Point of Care Neurosonogram in Neonates - Utility and Prognostic Value

2019 ◽  
Vol 2 ◽  
pp. 1
Author(s):  
Bhushita Lakhkar ◽  
M. M. Patil ◽  
Bhavana Lakhkar ◽  
Bhushan Lakhkar
Keyword(s):  
Neonatal Intensive Care ◽  
Point Of Care ◽  
Color Doppler ◽  
Periventricular Leukomalacia ◽  
Birth Asphyxia ◽  
Common Finding ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Doppler Study

Objective The study aimed to utilize the neurosonographic findings in neonates in early diagnosis, prediction of their long-term outcome, parental counseling, and early intervention. Methods The study was carried out in neonatal intensive care unit (NICU) of Shri BM Patil Medical College and Hospital. All preterms and term babies with neurological clinical findings were included in the study. Neurosonogram was done within first 7 days in preterms and when indicated in terms. Philips HD11XE ultrasound and color Doppler unit were used with a small footprint probe. Color Doppler images for vessels were performed for screening of vascular changes. Results A total of 215 babies were included, of which 80 (32%) were term and the rest were preterm. Mean weight of term babies was 2.8 kg and that of preterm was 1.2 kg.Among term babies, 78% showed ultrasound abnormality, and among preterm, 42%showed abnormalities. Among term babies, 60% and, among preterms, 30% had birth asphyxia. Periventricular leukomalacia was the most common and earliest finding followed by thalamic hyperechogenicity and intracranial hemorrhage. Intraventricular hemorrhage was more common in preterm babies. Other common finding in NICU was meningitis which was more common in pretrms. Among congenital anomalies, corpus callosal agenesis was more common. Conclusions Point of care ultrasonography along with Doppler study is very useful and safe to use in NICUs. It helps in diagnosis, patient management as well as prediction of many short- and long-term outcomes.

Long Term Follow-Up of Pediatric SCD Patients with Abnormal High Velocities on Transcranial Doppler: Monocenter Experience in Creteil, France.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 1656-1656
Author(s):  
Francoise Bernaudin ◽  
Suzanne Verlhac ◽  
Lena COIC ◽  
Emmanuelle Lesprit ◽  
Pierre Brugieres ◽  
...  
Keyword(s):  
Stroke Risk ◽  
Color Doppler ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Vascular Abnormalities ◽  
Long Term Follow Up ◽  
Risk Patients ◽  
Selection Of

Abstract Abnormal high velocities are predictive of high stroke risk which can be significantly reduced by transfusion program (Adams and al). They are related to stenosis, severe anemia or tissue hypoxia. We hypothesized that high velocities observed in patients with normal MRA and normalized on transfusion program (TP), were anemia related and could be safely decreased with hydroxyurea (HU)-therapy. Patients and Methods: since 1992, 291 pediatric SCD patients (235 SS, 40 SC, 3 Sb0, 11 Sb+) were systematically explored once a year by TCD. The newborn screened cohort (n=149) had the first TCD exploration between 12 and 18 months age. TCD was performed with a real-time imaging unit, using a 2 MHz sector transducer with color Doppler capabilities. When abnormal high velocities (defined as mean maximum velocities > 200 cm/sec in MCA, ACA or ICA) were observed, TCD was controlled and the patient treated with TP and cerebral imaging (MRI/MRA) was performed within 3 months. In patients with severe stenosis, TP was pursued or transplantation performed. In patients with normal MRA and transfusion-normalized velocities, a progressive switch towards HU therapy was applied and TCD controlled once a trimester. Results: among the stroke-free patients (n=281), abn. high velocities were detected in 25 patients (all SS:11% of incidence in SS patients). In the newborn screened population, velocities became abnormal in 10 patients at the median age of 5.7 years (range 1.4 – 12.5 y). The first MRI/MRA (n=24/25) performed in the 3 months following the detection of high velocities showed MRI/silent infarcts in 9/24 (38%): only 1/11 among the newborn screened cohort had silent infarcts in contrast with 8/13 older patients secondary referred in our center. MRA detected severe vascular abnormalities in 10 and mild in 3 patients. Mean velocities (2.69 m/sec) were significantly higher (p=0.002) in the 7 patients with abn. MRI and MRA than in the 10 patients (2.11m/sec) who had normal MRI and MRA. One stroke occurred in a very young 1.6 y old girl just before the second TCD evaluation (first abn. TCD had been observed at 1.5 y) and before the beginning of the TP. Long-term outcome: no stroke was observed following the initiation of the TP. With a median follow-up of 4.4 years (0.5 to 11.4 y.), velocities remained abnormal in 11/25 patients: 7 of them had abnormal MRA and among the 4 patients with normal MRA at first exploration MRA became abnormal in 2 cases showing that abnormal TCD can precede the occurrence of cerebral vasculopathy. TP was maintained in 7 patients and safely stopped in 4 patients transplanted with genoidentical donor. Velocities normalization (defined as < 170 cm/sec) was observed in 13/25 patients in a median delay of 0.75 years (0.25 – 2.3 years). TP was stopped in 10 patients with normal MRA and therapy was switched towards HU in 7 patients with abstention in 3. However, abnormal TCD relapsed in 4 patients who were again placed on TP. Conclusion: abnormal high velocities concerned 11% of SS patients and were predictive of MRA and MRI lesions occurrence. TP was efficient to prevent the stroke risk and normalized velocities in about 50% of patients but relapses were observed in 4/7 patients following TP stop and HU switch. Only few patients with high velocities history did not develop cerebral vasculopathy. Also, early TCD allows a selection of very high risk patients justifying the research of suitable donors.

