Evaluation of pulse oximetry in the early detection of cyanotic congenital heart disease in newborns

Background: Delayed or missed diagnosis of critical and cyanotic congenital heart disease [CHD] in asymptomatic newborns may result in significant morbidity and mortality. The aim of this study was to determine the accuracy of pulse oximetry screening performed on the first day of life for the early detection of critical and cyanotic CHD in apparently normal newborns

Methods: This cross-sectional study used postductal pulse oximetry to evaluate term neonates born between 2008 and 2011 with normal physical examinations. Functional oxygen saturation < 95% was considered abnormal, and second measurement was done 2 hours later. If the second measurement remained < 95%, an echocardiogram was performed. On enrolment in the study, the following data for each neonate were recorded: gestational age, gender, birth weight, mode of delivery, and mother's age

Results: During the study period, totally 3,846 newborns were evaluated. Of the whole study population, 304 [7.9%] babies had a postductal functional saturation < 95%. The second measurement was also < 95% in 104 [2.7%] neonates. The mean age of the neonates at the time of pulse oximetry was 18.91 +/- 8.61 [min = 4.5 and max = 49] hours. Forty-nine percent of the subjects were female and 51% were male. Echocardiography was performed on 81 out of 104 newborns, and 14 [0.36%] of them had CHD. The types of CHD in our patients were tetralogy of Fallot [3 cases], transposition of the great vessels [2 cases], double-outlet right ventricle [2 cases], truncus arteriosus, total anomalous pulmonary venous return, atrioventricular septal defect, pulmonary atresia, persistent pulmonary hypertension, ventricular septal defect, and atrial septal defect [1 case for each type]. The best time for pulse oximetry was within 8-24 hours of the newborns' life

Conclusion: Pulse oximetry screening along with clinical examination may be able to assist in the early detection of critical and cyanotic CHD in asymptomatic newborns

Candida albicans interface infection after deep anterior lamellar keratoplasty.

The clinical features of interface Candida keratitis after deep anterior lamellar keratoplasty (DALK), may imitate rejection or crystalline keratopathy. We report here an 18-year-old woman presented with red eye, 4 months after undergoing DALK. Slit lamp examination revealed keratic precipitates (KPs) and cojunctival injection. She was prescribed corticosteroid treatment for endothelial rejection by another ophthalmologist because of misdiagnosis, but suffered a recurrence of symptoms after reduction of the corticosteroid treatment. At that time, she was referred to our office. The recurrence persisted despite antibiotic and antifungal therapies. Ten days after treatment with interface irrigation with amphotericin, the infiltration and hypopyon were resolved. Topical steroid was added after 3 months of antifungal monotherapy. Irrigant cultures confirmed the presence of Candida albicans. The corneal graft appeared semi-clear with no signs of infection at 17-month follow-up. We recommend a close follow-up and a timely intervention to prevent the need for more invasive treatment such as penetrating keratoplasty.

Neonatal mortality risk assessment in a neonatal intensive care unit [NICU]

This study aims to assess the utility of a scoring system as predictor of neonatal mortality rate among the neonates admitted within one year to the neonatal intensive care unit [NICU] of the Children's Medical Center in Tehran, Iran. Data were gathered from 213 newborns admitted to the NICU from September 2003 to August 2004. In addition to demographic data, Apgar scores at 1 minute and 5 minutes, history and duration of previous hospital ization, initial diagnosis and final diagnosis, and scoring system by using the score for the neonatal acute physiology-perinatal extension II [SNAP-PE II] were carried out within 12 hours after admission to the NICU. All of the parameters were prospectively applied to the admitted newborns. The exclusion criteria were discharge or death in less than 24 hours after NICU admission. 198 newborn infants met the inclusion criteria. The mean and standard deviation [SD] of the variables including postnatal age, birth weight, SNAP, and finally Apgar scores at 1 minute and 5 minutes of neonates under this study were 7.6 [0.5] days, 2479.8 [29.4] grams, 21.6 [1.1], 7.47 [0.08], and 7.71 [0.06], respectively. Twenty five of the 198 patients died [12.6%]. Gestational age [p=0.03], birth weight [P=0.02], Apgar score at 5 minutes [0.001], and SNAP-PE II [P=0.04] were significantly related to the mortality rate. By Analyzing through logistic regression to evaluate the predictive value of these variables in relation to the risk of mortality, it was shown that only SNAP-PE II and Apgar score at 5 minutes could significantly predict the neonatal mortality. According to this study SNAP-PE II and Apgar score at 5 minutes can be used to predict mortality among the NICU patients. SNAP-PE II score had the best performance in predicting mortality in this study. More studies with larger samples are suggested to evaluate all of the above-mentioned parameters among neonates who are admitted to NICUs countrywide