A clinical study of preterm labour

Background: There has been a rising incidence of preterm labour in India. Preterm labour poses greater risks of morbidity and mortality of the preterm neonates. Various factors contribute towards risk of preterm labour and its outcome. Addressing these factors appropriately improves the outcome in pregnant women.Methods: This prospective observational study was conducted in department of obstetrics and gynaecology from the period of July 2017 to July 2018.Results: The present study was in 98 patients admitted in our hospital with preterm labour. Clinical profile of those patients was studied. Statistically significant association was found between administration of antibiotics and tocolysis in prolongation of pregnancy (p value=0.00). There was an association found between gestational age at birth and immediate neonatal outcome (p value=0.00). Preterm labour was more common in multigravidae (62.4%) and women with cervical length less than 3 cm (85.17%).Conclusions: Preterm labour can be expected more commonly in multigravidae, pregnant women with cervical length less than 3 cm and in presence of high-risk factors. Anticipation of preterm labour, judicious use of antibiotics, tocolytics can improve the outcome of preterm labour.

High Flow Nasal Cannula in the Treatment of Respiratory Distress Syndrome in One Day-old Neonate.

Background: This study was carried out to compare high flow nasal cannula (HFNC) and nasal intermittent mandatory ventilation (NIMV) in respiratory support of one day-old neonates with respiratory distress syndrome (RDS). Methods: This was a clinical trial conducted in neonatology wards of two university affiliated hospitals from Sep 2013 to Dec 2014. Inclusion criteria were gestational age of 30 to 35 weeks, appropriate weight for gestational age, clinical signs and symptoms of RDS, and RDS suggestive chest-X ray. All patients with RDS were treated with NIMV for one day. Those requiring NIMV respiratory support more than one day and showed the signs of respiratory distress were randomized into two groups of NIMV and HFNC. Each group consisted of 30 patients. Outcome measures included chronic lung disease, mechanical ventilation, failure to treatment, the time to establish full enteral feeding and the mortality rate. In addition, all complications were recorded. Characteristics of the two groups were compared at baseline and after the intervention. Results: Mean gestational age of patients in NIMV and HFNC groups was 31.81 (1.83) and 31.83 (1.39) weeks, respectively. Distributions of sex, gestational age, height, head circumference, and Apgar scores at the first and fifth minute after the birth were not significantly different between the two groups. Mean (SD) duration of respiratory support after the 1st day was 16.48 (7.80) hours in NIMV group and 18.46 (6.95) in HFNC group (P=0.3). Mean (SD) duration of hospitalization in NICU was 3.24 (0.68) days in NIMV group and 3.2 (0.06) in HFNC group (P=0.8). Mean (SD) age when oral feeding was started, was 23.37 (5.78) hours in NIMV group and 20.13 (5.38) hours in HFNC group (P=0.03). Eleven patients (36.7%) in NIMV group vs. 2 patients in HFNC group required free oxygen therapy (P=0.005). No treatment failure, chronic lung disease, mechanical ventilation or endotracheal intubation was observed in any group. 100% vs. 10% in NIMV and HFNC groups, respectively, experienced grade 3 and 4 nasal mucosal damage (P<0.01). Conclusion: HFNC was more tolerable than NIMV in the treatment of RDS in premature neonates' ≥30 week-old when applied after the first day of life.

A Case of Ruptured Acute Appendicitis Presenting as Pneumoperitoneum in Low Birth Weighted Premature Baby

Acute appendicitis is very rare in premature neonates. Preoperative diagnosis of this condition is difficult, and then it leads to high morbidity and mortality. We report 9-day-old premature male with ruptured acute appendicitis presented with pneumoperitoneum on plain films of the abdomen. Awareness of this rare condition and possible differential diagnosis in this age group is also discussed.

Programa de follow-up de recém-nascidos de alto risco: relato da experiência de uma equipe interdisciplinar / Follow-up program of high risk neonates: report of the experience of an interdisciplinary team

