A comparative study to determine intermittent versus continuous phototherapy for reducing neonatal hyperbilirubinemia at tertiary care hospital in Chennai, Tamil Nadu, India

Background: Phototherapy is safe and effective in neonatal hyperbilirubinemia. Despite its worldwide application, questions regarding methods of optimizing efficacy remain unanswered, turning the infant is believed to be one of the methods to improve. Severe neonatal hyperbilirubinemia is associated with kernicterus, condition characterized by athetoid spasticity, gaze and visual abnormalities, and sensory-neural hearing loss. It may also be associated with mental retardation. Aim of this study was conducted to compare the efficacy of intermittent with continuous phototherapy.Methods: Study was conducted in 100 neonates from February 2018 to July 2018 in Sree Balaji medical college and hospital. Inclusion criteria were weight >2000 grams, absence of other concomitant diseases, and hyperbilirubinemia not requiring exchange transfusion. The neonates were randomly divided into two groups. Continuous phototherapy group received phototherapy on and off for 2 hours and half an hour respectively and the intermittent phototherapy group on and then off for one hour. Serum total bilirubin levels were measured in every 36 hours.Results: Mean age of the patients was 3.89'1.83(p=.91) days, mean baseline bilirubin was 17.56mg/dl'1.42 (p=0.36), while the mean follow-up bilirubin was 12.85mg/dl'1.65 (p=.95), and the mean difference between the baseline and follow-up bilirubin was 4.7 mg/dl'1.19 (p=.32). For group A and B babies, the mean difference between the baseline and follow-up bilirubin was 4.78 mg/dl'1.20 (p=.32) and 4.63mg/dl'1.18(p=0.32) respectively. The difference between the mean age, mean baseline bilirubin, mean follow-up bilirubin, and the mean decrease in bilirubin for both the groups was statistically not significant.Conclusions: Intermittent and continuous phototherapies were found to be equally effective for reducing neonatal hyperbilirubinemia.

Study on the effect of maternal anemia on birth weight of term neonates among rural population India

Background: Maternal anemia in pregnancy is common and has several deleterious effects on the health of the mother and the fetus. Maternal anemia is an important risk factor for LBW babies and preterm babies. There exists an insufficient information regarding the adverse effect of anemia during pregnancy especially among rural population. The aim of the study was to determine whether maternal anemia would affect the birth weight of the baby.Methods: The study was conducted in post-natal ward in Sri Venkateshwara Medical College Hospital and Research centre, Ariyur, Puducherry, India a tertiary care hospital in a rural area.Results: About 85% of low birth weight babies were born to mothers with severe maternal anemia with a p value of <0.001 which is statistically significant. None of the mothers who didn't have maternal anemia had low birth weight babies.Conclusions: Maternal anemia is directly proportional to fetal growth. Maternal anemia being an important risk factor for low birth weight should be prevented as early as possible thus helpful in de-creasing the incidence, mortality and morbidity of LBW babies.

Clinico-epidemiological spectrum of early onset neonatal sepsis in neonates admitted in NICU of a tertiary care institute

Background: Neonatal' sepsis' is' a' clinical syndrome' characterized by signs and symptoms' of' infection' with' or' without' accompanying' bacteremia' in' the' first' month' of' life. Neonatal' sepsis' may' be' classified' into' two' groups : early onset' sepsis and' late onset' sepsis . Early onset neonatal sepsis' is' generally' associated' with' the' acquisition' of' microorganisms' from' the' mother' and' usually' presents' with' respiratory' distress' and' pneumonia.Methods: The study included one hundred' term' neonates with early onset neonatal sepsis. A septic screen including total leukocyte count, absolute neutrophil count, blood smear evaluation, blood cultures and C-reactive protein (CRP) were performed in all neonates with suspected sepsis to corroborate early onset sepsis diagnosis. Epidemiological parameters including gender of the neonate, mode of delivery, rural/urban residence were recorded in addition to clinical profile.Results: Respiratory distress was the most common presentation in the form of tachypnea, seen in 63 (63.0%) neonates. In present study, Staphylococcus aureus was the most common organism isolated followed by Staphylococcus epidermidis, Staphylococcus hominis, Acinetobacter baumannii and Klebsiella pneumonae.Conclusions: Early onset neonatal sepsis' was seen more in males. Among the gram-positive Staphylococcus aureus and among gram negative Acinetobacter baumannii and Klebsiella pneumonae were most common organisms to be isolated.

