Neurological prognosis of perinatal asphyxia: a clinical and electroencephalographic study

Perinatal asphyxia complicated by hypoxic ischemic brain injury still remains the source of serious and definitive neurological lesions. To establish a relation between clinical signs, EEC and outcome of perinatal asphyxia. A cohort of 64 neonates from the Neonatal Intensive Care Unit [NICU] Faculty of Medicine, Cairo University was enrolled in a prospective study. All the newborns had at least one criteria of perinatal asphyxia. Full clinical assessment and staging was done immediately after birth and one month later. An early electroencephalogram [EEG] was carried out on seventh day of life. Multivariate analysis based on the intake variables identified hypotonia, spasticity, weak or absent crying and EEG epileptogenic activity as independent predictors of poor outcome. All patients with mild encephalopathy had normal EEG background activity. Severe stages of asphyxia were significantly associated with low amplitude background, burst suppression pattern and other forms of background abnormalities as well as non-reactivity. Epileptogenic activity in EEG of these neonates increased the likelihood of uncontrolled seizures. Our study confirms the interest of the association of clinical settings and EEG tracings in the diagnosis and the prognostic of the hypoxic-ischemic encephalopathy in neonates

effect of feeding programs on infant's health and the associated gastrointestinal troubles

The effect of regular and irregular feeding on infant's health was studied in 102 infants during the first six months of life. 24 were on regular while 78 were on irregular schedule. Gastro-intestinal problems, weight and had circumference were evaluated in both groups. Higher incidence of vomiting and diarrhoea was found in the group of infants on irregular feeding, while no significant difference between the two groups was found as regard the percent of colic, weight or head circumference

Obstructive uropathy as a cause of renal failure in paediatric care unit in Egypt

Out of 245 infants and children admitted to the Pediatric Intensive Care Unit at the New Cairo University Children's Hospital because of renal failure, 40 [16.3%] cases were identified as having obstructive uropathy. They were 32 males and 8 females ranging in age from 20 days to 13 years which indicates a great delay in recognition of the obstructive uropathy in the majority of cases. Diagnosis of obstructive uropathy, its cause and site was based on sonographic scanning, plain x-ray abdomen, intravenous pyelography [when clinically indicated], ascending cysto-urethrogram, urinalysis and blood chemistry. The different causes of obstruction were: urinary lithiasis [23 cases, 27.5%] posterior urethral valves [6 cases, 15%], bladder neck obstruction [2 cases, 5%], bilateral ureteric stricture [2 cases, 5%], pelviureteric junction obstruction [1 case, 2.5%], narrow ureteric orifices [1 case, 2.5%] and huge hydrocolpos obstructing both ureters [1 case, 2.5%]. Twenty-two [55%] patients were discharged with complete recovery of their renal function, 9 cases [22.5%] were discharged with chronic renal failure and 9 cases [22.5%] died. Our findings stress the importance of obstructive uropathy as a cause of renal failure in pediatric patients and confirm the value of ultrasound as an excellent screening procedure in such patients

Bacteriology of pneumonia in pediatric intensive care unit

The use of tracheobronchial aspirate versus throat swab in the diagnosis of bacterial pneumonia and the determination of PMNLs in lung fluid as a diagnostic tool has been investigated in this study. We found that bacterial infection is a more common cause of pneumonia than previously stated. 32 tracheal aspirates were positive on culture, representing 63.1%. Gram-ve bacilli were recovered from the trachea of 56.3% of these patients, Gram-ve anaerobes from 6.3% and Gram+ve organisms from 40.6%. 3 patients had Candida albicans. Throat swabs culture revealed pathogenic organisms in only 38.2%. The presence of high percentage [above 75% of total cells] of PMNLs on Wright's stain of tracheal aspirate from pneumonia patients correlated well with the presence of pathogenic organisms and bacterial pneumonia

Diagnostic value of electroencephalography [EEG] and electromyography [EMG] in floppy infants

Thirty seven floppy infants, their ages ranged from 6 to 20 months were examined clinically and investigated by EEG. Six causes of the floppy infant syndrome were recognized in patients under study and arranged in the order of their frequency. They were: atonic diplegia [32.4%] infantile spinal muscular atrophy, [ISMA] [21.6%] primary myopathies [16.2%] and inflammation or infection of peripheral nerves [16.2%], congenital hyperlaxity of ligaments [8.1%] and benign congenital hypotonia [5.4%]. Although a correct diagnosis could be suggested on clinical grounds in some patients, EMG and EEG are proved to be essential tools in the evaluation of floppy. They help to confirm correct diagnosis and hence provides better data for prognosis. However, there will remain very few cases in whom more invasive investigations, such as muscle biopsy, may be required. We do recommend the use of EEG and EMG in any work up for the investigation and the diagnosis of floppy infants