Selective Bronchial Occlusion for Treatment of a Bronchopleural Fistula in an Extremely Preterm Infant

Neonatal pulmonary air leak commonly occurs as a complication of mechanical ventilation in infants with underlying hyaline membrane disease. They can commonly be managed conservatively or with the application of a chest drain, but some severe cases pose a significant challenge in finding an alternative therapeutic solution. Selective bronchial occlusion represents an unconventional rescue therapy for treating bronchopleural fistula resistant to the standard therapy. A 27-week gestation preterm infant ventilated for respiratory distress syndrome developed tension right-sided pneumothorax. Conventional modalities of treatment were tried and were unsuccessful. Intermittent selective bronchial occlusion with a Fogarty’s catheter and high-frequency oscillatory ventilation resulted in considerable improvement in the infant’s clinical condition and radiographic findings.

The Magnitude and Risk Factors of Acute Respiratory Distress Syndrome among Newborn Admitted To Neonatal Intensive Care Unit at Benghazi Medical Center

Background: Hyaline Membrane Disease (HMD)/Respiratory Distress Syndrome (RDS) is the most common lung condition affecting premature babies. The inadequate amount of surfactant causes alveoli to collapse when the baby breathes out. It is hard for your baby to re-inflate the collapsed alveoli when he breathes. The lack of surfactant and resulting inflammation is called. Hyaline Membrane Disease (HMD)/Respiratory Distress Syndrome (RDS). Aim of the Study: To determine the magnitude of Hyaline membrane disease or respiratory distress syndrome and identify the risk factors and complication among newborn babies in neonatal intensive care unit at Benghazi medical center (BMC). Materials and Methods: Case series study. The study was conducted during the period between March 2017 to March 2018 of HMD cases at Benghazi medical center. A convenient sample of 120 cases diagnosed as HMD. Studied variables include the following; gestational age, birth weight, gender, type of pregnancy and type of delivery also the data for mothers such as (diabetes mellitus, preeclampsia hypothyroidism, receiving of Dexamethasone injection and premature rupture of membrane). Also investigation and treatment and finally the outcomes of babies. Statistical Methods: Data were analyzed with SPSS version 17, analysis of associations was made with application Chi - square test for categorical variables comparison, was applied for test of association P <0.25. P was considered statistically significant if ≤ 0.05. Results: Female gender was predominant (52%). Most of cases of HMD were between 1000 -2000 kg. Among the 120 cases we have (15%) sever HMD and the majority of cases have moderate –to sever Hyaline membrane disease 39 (32.5%) whereas very sever HMD were observed in nearly 27% of cases. The risk factors were history of maternal preeclampsia, maternal diabetes mellitus, prematurity and low birth weight babies and neonatal sepsis, all these were found to be very common risk factors of HMD. Pearson chi-square test p value highly significant of female gender with complications of HMD. Our results observed more than half of babies were died. Conclusion: The risk factors were history of maternal preeclampsia, maternal diabetes mellitus, prematurity and low birth weight babies and neonatal sepsis all these were found to be very common risk factors of HMD. Also we concluded that the cases had premature rupture of membrane, which identified as risk factors of hyaline membrane disease. Furthermore, we concluded that highly significant of female gender with complications of HMD, such as Pneumothorax, bronco pulmonary, dysplasia, intra ventricular hemorrhage and congenital heart diseases were common co- morbidities with respiratory distress syndrome, all these could be have an association with the development of hyaline membrane disease, finally we observed more than half of babies were died this is a warning sign for health services.

Evidence of an active Cushing reflex in a preterm neonate with hyaline membrane disease: a case report

Background The Cushing reflex does not appear to have been described in preterm neonates. This case report shows the presence of an active Cushing reflex in a 32-week preterm neonate with hyaline membrane disease. Case presentation The 1.94 kg Caucasian infant was delivered by caesarean section following concerns about possible maternal infection and fetal compromise. Chest X-ray showed mild-to-moderate hyaline membrane disease and treatment was initiated with supplemental oxygen and nasal continuous positive airway pressure. It is probable that a pneumothorax occurred at 5–6 hours of age, with progression during the day. Interstitial air, pneumomediastinum, and tension pneumothorax were diagnosed on subsequent X-ray, and ultrasound of the brain showed a grade IV intraventricular hemorrhage. A review of the nurses’ recordings of heart rate, blood pressure, and respiratory rate showed a progressive increase in blood pressure accompanied by slowing of the heart rate and irregular respiration. These are features of the Cushing reflex that is elicited in response to raised intracranial pressure. Conclusion While well-described in older children and adults, in neonates the Cushing reflex has mainly been described in animal experiments and infants who have developed hydrocephalus. It is likely that in this case, the reflex was elicited as a result of a progressive increase in intracranial pressure due to the combination of elevated intrathoracic pressure, obstructed venous return from the brain, and concurrent intraventricular hemorrhage.