Association of vitamin D deficiency with early onset sepsis in term neonates

Background: Vitamin D is a fat-soluble steroid hormone. Vitamin D also has immunomodulatory effects on immune function. Early onset sepsis (EOS) is characterized by signs and symptoms of infection with or without accompanying bacteremia in the first three days of life. The objective of the study was to determine the possible association between neonatal vitamin D levels and EOS in term neonates.Methods: 100 term neonates with clinical and laboratory findings of EOS (study group) and 100 healthy infants with no signs of clinical/laboratory infection (control group) were enrolled. Sera was drawn during first 3 postnatal days of life in both groups for measurement of 25-hydroxyvitamin D (25-OHD) levels.Results: Neonatal 25-OHD levels (17.4ng/dL) in the study group were significantly lower than those of the control group (26.8 ng/dL) (p=0.001). In present study negative correlation was found between vitamin D level and CRP.Conclusions: Lower neonatal 25-OHD levels are associated with EOS. Adequate vitamin D supplementation during pregnancy may be helpful to prevent EOS in term neonates.

Electrolyte Changes in the Term Neonates Following Phototherapy in Neonatal Hyperbilirubinemia

Hyperbilirubinemia is one of the most prevalent problems in neonates. Jaundice is observed during first week of life in approximately 60% of term neonates and 80% of preterm neonates. Phototherapy is the most common therapeutic modality used in the treatment of uncomplicated neonatal hyperbilirubinemia. Objective: To study electrolyte (Ca, Na, K, Cl) changes in the term neonates following phototherapy in neonatal hyperbilirubinemia. Methods: This study was performed on 100 term neonates (65 males, 35 females) admitted to the Department of Pediatrics, Bebe Nanki Mother and Child Care Centre, Government Medical College, Amritsar, Punjab with unconjugated hyperbilirubinemia and were managed with phototherapy. These neonates were completely normal on physical examination. Electrolytes were checked at 0 hr (at the time of admission) and after 48 hours of phototherapy or at discontinuation of phototherapy (second sample) whichever was earlier. The first sample was considered as control. Results: After phototherapy, among electrolytes (Ca, Na, K ,Cl) there was significant fall in serum calcium (ionized) level. 16 neonates developed hypocalcemia after 48 hr or less of phototherapy and 11 neonates developed hypocalcemia after 48 hr or up to 96 hr of phototherapy. The difference between pre and post phototherapy serum calcium (ionized) levels was found to be statistically significant (p <0.005). Of the 27 term neonates who developed hypocalcemia, 7 (26%) developed jitteriness and none of them developed irritability, seizures and aponea. No statistically significant fall/rise in levels of Na, K, Cl were observed in term neonates after phototherapy. The incidence of potassium, sodium and chloride changes following phototherapy was found to be nonsignificant irrespective of gestational age, birth weight and duration of phototherapy. Conclusion: The study concluded that among electrolytes (Ca, Na, K, Cl), phototherapy induced hypocalcemia is a significant problem. Thus calcium supplementation should be considered.

Retrospective analysis of risk factors for low 1-minute Apgar scores in term neonates

The current study was designed to investigate the perinatal risk factors for low 1-min Apgar scores in term neonates. We retrospectively analyzed the maternal and neonatal clinical data of 10,550 infants who were born through vaginal delivery from 37 weeks 0 days to 41 weeks 6 days of single gestation from January 2013 to July 2018. Because the 1-min Apgar score reflects neonatal status at birth, we analyzed the risk factors for low (score <7) 1-min Apgar scores through logistic regression. Among these 10,550 neonates, 339 (3.2%) had low (score <7) 1-min Apgar scores. Among them, 321 (94.7%) were admitted to the neonatology department for further observation or treatment. Multivariate analysis revealed that educational background, body mass index, gestational age, pathological obstetrics, longer duration of the second stage of labor, forceps delivery or vacuum extraction, neonatal weight, neonatal sex, and meconium-stained amniotic fluid were independent risk factors for 1-min Apgar scores <7. Neonates who had low 1-min Apgar scores were more frequently admitted to the neonatology department for further observation or treatment. Early detection of risk factors and timely intervention to address these factors may improve neonatal outcomes at birth and reduce the rate of admission to the neonatology department.

