Predictors of neonatal mortality in intensive care unit in children's Hospital, Cairo University

Variations in mortality rates are important because they permit inferences about quality of care. Examination of care practices associated with variations in mortality rates can provide insights into how care practices might be changed to improve outcomes. The purpose of this study is to determine and report important causes of admission, incidence and causes of death for a large group of infants admitted to our neonatal intensive care unit [NICU]. The study comprised all 826 infants admitted to our tertiary-level NICU from April 2003 to October 2004. Data of newborns admitted to the NICU were analyzed retrospectively. Overall, the most prevalent indications of admission to our NICU were neonatal jaundice [n=296 [35.8%], infection [n=186 [22.5%], prematurity [n=162 [19.6%]], hypoxic-ischemic encephalopathy [HIE] [n=101[12.2%]], respiratory distress syndrome [RDS] [n=79 [9.6%], congenital heart disease [CHD] [n=44 [5.3%]], transient tachypnea of the newborn [TTN] [n=40[4.8%]], chromosomal or congenital anomalies [n=40[4.8%]]. The overall mortality rate was 29.1% [240 deaths]. The mortality rate was 69.4% for infants with birth weight less than 1000 g. 2.1% of the deaths = [n=5] occurred within the first 24 hours of NICU admission, 15.8% [n=38] within 2 days and 29.2% [n=70] within 3 days, and 91.3% [n=219] within 12 days. Only 8.75% of deaths [n=21] occurred after the fist month of NICU admission. The most prevalent conditions associated with death in The NICU were infection [135deaths [56.25%], RDS [64 deaths [26.7]], HIE [45deaths [18.8%], CHD [25 deaths [10.4%] and chromosomal or congenital anomalies [18 deaths [17.5%]]. Sex was not a significant predictor of death on multivariate analysis. Mortality rate in the NICU still unacceptably high, these results highlight the fact that many causes of neonatal deaths may be preventable

Pulmonary function tests in patients with systemic lupus erythematosus [SLE]

Systemic lupus erythematosus [SLE] is and autoimmune disorder which primarily affects females. It may affect virtually any organ. Abnormalities of pulmonary function have been found in children with SLE even in absence of clinical or radiological evidence of pulmonary involvement. It is unknown whether these abnormalities represent an early sign of progressive lung disease or whether they associated with disease activity. The aim of our study was to investigate the frequency of pulmonary involvement in childhood SLE and to find the relationship between pulmonary function tests and other parameters of the disease. Our study included 70 patients with SLE; pulmonary manifestations were present in 36 patients with a percentage of 51.4%. All patients with pulmonary affection whether clinical or radiological were subjected to pulmonary function tests [PFT]. These included forced vital capacity and forced expiratory volume during first second. Among those 36 patients, restrictive pulmonary function was present in 22 patients [31.4%]. A significant statistical relation was detected between pulmonary function and C3 only [p value 0.4%]. Abnormalities of pulmonary function may be found in children with SLE even in absence of radiological evidence of pulmonary involvement and it is not related to other parameters of disease activity. So, it is recommended to perform pulmonary function tests even in absence of radiological evidence of pulmonary involvement to establish a diagnosis and aid long term follow up of SLE patients with acute lupus pneumonitis and diffuse interstitial lung disease which has a major impact on the mortality and morbidity of SLE patients. Studies to demonstrate the efficacy of PFT in diagnosing pulmonary involvement in SLE patients even in absence of clinical pulmonary manifestations are needed

Late-onset neutropenia in neonatal intensive care unit in children's Hospital, Cairo University

Neutropenia, defined as absolute neutrophil count [ANC] <1500/mm[3], affects 6% to 58% of premature infants in the first week of life. This early-onset neutropenia in premature infants has previously been correlated with sepsis, maternal hypertension, severe asphyxia, and periventricular hemorrhage. Late-onset neutropenia, defined as ANC <1500/mm[3] at a postnatal age of =3 weeks, has been recently reported. The purpose of this study is to determine the prevalence of late-onset neutropenia in low birth weight [LBW] infants and to examine the factors that may be associated with this phenomenon.The study comprised 150 premature infants who were admitted to our tertiary-level neonatal intensive care unit[NICU] from August 2003 to June 2004. A weekly complete blood cell count [CBC] was performed routinely at day 1, and then weekly until discharge in all premature infants with birth weight =1500 g [n=86] who survived until discharge. Late-onset neutropenia was detected in 18 infants [21%]. In both neutropenic [n=18] and nonneutropenic infants [n= 68], ANC increased postnatally, remained above 5000/mm[3] for the first 3 weeks of life, and had a marked decrease at 4 weeks of age. Thereafter, ANC decreased to a level of 1300/mm3 in the neutropenic infants and 4000/mm[3] in the nonneutropenic infants. The neutropenic infants had a significantly lower hemoglobin, than did the nonnentropenic infants with similar platelet counts. None of the study infants received erythropoietin during their hospitalization. This late-onset neutropenia occurred at postnatal age of 4.5 +/- 1.8 weeks [range: 3-10 weeks]. The duration of neutropenia was 1.2 +/- .7weeks [range: 1-3weeks]. The neutropenic infants were stable, growing on full oral feedings, and had no signs or symptoms of sepsis. No adverse effects of late-onset neutropenia were apparent in these infants. Late-onset neutropenia appears to be a benign condition that is not associated with any particular complication and does not require specific treatment. Reference ranges after the early neonatal period and during the first few months of life in LBW and VLBW infants should probably be set at lower values

Retinopathy of prematurity: incidence and risk factors

Improved survival of low birth weight, premature babies have increased the incidence of retinopathy of prematurity [ROP]. ROP is a bilateral vasoproliferative retinopathy affecting preterm or low birth weight babies, which sometimes progresses to cause visual impairment or blindness. The purpose of this study is to highlight the magnitude of the problem due to ROP in Egyptian preterm babies and to define risk factors associated with ROP. The study was performed at Research Institute of Ophthalmology and different neonatal intencive care units[NICUs] participating in the study during the period from April 2004 to March 2005. The study population included 68 infants, infants were divided into 2 groups, group I included 43 infants who were reffered for Ophthalmological consultation and group II included 25 infants who were examined during their presence in different neonatal intensive care units. Included were infants with birth weight of less than 1500g or with gestational age of 32 weeks or less, as well as selected infants between 1500g and 2000g who were belived to be at high risk. Multiple variables for ROP positive and ROP negative infants were compared. Data of patients were analyzed retrospectively,patients were examined by indirect Ophthalmoscopy once, scheduling of follow-up examinations were determined by the findings at the first examination using the international classification of ROP. Of the total infants examined,20 [29.4%] were ROP positive. Statistically significant risk factors included: lower gestational age, lower birth weight, sepsis,seizures, intraventricular hemorrhage, higher number of days on ventilator, and twin births, There was no correlation between the sex of the infant and the risk of developing ROP. The total number of days on oxygen did not reach statistical significant. The present study clearly highlights the magnitude of the problem due to ROP in Egyptian preterm babies. Prematurity and low birth weight remains on the top of the list of risk factors for developing ROP. These risk factors are difficult to control, The most practical recommendation would be proper screening of infants at risk for early detection and treatment.We suggest that indirect Ophthalmoscopy should be performed in all preterm babies weighing = 1500 g, beginning first at 4 weeks postnatal age. Screening should be intensified in the presence of factors like apnea, oxygen administration and septicemia