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1.
Objective
To determine whether residential environmental tobacco smoke (ETS) exposure during pregnancy is associated with low birth weight (LBW) neonates and establish a dose response relationship.Design
Case control study.Setting
Tertiary care hospital.Methodology
Mothers giving birth to LBW neonate (<2.5 kg) were cases and those whose neonates weighed ≥2.5 kg at birth were controls. Excluded were women smokers and tobacco chewers, high parity (>3), multiple pregnancy and still births. Included were 100 cases and 200 controls, aged 20 to 30 years. Information was collected on ETS exposure and other risk factors of LBW within 24 hours of delivery. Clinical information like maternal haemoglobin levels, birth weight and gestational age of the neonate was extracted from hospital records.Results
On univariate analysis, preterm pregnancy, low socioeconomic status, previous LBW neonate, no utilization of antenatal care (ANC), severe anemia and ETS exposure were statistically significantly associated with LBW neonate and controlling for these in logistic regression analysis, adjusted Odds ratio for ETS exposure association with LBW neonate was 3.16 (95% CI=1.88–5.28). A dose response relationship was also found which was statistically significant (10–20 cigarettes smoked/day: OR = 4.06, 95% CI=1.78–9.26 and >20 cigarettes smoked/day, OR = 17.62, 95% CI= 3.76–82.43).Conclusion
Exposure to ETS during pregnancy is associated with LBW of neonates. Hence, there is an urgent need to increase awareness about health hazards of ETS during pregnancy and bring about behavioural changes accordingly as a one of the strategies to reduce LBW deliveries in India. 相似文献2.
Gaurav Ameta Amit Upadhyay Sunil Gothwal Kuldeep Singh Kirti Dubey Abhilasha Gupta 《Indian journal of pediatrics》2013,80(3):195-198
Objective
To compare reduction in incidence of feed intolerance in neonates born with meconium stained amniotic fluid (MSAF) by use of gastric lavage to those who did not receive lavage.Methods
This Randomized controlled trial was conducted in all vigorous newborns delivered through MSAF, with birth weight ≥1800 g and gestation ≥34 wk. In the lavage group, gastric lavage with 10 ml/kg of normal saline was done.Results
Twelve neonates in the lavage group (n?=?124) developed feed intolerance compared to 16 neonates in control group (n?=?120), (p?=?.309; OR 0.69; 95%CI 0.27–1.58). No difference in any other morbidity was noted.Conclusions
Gastric lavage in neonates with MSAF does not reduce feed intolerance, irrespective of thickness of MSAF and it confers no advantages. 相似文献3.
Objectives
(i) To construct hour-specific serum total bilirubin (STB) nomogram in neonates born at ≥35 weeks of gestation; (ii)To evaluate efficacy of pre-discharge bilirubin measurement in predicting hyperbilirubinemia needing treatment.Design
Diagnostic test performance in a prospective cohort study.Setting
Teaching hospital in Northern India.Subjects
Healthy neonates with gestation ≥35 weeks or birth weight ≥2000 g.Intervention
Serum total bilirubin was measured in all enrolled neonates at 24±6, 72–96 and 96–144 h of postnatal age and when indicated clinically. Neonates were followed up during hospital stay and after discharge till completion of 7th postnatal day.Outcome
Key outcome was significant hyperbilirubinemia (SHB) defined as need of phototherapy based on modified American Academy of Pediatrics (AAP) guidelines. In neonates born at 38 or more weeks of gestation middle line and in neonates born at 37 or less completed weeks of gestation, lower line of phototherapy thresholds were used to initiate phototherapy. For construction of nomogram, STB values were clubbed in six-hour epochs (age ± 3 hours) for postnatal age up to 48 h and twelvehour epochs (age ± 6 hours) for age beyond 48 h. Predictive ability of the nomogram was assessed by calculating sensitivity, specificity, positive predictive value, negative predictive value and likelihood ratio, by plotting receiver-operating characteristics (ROC) curve and calculating c-statistic.Results
997 neonates (birth weight: 2627 ± 536 g, gestation: 37.8±1.5 weeks) were enrolled, of which 931 completed followup. Among enrolled neonates 344 (34.5%) were low birth weight. Rate of exclusive breastfeeding during hospital stay was more than 80%. Bilirubin nomogram was constructed using 40th, 75th and 95th percentile values of hour-specific bilirubin. Pre-discharge STB of ≥95th percentile was assigned to be in high-risk zone, between 75th and 94th centile in upper-intermediate risk zone, between 40th and 74th centile in lower-intermediate risk zone and below 40th percentile in low-risk zone. Among 49 neonates with pre-discharge STB in high risk zone. 34 developed SHB (positive predictive value: 69.4%, sensitivity: 17.1%, positive likelihood ratio: 8.26). Among 342 neonates with pre-discharge STB in low risk zone, 32 developed PHB (negative predictive value: 90.6% and specificity: 42.5%, positive likelihood ratio: 0.37). Area under curve for this risk assessment strategy was 0.73.Conclusion
Hour-specific bilirubin nomogram and STB measurement can be used for predicting subsequent need of phototherapy. Further studies are needed to validate performance of risk demarcation zones defined in this hour-specific bilirubin nomogram. 相似文献4.
