Acute massive feto-maternal hemorrhange: a challenge to the neonatologist

Acute Feto-Maternl hemorrhage [FMH] is an unexpected medical emergency. The diagnosis should be considered in all cases of unexplained fetal deaths, fetal distress, in severe asphyxia, in non-immune hydrops fetalis, neonatal shock, severely pale baby, and in non-hemolytic anemia presenting in the newborn period. Prognosis remains poor with mortality around 50%. Anticipation, ideal aggressive management of the newborn and successful outcome in such cases remains even today a real challenge for the neonatologist

Sextuplets in Oman

Use of ovulation inducing agents has increased the incidence of high order multifetal gestation. Such pregnancies are associated with increased maternal morbidity and poor perinatal outcome especially due to prematurity. Here, we report a case of sextuple pregnancy following ovulation induction with gonadotrophins. This is the first reported case of sextuplets from Oman

Non-invasive ventilation in neonates and children

To explore the use of non-invasive ventilation with nasal CPAP [continuous positive airway pressure] and BiPAP [Bilevel positive airway pressure] ventilatory support system in neonates and children. Prospective hospital-based study. Hospitalised neonates and children with respiratory distress. Neonates admitted in neonatal intensive care unit with moderate respiratory distress and grunting, requiring >40% oxygen were put on a discontinuous system of nasal CPAP using Benveniste's valve and silastic nasal prongs. A similar study was conducted in the paediatric ICU in a limited number of patients using nasal CPAP and bilevel PAP device. 121 out of 589 babies required respiratory support [20.54%], either mechanical ventilation or nasal CPAP. 54.5% required nasal CPAP. Indications for CPAP were RDS [69.7%], birth asphyxia with respiratory distress [9.1%], pneumonia [6.1%], sepsis [4.5%], aspiration [3%] and others [7.6%]. Nasal CPAP group had statistically significant lower incidence of apnoea, intraventricular haemorrhage [IVH], retinopathy of prematurity [ROP], sepsis and no pneumothorax, compared to mechanically ventilated babies. Birth weight and gestational age had no detrimental effect on the success of CPAP. In the paediatric ICU, nasal CPAP was used in 18 cases out of 159 children [11.3%].The Bi-level PAP device was successfully used in a child with acute Guillain Barre syndrome with respiratory compromise. Non-invasive ventilation in selected cases had clear advantage over endotracheal intubation and mechanical ventilation with less complications, morbidity and duration of intensive care, and was cost-benefit effective. The need for sedation, analgesia and paralysis could be totally avoided. Use of discontinuous system of CPAP was advantageous, in that babies could be given even bath, breast feeding and mother-infant bonding. The child on BiPAP could move around, swallow and verbally communicate

Prazozin - a first line drug in scorpion envenomation

Scorpion envenomation is an acute life-threatening medical emergency. Prazosin as a first line of drug can easily reverse the alpha receptor stimulation and the resultant autonomic stom witnessed in scorpion envenomation. Here we present a case of a one-and-a-half-years old. Omani girl who presented with multiple scorpion stings and severe envenomation but effectively managed with prazosin and anti-venom without any cardiac and pulmonary problems

Use of analgesia, Sedation and paralysis in ventilated newborn infants

The article discusses the one-year experience of the neonatal unit at Sultan Qaboos University Hospital, Oman, with respect to the use of analgesic, sedative and paralytic agents in ventilated neonates. It was noted that all ventilated neonates received sedation [100%] while paralysis was received by 45% of the neonates. Analgesics were used very rarely [5%]

Fulminant septicemia in a preterm neonate secondary to multi-resistant enterobacter cloacae

We present a case of a preterm infant who developed fulminant septicemia secondary to multi-resistant Enterobacter cloacae and died. This is the first neonatal mortality secondary to E. Cloacae since the opening of the neonatal intensive care unit. November 1991

Sialldosis a rare cause nof neonatal hydrops

We report a neonate with Sialidosis type II, a rare metabolic disorder, who presented as hydrops fetalis and early cardiomyopathy. The clinical features, diagnosis and management are discussed. We emphasise that a full metabolic work-up should be performed in any neonate with non-immune hydrops. Also the role of echocardiography in such a case is highlighted