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Clinical Profile of Non-traumatic Acute Abdominal Surgeries in the Pediatric Patients: A Philippine Regional Experience
Johann Paulo Suico Guzman
Issue:
Volume 8, Issue 4, December 2022
Pages:
196-200
Received:
27 August 2022
Accepted:
22 September 2022
Published:
11 October 2022
DOI:
10.11648/j.ajp.20220804.11
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Abstract: This 5-year study on pediatric (< 18 years old) non-traumatic abdominal surgeries establishes local demographic and clinical profiles, and correlates these factors for risk of complicated appendicitis (rupture, abscess or phlegmon formation). Patient data on clinico-demographic profiles, type of surgery, and indications for surgery were collected. Chi-Square was done to determine risk of complicated appendicitis in terms age and sex. A total 826 cases were included. The mean age of males was 11.08 years and 12.53 years for females (male:female ratio 1.51). Majority of the cases were acute appendicitis (677 cases or 84.5%). Appendicitis cases were categorically divided into two: uncomplicated (suppurative or congestive) and complicated. Ratio of uncomplicated to complicated is 1.23. The rest of the cases were intestinal obstruction, congenital, intestinal perforation, intestinal bleeding and biliary problems. Most congenital surgeries were for infants (< 2 years), while acquired cases were noted in older patients. No reported infantile appendicitis. The risk of complicated appendicitis during childhood was significantly higher compared to adolescence (OR 1.69, [95% CI 1.17-2.47], p- 0.005) and males have a higher risk compared to females. (OR 2.01 [95% CI 1.47-2.75], p- < 0.001). In conclusion, appendicitis is the most common indication for surgery in children. There is a higher risk for complicated cases among males and those of younger age groups.
Abstract: This 5-year study on pediatric (< 18 years old) non-traumatic abdominal surgeries establishes local demographic and clinical profiles, and correlates these factors for risk of complicated appendicitis (rupture, abscess or phlegmon formation). Patient data on clinico-demographic profiles, type of surgery, and indications for surgery were collected. Chi-Square was done to determine risk of complicated appendicitis in terms age and sex. A total 826 cases were included. The mean age of males was 11.08 years and 12.53 years for females (male:female ratio 1.51). Majority of the cases were acute appendicitis (677 cases or 84.5%). Appendicitis cases were categorically divided into two: uncomplicated (suppurative or congestive) and complicated. Ratio of uncomplicated to complicated is 1.23. The rest of the cases were intestinal obstruction, congenital, intestinal perforation, intestinal bleeding and biliary problems. Most congenital surgeries were for infants (< 2 years), while acquired cases were noted in older patients. No reported infantile appendicitis. The risk of complicated appendicitis during childhood was significantly higher compared to adolescence (OR 1.69, [95% CI 1.17-2.47], p- 0.005) and males have a higher risk compared to females. (OR 2.01 [95% CI 1.47-2.75], p- ...
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A Rare Case of Non Classic Congenital Adrenal Hyperplasia with Systemic Lupus Erythematosus in a 14-year-old Girl
Maria Angela Yustina Fernandez,
I Made Arimbawa,
I Made Darma Yuda,
Ketut Dewi Kumara Wati
Issue:
Volume 8, Issue 4, December 2022
Pages:
201-206
Received:
23 August 2022
Accepted:
7 September 2022
Published:
18 October 2022
DOI:
10.11648/j.ajp.20220804.12
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Abstract: Introduction: Congenital Adrenal Hyperplasia (CAH) is classified into salt-wasting (SW), simple virilising (SV) CAH and Non Classic Congenital Adrenal Hyperplasia (NC-CAH). This disease can present with autoimmunity disorders but very little has been reported. We reported a girl with NC-CAH who presented with a life-threatening condition. She was recovered well after proper diagnosis and therapy. Case: A 14 year old girl came with chest pain and shortness of breath revealed a severe pericardial effusion and impending cardiac tamponade. Further evaluation showed acute malar rash, non scaring alopecia, proteinuria > 0.5 gram/24 hours and hemolytic anemia. Laboratory confirmation showed ANA (IF) pattern: speckled with titer 1:100, ANA Profile revealed Sm (Sm) antigen (+) and Jo-1 (Jo) antigen (+++), C3 84.2 mg/dL and anti-dsDNA < 10 IU /mL. She was fulfilled Systemic Lupus International Collaborating Clinics (SLICC) 2015 and European League Againts Rheumatism (EULAR) 2019 criteria for Systemic Lupus Erythematosus (SLE). At the same time, we also noticed about the excessive terminal hair (hirsutism) on the sideburns, upper lips, chin, chest, midline stomach, pubic, hands and legs on her. Further investigation was done to rule out the caused of hirsutism and masculinization. Investigation of testosterone was high 1.202 ng/dL, 17-OH progesterone 63.87 ng/mL, LH < 0.1 mIU/mL, FSH < 0.1 mIU/mL and estradiol 76 pg/mL. These revealed she suffered from NC-CAH. After treatment with pericardiostomy, high dose of methylprednisolone, cyclopohosphamide and hidrocortisone, she recovered completely. Conclusion: Hirsutism is one of the symptoms of late-onset NC-CAH. Children with NC-CAH are at risk of developing autoimmune disorders because the genetic defect that occurs is in a highly active in the immune system.
