Questions related to Neonatal Medicine
I would like to ask the pediatric surgeons and urologists concerning circumcision in Caucasian children. What are the medical indications for performing circumcision in the neonatal period? What urological indications exist for this intervention in early childhood? What are the advantages and disadvantages of this manipulation, in case there are no other indications for it?
Which of the organism is more common and which is dangerous and how is it considered dangerous to the neonate?
A male neonate 21 days old who is breast fed, with positive moro reflex, with good weight gain and yellow colored stool.
On day 9: TSB 9.2mg/dl, PCV =50
On day 11: TSB 8.6mg/dl; Direct bilirubin 2.5mg/dl; PCV 50
On day 14: TSB 8.2; Direct bilirubin 2.2mg/dl; PCV 50
On day 21: TSB 6.5mg/dl; direct bilirubin 2.5mg/dl; PCV 43
Non fasting Ultrasound: normal size and texture for kidneys, spleen, liver, gallbladder and common bile duct, with no stones
Day 22: Stop breastfeeding and start formula milk for 48 hours
Day 25: TSB 7.6mg/dl; Direct bilirubin 2.4mg/dl; PCV 41
So what is the expected diagnosis for this case?
Does somebody have an experience with patient with isolated duodenum.
In our department we have a patient in whom already prenataly cystic mass in the abdominal cavity was diagnosed.Postnataly in the 1st day of life he was tranfered to our department with exteremly enlarged abdomen, no vomiting. In laparotomy megaduodenum with duodenal atresia was diagnosed, stomack was absolutaly normal. There was isolated megaduodenum. Duodenojejunostomy was performed. In histology - nerve cells and fibres are present in the wall of dilated megaduodenum, fibrotic tissue in submucosa is seen. Transfer through anastomosis was not observed although 4,8 mm endoscope freely entered the anastomosis. In order to provide the patient enteral feeding jejunostomy was performed. Acholic stool appeared. Discharege from nasoduodenal tube - with bile around 120-160 ml/day. Third laparotomy was performed - duodeno-jejunal anastomosis was re-made, jejunal tube was put through nose (naso-jejunal). After this third operation - still acholic stool, large amount of discharge with bile from nasoduodenal tube. In contrast X ray - no passage through the anastomosis, endoscopy - 4,8 mm endoscope enters the anastomosis without problems.
What could be the tactic and managemnt of this patient?
Thank you all in advance!
Because of the theoretical immunosuppression in neonates and infants, the trend has been to overuse perioperative antibiotics after surgery in this patient population. Is there any evidence in the literature that justify the use of prophylactic antibiotics for more than 24 hours after clean or clean-contaminated procedures in neonates?
She has hypotonia, no language, and at 7 months old she is unable to hold her head up. There are no facial or other visible deformities. I am referring to asplenia as it relates to the corpus callosum. The child that I am referring to has the spleium missing on both sides of the brain so they are not communicating. There is a balanced translocation of 5 th and 6th chromosome
Hypothermia is still a problem in newborn babies born in lower middle income countries. Technologies manufactured in the industrialised nations are too expensive and difficult to repair and maintain. Simple warming devices (e.g. hot water mattress) and strategies (e.g. the 'kangaroo method') are of some benefit, but the problem of hypothermia remains. New simple approaches are therefore still needed.
Maternal diagnosis of VZV was based on clinical symptoms and signs, positive specific IgM and IgG and positive PCR for VZV on samples from cutaneous lesions.
The newborn, was born at 37+5 weeks and IgG and IgM for VZV were tested two times in different laboratories.
No evidence of immunodeficency in mother and child.
I have found several different calculations and methods in various studies for calculating growth velocity, but many do not provide detail on how they calculated the weight gain reported. Can anyone make a recommendation for a specific method when assessing NICU-wide nutrition progress?
I have a mother with CCHF who got illness just one day before delivery.What do I do with her neonate?
Failure of neonatal hepatitis B vaccination: the role of HBV-DNA levels in hepatitis B carrier mothers and HLA antigens in neonates.
Are HSV outbreaks prone in pediatric populations or do they go unnoticed as unexplained etiology from the currently lacking routine viral diagnostics for meningitis?
Adaptation is necessary for tests in different cultures. In neonatal period for assessment of behavioral state, is it necessary?
The use of dextrose gel has been shown to be an effective treatment for hypoglycemia. I'm curious how many nurseries actually use it?
Several protocols can be found in the literature, with different medications best preferred.
In our unit (a tertiary care, referral center) a review over a 2 year period revealed the incidence of UVC extravasation to be 4.2%. The most common mode of diagnosis was ultrasound of abdomen with the following features.
In our setup we have detected that prematurity, low birth weight, morbidity, need for ventilaroty support and age at achieving full feeds lead to longer stay. In mutiple regression fashion the best predictor is age at achieving full feeds. We have also found that source of patient (inhouse/ accepted from outside), region of surgery, age at admission, age at surgery, need for ionotropic support, maternal comorbidities and assoicated cardiac and non cardiac anomalies do not lead to delayed discharge. Has anybody else find similar findings?
A a loose/broad questionnaire has been drafted but as students working on this project, we need more opinionated customer insight from professionals or individuals that are associated with medical devices. Any Ideas? What do you think would be the most important factors to consider? Would you say infection control, cost, professional expertise, ease of access, etc. would be the most eminent problems? Have a look at the questionnaire... And If you can answer even just two questions, I'd love to hear from you.
