Ventilator modes in neonatal intensive care unit: introduction of bubble continuous positive airway pressure

The association of conventional mechanical ventilation [CMV] with the later development of bronchopulmonary dysplasia [BPD] called for trials of noninvasive modalities. The first introduction of Continuous Positive Airway Pressure [CPAP] in 1971 by Gregory et al., was followed by many other studies and different techniques. We included 81 neonates with respiratory distress syndrome [RDS] of all weights and all gestational ages. They were divided into two period groups according to the time of introduction of bubble CPAP to the Neonatal Intensive Care Unit [NICU] as 1st period [before introduction of CPAP] and 2[nd] period [after introduction of CPAP], also divided to further groups according to their birth weights. Comparing respiratory outcomes as duration of ventilation, failed extubation, duration of CPAP, duration of apnea, duration of oxygen therapy and postmenstrual age [PMA] off oxygen. The non-respiratory outcomes were also reviewed as duration of total parenteral nutrition [TPN], incidence of necrotizing enterocolitis [NEC] or intraventricular hemorrhage [IVH]. Thirty nine percent of infants in the 2[nd] period were assisted by BCPAP, whether as the only ventilatory support, after weaning from CMV or before the need for CMV or ventilator derived CPAP. Less intubations were reported in low birth weight infants [P=0.037], less surfactant was used in normal birth weights [P=0.01]. However, the duration of CPAP was longer in LBW and VLBW in 2nd period [P = 0.000 and 0.002 respectively]. Also, longer duration of O2 therapy in LBW and ELBW in the 2[nd] period [P = 0.015 and 0.032 respectively]. No significantly associated apneas, ICH or NEC. The non-respiratory outcome of both study periods in all weight groups, were similar. There was no significant difference in the incidence of respiratory complications among the different ventilation modes, and between different weight groups in both periods. No associated air leak among those assisted by BCPAP. No difference in the incidence of non respiratory complications in different ventilation modes. It was concluded that Hudson prong bubble continuous positive airway pressure therapy is a non invasive respiratory support that is promising to reduce the need for invasive mechanical ventilation of infants with respiratory distress. Institution of Early Nasal Continuous Airway Pressure [ENCPAP] as a preferred method for initial airway management seems to require time to demonstrate its optimum feasibility and efficacy

Protein C and microalbuminuria in insulin dependent diabetic children

The aim of this study was to assess one of the coagulation parameters, protein C, in insulin-dependent diabetic children and to find out its relation to the development of vascular changes manifested by microalbuminuria and to the glycemic control indices in diabetic children. The study was performed on 46 children including 24 diabetic patients with normoalbuminuria [mean age 11.2 +/- 1.9 years], 10 patients with microalbuminuria [mean age 13.5 +/- 1.23 years] and 12 healthy children of comparable age and sex with the patients as a control group. All children were subjected to full history taking, thorough physical examination, anthropometric assessment, fundus examination and laboratory investigations including a measurement of complete blood picture [CBC], fasting blood sugar [FBS], glycosylated hemoglobin [HbA1c], cholesterol [CH], triglycerides [TG], microalbuminuria and protein C [PC] levels. There was a highly significant increase in plasma PC level in diabetic children when compared with the controls and this increase was significantly more in microalbuminuric than in normoalbuminuric children. Moreover, PC level was significantly positively correlated with the duration of the disease and with other parameters and indices of diabetic control including HbA1c, CH, TG and microalbuminuria, which indicated that PC assessment could be used as a predictor of development of vascular complications as atherosclerosis and nephropathy in insulin-dependent diabetes mellitus

Procalcitonin: an early marker of neonatal sepsis after premature rupture of membranes

In order to assess the predictive value of procalcitonin [PCT] in the early diagnosis and management of neonatal sepsis following premature rupture of membranes [PROM], cord blood procalcitonin [PCT] was evaluated by radioimmunoassay in addition to complete blood count, C- reactive protein [CRP] and blood cultures in 80 newborn infants following PROM of >/24 hours and in 20 healthy comparable controls. Then, a clinical follow up of all cases was done during the neonatal period for the diagnosis of any manifestations and outcomes of infection. A highly significant mean cord blood level of PCT was detected in PROM group compared with the controls. PCT levels were positively correlated with the hematologic score for sepsis and with CRP levels. Moreover, newborns with proven infection [positive blood cultures] showed a significant higher mean PCT level than those with negative cultures and the level was markedly increased in non- survivors compared with the survivors indicating its value as both diagnostic and prognostic test. Higher sensitivity [100%] and specificity [75%] of PCT to sepsis were noted when compared with other indicators of infection; namely, hematologic score and CRP