scholarly journals Newborn Individualized Developmental Care and Assessment Program (Nidcap) Terhadap Hasil Jangka Panjang Perkembangan Bayi Prematur: Suatu Telaah

2013 ◽  
Vol 16 (3) ◽  
pp. 161-167
Author(s):  
Defi Efendi ◽  
Yeni Rustina
Keyword(s):  
Intensive Care ◽  
Preterm Infant ◽  
Neonatal Intensive Care ◽  
Long Term Results ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Developmental Care ◽  
Assessment Program ◽  
Developmental Disturbance

AbstrakNeonates Intensive Care Units (NICU) merupakan tempat penting untuk bayi prematur yang sekaligus merupakan tempat berbahaya akibat karakteristik NICU. NICU dapat meningkatkan risiko gangguanperkembangan bayi. Gangguan ini dapat dicegah melalui penerapan asuhan perkembangan. Newborn Individualized Developmental Care and Assessment Program (NIDCAP) merupakan metode asuhan perkembangan yang dianggap sebagai salah satu pendekatan terbaik dalam pemberian asuhan perkembangan dengan pertimbangan NIDCAP mampu memberikan pelayanan secara individual berdasarkan isyarat bayi dengan pendekatan perawatan berfokus keluarga. Pengukuran efektifitas NIDCAP didasarkan pada respon neurobehavioral bayi prematur saat berada di NICU. NIDCAP terbukti dapat memperbaiki pola tidur bayi, dan respons fisiologis bayi seperti saturasi oksigen, pernafasan, dan nadi. Hasil studi literatur menunjukkan bahwa asuhan perkembangan dengan menggunakan metode NIDCAP tidak berpengaruh terhadap hasil perkembangan bayi prematur jangka panjang. Studi dan pengkajian yang mendalam diperlukan untuk menemukan asuhan perkembangan dengan menggunakan metode yang lebih efektif dan efisien.Kata Kunci: Bayi prematur, hasil jangka panjang, Newborn Individualized Developmental Care and Assessment Program (NIDCAP)AbstractA Review: Newborn Individualized Developmental Care and Assessment Program (NIDCAP) to Development of Long-Term Results Premature Infants. Neonatal Intensive Care Unit (NICU) is both vital spot for preterm infant and also dangerous spot which caused by NICU’s characteristics. NICU increases the risk of infant developmental disturbance. Infant developmental disturbance can be prevented by implementing Developmental care in NICU setting. Newborn Individualized Developmental Care and Assessment Program (NIDCAP) is method who beingregarded as one of the best approach for delivering developmental care with those consideration NIDCAP is able to give an individual service base on the infant cues trough family-centered care approach. The measurement of NIDCAP effectiveness is shown by the infant’s neurobehavioral response in the NICU. NIDCAP can repair the baby’s sleep-awake pattern, and her physiological response such as oxygen saturation, respiration rater, and hearth rate. This study show that the implementation of developmental care using the NIDCAP method doesn’t affect to the long-term outcome for the preterm infants. The further research is needed to find out the other developmental care method which is more effective and efficient.Keywords: Long-term outcome, Newborn Individualized Developmental Care and Assessment Program (NIDCAP), preterm infant.

Laparoscopic pyeloplasty for UPJ obstruction with crossing vessels: contrast-enhanced color Doppler findings and long-term outcome

Urology ◽  
2002 ◽  
Vol 59 (4) ◽  
pp. 500-505 ◽  
Author(s):  
Ferdinand Frauscher ◽  
Guenter Janetschek ◽  
Andrea Klauser ◽  
Reinhard Peschel ◽  
Ethan J Halpern ◽  
...  
Keyword(s):  
Color Doppler ◽  
Laparoscopic Pyeloplasty ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Upj Obstruction ◽  
Contrast Enhanced ◽  
Crossing Vessels

scholarly journals Precision Treatment in ACS–Role of Assessing Fibrinolysis

2021 ◽  
Vol 10 (5) ◽  
pp. 929
Author(s):  
Ying X. Gue ◽  
Young-Hoon Jeong ◽  
Mohamed Farag ◽  
Nikolaos Spinthakis ◽  
Diana A. Gorog
Keyword(s):  
Thrombus Formation ◽  
Point Of Care ◽  
High Cardiovascular Risk ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Coronary Syndrome ◽  
Antiplatelet Medication ◽  
Endogenous Fibrinolysis

