scholarly journals Use of Topical Nitroglycerine in the Neonatal Population Following Peripheral Tissue Ischaemia: Case Report and Updates about Safety Concerns

2021 ◽  
pp. 1-3
Author(s):  
Lama Charafeddine ◽  
Mariam Anka ◽  
Therese Saad ◽  
Christelle Tayeh ◽  
Lama Charafeddine
Keyword(s):  
Neonatal Intensive Care ◽  
Unusual Case ◽  
Tissue Injury ◽  
Vascular Occlusion ◽  
Peripheral Tissue ◽  
Efficacy And Safety ◽  
Central Lines ◽  
Critically Ill Neonates ◽  
Local Warming ◽  
Neonatal Population

Neonatal thrombosis is a well-described morbidity occurring in the neonatal intensive care unit. Critically ill neonates are most vulnerable to developing thrombosis with serious complications. Fingers and toes ischaemia secondary to vascular occlusion following central lines insertion remains an uncommon occurrence. The therapeutic approach for peripheral tissue injury using local warming, anticoagulants, thrombolytics or topical hyaluronidase showed limited benefits and potential side effects. Here we report an unusual case of finger ischaemia treated successfully using topical nitroglycerine. This complements previous reports confirming the efficacy and safety of this drug and highlighting its potential benefit in neonates.

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.

2. Peripheral injury in the rat: behavioural and neuronal correlates

1985 ◽  
Vol 308 (1136) ◽  
pp. 408-408
Keyword(s):  
Tissue Injury ◽  
Primary Afferents ◽  
Peripheral Tissue ◽  
Peripheral Injury ◽  
Induced Changes

Peripheral tissue injury alters dramatically the relation between a cutaneous stimulus and the sensation experienced by producing both a decrease in the threshold necessary to elicit pain and an increase in the pain resulting from suprathreshold stimuli (hyperalgesia). We have now investigated whether these injury-induced changes result from alterations in the properties of primary afferents (sensitization) (Lynn 1977) or whether the injury triggers a change within the c.n.s. (Woolf 1983).

Late Vascular Occlusion of Central Lines in Pediatric Malignancies

PEDIATRICS ◽  
1998 ◽  
Vol 101 (2) ◽  
pp. e7-e7 ◽  
Author(s):  
J. A. Wilimas ◽  
M. Hudson ◽  
B. Rao ◽  
X. Luo ◽  
L. Lott ◽  
...  
Keyword(s):  
Vascular Occlusion ◽  
Central Lines ◽  
Pediatric Malignancies

Evaluation, Development, and Implementation of Potentially Better Practices in Neonatal Intensive Care Nutrition

PEDIATRICS ◽  
2003 ◽  
Vol 111 (Supplement_E1) ◽  
pp. e461-e470
Author(s):  
Barbara Kuzma-O’Reilly ◽  
Maria L. Duenas ◽  
Coleen Greecher ◽  
Lois Kimberlin ◽  
Dennis Mujsce ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Neonatal Intensive Care ◽  
Outcome Measure ◽  
Implementation Strategies ◽  
Cost Savings ◽  
Nutrition Support ◽  
Evidence Based ◽  
Published Evidence ◽  
Support Practices ◽  
Neonatal Population

Objective. The desire for evidence-based clinical guidelines for nutritional support of the preterm infant has been identified. Published evidence has not yielded clear guidelines about the best method of delivery, substrate use, or appropriate outcome measure to evaluate nutrition support. In addition, reports on research of nutrition support often fail to give the most rudimentary process necessary to improve quality in various unit settings. Methods. The Vermont Oxford Network “Got Milk” focus group developed eight potentially better practices for nutrition support, implementation strategies for these practices, and a comprehensive appraisal process to measure nutrition outcome in preterm infants. Results. After implementation of the potentially better practices, all participating institutions showed earlier initiation of nutrition support, earlier attainment of adequate energy intakes, reduced delay in reaching full enteral feeds, more consistent nutrition support practice, decreased length of stay, cost savings, and improved growth at time of discharge. Conclusions. Development and implementation of evidence-based better nutrition support practices in neonates led to improved nutrient intake and growth with reduced length of stay and related costs. Consistent, comprehensive, multidisciplinary appraisal of practice is an integral component of improving nutrition outcomes in the neonatal population.

