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1.
Eur Heart J Case Rep ; 7(7): ytad312, 2023 Jul.
Article in English | MEDLINE | ID: mdl-37501712

ABSTRACT

Background: There is currently a lack of evidence-based guidelines regarding ideal management of a neonate, specifically a preterm, with thrombo-embolus. There are no clear guidelines as to the time-frame of spontaneous resolution of a thrombo-embolus. Case summary: A large pedunculated right atrial mass was identified on a clinician-performed cardiac ultrasound in a preterm neonate. The mass was smaller than half of the atrial size and was not causing obstruction. The mass disappeared spontaneously within 6 days and was retrospectively presumed to have been a thrombus. The neonate remained asymptomatic with no signs suggesting that the mass may have embolized. Discussion: In this case of an incidentally identified asymptomatic intracardiac mass in a preterm infant, presumed to be a thrombus, our conservative 'wait and watch' approach was not associated with any adverse pulmonary or systemic effects.

2.
Front Pediatr ; 11: 1296184, 2023.
Article in English | MEDLINE | ID: mdl-38250589

ABSTRACT

Introduction: The current recommendations for the management of neonatal polycythemia are that partial exchange transfusion (PET) should be performed if the hematocrit is >70% in an asymptomatic neonate, or if the haematocrit is >65% in a symptomatic neonate. The hemodynamic effects of PET for neonatal polycythemia have not been well researched. Objectives: To evaluate the hemodynamic effects of PET in neonates with polycythemia. Methodology: Prospective observational study conducted in a neonatal intensive care unit of a tertiary care teaching hospital enrolling 21 neonates with polycythemia who underwent PET. Hemodynamic and echocardiographic parameters were obtained prior to PET and 6 h after procedure. Results: The mean gestational age of neonates with polycythemia was 35.08 ± 2.35 weeks with a mean birth weight of 1,929 ± 819.2 g. There was a significant improvement noted in heart rate and oxygen saturation post PET procedure (p < 0.05). Right ventricular systolic function parameters showed significant improvement (Tricuspid annular plane systolic excursion, fractional area change, right ventricular output) (p < 0.05). Left ventricular function parameters showed significant improvement (Fractional shortening, left ventricular output, E:A ratio) (p < 0.05). Resolution of symptoms was noted after PET procedure with no adverse events associated with PET. Conclusion: PET maybe effective in improving heart rate and oxygen saturation levels in polycythemic neonates. It has good short-term hemodynamic stability with improvement in right ventricular systolic, as well as left ventricular systolic and diastolic function. It is a safe and effective procedure with minimal adverse effects. Further studies with larger sample size and a control group would be required to corroborate our findings.

3.
Endokrynol Pol ; 73(5): 863-871, 2022.
Article in English | MEDLINE | ID: mdl-35971925

ABSTRACT

Nearly 30% of patients with lipid profile abnormalities suffer from secondary dyslipidaemias. Endocrine disorders are one of the most important causes of dyslipidaemia. Dyslipidaemia can be observed in the pathologies of a variety of endocrine glands, including the thyroid, the pituitary, the adrenals, and the gonads. The most common endocrinopathy causing dyslipidaemia is hypothyroidism. In this paper, we review the lipid profile alterations observed in endocrinopathies. We describe changes in classic lipid profile parameters, including total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides. However, we also focus on the influence of endocrine disorders on relatively new cardiovascular markers such as apolipoprotein B, apolipoprotein A1, and lipoprotein(a). While almost all endocrinopathies cause detrimental changes to the lipid profile, hyperthyroidism seems to be a disorder in which lowering of such parameters as total cholesterol, low-density cholesterol, and triglycerides can be observed. Comprehensive screening for endocrine disorders should always be included in the differential diagnostic process of secondary causes of dyslipidaemia. Early detection and treatment of endocrinopathy have a considerable impact on a patient's health. Proper treatment of those disorders plays a crucial role in modifying the cardiovascular risk and improving the lipid profile of those patients. Even though lipid-lowering therapy is usually still needed, in some cases restoration of hormonal balance might be sufficient to normalize the lipid profile abnormalities.


