Intra- and inter-rater reliability of a biophotogrammetric assessment protocol for preterm infants / Confiabilidade intra e interexaminador do protocolo de avaliação biofotogramétrica em prematuros

ABSTRACT Objective: To measure the intra- and inter-rater reliability of a biophotogrammetric assessment protocol for thoracoabdominal motion in preterm infants. Methods: This is an analytical cross-sectional study. Footage of 40 preterm infants was made in two views (lateral and anterior). The babies were placed in the supine position, with retroverted pelvis and semiflexed knees. Acrylic markers were positioned on surgical tape in eight predetermined anatomical points. We analyzed 4 variables in lateral view and 11 in anterior view (angular and linear) (ImageJ®), divided into two stages: 1. same frames - three blinded evaluators analyzed frames previously selected by the main researcher (inter-rater analysis 1), reviewing these same frames after 15 days (intra-rater analysis 1); 2. different frames - each evaluator selected the frames from the original video and repeated the protocol (inter-rater analysis 2), with a review after 15 days (intra-rater analysis 2). In stage 2, we tested the reliability of the entire process, from image selection to the analysis of variables. Data agreement and reproducibility were obtained by the intraclass correlation coefficient (ICC). Results: Agreement was high, particularly in angular variables (ICC 0.82 to 0.99). Linear variables ranged between very good and excellent in analysis 1 (same frames: ICC 0.64 to 0.99) and analysis 2 (different frames: ICC 0.44 to 0.89). Conclusions: The present study suggests that the proposed protocol for the thoracoabdominal motion analysis of preterm neonates has high reliability.

RESUMO Objetivo: Mensurar a confiabilidade intra e interexaminador de um protocolo de avaliação biofotogramétrica da mobilidade toracoabdominal de prematuros. Métodos: Estudo de caráter transversal e analítico. Incluíram-se filmagens de 40 prematuros em duas vistas (lateral e superior), realizadas em supino, pelve retrovertida e joelhos em semiflexão. Marcadores de acrílico foram posicionados sobre Micropores em oito pontos anatômicos predeterminados. Foram analisadas 4 variáveis na vista lateral e 11 na vista superior (angulares e lineares) (ImageJ®), divididas em duas etapas: (1-Frames iguais) análises de fotogramas previamente selecionados pela pesquisadora principal por três avaliadores cegos (análise interexaminador 1), com reanálise desses mesmos fotogramas após 15 dias (análise intraexaminador 1); (2-Frames diferentes) cada avaliador selecionou os fotogramas por meio do vídeo original e repetiu o protocolo (análise interexaminador 2), com reanálise após 15 dias (análise intraexaminador 2). Em (2), foi testada a confiabilidade de todo o processo de análise, desde a separação das imagens até a análise das variáveis. A concordância e reprodutibilidade dos dados foram obtidas pelo coeficiente de correlação intraclasse (CCI). Resultados: Houve concordância forte, com ênfase nas variáveis angulares (CCI [0,82 a 0,99]). As variáveis lineares apresentaram variação entre muito boa e excelente na análise 1 (frames iguais: CCI 0,64 a 0,99) e na análise 2 (frames diferentes: CCI entre 0,44 e 0,89). Conclusões: O presente estudo sugere forte confiabilidade do protocolo proposto para análise da movimentação toracoabdominal de neonatos prematuros.

Construction and validation of the neonatal nutritional risk screening tool / Construção e validação da ferramenta de avaliação de risco nutricional neonatal

ABSTRACT Objective: To develop and validate both the content and reliability of the Neonatal Nutritional Risk Screening Tool (FARNNeo). Methods: Methodological study, convergent care. The instrument was built prior to the literature review and was analyzed by eight judges, during three cycles of the Delphi technique. The judges assessed their relevance and clarity with responses on the Likert scale with three levels, in addition to suggestions. The validation of the instrument was calculated using the agreement rate and content validity index (CVI). After content validation, the instrument was applied by four assisting nutritionists to verify reliability, using Cronbach`s alpha coefficient and the agreement between the evaluators by the Kappa coefficient. Results: All items of the instrument`s content reached the minimum agreement rate (90%) and/or CVI (0.9), except for item three, which in the first cycle obtained CVI 0.77 and 40% of agreement and, in the second cycle, CVI 0.75 and 38% agreement. At the end of the third cycle, all items had CVI values above 0.9. In the instrument application, alpha of 0.96 and Kappa of 0.74 were obtained, which reflect adequate values of internal consistency and agreement between the evaluators. Conclusions: FARNNeo proved to be reliable, clear, relevant, and reproducible for tracking early nutritional risk, systematizing the care of Brazilian newborns admitted to an intensive care unit.

