Feasibility of MR urography in neonates and infants with anomalies of the upper urinary tract

The aim of this study was to evaluate the feasibility and diagnostic potential of dynamic MR urography (MRU) in neonates and infants with sonographically detected abnormalities of the upper urinary tract. Thirty infants (age range 5 days to 3 years, mean age 7.9 months; male:female: 22:8) underwent MRU using T2 and contrast-enhanced dynamic T1-weighted sequences. The results were compared with the findings of ultrasound ( n=30), intravenous urography (IVU, n=19) and/or scintigraphy ( n=25) based on the criteria suggestive of obstructive uropathy. Oral sedation was sufficient to perform MRU with diagnostic quality in 20 of 21 patients younger than 1 year; 9 older patients needed intravenous sedation. Diagnosis of the 66 renal units (58 kidneys, 29 successful examinations) included normal systems (contralateral units), duplex systems, vesico-ureteral reflux, obstructive megaureter, ureteropelvic junction obstruction and accompanying renal parenchymal disease, with complex pathology in 10 patients. Magnetic resonance urography demonstrated anatomy better than IVU, particularly the renal parenchyma, (ectopic) ureters, and poorly functioning dilated systems. Magnetic resonance urography was superior to US in showing ureteral pathology. Tiny cysts in dysplastic kidneys were better seen by US. Gadolinium-enhanced dynamic MRU allowed accurate assessment of obstruction applying IVU criteria. Here MRU matched IVU results, and most of the scintigraphic findings. Magnetic resonance urography can be performed in young infants with diagnostic quality using oral sedation. Magnetic resonance urography correctly depicts anatomy and allows assessment of the urinary tract better than US and IVU, with additional functional information. Magnetic resonance urography thus has the potential to replace IVU for many indications.     

Identifying neonates at a very high risk for mortality among children with congenital diaphragmatic hernia managed with extracorporeal membrane oxygenation

Purpose

The purpose of this study was to identify mortality risk factors in children with congenital diaphragmatic hernia (CDH) treated with extracorporeal membrane oxygenation (ECMO) and generate a prediction score for those at a very high risk for mortality.

Methods

Data on first ECMO runs of all neonates with CDH, between January 1997 and June 2007, were obtained from the Extracorporeal Life Support Organization registry (N = 2678). The data were split into “training data (TD)” (n = 2006) and “validation data” (n = 672). The primary outcome analyzed was in-hospital mortality. Modified Poisson regression was used for analyses.

Results

Overall in-hospital mortality among 2678 neonates (males, 57%; median age at ECMO, 1 day) was 52%. The univariate and multivariable analyses were performed using TD. An empirically weighted mortality prediction score was generated with possible scores ranging from 0 to 35 points. Of 69 who scored 14 or higher in the TD, 62 died (positive predictive value [PPV], 90%), of 37 with 15 or higher, 35 died (PPV, 95%), of 23 with 16 or higher, 22 died (PPV, 96%). A cut-off point of 15 was chosen and was tested using the separate validation dataset. In validation data, the cut-off point 15 had a PPV of 96% (23 died of 24).

Conclusion

Scoring 15 or higher on the prediction score identifies neonates with CDH at a very high risk for mortality among those managed with ECMO and could be used in surgical decision making and counseling.     

Vacuum-assisted closure for complicated neonatal abdominal wounds

Background

Neonatal experience in vacuum-assisted closure (VAC) for complex abdominal wounds remains scant.

Methods

A neonatal VAC protocol was instituted in 2004. The medical records of patients treated with this protocol for the ensuing 3 years were retrospectively reviewed. Continuous data are reported as mean ± SD (range).

Results

Ten VAC applications occurred in 8 neonates for a 3-year period. Gestational age and age at VAC application were 30 ± 6.9 (24-40) weeks and 84.5 ± 51 (21-165) days, respectively. Birth weight and weight at VAC application were 1495 ± 1118 (615-3415) g and 3515 ± 2118 (989-7965) g, respectively. All wound complications occurred after laparotomies (7 elective, 3 emergent). Three wounds included intestinal stomas, and 3 included enterocutaneous fistulae. Average wound area at VAC initiation was 13.6 ± 6.0 (8.5-25) cm². Duration of VAC use was 19.1 ± 15.3 (7-60) days. Vacuum-assisted closure resulted in complete wound closure in all cases and did not result in any local or systemic complications. Five patients (63%) survived to discharge.

