Fetal thoraco-abdominal lymphangioma: a case report

Lymphangiomas are rare congenital malformations of the lymphatic system. Authors present a case with giant, septated, axillary thoraco-abdominal lymphangioma. Diagnosis was made at 19 weeks’ gestation by antenatal ultrasonography. The case underwent prenatal expectation treatment.

Cesarean Section and Urinary Tract Infection Correlation with Bronchiolitis in Lebanese Hospitalized Children between One Month and Two Years Old.

Background: Bronchiolitis of infancy is a clinically diagnosed respiratory condition presenting with breathing difficulties, cough, poor feeding, and irritability and, in the very young, apnea. Objective: To determine the effect of cesarean section and UTI on bronchiolitis in children aged 2 months to 2 years. Design: Retrospective population-based data linkage cohort study of 202 cases in Rafic Hariri University Hospital (RHUH) and Makassed University Hospital (MUH). Methods: We reviewed retrospectively and studied prospectively the charts of the bronchiolitis hospitalized children between one month and two years in RHUH and MUH between 2011 and 2012 and continued prospectively until 2013. We studied: age, date of admission, type of delivery, gestational age, presence of UTI, screening and investigations done, related congenital diseases. The UTI is considered only when urine culture is positive. The type of delivery also mentioned. Results: Our study showed that 48% of bronchiolitis patients were born by cesarean section delivery compared with spontaneous vaginal delivery, these children had increased risk of admissions for bronchiolitis with (OR 2.71; CI 95%) and 10.16% of all patients had UTI. Conclusion: Physicians and expectant parents need to be made aware of this additional risk of elective cesarean sections and associated infant morbidity to aid in deciding the most appropriate mode of delivery. In infants and children with bronchiolitis continue to have a clinically important rate of UTIs.

Allergic Rhinitis in Children with Asthma: A Questionnaire Based Study in Lebanon.

Introduction: Allergic rhinitis and asthma frequently coexist but has rarely been evaluated in Lebanese children. Aim: This prospective study aimed to estimate the prevalence of allergic rhinitis in asthmatic children in Lebanon, and to ascertain whether allergic rhinitis is a risk factor for the severity of asthma. Patients and Methods: Parents of 124 children aged 1-13 years admitted to the pediatric floor of the Makassed General Hospital between July 2008 and March 2009 and diagnosed as having asthma; parents were interviewed and followed up with a questionnaire concerning allergic rhinitis symptoms and signs with para-clinical data if available. The questionnaire was based on a study done in France by Hammouda et al. (2005). This was modified from an adult score for allergic rhinitis (SFAR). Results: This well recognized score defines the association of allergic rhinitis and asthma in children. A score of ³ 9 out of 17 total score corresponds to the presence of allergic rhinitis in asthmatic children. The prevalence of allergic rhinitis was recognized in 67 patients out of 124 (54%). This prevalence was evident mainly in the age group 3-5 years. Conclusion: Allergic rhinitis is prevalent in children of the Lebanese population, the severity of asthma was found to be clearly associated with allergic rhinitis. The SFAR modified for children was found to be a simple and reliable tool to detect allergic rhinitis in asthmatic children.

A Quality Improvement Program to Reduce Central Line Associated Blood Stream Infections in Neonates.

Introduction: Late onset sepsis is a common problem among neonatal intensive care unit (NICU) population with central venous catheter (CVC) being the primary source of infection in the majority of the cases. Central line associated bloodstream infections (CLABSIs) have been significantly reduced by care bundles implanted in NICUs. This study is conducted to detect the overall CLABSI rate, by comparing the rate per 1000 line days in the pre-intervention to that in the post-intervention periods, to prove that change could be attributed to the quality improvement bundles. Methods: This was a retrospective observational study. It included all patients with central line inserted at NICU of MGH from January 2012 to February 2014 and compared these patients with historical cohort from 22 months of 2010 and 2011. Specific interventions were designed for the central line related practices. Specific interventions according to CDC recommendations emphasize best practices in all areas of central line care: reduction of line entries, aseptic entries into the line, and aseptic procedures when changing line components. Results: Overall, CLABSI rates, in our NICU, declined significantly by 57.3% from 15 CLABSI per 1000 central line days in the pre-intervention period to 6.4 CLABSI in 1000 central line days in the post-intervention period (P<0.05). Significant reductions in CLABSI rates were noted for neonates with birth weight less than <1000g and neonates between 1001 g and 1500 g during the postintervention period, compared with the CLABSI rates for neonates from pre-intervention period. Conclusion: We found that our efforts didn’t result in a decrease in the use of CVC among neonates. Hence, central line utilization rate was not associated, in our study, with CLABSI risk. Our quality improvement effort was successful in significantly reduced CLABSI rates. The majority of our success can be linked to educational efforts based on pertinent and timely data and literature.