Clinical analysis of the difference between full-term and preterm infants with purulent meningitis / 国际检验医学杂志

Objective To discuss and compare the clinical characteristics and difference of full-term and preterm neonatal purulent meningitis(NPM),for early diagnosis and reasonable treatment.Methods 72 newborns with NPM were collected.According to the gestational age,33 cases were divided into the full-term group(37-42 weeks) and 39 cases were divided into the preterm group (＜37 weeks).The clinical data,symptoms and signs,the related infection,the lab tests of blood and cerebrospinal fluid and pathogenic examination were analyzed and compared.Results The sex,the day age of hospital admission and onset between the two groups were no difference(P＞0.05).The rate of low-birth weight infant was 6.1％,which was significantly lower than preterm neonates(59.0 ％)(P＜0.05).The mainly clinical manifestations of full-term newborns with NPM were fever(75.8 ％),convulsions (45.5％),poor response(78.8％),and poor eating milk(45.5％).But the mainly clinical manifestations of preterm neonates with NPM were jaundice(30.8 ％),apnea(20.5 ％) and lower muscular tension(61.5 ％).There were 17 cases(51.5 ％) with NPM combined with septicemia in the full-term group,which was more than preterm neonates(20.5 ％)(P＜0.05).According to the results of the lab tests,18 full-term neonates (54.5 ％) with NPM with increased CRP levels were more than preterm neonates (28.2 ％) (P＜0.05).Besides,the preterm NPM neonates showed higher protein levels (2.35 ± 0.78) g/L and lower glucose(1.84 ±0.69) mmol/L in cerebrospinal fluid than these in the full-term group(P＜0.05).However,there was only 2 full-term NPM neonate with a positive cerebrospinal fluid culture,and 15 patients with a positive blood culture(8 full-term neonates and 7 preterm neonates).Conclusion Because of the atypical clinical characteristics and difference between the full-term neonates and the preterm neonates,the clinical symptoms and signs of neonates should be closely monitored.Therefore,it's suggested that the early diagnosis and reasonable treatment be a key plan for the low mortality and disability.

Clinical analysis of the difference between full-term and preterm infants with purulent meningitis / 国际检验医学杂志

Objective To discuss and compare the clinical characteristics and difference of full-term and preterm neonatal purulent meningitis(NPM),for early diagnosis and reasonable treatment.Methods 72 newborns with NPM were collected.According to the gestational age,33 cases were divided into the full-term group(37-42 weeks) and 39 cases were divided into the preterm group (＜37 weeks).The clinical data,symptoms and signs,the related infection,the lab tests of blood and cerebrospinal fluid and pathogenic examination were analyzed and compared.Results The sex,the day age of hospital admission and onset between the two groups were no difference(P＞0.05).The rate of low-birth weight infant was 6.1％,which was significantly lower than preterm neonates(59.0 ％)(P＜0.05).The mainly clinical manifestations of full-term newborns with NPM were fever(75.8 ％),convulsions (45.5％),poor response(78.8％),and poor eating milk(45.5％).But the mainly clinical manifestations of preterm neonates with NPM were jaundice(30.8 ％),apnea(20.5 ％) and lower muscular tension(61.5 ％).There were 17 cases(51.5 ％) with NPM combined with septicemia in the full-term group,which was more than preterm neonates(20.5 ％)(P＜0.05).According to the results of the lab tests,18 full-term neonates (54.5 ％) with NPM with increased CRP levels were more than preterm neonates (28.2 ％) (P＜0.05).Besides,the preterm NPM neonates showed higher protein levels (2.35 ± 0.78) g/L and lower glucose(1.84 ±0.69) mmol/L in cerebrospinal fluid than these in the full-term group(P＜0.05).However,there was only 2 full-term NPM neonate with a positive cerebrospinal fluid culture,and 15 patients with a positive blood culture(8 full-term neonates and 7 preterm neonates).Conclusion Because of the atypical clinical characteristics and difference between the full-term neonates and the preterm neonates,the clinical symptoms and signs of neonates should be closely monitored.Therefore,it's suggested that the early diagnosis and reasonable treatment be a key plan for the low mortality and disability.

