Study on risk factors of respiratory distress syndrome in term neonates: a retrospective case-control study

Background: Respiratory distress syndrome (RDS) is one of the most common causes of neonatal respiratory failure and neonatal death. It is more common in preterm neonates but also been found in term and late preterm neonates. This study aims at studying the risk' factors for developing RDS in term neonates. Objectives was to study the maternal and perinatal risk factors for RDS in term neonates.Methods: This is a retrospective case control study conducted in neonatal intensive care unit of tertiary care centre. A total of 100 term neonates with RDS were taken as cases and 150 normal term neonates were taken as control. Data were collected from the hospital NICU records, maternal and neonatal history was taken. The ?2 tests or Fisher's exact text were used for one-way risk factor analysis. The effects of multiple factors on term neonatal RDS were analyzed using logistic regression analysis.Results: In our study RDS in term neonates' was significantly associated with following risk factors like selective cesarean section, male sex, SGA, oligohydramnios, MSAF, severe fetal distress, birth asphyxia, PROM, and maternal-fetal infection. Among the significant risk factors severe birth asphyxia, maternal-fetal infection, PROM, MSAF were showing positive association with RDS in full-term neonates.Conclusions: Several high-risk factors such as severe birth asphyxia, maternal-fetal infection, PROM, and MSAF were closely correlated with full-term neonatal RDS. Hence these could provide a significant reference for the diagnosis and treatment of term neonatal RDS.

Outcome of Bubble (CPAP) Continuous Positive Airway Pressure in Neonates with Respiratory Distress and its failure factors.

Introduction: Bubble CPAP is an important, simple, noninvasive, and cost effective treatment modality for respiratorydistress in neonates. The aim of our study was to know theoutcome of Bubble CPAP in preterm and term neonatesrequiring respiratory support and to study its failure factors.Material and methods: A retrospective observational studywith Bubble CPAP was done on 100 babies both term andpreterm with respiratory distress requiring for respiratorysupport admitted in NICU of Government General Hospital,Guntur. Monitoring was done clinically, with pulse oximeter,radiologically and with blood gases. Neonates with respiratorydistress secondary to sepsis, necrotizing entero colitis,congenital anomalies like Tetrology of Fallot, cleft lip withcleft palate, congenital diaphragmatic hernia, choanal atresia,who had severe respiratory distress with cardio vascularinstability were excluded in our study.Results: The mean gestational age was 32-34 weeks, birthweight was 1.4 kgs.52% were very low birth weight<1.5kgs. CPAP failure rate was higher in preterm and very lowbirth weight. The most common disease for starting BubbleCPAP was Respiratory Distress Syndrome 56 cases followedby Meconium Aspiration Syndrome 16 cases, congenitalpneumonia, Transient Tachypnea of New Born and BirthAsphyxia. The common complications on CPAP were shock,apnea and nasal damage. Overall failure rate was 36% (36cases). All babies who failed on CPAP were put on mechanicalventilation. Failure among Respiratory Distress Syndromewas about 42%, in Meconium Aspiration Syndrome 31%,congenital pneumonia 35.7%. Higher cases of sepsis andpulmonary hemorrhage were seen in failure group. Overallsurvival rate of the study was 64%(64cases).Conclusion: Bubble Continuous Positive Airway Pressure issafe, effective and easy to use in preterm and term neonateswith mild to moderate Respiratory Distress. The major failurefactors in our study were sepsis, recurrent apnea. The successrate was 64%

Maternal Risk Factor for Seizures in Term Neonate: A Hospital –Based Case Control Study.

Background: Assessing the maternal risk factors for seizure in first 72 hours of life in term neonate. Design: Case control study. Setting: Department of Paediatrics, Neonatology unit and Maternity ward tertiary care centre Govt. Medical College, Nagpur. Methods: A 210 cases [Term neonate with seizure within first 72 hours of life] and 210 controls [Term neonate without seizure in first 72 hours of life] were randomly selected as study subject over a period of two year. Primary exposure variables in mothers including age, parity, diabetes mellitus, hypertension, anemia, intrapartum fever, mode of delivery and prolonged second stage of labor were considered in study population. Neonates were carefully examined and observed for seizures and manage accordingly. Results: Maternal diabetes mellitus and anemia were potentially significant in their association with term neonatal seizure while maternal hypertension, intrapartum fever and prolonged second stage of labor were not significantly associated with seizure. Neonates born to diabetic mother, young maternal age, anemic mother and cesarean delivered neonate had 1.97, 0.95, 1.83 and 2.18 time more risk to developed seizure respectively. Conclusion: Early identification and timely intervention of maternal risk factor may reduces the seizure in term neonate.

