Validity of Two Point-of-Care Glucometers in the Diagnosis of Neonatal Hypoglycemia.

Objective: To estimate validity of two point-of-care glucometers for the diagnosis of neonatal hypoglycemia and to determine the glucometer’s cut-off values for which standard laboratory confirmatory test are no longer needed. Design: Prospective study. Settings: A tertiary care, university hospital in Bangkok, Thailand. Participants: The study included 180 blood specimens from 166 high-risk neonates aged between 1-24 hours. Results: On average, most of the blood glucose read-outs from the Nova StatStrip and SureStep were higher than laboratory plasma glucose throughout the glucose range with mean differences (SD) of 11.2 (8.4) mg/dL and 13.7 (6.8) mg/dL, respectively. Sensitivity of Nova StatStrip and SureStep were 62% and 53.3%, respectively. Specificity and positive predictive value of both glucometers were 100%. Negative predictive values of both glucometers were approximately 85%. The cut-off levels with 100% negative predictive values were 63 mg/dL and 62 mg/dL for Nova StatStrip and SureStep, respectively. Conclusions: None of the glucometers in this study has sufficient validity to replace laboratory testing in diagnosing hypoglycemia. Confirmatory plasma glucose for diagnosis of hypoglycemia is needed when POC readings are between 39 and 63 mg/dL for Nova StatStrip and between 39 and 62 mg/dL for SureStep.

Nosocomial bloodstream infection in pediatric patients: Siriraj Hospital, Bangkok; 1996-1999.

A retrospective study on nosocomial bloodstream infection (NBSI) in pediatric patients hospitalized at Siriraj Hospital from January 1996 to December 1999 was performed. Of the 18,087 blood specimens sent for culture, 533 (3%) were positive for organisms after 72 hours of hospitalization and were defined as NBSI. The rate of NBSI detected in blood culture specimens was highest among neonates (5.2%). Gram-positive cocci and gram-negative rods caused NBSI in an equal proportion (46% and 44% respectively) and Candida caused 10 per cent of NBSI. Coagulase-negative staphylococci was the most common pathogen followed by K. pneumoniae and Enterobacter. Antibiogram showed that 15 of the 35 (43%) S. aureus identified were methicillin-resistant. Only 35-38 per cent of Enterobacteriaceae were sensitive to cefotaxime or ceftazidime. Cefoxitin was still effective against 95 per cent of K. pneumoniae. Compared with other third generation cephalosporins, combination of cefoperazone and betalactamase-inhibitor (sulbactam) possessed an increased in vitro efficacy against K. pneumoniae, Enterobacter, E. coli, Acinetobacter and non-fermentative gram-negative rods. Resistant rate of amikacin among all gram negative rods was 25-69 per cent. Ciprofloxacin sensitivity varied from 62-100 per cent among all gram-negative rods. Imipenem was excellent against all gram-negative rods with the sensitivity of 80-100 per cent. Epidemiological data of this study is important for the decision of the appropriate empirical antimicrobial treatment in our hospital.

Perinatal asphyxia: multivariate analysis of risk factors.

Perinatal asphyxia contributes greatly to neonatal mortality and morbidity. In developing countries, the need for risk assessment in perinatal asphyxia is obvious because of the high birth rate and limited perinatal resources. OBJECTIVE: To determine the incidence and risk factors of perinatal asphyxia in infants who were delivered from mothers with high-risk conditions. STUDY DESIGN: A prospective study over a 5-year period from 1993 to 1997 was performed at a tertiary level, referral hospital. PATIENTS AND METHOD: Nine hundred and sixty-one infants who were delivered from 878 high-risk mothers were recruited. All of the risk factors that might have contributed to asphyxia were identified and recorded. Univariate and stepwise multiple logistic regression analysis was performed to identify significant factors that might have contributed to asphyxia, the odds ratios and 95 per cent confidence interval were computed. RESULTS: Abnormal fetal heart rate pattern, thick meconium stained amniotic fluid, and premature delivery, were three common risk factors for asphyxia. The mean gestational age was 37.6 +/- 3.5 weeks, 10.5 per cent (101/961) were infants less than 33 weeks. The incidence of asphyxia was 9.7 per cent and was highest (26.7%) in infants less than 1000 g. By univariate analysis, significant relationships between perinatal factors and asphyxia were found among birth weight, gestational age, premature and breech delivery but stepwise multiple logistic regression analysis revealed that only birth weight was significantly associated with perinatal asphyxia. CONCLUSION: In countries where resources are limited, a neonatal resuscitation team should be available for very low birth weight infants, premature and breech delivery.

Comparison of general and regional anesthesia for cesarean section: success rate, blood loss and satisfaction from a randomized trial.

