Cord blood and serial lactate levels in predicting short-term outcome in term new-born babies with perinatal asphyxia

Introduction: Birth asphyxia is a leading cause of neonatal deaths across the globe. Clinical examination, Apgar score, pH, EEG/aEEG, Lactate are being used as markers for prediction of outcome. Serum Lactate is a better reflector of metabolic mechanism. We intend to study cord blood lactate and serial lactate levels in term birth asphyxia babies. Aim: To determine correlation between cord blood lactate, serial lactate levels and short term outcome in term new-born babies with perinatal asphyxia. Materials and Methods: It was a prospective, observational study. Thirty term babies with birth asphyxia were selected. Their Cord blood lactate, serum lactate at 6, 12, 24 hours of life were correlated to short term outcomes (NICU stay, shock, Acute kidney injury, mortality). Results: Eighteen babies with moderate asphyxia and 12 with severe asphyxia had mean cord blood lactate of 10.4mmol/L and 13.47mmol/L respectively. There was difference in mean lactate levels at 6, 12, 24 hours of life between the babies who survived and expired; also survivors had significant reduction in mean lactate levels at various time points. Babies with moderate asphyxia had no shock and AKI. Babies with severe asphyxia and shock had mean lactate levels of 12mmol/L in survivors and 13.8mmol/L in who expired. Babies with severe asphyxia and AKI had mean lactate of 14mmol/L in survivors and 14.6mmol/L in who expired. Babies with moderate asphyxia had no mortality. In babies with severe asphyxia, survivors had mean lactate of 12.74mmol/L and 14mmol/L in babies who expired. There was no correlation between the lactate levels and the length of the NICU stay. Conclusion: Serial lactate levels can be used to predictor the short term prognosis in term babies with perinatal asphyxia. There was significant difference in mean lactate levels between the babies who survived and expired. Serial lactate levels showed significant reduction in babies who survived.

Management of Acute Respiratory Failure: A Case Report

In an Intensive Care Unit, acute respiratory distress syndrome (ARDS) is a serious condition. Non-cardiogenic pulmonary oedema was the prior name for it. It is caused by a variety of illnesses that cause lung injury, but sepsis is the most common cause. It causes interstitial and alveolar oedema, diffuse alveolar damage, refractory hypoxemia, and ventilation perfusion mismatch by damaging the alveolar capillary membrane. Dyspnoea with diffuse in ltration on chest X-ray is a typical clinical symptom. Low tidal volume, high positive end expiratory pressure (PEEP), and low plateau pressure are all used to treat ARDS. Prone placement improves patient perfusion and thereby increases the PaO/FiO ratio. To treat ARDS, doctors are increasingly turning to high frequency oscillation ventilation (HFOV).

Alveolar Bone Grafting - A Summary of History and Current Literature on the Technique

Cleft lip and palate is a common condition affecting thousands of children in India and overseas. With an incidence of 1 in 800 live births, these cleft lip and cleft palate patients face numerous aesthetic as well as functional challenges. The condition goes untreated in many scenarios, or patients do not receive adequate treatment due to various reasons like lack of awareness, lack of specialist dentists etc. leading to permanent facial deformity with significant deterioration of quality of life. There have been many changes in the management of alveolar cleft in the past 100 years. Documentation of the first cleft lip repairs dates back to 400 BC, and was performed by Hippocrates, while the first cleft velum repair was done for the first time by a French dentist, Monnier, in 1764. The treatment protocol for the same has been upgraded with time, with better understanding of the anatomy and pathophysiology of the condition, and for better results to the patients. Alveolar bone grafting (ABG) is now becoming an integral part of managing cleft patients. There still isn’t a fixed and widely accepted protocol for ABG in the management of cleft patients, but there are various opinions of researchers around the world regarding the indications of bone grafting, the type of grafting (primary or secondary) to be employed, timing of grafting, the source of bone graft and use of various bone graft substitutes in the procedure. An increasing value of multidisciplinary approach, including maxillofacial surgeons and orthodontists, towards managing such patients, is helping improve the outcome of such patients, and hence easing the overall treatment duration for the patient and relatives. Hence, through this article, we aim to shed some light over the evolvement and current place of alveolar bone grafting in treating cleft lip and palate patients. The anatomy of involved parts, types and indications of ABG, clinical evidences on the timing of the surgery, future evaluation, results and complications, and orthodontic treatment have been mentioned in this article.