Abstract: Introduction: Congenital Adrenal Hyperplasia (CAH) is classified into salt-wasting (SW), simple virilising (SV) CAH and Non Classic Congenital Adrenal Hyperplasia (NC-CAH). This disease can present with autoimmunity disorders but very little has been reported. We reported a girl with NC-CAH who presented with a life-threatening condition. She was r...
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Neonatal Audit in Prof. Dr. I Goesti Ngoerah Gde Ngoerah Hospital in Two Years
Ni Luh Ayu Sumbia Indriani,
Made Sukmawati,
I Wayan Dharma Artana,
I Made Kardana,
Putu Junara Putra,
Putu Mas Vina Paramita Cempaka
Issue:
Volume 8, Issue 4, December 2022
Pages:
207-212
Received:
9 September 2022
Accepted:
8 October 2022
Published:
18 October 2022
DOI:
10.11648/j.ajp.20220804.13
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Abstract: Introduction: The first month of life is the most vulnerable period for child survival, with 2.4 million newborns dying in 2020. Neonatal audit is important to support quality improvement in neonatal unit. This study is to comprehend factors that influence neonatal morbidity and mortality in neonatology unit Prof. Dr. I Goesti Ngoerah Gde Ngoerah Hospital in year of 2020 and 2021. Material and Methods: This study was descriptive cross sectional study, the sample were all neonates treated in neonatology unit and registered by medical record in neonatology unit. Results: This study involved 2270 neonates in both years. Neonates who were born in Prof. Dr. I Goesti Ngoerah Gde Ngoerah Hospital was decreased 13.4% in 2021 and cesarean section was the highest mode of delivery in both year (59.3% and 65.9%). The majority of gestational age was more than 37 weeks (53.1% and 60.6%) and also the majority of birth weight was more than 2500 gram (59.7% and 54.3%). There also had increasing case of sepsis with 9.3% in 2021. There was no significantly difference of surfactant exogen administration in both year (1.3% and 1.2%). Neonates with Retinopathy of prematurity (ROP) and mother used steroid in pregnancy was decreased 0.9% in 2021. Respiratory distress syndrome was increased 4.9% in 2021. Cardiac and blood vessel anomaly was the highest cause of congenital anomaly in both years (35.5% and 38.5%). Neonates who use ventilator support increased 9.7% in 2021 with duration of ventilator usage less than 7 days. There was decreased 0.7% neonatal death in 2021. The most common cause of mortality was sepsis (77.3% and 61.5%), respectively. Neonates who were born less than 28 weeks and birth weight less than 1000 gram were the highest case of mortality in both year. Conclusion: The neonatal audit is important to do to know more precise data about the situation among neonatal care in the hospital. Some strategies were needed to reduce neonatal mortality such as decreasing premature and low birth weight deliveries and prevention of neonatal sepsis.
Abstract: Introduction: The first month of life is the most vulnerable period for child survival, with 2.4 million newborns dying in 2020. Neonatal audit is important to support quality improvement in neonatal unit. This study is to comprehend factors that influence neonatal morbidity and mortality in neonatology unit Prof. Dr. I Goesti Ngoerah Gde Ngoerah H...