M. K. C. Nair Rajee Krishnan G. S. Harikumaran Nair Deepa Bhaskaran M. L. Leena Babu George Paul Swamidhas Sudhakar Russell 《Indian journal of pediatrics》2014,81(2):85-90
Objective
To assess the effectiveness of Trivandrum Developmental Screening Chart (TDSC) items based intervention package developed at Child Development Centre, Kerala on the developmental outcome of children at 18 mo of age using Developmental Assessment Scale for Indian Infants (DASII) and compare the same in different birth weight groups.Methods
Five hundred consecutive discharges from the Neonatal Intensive Care Unit (NICU), Sree Avittam Thirunal hospital, were recruited and followed up till 18 mo of age including 240 low birth weight (LBW;<2,500 g) babies and 260 normal birth weight babies. All 240 LBW babies were offered early intervention at monthly intervals till 12 mo of age, whereas the normal birth weight (NBW) group received only immunization service as per the routine of the hospital. The early intervention package for the low birth weight group was designed based on Trivandrum Developmental Screening Chart (TDSC 0–2 y) items delay. At 18 mo of age both the groups were offered developmental assessment using DASII by specially trained and experienced developmental therapists who were blind to the intervention status of the babies.Results
It was observed that the LBW (<2,500 g) group, who received intervention had a DASII mental age of 18.31 as against 18.16 in the NBW (≥2,500 g) group and mental DQ 101.84 (LBW group) and 98.65 (NBW group) and the observed differences were not statistically significant. Similarly, the LBW, who received intervention group had a DASII motor age of 18.68 as against 18.47 in the NBW group and motor DQ 139.40 (LBW group) and 135.39 (NBW group) and the observed differences were not statistically significant.Conclusions
The results of this TDSC based intervention package among low birth weight babies showed that at 18 mo of age there was no statistically significant difference in the developmental outcome using DASII, between low birth weight babies on intervention and the normal birth weight babies without any intervention.5.
Jagdish Kumar Amit Upadhyay Ajeet Kumar Dwivedi Sunil Gothwal Vijay Jaiswal Sunny Aggarwal 《Indian journal of pediatrics》2013,80(6):465-469
Objective
To study the effect of oil massage on growth in preterm babies less than 1800 g.Methods
This randomised controlled trial was conducted in Neonatal intensive care unit of a level II hospital. Neonates with birth weight?<?1800 g, gestation?<?35 wk and?<?48 h of age at enrolment were included in the studies. Eligible neonates were randomized to one of the two groups (a) Oil massage along with standard care of low birth weight (b) Standard care of low birth weight without massage. Weight, length and head circumference was measured in the two groups at 7 d intervals. Serum triglyceride levels were measured at enrolment and at completion of study. Primary outcome variable was weight gain at 28 d after enrolment.Results
A total of forty-eight neonates were randomisd to either oil massage group (n?=?25) or standard care of low birth weight without massage group (n?=?23). Mean (SD) weight of babies in the two groups was 1466.4?±?226.8 g in oil massage group and 1416.6?±?229.9 g in the control group. At 28 d, weight gain in the oil massage group (476.76?±?47.9 g) was higher compared to the control group (334.96?±?46.4 g) (p?<?0.05). At 7 d, less weight loss (7.80?±?9.8 g) was observed in babies in oil massage group compared to control group (21.52?±?19.4 g) (p?=?0.003). However, there was no significant difference in serum triglycerides and other anthropometric parameters.Conclusions
Oil application has a potential to improve weight gain and cause less weight loss in first 7 d in low birth weight neonates 相似文献6.
