The Etiological Profile of Neonatal Thrombocytopenia in Neonates in Neonatal Intensive Care Unit: A Cross-Sectional Study.

Background Neonatal thrombocytopenia is one of the most common clinical entities encountered in the neonatal intensive care unit (NICU); if not identified early, it can lead to significant morbidity and mortality. The aim of this study was to find out the etiological profile of neonatal thrombocytopenia in the NICU and to study the association between the etiology and onset of thrombocytopenia. Methods It was a single-center, cross-sectional, descriptive study of neonates having thrombocytopenia. The study was carried out in the NICU of the department of pediatrics in a tertiary care center over a period of one year. The study population included neonates admitted to the NICU having thrombocytopenia (platelet count: <150×109/L). The demographic data such as name, sex, gestational age, age at the onset of thrombocytopenia, and birth weight was recorded. Data was collected based on laboratory investigations. Results Early-onset thrombocytopenia was present in 34% of neonates, and late onset was seen in (66%). A statistically significant result was found in disseminated intravascular coagulation (DIC); the p value was 0.02. The majority of neonates had late-onset sepsis (LOS) (57%). In both early-onset sepsis (EOS) and LOS, 36.84% each, the majority of neonates had moderate thrombocytopenia. Statistically significant results were found in respiratory distress syndrome (RDS) and necrotizing enterocolitis (NEC); the p value was 0.004 and 0.03, respectively. Conclusion Thrombocytopenia is a universal finding in neonates in the NICU, and it is an important prognostic marker of various disease conditions in neonates. Thus, the timely recognition and management of thrombocytopenia is essential to reduce neonatal morbidity and mortality.

Patent vertical vein device closure: Peri procedural anesthetic management.

We present the peri-procedural anesthetic management in a case of transcatheter closure of an unligated patent vertical vein (VV) in a 2-year-old male child operated case of obstructed supra cardiac total anomalous pulmonary venous connection (TAPVC) who presented with significant left to right shunt causing symptoms of right heart failure. The procedure was carried out successfully under deep sedation and monitored anesthesia care (MAC) and had some specific clinical implications from the anesthetic management perspective which are highlighted and discussed in this report.

Clinical Application and Multidisciplinary Assessment of Three Dimensional Printing in Double Outlet Right Ventricle With Remote Ventricular Septal Defect.

BACKGROUND: Double outlet right ventricle (DORV) with two well-developed ventricles and with a remote ventricular septal defect (VSD) may present a therapeutic challenge. Echocardiographic imaging of such complex cases does not always provide all of the information required to decide on an operative approach (biventricular or univentricular) and to design an intracardiac baffle to direct left ventricular outflow through the VSD and to the aorta for biventricular repair. A three dimensional (3D) printed model of the heart based upon data derived from computed tomography (CT) or magnetic resonance imaging (MRI) may contribute to a more complete appreciation of the intracardiac anatomy. METHODS: From April to September 2015, six consecutive patients with DORV and remote VSD underwent CT/MRI scans. Data sets from these studies were used to generate life-size 3D models using a 3D printer. We compared the assessment of 3D printed heart model findings with information obtained from echocardiography, CT, or cardiac MRI and with details of the surgeon's intraoperative direct observations when available. Quantification of the information provided by the 3D model was achieved using a unique scale that was created for the purpose of this study. The accuracy and utility of information derived preoperatively from the models were assessed. RESULTS: Six data sets from six patients were analyzed. Five data sets could be successfully used to create sandstone models using 3D printing. The five patients ranged from 7 months to 11 years of age and weighed 6.7 to 26 kg. The spatial orientation of the heart in the thorax, the relationships of the great arteries and the semilunar valves, the size and location of the VSD were well appreciated in all models, as were the anticipated dimensions and orientation of a surgically planned interventricular baffle. Three of the five patients underwent successful biventricular repair. CONCLUSION: The 3D printed models scored higher than conventional imaging, with respect to most aspects of the surface spatial orientation and intracardiac anatomy. The models are a useful adjunct in preoperative assessment of complex DORV. The unique scale helps quantify the advantages and limitations of the 3D heart models.