Human Umbilical Cord Blood CD34-Positive Cells as Predictors of the Incidence and Short-Term Outcome of Neonatal Hypoxic-Ischemic Encephalopathy: A Pilot Study

BACKGROUND AND PURPOSE: Neonatal hypoxic-ischemic encephalopathy (HIE) is one of the leading causes of neurological handicap in developing countries. Human umbilical cord blood (hUCB) CD34-positive (CD34⁺) stem cells exhibit the potential for neural repair. We tested the hypothesis that hUCB CD34⁺ stem cells and other cell types [leukocytes and nucleated red blood cells (NRBCs)] that are up-regulated during the acute stage of perinatal asphyxia (PA) could play a role in the early prediction of the occurrence, severity, and mortality of HIE. METHODS: This case-control pilot study investigated consecutive neonates exposed to PA. The hUCB CD34⁺ cell count in mononuclear layers was assayed using a flow cytometer. Twenty full-term neonates with PA and 25 healthy neonates were enrolled in the study. RESULTS: The absolute CD34⁺ cell count (p=0.02) and the relative CD34⁺ cell count (CD34+%) (p<0.001) in hUCB were higher in the HIE patients (n=20) than the healthy controls. The hUCB absolute CD34⁺ cell count (p=0.04), CD34⁺% (p<0.01), and Hobel risk scores (p=0.04) were higher in patients with moderate-to-severe HIE (n=9) than in those with mild HIE (n=11). The absolute CD34⁺ cell count was strongly correlated with CD34⁺% (p<0.001), Hobel risk score (p=0.04), total leukocyte count (TLC) (p<0.001), and NRBC count (p=0.01). CD34+% was correlated with TLC (p=0.02). CONCLUSIONS: hUCB CD34⁺ cells can be used to predict the occurrence, severity, and mortality of neonatal HIE after PA.

Neonatal outcomes in early term neonates versus term neonates in a tertiary care hospital – A cross sectional comparative study.

Background: Preterm birth is one of the chief causes of neonatal mortality and morbidity. The larger studies presented higher rate of adverse outcomes in association to term infants in contrast of neonatal mortality and morbidity. The majority of studies confirmed significantly higher rate of adverse outcomes in preterm in the contrast of neonatal mortality and morbidity. In this contest, we studied Ramprakash MA, Charanraj H, Manikumar S, Srinivasan K, Umadevi L, Giridhar S, Rathinasamy. Neonatal outcomes in early term neonates versus term neonates in a tertiary care hospital - A cross sectional comparative study. IAIM, 2016; 3(4): 21-26. Page 22 the association between different antenatal parameters between early term neonates and full term neonates and to compare neonatal complications. Materials and methods: A total 180 neonates born in the study setting, for a period of 6 months were included and study was conducted in Department of Neonatology and Obstetrics and Gynecology in a tertiary care teaching hospital in south India. A structured and validated case report form was designed for the purpose of data collection. The tool was validated by including the inputs from five experts in the subject area. Descriptive analysis of demographic parameters, antenatal and intra natal parameters were done. Chi square test was used to assess the statistical significance of the association. P value < 0.05 was considered as statistically significant. IBM SPSS version 21 was used for statistical analysis. Results: A total of 180 infants were included in the study, out of which 92 infants (51.1%) were early term and the remaining 88 (48.9%) were full term infants. The odds of early term pregnancy were 2.44 (95 % CI 1.04 to 5.7, p value 0.028) times higher in diabetic mothers, compared to mothers without diabetes. The odds of early term pregnancy was 4.08(95% CI 1.66 to 10.06, p value 0.001) for maternal hypertension and 11.81(95% CI 1.50 to 93.77, p value 0.004) for maternal anemia. The proportion of LSCS was quite high in early term pregnancy, compared to term pregnancy (52.2% Vs 18.2%, p value <0.001). The proportion of small for gestational age (SGA) babies was 29.7% in early term pregnancies (P value 0.011). The odds of hypoglycemia were 3.42 times more in ET pregnancies, compared to full term pregnancies (OR 3.423, 95 % CI 1.37 to 8.52, p value 0.006). Conclusion: The early-term delivery is associated with greater morbidity. There was reasonable relationship was evident involving maternal diabetes mellitus, hypertension, anemia, IUGR and early term pregnancy. The proportion of LSCS was reasonably high in early term pregnancy with slightly higher proportion small for gestational age babies. Neonatal intensive care admissions were found higher in early term than full term pregnancies. Further, there is continual relationship between gestational age and neonatal morbidity from early pregnancy