RESUMO Objetivo: Desenvolver e validar o conteúdo e a confiabilidade da Ferramenta de Avaliação do Risco Nutricional Neonatal (FARNNeo). Métodos: Estudo metodológico, convergente assistencial. O instrumento foi construído previamente à revisão da literatura e analisado por oito juízes, durante três ciclos da técnica Delphi. Os juízes avaliaram sua pertinência e clareza com respostas na escala Likert com três níveis, além de sugestões. A validação do instrumento foi calculada pela taxa de concordância e índice de validade de conteúdo (IVC). Após a validação do conteúdo, o instrumento foi aplicado por quatro nutricionistas assistenciais para verificar a fidedignidade, utilizando o coeficiente de alfa de Cronbach e a concordância entre os avaliadores pelo coeficiente Kappa. Resultados: Todos os itens do conteúdo do instrumento alcançaram o valor mínimo da taxa de concordância (90%) e/ou IVC (0,9), com exceção do item três, que no primeiro ciclo obteve IVC 0,77 e 40% de concordância e, no segundo ciclo, IVC 0,75 e 38% de concordância. No fim do terceiro ciclo, todos os itens obtiveram valores de IVC acima de 0,9. Na aplicação da ferramenta, obteve-se alfa de 0,96 e Kappa de 0,74, que refletem valores adequados de consistência interna e concordância entre os avaliadores. Conclusões: A FARNNeo mostrou-se confiável, clara, pertinente e reprodutível para rastreamento do risco nutricional precoce, sistematizando o atendimento de recém-nascidos brasileiros internados em centro de terapia intensiva.

Red reflex technique training simulator in newborns / Simulador para o treinamento da técnica do reflexo vermelho em recém-nascidos

Abstract: Introduction: The Red Reflex Test (RRT) consists of visualizing the reflection that light causes in the retina when it passes through the pupil. It is a screening test for pathologies that can lead to blindness, which still have great social and economic impact on families and the government. Teaching through simulators allows students and health professionals to acquire and improve their clinical skills. Objective: The aim of the study is to develop a low-cost dummy, 3D printed and based on the Arduino platform, for the training of the red reflex technique (RRT) in newborns and evaluate its educational effectiveness. Method: A RRT dummy was presented to 7 expert judges: 6 pediatricians and 1 ophthalmologist to evaluate its applicability in medical learning. For this purpose, they used a 14-item Likert scale of 5 points. Subsequently, 40 individuals participated in a course: 33 medical students, 5 pediatric residents, a nurse and a general physician. The participants were randomly assigned to two groups: control (CG) and experimental (EG) group. Each group consisted of 20 participants. The EG went through 4 stages: 1) theoretical background; 2) handling of the simulator; 3) simulated clinical practice and; 4) evaluation in real-life patients. Whereas the CG went through the following teaching methodological processes: 1) theoretical background; 2) direct training in real-life patients and; 4) practical evaluation in a real-life patient. After each respective group intervention, both groups were assessed on their learning in 40 newborns at Santa Casa de Misericórdia do Pará Foundation in Belém, state of Pará, Brazil. Results: At the judges' evaluation regarding the simulator positive items (design, similarity, interest, relevance, content, memorization, didactics, previous reminiscence, comprehension and application), 49.2% answered 'strongly agree' and 44.4%, 'agree'. Regarding the negative questions (difficulty in understanding, information overload, abstraction, difficulty in handling and clarity of operation), 40.0% answered 'strongly disagree', and 57.1%, 'disagree'. The judges were 94.9% favorable to the use of the simulator in medical education. However, comparing the two groups of students, regarding the time of exam, the results showed no statistically significant difference (p-value = 0.29). Conclusions: The dummy showed its applicability for the learning of RRT, with the advantage of being able to perform the exam without having to disturb a real-life patient.

