Clinical audit on management of infants of diabetic mothers in neonatal intensive care unit assiut university children hospital

Background: infants of diabetic mothers [IDMs] are at increased risk of morbidity and mortality as well as poor perinatal outcome. Aim:it was to measure how much the staff in the neonatal intensive care unit at Assiut University Children Hospital are sticking to the agreed upon unitŒs protocol in management of infants of diabetic mothers

Patients and Methods: twenty five IDMs admitted to NICU with hypoglycemia were included in this study. The unitLs protocol was followed for the management of asymptomatic as well as symptomatic hypoglycemia in IDMs

Results: symptomatic hypoglycemia was present in 76% of IDMs. The rest of cases were asymptomatic hypoglycemia. The unitŒs protocol was completely followed in 76% of cases. However serum calcium was not measured in 24% of the cases

Conclusion: most [76%] of our cases of IDMs had symptomatic hypoglycemia. Maternal hyperglycemia is thought to lead to excess fetal glucose exposure and fetal hyperinsulinemia. Recommendation: close liaison with obstetricians in care of diabetic mothers particularly with monthly measurement of HbA1c during pregnancy and during labor with good adjustment and control of the maternal level of blood glucose

Apoptosis and oxidative stress in b thalassemia major in children

In B thalassemia the synthesis of beta globin chains is decreased .This interferes with the assembly of normal Hb A,. Recently apoptosis has been noted to play a central role in regulation of hemopieosis. Excess iron could generate reactive oxygen species [ROS] that may be involved in turn in lie damage of cellular compartment adding to apoptosis . The aim of this work is to study apoptosis and oxidative stress in B thalassemia major in children and their relationship to the severity of the disease and to the use of chelation . A cross sectional study of 56 patients with B thalassemia major aged 8 M -13 y as well as 10 apparently healthy age and sex- matched control . Beside full history and examination all patients and controls had the following investigations done Hb, serum ferritin, ALT, AST, ALP, FAS, TBARS and DNA damage measurement. Correlation studies showed that fas and TBARS showed significant negative correlation with Hb and significant positive correlation with ferritin . Newly diagnosed patients [First admission] showed significantly less severe DNA damage than recurrent cases . Chelated patients scored significantly better lhan non chelated patients . Patients on chelation showed significant better outcome regarding apoptosis and oxidative stress, therefore we must be ready with early chelation in all B thalassemia cases

Apoptosis and oxidative stress in infants and children with convulsions

Apoptosis and oxidative stress will be studied. The study included 150 pediatric patients admitted to Assiut University children Hospital because of convulsions. Their ages ranged from 6 M- 12y. The study also included 10 apparently healthy children of matchable age as controls. All cases and controls had the following investigations done: complete blood count, serum calcium, glucose, urea and creatinine. Nitric oxide [NO], Total thiobarbituric acid reactive species [TBARS], soluble fas, 5 hydroxytryptamine [5HT], gamma aminobutyric acid [GAB4] and DNA fragmentation percentage. All cases had an EEG done on admission. This study showed that apoptois and oxidative stress were significantly higher in cases than controls. Cases with prolonged and/or focal convulsions showed significantly higher % DNA fragmentation. Cases with simple febrile convulsions, higher degree of rise of temperature and shorter duration of convulsion [<5 minutes] showed significantly higher % DNA fragmentation. Younger cases [<2years] showed significantly higher degree of rise of temperature, oxidative stress and % DNA fragmentation. Cases with [temperature > 39 Degree C] also showed significantly higher % DNA fragmentation and significantly lower GABA levels. Correlation study showed significant positive correlation between % DNA fragmentation and rise of temperature

Conclusion and Recommendations. From this study, it can he concluded that the so called simple febrile convulsions showed significantly higher apoptosis

Recommendations: It is recommended that EEG monitoring should be done during the convulsion to be able to correlate the EEG, findings with the type of convulsion

study of some biochemical parameters of pulmonary hypertension in children with congenital and rheumatic heart disease

