Congenital pulmonary vein stenosis

A case of a newborn infant is described who presented with severe cyanosis at birth with rapid deterioration. The infant died at six hours of life. The diagnosis was determined at autopsy as congenital pulmonary vein stenosis

Head size at brith in neonates with transposition of great arteries and hypoplastic left heart syndrome

Appropriate fetal brain growth depends upon the cerebral blood flow [CBF]. Different congenital heart defects [CHDs], due to the difference in anatomy and physiology, alter the intrauterine CBF. Thus, variable brain growth is expected in different CHDs that is reflected by variability in the head circumference [HC] at birth. The present study was carried out to compare the HC of babies born with transposition of great arteries [TGA] and hypoplastic left heart syndrome [HLHS] in comparison to normal control. The data on the HC of neonates with TGA and HLHS were extracted from the computer database then compared with the control group. During the period from January 1996 to December 2003, a total of 7396 neonates were admitted, out of which 639 [8.6%] were admitted with the diagnosis of the CHD. After correcting for gestational age and non-availability of HC measurements, 236 infants were excluded. Out of the remaining 403 term appropriate for gestational age [AGA] infants, 46 had TGA while 28 had HLHS. The control group comprised of a total of 74 term AGA infants. The mean HC for the control group was noted to be 34.4 +/- 1.7 centimeters [cms], 33.7 +/- 1.5 cms for TGA while it was 32.9 +/- 1.3 cms for HLHS. The head size at birth for newborn with HLHS was significantly smaller than the TGA [p=0.03] and control group [p=0.001]. Similarly, HC of TGA group was significantly smaller than the control group [p=0.02]. The newborns with TGA and HLHS are found to have significantly small head size at birth. The clinical significance of this finding with respect to the neurodevelopmental outcome and value of early antenatal intervention to repair these defects remains to be evaluated in further studies

Correlation between body weight and serum albumin concentration in premature infants

Albumin is the most abundant protein in human plasma, exerting 75 to 80% of the normal colloid osmotic pressure. Its normal concentration is required for many of the physiological effects in the body. Premature babies are reported to have low serum albumin. However, it is not clear that this is weight related. To look into the relationship between the body weight and albumin in premature infants we selected a group of extremely low birth weight [ELBW] infants, defined as birth weight of less than 1000 grams, having the available data. The study was carried out at the Neonatal Intensive Care Unit [NICU] of Royal Hospital, Muscat. All ELBW infants admitted during the period from January 2000 to October 2003 were reviewed for the level of serum albumin concentration in the first 48 hours. The required data were extracted from the computer database in the NICU. Atotal of 90 ELBW infants, out of 114 ELBW admissions during the specified study period had complete information. The birth weight of ELBW infants ranged from 490 to 990 grams with a mean of 845 +/- 107 grams. The mean serum albumin concentration among the cohort was noted to be 22 +/- 4 g/Lwith a range varying from 12 to 33 g/L. No significant correlation [r = 0.13, p = 0.21] was noted between the birth weight and albumin concentration. There is no correlation between the body weight of premature infants and the serum albumin concentration

Use of nasal intermittent positive pressure ventilation to avoid intubation in neonates

Nasal intermittent positive pressure ventilation [NIPPV] has widely been used in neonates to prevent extubation failure and apnea. This pilot study was carried out to look at the early use of NIPPV to avoid intubation. The study was carried out over a period of 3 months from August 2003 to October 2003 at the Royal Hospital, Muscat, Sultanate of Oman. The neonates with clinical signs of moderate to severe respiratory distress were given a trial of early NIPPV based on the avoid-intubation protocol. Inclusion, exclusion and failure criteria with general procedure were made clear to all medical and nursing staff and the protocol was posted in the unit for further time to time referral. A total of 16 neonates met the inclusion criteria for early NIPPV trial. Out of these, 13 [81%] had a successful NIPPV. The mean age of entry was 0.95 hours; however, the mean duration of NIPPV was 23 hours. No NIPPV related complications were noted in the study group. We concluded that NIPPV is an appropriate mode of ventilation in neonates requiring respiratory support. The major advantage of NIPPV is the non-invasive mechanics. It is also less expensive and less labor intensive. Further randomized controlled trials with larger sample size are warranted to confirm our findings