Resumo: Introdução: O Teste do Reflexo Vermelho (TRV) consiste em visualizar o reflexo que a luz causa na retina ao passar pela pupila. Dessa forma, o TRV tria patologias que levam à cegueira e pode reduzir o impacto social e econômico das famílias e do governo. O ensino por meio de simuladores permite que estudantes e profissionais de saúde adquiram e melhorem as habilidades clínicas. Objetivos: Este estudo teve como objetivos desenvolver um manequim de baixo custo, impresso em 3D e baseado na plataforma Arduino, para o treinamento do TRV em recém-nascidos e avaliar a eficácia educacional desse exame. Métodos: Um manequim do TRV foi apresentado a sete juízes especialistas - seis pediatras e um oftalmologista - que avaliaram a aplicabilidade do teste na aprendizagem médica. Para isso, utilizaram a escala Likert de 14 itens de 5 pontos. Posteriormente, 40 participantes participaram de um curso: 33 estudantes de Medicina, cinco residentes em pediatria, uma enfermeira e um médico generalista. Dividiram-se aleatoriamente os participantes em dois grupos: controle (GC) e experimental (GE). Cada grupo foi composto por 20 participantes. Submeteu-se o GC ao ensino convencional em pacientes reais. O GE passou por quatro etapas: 1. fundamentação teórica, 2. manipulação do simulador, 3. prática clínica simulada e 4. avaliação nos pacientes reais. No GC, adotaram-se os seguintes passos: 1. fundamentação teórica, 2. treinamento direto em pacientes reais e 3. avaliação em pacientes reais. Após a intervenção de cada grupo, os dois grupos foram avaliados quanto à aprendizagem em 40 recém-nascidos da Fundação Santa Casa de Misericórdia do Pará, em Belém, no Pará. Resultados: Na avaliação dos juízes em relação aos itens positivos para o simulador (design, similaridade, interesse, relevância, conteúdo, memorização, didática, reminiscência anterior, compreensão e aplicação), 49,2% afirmaram que concordavam fortemente e 44,4% mencionaram apenas que concordavam. Nas questões negativas (dificuldade de entendimento, sobrecarga de informação, abstração, dificuldade de manuseio e clareza de operação), 40,0% discordaram fortemente e 57,1% discordaram. Os juízes concordaram em 94,9% a favor do uso do simulador na educação médica. Porém, comparando os dois grupos de estudantes, em relação ao tempo de exame, os resultados não mostraram diferença estatisticamente significante (p = 0,29). Conclusão: O manequim mostrou aplicabilidade na aprendizagem do TRV, com a vantagem de realizar o exame sem que o paciente real fosse incomodado.

Association between ankyloglossia and breastfeeding / Associação entre anquiloglossia e amamentação

ABSTRACT Purpose To analyze the association between ankyloglossia and breastfeeding. Methods A cross-sectional study was undertaken on 130 newborn infants in exclusive breastfeeding with Apgar score ≥ 8 within the first five days of life. The research was approved by the Ethics Committee on Human Research. The data collection was performed by the researcher and by three trained speech therapists of the team. The protocols applied were the Neonatal Tongue Screening Test from the Lingual Frenulum Protocol for Infants, the UNICEF Breastfeeding Observation Aid, and the collection of maternal complaints related to the difficulty in breastfeeding was also considered. The data were submitted to statistical analysis - chi-square test and Fisher's exact test, with a significance level of 5%. Results When correlating the data, the statistical analysis revealed an association between ankyloglossia and the items of suckling category of the Breastfeeding Observation Aid. The association between complaint of difficulty in breastfeeding and ankyloglossia was also seen. Conclusion On the first days of life, ankyloglossia is associated with the mother's breastfeeding complaint and with the newborn's sucking difficulty.