Dor Markush Kelleigh E. Briden Michael Chung Katherine W. Herbst Trudy J. Lerer Stephen Neff Amy C. Wu Brendan T. Campbell 《Pediatric surgery international》2014,30(5):503-509
Purpose
Surgical outcomes data for patent ductus arteriosus (PDA) ligation come primarily from single institution case series. The purpose of this study was to evaluate national PDA ligation trends, and to compare outcomes between pediatric general (GEN) and pediatric cardiothoracic (CT) surgeons.Methods
The Pediatric Health Information System database was queried to identify neonates who underwent PDA ligation from 2006 through 2009. Outcomes evaluated included surgical morbidity, in-hospital mortality, length of stay, and total charges. Outcomes were compared between pediatric general and pediatric cardiothoracic surgeons.Results
The records of 1,482 neonates who underwent PDA ligation were identified and analyzed. Overall mean gestational age was 26 ± 3 weeks and birth weight was 888 ± 428 g. The majority of patients among both surgeons had birth weights of ≤1,000 g (77.2 %) and were born at ≤27-week gestation (81.5 %). Most of the PDA ligations were performed by pediatric CT surgeons (n = 1,196, 80.7 %). The mortality rate did not differ by surgeon subspecialty training (GEN = 5.2 %, CT 7.9 %, p = 0.16). Neonates in the cardiothoracic surgeon cohort showed lower length of stay (p < 0.001–0.05) and total hospital charges (p < 0.05) among patients with birth weight ≤1,200 g. Proxy measures of surgical morbidity—gastrostomy, fundoplication, and tracheostomy—showed no significant differences between the two surgical subspecialists overall or across birth weight subgroups (p > 0.05).Conclusion
These data provide a contemporary snapshot of PDA ligation outcomes at American children’s hospitals. Pediatric general surgeons achieve comparable outcomes performing PDA ligation compared to pediatric cardiothoracic surgeons. 相似文献7.
Objective
To identify the risk factors for small for gestational age (SGA) babies.Methods
The present study was a nested case control study which was carried out by two Medical Officers of Health areas (The field level administrative unit responsible for provision of preventive and promotive health services) in Colombo district. SGA babies were identified using ‘weight for gestational age’ curves developed for Sri Lankan babies. Newborns of 1,200 pregnant women, who were identified within the first 8 wk of amenorrhea and who delivered in selected hospitals were included in the study. Sample size was calculated as n?=?167 cases and 4 n?=?668 controls, with four controls for each case. A case was defined as a newborn whose birth weight was less than the 10th percentile of the weight for gestational age, the control being a newborn whose birth weight was between the 10th and the 90th percentile of the weight for gestational age.Results
Multivariate analysis identified 7 significant risk factors as, number of live born children?=?0, inadequate weight gain during pregnancy according to initial BMI, maximum and minimum physical work, mother’s pre-pregnant weight less than 38 kg, high level of stress at second trimester, presence of pregnancy induced hypertension (PIH) and inadequate support from husband.Conclusion
The risk factors indicate the directions for planning intervention programs. 相似文献8.
Manisha Bhandankar Vishwanath D. Patil Dharmapuri Vidyasagar 《Indian journal of pediatrics》2014,81(3):254-256
Objective
To study the sequential changes in SpO2 values in newborns delivered in a teaching hospital in India.Methods
Full-term infants born by normal vaginal delivery to registered mothers at KLE University Hospital, Belgaum with birth weight more than 2,500 g, no congenital anomalies and who had received only routine care at birth were included in the study. After delivery, newborn infants were placed on a resuscitation trolley under a radiant warmer; the oxygen saturation sensor was attached (Nellcor DURA-Y multisite oxygen sensor) and then connected to the monitor (Planet 55 multiparameter recorder).Results
The mean (SD) gestational age of infants included in the study was 38.8 (1.1) wk and birth weight was 2,800 (300) g. The median (IQR) oxygen saturation level (SpO2) at 2 min of age was 69 % (68 %–79 %). The median level of SpO2 at 90 % and 95 % saturation was attained at 6.5 min and at 11 min of life, respectively.Conclusions
Infants delivered in resource poor facilities of developing countries take 11 min to reach 95 % saturations after birth but they are within the reference range values of Neonatal Resuscitation Program 2010 guidelines. 相似文献9.
