Oxygen Saturation in Neonate after Birth

Background: Oxygen saturation measures the quantity of haemoglobin in the blood that is saturated with oxygen. Hemoglobin is a component of red blood cells that binds oxygen and transports it to outlying tissues. Oxygen is commonly used throughout the world in neonatal units. Injudicious use of Oxygen may not maintain appropriate oxygen status rather can lead to hypoxemia or hyperoxemia, both of the conditions are injurious to neonatal health. Objective: To assess the oxygen saturation in neonate after birth.Methods:A cross-sectional study conducted in the Department of Neonatology BSMMU, Shahbag, Dhaka, Lab Aid Specialized Hospital, Dhaka, Bangladesh from October 2013 to March 2014. A total 317 patients were selected according to selection criteria. The parents were interviewed with a specific pre-designed and pre-tested questionnaire and some information were gathered by document review. All neonate both term and late preterm (?34weeks) who would not be anticipated for resuscitation was included.Results:A total 317 neonate were selected according to selection criteria. Among the study subjects more than half were male (57.1%). Rests were female (42.9%). Average gestational age of the study subjects was 37.47� 1.16 (SD) with the range of 34-40. On the other hand average birth weight was 2.88�46 (SD) with the minimum birth weight 2.0 kg and maximum weight 4.2 kg. Illustrates the median (IQR) heart rate from one to ten min for preterm versus term births. At one to three minutes and at five minutes after birth preterm infants had significantly lower SpO2 measurements. From six to 10 minutes after birth and four minutes after birth there was no significant difference between SpO2 measurements for mode of delivery. Paired sample t test showed that average SpO2 was less in 1 minute[88.42�8(SD)] than in 5 minute [94.25�5(SD)] and statistically this differences were highly significant (t=24.44, p=0.000). Pearson correlation showed high positive correlation (p=0.000) and correlation co-efficient r=0.479. Correlation was significant at the 0.01 level.Conclusion:It is 搉ormal� to have low oxygen saturation measurements in the first minutes after birth. It takes time for infants to reach oxygen saturation levels described as 搉ormal� in the later postnatal period. Oxygen saturation increased with time i.e., it was more in 5 minutes than in 1 minute and similarly more in 10 minutes than in 5 minutes. Conversely heart rate was found more in one minute than to five and ten minutes. Oxygen saturation was ? 90% within 3 to 4 minutes. Significant changes were found in Oxygen saturation by mode of delivery in three minutes & in heart rate by two minutes after birth. At one to ten minutes after birth preterm infants had lower SpO2 measurements.

Clinical Profile and Outcome of Neonates Requiring Mechanical Ventilation

Background: Mechanical ventilation is one of the importantadvancement which has contributed to the decline of neonatalmortality in the various parts of the world. Many sick neonatesadmitted to neonatal intensive care unit (NICU) requiremechanical ventilation for different clinical conditions but it isassociated with various complications and the outcome ofthese neonates is unpredictable.Objective: To find out the clinical conditions and immediateoutcome of neonates requiring mechanical ventilation.Methods: This prospective observational study was conductedin Neonatal Intensive Care Unit (NICU), Department ofNeonatology of Bangabandhu Sheikh Mujib Medical University,Dhaka during the period of August 2015 to July 2016.Neonates required to put on mechanical ventilation wereconsecutively enrolled. All babies were monitored for clinicalprofile and outcome as well as complications. The enrolledneonates were divided into two groups. Neonates whoremained successfully extubated for >48 hours and did notrequire re-intubation were grouped as survivors and who diedduring mechanical ventilation or within 48 hours of extubationwere grouped as non-survivors. Clinical, biochemical, ventilatorparameters and occurrence of complications were analyzed tofind out the factors associated with mortality of ventilatedneonates.Results: During the study period 53(8.6%) of admittedneonates in NICU received mechanical ventilation. Out ofthese 53 neonates 69.8% were male with male to female ratio2.3:1.Inborn babies were more (58.5%) than out born (41.5%).Mean age, gestational age and birth weight were3.58±5.45days 33.34±3.40 weeks and 1852.55±513.48grespectively. Commonest condition for initiating mechanicalventilation was refractory apnea (35.8%) followed by severerespiratory distress with Downe score >6 (20.8%) and SpO2<accepted level (17.0%). Disease pattern were sepsis (35.8%),RDS (20.8%), congenital pneumonia (18.9%), perinatalasphyxia (15.1%), meconium aspiration syndrome (3.8%), TTN(1.9%) and Meningitis (3.8%). The survival rate was 35.8%.Factors significantly different in non-survivors were meangestational age, mean birth weight, initial arterial pH, age atadmission and age at initiation of ventilation (p<0.05). Themean maximum PIP requirement was significantly higher innon-survivors (p<0.05). Hospital acquired sepsis (67.9%) wasthe most common complication during mechanical ventilationfollowed by tube block (52.8%) and ventilator associatedpneumonia (26.4%). Shock (64.2%) was the commonest comorbidity followed by dyselectrolytemia (52.8%), sepsis(35.8%) and DIC (28.3%). Hospital acquired sepsis, shock andDIC were associated with mortality (p<0.05). Shock was foundindependent predictor of mortality (p=0.001).Conclusion: The most common condition for initiatingmechanical ventilation was refractory apnea. Sepsis was thecommonest disease for which ventilation required. The survivalrate of ventilated neonates was 35.8% and percentage ofsurvival was more in babies with RDS. Hospital acquiredsepsis was the major complication of ventilated neonates.Presence of hospital acquired sepsis, shock and DIC wassignificantly high in non-survivors. Shock was found asindependent predictor of mortality.