RESUMO Objetivo Verificar associação entre anquiloglossia e amamentação. Método Estudo transversal, realizado em 130 recém-nascidos, em um Hospital Universitário. Foram incluídos recém-nascidos entre um a cinco dias de vida, com Apgar score ≥ 8, em aleitamento materno exclusivo. Participaram da pesquisa apenas recém-nascidos de termo e saudáveis. Esta pesquisa foi aprovada pelo Comitê de Pesquisa com Seres Humanos. A coleta de dados foi realizada pela pesquisadora e por três fonoaudiólogas da equipe, devidamente treinadas e calibradas. Os protocolos aplicados foram: avaliação anatomofuncional do Protocolo de avaliação do frênulo da língua em bebês, o Protocolo de Observação da Mamada da UNICEF e coleta das queixas maternas referentes a dificuldade ou não para amamentar. Os dados obtidos foram submetidos à análise estatística, sendo aplicado o teste Qui-quadrado e teste exato de Fisher, adotando nível de significância de 5%. Resultados Quando correlacionados os dados, a análise estatística demonstrou associação entre anquiloglossia e os itens da categoria de sucção do Protocolo de Observação da Mamada. Encontrou-se também associação entre queixa de dificuldade para amamentar e anquiloglossia. Conclusão Nos primeiros dias de vida, a anquiloglossia está associada com queixa da mãe para amamentar e com a dificuldade de sucção do recém-nascido.

Diagnostic usefulness of transcutaneous bilirubinometry in very preterm newborns

This study was performed to find out whether transcutaneous bilirubinometry could be a valid screening method for hyperbilirubinemia in preterm infants, especially for those who needed mechanical ventilation. We evaluated 63 preterm Iranian newborns who were managed in the neonatal intensive care unit of Shahid Beheshti University Hospital, Isfahan, Iran from April 2009 to April 2010. Transcutaneous bilirubin [TCB] measurements were obtained using BiliCheck [Trade mark sign] shortly before or 10 minutes after taking blood for determination of the plasma bilirubin level in premature newborns, who did not receive phototherapy. We assessed the correlation between the transcutaneous bilirubin and plasma bilirubin level by linear regression analysis. We also analyzed the gestational age, birth weight, postnatal age, sex, and hematocrit, for determination of their effect on transcutaneous bilirubin accuracy. The overall bilirubin concentration ranged from 5.4 to 17 mg/dL and from 4.8 to 17.3 mg/dl for total serum bilirubin [TSB] and transcutaneous bilirubin, respectively. The mean values obtained by transcutaneous bilirubinometry were slightly higher than the total TSB values. The correlation coefficient between TSB and TCB was r=0.82, P<0.001, and this was not influenced by gestational age, postnatal age or hematocrit, which were previously considered to be important. The correlation coefficient between TSB and TCB in mechanically ventilated preterm infants was r=0.75, P<0.001. Plasma bilirubin level can be accurately measured by BiliChec[Trade mark sign] in premature newborns, even in newborns who need mechanical ventilation

Comparación de la evaluación tradicional del desarrollo psicomotor versus una prueba autoadministrada / Comparison of traditional psychomotor development evaluation versus a self-administe-red test

Introduction: The purpose of this study is to evaluate the applicability of a self-administered questionnaire in the screening of psychomotor development (PD) in a primary care setting (PC). For that purpose, the degree of concordance between the Ages and Stages Questionnaire (ASQ) and a Psychomotor Development Evaluation Scale (Escala de Evaluación del Desarrollo Psicomotor-EEDP) currently utilized in PC was tested. In addition, perceptions and value judgment by professionals who participated in the study were explored. Methodology: This semi-quantitative study was performed between November 2008 and December 2009 in two PC centers of the Metropolitan Area of Chile on full-term newborns of the well-baby clinic. At age 8 and 18 months, parents or primary caretakers were asked to fill out the ASQ, and a PC professional completed the EEDP. Correlation and concordance between both tests was measured. Interviews and mini-focus groups were con-ducted with the participating professionals. Results: Three hundred and thirty newborns were recruited in the study. PD deficits were found on 8.79 percent of patients through the use of EEDP and in 12.73 percent through the use of ASQ (p = 0,05). Correlation between both evaluations was acceptable (r 0,5) as was concordance in deficit detection (kappa 0.576). The qualitative analysis showed appreciation of ASQ as a measuring tool as well as promoting awareness of PD. Staff of the PC settings utilized various strategies to overcome deficiencies of a self-administered test in populations of higher socio-educational and cultural risk. Conclusions: ASQ picked up significantly more PM deficits than EEDP, while correlation and concordance indices between both tests were adequate. Considering the subjective advantages expressed by staff in favor of ASQ, it is proposed that those PC centers that wish to implement the ASQ do so by progressively incorporating parents and caretakers into the observation of their children's development.

