BackgroundKangaroo mother care (KMC) has been widely used to improve the care of preterms and low birth weight infants. However, very little is known about cerebral hemodynamics responses in preterm infants during KMC intervention. The aim of this study is to evaluate the changes of cerebral blood flow (CBF) in middle cerebral artery, before and after a 30 minute application of KMC in stable preterm infants.MethodsIt is a prospective, pre-post test without a control group study. CBF flow paremeters were measured with Doppler ultrasonography in one middle cerebral artery. Sixty preterm stable infants were assessed before and after 30 min KMC. CBF indices were assessed in different positions before KMC, forty neonates in supine position and 20 in vertical suspension (baby is held vertically away from the skin of his mother). Other dependent variables heart rate and mean arterial blood pressure and Spo2 were also studied before and after KMC.ResultsThe mean gestational age of the infants was (32 ± 2 weeks), and mean birth weight was (2080 ± 270 gm). Comparing CBF indices (Pulsatility index and Resistive index) before and after KMC has shown a significant decrease in both Pulsatility index (PI) and Resistive index (RI) after 30 min. KMC, the mean values were (2.0 ± 0.43 vs 1.68 ± 0.33 & 0.81 ± 0.05 vs 0.76 ± 0.06 respectively P < 0.05*) with mean difference (0.32 & 95% CI 0.042-0.41 & 0.05 & 95% CI 0.04 to 0.06 respectively P < 0.05*) and increase in end diastolic velocity & mean velocity 30 min of KMC (10.97 ± 4.63 vs. 15.39 ± 5.66 P < 0.05*& 25.66 ± 10.74 vs. 32.86 ± 11.47 P < 0.05* ) with mean difference (− 4.42 & 95% CI −5.67 to −3.18 and −7.21 & 95% CI - 9.41 to 5.00 respectively). These changes indicate improvement in CBF. No correlation has been found between CBF parameters and studied vital signs or SpO2.ConclusionKangaroo mother care improves cerebral blood flow, thus it might influence the structure and promote development of the premature infant's brain.
BackgroundCardiomyopathy is noted in up to 40% of infants of diabetic mothers, and the exact mechanisms responsible for it are unknown. The aim of this study was to compare between infants of diabetic mothers (IDM) and infants of non- diabetic mothers (INDM) as regards cardiac troponin I (cTnI) levels (as a marker of cardiac dysfunction) and to examine the relationship between this marker and neonatal echocardiographic changes (cardiac structure and function).MethodsA prospective, comparative study included eighty full term neonates during the first three days of life, during the period from April 2008 to June 2011. They were divided into 2 groups, group I: included 40 infants of diabetic mothers (IDMs)and group II: included 40 infants of non diabetic healthy mothers as a control group.Results37.5% of the IDMs were large for gestational age and demonstrated a significantly lower blood glucose level than the control group (34.6 ± 11.3mg/dl Vs 77.2 ± 19.8 mg/dl respectively) , respiratory distress and cyanosis were the presenting signs in 67.5% of IDMs. Cardiac TnI on the second day of life increased significantly in infants of diabetic mothers in comparison to INDM (p < 0.006) . IDMs had a significant increase in left atrial thickness ( 11.5 ± 1.8mm in IDM Vs 10.5 ± 0.9mm in INDM P < 0.002*) and a significant increase in septal thickness (5.0 ± 1.2mm in IDM Vs 4.0 ± 0.5mm in INDM P < 0.001*). CTnI correlated positively with interventricular septum thickness (P-value = 0.002*). Cardiac TnI was significantly increased in IDMs with respiratory distress (P –value < 0.05).ConclusionsThis study demonstrated a highly significant positive correlation between cTnI level on the second day of life and the left ventricular end diastolic diameter (LVED) and interventricular septum diameter (IVSD). Cardiac troponin I (cTnI) is a useful biochemical marker for monitoring myocardial injury in infants of diabetic mothers. An elevated cTnI concentration in infants of diabetic mothers with respiratory distress was a good predictor for hypertrophic cardiomyopathy and/or left ventricular dysfunction.
Background: The presented evidence-based clinical practice guideline (CPG) is proposed as a National CPG using an evidence-based and formal CPG adaptation methodology. The purpose of this study was to adapt the international CPGs' recommendations for term and late preterm neonates with severe hyperbilirubinemia to suit the healthcare system in the Egyptian context. This CPG provides a framework for prediction, prevention and management of severe hyperbilirubinemia in newborn infants of 35 or more weeks of gestation. The quality of evidence and strength of recommendations are indicated. The guideline adaptation group was chosen from various Egyptian Universities. There was an active involvement of a Multidisciplinary Review Committee following a standardized process. The Neonatology Guideline Adaptation Group (NGAG) was assigned individual health questions to cover the different sections of the required CPG. A literature search for source CPGs was carried out. The NGAG studied several guidelines. Critical appraisal was done by AGREE II (Appraisal of Guidelines for Research and Evaluation) Instrument to rate and select the appropriate guidelines. Results: The NGAG decided to adapt mainly the American Academy of Pediatrics Guideline (2004Guideline ( , 2009Guideline ( & 2011 and for the questions which were not answered; the best and most relevant evidence available was used.Implementation tools were sought for to facilitate the application of the adapted CPG. Conclusion: The finalized CPG offers healthcare providers with applicable evidence-based guidance for severe neonatal hyperbilirubinemia in the Egyptian context. The Adapted ADAPTE method emphasized the value of collaborative clinical and methodological expert groups' efforts for adaptation of national guidelines.
The coronavirus disease 2019 (COVID-19) has spread rapidly across the world. With the sharp increase in the number of infections, the number of pregnant women and children with COVID-19 is also on the rise. Limited data are available for pregnant women and newborns with COVID-19. A few small case series suggest that congenital and perinatal transmission to newborns from infected women may occur. Pediatric data demonstrate that children of all ages are susceptible to SARS-CoV-2, and that infants under 1 year of age are at risk for severe disease although this still is a relatively rare outcome. This manuscript outlines the precautions and steps to be taken before, during, and after resuscitation of a newborn born to a COVID-19 suspected or/confirmed mother, including resuscitation of the newborn, disposition, nutrition, and post discharge care. Our aim is to conduct a rapid review to guide the health care practitioners to the practical approaches to ensure the best care for the newborn. In conclusion: neonates born to women with COVID-19as well as neonates born to women with testing for COVID-19 pending at the time of delivery-should be considered as persons under investigation
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