Low level of maternal knowledge in lactation, cesarean section and failure of early postnatal follow up was associated with the neonatal dehydration. Decreased urine and stool frequency might be considered as a warning for failure of lactation.
Persistent pulmonary hypertension of the newborn (PPHN) is a life-threatening neonatal pathology resulting from poor hemodynamic and respiratory transition to extra uterine life. Inhaled nitric oxide (iNO) is a current, commonly used treatment of PPHN. However, iNO is not available therapy in many developing countries and around 50% of infants with PPHN do not respond to iNO therapy. Sildenafil is a phosphodiesterase inhibitor type 5 (PDE5) that has been shown to selectively reduce pulmonary vascular resistance in both animal models and adult humans. Recent studies have found that in PPHN, administration of Sildenafil was associated with a significant increase in the oxygenation and a reduction in mortality with no clinically important side effects.
Prophylactic phototherapy was associated with a significant reduction of TSB in the first 48 hours of life but not later on. Clinical benefits of this strategy could not be proven.
Our objective was to compare the efficacy and safety of rectal cation-exchange resin (Kayexalate) versus salbutamol infusion for the treatment of nonoliguric hyperkalemia (NOHK) in preterm infants. Data of all neonates born with NOHK during the study period of 6 years and 8 months were recorded. Diagnostic criteria of NOHK included serum potassium (SK) concentration > or = 7 mmol/L during the first 72 hours of life with urine output > or = 1 mL/kg/hour. This before-after study was divided according to the date of admission; the first 15 patients were treated with Kayexalate enema 1 g/kg every 4 hours, and the remaining 30 patients were treated with intravenous salbutamol infusion as 4 mug/kg every 4 hours. Treatment discontinued when SK became < 6 mmol/L. SK was measured every 4 hours. Daily urine was collected. Fluid intake and output, serum electrolytes, urea, creatinine, and glucose concentrations were obtained in all infants every 12 hours. All infants were observed with a cardiorespiratory monitor and oxygen saturation and blood pressure measurements. Perinatal characteristics in both groups were comparable. Mean gestational age was 26 and 28 weeks for salbutamol and Kayexalate, respectively. The peak of SK ranged between 7 and 9.3 mmol/L in the Kayexalate group and between 7 and 8.7 mmol/L in the salbutamol group ( P = 0.64). At 12 hours of treatment, SK became normal in only 4 patients (26%) in the Kayexalate group compared with 18 patients (60%) in the salbutamol group ( P = 0.003). The number of doses of Kayexalate administration was significantly higher than the doses of salbutamol ( P = 0.003). No significant side effects were detected in the salbutamol-treated infants. In contrast, there were two cases of severe ventricular tachycardia and one case of intestinal obstruction in the cation-exchange resin group. We concluded that salbutamol infusion is more effective with faster action and safer than cation-exchange resin (Kayexalate) for the treatment of NOHK in preterm infants.
Shigellosis is extremely rare below the age of six months. Before this age, infants are highly resistant to shigellosis, probably due to changes in intestinal flora of breast-fed children. This resistance has been believed to be due to the presence of specific antibodies in breast milk 1 or perhaps because of the short transit time that Shigella is carried in an adult's stool. Thus, the presence of the organism at delivery is uncommon. Case ReportA 2.5 kilogram female was born at 38 weeks' gestation to a mother who had a history of diarrhea with fever for one week prior to delivery. The baby was delivered vaginally and had Apgar scores of 6 and 8 at the one and five minutes respectively. Because of the baby's mild respiratory distress, she was transferred to the Neonatal Intensive Care Unit.She was treated with an Oxy-hood, ampicillin and amikacin. The initial course was excellent. However, the third day of life she developed aqueous diarrheal stools containing blood and mucus. This was followed on her sixth day of life by the development of severe septic shock. Her symptoms included tachycardia (170/min), an undetectable blood pressure using a Dinamap BP monitor, semiconscious state, pallor, gasping respirations and a central temperature of 38.5°C. On examination she had hepatosplenomegaly and fresh bleeding was also noted in her gastric tube. Arterial blood gases showed a case of hypoxia with severe metabolic acidosis: pH 6.91, PCO 2 41 mg/Hg, PO 2 41 mm/Hg, bicarbonate 8 mmol/L, and base excess of -27. There were no signs of dehydration. Blood work showed: WBC 8200; platelet count 164,000; prothrombin time (PT) 21 (control 12) and the partial thromboplastin time (PTT) of 82 (control 30.4).She was immediately intubated and ventilated. She received albumin, dobutamine (10 μg/kg/min) and dopamine (5 μg/kg/min) and metabolic acidosis was corrected by intravenous sodium bicarbonate. Ceftriaxone 50 mg/kg/day was added to the previous antibiotics. Her general condition improved after several hours of this treatment. Dobutamine and dopamine were discontinued gradually and the baby was extubated after three days. Stool cultures showed the presence of ampicillin-resistant Shigella sonnei on the second and seventh days of life, but not on the 12th day. This bacteria was sensitive to ceftriaxone, amikacin and trimethoprim-sulfamethoxazole. Blood cultures revealed no growth. Seven days after delivery, the stool culture from the mother was also negative. The baby was discharged in good condition on her 15th day of life. DiscussionFour species of Shigella are responsible for this illness: S. dysenteriae (sero group A), S. flexneri (sero group B), S. boydii (sero group C) and S. sonnei (sero group D). One sero type of S. sonnei is known to be transmitted to newborns through the feco-oral route during vaginal delivery from infected mothers.2 A necessary factor for the pathogenesis of Shigella gastroenteritis is the ability of the organism to penetrate the intestinal mucosa. Virulent S. sonnei strains are characterized by the ...
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