Therapeutic hypothermia (TH) is used for hypoxic ischemic encephalopathy (HIE) of the term or near-term newborns to reduce the possible neurological handicap. The aim of this review is to focus on monitorization and management of newborns undergoing TH in Neonatal Intensive Care Unit. MEDLINE search was performed with keywords “therapeutic hypothermia, newborn.” Articles on human subjects published between 2004 and 2015 were included. TH is defined as moderate hypothermia where the core body temperature measured by the esophageal or rectal probe is cooled down to 33.0–35°C for 72 h. It may be administered by selective head cooling or with total body cooling methods by using a variety of different devices. TH is suggested to be used within certain guidelines in newborns with moderate to severe HIE meeting definitive criteria. For best results treatment needs to be started no later than 6 h of life which at times may be challenging for the clinician in newborns who initially appear mildly affected but later on progress to have more severe disease. TH has been used in many multicentered clinical studies showing neuroprotective effects. However, it has several effects that the clinician needs to be aware during treatment including; cardiopulmonary, renal, hematological, and metabolic effects. Drug metabolism may be delayed, there may be clotting disorders and the tendency for infection and skin problems as well. Optimal patient care including adequate sedation, antibiotic treatment, fluid, and nutritional management are very important during the course of TH. Patients need to be fully monitored including vital signs particularly core temperature. Frequent blood work may be necessary to follow the general condition of the patient and side effects. Echocardiographic assessment, head ultrasound, amplitude integrated electroencephalography are other methods used to evaluate treatment effects and guide management. Rewarming after 72 h of TH is also a very important part of treatment. Rewarming should be completed within 4–12 h and close follow-up including vital signs, respiratory, and circulatory conditions is required to detect the changes occurring in the patient and treat accordingly.

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Recognizing the need for neurological monitoring in critically ill neonates such as the other vital parameters, neonatologists, and neurologists is becoming more familiar and comfortable with the use of amplitude-integrated electroencephalography (aEEG) in the neonatal intensive care unit, with minimal training and can be interpreted by care providers without neurophysiology backgrounds. In its simplest form, aEEG is a processed single-channel electroencephalogram that is filtered and time compressed. Current evidence demonstrates that aEEG is useful to monitor cerebral background activity, diagnose and treat seizures, and predict neurodevelopmental outcomes for preterm and term infants. This review aims to explain the fundamentals behind aEEG and its clinical applications specially referring to neonatal hypoxic-ischemic encephalopathy and hypothermia.

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Severe hypoxic-ischemic encephalopathy (HIE) in the newborn period is known to cause multi-organ dysfunction. Our index case describes a 40 weeks newborn infant who was born in a depressed state with poor cord gases and Apgar scores and needed cardiopulmonary resuscitation. During the 2^nd week of life, the newborn infant became polyuric with persistent hypernatremia along with problems in maintaining body temperature. Investigations revealed the newborn infant to suffer from neurogenic diabetes insipidus, secondary adrenal, and thyroid insufficiency. Magnetic resonance imaging of the brain showed abnormal heterogeneous signals within the thalami and basal ganglia consistent with severe HIE. Commencement of regular desmopressin, hydrocortisone, and levothyroxine resulted in the improvement of hypernatremia, polyuria, thyroid functions, and serum cortisol levels but unstable thermoregulation continued to persist. Such multiple endocrinopathies involving both the anterior and posterior pituitary gland and hypothalamus as sequelae to severe HIE in newborn infants have not been widely reported in the literature.