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Risk Factor Associated with Retinopathy of Prematurity in Denpasar Tertiary Hospital
Dewa Ayu Angga Rainingsih,
Made Sukmawati,
I Made Kardana,
I Wayan Dharma Artana,
Putu Junara Putra,
Putu Mas Vina Paramitha Cempaka
Issue:
Volume 8, Issue 4, December 2022
Pages:
213-217
Received:
12 September 2022
Accepted:
8 October 2022
Published:
18 October 2022
DOI:
10.11648/j.ajp.20220804.14
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Abstract: Introduction: Retinopathy of prematurity (ROP) is an eye condition that affects the blood vessels of the retina in preterm infants. For the majority of children, retinopathy of prematurity occurs in a mild to moderate form and spontaneously regresses; however, more severe types of ROP can result in blindness in one or both eyes. Retinopathy of prematurity is often correlated with preterm delivery, however the risk for its emergence is a result of the interacting effects of other variables. This study seeks to identify the risk factors for ROP in neonates treated at the Prof. DR. I. G. N. G. Ngoerah Hospital in Denpasar, Bali. Material and methods: This study was retrospective study with design of case control study that conducted from Januari 2020 until January 2022. Samples of this study is neonates born prematurely undergone screening for ROP at Prof. DR. I. G. N. G. Ngoerah Hopital during study period. Results: The total sample of the study was 60 subjects, consisting of 30 subjects with ROP and 30 subjects without ROP. Multivariate analysis with logistic regression shows that gestational age < 32 weeks (OR 29.14; 95% CI 2.87 – 295.80), length of oxygen supplementation 14 days (OR 9.83; 95% CI 1.53 – 63.03), and severe infection (OR 12.17; 95% CI 1.05 – 141.69) was statistically significant for the occurrence of retinopathy of prematurity. Conclusion: The evaluation of risk factors that impacted the development of active ROP indicated statistically significant effects for gestational age, severe infection, and oxygen treatment duration. In order to avoid childhood blindness, timely screening and appropriate treatment are crucial.
Abstract: Introduction: Retinopathy of prematurity (ROP) is an eye condition that affects the blood vessels of the retina in preterm infants. For the majority of children, retinopathy of prematurity occurs in a mild to moderate form and spontaneously regresses; however, more severe types of ROP can result in blindness in one or both eyes. Retinopathy of prem...
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Risk Factors of Respiratory Distress Syndrome in Premature Infants at Prof Dr. I. G. N. G Ngoerah Hospital, Denpasar, Bali
Maria Angela Yustina Fernandez,
I Made Sukmawati,
I Made Kardana,
I Wayan Dharma Artana,
Putu Junara Putra,
Putu Mas Vina Paramitha Cempaka
Issue:
Volume 8, Issue 4, December 2022
Pages:
218-224
Received:
21 September 2022
Accepted:
8 October 2022
Published:
18 October 2022
DOI:
10.11648/j.ajp.20220804.15
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Abstract: Introduction: Respiratory distress syndrome (RDS) previously known as hyaline membrane disease (HMD), is one of the most common respiratory disorders in preterm neonates, appearing in the first few hours or immediately after delivery. The lack of pulmonary surfactant caused by immaturity of the lung is the etiology of RDS. Risk factors of RDS include maternal (sociodemographic and obstetric abnormalities), intrapartum and fetal factors. Objectives: To know the risk factors of RDS in preterm neonates at Prof. DR. I. G. N. G. Ngoerah Hopital Denpasar, Bali. Methods: This study was a retrospective study with design of case control study that conducted from January 2021 until February 2022. Samples of this study is neonates born prematurely with diagnosed of RDS at Prof. DR. I. G. N. G. Ngoerah Hopital during this study periode. All the data were analyzed by SPSS version 25. Result: The total sample of this study was 170 subjects, consisting of 85 subjects with RDS and 85 subjects as control. Multivariate analysis with logistic regression showed that gestational age < 34 weeks (OR 4.6; 95% CI 1.882-11.346; p = 0.001), APGAR score < 7 (OR 2.7; 95% CI 1.216-6.295; p = 0.015) and maternal preeclampsia (OR 3.58; 95% CI 1.09-11.75; p = 0.03) were statistically significant as the risk factors of RDS. Conclusion: Respiratory Distress Syndrome still occurs often in preterm newborns younger than 34 weeks of gestation. The incidence of RDS in preterm newborns was significantly increased by gestational age less than 34 weeks, APGAR score less than 7, and maternal preeclampsia. In particular, prospective cohort studies with bigger, more focused sample sizes are required in order to generate more accurate study.
