Résumé
We report nasopharyngeal teratoma in a term female neonate, that presented within first week of life with episodic stridor, apnea and cyanosis. Laryngoscopy revealed a mass which was confirmed by MRI. The mass was surgically excised and diagnosed as nasopharyngeal teratoma on histopathology. The child is doing well on follow-up
Résumé
Raised intracranial pressure (ICP) is a life threatening condition that is common to many neurological and non-neurological illnesses. Unless recognized and treated early it may cause secondary brain injury due to reduced cerebral perfusion pressure (CPP), and progress to brain herniation and death. Management of raised ICP includes care of airway, ventilation and oxygenation, adequate sedation and analgesia, neutral neck position, head end elevation by 200 -300, and short-term hyperventilation (to achieve PCO2 32- 35 mm Hg) and hyperosmolar therapy (mannitol or hypertonic saline) in critically raised ICP. Barbiturate coma, moderate hypothermia and surgical decompression may be helpful in refractory cases. Therapies aimed directly at keeping ICP <20 mmHg have resulted in improved survival and neurological outcome. Emerging evidence suggests that cerebral perfusion pressure targeted therapy may offer better outcome than ICP targeted therapies.
Sujets)
Barbituriques/usage thérapeutique , Cause de décès , Enfant d'âge préscolaire , Association thérapeutique , Sédation consciente/méthodes , Maladie grave/thérapie , Diagnostic précoce , Traitement d'urgence , Femelle , Humains , Inde , Nourrisson , Nouveau-né , Unités de soins intensifs pédiatriques , Hypertension intracrânienne/diagnostic , Hypertension intracrânienne/mortalité , Hypertension intracrânienne/thérapie , Pression intracrânienne , Mâle , Mannitol/usage thérapeutique , Pronostic , Ventilation artificielle , Appréciation des risques , Solution saline hypertonique/usage thérapeutique , Analyse de survieRésumé
OBJECTIVE: To see the level of agreement on subjectively assessed sickness by NICU staff nurse with doctor. METHODS: Prospective study in NICU for three months. The nurses were asked to assess whether a baby is sick or not on the basis of observed physical variables. Both the nurses and the attending physician made their assessment on a progress sheet separately. Statistical analysis was carried out to see the agreement of the nurses with the doctors in respect to the sickness assessment, treatment, final outcome and the agreement between the symptoms picked up by the nurses and the doctors. RESULTS: Out of 112 babies admitted, 90 were observed to be sick by the nurses out of which 85 were observed to be sick by the doctors (Kappa=0.4098). Considerable accuracy was noted on comparing symptoms picked up by the nurses and the doctors'. The Kappa value for respiratory, GI and neurological system was 0.4278,0.401 and 0.59 respectively. A significant correlation was seen between the two groups with regard to the treatment given (p value=0.0456). CONCLUSION: Trained NICU staff nurse can identify sick neonate on observation.