Correlation of Transcutaneous Bilirubin with Serum Bilirubin in Term and Preterm Neonates with Jaundice

Background: Jaundice is a very common neonatal problemand contributes a lot to the admission into neonatal care unitsand hospitals. Early estimation of TcB may help identifyingneonates with significant jaundice requiring serum bilirubinestimation. This may help avoiding unnecessary estimation ofserum bilirubin by invasive method in preterm and termneonates. TcB has been practised mostly in the whitepopulation and studies in the nonwhite population is relativelyscarce. In Bangladesh, estimation of TcB is a very newapproach and not in practice in most of the centres; andinvolves only term and near-term neonates sparing pretermones.Objective: To evaluate the correlation of transcutaneousbilirubin with serum bilirubin in term and preterm neonates withjaundice.Methods: This cross sectional study was conducted in thedepartment of Neonatology, Bangabandhu Sheikh MujibMedical University (BSMMU) from September 2015 to August2016. Jaundiced neonates ranging from 28 to 42 weeks ofgestation were studied. JM-103 device and DichlorophenylDiazonium method were used to measure TcB and TSBrespectively. TcB measurements were obtained over thesternum 30 minutes prior or after blood sampling for TSB.Pearson’s correlation coefficient and linear regression analysiswere used to determine the correlation between TcB and TSB.Bland-Altman plot was used to analyse the agreement betweenTcB and TSB. ROC curve was constructed both for term andpreterm infants to determine the best cut-off values with theirsensitivity and specificity.Results: A total of 148 paired TcB-TSB readings for 102jaundiced term and preterm infants were obtained. Correlationcoefficient in total population, term and preterm neonates were0.83, 0.92 and 0.69 respectively. Bland-Altman plot showedreasonable agreement in term newborns but not in pretermbabies. Overall best sensitivity and specificity of TcB in termneonates was 90% and 73%, and in preterm neonates 65%and 60% respectively. Area under the curve for TcB was 86%in term neonates, whereas it was 63% in preterm neonates.

Infective Endocarditis by Pseudomonas Species Following Percutaneous Transluminal Mitral Commissurotomy.

Infective mitral valve endocarditis developed in a 35-year-old male patient after a percutaneous transvenous mitral commissurotomy (PTMC). The echocardiogram demonstrated vegetation in the anterior leaflet of the mitral valve and blood culture showed growth of Pseudomonas species which was sensitive to Ceftazidime, Ciprofloxacin, Cotrimoxazole and Imipenem and resistant to Amikacin, Ceftriaxone, Gentamycin and Nitilmycin. The patient underwent treatment with intravenous ceftazidime and ciprofloxacin for six weeks and patient improved significantly and got cure of the disease. Infective mitral valve endocarditis should be recognized as a potentially lethal complication after PTMC. The important measures to prevent bacteremia during PTMC and the appropriate role of antibiotics and operation are discussed

Influence of infection on iron profile in severely malnourished children.

Objective. To study the iron profile and find out an accurate diagnostic tool which reflects iron status in different types of infection in severely malnourished children aged 12 months to 71 months. Methods. Hundred and Eight (108) children of whom 72 children were infected and 36 non infected severely malnourished children according to WHO criteria in the age group of 12-71 months were interrogated. 36 healthy control in the same age group were also interrogated. Results. Mean serum iron, total iron binding capacity (TIBC), ferritin concentration in normal children were significantly higher (P<0.001) than non-infected severely malnourished children. On the other hand mean serum ferritin concentration was significantly higher (P<0.001) in infected group than non-infected group but still lower than normal. Mean serum TIBC concentration significantly reduced in severely malnourished children than normal children but no significant difference was observed between non-infected and infected group. Mean serum iron, and transferrin saturation were significantly reduced (P<0.05) in parasitic infestation. Conclusion. Severely malnourished children had reduced mean serum iron profile. Parasitic infestation influenced the marked reduction of mean serum iron concentration and transferrin saturation level. Mean serum iron concentration was reduced in acute respiratory infection(ARI) and parasitic infestation than other infections. Serum ferritin concentration was elevated in all types of infection as acute phase protein but still lower than normal. So Iron, TIBC and Transferin saturation <16% constitute good evidence for iron deficiency in both infected and non-infected severely malnourished children.

Serum lactate dehydrogenase as a prognostic marker of childhood acute lymphoblastic leukemia.