Abstract: Introduction: Respiratory distress syndrome (RDS) previously known as hyaline membrane disease (HMD), is one of the most common respiratory disorders in preterm neonates, appearing in the first few hours or immediately after delivery. The lack of pulmonary surfactant caused by immaturity of the lung is the etiology of RDS. Risk factors of RDS inclu...
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A Rare Case of Zellweger Syndrome Associated with Neonatal Ischemic Stroke
Suzi Mansour,
Rayanne Mahfouz,
Sandy Rabah,
Suzanne Borrhomee
Issue:
Volume 8, Issue 4, December 2022
Pages:
225-228
Received:
25 July 2022
Accepted:
11 August 2022
Published:
21 October 2022
DOI:
10.11648/j.ajp.20220804.16
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Abstract: The Zellweger disorders (ZSDs) is a prototype of the peroxisome biosynthesis disorders described as a cerebro-hepato-renal syndrome. It is an autosomal recessive systemic disorder characterized clinically by severe neurologic dysfunction such as profound hypotonia, weakness, neonatal seizures, craniofacial abnormalities, and liver dysfunction. Biochemical screening shows the absence of peroxisomes. Brain MRI finds cortical and white matter abnormalities, but it is not known to be associated with ischemic stroke. Here we report a rare case of a newborn presenting with a profound persistent hypotonia, bilateral clubfeet, and refractory seizure, who is diagnosed with Zellweger syndrome associated with ischemic stroke. Because ischemic neonatal stroke has not yet been described in Zellweger Syndrome, this specific association could lead to even greater diagnosis delay, making the situation harder on the medical team and of course the parents. We believe acknowledging the possibility of ischemic stroke in Zellweger Syndrome could help physicians achieve a diagnosis faster if they encounter a similar case. When we are confronted to refractory seizures in a newborn with an ischemic stroke, physicians must keep searching for arguments in favor of a differential diagnosis, and Zellweger Syndrome is one that should not be overlooked.
Abstract: The Zellweger disorders (ZSDs) is a prototype of the peroxisome biosynthesis disorders described as a cerebro-hepato-renal syndrome. It is an autosomal recessive systemic disorder characterized clinically by severe neurologic dysfunction such as profound hypotonia, weakness, neonatal seizures, craniofacial abnormalities, and liver dysfunction. Bioc...
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The Functional Gastrointestinal Disorders in Infancy and the Fundamental Role of Probiotics: A Review on the Pathophysiology, Current Research and Future Therapy
Ajmery Sultana Chowdhury,
Farhana Afroze,
Parisa Marjan,
Amina Akter,
Gule Tajkia,
Soma Halder,
Urmi Rahman
Issue:
Volume 8, Issue 4, December 2022
Pages:
229-238
Received:
13 August 2022
Accepted:
28 September 2022
Published:
10 November 2022
DOI:
10.11648/j.ajp.20220804.17
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Abstract: Probiotics are the live microorganisms that they provide health benefits when consumed, generally by improving or restoring the gut flora. Now a day, the general public, researchers, International organization like WHO/FAO, pharmaceutical companies and food industries are becoming more interested in probiotics. According to the growth of, products, publications and public knowledge, research into the effectiveness of probiotics is gaining traction. "Let healthy microorganisms work for you in various domains acquire their advantages and take a break," says probiotics. Food digestion, the synthesis of helpful compounds to fight undesirable microorganisms, the complementing of the activities of missing digestive enzymes, the maintenance of the digestive system's pH, and so on are examples of such activity. Probiotics will boost the effectiveness of our digestive system's biological fermenters. Many writers have written on the history and development of probiotics as well as their many uses. In this study, we will primarily concentrate on three points: health improvement, infection control, and illness management, all of which might be avoided by using various forms of direct Probiotics or foods containing Probiotics. The most prevalent functional gastrointestinal diseases are infantile colic, constipation, functional abdominal pain, and irritable bowel syndrome. The present data on the use of probiotics in the treatment of this FGID will be reviewed in this chapter. Although the etiology of FGID is complex, the role of the gut microbiota in its development has been frequently stressed. As a result, the function of probiotics in their therapy is being investigated more closely. The use of Lactobacillus reuteri DSM 17938 at a dosage of 108 CFU/day for the treatment of infantile colic in breastfed babies currently has the greatest evidence of effectiveness. Lactobacillus rhamnosus at a dosage of 3 109 CFU and a multi-strain formulation for the treatment of IBS have limited but promising data. There is some evidence for the use of L. reuteri DSM 17938 at a dosage of at least 108 CFU/day in the treatment of FAP. Irritable bowel syndrome, functional dyspepsia, abdominal migraine, and functional abdominal pain not otherwise specified are among the pediatrics functional abdominal pain disorders, also known as diseases of gut-brain interaction, as described by the Rome IV diagnostic criteria. Functional abdominal pain problems affect 3-16 percent of the population, depending on the nation, age, and gender. The diagnosis is difficult, although it is based mostly on clinical symptoms and the elimination of alternative organic causes, with a focus on avoiding intrusive diagnostic techniques. Improved knowledge and treatment of these puzzling illnesses are expected in the next decades.