Conclusions

Vacuum-assisted closure for complicated abdominal wounds is safe and successful in neonates of any gestational age and birth weight. It provides effective wound management, even in the presence of stomas or enterocutaneous fistulae.     

The Aachen MiniHLM--a miniaturized heart-lung machine for neonates with an integrated rotary blood pump

The operation of congenital heart defects in neonates often requires the use of heart-lung machines (HLMs) to provide perfusion and oxygenation. This is prevalently followed by serious complications inter alia caused by hemodilution and extrinsic blood contact surfaces. Thus, one goal of developing a HLM for neonates is the reduction of priming volume and contact surface. The currently available systems offer reasonable priming volumes for oxygenators, reservoirs, etc. However, the necessary tubing system contains the highest volumes within the whole system. This is due to the use of roller pumps; hence, the resulting placement of the complete HLM is between 1 and 2 m away from the operating table due to connective tubing between the components. Therefore, we pursued a novel approach for a miniaturized HLM (MiniHLM) by integrating all major system components in one single device. In particular, the MiniHLM is a HLM with the rotary blood pump centrically integrated into the oxygenator and a heat exchanger integrated into the cardiotomy reservoir which is directly connected to the pump inlet. Thus, tubing is only necessary between the patient and MiniHLM. A total priming volume of 102 mL (including arterial filter and a/v line) could be achieved. To validate the overall concept and the specific design we conducted several in vitro and in vivo test series. All tests confirm the novel concept of the MiniHLM. Its low priming volume and blood contact surface may significantly reduce known complications related to cardiopulmonary bypass in neonates (e.g., inflammatory reaction and capillary leak syndrome).     

集束化护理干预新生儿呼吸机相关性肺炎的临床研究

目的：探讨集束化护理干预新生儿呼吸机相关性肺炎的临床效果。方法将100例符合条件的机械通气新生儿随机分为实验组与对照组各50例,对照组给予常规护理干预措施,实验组给予集束化综合护理干预措施,比较两种护理方法的临床效果。结果实验组机械通气时间、住院时间较对照组明显缩短,呼吸机相关性肺炎发生率较对照组显著降低,基础护理合格率及患儿家属满意度较对照组明显提高,差异有统计学意义（P均〈0.05）。结论集束化护理可缩短机械通气时间,降低呼吸机相关性肺炎发生率,缩短住院时间,减少住院费用,减轻家庭经济负担,值得临床推广应用。     

Congenital Anomalies in Neonates Admitted to a Tertiary Hospital in Southwest Ethiopia: A Cross Sectional Study

BackgroundCongenital anomalies affect 2–3% of all live births. Anomalies of the central nervous system account for the highest incidence followed by that of the cardiovascular and renal systems. There is scarcity of data in developing countries like Ethiopia. The aim of the study was determining the magnitude and type of congenital anomalies and associated factors in neonates admitted to the neonatology ward of Jimma Medical Center, Southwest Ethiopia.MethodsInstitution based cross sectional study was done from March 1 to July 30, 2020. A total of 422 mother-infant pairs were enrolled into the study. Structured questionnaires were used to capture the socio-demographic, obstetric and medical characteristics of the mothers, demographic characteristics of the infants and type of congenital anomalies. Univariate and multivariate logistic regression analyses were done and results are presented as narratives and using figures and tables.ResultsCloser to one in five neonates admitted to the neonatology ward (78, 18.5%, 95%CI 14.7–22.3) had congenital anomalies; the majority (59, 13.98%) having only one type of anomaly. Anomalies of the nervous system (29, 6.87%) and gastrointestinal system (24, 5.68%) accounted for the majority of the cases. Inadequate antenatal care follow-up (p=0.018, AOR=1.9, 95%CI1.115, 3.257) and lack of folate supplementation during pregnancy (p=0.027, AOR=2.35, 95%CI 1.101, 5.015) were associated with congenital anomalies in the neonates.ConclusionCongenital anomalies account for significant number of admissions. Significant association was seen between neonatal congenital anomalies and poor antenatal attendance and lack of folic acid supplementation during pregnancy.     

