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ABSTRACT: Urinary ascites in a newborn infant is unusual and most commonly results from bladder perforation following umbilical arterial catheterisation or obstructive uropathy. The following report describes a case of fetal bladder rupture with urinary ascites in a mother ventilated and sedated with narcotics and benzodiazepines for H1N1 influenza. This was associated with a unique biochemical profile of hyponatraemia and elevated serum urea and creatinine characteristic of urinary autodialysis in the neonate.
Journal of Paediatrics and Child Health 07/2012; · 1.28 Impact Factor
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ABSTRACT: Many factors may effect blood pressure (BP) in the early neonatal period, including mode of delivery and anaesthesia, on which there is little reported.
To determine whether the mode of delivery, anaesthesia and maternal age have an effect on neonatal BP in the first three days of life.
Healthy, term neonates from August 2003-2005 were enrolled in the study. Infants of mothers with hypertension of any cause, diabetes of any cause, illicit substance use, congenital or chromosomal anomaly, and admission to the neonatal intensive care unit were excluded. Information on maternal age, duration of labour, mode of delivery, anaesthesia and postdelivery analgesic use was obtained. Blood pressure readings from day one to three of life were analysed.
Four hundred and six infants were enrolled into the study. Both spinal anaesthesia and elective caesarean delivery were associated with a lower systolic BP reading on day one, but not on day two or three (P = 0.004 and P = 0.023, respectively). Multivariate analysis indicated that spinal anaesthesia was the most significant variable for a lower systolic BP on day one (P = 0.022). There was no correlation between maternal age and BP on day one to three.
Spinal anaesthesia is associated with a statistically lower systolic BP on the first day of life; the clinical significance is as yet unclear.
Australian and New Zealand Journal of Obstetrics and Gynaecology 05/2008; 48(2):172-8. · 1.24 Impact Factor
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ABSTRACT: Neonatal hypertension occurs in up to 2% of neonatal intensive care survivors and in up to 3% of all neonates. Normal blood pressure (BP) measurements are required to diagnose and manage appropriately both hypotension and hypertension in the neonate and infant. The aim of this study was to provide normative BP measurements during the first year of life of healthy infants born at term, using an oscillometric method. Neonates were enrolled from August 2003 to August 2005. Exclusion criteria included: infants of mothers with hypertension or diabetes of any type, use of illicit substances, congenital or chromosomal anomaly, admission to the neonatal intensive care unit or possible sepsis. There were 406 infants enrolled, with 150 children followed at 6 months of age and 118 children at 12 months of age. There were no differences in BP measurements at 6 months or 12 months of age by gender, weight or height. A BP measurement above the 90th percentile on day 2 or at 6 months was not predictive of a BP above the 90th percentile at 12 months of age. Higher systolic and diastolic measurements at 6 months and 12 months were found, in comparison to those in previous studies using ultrasonic devices. The findings of this study provide normative BP values for infants during their first year of life, using the oscillometric method, the most frequently used method in paediatric, neonatal intensive care and emergency departments.
Pediatric Nephrology 11/2007; 22(10):1743-9. · 2.52 Impact Factor
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ABSTRACT: There has been a temporal trend towards increased birth weight over the past three decades. This increase in birth weight may have resulted in an increase in neonatal blood pressure. Neonatal hypertension is becoming more common, especially in neonatal intensive care unit survivors. Current normative values are required to assist in diagnosis and appropriate management of neonatal hypotension and hypertension. The objective of this study was to determine normative blood pressure readings in healthy term neonates. Term neonates from the postnatal ward were enrolled from August 2003 to August 2005. Exclusion criteria included infants of mothers with preeclampsia, hypertension of any cause, gestational diabetes, type 1 diabetes mellitus and illicit substance use, infant congenital or chromosomal anomaly, admission to the neonatal intensive care unit or possible sepsis. Of the 406 infants enrolled, 218 were male. The median systolic, diastolic and mean blood pressures on day 1 of life were 65 mmHg, 45 mmHg, and 48 mmHg, respectively. On day 4, these values had increased to 70 mmHg, 46 mmHg and 54 mmHg. There was a significant elevation in blood pressure from day 1 to day 2 of life. There was no significant difference in blood pressure readings with respect to birth weight or length. The only significant difference between the sexes was a lower mean and diastolic pressure on day 2 in boys. This study has provided current normative blood pressure readings of healthy term neonates that can be used to assess both hypotension and hypertension in the term neonate. No increase in blood pressure was noted from previous studies.
