Parathyroid hormone [PTH] and markers of calcium metabolism in children with congestive heart failure

Parathyroid hormone [PTH] regulates the content of calcium and exerts an effect on myocardial function. Abnormal secretion of PTH has been sporadically reported to be associated with depressed mechanical performance of the heart muscle. The aim of this study is to evaluate parathyroid function in patients with CHF due to dilated cardiomyopathy [DCM], measuring some different parameters of calcium metabolism This work was carried on 30 cases [20 males and 10 females] with congestive heart failure [CHF] having a mean age of 6.69 +/- 3.94 years. They were recruited from Cardiomyopathy Clinic at Cairo University Children Hospital [Abou El Riche], All our patients were subjected to full history taking, general examination and echo-cardiographic examinations. Thirty normal healthy children of matched age and sex were included to serve as control. Cases were further classified into[i] Decompensated HF[n=18] [NYHA III, IV] who were admitted to in patient units and[ii] Compensated HF[n=12] [NYHA II]. The following laboratory parameters were measured and compared. Osteocalcin[OC] and Parathyroid hormone[PTH], in addition to total serum calcium, phosphorus, creatinine, urea, alkaline phosphatase, sodium and potassium. The results of our work revealed statistically significant lower serum calcium, higher serum phosphorus levels and lower serum osteocalcin in DCM cases compared to controls [p=0.0001,0.002 and 0.0001 respectively].There was no statistically significant difference between cases and controls regarding serum PTH. l.e. normal PTH, however the calcium is depressed in DCM. Parathyroid hormone level was normal in patients with CHF, however three cases of the decompenstated group showed non-significant elevated levels. Significant hypocalcaemia, hyperphosphatemia and reduction in serum OC levels were noted in our CHF patients. Further studies of these factorscontributing to the associated morbidity of patients with decompensated CHF-should be well traced

Utility of routine daily chest radiographs in ventilated newborns in intensive care units of Children's Hospital, Cairo University

The aim of this study was to assess the frequency of new abnormalities on routine chest radiographs of ventilated, preterm and full term infants during the acute stage of their illness; thus determining whether the interventions performed, were based on the routine portable morning CXR or not. It also aimed to identify patient subgroups for whom routine CXR is most useful. Seventeen preterm [group 1] and twelve full term [group 2] infants were recruited from the neonatal intensive care unit of Children's Hospital Cairo University. They were identified who had at least three daily routine chest radio graphs. The appearance of their subsequent radio graphs was compared to that obtained on the 1[st] day of ventilator sup port. The development of new abnormalities [malposition of the endotracheal or nasogastric tube, lobar collapse or consolidation, pleural effusion, pulmonary edema, etc.] was also noted. When the result of the routine chest radiograph led to an intervention; it was recorded. The third group [3] comprises ten ventilated sick full term infants who were not routinely radio graphed [i.e. only when clinically indicated] in order to determine the routine versus non-routine chest radiography protocol. [Premature newborns being at high risk of cardiopulmonary complications couldn't be included in that arm of the study]. The results revealed that a total of 107 radio graphs were examined from 39 infants. New changes were present on 26 [76.4%] of the 34 radio graphs taken on the 2[nd] or 3[rd] day[s] of ventilation of the seventeen ventilated preterms. In ventilated full term infants, new changes were present in 16 of 24 [66.6%] radiographs taken on the 2[nd] or 3[rd] day[s] of ventilation. In group [3] new abnormalities were detected only in 4/20 [20%] of the examined CXRs. The commonest problems were lung collapse and consolidation with the highest incidence among preterm infants. There was a significant relation between the results of routinely done CXRs and the interventional modifications [P value: 0.012] although they didn't seem to influence the outcome or the duration of ventilation or hospital stay. Routine daily chest radiographs in mechanically ventilated, preterm infants during the acute stage of their respiratory illness can yield new information important in patient care. New abnormalities have been demonstrated in almost the majority radio graphs examined, thus highlighting the importance of routine daily radiography for this high risk group that can be of value in further management

Predictors of neonatal mortality in intensive care unit in children's Hospital, Cairo University

Variations in mortality rates are important because they permit inferences about quality of care. Examination of care practices associated with variations in mortality rates can provide insights into how care practices might be changed to improve outcomes. The purpose of this study is to determine and report important causes of admission, incidence and causes of death for a large group of infants admitted to our neonatal intensive care unit [NICU]. The study comprised all 826 infants admitted to our tertiary-level NICU from April 2003 to October 2004. Data of newborns admitted to the NICU were analyzed retrospectively. Overall, the most prevalent indications of admission to our NICU were neonatal jaundice [n=296 [35.8%], infection [n=186 [22.5%], prematurity [n=162 [19.6%]], hypoxic-ischemic encephalopathy [HIE] [n=101[12.2%]], respiratory distress syndrome [RDS] [n=79 [9.6%], congenital heart disease [CHD] [n=44 [5.3%]], transient tachypnea of the newborn [TTN] [n=40[4.8%]], chromosomal or congenital anomalies [n=40[4.8%]]. The overall mortality rate was 29.1% [240 deaths]. The mortality rate was 69.4% for infants with birth weight less than 1000 g. 2.1% of the deaths = [n=5] occurred within the first 24 hours of NICU admission, 15.8% [n=38] within 2 days and 29.2% [n=70] within 3 days, and 91.3% [n=219] within 12 days. Only 8.75% of deaths [n=21] occurred after the fist month of NICU admission. The most prevalent conditions associated with death in The NICU were infection [135deaths [56.25%], RDS [64 deaths [26.7]], HIE [45deaths [18.8%], CHD [25 deaths [10.4%] and chromosomal or congenital anomalies [18 deaths [17.5%]]. Sex was not a significant predictor of death on multivariate analysis. Mortality rate in the NICU still unacceptably high, these results highlight the fact that many causes of neonatal deaths may be preventable