ABSTRACT
OBJECTIVE: To compare the need of mechanical ventilation between LISA (less invasive surfactant administration) method and conventional INSURE method (INtubation SURfactant administration and Extubation) in spontaneously breathing preterm infants with respiratory distress syndrome (RDS). STUDY DESIGN: An experimental study. PLACE AND DURATION OF STUDY: Department of Neonatology, PIMS, Islamabad, from April to December 2017. METHODOLOGY: A total of 100 preterm infants <34 weeks gestation, on nasal CPAP requiring fraction of inspire oxygen (FiO2) >0.4, with respiratory distress syndrome (RDS) were included in the study and divided randomly into two groups, 50 each. RESULTS: There were 28 (56%) males in LISA and 31 (62%) in the INSURE group. Median birth weight was 1300 grams (IQR 600) in LISA, while 1400 grams (IQR 400) in INSURE infants. C-section rate was 52% (n=26) and 48% (n=24) in LISA and INSURE, respectively. Pre-natal steroids were given to 38 patients (76%) in LISA and 30 patients (60%) in INSURE group. LISA patients had significantly less need of mechanical ventilation with p-value <0.05 {30% (n=15) vs. 60% (n=30)}. The median duration of mechanical ventilation was 40 hours (IQR 75) and 71 hours (IQR 62) in LISA and INSURE, respectively. Similarly, median FiO2 reduction was 30 (IQR 30) in LISA group and it was 25 (IQR 10) in INSURE group, with p-value <0.05. There was no significant difference in mortality, hospital stay and complications. CONCLUSION: LISA technique was safe, non-invasive approach of surfactant administration, with reduced need of mechanical ventilation rate and duration.
Subject(s)
Infant, Premature , Positive-Pressure Respiration/methods , Pulmonary Surfactants/administration & dosage , Respiration, Artificial/methods , Respiratory Distress Syndrome, Newborn/therapy , Surface-Active Agents/administration & dosage , Airway Extubation , Female , Follow-Up Studies , Humans , Infant, Newborn , Male , Pakistan , Patient Safety , Respiration, Artificial/adverse effects , Respiratory Distress Syndrome, Newborn/mortality , Risk Assessment , Survival Rate , Treatment OutcomeABSTRACT
Bartter syndrome is an autosomal recessive disorder caused by gene mutations that involve hypokalaemia, hypochloraemia and metabolic alkalosis along with raised serum renin, hyperaldosteronism and normal blood pressure. We report two cases of neonatal Bartter syndrome. Case 1 was a product of non-consanguineous marriage and mother had unexplained polyhydramnios in pregnancy while case 2 was a product of consanguineous marriage. Both cases were diagnosed based on hypokalaemia, hypochloraemia and metabolic alkalosis along with elevated serum renin and aldosterone levels. Case 1 positively responded to indomethacin while case 2 had Protein C and S deficiency and sepsis as coexisting diseases and thus could not be given indomethacin and expired. Regular antenatal visits can help in diagnosis of the syndrome particularly if unexplained poly hydramniosis investigated .
Subject(s)
Aldosterone/blood , Bartter Syndrome/diagnosis , Renin/blood , Bartter Syndrome/blood , Biomarkers/blood , Diagnosis, Differential , Humans , Infant, Newborn , MaleABSTRACT
McKusick-Kaufman Syndrome (MKKS) is one of rare syndromes which presents as polydactyly, hydrometrocolpos (HMC) and cardiac anomalies. This autosomal recessive disorder occurs due to mutations in MKKS gene. It is characterised predominantly by genitourinary and digit abnormalities. The diagnosis can be made on clinical findings; however, it is important to rule out Bardet-Biedl syndrome before making the definitive diagnosis. Treatment of MKKS revolves around treatment of its manifestations and complications. We hereby report a case of neonate with features of MKKS.
Subject(s)
Abnormalities, Multiple/diagnosis , Heart Defects, Congenital/diagnosis , Hydrocolpos/diagnostic imaging , Polydactyly/diagnostic imaging , Uterine Diseases/diagnosis , Abnormalities, Multiple/diagnostic imaging , Female , Heart Defects, Congenital/diagnostic imaging , Humans , Hydrocolpos/diagnosis , Infant, Newborn , Polydactyly/diagnosis , Uterine Diseases/diagnostic imagingABSTRACT
OBJECTIVE: To assess the uptake of influenza vaccination by pregnant women and maternity care providers and explore their attitudes towards influenza vaccination. DESIGN, SETTING AND PARTICIPANTS: Cross-sectional survey administered in a Victorian tertiary level public hospital to 337 pregnant women and 96 maternity care providers. RESULTS: 31.3% of patients planned to or had received influenza vaccination this year, but only a quarter had received education about influenza. Women were more likely to receive influenza vaccination if they had been vaccinated in the last two years (RR 4.5, 95% CI: 3.1-6.4, p<0.001), received education about influenza (RR 2.3, 95% CI: 1.6-3.2, p<0.001) or believed that they were at high risk of influenza-related complications while pregnant (RR 2.0, 95% CI: 1.4-2.7, p<0.001). While only 56.8% of maternity care providers believed pregnant women were at high risk of influenza-related complications, 72.9% would recommend influenza vaccination to all pregnant women. Of the maternity care providers studied, 69% planned to or had been vaccinated in 2011, with this group more likely to recommend vaccination to their patients (RR 2.0, 95% CI: 1.3-3.0, p<0.001). Significantly more maternity care providers indicated that they would routinely recommend influenza vaccination than the proportion of patients who reported receiving education. CONCLUSIONS: Influenza vaccination rates in pregnant women are low, reflecting inadequate patient education despite most maternity care providers indicating that they would routinely recommend influenza vaccination. Increasing influenza vaccination uptake by women in pregnancy will require better education of both women and maternity care providers.
