Head size at brith in neonates with transposition of great arteries and hypoplastic left heart syndrome

Appropriate fetal brain growth depends upon the cerebral blood flow [CBF]. Different congenital heart defects [CHDs], due to the difference in anatomy and physiology, alter the intrauterine CBF. Thus, variable brain growth is expected in different CHDs that is reflected by variability in the head circumference [HC] at birth. The present study was carried out to compare the HC of babies born with transposition of great arteries [TGA] and hypoplastic left heart syndrome [HLHS] in comparison to normal control. The data on the HC of neonates with TGA and HLHS were extracted from the computer database then compared with the control group. During the period from January 1996 to December 2003, a total of 7396 neonates were admitted, out of which 639 [8.6%] were admitted with the diagnosis of the CHD. After correcting for gestational age and non-availability of HC measurements, 236 infants were excluded. Out of the remaining 403 term appropriate for gestational age [AGA] infants, 46 had TGA while 28 had HLHS. The control group comprised of a total of 74 term AGA infants. The mean HC for the control group was noted to be 34.4 +/- 1.7 centimeters [cms], 33.7 +/- 1.5 cms for TGA while it was 32.9 +/- 1.3 cms for HLHS. The head size at birth for newborn with HLHS was significantly smaller than the TGA [p=0.03] and control group [p=0.001]. Similarly, HC of TGA group was significantly smaller than the control group [p=0.02]. The newborns with TGA and HLHS are found to have significantly small head size at birth. The clinical significance of this finding with respect to the neurodevelopmental outcome and value of early antenatal intervention to repair these defects remains to be evaluated in further studies

Pulmonary hypertension in neonates: does the cause influence the outcome?

To determine the influence of the cause of pulmonary hypertension in neonates on overall outcome. Design: Analytical study. Place and Duration of Study: Special Care Baby Unit [SCBU] at Royal Hospital in Muscat, Sultanate of Oman, from July 1998 to June 2003. Patients and All neonates with the diagnosis of pulmonary hypertension, based on history, clinical examination and 2-D echocardiogram were reviewed with respect to the cause of hypertension [primary or secondary], birth weight, Apgar score, gender, inborn/ outborn and outcome. According to the outcome, neonates were divided into two groups, group A [survived] and group B [expired]. Both groups were compared for described variables using Statistical Package for Social Sciences, version 7.5 for Windows and Epi Info version 6. Out of 37 neonates with pulmonary hypertension, Group A comprised of 22 neonates while group B had 15 neonates, giving a mortality of 40% [15/37]. The mean birth weight between the two groups showed no significant differences, 3088 +/- 479 gram and 2962 +/- 454 gram, p =0.42, respectively. Similarly, no difference in the one and five Apgar scores were noted, 4.9 +/- 2.1 and 4.7 +/- 1.3, p = 0.73 and 7.4 +/- 1.5 and 6.7 +/- 1.4, p = 0.16, respectively. The place of birth had also no significant influence on the outcome, however, the cause of pulmonary hypertension was noted to be significantly associated with the outcome, p=0.004. The cause of pulmonary hypertension in neonates does influence the survival. Primary pulmonary hypertension in neonates was noted to be associated with poor outcome as compared to secondary pulmonary hypertension

Use of nasal intermittent positive pressure ventilation to avoid intubation in neonates

Nasal intermittent positive pressure ventilation [NIPPV] has widely been used in neonates to prevent extubation failure and apnea. This pilot study was carried out to look at the early use of NIPPV to avoid intubation. The study was carried out over a period of 3 months from August 2003 to October 2003 at the Royal Hospital, Muscat, Sultanate of Oman. The neonates with clinical signs of moderate to severe respiratory distress were given a trial of early NIPPV based on the avoid-intubation protocol. Inclusion, exclusion and failure criteria with general procedure were made clear to all medical and nursing staff and the protocol was posted in the unit for further time to time referral. A total of 16 neonates met the inclusion criteria for early NIPPV trial. Out of these, 13 [81%] had a successful NIPPV. The mean age of entry was 0.95 hours; however, the mean duration of NIPPV was 23 hours. No NIPPV related complications were noted in the study group. We concluded that NIPPV is an appropriate mode of ventilation in neonates requiring respiratory support. The major advantage of NIPPV is the non-invasive mechanics. It is also less expensive and less labor intensive. Further randomized controlled trials with larger sample size are warranted to confirm our findings

Growth centiles for Omani premature infants born at 26 weeks of gestation

The present growth chart used in the Sultanate of Oman does not contain centile measurements for infants born at 26-weeks of gestation. With the increased survival of these premature infants, there is a growing need to develop such a chart. The present study was conducted with the aim to look at the anthropometric measurements [weight, length and head circumference] of Omani premature infants born at 26-weeks of gestation and to develop centile charts for these measurements. The study was conducted at the Special Care Baby Unit [SCBU] of the Royal Hospital, one of the major perinatal institutions in Muscat, Oman. A computerized database is maintained for all the admissions from 1996. We extracted the required anthropometric data for all 26-week gestation premature Omani infants admitted to SCBU from January 1996 to November 2003. A total of 49 babies were admitted during that period. Out of these, 43 had complete information on the growth parameters, including birth weight, length and head circumference. These parameters were noted down and by using the statistical package, an analysis was performed to get the normal distribution curve. By using the Microsoft Excel program, graphs were generated for all the 3 growth parameters. The mean birth weight for the premature infants born at 26-week gestation was noted to be 908 +/- 156 grams, with length and head circumference of 33.5 +/- 2.5 and 24.5 +/- 1.7 centimeters. The normal distribution curve was obtained with minimal skewing. We were able to generate centile charts of the anthropometric measurements for Omani infants born at 26-weeks of gestation. The next step is to collect the national data from other institutions in Oman and then incorporate it into the present growth chart to make the charts more valid, reliable and applicable