Introducción: El propósito del estudio fue evaluar la aplicabilidad de un cuestionario de autoreporte para el screening del desarrollo psicomotor (DSM) en atención primaria de salud (APS). Para ello se analizó el grado de acuerdo entre el cuestionario Ages and Stages (ASQ) y la Escala de Evaluación del Desarrollo Psicomotor (EEDP), que es el método empleado de rutina en APS. Además, se exploraron las percepciones y valoraciones comparativas de profesionales que participaron en la aplicación de dichos test. Metodología: Estudio cuanti-cualitativo, realizado entre noviembre 2008 y diciembre 2009. En 2 centros de Salud de la Región Metropolitana de Chile se reclutó lactantes nacidos de término, que acudieron a control sano. A los 8 y 18 meses se les solicitó a los padres o cuidadores principales completar el ASQ y un profesional de APS aplicó el EEDP. Se midió la correlación y concordancia entre ambos test. Se aplicaron entrevistas individuales y mini focus groups a los profesionales participantes en las evaluaciones. Resultados: Fueron reclutados 330 lactantes. La frecuencia de déficit del DSM fue 8,79 por ciento en EEDP y 12,73 por ciento en ASQ (p0,05). Hubo correlación entre ambas evaluaciones (r 0,5) y la concordancia en la pesquisa de déficit de DSM fue buena (kappa 0.576). En el análisis cualitativo destacó la valoración positiva del ASQ, tanto como instrumento de medición, como guía para promover el DSM. Para suplir las debilidades del ASQ, relacionadas con la modalidad de autoreporte, en grupos de mayor riesgo socio cultural o educacional, los centros de salud adoptaron diferentes estrategias. Conclusiones: El ASQ pesquisó significativamente más déficits del DSM que el EEDP, mientras que la correlación y concordancia entre ambas pruebas fueron adecuadas. Considerando las ventajas comparativas del ASQ en opinión de los profesionales, se propone que los centros de APS que deseen implementar ASQ, tomen una estrategia progresiva basada en la integración de ...

Tamizaje neonatal por espectrometría de masas en tándem: actualización / Neonatal screening by tandem mass spectrometry: an update

La espectrometría de masas en tándem (MS/MS) ha posibilitado la expansión de los programas de tamizaje neonatal en diferentes países. Esta tecnología permite el diagnóstico múltiple y rápido de diversos errores innatos del metabolismo. Sin embargo, su aplicación en distintos programas en el ámbito mundial es actualmente muy heterogénea. Existen diferentes criterios para determinar si se incluye una enfermedad específica en esos programas, en algunos casos con un enfoque más restrictivo que en otros, de acuerdo con los principios tradicionales de tamizaje enunciados por Wilson y Jungner, los que habrán de ser reevaluados a la luz de esta nueva tecnología. En este trabajo se presenta una actualización sobre el uso de la MS/MS en diferentes regiones del mundo en relación con las enfermedades tamizadas y con los criterios de inclusión de nuevos problemas de salud en los programas de tamizaje neonatal.

Tandem mass spectrometry (MS/MS) has made it possible to expand neonatal screening programs in different countries. This technology permits multiple and rapid diagnosis of diverse inborn errors of metabolism. However, its use in different programs around the world currently varies widely. There are different criteria for determining whether to include a specific disease in such programs, with some cases employing a more restrictive approach than others, based on the traditional screening principles enunciated by Wilson and Jungner, which will have to be reevaluated in light of this new technology. This article presents an update on the use of MS/MS in different regions of the world in terms of the diseases screened for, and the criteria for including new health problems in neonatal screening programs.

Transcutaneous bilirubinometry in preterm neonates.

