Early nasal continuous positive airway pressure in preterm neonates with Respiratory Distress Syndrome.

Objective: To assess the effectiveness of early nasal Continuous Positive Airway Pressure (nCPAP) in preterm neonates with respiratory distress syndrome (RDS). Study Design: Cohort study. Setting: Department of Neonatology, The Children’s Hospital and Institute of Child Health, Multan. Period: September 2018 to June 2020. Material & Methods: A total of 172 neonates admitted to neonatal intensive care unit (NICU), having RDS with gestational age as 28 to 34 weeks were enrolled. All study participants were administered early nCPAP (within 6 hours of onset of RDS). All babies with RDS were evaluated using Silverman–Anderson (SA) score, blood gas analysis and pulse oximetry. Results: Out of a total of 172 neonates, most, 91 (52.9%) were mal, nourished 89 (51.7%) had gestational age between 31 to 32 weeks and 97 (56.4%) with birth-weight between 1000 to 1500 grams. Majority of the neonates, 97 (56.4%) were found to have radiological grading of RDS as moderate. Successful outcome of early nCPAP was observed in 143 (83.1%) neonates. There was no statistical difference in terms of nCPAP outcome among study participants with respect to gender (p=0.4990). Gestational age, birth weight and severity of radiological grading of RDS were significantly associated with outcome of nCPAP (p <0.00001). Arterial blood gas parameters as PO2, PCO2 and HCO3 were also significantly associated with nCPAP outcome among study participants (p<0.0001). Conclusion: Early Nasal CPAP is safe, inexpensive and effective means of respiratory support in neonates with RDS. Early nasal CPAP is useful especially in mild to moderate grade RDS.

Freehand external ventricular drain insertion – is there a learning curve?

Background: Accuracy of freehand insertion of external ventricular drains (EVDs) is influenced by many factors including etiology and presence of midline shift. We sought to assess if junior neurosurgical trainees’ performance in accurately inserting EVDs improves with experience, using a radiological grading system. Methods: EVD insertion procedures from the first 3 years of training were identified from the operative logbooks of three trainees. Postoperative CT head scans were graded for accuracy of placement and intraventricular catheter length. Results: 40 frontal EVDs performed primarily by the trainees were identified, after 34 assists, revision surgeries, parietal, or occipital insertions were excluded from the study. The mean number (±1 SD) of procedures was 7.7 ± 4.5 at ST3, 4.7 ± 2.5 at ST2, and 1 ± 1 at ST1. About 80% of EVDs were optimally inserted. There was no statistically significant difference in placement accuracy between the three training grades (P = 0.669), nor any difference in intraventricular catheter length (P = 0.697). There were no statistically significant differences between surgeons’ accuracy at each grade. Conclusion: We report good accuracy of EVDs tip position inserted by junior neurosurgery trainees. Trainees perform more procedures independently as they progress in their career. Further studies including senior years of training performance, other procedure factors and outcome should be considered.

Doctrine of head injury sequelae

In this article, we provide the definitions of “sequelae” and “complications” of traumatic brain injury (TBI). We have developed the classification principles for TBI consequences and described their clinical forms and morphological substrates. We also provide a radiological grading for assessing the severity of sequelae of focal and diffuse brain injuries. The article covers conceptual approaches, technologies, and results of their application related to leading surgically significant consequences of TBI, including carotid cavernous fistulas, chronic subdural hematomas, post-traumatic hydrocephalus, long-term basal liquorrhea, and skull defects. We have developed the doctrine of sequelae of TBI.