteration of the aneurysm with preservation of the normal vasculature. CONCLUSION: Atheromatous, thrombotic, and previously coiled aneurysms may not be treatable with simple neck clipping and may not be curable with endovascular therapy. For such cases, we designed a novel “compression” clip that has been used safely and successfully in our experience with good short-term follow-up.

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Early Acute Kidney Injury in Preterm and Term Neonates: Incidence, Outcome, and Associated Clinical Features

Neonatology ◽

10.1159/000513666 ◽

2021 ◽

pp. 1-6

Author(s):

Dario Gallo ◽

Karen A. de Bijl-Marcus ◽

Thomas Alderliesten ◽

Marc Lilien ◽

Floris Groenendaal

Keyword(s):

Acute Kidney Injury ◽

Renal Function ◽

Perinatal Asphyxia ◽

Neurodevelopmental Outcome ◽

Birth Asphyxia ◽

Kidney Injury ◽

Preterm Neonates ◽

Term Infants

Background: Critically ill neonates are at high risk of kidney injury, mainly in the first days of life. Acute kidney injury (AKI) may be underdiagnosed due to lack of a uniform definition. In addition, long-term renal follow-up is limited. Objective: To describe incidence, etiology, and outcome of neonates developing AKI within the first week after birth in a cohort of NICU-admitted neonates between 2008 and 2018. Renal function at discharge in infants with early AKI was assessed. Methods and Subjects: AKI was defined as an absolute serum Cr (sCr) value above 1.5 mg/dL (132 μmol/L) after the first 24 h or as stage 2–3 of the NIDDK neonatal definition. Clinical data and outcomes were collected from medical records and retrospectively analyzed. Results: From January 2008 to December 2018, a total of 9,376 infants were admitted to the NICU of Wilhelmina Children’s Hospital/UMC Utrecht, of whom 139 were diagnosed with AKI during the first week after birth. In 72 term infants, the most common etiology was perinatal asphyxia (72.2%), followed by congenital kidney and urinary tract malformations (CAKUT) (8.3%), congenital heart disease (6.9%), and sepsis (2.8%). Associated conditions in 67 preterm infants were medical treatment of a hemodynamic significant PDA (27.2%), CAKUT (21%), and birth asphyxia (19.4%). Among preterm neonates and neonates with perinatal asphyxia, AKI was mainly diagnosed by the sCr >1.5 mg/dL criterion. Renal function at discharge improved in 76 neonates with AKI associated with acquired conditions. Neonates with stage 3 AKI showed increased sCr values at discharge. Half of these were caused by congenital kidney malformations and evolved into chronic kidney disease (CKD) later in life. Neurodevelopmental outcome (NDO) at 2 years was favorable in 93% of surviving neonates with detailed follow-up. Conclusion: During the first week after birth, AKI was seen in 1.5% of infants admitted to a level III NICU. Renal function at discharge had improved in most neonates with acquired AKI but not in infants diagnosed with stage 3 AKI. Long-term renal function needs further exploration, whereas NDO appears to be good.

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The Link Between Verbal Short-Term Memory and Anomia Treatment Gains

American Journal of Speech-Language Pathology ◽

10.1044/2019_ajslp-18-0176 ◽

2019 ◽

Vol 28 (3) ◽

pp. 1039-1052

Author(s):

Reva M. Zimmerman ◽

JoAnn P. Silkes ◽

Diane L. Kendall ◽

Irene Minkina

Keyword(s):

Short Term Memory ◽

Controlled Trial ◽

Treatment Success ◽

Linear Regression Models ◽

Language Performance ◽

Short Term ◽

Term Memory ◽

Treatment Gains ◽

Post Hoc

Purpose A significant relationship between verbal short-term memory (STM) and language performance in people with aphasia has been found across studies. However, very few studies have examined the predictive value of verbal STM in treatment outcomes. This study aims to determine if verbal STM can be used as a predictor of treatment success. Method Retrospective data from 25 people with aphasia in a larger randomized controlled trial of phonomotor treatment were analyzed. Digit and word spans from immediately pretreatment were run in multiple linear regression models to determine whether they predict magnitude of change from pre- to posttreatment and follow-up naming accuracy. Pretreatment, immediately posttreatment, and 3 months posttreatment digit and word span scores were compared to determine if they changed following a novel treatment approach. Results Verbal STM, as measured by digit and word spans, did not predict magnitude of change in naming accuracy from pre- to posttreatment nor from pretreatment to 3 months posttreatment. Furthermore, digit and word spans did not change from pre- to posttreatment or from pretreatment to 3 months posttreatment in the overall analysis. A post hoc analysis revealed that only the less impaired group showed significant changes in word span scores from pretreatment to 3 months posttreatment. Discussion The results suggest that digit and word spans do not predict treatment gains. In a less severe subsample of participants, digit and word span scores can change following phonomotor treatment; however, the overall results suggest that span scores may not change significantly. The implications of these findings are discussed within the broader purview of theoretical and empirical associations between aphasic language and verbal STM processing.

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Anticoagulation in addition to dual antiplatelet therapy has no impact on long-term follow-up after endovascular treatment of (sub)acute lower limb ischemia

VASA ◽

10.1024/0301-1526/a000786 ◽

2019 ◽

Vol 48 (4) ◽

pp. 321-329

Author(s):

Mariya Kronlage ◽

Erwin Blessing ◽

Oliver J. Müller ◽

Britta Heilmeier ◽

Hugo A. Katus ◽

...

Keyword(s):

Endovascular Treatment ◽

Antiplatelet Therapy ◽

Dual Antiplatelet Therapy ◽

Limb Ischemia ◽

Bleeding Complications ◽

Severe Bleeding ◽

Short Term ◽

Long Term Follow Up

Summary. Background: To assess the impact of short- vs. long-term anticoagulation in addition to standard dual antiplatelet therapy (DAPT) upon endovascular treatment of (sub)acute thrombembolic occlusions of the lower extremity. Patient and methods: Retrospective analysis was conducted on 202 patients with a thrombembolic occlusion of lower extremities, followed by crirical limb ischemia that received endovascular treatment including thrombolysis, mechanical thrombectomy, or a combination of both between 2006 and 2015 at a single center. Following antithrombotic regimes were compared: 1) dual antiplatelet therapy, DAPT for 4 weeks (aspirin 100 mg/d and clopidogrel 75 mg/d) upon intervention, followed by a lifelong single antiplatelet therapy; 2) DAPT plus short term anticoagulation for 4 weeks, followed by a lifelong single antiplatelet therapy; 3) DAPT plus long term anticoagulation for > 4 weeks, followed by a lifelong anticoagulation. Results: Endovascular treatment was associated with high immediate revascularization (> 98 %), as well as overall and amputation-free survival rates (> 85 %), independent from the chosen anticoagulation regime in a two-year follow up, p > 0.05. Anticoagulation in addition to standard antiplatelet therapy had no significant effect on patency or freedom from target lesion revascularization (TLR) 24 months upon index procedure for both thrombotic and embolic occlusions. Severe bleeding complications occurred more often in the long-term anticoagulation group (9.3 % vs. 5.6 % (short-term group) and 6.5 % (DAPT group), p > 0.05). Conclusions: Our observational study demonstrates that the choice of an antithrombotic regime had no impact on the long-term follow-up after endovascular treatment of acute thrombembolic limb ischemia whereas prolonged anticoagulation was associated with a nominal increase in severe bleeding complications.

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