Early Neonatal Respiratory Morbidities in Term Neonates

PURPOSE: This study aimed to investigate the respiratory morbidities in term neonates, as well as their relationship with mode of delivery and gestational age. METHODS: Medical records of term infants with respiratory symptoms, who were admitted to the neonatal intensive care unit (NICU) of Dong-A University Hospital from Jan 2008 to Dec 2013, were retrospectively reviewed. Term neonates with respiratory diseases, such as transient tachypnea of the newborn (TTN), respiratory distress syndrome (RDS), neonatal pneumonia, meconium aspiration syndrome (MAS), pneumothorax, and persistent pulmonary hypertension of the newborn (PPHN), were included. The respiratory morbidities were investigated according to the gestational age ( or =39 weeks) and/or mode of delivery (with labor vs. without labor). RESULTS: A total of 260 term neonates were enrolled in the study. The average gestational age was 38(+6)+/-1.3 weeks, while the birth weight was 3,233.7+/-462.0 g. The most common respiratory disease encountered in term neonates was TTN (n=98, 37.7%), followed by MAS (n=76, 29.2%), spontaneous pneumothorax (n=27, 10.4%), PPHN (n=24, 9.2%), neonatal pneumonia (n=19, 7.3%), and RDS (n=16, 6.2%). Incidence of TTN and RDS was higher in neonates aged or =39 weeks. Higher incidence of spontaneous pneumothorax and RDS was observed in neonates delivered before the onset of labor. The incidences of TTN, spontaneous pneumothorax, and RDS were higher in the elective cesarean section group before 39 weeks of gestation. CONCLUSION: Respiratory morbidities in term neonates are affected by the gestational age ( or =39 weeks) and/or mode of delivery (with labor vs. without labor).

Infarto cerebral espontáneo en un recién nacido de término / Spontaneous cerebral infarction in a full-term neonate

Introducción. Un accidente cerebro-vascular de origen isquémico y/o hemorrágico aumenta la morbi-mortalidad neonatal. Se estima que ocurre en 1:4,000 recién nacidos. En este trabajo se reporta un recién nacido de término con un accidente cerebro-vascular aparentemente espontáneo. Caso Clínico. Se trata de un recién nacido, madre de 31 años, segunda gesta de término que cursó con diabetes gestacional y fue tratada sólo con dieta. Inició con trabajo de parto a las 41.5 semanas de gestación por FUM; se efectuó cesárea por desproporción céfalo pélvica. Se obtuvo producto femenino de 3,640 g calificado con Apgar 8-9, se le aplicaron sólo pasos iniciales de reanimación. En el primer día de vida presentó desviación de la comisura labial a la derecha y movimientos tónico-clónicos en hemicuerpo derecho en 2 ocasiones; se inició fenobarbital. Los resultados de laboratorio para glucemia, sodio, calcio, potasio, creatinina, tiempos de coagulación y biometría hemática fueron normales; los cultivos de líquido cefalo-raquídeo fueron negativos, la punción lumbar se consideró traumática. El ultrasonido fontanelar no mostró alteraciones sugestivas de un evento hemorrágico ni alteraciones a nivel ventricular; sin embargo, al tercer día de vida se practicó tomografía axial computarizada de cráneo simple visualizándose una zona hipodensa con un patrón geográfico hacia la región tempo-parietal izquierda con aspecto de evento vascular isquémico en el territorio de la arteria cerebral media. Conclusiones. Se continuó con fenobarbital y ácido acetilsalicílico. Permaneció asintomática por lo que se egresó al séptimo día de vida. Se citó a consulta externa en Neurología Pediátrica.

Background. Cerebral vascular accident (CVA) is an important cause of hemorrhagic or ischemic cerebral injury and increases neonatal morbidity and mortality. It occurs in 1/4000 term neonates. We report a case of a neonate with a spontaneous CVA. Case report. We present the case of a newborn (NB) who was delivered from a 31-year old mother. It was the second pregnancy with 41.5 gestation weeks. The mother presented gestational diabetes controlled only by dietary therapy. A 3640 g, apparently healthy female was obtained by cesarean delivery that was indicated due to cephalopelvic disproportion. Apgar scores were 8-9 according to the conventional time points. The pediatrician used only initial steps of reanimation. During the first day of life, the infant presented a deviation of the right mouth commissure and tonic-clonic movements on the right half of the body two times. The newborn was treated with phenobarbital intravenous infusion. Laboratory tests were all normal, and cultures of cerebrospinal fluid and blood were considered negative. A head sonogram showed no evidence of hemorrhage or ventricular distortion but a cranial CT reported a low-density zone suggesting a cerebral infarction in the left parietal and temporal regions. Conclusions. We continued to treat with phenobarbital and acetylsalicylic acid and the patient remained asymptomatic prior to discharge at the 7th day of life, recommending follow-up with a pediatric neurologist.

The effect of clofibrate with phototherapy in late pre-term newborns with non-hemolytic jaundice.