Irena Ulanovsky Tatiana Smolkin Shlomo Almashanu Tatiana Mashiach Imad R. Makhoul 《World journal of pediatrics : WJP》2018,14(3):247-253
Background
Some neonates develop idiopathic hyperbilirubinemia (INHB) requiring phototherapy, yet with no identifiable causes. We searched for an association between abnormal thyroid levels after birth and INHB.Methods
Of 5188 neonates, 1681 (32.4%) were excluded due to one or more risk factors for hyperbilirubinemia. Total thyroxine (TT4) and thyroid stimulating hormone values were sampled routinely at 40–48 hours of age and measured in the National Newborn Screening Program.Results
Of the 3507 neonates without known causes for hyperbilirubinemia, 61 (1.7%) developed INHB and received phototherapy. Univariate analyses found no significant association between mode of delivery and INHB (vacuum-delivered neonates were a priori excluded). Nonetheless, in cesarean-delivered (CD) neonates, two variables had significant association with INHB: TT4 ≥ 13 µg/dL and birth at 38–38.6 weeks. In vaginally delivered (VD) born neonates, INHB was associated with weight loss > 7.5% up to 48 hours of age. Multivariate logistic regression analysis showed a strong effect of mode of delivery on possible significant association with INHB. In CD neonates, such variables included: TT4 ≥ 13 µg/dL [P = 0.025, odds ratio (OR) 5.49, 95% confidence interval (CI) 1.23–24.4] and birth at 38–38.6 weeks (P = 0.023, OR 3.44, 95% CI 1.19–9.97). In VD neonates, weight loss > 7.5% (P = 0.019, OR 2.1, 95% CI 1.13–3.83) and 1-min Apgar score < 9 (P < 0.001, OR 3.8, 95% CI 1.83–7.9), but not TT4, showed such an association.Conclusions
INHB was significantly associated with birth on 38–38.6 week and TT4 (≥ 13 µg/dL) in CD neonates, and with a weight loss > 7.5% in VD neonates. We herein highlight some acknowledged risk factors for neonatal hyperbilirubinemia, and thus minimize the rate of INHB.10.
Objectives
To evaluate arylesterase and lactonase activity of paraoxonase (PON)1 in cord blood of neonates in relation to their birth weight. The authors hypothesized that cord blood PON1 arylesterase and lactonase activities will be compromised in neonates having low birth weight.Methods
Eighty neonates born in authors’ hospital, irrespective of mode of delivery were included. Forty children with low birth weight were included in case group and 40 with normal birth weight were included as controls. PON1 arylesterase and lactonase activities were measured.Results
Serum arylesterase activity decreased significantly in low birth weight babies (p?<?0.05). Linear regression analysis (R?=?0.728) indicated significant correlation between arylesterase and birth weight. Serum lactonase activity was also reduced in low birth weight babies. Its linear regression analysis (R?=?0.727) indicated significant correlation between lactonase and birth weight.Conclusions
PON 1 activity is significantly reduced among low birth weight babies in comparison to normal weight babies. 相似文献11.
