value of functional echocardiography in the management of mechanically ventilated neonates

Background: Functional echocardiography [ECHO] for the neonates is a targeted bedside cardiovascular ultrasound that aiming to clinical evaluation and management of the current neonatal hemodynamic changes

Objective: This prospective follow up study aimed at assessment of the hemodynamic changes in mechanically ventilated neonates, determination of the correlation between ventilation settings and fECHO

Methods: fifty mechanically ventilated neonated due to non-congenital respiratory problem underwent fECHO after 24 hours of mechanical ventilation. Thirty neonates continued on mechanical ventilation and were available to 48 hours of fECHO follow up

Results: A 24 hours fECHO examination showed; highly significant negative correlation between the right ventricular output [RVO] and the peak inspiratory pressure [PIP] and mean airway pressure [MAP] [P value < 0.01] and significant negative correlation with positive and expiratory pressure [PEEP] [P value < 0.05]. A significant negative correlation between the left ventricular output [LVO] and the MAP [P value < 0.05]. A highly significant negative correlation between superior vena cava flow [SVC] flow and PIP and MAP [P value < 0.01], while no significant correlations found at 48 hours fECHO examination [P value >0.05]. A 24 hours fECHO examination showed 14 patients had significant patent ductus arteriosus [PDA]. There was highly significant increase [P value < 0.05] in LVO, and highly significant decrease [P value< 0.01] in SVC flow of significant PDA patients more than non-significant PDA or closed patients

Conclusion: fECHO is an extension of the bedside clinical assessment for neonatal hemodynamic changes, it assisted in many decision taking such as closure of significant PDA, surfactant replacement therapy, increasing total fluid intake, management of pulmonary hypertension

Assessment of splanchnic hemodynamics in neonates at risk of necrotizing enterocolitis

It has been suggested that either acute or chronic intestinal ischemia may play a primary role in the initiation of mucosol injury and subsequently the development of necrotizing enterocolitis [NEC]. Hence, this study aimed at assessment of gut blood flow in neonates at risk of developing NEC and to determine whether a disturbance in splanchnic perfusion could provide not only a pathophysiological basis for the development of NEC but also a mechanism linking a variety of seemingly disparate risk factors. Addingly, changes in splanchnic circulation with increasing postnatal age were evaluated. Duplex pulsed Doppler ultrasound was used to study changes in gut blood flow velocities during the first week of life in neonates at risk of developing NEC admitted to NICU of Obsteric and Gynecology Department, Ain Shams University Hospitals. This case-control study comprised 127 neonates [61 males and 66 females], their mean gestational age was 35.0 +/- 4.3 weeks and their mean birth weight was 2.35 +/- 0.63 kg. They were classified into 4 groups : 2 control groups [preterms [n=21] and fullterms [n=41]] and 2 patient groups recognized as being at risk of developing NEC [at risk preterms [n=30] and at risk fullterms [n=35]]. They were subjected to history taking, clinical examination, laboratory investigations relevant to the diagonosis on admission, radiological evaluation including chest and abdominal x-rays and echocardiography. Duplex pulsed Doppler ultrasound was used to determine blood flow velocities in coeliac axis [CA] and superior mesentric aretry [SMA] in all studied groups. Subjects were studied on the first, second, third, and seventh days of life. The results of the current study showed that the mean peak systolic velocities [PSVs] in the SMA were lower in the at risk groups than in the control groups on all 4 days of measurements [p<0.001]. In contrast to the SMA, PSVs of CA increased significantly in the at risk groups compared to their controls [p<0.001]. The ratio of PSV in the CA to that in the SMA, an index of relative downstream resistance in the SMA, was significantly greater in the at risk groups than in the control groups on days 1, 2 and 3 [p< 0.001]. PSVs of SMA tended to increase over the first week of life in control groups. On the other hand, the increase in PSVs of SMA was delayed in the at risk groups In conclusion, these data demonstrate that neonates at risk of developing NEC have abnormal gut blood flow velocities and splanchnic perfusion is severely compromised. Hence, alteration in the splanchnic circulation may be an important factor in the final common pathway of different risk factors of NEC and the liver could be considered as the fourth preferential organ for arterial blood supply in the compromised neonate, besides heart, brain and adrenals. Therefore, serial Doppler measurements are mandatory for early detection and prediction of NEC