The estimation of serum lactate dehydrogenase (LDH) is easy, readily available and economic. We can assume the prognosis of childhood acute lymphoblastic leukemia (ALL) through this measurement. This case control prospective study was aimed to evaluate that the level of serum LDH has the prognostic marker of childhood ALL. The study was carried out in the Paediatric Haematology and Oncology unit, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, during the period from January to December 2006 on 69 subjects with age ranging from birth to 15 years irrespective of sex. The study subjects were grouped into case (ALL-44) and control (healthy-25). Serum LDH level were performed in ALL patients on admission, day 14 and day 29 of induction and in healthy control when came for check up and found healthy. Haematological parameters were performed in ALL patients and in healthy control along with the measurement of serum LDH. On admission the level of serum LDH was significantly raised in ALL patients than healthy control (p<0.001). After induction, serum LDH level were significantly decreased at day 14 and day 29 of induction from admission (p<0.001). There was significant rise of platelet count were observed at day 29 of induction from admission (p<0.001). A significant decrease of peripheral and bone marrow blast cell percentages were observed at day 29 of induction from admission (p<0.001). The total WBC count was significantly decreased along with serum LDH at day 14 and day 29 of induction from admission (p<0.001). So, the measurement of serum LDH can be accepted as a good and reliable prognostic marker of childhood acute lymphoblastic leukemia.

Serum lactate dehydrogenase level in childhood acute lymphoblastic leukemia.

Serum lactate dehydrogenase (LDH) level was estimated in 44 childhood (age range 1-15 years) acute lymphoblastic leukemia (ALL) on admission, day 14 and day 29 of induction. Another 25 children without ALL were included as control. On admission, the level of serum LDH was significantly high in ALL cases than control (p < 0.001). Total WBC count was significantly decreased along with serum LDH level at day 14 and day 29 of induction (p < 0.001). A significant rise of platelet count was observed at day 29 of induction in relation to significant decrease of serum LDH level (p < 0.001). A significant decrease of peripheral and bone marrow blast cell percentages were also observed at day 29 of induction along with significant decrease level of serum LDH (p < 0.001). So, the measurement of serum LDH level can be accepted as an enzymatic tool for presumption of childhood ALL and the response to chemotherapy during induction of remission.

Rickets among children of a coastal area of Bangladesh.

Many children with rachitic deformities have been reported in southern coastal area of Bangladesh but the actual rate of prevalence was not known. A survey was conducted to determine the magnitude of rachitic problem among the children of Chakaria thana of Cox's Bazar district of Bangladesh. Nine hundred children between 1-15 years selected randomly from 30 villages of total 340 villages. Face to face interview of the parents was taken and the children were examined for evidences of rickets. Serum calcium, phosphorus, alkaline phosphatase (ALP) were estimated and radiology of limbs were done in all clinically suspected cases and in a control of every eighth child. Seventy eight children (8.7%) had physical features suggestive of rickets. Fifty eight (6.4%) children had 'clinical rickekts' (positive physical feature(s) but normal ALP and negative radiology), 12 (1.3%) children had 'biochemical rickets' (positive physical features and raised ALP but negative radiology) and 8 (0.9%) children had 'confirmed rickets' (positive physical features, raised ALP and positive radiology). Out of 78 children with rachitic feature(s), Pectus carinatum was found as the most common clinical feature in 26 (33.3%) children followed by genu valgum in 23 (29.4%) cases. Twenty two normal children (2.2%) had raised level of ALP (>300U/L). The prevalence of rickets is high in children of Chakaria and further study is needed to find out the exact aetiology of rickets in children there.

Obesity management in patients with type 2 diabetes mellitus.

Obesity infrequently associated with type 2 diabetes mellitus and may cause insulin resistance, hypertension and other complications of obesity. So obesity management in Type 2 diabetes mellitus is essential. Prevention is a logical first step in the management of the obese Type 2 diabetic patient, such programs have had little long-term success. Diet, exercise and behavioral modification still form the cornerstones of treatment and relatively small weight loss results in improvement of all major obesity related co-morbidity's, including Type 2 diabetes. The obese diabetic patient faces extra impediments to weight loss, including the adverse effects of diabetic medication, poor glycaemic control and diabetes related complications. New drugs may offer some additional help, in general by providing the benefit associated with the weight loss as such, Bariatric surgery can produce major long-term weight loss in the severely obese subjects.

Infective polyneuropathy (a report of 14 cases).

Fourteen cases of infective polyneuropathy were admitted in the Institute of Postgraduate Medicine and Research, Dacca, during a period of one year. The clinical features and laboratory investigations of these patients have been recorded. The management was done as usual but particular stress was given to the use of a short course of corticosteriod to all patients. The results of treatment was satisfactory and uniform for majority of the cases.

Cerebrovascular diseases. (A report of 53 cases).

Fifty-three patients suffering from cerebrovascular disease admitted to the Neurology unit of the Institute of Postgraduate Medicine and Research, Dacca, have been analyzed. It has been observed that the age incidence, sex ratio, causes and clinical pattern of cerebrovascular diseases are similar in developed and developing countries.