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 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We studied the maternal and neonatal profile and outcome of extremely low birth weight (ELBW) babies at the level III neonatal intensive care unit (NICU) in Delhi. Case records of ELBW inborn babies delivered between August 2000 and August 2001 were analysed by using a pre-set proforma. A total of 52 ELBW babies were admitted to the NICU in the relevant period, of whom 30 (57%) survived. Maternal anaemia, previous preterm delivery and pregnancy-induced hypertension (PIH) were the common predisposing factors for preterm delivery. Mean gestational age was 27.8 weeks and mean birth weight was 831 g. The highest mortality (55%) was seen in babies with 26-28 weeks'gestation and those in the birth weight category of < 800 g. Neonatal hyperbilirubinaemia (78%) and hyaline membrane disease/respiratory distress syndrome (65%) were the most common causes of morbidity. A total of 25 babies were mechanically ventilated while 24 (46%) received total parenteral nutrition. Sepsis, pulmonary haemorrhage, intracranial haemorrhage and necrotizing enterocolitis accounted for the deaths in the study population. Retinopathy of prematurity screening was performed in 35 babies (68%), of whom 22 were found to be normal. According to the International Classification of Retinopathy of Prematurity, most babies (72%) had involvement of zone 3 and stage I (63%). The incidence was highest in 26-28 weeks'gestation babies (71%) and the < 800 g birth weight category (62%). Maternal risk factors such as anaemia and PIH commonly predispose to preterm delivery. There is an alarmingly high mortality in this population. Effective steps are required not only to avoid extreme prematurity but also to reduce morbidity and mortality of all newborns weighing <1000 g at birth.
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PMID:Maternal and neonatal profile and immediate outcome in extremely low birth weight babies in Delhi. 1526 50

Preterm babies born before the 33rd week of gestation often exhibit primary surfactant deficiency responsible for the respiratory distress syndrome or hyaline membrane disease. In that situation, there is a limited and insufficient production of surfactant by type II alveolar cells of the lung due to immaturity. Secondary surfactant deficiencies occur in patients with prior normal surfactant synthesis and can be related to sepsis, hypoxia, ventilator induced lung injury or surfactant inhibition by a variety of substances reaching the alveolar spaces. They occur in full-term newborns with meconium aspiration syndrome, acute respiratory distress syndrome and congenital diaphragmatic hernia. In children and adults, acute respiratory distress syndrome and respiratory syncytial virus bronchiolitis can be responsible. In prematures they occur after the initial primary deficiency during pulmonary hemorrhage, pneumonia and bronchopulmonary dysplasia. Treatment with exogenous surfactant may be beneficial. There is a need for randomized controlled studies for evaluation of this treatment. Next generation of surfactants containing recombinant surfactant protein or synthetic peptides appear as promising agents in these situations of secondary surfactant deficiencies.
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PMID:[Secondary surfactant deficiencies]. 1551 36

We sought to describe neonatal morbidities and therapeutic interventions in very low-birth-weight (VLBW) and extremely low-birth-weight (ELBW) infants cared for in Spanish hospitals. We preformed a prospective collection of data covering the perinatal period until discharge by the SEN1500 network. This network, set up by the Spanish Society of Neonatology, targets VLBW and ELBW infants (400 to 1500 g) admitted to neonatal units in Spanish hospitals. Data were recorded in electronic form and controlled for possible errors or inconsistencies before analysis. We report data for 8836 neonates admitted to 48 neonatal units from January 2002 to December 2005. Prenatal steroids were given to significantly more newborns in 2003 to 2005 (79.4%) than in 2002 (73.4%), although the remaining perinatal data examined failed to significantly vary. Delivery was by cesarean section in 69.8% of cases but significantly lower (35.9%) for infants under a postmenstrual age of 26 weeks. Hyaline membrane disease was diagnosed in 53.9% of the newborns and bronchopulmonary dysplasia (BPD) in 10.46%. Mechanical ventilation was employed in 69.1%, surfactant in 50.3%, and steroids for BPD in 5.3%. Intraventricular hemorrhage grades 3 to 4 (8.1%) and cystic leukomalacia (2.6%) were the most relevant brain ultrasonography findings. Rates of early- and late-onset septicemia were 5% and 29.4%, respectively. Further diagnoses were necrotizing enterocolitis (NEC; 6.9%) and persistent ductus arteriosus (PDA; 24.2%); 40.6% of the cases of NEC and 15.3% of those of PDA required surgery. In addition, 26.6% of the newborns required supplementary oxygen at 28 days of life. The number of newborns who had not recovered their birth weight at this age fell from 3.1% in 2002 to 1.5% in 2005. Rates of prenatal steroid use, cesarean delivery, and main morbidities were comparable to figures cited for other patient series, although our BPD rate was among the lowest reported and nosocomial sepsis rate among the highest.
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PMID:Predischarge morbidities in extremely and very low-birth-weight infants in Spanish neonatal units. 1909 Apr 53

The objectives of our study were to describe the epidemiology of child-health indicator diseases in western Jamaica, examine differences in indicator diseases between sex and age, and generate hypotheses about causes of disease burden. International Classification of Disease, 10th Revision, coded discharge diagnoses were collected from consecutive admissions for 2003-2005 from a public tertiary care hospital. Mortality data were not coded. Perinatal disease was the most common cause of mortality, with hyaline membrane disease the primary cause. Younger children, particularly males, are disproportionately affected by all indicator diseases (P < 0.001) and more likely to die from acute respiratory tract infections and infectious diseases (P < 0.05). Sickle cell disease was the fourth most common diagnosis. Children in western Jamaica are most affected by diseases of prematurity. These children experience disease burden similar to that of children in other developing countries, but fewer neonatal sepsis and insect-borne infections, and more hematologic illness.
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PMID:Descriptive epidemiology of mortality and morbidity of health-indicator diseases in hospitalized children from western Jamaica. 1934 83