S. N. Singh Roli Srivastava Anita Singh M. Tahazzul Mala Kumar Chandra Kanta S. Chandra 《Indian journal of pediatrics》2013,80(7):538-543
Objective
This study aimed to find out incidence, predictors, onset and severity of respiratory distress including meconium aspiration syndrome (MAS) among vigorous neonates born through meconium stained amniotic fluid (MSAF), which may or may not be evident at birth.Methods
Two hundred ninety vigorous neonates were studied. Data were collected on perinatal risk factors, clinical course and development of respiratory distress. Predictors of respiratory distress were identified by logistic regression and a score based on adjusted OR was assigned for each. Diagnostic performance of the score (0–24) was assessed on another 247 vigorous neonates using receiver operator characteristic analysis (ROC).Results
Respiratory distress developed in 97(33.4 %) infants, MAS in 75(25.9 %). The distress appeared within 12 h in 97.9 %, was severe in only 21.7 %. Of 10 risk factors significantly associated with respiratory distress, seven entered in regression analysis. Fetal distress(adj OR?=?11.8; 95%CI?=?6.2–22.5), prolonged labor(adj OR?=?5.2; 95%CI?=?2.5–10.7), and absent/poor cry(adj OR?=?5.6; 95%CI?=?2.4–13.3) were identified as independent predictors; each assigned a score of 12, 6 and 6, respectively. To predict respiratory distress, a cut-off score of 9 points had sensitivity-74.1 % (95%CI?=?63.3 %–82.7 %), specificity-84.6 % (95 % CI?=?77.9 %–89.6 %), positive predictive value- 71.6 % (95%CI?=?60.8 %–80.4 %), negative predictive value- 86.2 % (95 % CI?=?79.6 %–90.9 %), likelihood ratio (LR)?+?ve 4.8(95%CI?=?3.3–7.0) and LR-ve 0.3(95%CI?=?0.2–0.4).Conclusions
Respiratory distress occurred in one third neonates, mostly had onset within 12 h of birth, and it was mild to moderate in majority. Fetal distress, prolonged labor, and absent/poor cry predicted respiratory distress and were validated. However, larger studies in different settings are required to confirm its utility. 相似文献12.
Jyoti Singh Dharmendra Soni Devendra Mishra H. P. Singh S. Bijesh 《Indian pediatrics》2014,51(4):285-288
Objective
Primary: To determine the incidence of congenital malaria in a cohort of pregnant women in a hyper-endemic area of central India. Secondary: (1) To find out the placental weight and placental malaria positivity, and to assess fetal and neonatal outcome in terms of survival, mean hemoglobin and mean birth weight.Design
Prospective observational study.Setting
Maternity and neonatal ward of a tertiary level hospital attached to a medical college located in Rewa, Madhya Pradesh, India.Participants
Near term and term pregnant women admitted in the maternity ward with a singleton pregnancy, whose neonates were available for examination till at least 6 hours after birth.Methods
Thick and thin blood smear were examined for malarial parasites from mothers prior to delivery. Based on the results of peripheral smear they were divided into ‘exposed group’ (peripheral smear positive for malaria parasite) and unexposed group’ (smear negative for malaria parasite). These groups were then followed prospectively till delivery and subsequently till the mother and the neonates were discharged from the hospital.Outcome variables
Primary: Presence of asexual parasite in neonate. Secondary: Placental weight, presence of asexual malarial parasite in placenta, still births, early neonatal deaths, mean birth weight and mean hemoglobin.Results
Seventy-two (35.5%) of 203 blood smears of near term and term pregnant women were found positive for malaria parasite (60 P. vivax and 12 P. falciparum); rest 131 comprised the unexposed group. Six (2.95%) neonates had parasitemia (4 P. vivax and 2 P. falciparum). Of the 203 smears made from placental blood, 24 (11.8%) were positive for malaria parasite. The mean (SD) birth weight [2300 (472) g vs 2430 (322) g; P=0.98], proportion of preterm babies (6.9% vs 8.4%, P=0.71), incidence of still birth (4.2% vs 3.0%, P=1.0) and early neonatal death (2.8% vs 3.0%, P=1.0) were not significantly different between the exposed and unexposed group.Conclusions
The incidence of congenital malaria is low despite high maternal smear positivity for malaria. 相似文献13.