Subject(s)
Dyslipidemias , Endocrine System Diseases , Hypothyroidism , Humans , Endocrine System Diseases/complications , Hypothyroidism/complications , Cholesterol, LDL , Triglycerides , Dyslipidemias/complications
4.
J Ultrasound ; 25(2): 233-239, 2022 Jun.
Article in English | MEDLINE | ID: mdl-33991307

ABSTRACT

PURPOSE: Pulmonary hypertension (PH) in the newborn period is associated with significant morbidity and mortality. Sepsis has been identified as an independent risk factor for PH in newborns. Data on the proportion and severity of PH in association with neonatal sepsis are scarce. This study was aimed to measure the pulmonary artery systolic pressure (PASP) in neonates with late onset sepsis (LOS) and to estimate the proportion of PH in neonatal sepsis using functional echocardiography (FnECHO). METHODS: This prospective observational study was conducted at a tertiary neonatal intensive care unit (NICU). All neonates admitted in the NICU with suspected LOS underwent FnECHO within 6 hours of onset of clinical signs and PASP was recorded. Pulmonary hypertension was defined as PASP of > 35 mmHg. PASP of neonates with positive culture results (proven LOS) was compared with that of gestational age-matched stable controls without sepsis. RESULTS: Thirty three neonates with proven LOS were analysed (study group). Sixteen neonates (49%) in the study group had PH. Mean PASP of the study group was significantly higher than that of the control group (35.3 ± 10.13 mmHg and 12.58 ± 3.92 mmHg, respectively; P < 0.0001). None of the neonates in the control group had PH. CONCLUSION: Pulmonary artery pressure was higher in neonates with late onset neonatal sepsis as compared to that of stable babies without sepsis. Pulmonary hypertension was seen in nearly half of term as well as preterm neonates with late onset sepsis.


Subject(s)
Hypertension, Pulmonary , Neonatal Sepsis , Sepsis , Echocardiography , Humans , Hypertension, Pulmonary/diagnostic imaging , Infant, Newborn , Intensive Care Units, Neonatal , Neonatal Sepsis/diagnostic imaging , Prospective Studies
5.
Acta Paediatr ; 107(11): 1867-1878, 2018 11.
Article in English | MEDLINE | ID: mdl-29869341

ABSTRACT

AIM: Cardiorespiratory physiology plays an important role in neonatal care with increasing utility of point-of-care ultrasound. This review is to bring to light the importance of systemic to pulmonary collaterals (SPCs) in the preterm population without congenital heart disease (CHD) and provide a useful diagnostic tool to the neonatologist performing a cardiac ultrasound. METHODS: Medline, PubMed, EMBASE and the Internet were searched up to November 2017 for articles in English which included SPCs in preterm infants without CHD. This comprised title, abstract and full-text screening of relevant data. RESULTS: A total of 10 studies which included case reports, retrospective observational studies and one small prospective cohort study were identified and analysed in detail. The studies had varying focus such as variable incidence, clinical presentation, association with chronic lung disease, pathophysiology and clinical importance of SPCs. SPCs were overall thought to be prevalent, underdiagnosed and of clinical significance in preterm infants. CONCLUSION: Systemic to pulmonary collaterals are a potential left-to-right shunt in preterm infants and may contribute to worsening chronic lung disease (CLD) or heart failure. They should be carefully looked for when performing bedside cardiac ultrasound as the findings can mimic those seen in patent ductus arteriosus (PDA).


Subject(s)
Collateral Circulation , Heart/diagnostic imaging , Infant, Premature/physiology , Pulmonary Circulation , Echocardiography , Heart/embryology , Humans , Infant, Newborn
6.
Australas J Ultrasound Med ; 20(2): 66-71, 2017 May.
Article in English | MEDLINE | ID: mdl-34760474

ABSTRACT

INTRODUCTION: To assess the accuracy of neonatal clinician-performed cardiac ultrasound (CPU) in detection of congenital heart disease (CHD) in newborn infants with no antenatally suspected cardiac abnormality. METHODS: We reviewed records of all infants diagnosed with CHD, identified all new cases of CHD detected by CPU and classified them as 'severe' or 'other'; the 'severe CHD' was further classified as 'critical' or 'non-critical CHD'. We compared the CPU diagnosis to the final diagnosis as per paediatric cardiologist echocardiography. RESULTS: A total of 357 infants identified to have any form of CHD; 50 newly diagnosed by neonatal CPU: 21 'severe' and 29 'other' CHD. The neonatologist CPU had a high concordance rate with the final diagnosis. There were three incorrect diagnoses identified by CPU. CONCLUSION: This audit demonstrates high accuracy, in our unit, of neonatal CPU in identifying new cases of CHD not suspected antenatally. A neonatal CPU could enhance the pickup rate and, with appropriate referral to a paediatric cardiologist, improve the clinical care of infants born with CHD.

