Effect of lower leg compression during cesarean section on post-spinal hypotension and neonatal hemodynamic parameters: nonrandomized controlled clinical trial

ObjectivesThis study aimed to determine the effect of lower leg compression during cesarean section (CS) on post-spinal hypotension (PSH) and neonatal hemodynamic parameters.MethodsThis study is a nonrandomized controlled clinical trial conducted in the cesarean delivery unit of the National Medical institute, Damanhour, Egypt. The sample included 120 parturients (60 intervention and 60 control). The researchers developed three tools for data collection: sociodemographic data and reproductive history interview schedule, electronic monitoring of maternal hemodynamic parameters, and neonatal hemodynamic assessment sheet. All parturients received ordinary pre-operative care. For the intervention group, a long elastic stocking (ordinary pressure 20–30 mmHg, 1 mmHg = 0.133 kPa) was applied on both legs during cesarean section. The control group received the same care without the elastic stocking.ResultsSystolic blood pressure, diastolic blood pressure, and mean arterial blood pressure were significantly higher in the intervention group throughout the entire operation period except in the last 5–15 min. Heart rate was significantly lower in the intervention group. Only 13.3% of the intervention group took ephedrine compared with 45% of the control group. Apgar score was higher among neonates of intervention group compared with the control group at 1 min. Neonatal acidosis was significantly higher in the control group than in the contral group.ConclusionLower leg compression technique can effectively reduce PSH and neonatal acidosis.     

Ultrasound Fetal Weight Estimation: How Accurate Are We Now Under Emergency Conditions?

The primary aim of this study was to evaluate the accuracy of sonographic estimation of fetal weight when performed at due date by first-line sonographers. This was a prospective study including 500 singleton pregnancies. Ultrasound examinations were performed by residents on delivery day. Estimated fetal weights (EFWs) were calculated and compared with the corresponding birth weights. The median absolute difference between EFW and birth weight was 200 g (100–330). This difference was within ±10% in 75.2% of the cases. The median absolute percentage error was 5.53% (2.70%–10.03%). Linear regression analysis revealed a good correlation between EFW and birth weight (r = 0.79, p < 0.0001). According to Bland–Altman analysis, bias was −85.06 g (95% limits of agreement: −663.33 to 494.21). In conclusion, EFWs calculated by residents were as accurate as those calculated by experienced sonographers. Nevertheless, predictive performance remains limited, with a low sensitivity in the diagnosis of macrosomia.     

Tyrosinemia type 1 in pediatric nephrology: Not always straightforward

The main clinical features of tyrosinemia type 1 usually appear in the first months of life, including fever, diarrhea, vomiting, liver involvement, growth failure, and renal proximal tubulopathy with subsequent hypophosphatemic rickets. An early diagnosis is crucial in order to provide specific management and to prevent complications. Here, we report on two cases referred primarily to pediatric nephrologists for the diagnosis of “neonatal tubulopathy” and management of “X-linked hypophosphatemia (XLH),” respectively. Our aim is to emphasize that (1) even a mixed tubulopathy can reveal tyrosinemia, and (2) tyrosinemia is a classic differential diagnosis of XLH that should not be forgotten, especially in the era of the anti-FGF23 burosumab.     

鼻塞式同步间歇正压通气(NIPPV)联合布地奈德雾化治疗新生儿急性呼吸窘迫综合征疾病的临床应用研究

目的:分析鼻塞式同步间歇正压通气(NIPPV)联合布地奈德雾化治疗ARDS(新生儿急性呼吸窘迫综合征)疾病的临床应用效果。方法:纳入病例是2017年5月—2019年11月收治的104例ARDS新生儿,随机平均分为两组。参照组52例采纳CPAP(持续气道正压通气通气)治疗,实验组52例采纳NIPPV+布地奈德雾化治疗,对比两组呼吸机通气时间、用氧时间、住院时间、血气指标以及并发症发生情况。结果:实验组呼吸机通气时间、用氧时间、住院时间均明显短于参照组,差异有统计学意义P<0.05;实验组治疗3 d后PaCO2明显低于参照组,实验组治疗3 d后PH以及PaO2明显高于参照组,差异有统计学意义P<0.05;实验组并发症发生率(3.85%,2/52)明显低于参照组(21.15%,11/52),差异有统计学意义P<0.05。结论:NIPPV+布地奈德雾化可有效缩短ARDS患者机械通气时间,改善血气指标,降低并发症发生率,值得借鉴。