Lipofuscin; a new lipid peroxidation marker among jaundiced neonates with oxygen free radical induced diseases

This study was an attempt to investigate the lipid peroxidation represented by lipofuscin in correlation to some serum antioxidants levels such as vitamins A and E, ceruloplasmin and bilirubin in jaundiced neonates suffering from oxygen free radical induced diseases [ORD] in comparison to a control group. This case-control study was conducted in the NICU, Gynecology and Obstetric Department, Ain Shams University Hospitals in the period from December 1999 to January 2002. This study included 107 jaundiced neonates diagnosed as necrotizing enterocolitis, chronic lung disease, hypoxic-ischemic encephalopathy and neonatal sepsis [ORD Patients group]. They were classified into two subgroups: subgroup I, [51 term and preterm babies] with non pathological level of bilirubin i.e not needing interference and subgroup II, [56 newlyborn term and preterm infants] with pathological level of bilirubin i.e needing interference. One hundred and seven apparently healthy neonates were enrolled in this study as a control group. The results of this study revealed that the mean serum levels of vitamins A and E, ceruloplasmin, and hemoglobin were highly significantly decreased while, the mean serum lipofuscin and bilirubin levels were highly significantly increased in the ORD patients group compared to controls [p

Effect of some antimicrobials on endotoxin release in gram-negative sepsis

This study was conducted on seven groups of rats: Group 1 included a normal control group, group 2 included E. coli infected untreated rats, group 3 included infected, cefotaxime-treated [90 mg/kg] rats, group 4 included infected, gentamicin-treated [7.2 mg/kg], group 5 included infected, clindamycin-treated [27 mg/kg], group 6 included infected, cefotaxime- and clindamycin-treated rats and group 7 included infected, gentamicin- and clindamycin-treated rats. In all groups, mean arterial blood pressure, heart rate, temperature and lethality percentage were measured and blood samples were collected at 0, 3, 6, 12 and 24 hours from the antimicrobial injection. While, blood cell [WBCs] count, tumor necrosis factor-alpha [TNF-alpha], interleukin-6 [IL-6] and erythropoietin plasma levels were measured. It was concluded that antimicrobials resulting in lower amounts of free endotoxin may be more efficacious in treating Gram-negative sepsis. Also, in order to reduce the mortality during treatment of sepsis by Gram-negative E. Coli, a focus should be done on both reduction of endotoxin production and killing of bacteria. Regimen with the combination of bactericidal antimicrobial and a protein synthesis inhibitor, which offers the advantage of potent antimicrobial activity with an inhibition of endotoxin synthesis, may be an alternative to therapy by antimicrobial producing large amounts of endotoxin during its bactericidal action

Balloon dilatation of cradiac achalasia in children

Surgical treatment of cardiac achalasia in children is still the main line of treatment with a success rate of 70-80%. Balloon dilatation is less widely used due to inappropriate size of balloons. The authors report their experience in 11 children with cardiac achalasia over the last 3 years using balloon dilatation as the first line of treatment. There were 8 boys and 3 girls -with ages ranging from 1.5-14 years [average 7.5 years]. One family presented to us [brother and sister] but with no glucocorticoid deficiency or other anomalies, one patient had mental retardation otherwise the rest had no associated anomalies.All Patients presented with vomiting, 7 with dysphagia, 6 with loss of weight, 5 with recurrent chest infection and 2 with retrostenal pain. Radiological diagnosis was accurate in all patients, endoscopy with biopsy were done to confirm diagnosis and exclude other pathology, manometry was confirmative in 4 patients. Dilatation was done under fluoroscopic control, balloons were used over a guide wire [balloon size were 18-35 mm]. Seven patients had 2 sessions and 4 had 3 sessions with radiological follow up after the second dilatation. Follow up ranged from 6 months to 3 years: excellent results were achieved in 8 pateints [72.7%] with disappearance of symptoms and marked radiological improvment, 2 still have mild symptoms with over all success of [90.9%] one has mild gastroesphageal reflux controlled medically and one has mild dysphagia but better than before dilatation. One pateint had recurrent dysphagia necessitating cardiomyotomy [9.1%]. Results were not related to age and sex. the authors recommend balloon dilatation in children with achalasia as the first line if not the definitive line of treatment