Correlation between umbilical cord blood pH and meconium stained deliveries

Background: Among all live births approximately 13% neonates are born through meconium-stained amniotic fluid and out of these 5-10% developed MAS, which increases neonatal morbidity and mortality. The incidence increases as the gestational age advances with reported frequencies at 37, 40, and >42 weeks being 3%, 13%, and 18% respectively. Although there is a significant decrease in the occurrence of MAS and associated mortality in developed countries, MAS remains a major problem in developing countries. The objective was to study the correlation between umbilical cord blood PH and Meconium stained amniotic fluid.Methods: Observational study done in KIMS hospital Bangalore, Karnataka, India in a study period of 18 months on a sample size of 100. Within 30 sec of delivery a segment of umbilical cord was clamped at both ends. Cord blood was collected in heparinised syringe. It was then transported with cold ice packs and blood pH, pCO2, pO2 were measured.Results: In present study population, among those with MSAF, 72% had acidemia and 28% did not have acidemia. The mean (SD) of pH in the group with MSAF was 7.16 (0.10). The median (IQR) of pH in the group with MSAF was 7.14 (0.12). There was no significant difference between the groups (those with MSAF and those without MSAF but other risk factors) in terms of pH (W = 867.500, p = 0.580).Conclusions: The presence of acidosis in the umbilical cord blood, used as a biochemical marker for perinatal asphyxia can be used to evaluate the significance of intrauterine passage of meconium. But a normal acid-base status at delivery present in many cases of MSAF, suggests that either a pre-existing injury or a non-hypoxic mechanism is often involved. MSAF is not always secondary to an acute hypoxic event.

Base excess as a prognostic factor determining the perinatal outcome

Background: Umbilical cord blood gas assessment seems to be the most objective determination of fetal metabolic condition at the time of birth and can be used to assess the perinatal outcome of the baby. In the early stage of an impaired placental circulation, hypoxemia and hypercapnia result in a decrease in pH with BD maintained normal (respiratory acidemia), whereas if the hypoxic process develops into a sustained anaerobic metabolism the BD rises secondary to lactic acidosis and consumption of buffer.Methods: Observational study done in KIMS hospital Bangalore, Karnataka, India, in a study period of 18 months on a sample size of 100. Within 30 sec of delivery a segment of umbilical cord was clamped at both ends. Cord blood was collected in heparinised syringe. It was then transported with cold ice packs and blood pH, pCO2, pO2 were measured.Results: In present study, there was a significant difference between the 2 groups in terms of BE, BE being highest in the group without complication. There was a moderate negative correlation between duration of NICU stay (days) and BE (mmol/L), and this correlation was statistically significant. There was a significant difference between the 2 groups in terms of BE with the median BE (mmol/L) being highest in the group not requiring resuscitation. At a cutoff of BE (mmol/L) <-17.5, it predicts complications with a sensitivity of 71.4%, and a specificity of 88.2%.Conclusions: Hence cord blood base excess can be used as a prognostic factor in determining the perinatal outcome.

A Comparison of EtCO and PaCO in Laparoscopic Surgery during General Anaesthesia.

Introduction : Pneumoperitoneum leads to multiple changes in the mechanics of respiration and heart function.We decided to study the changes in arterial blood gas, EtCO and pH. We also studied hemodynamic changes due to pneumoperitoneum. Methodology : Fifty patients of ASA grade I and II, between the ages of20 to 65 years posted for elective laparoscopic surgery were selected. Arterial blood samples were collected pre-operatively.We also collected arterial blood intra-operatively at 10 min, 60 min and 120 min after insufflation of CO and soon after desufflation. Result : There was significant increase in EtCO after CO insufflation maximum at 60 minute and return to near baseline value after desufflation. There was significant rise in PaCO but within physiological range. There was significant decrease in pH maximum at the time of 120 minute. Blood pressure changes shows significant rise in diastolic blood pressure (p < 0.05). Conclusion : We concluded that diastolic blood pressure was kept under control by using volatile anesthetic agent. The EtCO PaCO and pH changes occurred significantly but remains within physiological range and corrected by increasing minute ventilation. Soon after desufflation all value returned to baseline in normal healthy patients. The EtCO correlate well with PaCO , so it is the best parameter to diagnose hypercarbia.