Mães de recém-nascidos prematuros e a termo hospitalizados: avaliação do apoio social e da sintomatologia ansiogênica / Madres de recién nacidos prematuros y a término hospitalizados: evaluación del apoyo social y de la sintomatología ansiógena / Mothers of hospitalized preterm and full-term newborn infants: assessment of the social support and anxiogenic symptomatology

O presente estudo tem como objetivo investigar se existe relação entre apoio social e sintomas de ansiedade em mães de bebês prematuros hospitalizados em Unidade de Terapia Intensiva Neonatal (UTIN). Além disso, objetiva-se comparar a prevalência de sintomas de ansiedade e o apoio social percebido por mães de recém-nascidos prematuros hospitalizados em UTIN e mães de neonatos a termo. Trata-se de um estudo transversal, do qual participaram 70 genitoras de bebês a termo e 70 mães de recém-nascidos prematuros internados. Os instrumentos utilizados foram a Escala de Apoio Social e o Inventário de Ansiedade Traço-Estado. Na análise dos dados foi usado o Teste U de Mann-Whitney e o Teste de Correlação de Spearman. Os resultados das correlações investigadas no grupo de mães de neonatos pré-termo, demonstraram haver uma associação negativa de intensidade fraca entre a Ansiedade-Estado e o Apoio Emocional, assim como relação negativa de intensidade de fraca a moderada entre a Ansiedade-Traço e o Apoio Social. Ademais, foi encontrada uma diferença estatisticamente significativa entre os grupos pesquisados, tendo as genitoras de bebês prematuros apresentado uma mediana maior de Ansiedade-Estado. Destaca-se, portanto, a importância deste estudo ao constatar que existe relação entre sintomas de ansiedade e o apoio social percebido por mães de recém-nascidos prematuros hospitalizados. Também foi possível realizar a comparação entre genitoras que estavam vivendo o período do puerpério, sendo observado que a ansiedade do tipo situacional é mais prevalente em mães de neonatos pré-termo.

Este estudio investigó la relación entre el apoyo social y los síntomas de ansiedad en madres de bebés prematuros hospitalizados en la Unidad de Terapia Intensiva Neonatal (UTIN). Además, tuvo como objetivo comparar la prevalencia de síntomas de ansiedad y el apoyo social percibido por madres de recién nacidos prematuros hospitalizados en UTIN y madres de neonatos a término. Se trata de un estudio transversal, en el cual participaron 70 progenitoras de bebés a término, y 70 madres de recién nacidos prematuros internados. Los instrumentos utilizados fueron la Escala de Apoyo Social y el Inventario de Ansiedad Rasgo-Estado. En el análisis de los datos fueron utilizados el Test U de Mann-Whitney y el Test de Correlación de Spearman. Los resultados de las correlaciones investigadas en el grupo de las madres de bebés prematuros demostraron tener una asociación negativa de intensidad débil entre la Ansiedad-Estado y el Apoyo Emocional, así como una relación negativa de intensidad débil a moderada entre la Ansiedad-Rasgo y el Apoyo Social. Se encontró una diferencia estadísticamente significativa entre los grupos investigados, donde las progenitoras de bebés prematuros presentaron una mediana mayor en lo que se refiere a la Ansiedad-Estado. Se destaca la importancia de este estudio al constatar que existe una relación entre los síntomas de ansiedad y el apoyo social percibido por madres de recién nacidos prematuros hospitalizados. Además, fue posible realizar la comparación entre las progenitoras que estaban viviendo el período de puerperio; se constató que la ansiedad de tipo situacional es más prevalente en madres de neonatos pre-término.

This research aims to examine whether a relationship exists between perceived social support and the expression of anxiety in mothers with premature hospitalized babies at the Neonatal Intensive Care Unit (NICU). It also aims to compare the prevalence of anxiety symptoms and the social support perceived by mothers of premature newborns hospitalized at NICU and mothers of full-term neonates. It is a cross-sectional study in which 70 mothers of full-term babies and 70 mothers of hospitalized preterm newborns participated. The instruments used were the Social Support Scale and the State-Trait Anxiety Inventory (STAI). The Mann-Whitney U and the Spearman correlation tests were used to analyze data. The results of the correlations studied in the group of mothers of preterm neonates showed a negative correlation of weak intensity between State-Anxiety and Emotional Support, as well as a negative correlation of weak to moderate intensity between Trait-Anxiety and Social Support. A statistically significant difference was found between the examined groups, where the mothers of the premature newborns showed a greater median in the State-Anxiety inventory. The importance of this study is highlighted in finding a relationship between the symptoms of anxiety and social support perceived by mothers of premature hospitalized newborns. In addition, it was possible to make the comparison between mothers who were going through the postpartum period. It became clear that situational anxiety is more prevalent in mothers of preterm infants.