Background : Despite an understanding of the enzymatic pathways leading to bilirubin production and degradation, very few pharmacologic interventions are utilized and the mainstay of treatment remains phototherapy. Aims : To evaluate the efficacy of clofibrate in reducing total serum bilirubin levels in late pre-term neonates with non-hemolytic jaundice. Design and Setting : Double-blind, placebo-controlled, randomized trial; tertiary level neonatal unit. Materials and Methods : A randomized controlled study was carried out in the neonatal ward of Children's Hospital, Tabriz, Iran, over a 1-year period. Sixty-eight healthy late pre-term infants readmitted with non-hemolytic hyperbilirubinemia were randomized to receive phototherapy and clofibrate (n= 35) or phototherapy and placebo (n= 33). Statistical Analysis Used : Chi-square test and independent sample 't' test. Results : There were no significant differences in the weight, gender, modes of delivery and age of neonates between the two groups. Similarly the mean total serum bilirubin (TSB) level at the time of admission was not significantly different between the two groups [mean± SD: 19.72 ± 1.79 (95% confidence interval: 19.12-20.54 mg/dL) vs. 20.05 ± 2.82 (95% confidence interval, 19.54-22.04 mg/dL), P= 0.57]. The mean TSB 48 hours after phototherapy [mean± SD: 8.06± 1.34 (95% confidence interval: 7.94-10.18 mg/dL) vs.10.94 ± 2.87 (95% confidence interval: 9.92-12.16 mg/dL), P= 0.02] and the mean duration of phototherapy [mean± SD: 64.32 ± 12.48 (95% confidence interval: 60-81.6 hours) vs. 87.84 ± 29.76 (95% confidence interval: 79.2-108 hours), P< 0.001] were significantly lower in the clofibrate-treated group. Conclusions : Clofibrate is an effective adjunctive drug in neonatal hyperbilirubinemia, which results in decreased TSB level and reduced duration of phototherapy in late pre-term newborns.

Hemorragia cerebelosa neonatal. A propósito de un caso / Neonatal cerebellar hemorrhage. A case report

Teniendo en cuenta que las lesiones del sistema nervioso central ocupan un lugar importante en la morbimortalidad neonatal, presentamos el caso de un recién nacido a término, sexo masculino, nacido en parto distócico, con hipoxia severa al nacer, que presentó manifestaciones clínicas de una hemorragia intracraneal. En ultrasonido transfontanelar se observó una imagen compatible con una hemorragia de cerebelo, la cual se corroboró con la TAC de cráneo. Es egresado vivo los 17 días.

Taking into account that damages of the Central Nervous System play an important role in neonatal morbidity and mortality, a case of a term neonato is presented: A male newborn from a dystocic delivery, with severe hypoxia, presenting clinical manifestatins o fan intracraneal haemorrhage. Transfontanel ultrasound whowed an image consistent with a cerebellar haemorrhage which could be proved through a Craneal comuterized Axial Tomography. The patient was discharged from the hospital at 17 days old.

Two Cases of Upper Gastrointestinal Bleeding in Healthy Full Term Neonates

Upper gastrointestinal bleeding (UGIB) secondary to gastritis or peptic ulcer is unusual in neonates and possibly related to several risk factors such as intracranial hemorrhage, intracranial hypertension, congenital heart disease, perinatal asphyxia, respiratory failure and hypovolemia. It is even more unusual that healthy full term neonates get UGIB. Upper gastrointestinal endoscopy is indicated in neonates with persistent UGIB to identify the cause and location of bleeding. We report two cases of UGIB successfully treated with injection of epinephrine by means of endoscopy in healthy full term neonates. One infant had duodenal ulcer and the other had hemorrhagic gastritis.

Symptomatic Pneumothorax in the Full-term Neonate / 영남의대학술지

BACKGROUND: This study was performed to evaluate the incidence and clinical characteristics of symptomatic pneumothorax in the full-term neonate. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 32 symptomatic pneumothorax patients in the full term neonates who admitted to the neonatal intensive care unit in Ulsan Dong Kang General Hospital from January, 2000 to December, 2004. The subjects were divided into two groups according to underlying causes; spontaneous pneumothorax group and secondary pneumothorax group, then each clinical characteristics were assessed. RESULTS: Spontaneous pneumothorax patients were 10 (31%) and secondary pneumothorax patients were 22 (69%). Overall incidence of spontaneous pneumothorax was 0.4%. Most common cause of secondary pneumothorax was pneumonia. Twelve cases (54.5%) among secondary pneumothorax patients were associated with mechanical ventilator care. Clinical characteristics, courses and managements were similar between two groups, but more shorter duration of admission and chest-tube insertion in spontaneous pneumothorax group CONCLUSION: The patient with symptomatic pneumothorax needs careful observation and proper management with or without underlying respiratory diseases