RESUMEN
UNLABELLED: It has become clear in the recent years that inherited thrombophilias (IT) are associated with serious abnormalities during pregnancy. This includes miscarriage, still birth, placental abruption, praeclamcspia and intrauterine fetal growth restriction. The aim of this study is to share our experience in the field. MATERIALS AND METHODS: 38 patients with medical history of abnormal pregnancies (miscarriage, still birth, placental abruption, praeclamcspia and intrauterine fetal growth reastriction). They were all tested for the following gene alterations: V Laidon-R506Q/phiVL-R506Q/, protrombin G/A 20210 /Pi pG/A20210/, Plasminogen activator inhibitor- PAI- 4G/4G/PAI 4G/5G/). IT were diagnosed in 24 patients. They were all treated by: Aspirin 75 mg form prior to conception and low molecular Heparin after detection of fetal heart movement. Due to the observed NRDS in some of the newborns, the low molecular heparin intake was discontinued 30 days prior to expected delivery. RESULTS: keeping up to the therapeutic scheme, 70% (17) of women with IT gave birth to a term baby, and 30% (7)-to a preterm one, all pregnancies were successful. Amongst the patients with medical history of miscarriage, 72% were diagnosed with IT and 87.5% of them gave birth to a term newborn as a result of the anticoagulant treatment. CONCLUSIONS: Undiagnosed IT is a common cause of adverse pregnancy outcome. Uninterrupted anticoagulant treatment of these patients is very successful. The whole pregnancy should be followed up closely. Due to the higher risk of respiratory complications in the infants, delivery should be performed in a specialized hospital with neonatology department, capable of newborn resuscitation.
Asunto(s)
Aspirina/uso terapéutico , Fibrinolíticos/uso terapéutico , Heparina de Bajo-Peso-Molecular/uso terapéutico , Complicaciones Hematológicas del Embarazo/tratamiento farmacológico , Trombofilia/tratamiento farmacológico , Femenino , Humanos , Embarazo , Complicaciones Hematológicas del Embarazo/genética , Resultado del Embarazo , Trombofilia/complicaciones , Trombofilia/genéticaRESUMEN
UNLABELLED: It has become clear in the recent years that inherited thrombophilias (IT) are associated with serious abnormalities during pregnancy. This includes miscarriage, still birth, placental abruption, praeclamcspia and intrauterine fetal growth restriction. The aim of this study is to share our experience in the field. MATERIALS AND METHODS: 38 patients with medical history of abnormal pregnancies (miscarriage, still birth, placental abruption, praeclamcspia and intrauterine fetal growth reastriction). They were all tested for the following gene alterations: V Laidon- R506Q/phiVL-R506Q/, protrombin G/A 20210/pG/A20210/, Plasminogen activator inhibitor- PAI- 4G/4G /PAI 4G/5G/). IT were diagnosed in 24 patients. They were all treated by: Aspirin 75mg form prior to conception and low molecular Heparin after detection of fetal heart movement. Due to the observed NRDS in some of the newborns, the low molecular heparin intake was discontinued 30 days prior to expected delivery. RESULTS: keeping up to the therapeutic scheme, 70% (17) of women with IT gave birth to a term baby, and 30% (7)- to a preterm one, all pregnancies were successful. Amongst the patients with medical history of miscarriage, 72% were diagnosed with IT and 87.5% of them gave birth to a term newborn as a result of the anticoagulant treatment. CONCLUSIONS: Undiagnosed IT is a common cause of adverse pregnancy outcome. Uninterrupted anticoagulant treatment of these patients is very successful. The whole pregnancy should be followed up closely. Due to the higher risk of respiratory complications in the infants, delivery should be performed in a specialized hospital with neonatology department, capable of newborn resuscitation.