This prospective study was conducted to evaluate the accuracy of transcutaneous bilirubinometry in preterm newborns less than 32 weeks of gestation. Serum bilirubin values measured by direct spectrophotometry were considered as standard, the range was 2.2-12.5 mg/dL. 32 jaundiced infants of less than 32 weeks of gestation without phototherapy, including 10 ELBW neonates, were enrolled. Close correlation (R=0.933) existed between total serum bilirubin and transcutaneous bilirubin values measured over sternum.

Comparison of two transcutaneous bilirubinometers--Minolta AirShields Jaundice Meter JM103 and Spectrx Bilicheck--in Thai neonates.

Transcutaneous bilirubin (TcB) has been reported to have a high correlation with serum bilirubin. The objectives of this study were: (1) to compare the accuracy of two transcutaneous bilirubinometer (Minolto AirShields Jaundice Meter, JM103 (JM) and SpectRx, Bilicheck (BC) in estimating total serum bilirubin (TSB) levels; and (2) to assess the predictive ability of transcutaneous bilirubin in relation to specific selected TSB levels. A total of 154 measurements of TcB, using JM and BC, and TSB were recruited from 134 term and near-term infants. Postnatal ages ranged from 19 to 160 hours (x = 64.7, SD = 25.6). TSB levels ranged from 4.5 to 17.5 mg/dl (x = 10.4, SD = 2.5). The correlation coefficients between TcB (JM and BC) and TSB measurements were significant and similar (r 0.80 and 0.82, respectively). The errors of distribution were, for TSB and TcB-JM, the mean difference of 0.7 mg/dl (SD 1.6 mg/dl and 95% confidence interval of the mean (CI) 0.4 and 1.0]; and, for TSB and TcB-BC, the mean difference of -0.6 mg/dl (SD 1.5 mg/dl and 95% CI -0.4 and -0.8). TcB-JM had a tendency to underestimate TSB levels, and TcB-BC had a tendency to overestimate TSB levels. The sensitivity of BC was higher, but specificity was lower, than JM in corresponding to different TSB levels, except at a TSB level of 15 mg/dl when both instruments yielded 100% sensitivity. The accuracy of JM in predicting TSB was higher than BC at all TSB levels. Operating the JM was simple and uncomplicated. It would be suitable for clinical use when a number of personnel perform the measurement.

Mid-arm circumference: an alternative measure for screening low birth weight babies.

Birth weight is a reliable and sensitive indicator for predicting the immediate or later outcome of a newborn child. In a developing country like Bangladesh, where more than 75% of deliveries occur in rural community and are mostly attended by Traditional Birth Attendants (TBA) or relatives, birth weight cannot be recorded mainly due to paucity of suitable weighing scale. To overcome the problem associated with weighing the newborn, it was considered justified to find out other simpler measurements that could be used as substitute of weighing, in order to identify low birth weight babies. A cross sectional, analytical, hospital based study was conducted at Dhaka city on 560 newborn babies born during a period of 18 months in 2000-2001 to examine relative validity of mid-arm circumference as a screening measure of low birth weight babies. Mid-arm circumference, length, head circumference, chest circumference, abdominal girth, and calf circumference were considered. The study showed a strong correlation (p < 0.001) between mid-arm circumference (r = 0.956) and birth weight, followed by calf circumference (r = 0.946) and birth weight. Other parameters were also strongly correlated (p < 0.001). The study showed that in identifying newborns of <2500 gm a mid-arm circumference of <9 cm had the best sensitivity (96.2%) and specificity (97.3%). A value of <8 cm and <6.8 cm for mid-arm circumference showed highest validity for picking up newborns weighing <2000 gm and <1500 gm respectively. Measurement of arm circumference is easier, convenient and statistically superior to other anthropometrical parameters in this work. The researchers recommend designing of simple 'Tri-colored tape' for early detection of 'At Risk' newborns in rural community for their timely management.

Noninvasive transcutaneous bilirubin as a screening test to identify the need for serum bilirubin assessment.