Cementless Total Hip Arthroplasty Using the ABG I Hydroxyapatite-coated Prosthesis: Minimum 10 Year Follow-up / 대한고관절학회지

PURPOSE: The purpose of this study was to evaluate the outcomes of total hip arthroplasty (THA) with an ABG I hip prosthesis after a minimum ten-year follow up. MATERIALS AND METHODS: From January 1996 to March 2001, 121 hips in 104 patients, whi were followed up for a minimum of ten-years, were enrolled in this study. The clinical and radiographic outcomes were evaluated and Kaplan-Meier survival analysis was performed. RESULTS: The mean Harris hip score at the last follow-up was 84 points. A radiolucent line around the cup, osteolysis, and cup loosening were observed in 5 hips(4.1%), 53 hips(43.8%), and 5 hips(4.1%), respectively. In the femoral side, osteolysis and stem loosening were observed in 11 hips(9.1%) and 2 hips(1.7%), respectively. The mean linear wear rate of the polyethylene liner was 0.23 mm/yr. Forty four revisions(36.3%) were performed. The outcomes were similar regardless of the cause of primary THA. The survival rate with the end point of revision due to cup loosening was 56.3%, and revision due to stem loosening was 98.1% after a 16 year follow-up. CONCLUSION: High polyethylene wear and the disappointing survival rate of the ABGI cup were observed after a minimum ten year follow-up. Therefore, close observation of patients who have received an ABG I prosthesis is necessary.

Analytical calculation and acid-base analysis for detection of mixed disorders in critical care medicine.

Aim: The purpose of the study was to validate the systematic six-step arterial blood gas (ABG) analysis in critically ill patients to diagnose mixed ABG disorders. Materials and method: The study was conducted in the ICU of a tertiary care hospital (between 1 June and 30 September, 2007) for 4 months. A total of 560 ABG samples were evaluated from 183 patients. 50 samples were randomly picked and evaluated by single step, quick look method and six-step approaches for detecting mixed ABG disorders. Results: Single, quick and six-step methods when applied on same data, revealed higher number of mixed disorders with systematic six-step approach. Quick-step method revealed only 48% mixed disorders while six-step analysis confirmed 62% having mixed disorders, from the samples which initially appeared to be single disorder. Metabolic acidosis with respiratory acidosis (26%) was the commonest disorder. Metabolic acidosis with respiratory alkalosis (20%), respiratory alkalosis with metabolic alkalosis (6%), metabolic alkalosis with respiratory acidosis (4%), metabolic acidosis with NGMA (4%) and metabolic acidosis with metabolic alkalosis (2%) were the other mixed disorders seen. Conclusion: Mixed disorders as suspected on clinical grounds can only be validated after complete analysis by six-step approach in critically ill patients. pH, PaCO2, and HCO3 – allow determination of primary disorder, but it is only the inequality between predicted and actual compensatory response for simple acid-base disorders which reveals a mixed disorder.

Changes of Mean Arterial Pressure, Intracranial Pressure, Blood Gas and Serum Electrolytes during N2O - Halothane Anesthesia in Rabbits / 대한마취과학회지

This experiment was undertaken to study the effects of different ratios of N2O-O2 in N2O- halothane anesthetized rabbits weighing about 4-4.5 Kg. The N2O-O2 ratios were 2:1 (group 1), 3:1 (group 2) and 4:1 (group 3). We measured the mean arterial pressure, intracranial pressure and cerebral pressure and analysed the blood gas and electrolytes in each group and compared each group to the other two. The results are summarized as follow; The mean arterial pressure was 101.7+/-14.6, 92.7+/-11.0 and 89.4+/-15.1mmHg in each group respectively. The mean arterial pressure of the group 3 decreased more significantly than that of group 1. The intracranial pressure was 12.7+/-4.3, 11.8+/-4.2 and 13.6+/-4.6mmHg in each group respectively and was non-significant as compared to other groups. The cerebral perfusion pressure was 90.8+/-13.3, 82.6+/-9.9 and 76.9+/-16.9mmHg in each group respectively and the cerebral perfusion pressure of group 3 decreased more significantly than that of group l. In the blood gas analysis, PaQ2 was 162+/-27, 119+/-13 and 105+/-8 mmHg in each group respectively and was non-significant in respect to other groups. PaCO2 and O2 content were not different significantly in each group and were within normal values. The oxygen saturation was 98.9+/-0.3, 97.8+/-0.4 and 97.6+/-1.1% in each group respectively and group 2 and 3 decreased more significantly than group 1. Na+, Cl-, HCO-(3), pH and BE were not different significantly in each group, pH, BE and HCO-(3) were measured as being slightly low values, but PaCO2 was kept within normal values. These are explained as probably being due to metabolic acidosis. The serum K' was 2.94+/-0.46, 3.07+/-0.44 and 3.40+/-0.7 mEq/1 in each group respectively and the serum K+ of group 3 increased more significantly than groups 1 and 2. With these results, it is suggested that a ratio above a 2:1 ratio of N2O-O2 is more dangerous in halothane-N2O anesthesia.