ABSTRACT
Brachial plexus birth injury (BPBI) and phrenic nerve injury can sometimes occur concurrently in neonates following difficult deliveries like breech presentation, shoulder dystocia, forceps or vacuum extraction. Phrenic nerve palsy should be suspected in a newborn with respiratory distress and an elevated hemidiaphragm on the imaging studies in presence of the associated risk factors. The right side is affected more often than the left side and most of it is associated with BPBI. We present here a rare case of a newborn baby with a left-sided Erb's palsy and a contralateral/right-sided diaphragmatic paralysis who recovered from the persistent respiratory distress and feeding difficulties following plication of the diaphragm. The left-sided Erb's palsy also fully recovered at follow-up examination.
Subject(s)
Birth Injuries/physiopathology , Brachial Plexus Neuropathies/physiopathology , Diaphragm/physiopathology , Diaphragm/surgery , Paralysis/physiopathology , Vacuum Extraction, Obstetrical/adverse effects , Birth Injuries/surgery , Brachial Plexus/physiopathology , Brachial Plexus Neuropathies/surgery , Diagnosis, Differential , Female , Humans , Infant, Newborn , Paralysis/surgery , Risk FactorsSubject(s)
Continuous Positive Airway Pressure , Pneumopericardium/diagnostic imaging , Pneumothorax/diagnostic imaging , Respiratory Distress Syndrome, Newborn/therapy , Female , Humans , Infant, Newborn , Pneumopericardium/physiopathology , Pneumopericardium/therapy , Pneumothorax/physiopathology , Pneumothorax/therapy , Radiography, Thoracic , Respiratory Distress Syndrome, Newborn/diagnostic imaging , Respiratory Distress Syndrome, Newborn/physiopathology , Term Birth , Treatment OutcomeABSTRACT
OBJECTIVE: To assess the seasonal pattern of healthcare-associated infections (HCAI) among neonates and to describe the trend of HCAI. DESIGN: Secondary analyses of database. SETTING: The Canadian Neonatal Network database (2003-2009). PARTICIPANTS: Neonates with HCAI defined as blood/cerebrospinal fluid positive with pathogenic organism in a symptomatic infant after 2 days of age. MAIN OUTCOME MEASURE: The incidence rate for HCAI per 1000 days with a 95% CI, for the 4 warmest months (June-September) was compared with the remaining 8 months, to calculate the incidence rate ratio (IRR). RESULTS: Of 75 629 total infants, 4305 (5.7%) had HCAI (3367 had 1 and 938 had >1 episodes). Infants who had HCAI were of lower gestation, birth weight and Apgar score; but had higher severity of illness scores and clinical chorioamnionitis. There was a borderline increase in all HCAI (IRR 1.05, 95% CI 1.00 to 1.11) and a significant increase in Gram-negative HCAI (IRR 1.20, 95% CI 1.04 to 1.39) during the summer months. Overall, there was a 20% reduction in HCAI from 4.45/1000 days in January 2003 to 3.54/1000 days in December 2009 (mean difference 0.91/1000 days (95% CI 0.89 to 0.92). CONCLUSIONS: Gram-negative infections were significantly increased during the summer months of the year compared with the rest of the year among neonates. Overall, there was a significant temporal reduction in HCAI rates over the study period.
