Hepatic involvement in common neonatal problems

Hepatic involvement has been reported to occur in the common neonatal problems as neonatal asphyxia, neonatal sepsis, and neonatal jaundice. However the exact type of involvement, incidence of occurrence, risk factors associated in and the impact outcome are not exactly known. To identify the risk factors, the incidence, and the types of hepatic involvement in the common neonatal problems and to determine the correlation between the types of hepatic involvement and the outcome of all cases. We studied 3 groups of neonates:- group with perinatal asphyxia, group with neonatal sepsis and group with neonatal jaundice and all the 3 groups were subjected to complete perinatal history, clinical examination, and some investigations for the diagnosis of the neonatal affections according to the clinical condition but all groups were subjected to liver function tests at admission and repeated according to clinical indications and hepatic involvement. Only the patients who showed severe hepatic affection will be subjected to liver biopsy. There was hepatic involvement in 20.5% in septic cases [transient in 87.5% and persistent in 12.5%]. There was hepatic involvement in 18% of cases with perinatal asphyxia [40% transient and 60% persistent]. There was hepatic involvement in 16% of cases with neonatal jaundice [80% transient and 20% persistent]. Three newborns with persistent hepatic affection were subjected to liver biopsy which showed galactosemia in one case, neonatal hepatitis syndrome in other case and biliary atresia in the third case

Comparative study of peripheral intravenous cannulae versus peripherally inserted central venous catheters in newborn infants

Newborn infants especially the high-risk groups require venous access for total or partial parenteral nutrition, intravenous fluids and medications for prolonged periods of time. The aim of this study was to compare between the complications of peripheral intravenous cannulae [nosocomial infection, local complications and mechanical complications] versus peripherally inserted centrally placed catheters in neonates. The present study was carried out on 50 neonates admitted to the Neonatal Intensive Care Unit [NICU] of Minoufiya University Hospital from June 2002 to June 2003 and expected to require venous access for at least 7 days for intravenous [IV] fluids, IV antibiotics, IV medications or parenteral nutrition. All infants were assigned randomly on admission to use either peripheral intravenous [PIV] cannula [n=25] referred to as [PIV group] or peripherally inserted central [PICC] catheters [n=25] referred to as [PICC group]. We found that there was a significant difference between both groups as regard number of attempts of insertion required for total IV therapy [2.36 +/- 1.07 in PICC group versus 11.48 +/- 5.72 in PIV group P<0.001]. The mean number of catheters used was significantly lower with PICC group than PIV group [1.08 +/- 0.27 in PICC group versus 6.52 +/- 3.77 in PIV group P<0.001]. Episodes of proven sepsis in PICC group were found to be significantly lower than in PIV group [5 cases [20%] in PICC group versus 12 cases [48%] in P/V group P<0.05]. The average time to develop sepsis [infection free catheter days] in PICC group was significantly higher than that in Ply group [5.67 +/- 3.13 in PICC group versus 2.83 +/- 1.03 in PIV group P<0.001]. The mechanical complication was statistically significantly lower in the PICC group than that in the PIV group. The rates of phlebitis and catheter associated infection are lower in the PICC group than the PIV group. Apart from the high cost, PICC is a desirable intravascular device in newborn with difficult venous access and in those requiring prolonged antibiotics or fluid therapy