Growth centiles for Omani premature infants born at 26 weeks of gestation

The present growth chart used in the Sultanate of Oman does not contain centile measurements for infants born at 26-weeks of gestation. With the increased survival of these premature infants, there is a growing need to develop such a chart. The present study was conducted with the aim to look at the anthropometric measurements [weight, length and head circumference] of Omani premature infants born at 26-weeks of gestation and to develop centile charts for these measurements. The study was conducted at the Special Care Baby Unit [SCBU] of the Royal Hospital, one of the major perinatal institutions in Muscat, Oman. A computerized database is maintained for all the admissions from 1996. We extracted the required anthropometric data for all 26-week gestation premature Omani infants admitted to SCBU from January 1996 to November 2003. A total of 49 babies were admitted during that period. Out of these, 43 had complete information on the growth parameters, including birth weight, length and head circumference. These parameters were noted down and by using the statistical package, an analysis was performed to get the normal distribution curve. By using the Microsoft Excel program, graphs were generated for all the 3 growth parameters. The mean birth weight for the premature infants born at 26-week gestation was noted to be 908 +/- 156 grams, with length and head circumference of 33.5 +/- 2.5 and 24.5 +/- 1.7 centimeters. The normal distribution curve was obtained with minimal skewing. We were able to generate centile charts of the anthropometric measurements for Omani infants born at 26-weeks of gestation. The next step is to collect the national data from other institutions in Oman and then incorporate it into the present growth chart to make the charts more valid, reliable and applicable

Appropriateness of blood gas analysis in newborns with respiratory distress

To look at the appropriateness of blood gas analysis in newborn with respiratory distress. Subjects and We carried out an audit at the neonatal intensive care unit [NICU] of King Fahd Hospital of the University, Al-Khobar, Saudi Arabia. All newborn who got admitted to the NICU with the signs of respiratory distress were included. The neonates were only receiving oxygen as respiratory support. None were intubated or received positive pressure ventilation. The records of sixteen newborns with admission blood gas analysis available were reviewed. Except for the two cases, none had hypoxemia [PaO2 < 80 mm Hg]. Similarly only two cases were noted to have acidosis [pH < 7.30] while only one case had hypercarbia [PaCO2 > 40 mm Hg]. The base excess and bicarbonate measurements, in most of the cases, were also within the normal range. Conclusions: The blood gas analyses were essentially normal of most of the samples suggesting inappropriateness and unnecessary use of this painful and costly procedure in otherwise stable newborns with respiratory distress. Based on these findings, an alternative approach, a combination of clinical parameters, pulse oximeter reading and findings on chest x-ray is suggested that may be useful in management of neonates with respiratory distress. The goal is to minimize the overuse of invasive painful procedure

Feasilbility of group objective structured clinical examination

The Objective Structured Clinical Examination [OSCE] is a valid, reliable and practical method of assessment. It consists of multiple-timed stations where each student is presented with the same situation and evaluated using a checklist of predetermined detailed evaluation criteria. The OSCE setting presents each examinee with an identical controlled, stimulated situation in which only particular skills are evaluated. Because of the use of multiple individual stations, OSCE becomes a very labour intensive function requiring extensive time from the faculty in designing and running it. The solution could be running OSCE in a 'group' fashion [G-OSCE]. To look at the feasibility of this concept, this study was carried out and conducted at Hamdard University Hospital, Karachi. Third year students rotating through the Paediatric ward as part of their clerkship volunteered for the trial of group OSCE. The slides were used to represent OSCE stations which comprised topics of applied anatomy and physiology. The slides were projected serially on the screen each for a period of five minutes. The student group had to complement the OSCE answer sheets with answers to modified essay questions pertaining to the slide number at the same time. A total of thirty-five students participated in the study. Most of the students were able to answer the questions. The whole process took thirty minutes. This, when compared to the same OSCEs run in standardized manner would have taken 175 minutes [35 students, five minutes each]. In conclusion, we have indicated the feasibility of 'group' OSCE among the third year students. With the increasing role of OSCE in teaching and evaluation, we recommend more of its use in a group form. This will save time of the faculty and is less labour intensive