Pediatric Nephrology 10/2007; 22(9):1335-41. · 2.52 Impact Factor
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ABSTRACT: Neonatal herpes encephalitis is usually caused by herpes simplex virus type 2 and results in significant morbidity and mortality. Imaging diagnosis with ultrasound, computed tomography scan and conventional magnetic resonance imaging may be normal in the early course of the disease. In this case diffusion-weighted magnetic resonance imaging detected the disease process earlier and better than the conventional T2-weighted or fluid-attenuated inversion recovery imaging sequences. The use of diffusion-weighted magnetic resonance imaging in neonatal herpes encephalitis proved to be a useful tool in the early stage of the disease.
Journal of Paediatrics and Child Health 01/2007; 42(12):824-6. · 1.28 Impact Factor
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ABSTRACT: Persistent pulmonary hypertension of the newborn (PPHN) remains an important cause of mortality and morbidity in the term neonate. Preliminary but limited data suggest that there may be a role for sildenafil in the treatment of PPHN. We report the successful treatment of PPHN caused by pulmonary hypoplasia in a patient with spondyloepiphyseal dysplasia congenita.
Journal of Maternal-Fetal and Neonatal Medicine 10/2006; 19(9):579-82. · 1.50 Impact Factor
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ABSTRACT: Perinatal asphyxia is an important cause of neonatal morbidity and mortality. There is the potential to halt cerebral damage if neural rescue strategies are applied within a short period of time after an insult. It is therefore important to be able to accurately identify neonates who may benefit from neural rescue therapies. Recent studies in asphyxiated neonates have correlated S100B and NSE with outcome; however, interpretation of these studies were difficult, as the timing of the measurements were not consistent. We measured NSE and S100 in 1-d-old piglets after a mild or severe hypoxic insult. Measurements were performed at 6-72 h after the insult and correlated with histologic outcome. There were no differences of the NSE or S100 concentrations between controls and the mild hypoxia group. After 24 h, there was a significant difference of NSE between the control/mild insult group and severe insult group. After 48 h, the S100 concentrations were significantly different between the control/mild insult group and the severe insult group. Both proteins showed good correlation at these time points with outcome as measured by histology score at 72 h. In conclusion, NSE and S100B measured in the serum of piglets after hypoxia increased significantly and correlated with outcome. This increase occurs too late to be used within the first 24 h but might be helpful for the clinician in determining the timing of an insult.
Pediatric Research 12/2005; 58(5):953-7. · 2.70 Impact Factor
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Australian and New Zealand Journal of Obstetrics and Gynaecology 03/2002; 42(1):100-1. · 1.24 Impact Factor
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ABSTRACT: Placental mesenchymal dysplasia is an uncommon disorder in which the placenta is enlarged with abnormal, large, and often cystic villi with dilated and/or thick-walled vessels. These placental changes can mimic a partial hydatidiform mole but in contrast to a partial mole can coexist with a fully viable fetus. Fetal anatomical and vascular anomalies frequently coexist with placental mesenchymal dysplasia. In this case, placental mesenchymal dysplasia was associated with preterm labor at 33 weeks' gestation, fetal compromise, and a large abdominal mass with a large hepatic cyst that was de-roofed at exploratory laparotomy. The neonate remained critically ill with hypoxic ischaemic encephalopathy and coagulopathy and died despite intensive care. Biopsy and autopsy findings showed a large cystic mesenchymal hamartoma affecting the left lobe of the liver. This appears to be the 3rd histologically confirmed association of placental mesenchymal dysplasia with mesenchymal hamartoma of the liver in the English language literature.
Pediatric and Developmental Pathology 10(1):50-4. · 0.99 Impact Factor
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