Early prediction of sepsis can help better management of patients and better prognosis. Our protocol for treating suspected neonatal sepsis is to start empirical broad spectrum antimicrobials and to send sepsis screen which consists of a battery of tests like total counts, platelets counts, immature neutrophils counts (Band cells), CRP, Micro ESR, and blood culture. If Sepsis Screen results are positive but blood culture negative, we stop antimicrobials after 5 days and if blood culture positive then we change antimicrobials accordingly and complete 14 days.
Osteopenia of prematurity is a common occurrence. It is believed to be mainly a result of a lack of substrate (Calcium) to the growing bones rather than vitamin D deficiency.
Severe cases are still encountered despite careful nutritional support.
Some colleagues advocate using a "high" dose of Vitamin D (thousands of units) with little or no evidence other than their "experience". Do you subscribe to this practice? Any good evidence?
The Brown Adipose Tissue (BAT) plays an important thermogenic role in newborns among mammals. Thermogenesis of brown adipose tissue is triggered by the cold stimuli. It seems that the neonates with relatively more amounts of brown fat may be able to metabolise their brown adipose tissue stores to generate more heat under very cold conditions and thus have better survival chances than others.
Surgical management of imperforate anus is associated with anal incontinence for the child. We have a 3 month old baby born out of ivf pregnancy. At delivery, imperforate anus was identified and a primary colostomy was done. Now the couple are planning surgical correction. The question is to find out the ideal technique which can minimize the fecal incontinence risk as the child grows up.
Experiences vary, but I for one- have seen the miraculous effect of kangaroo mother care in babies who have been admitted to our NICUs and nurseries - not just pre-terms, but also those recovering from serious illnesses. There is a definite improvement in weight gain, immunity, respiratory effort and various other parameters. Do narrate your experiences and wonders you have observed with this simple but effective technique. Do you use it only in pre-terms? Or do you advise it for all babies?
Umbilical care is an area of concern for parents and a source of a lot of myths. Some physicians advice for a specific type of care which warned by another.
Do not reply with any comments on adult murine morphology. So, I have H&E cuts of P1(day one after birth) lungs. However, although I did not collect any LIVER tissue, I have what looks like cuts of mature lung tissue alongside some "liver looking" tissues. This has been seen in 4 separate samples from 4 mice. Anyone have experience with Day1 lung tissue and potentially heterogeneous structures? I know what alveolar sacs look like and the samples contain those structures, similar to adult lungs, however, it looks like they contain sections of preemie collapsed or undeveloped dense tissue. Anyone have experience on this?
A lot of data on the use of taurine for neurologic and cardiac disorders is becoming available, but the standard medical research on it seems mainly to be on it as a component of energy drinks so most doctors are avoiding it. There is one reference I found on its increasing contractility. I need to find out what effects it has on electric activity of myocardium and on cns/pns, so if anyone knows of any research findings on this, perhaps on myocardial cells in vitro, or in animals or humans, I would appreciate some information or a url. thank you.
My phenomenological qualitative research study will focus on the lived experience of parents whom have had a neonate diagnosed with HIE and undergo the hypothermia (cooling) treatment. Hypoxic-ischemic encephalopathy (HIE) is a condition during the initial delivery stages of a neonate’s life when a portion of the brain (cerebral hypoxia) or the entire brain (cerebral anoxia) is deprived of adequate oxygen supply and blood flow. HIE is when oxygen deprivation (hypoxic) and minimal blood flow (ischemic) may potentially result in brain injury (encephalopathy).
Whereas breast milk provides optimal nutrition for the neonate, it is doubtful if it will also provide enough fluids and electrolytes for correction of deficits in neonates with mild to moderate dehydration, especially in the face of continuation of the processes causing the dehydrtion such as diarrhoea and vomiting. Oral rehydration solutions will therefore be necessary to provide corrections for these losses in these babies while continuing breastfeeding for provision of optimal nutrition.I would like to know what others from other centres think of this.
Using a shorter averaging time ends up in a different "significant" apnea detection rate, i.e.less episodes of more than 20 seconds duration and more episodes of less than 20 seconds length.
It seems logical to redefine the significance based on other than the DURATION of apnea to some other markers that are more closely associated with cardiao-respiratory stability.
deep suctioning or nasal pharyngeal suctioning causes mucosal trauma, edema though it is recommended frequently to clear airway. Does anyone see this done with frequency?
I am new in Bahrain and I noticed that nobody is prescribing Vitamin D as a supplement. So, what is your practice and how common are you seeing children with a vitamin D deficiency?
Im doing a meta-analysis for the estimation of delays in treatment seeking at different levels for neonatal morbidity, The analysis is region-wise e.g. sub-Saharan Africa, south Asia, Latin America and Caribbean. Three levels of delay are considered.this would result in 9 forest plots. How can i combine the results of all three levels of delay into one figure (region-wise)?. This would result in just 3 plots which will be compact and easier to comprehend. Kindly help
Rational use of antibiotics is necessary for optimal results in the care of newborns with sepsis. Clear guidelines are often not available in many a center in developing countries. Due consideration needs to given to various issues before settling on certain antibiotics in initiating treatment for neonatal sepsis. What are some of these issues?
There are some reports and a few clinical studies that illustrate a potential positive effect of music therapy on well-being, energy consumption and other short term parameters in premature neonates. Do colleagues in this network have own experience in active music , i.e. with live music (not passive music e.g. from CD)? Which kind of music, instruments or sounds has been used? Is anyone aware of studies that show a long term effect on neurodevelopmental outcome? For instance, could there be any data that might illustrate an effect on the incidence and severity of attention disorders in low birth weight children? And how about the mothers?