OBJECTIVE: A prospective randomized trial was organized to compare the effectiveness of general and regional anesthesia for cesarean section (C/S). METHOD: Three hundred and forty-one patients were randomized into the general anesthesia group (GA), epidural anesthesia group (EA) and spinal anesthesia group (SA). The effectiveness of interest was success rate, blood loss and patient satisfaction. RESULT: We found that the success rates of EA and SA were lower than GA. Success in EA should be improved by using an epidural catheter to add more local anesthetic drug instead of a single shot; and the surgeon should allow more time for the block to work adequately. Success in SA should be improved by using bupivacaine instead of lidocaine. GA resulted in significantly more blood loss, lower postoperative hematocrit, and higher proportion of patients who had postoperative hematocrit < 30 per cent than EA and SA. The patients' satisfaction scores were not different among the 3 techniques. This meant that, given adequate explanation and perioperative care, Thai women were satisfied with regional anesthesia. CONCLUSION: Regional anesthesia is a better choice of anesthesia for C/S than general anesthesia. However, the availability of different techniques and ability to change the technique when needed were very useful and important. If GA is chosen, all safety procedures must be followed. Oxygen supplement and endotracheal intubation facilities must be available in all techniques. Guidelines of anesthesia for C/S at a national level should be agreed upon, including the type of personnel, monitoring equipment and postoperative care.

Effects of general and regional anesthesia on the neonate (a prospective, randomized trial).

Anesthetic methods used during cesarean section have advantages and disadvantages to both mothers and infants and may result in short and long term neonatal effects. OBJECTIVE: To determine the effects of general and regional anesthesia on the infants, a prospective, randomized trial was performed in Siriraj Hospital, Mahidol University. MATERIAL AND METHOD: 341 uncomplicated pregnant women who were to be delivered at term by Cesarean section were recruited and randomized to receive general anesthesia, GA (103); epidural anesthesia, EA (120) and spinal anesthesia, SA (118). The immediate fetal and neonatal effects were assessed by cord blood gas analysis and the infant's Apgar scores. The Neurologic and Adaptive Capacity Scores (NACS) was performed within 4 hours after birth by two pediatricians who were blind to the anesthetic method. RESULT: Maternal age, weight, height, duration of the operation and infants' birth weight were not different among the study groups. In the EA and SA group, maternal systolic blood pressure decreased more than 20 per cent from the baseline in more than half. The infants' Apgar scores at 1 and 5 minutes were 8.3 +/- 1.9; 8.2 +/- 1.6; 6.7 +/- 2.8, and 9.7 +/- 0.9; 9.8 +/- 0.7; 9.2 +/- 1.6 in EA, SA and GA group respectively. The adaptive capacity, active tone, passive tone, general assessment and primary reflexes of the NACS were not statistically different. CONCLUSION: Apgar scores of the infants whose mothers received general anesthesia were lower than infants whose mothers received regional anesthesia but the NACS were not statistically different among the three study groups.

Prevalence and risk factors of bronchopulmonary dysphasia in neonates who requiring mechanical ventilation.

To find the prevalence and risk factors of bronchopulmonary dysphasia (BPD) in neonates requiring ventilator support, a retrospective study was performed of neonates admitted to the Pediatric Intensive Care Unit, Department of Pediatrics, Siriraj Hospital during January 1990-January 1992. Of the 195 neonates who were admitted, sixty-eight died before the age of 28 days. The data was analyzed from 107 neonates; 48.6% of the infants weighed less than 1,500 gm. According to Bancalari’s criteria, forty infants (37.4%) suffered from BPD. The mean birth weight and gestational age in the non BPD group was statistically significant higher than the BPD group (1,783 gm, 37 wk vs 1,486 gm, 30 wk). From this study, the incidence of prematurely, patent ducts arterioles, the amount and duration of oxygen therapy, peak inspiratory pressure (PIP), mean airway pressure (MAP) and amounts of fluid therapy during the first 7 postnatal dais in the BPD group are all statistically higher than in the non BPD group. The etiology of BPD may be multifactorial, but prematurely and oxygen toxicity seem to be the two most important factors. Prevention of prematurely, administration of artificial surfactant as an initial therapy for respiratory distress syndrome, the avoidance of barotrauma by using the lowest PIP to maintain PaO2, PaCO2, and the implementation of transcutaneous oxygen saturation monitoring, may decrease the incidence of BPD in these high risk neonates.

High-frequency flow interruption in the rescue of preterm infants with severe RDS.

High-frequency flow interruption (HFFI) was used successfully to rescue three preterm infants with severe respiratory distress syndrome (RDS) whose clinical condition continued to deteriorate while on the conventional mechanical ventilation. Had the HFFI not been used, the survival chances might have been 25 per cent for Case 1 and 2, and 45.5 per cent for Case 3. A dramatic, immediate, and sustained improvement in ventilation and oxygenation was demonstrated once the critical frequency and amplitude of HFFI were established. Bronchopulmonary dysplasia which was already evidenced in one infant before the HFFI attempt was detected in two infants. This study demonstrates that HFFI is capable of achieving adequate gas exchange and improving survival in infants with severe RDS.