The Cost of Treating Neonates in Intensive Care Unit in a Tertiary Level Teaching Hospital

Neonatal intensive care is associated with high costs world-wide and remains a matter of financial stress for families. This is an issue of great importance in a developing country like ours as financial burden may have a negative impact in the overall outcome of a newborn. The objective of this study was to evaluate the direct cost of treating newborns by family members in a neonatal intensive care unit (NICU). This was a prospective cross sectional study carried out in the NICU of Manipal Teaching Hospital, Pokhara, Nepal. There were 96 neonates included in this study over a period of 3 months from September to November 2020. The average cost per neonate per day was NRs. 5858 (USD 50). The highest health expenditure was incurred in neonates of gestational age of 32 to less than 37 weeks, and it was also significantly higher in neonates having birth weights less than 1.5kg. Preterms with hyaline membrane disease, followed by newborns with meconium aspiration syndrome resulted in maximum health costs. Maximum expenditure of the total bill was due to the cost of the bed charges. The median length of stay in the study was 5 days and the length of stay was directly and significantly related to the treatment costs.

Enalapril and Acute Kidney Injury in a Hypertensive Premature Newborn – Should It Be Used or Not?

Extremely low birth weight infants (birth weight ≤1000 g) have a significantly lower nephron number. The glomerular filtration rate (GFR) is usually sufficient under normal conditions but is unable to meet the needs during stress, which results in acute kidney injury (AKI). We describe the case of an extremely low birth weight infant (970 g) with a gestational age of 27 weeks (immature preterm) who was mechanically ventilated because of hyaline membrane disease. AKI with anuria and a rise in serum creatinine to 3.4 mg/dL developed in the second week. Diuresis was restored after diuretics and dopamine were administered intravenously and kidney function recovered in the next two weeks. However, he slowly became hypertensive, so intravenous enalapril was introduced in the 6th week. After the third dose, he suffered another AKI. After cessation of enalapril, kidney function recovered over the next few days. Although angiotensin-converting enzyme inhibitors (ACEi) may cause kidney injury, it can be used with great caution in the treatment of hypertension or heart failure in preterm infants. There remains a real dilemma of whether enalapril should be used in extremely low birth weight immature infants.

Detection of Pneumocystis jirovecii in Hospitalized Children Less Than 3 Years of Age

Few data are available in the literature regarding Pneumocystis jirovecii infection in children under 3 years old. This retrospective cohort study aimed to describe medically relevant information among them. All children under 3 years old treated in the same medical units from April 2014 to August 2020 and in whom a P. jirovecii evaluation was undertaken were enrolled in the study. A positive case was defined as a child presenting at least one positive PCR for P. jirovecii in a respiratory sample. Medically relevant information such as demographical characteristics, clinical presentation, microbiological co-infections, and treatments were collected. The objectives were to describe the characteristics of these children with P. jirovecii colonization/infection to determine the key underlying diseases and risk factors, and to identify viral respiratory pathogens associated. The PCR was positive for P. jirovecii in 32 children. Cardiopulmonary pathologies (21.9%) were the most common underlying disease in them, followed by severe combined immunodeficiency (SCID) (18.8%), hyaline membrane disease (15.6%), asthma (9.4%) and acute leukaemia (6.3%). All SCID children were diagnosed with pneumocystis pneumonia. Co-infection with Pj/Rhinovirus (34.4%) was not significant. Overall mortality was 18.8%. Paediatric pneumocystis is not restricted to patients with HIV or SCID and should be considered in pneumonia in children under 3 years old.

A Clinical Study of Obstetrical and Perinatal Outcome In Teenage Pregnancies In Central Referral Hospital (CRH), Gangtok