Asunto(s)
Aspirina/uso terapéutico , Fibrinolíticos/uso terapéutico , Heparina de Bajo-Peso-Molecular/uso terapéutico , Complicaciones Hematológicas del Embarazo/tratamiento farmacológico , Trombofilia/complicaciones , Trombofilia/tratamiento farmacológico , Factor V/genética , Femenino , Pruebas Genéticas , Humanos , Recién Nacido , Embarazo , Complicaciones Hematológicas del Embarazo/genética , Resultado del Embarazo , Trombofilia/genéticaRESUMEN
Hypospadia is abnormal sex differentiation of the external genitalia with ventral and proximal displacement of the urethral orifice from its usual location on glans penis. Three prenatally diagnosed cases of hypospadia are presented and the major ultrasound findings of this entity are discussed.
Asunto(s)
Anomalías Múltiples , Hipospadias , Ultrasonografía Prenatal , Anomalías Múltiples/diagnóstico por imagen , Anomalías Múltiples/embriología , Femenino , Edad Gestacional , Humanos , Hipospadias/diagnóstico por imagen , Hipospadias/embriología , Recién Nacido , Masculino , Embarazo , Resultado del EmbarazoRESUMEN
OBJECTIVES: To look for a correlation between way of delivery and the effect from surfactant therapy with extremely low birth weight infants. METHODS: The is a retrospective study and includes babies < or = 1000 g, < or = 28 g.w., born in University Maternity Hospital Maichin dom during the period 2001-2005. Babies were treated with surfactant because of RDS. Babies with severe inborn malformations and those, who died before 28-th day due to severe IVH were excluded from the study. All babies were treated and monitored according to the protocols for surfactant and intensive care therapy. Babies were divided in two groups: group N--33 babies; born by normal delivery, group S--27, born by Cesarean Section. RESULTS: There are no significant differences between the groups according birth weight, gestational age, gender; severity of RDS, incidence of IUGR; kind of surfactant, timing and number of doses. In both groups there is a slight prevalence of female sex. Incidence of full course corticosteroid prophylactics and of inborn infections is definitely higher in gr. N. Babies were followed for: duration of mechanical ventilation (8 days in gr. S vs 20 in gr. N); duration of O2 therapy (34 days in gr. S vs 55 in gr. N); incidence of IVH: gr. S 74% are IVH grade I-II, 11% are grade III-IV; while in gr. N IVH I-II cm. are 38%, IVH grade III-IV are 56%; incidence of BPD--gr. S 14%, vs gr. N --30%; incidence of rethinopathy--23% in gr. S vs 56% in gr. N; incidence of anaemia--100% in both groups. CONCLUSIONS: With ELBWI treated with surfactant chosing the least traumatic way of delivery is important, ensuring smaller duration of mechanical ventilation and O2 therapy, less severe IVH, BPD and ROP.
Asunto(s)
Parto Obstétrico/métodos , Recien Nacido con Peso al Nacer Extremadamente Bajo , Surfactantes Pulmonares/uso terapéutico , Síndrome de Dificultad Respiratoria del Recién Nacido/tratamiento farmacológico , Peso al Nacer , Femenino , Edad Gestacional , Humanos , Recién Nacido , Masculino , Terapia por Inhalación de Oxígeno , Surfactantes Pulmonares/administración & dosificación , Respiración Artificial , Síndrome de Dificultad Respiratoria del Recién Nacido/terapia , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
AIM: The aim of the present study is to define criteria for erythropoietin therapy of hyporegeneratory anemia in premature newborns according to hemoglobin (Hb) and hematocrit (Hct) concentration, and reticulocyte count (Ret). MATERIALS AND METHODS: The prospective study includes two groups of 20 newborns with anemia of prematurity, body weight at birth below 1500 grams and gestation age below 33 gestation week. The newborns in the first group have been treated with beta-erythropoietin for four weeks--750-1000 E/kg weekly dose, divided q48h. Hb, Hct and Ret have been monitored and compared with that of control group newborns. The therapy of newborns in the control group consisted of blood transfusions. RESULTS: The hematological parameters in the newborns from the first group have been increased permanently after the first week of therapy, with Ret being most sensitive to the therapy. In the second group of newborns, due to blood transfusions, transient increase of Hb and Hct, and decrease of Ret have been observed in next days after the blood transfusions. CONCLUSIONS: The erythropoietin therapy of hyporegeneratory anemia in preterm newborns leads to rise in Hb, Hct and Ret. The therapy with blood transfusions suppresses erythropoiesis. This leads to decrease in Ret and transient rise in Hb, Hct and erythrocytes. That's why each blood transfusion leads to another one.