Ida Sirgiovanni Sabrina Avignone Michela Groppo Laura Bassi Sofia Passera Paola Schiavolin Gianluca Lista Claudia Cinnante Fabio Triulzi Monica Fumagalli Fabio Mosca 《Pediatric radiology》2014,44(3):289-296
Background
Intracranial haemorrhage (ICH) in term newborns has been increasingly recognised but the occurrence in late preterm infants and the clinical presentation are still unclear.Objective
To investigate the appearance of intracranial haemorrhage at MRI in a cohort of infants born at 34 weeks’ gestation or more and to correlate MRI findings with neonatal symptoms.Materials and methods
We retrospectively reviewed neonatal brain MRI scans performed during a 3-year period. We included neonates ≥34 weeks’ gestation with intracranial haemorrhage and compared findings with those in babies without intracranial haemorrhage. Babies were classified into three groups according to haemorrhage location: (1) infratentorial, (2) infra- and supratentorial, (3) infra- and supratentorial + parenchymal involvement.Results
Intracranial haemorrhage was observed in 36/240 babies (15%). All of these 36 had subdural haemorrhage. Sixteen babies were included in group 1; 16 in group 2; 4 in group 3. All infants in groups 1 and 2 were asymptomatic except one who was affected by intraventricular haemorrhage grade 3. Among the infants in group 3, who had intracranial haemorrhage with parenchymal involvement, three of the four (75%) presented with acute neurological symptoms. Uncomplicated spontaneous vaginal delivery was reported in 20/36 neonates (56%), vacuum extraction in 4 (11%) and caesarean section in 12 (33%). Babies with intracranial haemorrhage had significantly higher gestational age (38?±?2 weeks vs. 37?±?2 weeks) and birth weight (3,097?±?485 g vs. 2,803 ± 741 g) compared to babies without intracranial haemorrhage and were more likely to be delivered vaginally than by caesarian section.Conclusion
Mild intracranial haemorrhage (groups 1 and 2) is relatively common in late preterm and term infants, although it mostly represents an incidental finding in clinically asymptomatic babies; early neurological symptoms appear to be related to parenchymal involvement. 相似文献14.
Kailash Nath Agarwal Dev K. Agarwal Arti Gupta Ajay Kr Bansal 《Indian journal of pediatrics》2013,80(1):11-15
Objective
To assess if linear growth in infant is optimal, with exclusive breast feeding for 6 mo as advised by the WHO.Methods
This prospective follow up study included 71 full term babies of middle socio economic group healthy mothers. The mothers were instructed to breast feed the babies who were followed up to 18 mo of age for assessment of linear growth. The study was conducted in Metro General Hospital, Noida, U.P. Fifty six babies weighed ≥2.5 kg, and 15 babies weighed <2.5 kg at birth. The main outcome measure was linear growth in exclusively breast fed infants.Results
At 18 mo, infants ≥2.5 kg on exclusive breast feeding for <6 mo and receiving semisolids early gained more length by 3.4 cm than those receiving breast feeding for ≥6 mo, and infant <2.5 kg gained more weight by 1.2 kg.Conclusion
For infants ≥2.5 kg of middle socioeconomic group, exclusive breast feed for 6 mo seems sufficient for optimal growth as compared to standard and reference growth data. 相似文献15.
Bahubali Gane B. Vishnu Bhat B. Adhisivam Rojo Joy P. Prasadkumar P. Femitha B. Shruti 《Indian journal of pediatrics》2014,81(5):425-428
Objectives
To analyze multiple risk factors of necrotizing enterocolitis (NEC) and the outcome.Methods
Hundred neonates with NEC were compared with 100 normal neonates matched for sex, gestation and weight. Their data including antenatal, natal, course of illness, hospital stay, progress and outcome were collected. Univariate analysis and logistic regression were used to analyze the risk factors.Results
Mean age of onset of NEC was 2.35?±?1.11 d. Stage I, II and III were noted in 48 %, 39 % and 13 % of cases respectively. Most common clinical features were abdominal distension (85 %) and feed intolerance (70 %). Important risk factors associated with NEC were sepsis, top feeding, perinatal asphyxia, respiratory distress and mechanical ventilation. Antenatal steroids and breast feeding had beneficial effect. No association was found with occurrence of NEC and cyanotic heart disease or administration of H2 blockers. Outcome in stage III was very poor.Conclusions
Early identification of risk factors and appropriate intervention may reduce the incidence and improve the outcome in NEC. 相似文献16.
Puja Amatya Dheeraj Shah Natasha Gupta Nisha K. Bhatta 《Indian journal of pediatrics》2014,81(5):441-445
Objectives
To measure the normal range of dimensions of liver in children of various age groups and to compare the liver measurement obtained by palpation-percussion, auscultation and ultrasonography.Methods
This was a cross-sectional comparative study in which 500 normal (weight for height between ± 2 SD of WHO standards for children aged less than 5 y and BMI between ± 2 SD of WHO standards for children aged more than 5 y) children (0–15 y) divided in 5 age groups (100 in each age group). Subjects were enroled from normal hospital delivery neonates, children visiting immunization and well baby clinics, children visiting outpatient and inpatient department with minor illnesses and healthy school children.Results
The normal range of dimensions of liver in children were estimated and percentile tables of liver size were established. Though the measurements obtained by clinical methods were significantly (P?<?0.001) lower than those obtained by ultrasonography, there was a strong correlation between clinical and ultrasonographic measurement. Palpation-percussion method could estimate the liver size within ± 1.0 cm of what was obtained by ultrasonography in 88 % of cases. In more than half of the study children (54.2 %), this estimation was within ± 0.5 cm.Conclusions
Clinical methods of liver span estimation strongly correlate with ultrasonographic measurement. The performance of palpation-percussion method is better than that of auscultation. Clinical methods should continue to be used for the estimation of liver size. 相似文献17.