Background: Teenage pregnancy can be defined as pregnancy that occurs after menarche up to the age of 19 years. It is one of the important causes of maternal as well as neonatal morbidity and mortality. There is an increased incidence of preterm deliveries in teenage girls with its associated complications in newborn such as increased incidence of hyaline membrane disease in newborn baby, anaemia of prematurity, neonatal hypoglycaemia, hyperbilirubinemia and need for neonatal intensive care unit admissions. Aims and Objectives: 1.To assess the quantum of problem of teenage pregnancy. 2. To ascertain the different risk factors associated with teenage pregnancy. 3. To evaluate outcome of pregnancy in teenage mothers. 4. Todetermine the extent and association of teenage pregnancy with poor obstetric outcome. Materials and Methods: It was a hospital based prospective case control study. All teenage pregnant patients who were admitted during the study period were included in the study and a representative group of equal number of non-teenage pregnant women who were admitted during the study period were included in the study. For statistical purposes p value less than 0.05 was taken as statistically significant. Results: The most common single complication in teenage pregnancies was found to be preterm deliveries which was seen in 15 (12%) patients followed by fetal distress (10.40%) Pre-Eclampsia (6.40%) and PROM (4.80%). Amongst non-teenage pregnancies the common complications seen were fetal distress (17.60%), PROM (8.80%). The incidence of PPH was found to be high in teenage pregnancies as compared to non-teenage pregnancies. The comparison of the neonates on the basis of incidence of low birth weight (LBW) showed that more LBW babies were born to teenage mother as compared to non-teenage pregnancies and the difference was found to be statistically significant (P<0.05). Conclusion: Teenage pregnancy is associated with increased incidence of maternal as well as neonatal complications. In additions to maternal and neonatal complications it also has an immense impact on psychosocial consequences on teenage mothers.

Fetomaternal outcome in preterm labour

Background: Preterm birth is the leading cause of infant morbidity and mortality in the world. It affects not only the immediate neonatal period but also affects infancy, childhood and even adulthood. The aim of the study was to ascertain the causes and outcome of preterm labor and delivery and also the neonatal outcome.Methods: A hospital based cross-sectional study was conducted among patients who entered the third trimester of pregnancy and diagnosed as a case of threatened preterm labor or preterm labor from September 2017 to August 2019 in the department of obstetrics & gynaecology in collaboration with department of paediatrics, Regional institute of Medical Sciences, Imphal. Detailed clinical history and socio-demographic profile were recorded in pre-designed proforma. General physical examination and systemic examination and obstetrical examination was carried out for the participants.Results: Out of 918 preterm births 88.9% of neonates between the gestation period 28 weeks and <32 weeks were admitted to NICU. 48.8% of the neonates were having low birth weight. 23.8% of neonates required NICU admission and the most common neonatal complications were sepsis (5.2%), asphyxia (4%), jaundice (4%) and hyaline membrane disease (1.7%). Apgar score significantly improved as the period of gestation increased at 5 minute and 10 minutes (p=0.006 and p<0.001 respectively). The overall mortality among preterm births was 8.1% and only 3.7% neonatal deaths were seen in gestational age 34 weeks to <37 weeks, whereas 24.1% and 22.2% mortality were seen in 32 weeks to <34 weeks and 28 weeks to <32 weeks of gestation (p=<0.001).Conclusions: Preterm infants are at high risk for overall morbidity and mortality compared with term infants. Proper antenatal care, clinical suspicion, early detection and correction of risk factors, institutional delivery and good neonatal care facilities can improve the outcome of preterm labour.

The burden of hyaline membrane disease, mortality and its determinant factors among preterm neonates admitted at Debre Tabor General Hospital, North Central Ethiopia: A retrospective follow up study

Background Hyaline membrane disease (HMD) is a leading cause of morbidity and mortality in preterm newborn babies. Though, there are studies related to Hyaline membrane disease inclusive of all neonates, studies related to the burden among preterm neonates were limited. In addition, increasing neonatal mortality in Ethiopia could be related to increase in the burden of hyaline membrane disease among preterm neonates. Therefore, this study was aimed to assess the burden of hyaline membrane disease, mortality and its associated factors among preterm neonate admitted at neonatal intensive care unit, North Central Ethiopia. Methodology An institution-based retrospective follow-up study was conducted among 535 preterm neonates admitted at neonatal intensive care unit from January 1, 2014-December 30, 2017. Data were entered into EPi-data 4.2.0.0 and transferred to STATA version 14 statistical software for statistical analysis. Binary logistic regression was used for the analysis. All variables with P-value < 0.25 during bi-variable analysis were considered for multivariable logistic regression. Level of statistical significance was declared at P value ≤0.05. Results In the current study, proportion of hyaline membrane disease was 40% (95% CI; 35.8, 44.3) of which 49.5% died. Preterm neonate born with Gestational age of less than 34 weeks of age (Adjusted odd ratio (AOR = 2.64; 95 CI: 1.49, 4.66)), 5th minute Apgar score less than 7 (AOR = 2.2; 95% CI: 1.20, 4.07), and newborn with birth weight of less than 1500 gram (AOR = 2.4, 95% CI: 1.3, 4.3) were predictors of hyaline membrane disease. Conclusions The mean gestational age (±) was 33.46 (±2.55) weeks. The incidence of hyaline membrane disease among preterm admissions was high. Preterm neonate born with gestational age of less than 34 weeks of age, asphyxiated newborns and newborn with birth weight of less than 1500 gram were predictors of hyaline membrane disease. So, emphasis should be given on early screening, follow up and timely interventions for preterm neonate.