Background: Mechanical ventilation is extensively used in neonatal intensive care units. However, many risk factors are associated with mortality rates in neonates on mechanical ventilation. Various techniques have been introduced to assess the weaning time from mechanical ventilation with least risks including diaphragmatic ultrasound. This study aimed at evaluating the role of diaphragmatic ultrasound in predicting failure of weaning from mechanical ventilation in both Full Term (FT) and Preterm (PT) neonates by measuring diaphragmatic excursion before extubation using and determines a cut off value for diaphragmatic excursion for expecting weaning failure. Patients and Methods: A prospective cohort study was performed in the neonatal intensive care unit (NICU) of Mataria Teaching Hospital (MTH) from June 2018 to May 2019. All full and pre-term neonates who need mechanical ventilation from first day of admission were included major congenital anomalies, need surgical intervention, congenital diaphragmatic hernia, weaned before 72 hours, pleural effusion, hepato-splenomegaly were excluded. Results: Neonates with low gestational age, presence of respiratory distress, longer period on mechanical ventilation and higher ventilator setting were more prone to weaning failure. Additionally, excellent sensitivity and specificity of diaphragmatic ultrasound in prediction of weaning failure in neonates especially in full term whether using excursion of right and left hemidiaphragm. Conclusion: Bedside ultrasound can predict weaning failure through measuring right or left diaphragmatic excursion in full term and preterm neonates.
Background Retinopathy of prematurity (ROP) is increasing in incidence in developing nations, including Egypt. Secondary prevention requires timely detection through the development of regional screening guidelines, which should be preceded by large-scale studies to characterize the population at risk. Methods A prospective, multicentric exploratory study that included five large tertiary institutions in an urban Egyptian setting. All infants born with gestational age (GA) < 37 weeks and/or birth weight (BW) ≤ 2000 grams were screened. More mature and heavier infants with unstable clinical course were also included. The primary outcome measure was the rate of ROP and high-risk disease occurrence in relation to underlying risk factors. Results Of the 768 eyes (384 screened infants), 347 eyes (45.2%) had stage 1 or higher disease, and 43 eyes (5.6%) had high-risk disease. Eyes with stage 1 or higher ROP and treatment-requiring ROP had a mean (± SD) GA of 33.4 (± 2.6) weeks and 32.8 (± 3.2) weeks, and BW of 1842.3 (± 570.1) grams and 1747.6 ± (676.2) grams, respectively. Treatment-requiring eyes belonged to infants that had significantly lower GA and significantly higher prevalence of co-morbidities than non-treatment-requiring eyes. Conclusion The incidence of ROP and high-risk disease in an urban Egyptian setting are similar to those in comparable settings elsewhere and locally. This exploratory study supports tailoring local screening criteria for ROP, and may aid the future development of national guidelines.
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