Objectives
To determine predictors of mortality and morbidity in extremely low birth weight neonates (ELBW) from a developing countryStudy design
Prospective observational study.Setting
Level III neonatal unit in Northern India.Subjects
Neonates <1000g born and admitted to intensive care during study period were enrolled. They were analyzed based on survival and development of major morbidity. Multivariable logistic regression model was used to determine independent risk factors.Outcome
Mortality and major morbidity (one or more of the following: Bronchopulmonary dysplasia (BPD), Retinopathy of Prematurity (ROP) requiring laser, grade III or IV intraventricular hemorrhage (IVH), periventricular leukomalacia (PVL) and necrotizing enterocolitis (NEC) stage III) during hospital stay.Results
Of 255 ELBW neonates born, 149 received optimal care, of which 78 (52%) survived and 57 (39%) developed morbidities. Mean birth weight and gestational age were 29.1±2.6 weeks and 843±108g. Major causes of mortality were sepsis (46%), birth asphyxia (20%) and pulmonary hemorrhage (19%). Birth weight ≤800g [OR (95% CI)-3.51 (1.39–8.89), P=0.008], mechanical ventilation [4.10 (1.64–10.28), P=0.003] and hypotensive shock [10.75 (4.00–28.89), P<0.001] predicted mortality while birth weight ≤800g [3.75 (1.47–9.50), P=0.006], lack of antenatal steroids [2.62 (1.00–6.69), P=0.048), asphyxia [4.11 (1.45–11.69), P=0.008], ventilation [4.38 (1.29–14.79), P=0.017] and duration of oxygen therapy [0.004 (1.001–1.006), P=0.002] were the predictors of major morbidities.Conclusions
Low birth weight, mechanical ventilation and hypotensive shock predicted mortality in ELBW neonates while low birth weight, lack of antenatal steroids, birth asphyxia, ventilation and duration of oxygen therapy were predictors for major morbidity. 相似文献18.
Gopi K. Nayak Terry L. Levin Jessica Kurian Anirudh Kohli Steven H. Borenstein Harold S. Goldman 《Pediatric radiology》2014,44(10):1252-1257
Background
The upper gastrointestinal (UGI) series is the preferred method for the diagnosis of malrotation. A bedside UGI technique was developed at our institution for use in low birth weight, critically ill neonates to minimize the risks of transportation from the neonatal intensive care unit (NICU) such as hypothermia and dislodgement of support lines and tubes.Objective
To determine the ability of a bedside UGI technique to identify the position of the duodenojejunal junction (DJJ) in low birth weight, critically ill infants in the NICU.Materials and methods
We retrospectively reviewed bedside UGI examinations performed in premature infants weighing less than 1,500 g from 2008 to 2013 and correlated the findings with clinical data, imaging studies and surgical findings.Results
Of 27 patients identified (weight range: 633–1,495 g), 21 (78%) bedside UGI series were diagnostic. Twenty of 27 cases (74%) demonstrated normal intestinal rotation. One case demonstrated malrotation with midgut volvulus, which was confirmed at surgery. In six cases (22%), the position of the DJJ could not be accurately determined. No cases of malrotation with midgut volvulus were missed. None of the patients with normal bedside UGI studies was found to have malrotation based on clinical follow-up (mean: 20 months), surgical findings or further imaging.Conclusion
The bedside UGI is a useful technique to exclude malrotation in critically ill neonates and minimizes potential risks of transportation to the radiology suite. Pitfalls that may preclude a diagnostic examination include incorrect timing of radiographs, patient rotation, suboptimal enteric tube position and bowel distention. In cases of diagnostic uncertainty, a follow-up study should be performed. 相似文献19.