Abstract: Probiotics are the live microorganisms that they provide health benefits when consumed, generally by improving or restoring the gut flora. Now a day, the general public, researchers, International organization like WHO/FAO, pharmaceutical companies and food industries are becoming more interested in probiotics. According to the growth of, products,...
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Red Cell Distribution Width (RDW) - An Early Predictor of Persistent Pulmonary Hypertension of Newborn (PPHN): A Comparative Study in Dhaka, Bangladesh
Nargis Ara Begum,
Sharmin Afroze,
Abrar Wahab,
Runa Laila,
Shahnaz Parvin Siddiqua,
Nurun Nahar Begum,
Sabrina Khondoker Nila
Issue:
Volume 8, Issue 4, December 2022
Pages:
239-243
Received:
8 October 2022
Accepted:
29 October 2022
Published:
10 November 2022
DOI:
10.11648/j.ajp.20220804.18
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Abstract: Objective: Early diagnosis of Persistent pulmonary hypertension of newborn is a challenge in developing countries. This study aimed to observe the association of Red Cell Distribution Width (RDW) in this critical condition of neonates. Method: This retrospective study was performed in Neonatology department of United Hospital Limited, Dhaka, over 5 years (2013 to 2017) where all PPHN cases were enrolled and compared with neonates without having PPHN. Pre-formed questionnaire was used to collect data. Baseline complete blood count was reviewed in all cases to see the mean Red Cell Distribution Width (RDW). Risk factors for developing persistent pulmonary hypertension was analyzed and cut off value of RDW was observed using Receiver-operating characteristics (ROC) curve. Result: A total of 157 cases were found with PPHN having male predominance (66%). Important risk factors for PPHN were maternal pregnancy induced hypertension and asthma. Respiratory Distress Syndrome and Meconium Aspiration Syndrome were strongly associated with PPHN. RDW was found higher in PPHN neonates than those in the control group (p <0.05). The cutoff point of RDW predictive of PPHN was 17.05 (with 85% sensitivity). Conclusion: Red Cell Distribution Width is an early predictor of persistent pulmonary hypertension of Newborn.
Abstract: Objective: Early diagnosis of Persistent pulmonary hypertension of newborn is a challenge in developing countries. This study aimed to observe the association of Red Cell Distribution Width (RDW) in this critical condition of neonates. Method: This retrospective study was performed in Neonatology department of United Hospital Limited, Dhaka, over 5...
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Interpretation of Discordant Results in Maternal/Newborn Dyad Drug Screening
Norah Alghamdi,
Tonya Robinson,
Cierra Sharp,
Saeed Jortani
Issue:
Volume 8, Issue 4, December 2022
Pages:
244-251
Received:
14 October 2022
Accepted:
4 November 2022
Published:
16 November 2022
DOI:
10.11648/j.ajp.20220804.19
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Abstract: Background: Identification of in utero illicit drug exposure has paramount importance in medical care and well-being of the newborn. Newborn drug screening has traditionally been performed on meconium; however, umbilical cord tissue has gained popularity as an alternative specimen. We present six cases of newborn drug testing results from different specimens to highlight the potential inconsistencies and challenges with interpretation. Methods: Six infants born to mothers with illicit drug use who underwent drug screening are reviewed. Analysis was performed on meconium, umbilical cord tissue, newborn and/or maternal urine samples. Available meconium and umbilical cord tissue were analyzed using immunoassay and confirmed by HPLC-MS/MS. Urine drug screening was performed on available specimens using Enzyme-Multiple Immunoassay Technique and confirmed using HPLC-MS/MS. IRB approval for the study was granted by the University of Louisville and University of Louisville Hospital. Results: In each case presented there was significant variation in toxicology results between maternal/infant urine, meconium, and umbilical cord tissue analysis. Conclusions: Discrepancies in drug screening results from different specimens have been observed in the six mother/infant dyads presented. The utility of each specimen is dependent on several considerations and may warrant the testing of different sample types. Review of potential causation for conflicting results can help clinicians to select the proper tests and assist with interpretation when results deviate between the types of specimens analyzed.