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Background: Fetal echocardiography (FE) has contributed in early identification of serious conotruncal anomalies that require early intervention in postnatal life. Objective: Our study aims to evaluate the incidence of development of conotruncal anomalies in pregnant women with high-risk pregnancies referred for extended FE. Subjects and Methods: One hundred and fifty-one pregnant mothers were referred between 2013 and 2014, from the feto-maternal clinic for FE in a pediatric cardiology unit, as they had risk factors for developing fetal cardiac anomalies. Results: Consanguineous marriage was reported in 62% of cases. Twelve studies (7.9%) showed abnormal cardiac examination, nine of which were outcomes of consanguineous marriage. Two cases had Ebstein anomaly; both cases were outcomes of consanguineous marriage, in one of them the mother received Aspirin during the 1^st trimester. Another two cases were diagnosed as a muscular ventricular septal defect, one had a family history of congenital heart defects and was the outcome of consanguineous marriage, the other had a history of Aspirin administration during the 1^st trimester and nonconsanguineous marriage, only one case had hypoplastic left heart syndrome, and the maternal age was 36 years. Six cases (3.9%) had fetuses with conotruncal anomalies; all were outcomes of consanguineous marriage. Conclusions: FE is valuable in early detection of serious defects as conotruncal anomalies that may require early peri-natal intervention, especially in cases with high risk. Positive consanguinity is a major problem in developing countries, possibly associated with serious problems in offspring.

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Proteus mirabilis infection is rare in neonates. In this population, the majority of described infections involve the central nervous system (CNS). We describe an unusual case of congenitally acquired P. mirabilis infection in a neonate presenting as sepsis, pancytopenia, and coagulopathy. Providers should consider this organism as a cause of severe illness in the newborn period, even in the absence of CNS involvement.

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Objectives: To compare the analgesic effect of breastfeeding and 30% glucose on pain induced in term newborns during a single painful procedure. Study Design and Setting: We conducted an open design trial, from January to October 2013, at the maternity of the Yaounde Gynaeco-Obstetric and Paediatric Hospital. Patients and Methods: We included healthy term newborns of at least 24 h of life; a heel prick was done, using a 23-gauge syringe, after an analgesic with breastfeeding or 30% glucose. The newborns were divided into two groups by drawing of lots. The pain was evaluated using the Neonatal Infant Pain Scale. Results: Fifty newborns were recruited per group. The median (interquartile range [IQR]) pain scores, during pricking, were 2 (1.5–3.5) and 3 (2.5–4.5), in the groups of breastfeeding and 30% glucose respectively, with a significant statistical difference (P < 0.001). We found a median (IQR) pain score of 3 (2.5–4), in newborns weighing between 2500 and 3000 g, against 2 (1–3) in those weighing above 3000 g with a significant statistical difference (P = 0.02). Conclusion: The analgesic effect of breastfeeding is greater than that of 30% glucose solution, in newborns undergoing a single painful procedure. Term newborns weighing between 2500 and 3000 g express pain more than those weighing more than 3000 g.

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Despite the successful clinical translation of therapeutic hypothermia for perinatal encephalopathy into routine care, treatment is only partially effective. It is likely that this reflects the formidable challenges of initiating treatment for neonatal encephalopathy within a few hours after birth. In randomized controlled trials, cooling has been typically initiated at a mean of 4 to 5 h after birth. This is clearly not optimal, given accumulating evidence that cooling is significantly more effective when it can be initiated before 3 h. In this review, we propose that given the consistent evidence that milder hypoxic-ischemic injury is associated with slower evolution of damage, any future clinical trials of delayed treatment starting more than 6 h after an insult should target infants with milder encephalopathy. We then critically examine the evidence that erythropoietin is one of the most promising preclinical candidates either for co-treatment with the mild therapeutic hypothermia or to support neuroregeneration after the therapeutic window for acute neuroprotection.

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Primary hypertrophic osteoarthropathy (PHO), known with various name, is a very rare syndrome, seen infrequently in clinical practice and presents with a wide spectrum of diverse radiological and clinical features in the patient. PHO was first described by Friedreich in 1868 with typical words of “excessive growth of bone of the entire skeleton.” The further classification of different form was done by Touraine, Solente, and Golé in 1935 and they described PHO as the primary form of bone disease. We report an infant who was diagnosed as a case of PHO.