Asunto(s)
Anemia Neonatal/sangre , Anemia Neonatal/terapia , Transfusión Sanguínea , Eritropoyetina/uso terapéutico , Recien Nacido Prematuro/sangre , Recién Nacido de muy Bajo Peso/sangre , Anemia Neonatal/tratamiento farmacológico , Eritropoyetina/administración & dosificación , Edad Gestacional , Hematócrito , Hemoglobinas/análisis , Humanos , Recién Nacido , Estudios Prospectivos , Proteínas Recombinantes , Recuento de Reticulocitos , Reticulocitos/citología , Resultado del TratamientoRESUMEN
UNLABELLED: The illness severity by admission in NICU reflects the intensity of the therapy, the prognosis for the newborn and the hospital costs. Using the CRIB (Clinical Risk Index for Babies) as an objective and easy method for measuring the illness severity in the first 12 h of life allows assessing the risk of death until discharge. AIM: To apply the CRIB for assessing the illness severity and to investigate its prognostic value for life and risk of permanent disabilities among very low birthweight (VLBW) and gestational age (VLGA) infants. METHODS: The study includes the inborn babies in the Specialized Obstetrics & Gynaecology Hospital "Maichin dom" with birthweight < 1500g and gestational age < 32 weeks of gestation, who are admitted in the NICU for 2 periods: I group--250 newborns in the period 01.2002-06.2004 and II group--186 newborns in the period 07.2004-06.2006. The CRIB is estimated based on data collected in the first 12 h of life. An analysis was made about the prognostic value of the CRIB score and the outcome. Criteria for outcome are: the in hospital mortality rate and disabilities such as severe intraventricular hemorrhages (IVH gr. III and IV), chronic lung disease (CLD) and retinopathy of prematurity (ROP). RESULTS: We establish that the CRIB score is significantly higher among the infants who died--12.7%/13% in the I / II period compared with survivors--6.2% / 5.7% (P < 0.001). The mortality rates raise progressively with the CRIB score: among the newborns with CRIB 0-5 they are 2.9% / 2.6% and reaches up to 78.6% / 90% when the CRIB is > 15. The infants with permanent disabilities were with significantly higher CRIB scores too: 11.7 / 11.4% among the infants with IVH III-IV compared to 6.2 / 5.2 without; 9.6 / 10.1 among infants with CLD compared to 5.7 /5.2 without; 10.1 / 10 among infants with ROP compared to 5.5 / 5.1 without. CONCLUSIONS: The CRIB score is useful and easy to apply early and objective prognostic criterion about the risk of in hospital death and permanent disabilities among VLBW newborns. It can be used as a basis for comparing the results of the different NICUs too.
Asunto(s)
Recién Nacido de muy Bajo Peso , Unidades de Cuidado Intensivo Neonatal/normas , Cuidado Intensivo Neonatal/normas , Evaluación de Resultado en la Atención de Salud , Índice de Severidad de la Enfermedad , Edad Gestacional , Mortalidad Hospitalaria , Humanos , Mortalidad Infantil , Recién Nacido , Estudios Retrospectivos , RiesgoRESUMEN
Congenital cystic adenomatoid malformation (CCAML) is a rare anomaly of the fetal lung which can be diagnosed prenatally by ultrasound. We present two cases of CCAML with different pregnancy outcome diagnosed at 17 and 24 weeks gestation, respectively, and discuss the major aspects of the obstetrical and therapeutical management.
