Raid M R Umran Umran

Abstract Background: Improving the neonatal mortality is a challenge in developing countries like Iraq. Increasing demands and overload of maternity services can considerably limit the improvement in neonatal outcomes. We aimed to document the numbers, disease patterns and outcomes of admitted newborns and the improvement after implementing clinical protocols and to identify possible future target measures. Method: A descriptive study was conducted at neonatal intensive care unit (NICU) at a regional hospital from 2011 to 2013. Out of 72320 deliveries, 4694 were admitted and met selection criteria. Clinical guidelines, clinical skills training of nurses and resident doctors and improving medical records were implemented during study period. All patients' demographics, causes of admission/death and the mortality were analyzed. Results: From total 4694 admitted newborns; 42% were delivered vaginally, 60% were males, 43% were less than 2500 g, and 31% of them were premature. The neonatal fatalities consisted of 1076 newborns, 84% of them died before 7 days of age, and 39% of them weighed ≤ 1500 g. Respiratory distress syndrome was the main cause of death (62.2%). The total number of deliveries was increased, corresponding with an increased number of vaginal deliveries (R=0.97), thereby significantly increasing the number of NICU admissions (R=0.569, p=0.009). Notably, the mortality rate was significantly decreased (R=-0.487, p=0.004). Conclusions: The maternity overload contributed to high neonatal mortality and implementing clinical guidelines and medical staff training improve the neonatal outcomes. Adequate timing of cesarean section and increasing the awareness to detect potentially complicated deliveries are the future target interventions. This article is protected by copyright. All rights reserved.

ABSTRACT: Objective This study aims to evaluate the correlation of changes in serum insulin-like growth factor-1 (IGF-1) levels with the clinical staging of hypoxic-ischemic encephalopathy (HIE) in term newborns. Study Design A prospective study of 29 newborns with HIE (stage I = 15, stage II + III = 14) and 28 healthy term newborns as the control group was performed in the neonatal intensive care unit. IGF-1 levels were obtained within 6 hours after birth from HIE and control groups and again on day 3 from HIE group. HIE was classified using the Sarnat staging I to III. Results IGF-1 levels were significantly lower in the HIE group than in the control group (p = 0.024). It was lower in the HIE stage II to III group compared with HIE stage I group at birth (p < 0.0001) and on day 3 (p = 0.009). The mean IGF-1 levels were significantly higher on day 3 than on day 1 among stage II to III HIE (p = 0.006) and it was inversely correlated with staging (R = - 0.475, p = 0.009). There was a significant correlation between IGF-1 levels and Apgar score at 5 (R = 0.39, p = 0.042) and 10 minutes (R = 0.38, p = 0.035). Conclusions IGF-1 was lower in HIE and inversely correlated with clinical staging. It was increased with clinical improvement in the subsequent days.

ABSTRACT: Rituximab was trialed in a refractory Vogt-Koyanagi-Harada disease (VKH). A 10-year-old girl with panuveitis recalcitrant to treatment, including corticosteroids, was diagnosed with VKH 20 months later. Following Rituximab at 0, 1, 6, and 18 months, response was favorable after the second dose, usual life activity resumed after the third (uveitis was inactivated, vision improved), and eyes stabilized 9 months after the fourth. Rituximab is effective in the treatment and long-term control of advanced, pediatric VKH.

Impact of timing of the repeated elective cesarean section on the early neonatal outcomes

ABSTRACT: Acute bacterial meningitis in pediatrics remains a serious and potentially lethal disease. Its prognosis is critically dependent on rapid diagnosis and treatment. The use of biological markers, like procalcitonin, has been proposed to facilitate the accuracy of the initial diagnosis of bacterial meningitis. The aim of this study was assessment the diagnostic values of serum procalcitonin (PCT) assay in the diagnosis and differentiation of acute bacterial from non bacterial meningitis. 45 patients with suspicion of meningitis were enrolled in the study and were clinically evaluated and investigated by lumbar punctures for cerebrospinal fluid analysis, C-reactive protein and differential leukocyte count. Patients with clinical and laboratory suggestion of bacterial causes were regarded as bacterial meningitis group (29 patients), and those who were suggestive of nonbacterial causes were regarded as nonbacterial group (16 patients). Serum procalcitonin levels were significantly higher in bacterial meningitis group (637±325 pg/ml) compared with non-bacterial meningitis (380±170 pg/ml); P<0.001. Procalcitonin levels were more sensitive and specific (79%, 81%) than C-reactive protein (76%, 75%) and white blood cell count (72%, 75%) in the diagnosis of bacterial meningitis. Elevated serum procalcitonin level could be a predictor of bacterial causes of meningitis and is more sensitive and specific than other diagnostic predictors.

Metabolic and rare diseases in children

Karbala second international pediatrics conference 15-3-2017