Pulmonary hemorrhage in preterm neonates: risk factors and management

Pulmonary hemorrhage in neonates is an acute catastrophic event requiring prompt recognition and emergency intervention. It represent one end of a spectrum of disorders characterized by pulmonary oedema. It is characterized by sudden onset, rapid progression into respiratory failure and high mortality. Twenty two babies with documented pulmonary hemorrhage were analysed for risk factors. High frequency oscillatory ventilation [HFOV] as a rescue strategy for respiratory support of those patients was assessed by comparing oxygenation before and after its use. Pulmonary hemorrhage was exclusively seen among preterm babies during the period of the study. Al 22 babies suffered a primary respiratory illness namely respiratory distress syndrome [RDS], all [100%], received surfactant. Fourteen babies [70%] had patent ductus arteriosus [PDA]. Out of 22 babies, 7 babies [2%] expired, 15 babies [68%] survived. Oxygenation improved after HFOV. In survivors, oxygen index [OI] before HFOV was 14.2 +/- 1.1, compared to 14.9 +/- 1.2 in non survivors. While, after HFOV, OI was 6.7 +/- 0.7 in survivors, compared to 12.8 +/- 1.2 in non survivors. P-value<0.05. A similar trend was seen for a/ApO[2]. Pulmonary hemorrhage is a life threatening condition, with high mortality rate. Mortality is more common in extremely low birth weight infants [ELBW], who had RDS, received surfactant therapy and had significant PDA.HFOV is a good option to ventilate those babies who suffered this serious complication

Persistent fetal bradycardia - a marker for inherited metabolic disorder?

This case report highlights the persistent fetal bradycardia without fetal distress presenting at 29 weeks gestation. Approach to etiological diagnosis is discussed. The neonatal inborn error of metabolism as a cause for this bradycardia is emphasized

Neonatal septicemia in Al - Jahra hospital, Kuwait: Etiologic agents and antibiotic sensitivity pattems

Neonatal septicemia [NNS] occurs frequently in neonatal intensive care units [NICU] and is often associated with high morbidity and mortality. However, information on its incidence and causative agents in Kuwait hospitals is scanty. To investigate the bacterial causative agents of NNS in a NICU and their susceptibility patterns to antimicrobial agents. Between May 1 and December 31, 1996, blood cultures were performed on all admissions to the Neonatal Unit, Al-Jahra Hospital, Kuwait, with the Bactec 9240 instrument [Becton Dickinson, USA]. Microorganisms were identified by cultural characteristics, Gram stain and biochemical profiles and antimicrobial susceptibility patterns performed by disk diffusion and by measuring their minimum inhibitory concentrations. From a total of 995 neonates admitted to the neonatal unit during the study period, 117 [11.7%] had positive blood cultures. Eighty-seven [8.7%] of the neonates had confirmed septicemia. Gram-positive organisms were cultured from 65 [75%] and gram-negative organisms from 22 [25%] of them. The most frequent organisms isolated were Staphylococcus epidermidis [34%], Streptococcus viridans [28%] and Candida species [14%]. Resistance to ampicillin and cephalosporins was detected in both gram-positive and gram-negative organisms associated with sepsis. Conclusions: The study identified the common bacterial pathogens associated with NNS in a neonatal unit, their susceptibility patterns to antimicrobial agents and emphasized the importance of understanding local epidemiology of NNS in formulating an antibiotic policy