Asunto(s)
Malformación Adenomatoide Quística Congénita del Pulmón , Ultrasonografía Prenatal , Adulto , Malformación Adenomatoide Quística Congénita del Pulmón/diagnóstico por imagen , Malformación Adenomatoide Quística Congénita del Pulmón/embriología , Diagnóstico Diferencial , Femenino , Edad Gestacional , Humanos , Recién Nacido , Embarazo , Resultado del Embarazo , Tomografía Computarizada por Rayos XRESUMEN
Considering the high mortality and serios morbilidy associatent with neonatal infections. A competent diagnostic marker also needs to have reasonably high specificity. Good evidence exists to support the use of CRP measurements in conjunction with other established diagnostic tests (such as a white blood cell (WBC) count with differential and blood culture) to establish or exclude the diagnosis of sepsis in full-term or near-term infants. Sepsis was suspected within the first 3 days after birth in. There were 20% early-onset and 53% late-onset episodes of proven sepsis. CRP had sensitivities of 39.4% and 64.6% for proven or probable sepsis and 35.0% and 61.5% for proven sepsis in early-onset and late-onset episodes, respectively. To compare the clinical informative value of and C-reactive protein (CRP) plasma concentrations in the detection of infection and sepsis and in the assessment of severity of sepsis. PCT is a better marker of sepsis than CRP. The course of PCT shows a closer correlation than that of CRP with the severity of infection and organ dysfunction. Diagnostic markers are useful indicators of neonatal bacterial infections C-reactive protein (CRP), procalcitonin (PCT) Intralevcin 6, 8 are early sensitive markers of infection.
Asunto(s)
Infecciones Bacterianas , Enfermedades del Prematuro , Antibacterianos/uso terapéutico , Infecciones Bacterianas/congénito , Infecciones Bacterianas/diagnóstico , Infecciones Bacterianas/tratamiento farmacológico , Infecciones Bacterianas/microbiología , Biomarcadores/análisis , Proteína C-Reactiva/análisis , Citocinas/análisis , Humanos , Recién Nacido , Recien Nacido Prematuro , Enfermedades del Prematuro/diagnóstico , Enfermedades del Prematuro/tratamiento farmacológico , Enfermedades del Prematuro/microbiología , Factores de Riesgo , Sensibilidad y EspecificidadRESUMEN
UNLABELLED: The objective of this study is to establish the reference values range of the fetal oxygen saturation during the first and the second period of labor and their dispersal according to the extent of cervical dillatation in cases with normal FHR--absence of fetal hypoxia and asphyxia of the newborn. MATERIAL AND METHODS: This is a prospective study which involves 94 women with normal FHR. All of the newborns are with umbilical artery pH values greater than 7.15 and 5 min Apgar score greater than 7; there was no necessity for any reanimation procedures, assisted ventilation or intensive care treatment. The fetal oxygen saturation (SpO2) is monitored by fetal pulseoxymeter Nellcor N 400, fetal sensors FS - 14. Cardiotocographic monitoring is carried out simultaneously. Blood is obtained from the fetal scalp during labor for blood gas and pH analysis, and umbilical artery pH as well as the Apgar score of the newborn are determined. RESULTS: The average monitoring time during the first period of labor is 107.19+/-29.49 min. with reliability of the recordings 86.54+/-6.10%. The average monitoring time for the second period of labor is 36.72+/-8.31 min. with reliability of the recordings 75.42 +/-9.61%. The mean SpO2 values are 48.71+/-5.52% during the first period and 47.30+/-4.62% during the second period of labor. The reference SpO2 values ranging between the 25-th and 75-th percentile in fetuses with normal FHR are 46-52 % for the first and 44-50 % for the second period. The results for fetal SpO2 during the different stages of cervical dillatation are as follows: for 4-5 cm - 49.49+/-5.12%, for 6-7 cm - 48.76+/-5.42%, for 8-9 cm - 48.39+/-5.49%. CONCLUSIONS: The fetal SpO2 dispersal during cervical dillatation of 4-5, 6-7 and 8-9cm accordingly demonstrates a nonsignificant decrease of SpO2 for the different groups (p>0.05). The fetal SpO2 dispersal between the first and the second period of labor also demonstrates decrease of SpO2 values and shows a minor statistically significant difference (p < 0.05 - Repeated measures ANOVA), which is considered to be within the normal range and does not reflect on the newborn's well-being.