早期抚触干预对缺氧缺血性脑病患儿神经行为康复的影响

目的探讨早期抚触干预对缺氧缺血性脑病(HIE)患儿神经行为康复的影响。方法选取2013年4月～2017年10月新生HIE患儿140例,采用随机数字表法分为抚触组(70例)和对照组(70例)。对照组患儿予以育儿指导、康复教育、病情监测及药物用法指导常规干预。抚触组患儿在对照组基础上加以早期抚触干预,连续干预28 d。观察两组患儿干预前与干预28 d后神经行为发育情况,并比较1年后神经系统损害情况。结果干预28 d后,两组患儿NBNA评分较干预前明显升高,差异有统计学意义(P0.05),且抚触组患儿明显高于对照组,差异有统计学意义(P0.05);干预1年后,抚触组患儿神经系统损害的总发生率(11.43%)明显低于对照组(25.71%),差异有统计学意义(P0.05)。结论早期抚触干预用于新生HIE患儿治疗具有一定的辅助作用,能加快神经行为康复;且其远期效果亦较确切,能有效改善患儿神经系统发育,减轻神经系统损害,改善预后。     

正常出生新生儿瞬态诱发耳声发射与畸变产物耳声发射听力筛查结果比较

目的 探讨瞬态诱发耳声发射(transient evoked otoacoustic emissions,TEOAE)和畸变产物耳声发射(distortion products otoacoustic emissions,DPOAE)用于新生儿听力筛查特点,为正常出生新生儿听力筛查方法的选择提供参考.方法 于出生后48~72小时,对1 062例正常出生的新生儿分别使用TEOAE和DPOAE进行听力初筛,其中135例未通过初筛者,在42天龄左右,同时进行TEOAE和DPOAE复筛;复筛未通过者3月龄左右进行诊断型听性脑干反应测试. 结果 1 062例新生儿中TEOAE初筛未通过率为11.02%(117/1 062),DPOAE未通过率为13.65%(145/1 062);135例进行了复筛,TEOAE和DPOAE未通过率分别为17.78%(24/135)和20.74%(28/135),DPOAE初、复筛未通过率均高于TEOAE,差异均有统计学意义(P<0.001);TEOAE和DPOAE在初筛和复筛中的一致率分别为96.04%和95.56%,kappa值分别为0.817和0.857.在初筛中TEOAE每耳的平均测试时间为24±25 s,DPOAE为40±34 s;在复筛中TEOAE为52±41 s,DPOAE为73±62 s,配对样本t检验显示两种方法的测试时间差异有统计学意义(P=0.000).复筛的135例中,共有7例(10耳)最终被诊断为不同程度的传导性听力损失(9耳)及感音神经性听力损失(1耳),这10耳TEOAE和DPOAE初、复筛均未通过. 结论 作为正常出生新生儿的听力筛查方法,TEOAE较DPOAE未通过率低,耗时少;作为新生儿听力筛查工具,TEOAE可能比DPOAE有优势.     

Neonatal thrombosis

Neonatal thrombosis is a serious event that can cause mortality or result in severe morbidity and disability. The most important risk factor for the development of thrombosis during the neonatal period is the presence of an indwelling central line and consequently the vessels involved tend to be those most frequently used for catheterization. Other documented risk factors for the development of neonatal thrombosis include asphyxia, septicemia, dehydration, maternal diabetes and cardiac disease. Main laboratory findings for the diagnosis of hypercoagulable states, include shortened aPTT, decreased levels of inhibitors (AT III, Protein C and Protein S), increased resistance to activated protein C, defective fibrinolysis (basal and after stimuli), increased levels of clotting factors (fibrinogen, factor VII, factor VIII, etc.), increased and/or hyperactive platelets, increased whole blood and/or plasma viscosity, Antiphospholipid antibodies and presence of prothrombotic molecular defects like FV Leiden, P20210 and MTHFR. Approximately 4% and 2% respectively of Caucasians are heterozygous for these gene defects. Their causative role in neonatal thrombosis is unknown but they may have a contributory role in the pathogenesis of thrombosis in neonates.