Evaluation of TSH Levels in the Program of Congenital Hypothyroidism Newborn Screening in a Pilot Study of Preterm Newborns in Bogotá, Colombia

Abstract Introduction: Preterm infants (<37 weeks of gestation) have low levels of thyroid hormones due to multiple factors. Objective: To evaluate levels of thyroid-stimulation hormone (TSH) in the program congenital hypothyroidism (CH) newborn screening in a sample of preterm infants in the city of Bogotá, Colombia. Methods: The Secretaría de Salud Distrital screening protocol for CH (blood sample is collected from the umbilical cord in all the newborns) remeasured the serum TSH and heel TSH when preterm infants completed 37 weeks of gestation. Results: A total of 59 preterm neonates were rescreened, of which 2 neonates had elevated levels of TSH and 1 neonate had transient hypothyroxinemia. The Kolmogorov-Smirnov 2-sample/bilateral statistical test was used to compare the neonatal TSH levels of preterm and full-term newborns, which do not follow the same distribution. Conclusion: In our pilot study, 2 of the rescreened infants presented high levels of TSH and 1 had transient hyperthyrotropinemia, suggesting the need for rescreening of preterm infants. Additionally, a larger study should be performed to determine the screening cutoff values for preterm newborns.

Reversibility of Brainstem Evoked Response Audiometry Abnormalities at 3 Months in Term Newborns with Hyperbilirubinemia.

Background: High bilirubin level is toxic to developing brain and auditory system but the current debate surrounds the toxicity of bilirubin in healthy term infants. Methods: Longitudinal observational study to find BERA abnormalities in term newborns with isolated hyperbilirubinemia of 20 mg/dL and more and to follow up babies at 3 months to find out about the reversibility in BERA abnormalities noted at birth. Results: BERA abnormalities were present in 17.64% of babies with isolated hyperbilirubinemia at discharge. There was a reversibility of BERA abnormalities in 61.61% during follow up. Conclusion: BERA abnormalities are reversible in term neonates with hyperbilirubinemia.

Clinical evaluation of Calsurf in treating full-term neonatal respiratory distress syndrome / 中国小儿急救医学

Objective To evaluate the effectiveness of domestic exogenous pulmonary surfactant (EPS)-Calsurf in treating full-term neonatal respiratory distress syndrome (RDS).Methods (1) From January 2011 to June 2012,154 full-term neonates with RDS were divided into Calsurf group (74 cases) and Curosurf group (80 cases),comparing differences in changes of arterial blood gas,the length of hospital stay,hospitalization expenses,duration of mechanical ventilation,inspired oxygen time,the incidences of complications and repeated EPS use rates between two groups.(2) In order to compare the effectiveness of different doses of Calsurf in treating full-term neonatal RDS,from July 2012 to March 2013,80 RDS patients who received Calsurf were divided into mild-moderate group (grade Ⅱ ～ Ⅲ on chest X-ray,50 cases) and severe group (grade Ⅳ on chest X-ray,30 cases).Furthermore,each group was divided into two subgroups,which were low-dosage(per-time 30 ～40 mg/kg) and high-dosage group (per-time 30 ～40 mg/kg).Results (1) Before administrating Calsurf and after administrating it at 0.5 h and 6 h,the pH,PaCO2 and PaO2 of RDS patients were no significant difference in two groups (P ＞ 0.05).(2) There were no significant difference between the duration of mechanical ventilation,inspired oxygen time,length of hospital stay in two groups (P ＞ 0.05).But the hospitalization expenses in Calsurf and Curosurf groups were 28.778 versus 31.827 thousand yuan,respectively,with the average reduction of 9.6％ in Calsurf group (P ＜ 0.05).(3) There were no significant difference between the morbidities and mortalities of multiple organ failure,persistent pulmonary hypertension,acute renal failure and pneumothorax in two groups (P ＞ 0.05).(4) In mild-moderate grade RDS patients,the low-dosage or high-dosage of Calsurf had similar effectiveness in improving bloog gas (P ＞ 0.05),the repeated Calsurf use rates of both subgroups were 16.0％ (4/25) and 20.0％ (5/25) (P ＞ 0.05).While in severe RDS patients,high-dosage Calsurf got a better effectiveness in improving bloog gas than low-dosage Calsurf(P ＜ 0.05).Meanwhile,the repeated Calsurf use rates of the low-dosage and high-dosage subgroups were 20.0％ (3/15) and 33.3％ (5/15),with a 40％ reduction in high-dosage subgroup.Conclusion (1) Both Calsurf and Curosurf can significantly improve the conditions of hypoxemia and hypercapnia,moreover,the length of hospital stay and duration of mechanical ventilation of both groups are similar,with less hospitalization expense in Calsurf group.(2) Both low and high-dosage Calsurf have similar curative effect on mild-moderate RDS,but for severe RDS,high-dosage Calsurf works better,reducing the repeated EPS use rate to some extent.