Despite advancements in pharmacotherapy and interventional strategies, patients with acute coronary syndrome (ACS) remain at risk of recurrent thrombotic events. In addition to an enhanced tendency to thrombus formation, impairment in the ability to naturally dissolve or lyse a developing thrombus, namely impaired endogenous fibrinolysis, is responsible for a major part of this residual risk regardless of optimal antiplatelet medication. Global assessment of endogenous fibrinolysis, including a point-of-care assay, can identify patients with ACS at persistent high cardiovascular risk and might play an important role in allowing the personalisation of potent antithrombotic therapy to enhance fibrinolytic status, providing precision treatment of ACS to improve long-term outcome.

scholarly journals ETIOLOGICAL PROFILE OF NEONATAL SEIZURES WITH SPECIAL REFERENCE TO BIOCHEMICAL ABNORMALITIES

2019 ◽  
Vol 8 (6) ◽  
Author(s):  
Gurdeep Singh Dhanjal ◽  
Vikramjot Singh ◽  
Gurnoor Singh
Keyword(s):  
Seizure Activity ◽  
Early Recognition ◽  
Birth Asphyxia ◽  
Neurological Dysfunction ◽  
Neonatal Seizure ◽  
Neonatal Seizures ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Biochemical Abnormalities

Introduction: Neonatal seizure are the most frequent manifestation of neurological dysfunction in a neonate.  Detection of seizure and its etiology is important for guiding therapy. In the presence of biochemical abnormalities, it is difficult to control seizures and there is a risk of further brain damage. Early recognition and treatment of biochemical abnormalities are essential for optimal management and satisfactory long term outcome. The aim was to determine the etiology of neonatal seizures and to study the biochemical abnormalities. Material and Methods: The present study included 70 inborn neonates presenting with seizures admitted to the neonatal unit in MMIMSR, Mullana, Ambala, Haryana, India over a period of one and a half years. A detailed history was taken and clinical examination of the neonate was done. Etiological causes and various biochemical parameters were evaluated. Results:  Neonatal seizures occurred more commonly in males. The most common cause of neonatal seizures was birth asphyxia seen in 26 (37.1%) neonates followed by sepsis in 24 (34.3%) neonates. The Primary Biochemical abnormalities were seen in 12 (17.1%) neonates with seizures. Among these neonates, hypoglycemia was most commonly seen in 4 (33.3%) neonates followed by hypocalcemia seen in 3 (25%) neonates. Conclusion: Biochemical abnormalities are common in neonatal seizures and often go unrecognized. These abnormalities may significantly contribute to seizure activity and hence a biochemical workup is necessary for all cases of neonatal seizures.

scholarly journals Perspectives of time: a qualitative study of the experiences of parents of critically ill newborns in the neonatal nursery in North Queensland interviewed several years after the admission

BMJ Open ◽  
2019 ◽  
Vol 9 (5) ◽  
pp. e026344 ◽  
Author(s):  
Susan Ireland ◽  
Robin A Ray ◽  
Sarah Larkins ◽  
Lynn Woodward
Keyword(s):  
Grounded Theory ◽  
Qualitative Study ◽  
Neonatal Intensive Care ◽  
Neonatal Unit ◽  
Large Area ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Extremely Preterm ◽  
Eastern Australia

DesignA qualitative study informed by grounded theory principles to explore the experiences of parents who had extremely preterm or babies with antenatally diagnosed life-threatening diagnoses who were cared for in a regional tertiary neonatal unit. The study was conducted when the child was old enough to be diagnosed with long-term neurodevelopmental or medical sequelae.SettingNorth Queensland is a large area in Eastern Australia of 500 000 km2, which is served by one tertiary neonatal unit.ParticipantsSeventeen families representing 21 extremely preterm babies and one baby with congenital malformations who was not expected to survive prior to delivery (but did) were interviewed using grounded theory principles. Interviews were coded and themes derived.ResultsParents who recollect their neonatal experiences from 3 to 7 years after the baby was cared for in the neonatal intensive care described negative themes of grief and loss, guilt and disempowerment. Positive enhancers of care included parental strengths, religion and culture, family supports and neonatal unit practices. Novel findings included that prior pregnancy loss and infertility formed part of the narrative for parents, and hope was engendered by religion for parents who did not usually have a religious faith.ConclusionsAn understanding of both the negative aspects of neonatal care and the positive enhancers is necessary to improve the neonatal experience for parents. Parents are able to contextualise their previous neonatal experiences within both the long-term outcome for the child and their own life history.

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