Abstract: Background: Identification of in utero illicit drug exposure has paramount importance in medical care and well-being of the newborn. Newborn drug screening has traditionally been performed on meconium; however, umbilical cord tissue has gained popularity as an alternative specimen. We present six cases of newborn drug testing results from different...
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Prematurity Combined with Parental Risk Factors Increase the Number of Intestinal Perforations: A Case Control Study
Melanie Kapapa,
Janina Hahne,
Alexandre Serra
Issue:
Volume 8, Issue 4, December 2022
Pages:
252-257
Received:
27 September 2022
Accepted:
25 October 2022
Published:
23 November 2022
DOI:
10.11648/j.ajp.20220804.20
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Abstract: Background: Survival in preterm infants is strongly related to the occurrence of necrotizing enterocolitis (NEC) with intestinal perforation (NECp) compared to preterm with a focal intestinal perforation (FIP). Objective: The aim of this study was to elicit potential parental risk factors through a detailed maternal medical history and a comprehensive family history. Methods: A case-control design was used to compare both maternal medical history, factors such as drug use, individual lifestyle habits and external risk factors using standardized antenatal based questionnaires. The survey is completed by an interview with the participating parents of NEC, NECp, FIP and the control group (CG). Approval was granted by the local ethics committee (no. 13/15). Results: NEC/NECp mothers took more contraceptives (p=0.001), paracetamol (p=0.004), iodide (p=0.05) and calcium (p=0.04) and suffered from placental abruption (p=0.047), while fathers smoked more cigarettes/d (p=0.049). FIP mothers suffered from prolapsing amniotic sac (p=0.028) and alcohol consumption (p=0.034). NECp/ FIP mothers took more antibiotics (p<0.001). NEC/ FIP mothers were more likely to have uterine isthmus insufficiency (p=0.042). Conclusion: The accumulation of external factors such as alcohol consumption and passive nicotine use, the use of antibiotics and oral contraceptives together with pregnancy-associated maternal factors such as placental abruption and uterine isthmus insufficiency leads to higher rates of intestinal perforation in preterm infants.
Abstract: Background: Survival in preterm infants is strongly related to the occurrence of necrotizing enterocolitis (NEC) with intestinal perforation (NECp) compared to preterm with a focal intestinal perforation (FIP). Objective: The aim of this study was to elicit potential parental risk factors through a detailed maternal medical history and a comprehens...
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Digoxin Toxicity in a 9 Year Old Girl: A Case Report
Nneka Chioma Okoronkwo,
Cecil Levy
Issue:
Volume 8, Issue 4, December 2022
Pages:
258-262
Received:
23 September 2022
Accepted:
21 November 2022
Published:
29 November 2022
DOI:
10.11648/j.ajp.20220804.21
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Abstract: Digoxin toxicity is still a possibility in any child on the medication. Therefore, a higher index of suspicion, with regular serum level estimations and possible dose readjustment should be considered in every child using the drug. Digoxin is no longer commonly used in the treatment of non-anaemic heart failure in children due to its toxicity. It is presently giving way to newer drugs like Angiotensin converting enzyme and Beta-adrenergic inhibitors in the management of congestive cardiac failure (CCF). The narrow margin between the therapeutic and toxic doses of digoxin remains a cause for concern. Female sex, lean body mass, extremes of age and renal insufficiency contribute to an increase in serum levels and toxicity. Reports in the literature of digoxin toxicity in children are very limited compared to adult cases, and any such case in a child ought to be documented to add to the sparse reviews. A 9-year-old girl with chronic kidney disease stage 5 (CKD-5) and heart failure developed digoxin toxicity recently. This manifested with bradycardia, prolonged PR interval, and 3rd degree heart block. Her serum digoxin level was 6.4ng/ml (normal reference is 0.8-2.0 ng/ml) at the time of the crises. She was managed with discontinuation of digoxin, intranasal oxygen, constant cardiac monitoring, haemodialysis and symptomatic treatment of electrolyte disturbances until the toxic crises resolved.