Over a two-year period, we studied a total of 100 newborns delivered in our hospital, needing ventilation. The indications for ventilation, complications, outcome, and factors influencing outcome were analyzed. Of the 100 babies, 54 were preterm, 44 term and 2 post-term. Overall survival was 58%. The commonest indication for ventilation was meconium aspiration syndrome in term babies and hyaline membrane disease in preterms. Babies ventilated for pneumonia had the best outcome, while the poorest outcome was in sepsis. Survival increased significantly with increasing birth weight and gestational age. Downes score, Apgar score and pH at birth did not correlate significantly with outcome. The maximum peak inspiratory pressure requirement was significantly higher in the non-survivors. In pneumonia and sepsis, increased FiO2 requirement significantly impaired survival. The commonest complication was shock. Incidence of disseminated intravascular coagulation, pulmonary hemorrhage and pneumothorax was significantly higher in non-survivors; however, none of these factors was independently predictive of mortality.
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PMID:Outcome of neonates requiring assisted ventilation. 2227 57

Establishing and running a neonatal intensive care unit in a resource poor country is a big challenge. Neonatal Intensive care units (NICU) and Paediatric Intensive care units (PICU) has been started in Patan Hospital from July 2009. The in-born neonates are admitted to NICU and the out-born neonates to PICU. A retrospective hospital based study looking at the common indications for admission and the outcome of the neonates in the intensive care unit was carried out from July 2009 to December 2010. Data was collected from the admission discharge registers at the units and from patient record files. Over the 18 month period there were total 289 neonatal admissions, 214 to NICU and 75 to PICU. More than half of the neonates (53%) admitted to NICU and PICU were preterm. The most common neonatal condition leading to Intensive care unit (ICU) admissions was respiratory distress which accounted for 42%. Of the total neonates admitted to ICUs one third (33.5 %) needed mechanical ventilation. The most common conditions needing mechanical ventilation were hyaline membrane disease (33%) and severe sepsis (24%). The overall mortality rate was 26.6% .The mortality was higher among neonates weighing less than 2.5kg (32%) compared to those weighing >2.5kg (15.5%) (P value - 0.001) and it was higher in babies born before 34 weeks of gestation (P value - 0.009). Neonatal intensive care facilities though is expensive and not readily accessible, establishing a unit can not only save some of the precious lives but also helps in managing critically sick neonates aiming for an intact survival.
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PMID:Indications of admission and outcome in a newly established neonatal intensive care unit in a developing country (Nepal). 2344 99

Neonatal respiratory distress (NRD) is a common neonatal problem, which is responsible for high morbidity and mortality. There are few published studies in developing countries addressing neonatal respiratory distress. There is no previously published study in Sudan on this problem. The objective of the study is to determine the frequency, different causes, immediate outcome. It was a prospective, descriptive, cross sectional hospital-based study which was carried out in neonatal intensive care unit (NICU) of Omdurman Maternity Hospital, between February-March 2013. The study enrolled all Sudanese newborns from 0-28 days including normal, low and high birth weight of different gestational ages admitted to the neonatal intensive care unit and diagnosed as neonatal respiratory distress. The frequency of NRD was calculated, the causes and immediate outcome were determined. Results showed that the frequency rate of NRD was (4.83%) among the total number of hospital (2071) live births during the period of the study. The commonest causes were transient tachypnoea of the newborn (TTN) in 28% of cases, sepsis in 24% of cases and hyaline membrane disease (HMD) in 15% of cases. The outcome of NRD was: cure in 56% of cases, death in 36% of cases, and patients discharged with complications in 8% of cases. In conclusion, the study confirmed the importance of NRD with a frequency rate of 4.83%, morbidity of 8% and mortality of 36% of cases. The causes and immediate outcome were determined and discussed. Some recommendations were suggested in order to reduce its frequency, morbidity and mortality.
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PMID:Neonatal respiratory distress in Omdurman Maternity Hospital, Sudan. 2749 92

The clinical and etiological pattern of ventilated newborns, their outcome in relation to morbidity and mortality was studied with 50 ventilated newborns, including outborns. M:f ratio was 2.1:1. The most common gestational age 28-36 weeks (60%) and mostly were appropriate for gestational age (66%). Survival rate 40% (20/50) being directly proportional to the gestational age and intrauterine growth pattern (P < 0.01). Babies by LSCS Lower Segment Cessarian Section survived more than born by normal vaginal delivery (46.7% vs. 37.1%). More outborn survival could be related to their advanced gestational age on presentation. The initial assessment of APGAR score of >7 had a better outcome (56.3%; P < 0.03). The most common indication of ventilation was hyaline membrane disease (19/50) but the survival rate best in babies with meconium aspiration syndrome (54.5%). The most prevalent complication was sepsis (survival rate 60%) while conditions such as shock, intraventricular hemorrhage, disseminated intravascular coagulation, air leak syndrome, and pulmonary hemorrhage had 100% mortality. Thus, the outcome as survival is constrained by many factors; newborn's profile, conditions at birth, and postnatal resuscitation.
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PMID:Clinicoetiological Pattern and Outcome of Neonates Requiring Mechanical Ventilation: Study in a Tertiary Care Centre. 2991 May 48


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