Hyperbilirubinemia is a common problem in the newborn infant. It can progress to develop kernicterus unless intervention is initiated. Severity and decision for management are usually based on serum bilirubin (TsB) which needs blood sampling. Transcutaneous bilirubin measurement is a noninvasive technique and the result correlates closely with TsB. A new transcutaneous bilirubinometer, Minolta AirShields Jaundice Meter, JM103, has been introduced The objectives of this study were: 1) To evaluate the accuracy of transcutaneous bilirubin (TcB) measured by JM 103, when compared to TsB, used clinically in a hospital setting (Leica Unistat Bilirubinometer) and 2) To develop a cut-off point of TcB level which indicated the need for serum bilirubin assessment. Three hundred and eighty eight term and near-term newborn infants with 460 paired TcB-TsB specimens were studied from August to November 2003. Birth weight was 3117.57 +/- 424.82 grams. TsB ranged from 4 to 19.6 mg/dL (x 10.5, SD 2.46). The correlation coefficient between TcB and TsB was significant (r 0.8, p < 0.001). TcB showed a tendency to underestimate TsB, with mean difference of 0.7 mg/dL, SD 1.6 mg/dL, and 95% confidence interval 0.85 and 0.55 mg/dL. TcB values of 8, 9, 10, 12 mg/dL were chosen as cut-off points that indicated the need for blood sampling for TsB (corresponded to hour-specific levels of 10, 12, 13 and 15 mg/dL, respectively when phototherapy should be initiated). In conclusion, noninvasive TcB assessment demonstrates significant accuracy, compared to TsB. It can be used as a screening test to identify the need for blood sampling for serum bilirubin level.

Automated determination of glucose-6-phosphate dehydrogenase (G6PD) on a SPOTCHECK Microflow analyzer.

Glucose-6-phosphate dehydrogenase (G6PD) is the initial enzyme in the hexose monophosphate pathway of glucose metabolism. Deficiency of G6PD has been linked to increased sensitivity of red cells to hemolytic anemia due to certain oxidant drugs, infectious agents or fava beans. It is an inherited error in metabolism and has a high incidence in certain ethnic groups. Astoria-Pacific has developed an automated assay for use on the SPOTCHECK Microflow Analyzer for the semi-quantitative determination of G6PD activity in erythrocytes. After sample extraction, all assay steps are automated including reagent addition, incubation and data collection. Use of on-line dialysis removes interferences. The assay is intended primarily as a screening tool in the diagnosis and treatment of disease states associated with G6PD deficiency in newborns. G6PD in the dried blood spot is extracted and placed on the instrument. Samples are then aspirated into the system at a rate of 90 samples/hour. All other reagents are added by the SPOTCHECK Analyzer on-line during sample processing. Incubation of each sample occurs on-line at 37 degrees C, and after dialysis the NADPH reaction product is excited at 365 nm. Fluorescence is measured at 500 nm. A lack of fluorescence indicates a probable G6PD deficiency. Data reduction occurs real time through a FASPac software thus individual results are available during a run as soon as each sample analysis is complete. The Astoria-Pacific International G6PD reagent kit paired with the SPOTCHECK Microflow Analyzer provides an effective and easy to use screening tool for determining G6PD deficiency in newborns.

The value of methemoglobin reduction test as a screening test for neonatal glucose 6-phosphate dehydrogenase deficiency.

Glucose 6-phosphate dehydrogenase (G-6-PD) deficiency is common in the Thai population and is the cause of neonatal hyperbilirubinemia and hemolytic anemia. This X-linked disorder is much more common in males than females. The objectives of this study were to compare the result of the screening methemoglobin reduction test (MRT) with the gold standard G-6-PD activity, and also to determine the prevalence of G-6-PD deficiency in the cord blood and blood of neonates with hyperbilirubinemia. Five hunderd and twenty two randomly selected cord blood (350 males, 172 females) and 229 peripheral blood from neonates with hyperbilirubinemia were assayed for G-6-PD enzyme activity using a WHO-recommended standard test as well as methemoglobin reduction (MR) test. The results showed that prevalence of G-6-PD deficiency from the cord blood was 11.1 per cent in males, and 5.59 per cent in females. Among newborns with neonatal jaundice, the prevalence of G-6-PD deficiency was 22.1 per cent in males and 10.1 per cent in females. MRT in cord blood G-6-PD deficiency screening had acceptable sensitivity (85.7%) and high specificity (98.1%). The sensitivity of MRT in jaundiced infants was low (60.0%) whereas the specificity was acceptable (92.1%). The negative predictive values were more than 90 per cent while the positive predictive values were low (61-65%) from both specimens. Conclusions: G-6-PD deficiency is common in the Thai population, both in males and females and can be screened from cord blood by using low cost MRT. G-6-PD deficiency contributes to 20 per cent of neonatal jaundice, and screening with MRT yields low sensitivity.

