Abdominal ultrasonography: clinical significance in the pediatric out-patients' clinics

Ultrasound is the basic first-line investigation for an enormous variety of abdominal symptoms in pediatric patients, This is because it is non-invasive and because of its accessible nature, and its success in terms of diagnosis depending on the skill of the operator, The objective of this prospective study is to further elucidate the role of abdominal ultrasonography for screening purposes as well as investigating the relevance of sonographic findings in patients with clinical problems related to the abdomen. This work was conducted on 10114 infants and children [4900 males and 5214 females], ranging in age from 1 day to 12 years. They were referred to the various outpatients' clinics, Cairo University Children's Hospital. Proper history taking, thorough clinical examination, and ultrasonography of the abdomen and basal parts of the thorax were done for all patients. Other investigations were done for certain cases to reach the final diagnosis. Patients were divided into 2 groups: Group I consisted of 2668 patients [26.4%] without specific symptoms in the abdomen, it represented the screening group. Group II consisted of 7446 patients [73.6%] with abdominal symptoms and therefore well-defined sonographic requests. The results revealed that 60% of the whole group had pathologic sonographic findings. Pathological findings were discovered in 61.7%, 59.3% of group I and group II patients respectively. According to their individual influence on the patient's disease course, sonographic findings were subdivided into 3 categories: Relevant, prospectively relevant and irrelevant findings. In each of group I, and group I1 patients these findings constituted 47.8%, 76% and 36%, 10.6% and 16.2%, 13.3% of total findings in each group respectively, The difference between both groups was statistically significant, Most of relevant findings [81%] were detected in group I1 patients as compared to 19% in group I, The nephrology clinic was ranked as the No 1 clinic regarding the frequency of pathologic findings discovered in patients referred from it [27%]. Also, the highest frequency of relevant findings was detected in patients from the hepatology [87%] and nephrology [82%] clinics

Conclusion: abdominal ultrasonography can detect various relevant findings in asymptomatic out- patients as well as in patients with a clinical problem related to the abdomen. Also, ultrasonography completes the physical examination, adding a substantial amount of clinically important information to the patient's medical record and physician's report

Transcutaneous bilirubinometery: its role in the assessment of neonatal jaundice with comparable precision with serum bilirubin

Transcutaneous bilirubinometry [TCB] provides a noninvasive, cost effective screening method for significant neonatal jaundice. The aim of this study is to comment on the usefulness of the jaundice meter as a non invasive screening device for hyperbilirubinemia in neonatal intensive care units. The study included 40 neonates suspected on clinical grounds to have neonatal jaundice, admitted to the unit for either prematurity or other clinical conditions. Our results showed a correlation coefficient between total serum bilirubin and the mean of transcutaneous bilirubinometry of the forehead and sternum at 24 and 48 hours of appearance of jaundice to be 0.629 and 0.823 respectively with a significant P value of [0.07. Also, the correlation coefficient between assayed total serum bilirubin level and expectant serum bilirubin level at 24 and 48 hrs. of appearance of jaundice was 0.599 and 0.863 respectively with a significant P value of <0.01

Conclusion: transcutaneous bilirubinometry is a well-established screening method for neonatal jaundice, yet it has limitations of use due to the sensitivity of the method for defecting variation in melanin content of the skin. Also TCB monitoring should not be used to follow babies who have undergone exchange transfusions nor solely relied up to follow infants undergoing phototherapy

study on oxidative stress in full-term newborns with hypoxic- ischemic-encephalopathy

The study included 50 full term newborns with a 5 minute Apgar score

Conclusion: the consequences of perinatal asphyxia and HIE are tremendous. Both metabolic and biochemical changes are recorded. Enzymes as well as increases in injurious oxygen free radicals [L.per and NO] with decreases in the cell defence antioxidants [SOD and T.th] occur. Factors that lead to HIE are in the major part preventable [by good antenatal and perinatal care with fetal monitoring]. The present study has highlighted areas of intervention and treatment of HIE. Knowledge of cellular and biochemical events that occur in HIE may lead to recognition of certain steps that may be amenable to pharmacologic intervention to limit or even prevent neuronal cell damage due to HIE. The bleak outcome of HIE may be improved. Apgar score commonly used to judge asphyxia was not found to be a reliable indicator of HIE severity and/or outcome

Acute renal failure in cases at perinatal asphyxia

Acute renal failure in the neonates usually occurs following complicated delivery with perinatal hypoxia and shock. In our study, 41 neonates who suffered perinatal asphyxia and needed admission to the Neonatal Intensive Care Unit of Cairo University, were investigated for the detection of occurrence of acute renal failure. 15 normal infants were included as controls. Out of the 41 cases, 11 asphyxiated babies developed renal impairment suggestive of acute renal failure [26.8%]. Mean serum urea was significantly higher both in preterm [47.65 +/- 23.7 mg/dl] and term infants [61.47 +/- 55.6 mg/dl] than in control cases [24.5 +/- 7.69 mg/dl]. It was also significantly higher in cases who developed acute renal failure [111.9 +/- 45.7 mg/dl] than those cases without failure [33.7 +/- 12.5 mg/dl]. Mean serum creatinine was also significantly higher in asphyxiated babies [0.96 +/- .35 mg/dl in preterms and 1.005 +/- 0.432mg/dI in full terms] than in control eases 0.813 +/- 0.178] mean serum sodium was significantly lower in preterm and full term cases [129.2 +/- 12.02 mEq/I and 130.5 +/- 12.23 mEq/l]. This hyponatremia is explained by the inappropriate secretion of antidiuretic hormone secondary to hypoxIa insult to the central nervous system. Hyperkalemia occurred in 75% of asphyxiated babies [7.49 +/- 2.815 in preterm and 7.55 +/- 2.59 mEq/l in term cases]. Urinary casts [hyaline and granular] with many epithelial cells were found in 60% of cases. Convulsions were reported more frequently in the asphyxiated infants with renal failure. Hypoxia, uremia and hyponatremia were the contributary factors of the occurrence of convulsions. Abnormal ultrasound findings in the form of enlarged kidney size and increased pyramid echogenicity were reported. Prevention of perinatal asphyxia and prompt postnatal ressuscitation should be the cornerstone in avoiding and minimizing renal damage. Non invasive investigation tooIs as simplc urine analysis and abdominal utlrasonography are greatly valuable for the early diagnosis of acute renal damage in these asphyxiated neonates

Prevalence of hepatitis B virus markers in Egyptian neonates

95 parturient women were tested for serologic markers of hepatitis B virus [HBV] infection. Of these ten cases [10.53%] were HBs Ag positive; 48 cases [50.53%] were anti HB s AB positive; and 29 cases [30.53%] had only anti-HB s AB positive; and 29 cases [30.53%] had only anti-HB c AB. Of the ten HB s Ag positive mothers none were HB e Ag positive. This points to a very low proportion of infectious carriers to be contrasted to the higher incidence in African and Asian countries. A single mother was positive for HdV antibody [1.053%]. Out of the 95 newborns only one infant [1.053] was positive of HB s Ag at the age of 3 days. 46 neonates [48.42%] were HB s AB positive. Twenty three neonates [24.21%] were positive for anti core antibody. The incidence of manifest HB s antigenemia, in the early neonatal period, appears to be very low particularly with the absence of e antigen positive carrier mothers. The incidence of manifest HB s antigenemia, in the early neonatal period, appears to be very low particularly with the absence of e antigen positive carrier mothers. These observations may indicate that HBV infection in Egypt most probably do not occur vertically