Diagnóstico por imagem e aspectos clínicos da trombose venosa cerebral em recém-natos a termo sem dano cerebral: revisão em 10 anos / Imaging diagnosis and clinical findings of cerebral venous thrombosis in full-term neonateswithout brain damage: a ten-year review

OBJETIVO: Descrever e comparar os métodos de imagem e os aspectos clínicos em quatro recém-natos a termo diagnosticados como trombose venosa cerebral, sem dano encefálico, adscritos a uma unidade de terapia intensiva neonatal. MATERIAIS E MÉTODOS: Revisão em 10 anos com quatro casos diagnosticados como trombose venosa cerebral por meio de ultrassonografia transfontanela com Doppler e confirmados por ressonância magnética/angiorressonância, correlacionados aos aspectos clínicos e evolução neurológica. RESULTADOS: A ultrassonografia foi normal em 75 por cento dos casos e a ressonância magnética, em 100 por cento. No caso alterado, a dilatação venosa foi identificada. O Doppler e a angiorressonância estavam alterados em 100 por cento dos casos. Dos aspectos clínicos, a hipóxia (100 por cento) e a convulsão precoce (100 por cento) predominaram, com potencial evocado alterado em 50 por cento dos casos. Na avaliação do neurodesenvolvimento, todas as áreas estiveram dentro da normalidade até a última avaliação. CONCLUSÃO: A ultrassonografia associada ao Doppler é capaz de identificar as alterações da trombose venosa cerebral, devendo ser complementada com a ressonância magnética, que é o padrão ouro de diagnóstico.

OBJECTIVE: To describe and compare imaging methods and clinical findings of cerebral venous thrombosis in four full-term neonates without brain damage, admitted to a neonatal intensive care unit. MATERIALS AND METHODS: Ten-year review of four cases diagnosed with cerebral venous thrombosis by transfontanellar ultrasonography associated with Doppler fluxometry and confirmed by magnetic resonance imaging/magnetic resonance angiography in correlation with clinical findings and neurological progression. RESULTS: Ultrasonography presented normal results in 75 percent of cases and magnetic resonance imaging in 100 percent. Doppler fluxometry and magnetic resonance angiography were abnormal in 100 percent of cases. Hypoxia (100 percent) and early seizures (100 percent) were predominant among clinical findings with evoked potential changes in 50 percent of cases. In the assessment of the neurodevelopment all the areas remained within normality parameters up to the conclusion of the present study. CONCLUSION: Ultrasonography in association with Doppler can identify changes related to cerebral venous thrombosis and should be complemented with magnetic resonance imaging that is the gold standard for diagnosis in these cases.