Abstract: Digoxin toxicity is still a possibility in any child on the medication. Therefore, a higher index of suspicion, with regular serum level estimations and possible dose readjustment should be considered in every child using the drug. Digoxin is no longer commonly used in the treatment of non-anaemic heart failure in children due to its toxicity. It i...
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The Association Between Gestational Weight Gain with Birth Weight at Tanjung Public Health Center
Dewa Ayu Viennita Verdyanti Suria,
I Gusti Lanang Sidiartha,
Putu Tarita Susanti
Issue:
Volume 8, Issue 4, December 2022
Pages:
263-266
Received:
31 October 2022
Accepted:
16 November 2022
Published:
29 November 2022
DOI:
10.11648/j.ajp.20220804.22
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Abstract: Background: West Nusa Tenggara have 3.7% cases of neonates with low birthweight from 98,165 life birth and 7.3% was at Tanjung City. Gestational weight gain and birth weight may relate and there are many factors that influence them indirectly. Many low birthweights delivered by maternal with low nutrition status that undetected and untreated in pregnancy. Objective: To Assess the association of gestational weight gain with birth weight. Methods: This is a retrospective crossectional. This research include 202 samples from Tanjung Public health care. This research was conducted since August-October the data from cohort book at Tanjung Public health care. This research uses 202 samples without placenta previa and preeclampsia. The bivariate analysis use chi-square to find the association. Result: There is a significant association between maternal weight gain and birth weight with Confident interval (CI) 95%, significant if P < 0.05. The means of weight gain of maternal is 11.2 kg. The means of neonatal birth weight is 2727 gram. From 202 samples, there are72% maternal have suitable weight gain and the baby have normal weight birth. The prevalence of neonate with low birth weight is 43.06%. There are 75% low birth weight neonates came from maternal with inappropriate birth gain. Conclusion: Maternal weight gain that suitable to the target, have neonates with normal birth weight. Many factors predict might impact maternal weight gain that may need further research.
Abstract: Background: West Nusa Tenggara have 3.7% cases of neonates with low birthweight from 98,165 life birth and 7.3% was at Tanjung City. Gestational weight gain and birth weight may relate and there are many factors that influence them indirectly. Many low birthweights delivered by maternal with low nutrition status that undetected and untreated in pre...
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Renal Vein Thrombosis in Extremly Low Birth Weight Preterm Neonate & Utility of Bed Side Renal Doppler in NICU
Prakash C. Vaghela,
Chirag Gabani,
Hiral D. Mangukiya,
Jatin Rajyaguru
Issue:
Volume 8, Issue 4, December 2022
Pages:
267-270
Received:
28 June 2022
Accepted:
1 September 2022
Published:
15 December 2022
DOI:
10.11648/j.ajp.20220804.23
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Abstract: Renal vein thrombosis (RVT) is though common form of thromboembolism in neonates yet uncommon in extremely low birth weight pre-term neonates. Neonatal thromboembolism is more commonly associated with central venous catheter but we present a case report of an extremely low birth weight preterm with left side RVT which was not associated with central venous catheter and diagnosed by using bedside point of care renal ultrasound in the NICU. Though the incidence of RVT in adults and children is very low in Asian countries, its incidence, risk factors and finale outcome in neonatal RVT may be different from other countries. Acquired as well as genetic risk factors are significantly contributes in thromboembolism in neonate and central venous lines are one of the most common acquired risk factor. However mortality rate associated with renal vein thrombosis is less than other forms of thrombosis in neonate but there is significant degree of short term as well as long term sequelae. Initiation of thrombus formation may be triggered by vascular trauma, decreased vascular blood flow, increased viscosity of blood, thrombophilia or hyper osmolality. The classical triad for the renal vein thrombosis includes thrombocytopenia, hematuria along with unilateral or bilateral mass in flank. We recognised the pitfalls in managing RVT in preterm neonates. RVT, though rare, should be considered in the differential diagnosis while managing a preterm with hematuria or sepsis. Renal venography is the gold standard test for diagnosis of RVT however bedside renal ultrasound is very useful & prompt in diagnosing & monitoring doppler flow in renal vessels in RVT in neonates. There are no evidence based clear guidelines for management of the disease.
Abstract: Renal vein thrombosis (RVT) is though common form of thromboembolism in neonates yet uncommon in extremely low birth weight pre-term neonates. Neonatal thromboembolism is more commonly associated with central venous catheter but we present a case report of an extremely low birth weight preterm with left side RVT which was not associated with centra...
