ABSTRACT
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
ABSTRACT
Abdominal sonography may be of great value in the evaluation and early detection of sequel of neonatal sepsis. A significant number of neonates develop clinical signs compatible with necrotizing enterocolitis, cholecystitis but with inconclusive plain radiographs, which may result in delayed, inappropriate or unnecessary therapy. Therefore, this prospective study is an attempt to assess the abdominal ultrasonographic abnormalities in neonatal sepsis, correlate it with the clinical findings and evaluate its impact on the early diagnosis of sequel of neonatal sepsis. This study was conducted on 56 consecutive neonates [36 males and 20 females] with sepsis admitted to the NICU of the Obstetrics and Gynecology Department, Ain Shams University Hospitals. Their mean gestational age was 34.0 +/- 4.5 weeks; their mean birth weight was 2.2 +/- 0.530kg. All patients were subjected to history taking, clinical evaluation, laboratory investigations and radiological evaluation, including plain chest and abdominal x-rays as well as abdominal ultrasonographic examination. The study showed that 59% of patients had hepatomegaly, 25% had splenomegaly, and 7% had ascites. Specific findings of necrotizing enterocolitis [NEC] were detected in 14 patients [25%], while gall bladder abnormalities per se were detected in 57% of septic patients. Mixed abdominal ultrasonographic findings were recorded in 20 cases [35.71%]. Specific findings of NEC included pneumatosis intestinalis [17.9%], thickened intestinal wall [25%] and air in portal vein [7.14%]. As regards gall bladder affection the following sonographic abnormalities were detected: thickened gall bladder wall [28.5%], biliary sludge / mud [17.9%], pneumobilia [7.14%] and hydrops [3.57%]. Risk factors for developing NEC included sepsis, prematurity, total parentral nutrition [TPN], umbilical vein catheterization and birth asphyxia. The most frequent risk factors for gall bladder affection were sepsis, nothing per [NPO], TPN, blood or blood products transfusion as well as mechanical ventilation. In conclusion, NEC, gall bladder affection and hepatosplenomegaly are complications of neonatal sepsis in NICU and could be detected early by ultrasound examination prior to plain radiography. Abdominal ultrasound is a simple, quick, easy and cost effective method, therefore it is recommended to be used for the evaluation and follow up of septic infants in NICU
ABSTRACT
Background: Asthma is now recognized as an eosinophil mediated inflammation of the airways. Pulmonary function tests are less easily performed in young children. So, measuring markers of eosinophil activation is of special importance in pediatric practice
Objective: This study aimed at evaluating the role of eosinophil protein X [EPX] as a marker for assessment of asthma attack severity and control of the exacerbation. Methods: Serum EPX was measured in 35 asthmatic Egyptian children aged between 7 and 10 and 35 age and sex matched healthy children using radioimmunoassay technique [RIA]. Asthmatic patients were graded according to severity of the attack into mild, moderate and severe and the measurement was performed during and after the resolution of acute asthma attack. In addition, complete hemogram, total serum IgE, arterial blood gases and stool analysis were performed and peak expiratory flow rate [PEFR] was assessed in asthmatic children during and after acute exacerbation
Results: Serum concentrations of EPX, total serum IgE and absolute eosinophilic count [AEC] were significantly higher in asthmatic children than healthy controls [P<0.001]. Serum EPX and AEC were significantly higher in all studied groups before treatment compared to the corresponding levels of the same patients after treatment [P<0.001]. Total serum IgE was significantly higher only in mild and moderate asthma before treatment [P<0.001]. Serum EPX level was significantly elevated among patients with severe attacks [84.70 +/- 7.18 micro g/L] than those with moderate attacks [67.2 +/- 5.31 micro g/L] and patients with mild attacks [53.47 +/- 11.47 micro g/L][P<0.001]. It was negatively correlated to PEFR measurement during attacks [r=-0.75, P<0.05]. A significant reduction in serum EPX and AEC was observed after the resolution and improvement of pulmonary function. Meanwhile, total serum IgE decreased after treatment with the resolution of asthma attack, yet it remained significantly higher than that of controls [P<0.001]
Conclusion: Our findings support the concept that EPX may be implicated in the pathogenesis of asthma and highlights its importance in monitoring the severity and control of asthma exacerbation. Hence, it might represent an objective guide of treatment efficacy