Incidence of extrapulmonary congenital anomalies with neonatal respiratory distress at Sharkia governorate

Congenital anomalies are one of the leading causes of death in infancy. Not all the disorders producing neonatal respiratory distress are primarily diseases of the lung. So the aim of this work is to find out the spot incidence of extrapulmonary congenital anomalies among neonates with respiratory distress at Sharkia Governorate. For this purpose, all neonates who presented with respiratory distress during a period of one year [from January to December, 1998] were admitted to Neonatal Intensive Care Unit, Pediatric Department, Zagazig University Hospital and were the candidate of this study. Their number was 520 newborn infants, all of them were subjected to full clinical history, thorough clinical examination and the following investigations: complete blood count, blood glucose level, serum calcium level, serum electrolyte, arterial blood gases, chest X-ray and the following investigations were done when indicated, upper gastrointestinal tract [GIT] series with contrast, ultrasonography, CT and Echo- cardiography.The results of this study show that, thirty three out of the 520 neonates with respiratory distress [6.3%] had extrapulmonary congenital anomalies [group I] while the remaining 487 neonates [93.7%] had respiratory distress due to other causes [group II]. In group I, the GIT anomalies were the most common extrapulmonary congenital anomalies with respiratory distress 16/33 [48.50%], while in group II, septicemia with or without bronchopneumonia was the most common cause of neonatal respiratory distress 236/481 [48.5%]. As regards some clinical parameters, we have found that, group I was significantly more common with vaginal deliveries, full term neonates, good moro reflexes, low birth weight neonates, and consanguineous marriages. Whereas group II was significantly more common with caesarian section, premature neonates, poor moro reflexes, normal birth weight neonates and history of maternal drug intake extrapulmonary congenital anomalies are not uncommon causes of neonatal respiratory distress. The diagnosis of these anomalies depends primarily on a high index of suspicion, careful clinical evaluation and if required, investigations according to the suspected anomalies

Effect of exchange transfusion on oxygen free radicals and some antioxidants in newborn infants

Exchange transfusion rapidly produces variable changes in pro-oxidants and antioxidants plasma concentrations in neonates which may be responsible for free radical metabolism. So our study aimed to evaluate the effect of exchange transfusion on some pro-oxidants [iron, and ferritin] and primary antioxidants [ceruloplasmin and transferrin] in newborn infants. The study included 25 neonates [16 males and 9 females] with mean gestational age of 34.4 +/- 3.9 weeks. They were divided into 2 groups according to clinical presentation, 17 with hyperbilirubinemia [6 haemolytic and 11 non haemolytic] and 8 hyperbilirubinemia with sepsis. All neonates were subjected to full clinical history, Gestational age assessment, thorough clinical examinations for all systems and laboratory investigations [before and after exchange transfusion] in the form of complete blood count, serum levels of total and direct bilirubin, serum levels of ferritin, Iron and T.I.B.C., serum level of malondialdehyde and serum levels of ceruloplasmin and transferrin.Regarding to our results, serum level of total bilirubin showed statistically highly significant decrease after exchange transfusion [E.T.] and primary antioxidant [ceruloplasmin and transferrin] were significantly elevated after E.T. As regard pro oxidants, there was highly significant decrease in serum levels of ferritin, iron and malondialdehyde after E.T. and highly significant rise in serum level of T.I.B.C. after E.T. The differences between the mean values of serum ferritin, iron, T.I.B.C., transferrin and - ceruloplasmin before and after exchange transfusion were statistically significant in preterm and neonates with birth weight less than 2kg. Transferrin showed positive correlation with gestational age.After exchange transfusion there was significant decrease in serum levels of ferritin and iron and significant increase in T.I.B.C. in both groups of neonataI hyperbilirubinemia and neonatal hyperbilirubinemia with septicemia. Serum levels of transferrin and ceruloplasmin were also increased after exchange transfusion in both groups but without significant statistical difference. Finally we can conclude that elevation of serum levels of primary antioxidants [ceruloplasmin and transferrin] and lowering serum levels of oxygen free radicals [MDA as an index] after exchange transfusion indicate its important role not only in decreasing the serum bilirubin level but also in improving the defence mechanism against oxygen free radical injury especially in preterm neonates. Preterm and neonates with low birth weight are more vulnerable to neonatal oxygen radical diseases because of their developmentally low iron associated antioxidant proteins [transferrin]