O avanço da Neonatalogia nas últimas décadas trouxe grandes mudanças na assistência ao recém-nascido, levando a um aumento na sobrevida de neonatos que apresentarão um alto risco para o surgimento de sequelas no desenvolvimento neuropsicomotor. Quando se comparam crianças prematuras com as nascidas a termo, é possível observar diferenças marcantes nas habilidades cognitivas, na performance escolar, no comportamento, entre outras. Dessa forma, o acompanhamento clínico dessas crianças, durante os primeiros anos de vida, é essencial para que haja a detecção precoce de alterações no desenvolvimento e as intervenções necessárias, além da identificação das necessidades da família e a orientação dos pais quanto às dificuldades que enfrentarão nos cuidados com essas crianças. Esse tipo de serviço é chamado de follow-up e sua implantação é recomendada pela Organização Mundial de Saúde, mas, infelizmente, a rede de assistência prestada aos bebês que recebem alta das UTIs Neonatais ainda é deficiente em nosso país. Há cerca de sete anos, foi criado, no Hospital Universitário da Universidade Federal de Juiz de Fora, um programa de follow-up de recém-nascidos de alto risco, que atende crianças egressas das UTIs Neonatais de Juiz de Fora e Zona da Mata. Desde sua criação, o programa cadastrou 356 pacientes. As crianças são acompanhadas até os cinco anos de idade por uma equipe interdisciplinar, composta por médicos (Pediatras Neonatalogistas), enfermeiros, fisioterapeutas,fonoaudiólogo, nutricionista, assistente social, psicólogos e profissionais afins. O presente artigo tem por objetivo relatar a experiência dessa equipe interdisciplinar no atendimento dessas crianças.

The advance of Neonatology in the last decades has brought great changes to neonatal care, leading to an increase in the survival rates of neonates which will present a high risk of neurodevelopmental impairment. When we compare premature children with those born at term, it is possible to observe clear differences in cognitive abilities, school performance,behavior, etc. Thus, clinical assessment of these children during the first years of life is essential. This strategy can provide early detection of neurodevelopmental disabilities, propose timely interventions, identify psychological needs of families and parents, and provide advice regarding the difficulties that they will face in the care of their children. This service is called follow-up, and the World Health Organization recommends its implantation, but unfortunately the chain of care provided to the babies who have received high-quality care in Neonatal Intensive Care Units is defficient in Brazil. About seven years ago, the University Hospital/Health Care Center of the Federal University of Juiz de Fora created a follow-up program for high-risk neonates, which attends children from Neonatal Intensive Care Units in Juiz de Fora and region. Since its creation, the program registered 356 patients. Follow-upoccurs up to the age of five years, and is provided by an interdisciplinary team, composed of physicians (Pediatricians),nurses, physical therapists, audiologists and speech therapists, nutritionists, social workers, psychologists and other professionals. The aim of this article is to reportthe experience of this interdisciplinary team in the care of these children.

Therapeutic Effect of High Frequency Oscillatory Ventilation on Premature Infants with Respiratory Distress Syndrome / 实用儿科临床杂志

Objective To evaluate the effect of the high frequency oscillatory ventilation(HFOV) on the treatment of premature neonates with respiratory distress syndrome(RDS).Methods Seventy premature infants with RDS were randomly grouped as HFOV group(n=33) and conventional mandatory ventilation group(CMV group,n=37),based on their fetal age,weight,age,and their clinical condition from Jan.to Sep.in 2009.The blood gas analysis was detected and compared between the 2 groups.Results In HFOV group,the inhaled oxygen concentration,pa(CO2) decreased after treatment for 6 h,which were significantly lower than those at the beginning of the therapy(Pa

Central Vein Catheterization for Prematurity / 대한마취과학회지

BACKGROUND: The establishment of safe and functional intravenous lines is of fundamental importance in premature sick neonates. Due to technical difficulties and various potential complications, central venous catheterization(CVC) has become an important part of long term care for prematurity. In terms of safety, it is believed by some that the central vein catheter tip should not be in the right atrium to avoid fatal complications. However, catheter performance and durability can be improved by positioning the catheter tip within the right atrium. Here, we evaluated the effectiveness of intraatrial catheter tip positioning for prematurities, to resolve this controversy between patient safety and catheter performance. METHODS: Premature neonates in whom CVC had been attempted at a nursery and pediatric intensive care unit were enrolled in this study. We successfully performed eighteen CVCs in twenty patients from September 2003 to December 2004. CVC tips were in positioned within the right atrium, and central venous route, central venous catheter depth, duration of catheterization, and any complications during or after catheterization were evaluated. RESULTS: Eighteen CVC were successful among twenty attempted in premature neonates. Two attempts failed due to guidewire insertion failure. A left supraclavicular venous approach was selected for 16 patients and a right approach for two. For intraatrial tip positioning, distances from skin to catheter tip were adjusted to an average depth of 5 cm in 11 patients and 6 cm in three patients. Two arterial punctures were the only minor complications. Mean duration of catheterization was 19 days without any long term complicaions. CONCLUSIONS: To prematue long term CVC performance, left supraclavicular subclavian vein catheterization and intraatrial catheter tip positioning should be considered a first option in premature neonates.