7.
Acta Paediatr ; 103(5): e182-7, 2014 May.
Article in English | MEDLINE | ID: mdl-24460811

ABSTRACT

AIM: To determine changes in respiratory mechanics when chest compressions are added to mask ventilation, as recommended by the International Liaison Committee on Resuscitation (ILCOR) guidelines for newborn infants. METHODS: Using a Laerdal Advanced Life Support leak-free baby manikin and a 240-mL self-inflating bag, 58 neonatal staff members were randomly paired to provide mask ventilation, followed by mask ventilation with chest compressions with a 1:3 ratio, for two minutes each. A Florian respiratory function monitor was used to measure respiratory mechanics, including mask leak. RESULTS: The addition of chest compressions to mask ventilation led to a significant reduction in inflation rate, from 63.9 to 32.9 breaths per minute (p < 0.0001), mean airway pressure reduced from 7.6 to 4.9 cm H2 O (p < 0.001), minute ventilation reduced from 770 to 451 mL/kg/min (p < 0.0001), and there was a significant increase in paired mask leak of 6.8% (p < 0.0001). CONCLUSION: Adding chest compressions to mask ventilation, in accordance with the ILCOR guidelines, in a manikin model is associated with a significant reduction in delivered ventilation and increase in mask leak. If similar findings occur in human infants needing an escalation in resuscitation, there is a potential risk of either delay in recovery or inadequate response to resuscitation.


Subject(s)
Heart Massage , Masks , Respiration, Artificial/instrumentation , Humans , Infant, Newborn , Manikins , Outcome Assessment, Health Care , Practice Guidelines as Topic , Respiration, Artificial/methods
8.
J Paediatr Child Health ; 50(10): 827-8, 2014 Oct.
Article in English | MEDLINE | ID: mdl-20598068

ABSTRACT

Pyloric stenosis is a common infantile disorder typically occurring between 2 weeks and 8 weeks of age. Presentation outside this range and in premature infants is uncommon and often atypical. We present three cases, a pair of premature twins and a 5.5-month-old infant with pyloric stenosis. We highlight that despite their difference in size and weight, ultrasound examination remains a reliable diagnostic tool. However, pyloric measurements should be interpreted in combination with the other dynamic features on ultrasound.


Subject(s)
Infant, Premature , Pyloric Stenosis, Hypertrophic/surgery , Pylorus/pathology , Follow-Up Studies , Humans , Infant , Infant, Newborn , Male , Organ Size , Pyloric Stenosis, Hypertrophic/diagnostic imaging , Pyloric Stenosis, Hypertrophic/pathology , Pylorus/surgery , Risk Assessment , Sampling Studies , Severity of Illness Index , Treatment Outcome , Twins , Ultrasonography, Doppler
9.
J Paediatr Child Health ; 42(3): 140-2, 2006 Mar.
Article in English | MEDLINE | ID: mdl-16509915

ABSTRACT

AIMS: To determine whether using a respiratory function monitor alters clinicians' choice of ventilator settings, tidal volumes or blood gases in the first 48 h of ventilation. METHODS: Clinicians were trained to use a respiratory function monitor to optimize neonatal ventilation. Thirty-five infants, weighing < 2 kg, treated with the Infant Star ventilator were randomized to have a respiratory function monitor display visible or concealed. All reasons for altering ventilator settings were noted. Data on ventilator parameters and clinical care were collected hourly. The primary outcome was the mean peak pressure used during the first 48 h. RESULTS: There were no statistically significant differences in peak pressures, tidal volumes or arterial carbon dioxide levels between the two groups. CONCLUSIONS: Using the Florian respiratory function monitor in the first 48 h of ventilation with the Infant Star ventilator did not alter the choice of ventilator settings, tidal or minute volumes or arterial blood gases. Possible explanations for this result include lack of power due to the small numbers recruited and bias due to the unblinded nature of the trial.


Subject(s)
Intensive Care, Neonatal/standards , Monitoring, Physiologic , Respiration, Artificial/standards , Respiratory Function Tests , Blood Gas Analysis , Decision Making , Female , Humans , Infant, Low Birth Weight , Infant, Newborn , Infant, Premature , Intensive Care Units, Neonatal , Intensive Care, Neonatal/methods , Male , Monitoring, Physiologic/instrumentation , Monitoring, Physiologic/methods , Pulmonary Ventilation/physiology , Respiration, Artificial/instrumentation , Respiration, Artificial/methods , Tidal Volume
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