The study included 36 cases with congenital heart disease [CHD] all of them had left to right shunt [17 cases of them had pulmonary hypertension [PHT], 30 cases with valvular rheumatic heart disease [RHD] [15 of whom had PHT]. Ten healthy normal age-matched children were taken as control for each group. Full history and physical examination, pulse oximetry, standard 13-lead ECG and detailed echocardiographic examination were done for every patient and control case. Chest radiograph posterantrior view in erect position was done for all patients. Erythrocytic sedimentation rate, C-reactive rotein and antistreptolysin-O titer were done for patients with RHD. All cases and controls had the following done: plasma level of endothelin-1 [ET-1], angiotesin-II [ANG-II], nitric oxide [NO] and serum level of angiotesin-converting enzyme [ACE] activity. The mean peak pulmonary pressure [PP] in patients having CHD and PHT was 54.35 +/- 9.69 mm Hg, while it was 61.73 +/- 11.55 mm Hg in those with RHD and RHT. The mean peak PP in the group of patients having CHD without PHT was 22.64 +/- 4.11 mm Hg. It was significantly higher than in those with RHD without PHT [9.41 +/- 1.98 mm Hg, P<0.05] and than controls [4.12 +/- 1.25, P<0.01]. It was observed that the mean levels of ET-1, NO, ANG-II and ACE were significantly higher in all cases with CHD [3.42 +/- 0.77, 77.21 +/- 29.14, 81.27 +/- 37.3, 107.2 +/- 47.65, P<0.001], cases with PHT [3.76 +/- 0.81, 94.1 +/- 21.1, 101.4 +/- 33.8, 136.2 +/- 37.9, P<0.001] OR without PHT [2.92 +/- 0.6,61.36 +/- 27.5, 63.28 +/- 16.5, 85.36 +/- 22.6, P<0.5 and 0.01] than in their controls [1.86 +/- 0.6, 34.07 +/- 10.7, 19.15 +/- 10.9, 54.1 +/- 32.1]. It was observed that the mean level of ET-1, NO, ANG-II and ACE were significantly higher in cases with CHD with PHT than in those without PHT [p<0.05 for each]. In the group of patients with RHD, it was observed that the mean levels of ET-1, NO, ANG-II and ACE were significantly higher in all cases [3.89 +/- 1.4, 78.46 +/- 59, 70.35 +/- 37.4, P<0.01 and 0.001] and cases with PHT [4.9 +/- 1.0, 100.5 +/- 32, 95.7 +/- 36.8, 121 +/- 40.9, P <0.001] than in controls [1.55 +/- 0.5, 33.47 +/- 13.0, 22.68 +/- 11.1, 53.27 +/- 32.4]. It was also observed that the mean levels of ET-1, NO, ANG-II and ACE were significantly higher in cases with than in those without PHT [2.6 +/- 0.8, 56.5 +/- 18.0, 44.96 +/- 12.7, 63.3 +/- 37] [P<0.01]. It was observed that the mean levels of ET-1, ANG-II and ACE were significantly higher in cases with CHD having heart failure [3.8 +/- 0.73, 106.8 +/- 50.37, 155.3 +/- 65.66] than those without heart failure [3.26 +/- 0.7, 69.88 +/- 25.1, 91.85 +/- 32.8], P<0.05 and 0.001. There was statistically significant positive correlation between PP in all the studied patients and serum level of ET-1, NO, ANG-II and ACE [P<0.001]. A significant positive corrlation was found between serum level of ET-1 and NO in all the studied cases [P<0.05]. A significant positive correlation was also found between serum level of ANG-II and ACE in all the studied cases [P<0.03]. ET-1 and NO production is increased in cases with PHT secondary to CHD with left to right shunt and to RHD and its production correlates with the level of PP. It could be also concluded that the level of ANG-II and ACE activity is increased in cases with PHT secondary to CHD with left to right shunt and to RHD and its production correlates with the level of PP. The use of NO, NO donors, prostacyclin and ET-1 antagonists should be considered in the management of pulmonary hypertension secondary to hyperkinetic arterial PHT due to CHD with left to right shunt and in the management of venous pulmonary hypertension secondary to RHD. The long-term effect of such drugs on the pathological process in such cases should be studied. Still early intervention in cases with hyperkinetic arterial PHT due to CHD with left to right shunt before the end of the first year of life is highly recommended. It may be also suggested that the use of ACE inhibitors could be useful to prevent the effects of ANG-II on the pulmonary vascular pathology

study on thyroid function on newborns

The study included one hundered newborns at Assiut University Hospital. All cases had full clinical assessment including antenatal, natal, and perinatal events and method of feeding. Birth weight, birth length, Apgar score and neonatal jaundice were taken into account. A risk factor score for maternal and neonatal hazards was done for all cases. On the fifth of life a speceimen of venous blood was taken from all newborns and the serum levels of TSH, T3 and rT3 were measured the ratios of T3 / rT3 and / T3 / TSH were calculated. Correlation studies were done for TSH, T3 and rT3 in relation to the risk factors studied. Whereas T3 level was significantly higher in newborns belonging to elderly, multiparous mothers and those born by an abnormal method it was significantly lower in the presence of infant risk factors where the preservation of O2 consumption, body heat and energy is needed. Newborns with higher score for risk factors had significantly higher percentage frequency of abnormal high rT3 and of abnormally low T3. Neither maternal nor neonatal risk factors seemed to have any effect on T.S.G. level. In Conclusion. Maternal risk factors seem to raise the level of thyroid hormones whereas neonatal risk factors seem to decrease this level. It is recommended to include measurement of T.S.H in screening programs for detection of hypothyroidism particularly in developing countries where maternal and neonatal risk factors prevail. It is not advisable to give thyroxine medication to every newborn with low T3 level especially in the presence of neonatal risk factors

study on haemostasis in newborns

Prothrombin time [Pt] and coagulation factors, II, VII, IX and X were measured in 91 newborns both initially at birth and on the second day of life. For the first group of infants [52], a single im injection of 1 mg of vitamin K1 was given at birth. No vitamin K1 was given to the second group of infants [39]. A significant correlation was found between perinatal risk factors [low birth weight [BW], short gestational age [GA] and poor Apgar score 7] and the measured coagulation parameters. Perinatal risk factors were interrelated and the higher the number of the present risk factors, the higher the percentage frequency of the abnormal values for coagulation parameters. On the second day of life, newborns who did not receive vitamin K1 at birth showed significant prolongation of Pt and a significant decrease in coagulation factors than those who were given such therapy. This was true for the patients as a whole and for newborns suffering from each perinatal risk factor. It was concluded that the second day drop in coagulation factors could be prevented by a single im injection of vitamin k1 at birth preventing the occurrence of hemorrhagic disease of newborns. This is cheaper than giving supplementary cow's milk formula feed and it avoids the occurrence of milk protein allergy. Therefore, it is recommended that vitamin K should be given prophylactically to all newborns whether risk factors are present or absent