Umbilical Cord Blood Bilirubin Level Measurement in Predicting the Development of Significant Hyperbilirubinemia

Objectives This prospective study was undertaken to identify the newborns at risk for developing significant hyperbilirubinemia using cord blood serum bilirubin levels. Methodology This was prospective study with total of 282 healthy term newborns delivered at MNR Hospital, were included in study with birth weight more than 2,500 grams during one year period from March 2013 to March 2014. Soon after delivery cord blood was sent for serum bilirubin analysis. The data was analyzed using t-test, ROC curve and chi test and was considered statically significant, if value is P<0.05. Results In total 282 children, 51 developed significant hyperbilirubinemia (18.09%). There were no significant differences between the cases who did and who did not develop significant hyperbilirubinemia with respect to various factors that may be associated with the risk of hyperbilirubinemia such as birth weight, type of delivery, gestational age, maternal age, gender, and APGAR value P > 0.05, while in cord bilirubin level there is highly significant difference P <0.05. In our study on the amount of umbilical cord bilirubin cut off pointof 2 mg/dl had good sensitivity(94.12), specificity(90.9%), positivepredictivevalue (69.57%) and negative predictive value (98.59%). Conclusion The present study led to the conclusion that the bilirubin levels that were equal to or greater than 2 mg/100 ml umbilical cord blood can predict significant hyperbilirubinemia with high negative and positive predictive values and high levels of sensitivity and specificity.

Tension Pneumothorax in the First Hour of Newborn Life

Pneumothorax is an uncommon occurrence at birth. We report a case of a preterm male baby born to a primip through caesarean section. He did not cry immediately after birth, but spontaneous respirations developed after successful neonatal resuscitation. However, a few minutes after resuscitation, the infant developed respiratory distress, grunting and cyanosis. On examination, decreased air entry to the left side of the chest and shift of the trachea and apex beat to the right side were observed, and transillumination of the left side of the chest was positive. Infantogram was done to confirm the diagnosis of pneumothorax on left side of the chest.

ICU management of blunt chest trauma: our experience.

Blunt chest tramma is a major cause of mortality and morbidity following road side accident. An understanding of the factors affecting the mortality and morbidity will help in formulating better management strategies. The records of 40 consecutive patients presenting with blunt chest trauma (BCT) requiring ICU care from 1994-1996 were reviewed. Flail chest was the most common chest injury seen in 35 patients (87.5%). Isolated flail chest was seen in 22 patients, isolated pulmonary contusion in 2 patients and a combined injury in 13 patients. Ventilatory assistance was required in 34 patients (85%) for an average duration of 16 days (range 2-43 days). All patients with anterior flail required assisted ventilation in contrast to 75% and 88% of patients with unilateral and bilateral flail respectively. Presence of pulmonary contusion with or without flail was also associated with a high incidence of ventilatory support requirement. Chest infection (pneumonia) was the most common complication seen (65%). Adverse outcome occurred in 12 patients (30%). The main contributing factors for increased morbidity and mortality were: associated pulmonary contusion, associated extrathoracic injuries and preexisting medical illness. Statistical significance was observed only with pulmonary contusion.