Respiratory Syncytial Virus: Prevalence and Features among Hospitalized Lebanese Children.

Background: Respiratory Syncytial Virus (RSV) is an important cause of acute respiratory tract infections among infants and children requiring hospitalization. No data is available concerning RSV epidemiological and demographic characteristics among Lebanese children. Methods: This is an observational comparative retrospective and prospective study including two RSV seasons from October 2012 till March 2014 conducted at Makassed General Hospital, Lebanon. RSV rapid antigen detection test (Respi-Strip) was used for detection of RSV in nasopharyngeal wash swabs collected from all children 0 to 13 years with acute respiratory symptoms admitted at our hospital. Enrolled patients were divided according to age group and Respi-Strip results. Clinical presentation, risk factors, management interventions, course in hospital and severity parameters were compared between the different groups. Results: Among the 443 patients enrolled in the study, 98 (22.1%) were RSV positive. RSV was mostly found among younger ages (P<0.0001). Younger ages were most likely to present with moderate or severe respiratory distress (P=0.014). Patients with RSV had a more severe course during hospitalization in all parameters (P=0.0001). However, both groups received same management during their stay including bronchodilators, α-adrenergic, steroids and antibiotics despite the latest AAP guidelines. Conclusion: Respiratory Syncytial Virus is major cause of hospitalization among Lebanese children. It has a severe course even in previously healthy children and thus, immunoprophylaxis should be highly stressed on by clinicians.

Effect of Instituting a Hospital Pre-discharge Bilirubin Screening on Subsequent Significant Hyperbilirubinemia in Term and Near Term Newborn.

Background: Neonatal Jaundice is a common disorder worldwide. Early identification and proper management is needed to prevent the serious neurological complications associated with it. Objective: The aim of this study is to assess the predictive ability of a pre-discharge serum bilirubin measurement to screen for subsequent significant hyperbilirubinemia in the term and near-term newborn. Materials and Methods: This is a historic cohort study conducted at Makassed General Hospital during two periods of time: January 2011 till December 2011, versus January 2013 till December 2013. A bilirubin screening program, instituted in February 2012, called for a total serum bilirubin to be performed on every neonate before discharge regardless of whether clinical jaundice was observed. For non-jaundiced neonates, the nursery staff was encouraged to obtain the screening total serum bilirubin at the sametime they obtained the hospital-mandated newborn screen for inborn errors of metabolism. Bilirubin values were plotted on an hour-specific nomogram. This study compared mean total serum bilirubin and hospital readmission data for two different periods before and after implementing the program. Results: The study involved 1200 neonates: 601 in period one and 599 in period two. After initiating the program, the mean peak of total serum bilirubin fell from 14.76 mg/dl to 11.03 mg/dl. Also the rate of hospital readmission with a primary diagnosis of jaundice fell from 10% in period one to 1.8% in period two. Conclusion: A pre-discharge total serum bilirubin applied as a policy in hospitals would facilitate targeted intervention and follow-up for indirect hyperbilirubinemiaina safe, cost-effective manner.

Persistent left superior vena cava: a case report and review of literature.

Persistent Left Superior Vena Cava (PLSVC) is rare but important congenital vascular anomaly. It results when the left superior cardinal vein caudal to the innominate vein fails to regress. It is most commonly observed in isolation but can be associated with other cardiovascular abnormalities. The presence of PLSVC can render access to the right side of heart challenging via the left subclavian approach, which is a common site of access utilized. Incidental notation of a dilated coronary sinus on echocardiography should raise the suspicion of PLSVC. Here we present a case of PLSVC that was discovered in an infant accidently after central line insertion.