Prenatal Diagnosis of congenital diaphragmatic hernia improves the postoperative outcome: a local experience

To date, uniform standards for congenital diaphragmatic [CDH] management have not existed. This study was to compare infants with congenital diaphragmatic hernia [CHD] who had undergone a prenatal diagnosis to those who had not undergone such diagnosis. Sixteen infants with CDH who were admitted to the neonatal intensive care unit [NICU] of Suez canal university hospital from December 2000 to August 2004 were prospectively studied. They were classified into two groups; group I including 7 infants who were prenatally diagnosed as CDH by serial ultrasound scans. In group II: 9 infants were diagnosed as having CDH after birth with no prenatal diagnosis. Special care for respiration and resuscitation was performed for all patients in the two group according to a special resuscitation protocol. After stabilization and resuscitation, surgical intervention was done under special anesthetic care. The outcome of the morbidity and mortality in both groups were studied and statistically evaluated. The mean gestational age was 37. +/- 1.05 weeds in group I in contrast to 35.18 +/- 2.7 weeks in group II. [P=0.04] and the mean birth weight was 2.5 +/- 0.8 kg in group I in contrast to 2.1 +/- 1.3 in group II. All infants required mechanical ventilation. In group I, the mean gestational age at prenatal diagnosis was 26.5 weeks. The lung area head circumference ratio [LHR] ranged from 0.36 to 0.23. associated abnormalities in group I included ventricular septal defect, atrial septal defect, polyhydramnios, premature rupture of membrane and preterm labor. In group I, the overall survival rate was 4 patients out of 7 [57.1%] in group II, 2 infants out of 9 survived with a survival rate of 22.2% with a statistically significant difference. Prenatally diagnosed infants with CDH have a better survival rate and a less morbidity compared with those who have not undergone this diagnosis

Antibiotic prophylaxis before vs after cord clamping during cesarean section: reflection on maternal and neonatal sepsis

To compare rate of infection among c-sectioned women who were administered a single antibiotic dose before cord claming to those administered the same dose after cord claming. To determine the rate of early and late sepsis/infection among their born infants. A randomized double blinded clinical trial of 80 women undergoing cesarean section. The study compared 2 groups of c-sectioned women, both groups were administered a single dose of Ampicilin/sublactam. Group I n=40 was administered the antibiotics before cord clamping [BCC] and group II n=40 after cord clamping [ACC]. Follow up of both mothers after delivery and their born infants continued for 6 weeks. Wound infection occurred among 5% in group I compared to 12.5% in group II, while urinary tract infection occurred among 2.5% in group I compared to 5% in group II, P=0.42 and P0.56 respectively. Two cases of positive blood cultures were detected among the ACC group compared to one case of the BCC group. A mean CRP of 4.3?3.7 was reported among infants of group I [BCC], compared to 13.8 +/- 2.5 among infants of group II [ACC], p<.05. treatment for sepsis based on clinical suspicion and pneumonia among infants born to mothers of the ACC group was more frequent compared to the BCC group. Conclusion: there was a trend of decreased rate of infection among both mothers and infants if the mothers received prophylaxis antibiotics before cord clamping during c-section