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Background: It has been shown in several investigations that smooth muscle cells (SMCs) are present on the patent processus vaginalis (PV) peritonei in cases of inguinal hernia (IH) preventing its obliteration. The PV fails to obliterate in cases of undescended testis (UT) as well, but without causing herniation. Materials and Methods: We conducted a case control study in order to compare the status of the SMCs present on the PV in UT and IH cases and correlate it with the clinical outcome of herniation. Specimens were harvested from the hernia sacs of 26 boys with IH aged from 2 days to 16 years (mean 44.31 months) and the PV of 14 children with UT, aged from 13 months to 13 years (mean 30.28 months). They were examined histologically and immunohistochemically for markers of mature SMC such as smooth muscle actin (SMA), desmin and h-caldesmon as well as for vimentin, an immature SMC marker. Results: The expression of SMA, desmin, and h-caldesmon was present in all cases of IH and UT. Vimentin was expressed in 13 out of 14 (93%) UT specimens and in 12 out of 26 IH sacs (46.1%), (P = 0.0102). In IH and UT cases, when vimentin was not expressed, SMCs were organized in bundles. Conclusion: The SMCs on the PV in UT cases reach a more advanced stage of dedifferentiation that corresponds to a status more close to that of the natural obliteration, compared to IH cases, preventing herniation to occur.

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Background: Prenatal consultation is an integral step in the care of women at high risk for preterm delivery. Aims: To examine whether the provision of written information regarding prematurity would improve factual recall and satisfaction following prenatal consultation. Methods: We conducted a randomized controlled trial of expectant mothers from 22 to 30 weeks gestational age. Eligible women received routine verbal prenatal consultation prior to enrollment and randomization. Women in the control group received written information about breast feeding. Women in the intervention group received additional written information about prematurity. Later, a survey was administered to elicit their factual recall and satisfaction. Results: A total of 32 women completed the survey. There was no significant difference in mean factual recall score between both groups (control 76%; intervention 71%; P = 0.45) nor in patients' satisfaction (control 4.31; intervention 4.18; P = 0.71). Conclusions: Providing written information about prematurity to mothers in preterm delivery did not improve their factual recall or satisfaction. This suggests that written information may not have added value to verbal communication in delivering key information to women overwhelmed by the stress of preterm labor. The wide range of individual performance on the factual recall test indicates that some women in preterm labor may not be adequately informed by the prenatal consultation, despite their high level of satisfaction.

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Kasabach–Merritt syndrome (KMS) is a rare clinical presentation in patients with preexisting hemangioma. Abnormal trapping of platelets within proliferating blood vessels and subsequent premature activation of coagulation cascades lead to thrombocytopenia and coagulopathy. Management of KMS is often challenging particularly in neonates without any fixed protocols for treatment. Management strategies include use of corticosteroids, propranolol, compression, embolization, use of interferon, laser therapy, sclerotherapy, chemotherapy, radiation, and/or surgery. The treatment plan should be individualized depending on type of vascular anomalies, age at presentation and patient response. We hereby present a rare case of KMS in a neonate with giant congenital hemangioma successfully managed surgically at our institute.

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Aphallia (Penile agenesis) is a very rare genitourinary anomaly that has profound surgical and psychological implications. Aphallia cases have 46, XY karyotype, except one reported case of penile agenesis having XX/XY mosaic karyotype. Early assignment of female gender and feminizing reconstruction of the perineum is the goal of treatment in cases of penile agenesis. This disorder results from partial or complete failure of development of genital tubercle. It usually coexists with other serious anomalies, which are incompatible with normal life. We present here with a 1 day old neonate who presented with aphallia and urethro-rectal fistula along with horse shoe kidney.

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A late preterm male infant was admitted to the neonatal intensive care unit with an asymmetric chest wall and a herniating mass through the left second intercostal space on crying. On auscultation, the heart sounds were audible on the right side of the chest. Systemic examination was otherwise unremarkable. A roentgenogram of the chest revealed dextro position of heart and hyperlucent left lung fields. Echocardiogram showed heart on the right with a structurally normal heart. A clinical diagnosis of Poland's syndrome was made based on the hypoplasia of the left pectoral muscles, ribs and nipple, dextroposition of heart and lung herniation. His clinical course was uneventful and doing remarkably well on follow up.

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