Asunto(s)
Parto Obstétrico , Sufrimiento Fetal/sangre , Feto/fisiología , Frecuencia Cardíaca Fetal/fisiología , Oxígeno/sangre , Puntaje de Apgar , Cardiotocografía , Femenino , Sangre Fetal/fisiología , Monitoreo Fetal , Humanos , Concentración de Iones de Hidrógeno , Recién Nacido , Primer Periodo del Trabajo de Parto/sangre , Segundo Periodo del Trabajo de Parto/sangre , Oximetría , Embarazo , Valores de ReferenciaRESUMEN
We present a case report of a fetal ovarian cyst (d - 40/50 MM), which was diagnosed at 30 weeks of gestation [w.g.] and removed by laparotomy after a Cesarean section performed at term. The possible modalities for subsequent follow up and management are discussed.
Asunto(s)
Enfermedades Fetales/diagnóstico , Quistes Ováricos/diagnóstico , Diagnóstico Prenatal , Ultrasonografía Prenatal , Adulto , Cesárea , Femenino , Enfermedades Fetales/diagnóstico por imagen , Enfermedades Fetales/patología , Estudios de Seguimiento , Humanos , Laparotomía , Quistes Ováricos/patología , Quistes Ováricos/cirugía , Embarazo , Tercer Trimestre del Embarazo , PronósticoRESUMEN
The aim of the study is to establish the mean values of SpO2, during labour with symptoms of fetal distress and to find out when fetal hypoxia is expected to develop as well as unsatisfactory clinical status of the newborn. The study includes 62 women on labour at term with pathological decelerations from the fetal heart rate (FHR). SpO2 is monitored by means of fetal pulse oxymeter Nellcor N 400. Simultaneously FHR is monitored by means of cardiotocography. Fetal well-being is verified by pH u blood gas analysis from fetal scalp while the newborn well-being is proven by pH from umbilical artery and Apgar score at minute 1 and 5 after birth. The mean continuity of SpO2 recording during the first period of labour is 107.84 +/- 25.77 min., with mean 86.74 +/- 7.06% reliability of the recordings; for the second period--26 +/- 8.98 min. with reliability of the recordings 77.07 +/- 9.96%. During the first period of labour the mean value of SpO2 is 43.00 +/- 6.75%. With dilation of 4-5cm SpO2 is 46.25 +/- 5.92%, with 6-7CM SpO2 is 44.43 +/- 6.39% and with 8-9cm dilation SpO2 is 42.69 +/- 6.80%. During second period of labour the mean value of SpO2 is 39.14 +/- 8.41%. There is a statistically significant fall of SpO2 during the second period compared to the first period of labour (p<0.05). A correlation exists between the values of SpO2 and the well-being of the newborn and a fall of SpO2 equal or less than 30% is a sign of developing abnormal condition of the newborn.