scholarly journals P.130 Canadian physician attitudes towards long term EEG monitoring in the neonatal intensive care unit

2018 ◽  
Vol 45 (s2) ◽  
pp. S50-S50
Author(s):  
SG Buttle ◽  
E Sell ◽  
B Lemyre ◽  
D Pohl
Keyword(s):  
Neonatal Intensive Care ◽  
Physician Attitudes ◽  
Eeg Monitoring ◽  
Educational Materials ◽  
Education Session ◽  
Provider Attitudes ◽  
Canadian Physician ◽  
Critically Ill Neonates ◽  
Current Monitoring

Background: Long-term EEG monitoring (LTEM), including amplitude-integrated (aEEG) or conventional EEG (cEEG), is increasingly being used in critically ill neonates. Despite an abundance of studies regarding the clinical utility of LTEM, much is unknown regarding provider attitudes toward this tool. We aimed to evaluate neurologist and neonatologist opinions regarding LTEM in the NICU and describe current Canadian practices. Methods: A 15-item questionnaire was developed with input from neonatologists and pediatric neurologists at two Canadian centres. The questionnaire was piloted at our hospital and subsequently distributed to Canadian neonatologists and pediatric neurologists. Results: All 16 local respondents use LTEM in the NICU. Neonatologists were more likely to combine aEEG and cEEG, and monitor for longer durations than pediatric neurologists. However, most pediatric neurologists would like to monitor more (71%), compared to neonatologists who were more likely to say that current monitoring practices are sufficient. High rates of neonatologists (88%) and neurologists (85%) are interested in attending an education session on LTEM. Conclusions: Preliminary data suggests neonatologists and pediatric neurologists differ in their approach to LTEM. Results from our national questionnaire will be analyzed shortly, and may inform the development of educational materials as well as future studies that involve multi-centre efforts.

Effects of halothane, ketamine and nitrous oxide on dynorphin mRNA expression in dorsal horn neurons after peripheral tissue injury

1998 ◽  
Vol 811 (1-2) ◽  
pp. 88-95 ◽  
Author(s):  
Masaaki Tanimoto ◽  
Tetsuo Fukuoka ◽  
Kenji Miki ◽  
Atsushi Tokunaga ◽  
Chikara Tashiro ◽  
...  
Keyword(s):  
Nitrous Oxide ◽  
Mrna Expression ◽  
Dorsal Horn ◽  
Tissue Injury ◽  
Peripheral Tissue ◽  
Dorsal Horn Neurons

Development of a NeuroNICU with a Broader Focus on All Newborns at Risk of Brain Injury: The First 2 Years

2018 ◽  
Vol 35 (12) ◽  
pp. 1197-1205 ◽  
Author(s):  
Elisabeth Yan ◽  
Kathi Randall ◽  
Valerie Chock ◽  
Alexis Davis ◽  
Cecelia Glennon ◽  
...  
Keyword(s):  
At Risk ◽  
Intensive Care ◽  
Brain Injury ◽  
Neonatal Intensive Care ◽  
Near Infrared ◽  
Neurologic Injury ◽  
Medical Diagnoses ◽  
Critically Ill Neonates ◽  
Video Eeg

