1,721,073 research outputs found
Effective Passive Cooling During Neonatal Transport
No full textWe retrospectively evaluated the rectal temperature of 297 hypoxic-ischemic encephalopathy (HIE) outborn newborns who were passive-cooling transported by Neonatal Emergency Transport Service (Genoa and Rome, Italy) at their arrival in Neonatal Intensive Care Unit. By a total of 1461 transports, 297 were for suspected HIE. Transferring suspected HIE newborn does not mean with certainty directing him/her to cooling treatment, but rather to monitoring and deepening in the hypothesis of starting hypothermia. This is the main reason why we have chosen 35 degrees C (+/- 0.5 degrees C) as the temperature target to be maintained during transport. Our study demonstrated that 263/297 patients (88.55%) passively cooled during transport were within the target limit of 35 degrees C (+/- 0.5 degrees C), whereas 15 newborns were at rectal temperature >35.5 degrees C (5.05%) and 19 were <34.5 degrees C (6.39%); no patients were <33 degrees C. In our opinion, these are satisfactory results. Overcooling, failed temperature target, and unstable temperature values are the main problems claimed to occur during passive cooling in transport. We would like to conclude underlining that a well-experienced neonatal transport team can use passive cooling expecting appropriate performances
Arterial Thrombosis Following Umbilical Artery Catheterization: Visualising Uncommon Neonatal Intensive Care Unit (NICU) Complications
No full textBackground: Right internal iliac artery (RIIA) thrombosis is an extremely rare but serious complication associated with umbilical artery catheter (UAC) malposition in neonates in the Neonatal Intensive Care Unit (NICU). Timely diagnosis and appropriate management are essential to prevent long-term sequelae. Case Report: We present the case of a term neonate with hypoxic–ischaemic encephalopathy (HIE), who developed RIIA thrombosis secondary to UAC malposition, highlighting the role of bedside Doppler ultrasound in diagnosis and monitoring, and the success of a conservative therapeutic approach. Discussion: A term male neonate with HIE was undergoing therapeutic hypothermia when violaceous macular skin lesions appeared on the right buttock and loin shortly after UAC insertion. Imaging confirmed malposition of the catheter in the RIIA. The catheter was promptly removed, and the patient was closely monitored both clinically and with serial Doppler ultrasounds. Approximately 6 h after catheter removal, Doppler ultrasound revealed a clot in the RIIA. The patient was managed conservatively with continuous infusion of unfractionated heparin (10 IU/kg/h) and topical anti-inflammatory therapy. The skin lesions resolved within 36 h, and Doppler at 48 h post-removal confirmed re-established arterial flow. No invasive interventions were required. This case underscores the importance of careful catheter placement and the utility of bedside Doppler ultrasound in detecting and monitoring vascular complications. Moreover, prompt recognition and conservative treatment of arterial thrombosis can result in optimal outcomes, even in neonates with complex clinical conditions such as birth asphyxia
Massive Hepatic Subcapsular Hematoma As An Unexpected Hypoxic Complication: Preventable Neonatal Death, Not A Iatrogenic Rupture Of The Liver! A Case Series
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The Possible Role of the Superior Sagittal Sinus in Regulating Cerebrospinal Fluid Dynamics among Preterm Infants: A Case Report and a Review of the Literature
No full textWe report the case of a preterm of 27 weeks of gestation who developed posthemorrhagic ventricular dilatation associated to a complete thrombosis of the superior sagittal sinus, for its peculiar interest in clarifying the physiology of the cerebrospinal fluid (CSF) dynamics.The exact CSF volume that must be removed to improve cerebral hemodynamics and outcomes in infants with posthemorrhagic ventricular dilatation is unknown. According to Volpe's studies, a volume of 10 to 15 mL/kg/die of body weight is commonly chosen. The subject we report needed an excessive CSF drainage (up to 32 mL/kg/d), in presence of a functioning external ventricular drain.We review the literature on the topic, and we postulate that the superior sagittal sinus may play an active role in the CSF dynamics of the immature brain (as it happens for the adult brain)
Description of a novel chest wall anomaly: The postprematurity thoracic dysplasia
No full textBACKGROUND/PURPOSE: Many studies on ex-preterm babies were conducted to evaluate their respiratory sequelae, but, to our knowledge, the condition described in this paper was never reported before and is not included in the classifications of thoracic anomalies proposed so far.METHODS: Clinical data and images of a novel thoracic deformity observed in the last 10 years are shown. This anomaly is characterized by an indentation of the ribs on both (less frequently one) anterolateral parts of the chest wall. All our patients with this condition were ex-preterm babies. We named this novel thoracic anomaly as "postprematurity thoracic dysplasia" (PPTD). Possible etiopathogenetic mechanisms and treatment options are discussed.RESULTS: We observed 8 patients with variable range of respiratory symptoms. In 2 cases the malformation caused a severe functional restriction of lung volumes and surgery was performed to improve respiratory symptoms; in other cases the symptoms were mild or absent and the malformation was a matter of concern only for cosmesis.CONCLUSIONS: PPTD is a novel thoracic anomaly typical of ex-preterms. Clinical relevance is variable. In severe cases surgery can be considered.LEVEL OF EVIDENCE: IV
Blood withdrawal and infusion via umbilical catheters: Effect on cerebral perfusion and influence of ibuprofen
No full textWithdrawal and infusion of blood via umbilical catheters can affect cerebral blood flow in preterm infants. We compared the effects on cerebral perfusion of 3 ml/kg blood withdrawal and infusion via umbilical arterial (UAC) and venous (UVC) catheters in 16 infants ≤32 weeks gestation, age <24 h, on mechanical ventilation. Near infrared spectroscopy was used to monitor changes in cerebral oxy- and deoxyhemoglobin, total cerebral hemoglobin (an index of cerebral blood volume; CBV) and HbD (an index of cerebral intravascular oxygenation). In 10 infants the study was repeated 1 h after intravenous administration of 10 mg/kg ibuprofen as prophylaxis against PDA. Withdrawal and infusion via the UVC caused significant MABP and concordant HbD and CBV changes. Smaller modifications were seen following blood withdrawal and infusion via the UAC. Ibuprofen attenuated cerebral hemodynamic changes associated with withdrawal, but not infusion, from UAC and UVC. Copyright © 2003 S. Karger AG, Basel
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