Asunto(s)
Parto Obstétrico , Sangre Fetal/química , Sufrimiento Fetal/diagnóstico , Monitoreo Fetal , Frecuencia Cardíaca Fetal/fisiología , Oxígeno/análisis , Adulto , Cardiotocografía , Femenino , Sufrimiento Fetal/sangre , Sufrimiento Fetal/fisiopatología , Humanos , Oximetría , EmbarazoRESUMEN
THE AIM: Of this study is to determine the impact of the mode of delivery on survival, morbidity and prognosis of ELBW and extremely low gestational age (ELGA) newborns. METHODS: The retrospective review includes ELBW and ELGA infants born at the State maternity hospital "Maichin dom" Sofia from 1997 to 1999. These are 95 newborns divided into two groups: 31 born by Cesarean section (C. s.), and 64--per vias naturals (p. v. n.) with subgroups: 42--vertex, 22--breech delivery. Resuscitation is similar in all groups, according the routine practice. They are compared by the following indexes: rate of survival, Apgar scores at the 1-st and at the 5-th min, pH from the umbilical artery (u. a.), rate of the intraventricular hemorrhages (IVH) and periventricular leukomalacia (PVL), and early nevrodevelopmental outcome. RESULTS: The birth weight of all babies includes ranges from 500 to 999 g and the gestational age (g. a.) is > 24 weeks of gestation. There is no statistically significant difference (p < 0.05) according birth weight, pathology and treatment of the mother, between the two groups. In the C. s. group 17 babies survived (55%) while in p. v. n. 30 survived (47%), the worst was survival between the babies, delivered in breech presentation--7 (32%), p < 0.05. There is no significant difference between pH and BE from u. a., but Apgar scores are worse in the breech group, p < 0.05. The incidence of all grades IVH and PVL is almost the same, but there is a significant difference in the incidence of severe, grade 3 and 4 IVH and PVL (19% in C. s. group versus 48% p. v. n. group). The survivors with severe IVH are 57% among the breech delivered (p < 0.05) compared with respectively 33% and 26% among c. s. and vertex delivered groups. A CONCLUSION: Is made that C. s. provides better chances for a safe survival in ELBW and ELGA newborns and better prognosis for neurodevelopmental outcome. With the worst prognosis are the breech delivered ELBW babies.
Asunto(s)
Parto Obstétrico , Recién Nacido de muy Bajo Peso , Puntaje de Apgar , Femenino , Sangre Fetal/fisiología , Humanos , Concentración de Iones de Hidrógeno , Mortalidad Infantil , Recién Nacido , Recien Nacido Prematuro , Sistema Nervioso/crecimiento & desarrollo , Embarazo , Pronóstico , Estudios Retrospectivos , Arterias Umbilicales/fisiologíaRESUMEN
Antenatal corticosteroids are now administered for the purpose of hastening maturation of the preterm infant's organs and tissues, thus reducing neonatal mortality and the incidence of respiratory distress syndrome (RDS). Our purpose was to determine the efficacy of maternal corticosteroid therapy on fetal maturation in cases with preterm premature rupture of the membranes. The rates of RDS and survival in low birth weight infants treated with corticosteroids is influenced by the duration of the premature rupture of the membranes and the duration of the corticosteroid therapy, as well as by the gestational age.
Asunto(s)
Betametasona/uso terapéutico , Rotura Prematura de Membranas Fetales/prevención & control , Glucocorticoides/uso terapéutico , Adulto , Femenino , Rotura Prematura de Membranas Fetales/embriología , Madurez de los Órganos Fetales/efectos de los fármacos , Humanos , Pulmón/embriología , Embarazo , Tercer Trimestre del Embarazo , Atención Prenatal , Estudios RetrospectivosRESUMEN
UNLABELLED: The aim of this study is to evaluate the consequences of being extremely low birth weight (ELBW) under 1000 g at birth, small (SGA) or appropriate for gestational age (AGA). METHODOLOGY: A retrospective comparison of two cohorts of ELBW AGA (n = 47) and SGA (n = 38) infants, admitted to the Intensive Care Unite of State Maternity Hospital "Maichin Dom" from 01, 1995 to 06, 1998 is carried out. Infants with major congenital anomalies and those, who died in the first two hours of life, being extremely premature and unviable, are excluded. RESULTS AND CONCLUSIONS: The mean birth weight of the AGA group is 863 g, their mean gestational age is 26.6 weeks of gestation and of the SGA group--795 g and 29.6 weeks respectively. In the Sga C-section is preferred in 85%, vs only 34% in the AGA group. SGA babies are with two times greater survival rate (61%) then AGA (32%). The causes of death are similar. The AGA survivors have a greater rate of stage III-IV intraventricular hemorrhage, more prolonged need for ventilatory support (19 vs 12 days for SGA) and oxygen supplementation (37.5 vs 30.7 for the SGA), more difficulties with enteral feeding and their median hospital stay is somewhat longer (81.9 days), compared with those of the SGA (76.6 days). The two groups show a similar rate of respiratory distress syndrome, chronic lung disease, infections and neurological complications among the survivors.