Objective Many critically ill neonates have an existing brain injury or are at risk of neurologic injury. We developed a “NeuroNICU” (neurologic neonatal intensive care unit) to better provide neurologically focused intensive care. Study Design Demographic and clinical variables, services delivered, and patient outcomes were recorded in a prospective database for all neonates admitted to the NeuroNICU between April 23, 2013, and June 25, 2015. Results In total, 546 neonates were admitted to the NeuroNICU representing 32% of all NICU admissions. The most common admission diagnoses were congenital heart disease (30%), extreme prematurity (18%), seizures (10%), and hypoxic–ischemic encephalopathy (9%). Neuromonitoring was common, with near-infrared spectroscopy used in 69%, amplitude-integrated electroencephalography (EEG) in 45%, and continuous video EEG in 35%. Overall, 43% received neurology or neurosurgery consultation. Death prior to hospital discharge occurred in 11%. Among survivors, 87% were referred for developmental follow-up, and among those with a primary neurologic diagnosis 57% were referred for neurology or neurosurgical follow-up. Conclusion The NeuroNICU-admitted newborns with or at risk of brain injury comprise a high percentage of NICU volume; 38% had primary neurologic diagnoses, whereas 62% had medical diagnoses. We found many opportunities to provide brain focused intensive care, impacting a substantial proportion of newborns in our NICU.

scholarly journals Neonatologist performed echocardiography (NPE) in Italian neonatal intensive care units: a national survey

2019 ◽  
Vol 45 (1) ◽  
Author(s):  
Iuri Corsini ◽  
◽  
Benjamim Ficial ◽  
Stefano Fiocchi ◽  
Federico Schena ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Neonatal Intensive Care ◽  
Perinatal Asphyxia ◽  
Ductus Arteriosus ◽  
Neonatal Intensive Care Units ◽  
Formal Training ◽  
On Line ◽  
Critically Ill Neonates ◽  
Line Survey

Abstract Background Neonatologist performed echocardiography (NPE) has increasingly been used to assess the hemodynamic status in neonates. Aim of this survey was to investigate the utilization of NPE in Italian neonatal intensive care units (NICUs). Methods We conducted an on-line survey from June to September 2017. A questionnaire was developed by the Italian neonatal cardiology study group and was sent to each Italian NICU. Results The response rate was 77%. In 94% of Italian NICUs functional echocardiography was used by neonatologists, cardiologists or both (57, 15 and 28% respectively). All the respondents used NPE in neonates with patent ductus arteriosus and persistent pulmonary hypertension, 93% in neonates with hypotension or shock, 85% in neonates with perinatal asphyxia, 78% in suspicion of cardiac tamponade, and 73% for line positioning. In 30% of center, there was no NPE protocol. Structural echocardiography in stable and critically ill neonates was performed exclusively by neonatologists in 46 and 36% of center respectively. Conclusions NPE is widely used in Italian NICUs by neonatologists. Structural echocardiography is frequently performed by neonatologists. Institutional protocols for NPE are lacking. There is an urgent need of a formal training process and accreditation to standardize the use of NPE.

65: Utilization of Central Lines in Canadian Neonatal Intensive Care Units

2015 ◽  
Vol 20 (5) ◽  
pp. e57-e57
Author(s):  
R Esmaeilizand ◽  
V Shah ◽  
T Sorokan ◽  
XY Ye ◽  
K Dow
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Neonatal Intensive Care ◽  
Neonatal Intensive Care Units ◽  
Central Lines

Fetus in Fetu: An Unusual Case Study for the Neonatal Nurse Practitioner

2011 ◽  
Vol 30 (5) ◽  
pp. 313-319
Author(s):  
Natalie Mercy
Keyword(s):  
Neonatal Intensive Care ◽  
Unusual Case ◽  
Abdominal Distension ◽  
Final Diagnosis ◽  
Fetus In Fetu ◽  
Intensive Care Unit Team ◽  
Abdominal Masses ◽  
Unusual Occurrence ◽  
Severe Coagulopathy

Fetus in fetu is an extremely unusual occurrence where a rare congenital tumor containing a vertebral axis, often containing parts of other organs or limbs, is identified. Normally identified in the newborn period, the size and location of the mass may result in significant multiorgan compromise. This article presents the challenges encountered by the neonatal intensive care unit team in providing care for a late preterm female infant presenting with gross abdominal distension. Description of the case includes preoperative management along with management of severe coagulopathy and hemorrhage that arose during the intraoperative and postsurgical course of care. A brief overview of abdominal masses in the newborn is presented. The importance in determining the final diagnosis of fetus in fetu and its differentiation from teratoma is discussed.

Sign in / Sign up

Export Citation Format

Share Document