Infant hearing loss: the necessity for early identification

There has been controversy in the health professions about the necessity for newborn infant hearing screening. It is well accepted that patient history or a birth that places the infant in the high-risk registry (HHR) can identify 50 of all infants born with permanent bilateral hearing loss. Two major factors which have been cited as reasons for not screening the well-baby nursery have been poor cost effectiveness and the lack of documentation as to the benefits derived from early identification and intervention. Recent technological developments and published data are presented which indicate that economical well-baby hearing screening can be done in any setting, and that the language acquisition of the infant is permanently affected if the intervention is not done in the first six months after birth

Alfafetoproteína en suero materno para la detección de embarazos de alto riesgo / Maternal serum alphafetoprotein in the detection of high risk pregnancies

Objetivo: Evaluar la utilidad de la determinación de alfafetoproteína en suero materno (AFPSM) durante el segundo trimestre de la gestación, para identificar embarazos con riesgo aumentado para una gran variedad de padecimientos fetales y de la gestación, especialmente defectos de cierre del tubo neural y de la pared abdominal. Material y Métodos: Se estudiaron 120 mujeres embarazadas a quienes se les practicó una determinación de AFPSM durante el segundo trimestre de la gestación y se investigó la posible relación entre los niveles encontrados y la resolución del embarazo. Resultados: De las 15 pacientes con FPSM elevada, dos tuvieron un hijo con malformaciones congénitas, (trisomía 18 con mielomeningocele y otro con onfalocele). De las dos pacientes con AFPSM baja, una correspondió a un huevo muerto retenido. Respecto a otra patología obstétrica y/o fetal, no se encontraron diferencias significativas entre el grupo de AFPSM normal y anormal. Conclusión: La AFPSM fue útil en la detección de defectos de cierre del tubo neural y de pared abdominal, pero los resultados no son concluyentes para la detección de patología obstétrica

Ultrasonic diagnosis of intracranial hemorrhage in high risk neonates.

One hundred and eleven high risk neonates were subjected to (cranial ultrasound (CR-USG) Caranial sonography was performed by 2D realtime scanner with 5 MHz transducer through anterior and posterior fontanelle and temporo-squamal suture. One quarter of these neonates developed intracranial hemorrhage (ICH) within 120 hours of birth. Of them 42.8% neonates recovered completely, 21.4% developed ventriculomegaly, 21.4% neonates expired, 10.4% developed pseudo-porencephalic cysts and 3.5% developed aqueductal block. It is concluded that CR-USG is a useful technique for detection and monitoring of complications of ICH and at least one screening sonogram is essential in the first week of life of all high risk neonates.

Micro-invasive management of neonatal bilirubinemia.

The present study aims at analyzing the suitability of transcutaneous approach and filter paper technique using Minolta Jaundicemeter in the management of neonatal bilirubinemia. I compared serially measured values of Serum Bilirubin Index (SBI) by using filter paper technique and transcutaneous bilirubin index (TcBI) with serum bilirubin level determined by Diazo Method in 100 clinically jaundiced newborns and in 25 neonates at birth. The estimation of TcBI is simple, quick, reliable and non-traumatic to the newborn with no workload on the laboratory and technician. However, different nomograms are to be prepared for different laboratories, as also for the newborns with difference in skin pigmentation, gestational age and after phototherapy. SBI determined by filter paper technique eliminates these limitations. Moreover, the linear correlation was stronger between SBI and Diazo values (r = 0.9343, p < 0.001) in comparison to TcBI with Diazo values (r = 0.9090, p < 0.001). Further SBI readings almost correspond with actual serum bilirubin levels while corresponding TcBI values were much higher especially at higher diazo values. Thus TcBI can be used routinely for the surveillance of neonatal jaundice till it reaches a level corresponding to critical serum bilirubin level at which active management is required. At this point, serum bilirubin level may be confirmed by SBI.