Risk factors for post-cardiac surgery diaphragmatic paralysis in children with congenital heart disease

Injured phrenic nerve secondary to cardiac surgeries is the most common cause of diaphragmatic paralysis [DP] in infants. The aim of this study was to determine the risk factors for DP caused by congenital heart defect corrective surgeries in pediatrics. This cross-sectional study, conducted in a 2-year period [2006-2008], included 451 children with congenital heart diseases admitted to the Pediatric Cardiac Surgery Ward of Imam Khomeini Hospital. The diaphragmatic function was examined via fluoroscopy, and the frequency of DP and its relevant parameters were evaluated. Of the 451 patients, comprising 268 males and 183 females at an age range of 3 days to 204 months [28.2 +/- 33.4 months], 25 [5.5%] infants [60% male and 40% female, age range = 15 days to 132 months, 41.2 +/- 28.1 months] had DP as follows: 48% unilateral right-sided and 36% unilateral left-sided. Additionally, 68% had cyanotic congenital heart disease and 84% had DP following total correction surgery. The highest prevalence rates of DP resulting in phrenic hemiparesis were observed after arterial switch operation, Fontan procedure, and Blalock-Taussig shunt surgery, respectively. Thirteen [52%] of the 25 DP patients underwent surgical diaphragmatic plication because of severe respiratory distress and dependency on mechanical ventilation, and most of the cases of plication underwent arterial switch operation. The rate of mortality was 24% [6 patients]. DP with a prevalence of 5.5% was one of the most common complications secondary to cardiac surgeries in the infants included in the present study. Effective factors were age, weight, cyanotic congenital heart defects, and previous cardiac surgery. Diaphragmatic plication improved prognosis in severe cases

randomized controlled clinical trial of olive oil added to human breast milk for weight gaining in very low birth weight infants

Evaluating the effect of vegetable oil, as a supplement to breast milk in increase the weight gaining of VLBW neonates. In this single blind; Randomized clinical trials, in NICU of Vali-asr Hospital, Tehran University of Medical Sciences, 2005-2006;A total of 48 VLBW neonates referred and admitted to NICU, who did not have any major GI [especially NEC], respiratory or cardiac diseases; participated randomly in two groups: intervention and control.Vegetable oil was added to the milk of 25 neonates [0.5 cc per 30cc of milk] and the other 25neonates with similar conditions that were selected as a control group, did not get any type of supplementary nutrition. Daily feeding volume in both groups was 150-200 cc for each kilogram of body weight. Weight gaining in interventional groups was considerably more than control group. [p<0.04].There were also significant statistical differences in hospitalization period between the two groups, 28.9 days in interventional and 20.33 days in control group, [p<0.03].However, no significant side effects were observed. There is no report regarding contraindication linking the use of vegetable oil intended for appropriate weight gaining or reducing hospitalization period to neonatal chronic diseases