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Association Between Prolonged Maternal Smokeless Tobacco Use and Low Birth Weight Baby in a Tertiary Level Hospital
Mohammad Monir Hossain,
Salma Begum,
Faruk Ahmed,
Mohsin Uddin Ahmed,
Mohammad Salim Mridha,
Mohammad Ashraful Islam
Issue:
Volume 8, Issue 4, December 2022
Pages:
271-275
Received:
6 September 2022
Accepted:
28 November 2022
Published:
27 December 2022
DOI:
10.11648/j.ajp.20220804.24
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Abstract: Introduction: Low birth weight and preterm birth are significant predictors of morbidity and mortality in newborns and infants. For more than 40 years, it has been known that babies born to smoking mothers weigh less than babies born to nonsmoking mothers. Preterm birth is also increased by smoking during pregnancy. There is evidence that using smokeless tobacco may be as harmful to fetal health as cigarette smoking. Low birth weight (LBW) is often associated with increased morbidities and mortalities in newborns. Maternal smoking has a great contribution to having LBW babies. 28% of women in Bangladesh use smokeless tobacco frequently. The goal of the study was to find out the association between prolonged (>5 years) smokeless tobacco (ST) use and LBW babies. Methods: A retrospective cohort study was conducted with 300 mother-neonate pairs enrolled in the Department of Paediatrics and Department of Gynecology & Obstetrics, Dhaka Medical College, Dhaka from January 2009 to December 2010. Result: The majority of the mothers in this study used shada, followed by jorda, shada+jorda and gul. Smokeless tobacco (ST) which was used by mothers for more than 5 years significantly associated with the delivery of LBW baby (P <0.001) and carries a risk of having delivery of LBW baby 3.5 times higher in contrast with non users of smokeless tobacco. Conclusion: This study observed that prolonged use of smokeless tobacco for more than 5 years is considerably associated with LBW baby.
Abstract: Introduction: Low birth weight and preterm birth are significant predictors of morbidity and mortality in newborns and infants. For more than 40 years, it has been known that babies born to smoking mothers weigh less than babies born to nonsmoking mothers. Preterm birth is also increased by smoking during pregnancy. There is evidence that using smo...
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Topical Nitroglycerine Treatment for Sustaining Umbilical Arterial Catheter While Resolving Peripheral Ischemia: A Case Report
Sarah Gil,
Kamela Loo,
Indira Chandrasekar
Issue:
Volume 8, Issue 4, December 2022
Pages:
276-279
Received:
17 November 2022
Accepted:
8 December 2022
Published:
27 December 2022
DOI:
10.11648/j.ajp.20220804.25
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Abstract: Presence of umbilical arterial catheters in extremely low birth weight infants is critical for their management including minimal handling in first few days of life. However, one of the associated risks of indwelling umbilical arterial line is occasional development of peripheral ischemia. In most cases, it invariably leads to discontinuation of the catheter to salvage the ischemic tissue. Discontinuation of the arterial line places the preterm neonate at risk for multiple venipunctures and capillary blood draws and suboptimal hemodynamic monitoring. We report the first case of peripheral ischemia, specifically ischemia of the toes, due to umbilical arterial catheterization in an extremely low birth weight infant [380 grams and 25 weeks gestation secondary to maternal chronic hypertension, preeclampsia, and severe intrauterine growth retardation], where both the umbilical arterial catheter and toes were salvaged by use of topical nitroglycerine ointment. We conclude that topical application of nitroglycerine ointment did not lead to significant hypotension, methemoglobinemia, or intraventricular hemorrhage in this neonate. Currently there are no uniform guidelines regarding the frequency, duration, and safety of nitroglycerin topical administration in the treatment of ischemia in extremely low birth weight infants. A proposal for development of a guideline which should incorporate close blood pressure monitoring, methemoglobin levels, and serial cerebral ultrasounds. This method may help to reduce unnecessary early removal of catheters in the first few days of life, as many neonatal units are moving towards resuscitating peri-viable infants worldwide.
Abstract: Presence of umbilical arterial catheters in extremely low birth weight infants is critical for their management including minimal handling in first few days of life. However, one of the associated risks of indwelling umbilical arterial line is occasional development of peripheral ischemia. In most cases, it invariably leads to discontinuation of th...
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