The Difference between Clinical Manifestations and Feeding or Delivery Methods in Healthy Full-term Neonates and Those with Nosocomial Rotaviral Infection

PURPOSE: Rotavirus is the main cause of infantile diarrheal disease worldwide. The purpose of this study is to assess the difference between clinical manifestations and feeding or delivery methods in healthy full-term neonates and those with nosocomially-acquired rotaviral infection. METHODS: The study was conducted on 348 babies who were delivered in Dongguk University Kyongju Hospital from Jan 1 to June 30 in 2001. Stool specimens were collected from clinically symptomatic neonates. We studied the rate of positive stool rotazyme ELISA tests and positive symptoms. We compared the frequency of clinical manifestations according to the feeding methods [breast feeding(BF) or formula feeding(FF)] and the delivery methods[normal vaginal delivery(NVD) or Cesarean section(C/sec)]. RESULTS: Rotavirus was detected in 152 of 348 babies. The rate of positive rotazyme ELISA test was 43.7% in healthy full-term symptomatic neonates. The most common symptom of rotaviral enteritis was mild fever; the others were watery diarrhea, abdominal distension, vomiting, delayed weight gain, irritability, poor oral intake and dehydration. Compared with FF neonates, BF neonates have lower frequency of symptoms, especially watery diarrhea, delayed weight gain and poor oral intake. The symptomatic frequency was higher in FF and NVD neonates than BF and C/sec. CONCLUSION: The symptoms of rotaviral enteritis were less frequent in BF or C/sec delivered neonates. BF appeared to alleviate the rotaviral enteritis but further studies are needed. The cause of the lower frequency of symptoms in C/sec delivered neonates was unknown.

Study of Nosocomial Infection of Rotavirus in Preterm and Full-term Neonates

PURPOSE: The present study was designed to investigate rotavirus infection by comparing clinical characteristics of the nosocomial infection of rotavirus between preterm and full-term neonates. METHODS: The subjects were admitted from May to December, 1996. In 71 preterms, 44 were Rotazyme positive, 27 were negative, and in 321 full-terms, 64 were Rotazyme positive, 257 were negative. We studied the rate of positive Rotazyme ELISA test and positive symptoms. We compared clinical manifestations and parameters between both groups. Stools were examined with occult blood, stool culture and Rotazyme ELISA tests. RESULTS: The rate of nosocomial rotavirus infection in neonates was 27.6% and increased as the neonates matured. Rotazyme positive rate is not significantly related to sex, birth weight and symptoms with necrotizing enterocolitis(NEC) between preterm and full-term neonates. But, jaundice developed more frequently in Rotazyme positive groups. When the neonates matured, they had longer durations of positive symptoms and positive Rotazyme tests. Also they had shorter onset times of positive symptoms and positive Rotazyme tests. Positive symptoms rate was 74.0% in total, 95.5% in preterm and 59.4% in full-term. Abdominal distension, jaundice and NEC increased significantly in preterms. CONCLUSION: Rotavirus can be a significant pathogen in preterms more than in full-terms. Neonates suffering from suspected sepsis should be investigated for rotaviral infection. A new oral vaccine and oral immunoglobulin is needed for eradicating rotavirus infection in the nursery. Further studies about isolations, infection pathways, immune responses and treatment of rotavirus are needed.

Evaluation of the serum erythropoietin levels in neonates

Erythropoietin is the major hormonal regulator of erythropoiesis. It is controlled by many factors inducing hypoxia in tissue. The serum erythropoietin levels of neonates have shown gradual dccrease until 1 month of age, which they are reactivated in the period of physiologic anemia. This change is exaggerated if the meonates are born prematurely, and the levels of erythropoietin respond to lower hemoglobin are lower than those of term neonates and adults. The purpose of this study was to assess the values of erythropoietin levels to compare hemoglobin on the preterm and term neonates until 1 month of age. The results were as follows: 1) At birth mean erythropoietin values of preterm and term neonates were 16.5+/-1.4mU/ml, 16.5+/-1.7mU/ml respectively, there was no significant difference. Also erythropoietin values in preterm and term neonates were 23.6+/-13.3mU/ml, 10.9+/-1.5mU/ml respectively. Resticulocyte counts in preterm and term neonates were 10.7+/-3.3%, 5.7+/-2.9% respectively, so they were significantly higher in preterm than in term neonates. 2) The changes of mean hemoglobin, reticulocyte counts and erythropoietin according to postnatal ages were that those of reticulocyte counts and erythropoietin were significantly increased about 1 month of age. 3) At the 1 month of age, mean erythropoietin values in preterm neonates were lower than those of term neonates and adults, despite of the lowest hemoblobin. This results showed that erythropoietin values in preterm neonates during the physilolgic anemia were lower values than those of term neonates and adults in spite of the lowest hemoglobin.