Asunto(s)
Recién Nacido , Recién Nacido Pequeño para la Edad Gestacional , Recién Nacido de muy Bajo Peso , Resultado del Embarazo , Bulgaria/epidemiología , Femenino , Edad Gestacional , Humanos , Mortalidad Infantil , Enfermedades del Recién Nacido/epidemiología , Masculino , Embarazo , Estudios RetrospectivosRESUMEN
It is widely believed that premature rupture of membranes accelerates fetal pulmonary maturity. The purpose of our study was to determine the duration of the latent phase, in the cases of premature rupture of membranes, required to achieve this effect. Retrospective analysis of our database yielded a group of 42 patients, who were delivered between 26 and 34 weeks gestation. The results of this study suggest that pulmonary maturation continues but is not accelerated after premature rupture of membranes. Delaying delivery for more than 72 hours after rupture of membranes is more likely to result in chorioamnionitis than accelerated pulmonary maturation.
Asunto(s)
Rotura Prematura de Membranas Fetales/fisiopatología , Trabajo de Parto , Trabajo de Parto Prematuro/fisiopatología , Adolescente , Adulto , Femenino , Rotura Prematura de Membranas Fetales/embriología , Madurez de los Órganos Fetales , Edad Gestacional , Humanos , Recién Nacido , Recien Nacido Prematuro , Pulmón/embriología , Masculino , Trabajo de Parto Prematuro/embriología , Embarazo , Factores de TiempoRESUMEN
UNLABELLED: The aim of the study is to establish a correlation between Apgar score, acid-base status (ABS) and blood gases (bg) from cord blood and the early postnatal adaptation in healthy term newborns. The study is prospective and includes 52 babies at term born at the State University Hospital Maichin Dom, Sofia during a three month period--03-05, 1998 without evidence of asphyxia before and during delivery. All babies are monitored for Apgar score at minute 1 and 5, ABS and bg from umbilical artery (u.a.) and vein (u.v.) examined at birth, as well as capillary ABS and bg 1 hour after birth. Early postnatal adaptation is judged by a neonatologist in the course of two hours. RESULTS: A significant difference is found between all the examined points in the ABS and the blood gases in samples from umbilical artery and vein (p < 0.05), most significantly differ pH, pO2 and O2 Sat (p < 0.001). There is a correlation between 1 minute Apgar score and ABS and bg from umbilical vessels, babies with 1 minute Apgar score 7 having significantly lower pH from u.a. requiring wider range of resuscitation. Babies with 1 minute Apgar score 9/8 and 5 minute Apgar score 10 have definitely less early adaptational problems. CONCLUSION: The use of a combination of evaluation criteria for the condition of the newborn after birth (Apgar score, ABS and bg from cord blood and strict monitoring of early cardio-pulmonary adaptation) guarantees adequate resuscitation in term babies.
Asunto(s)
Equilibrio Ácido-Base/fisiología , Adaptación Fisiológica , Puntaje de Apgar , Sangre Fetal/fisiología , Recién Nacido/fisiología , Humanos , Valores de Referencia , Factores de Tiempo , Arterias Umbilicales , Venas UmbilicalesRESUMEN
A retrospective study is carried out with the aim of establishing the effect from surfactant therapy on pulmonary function, survival and complication from intensive therapy on VLBWI with RDS. 67 premature infants below 1500 grams are included in the study divided in 3 groups: I gr.--27 babies treated with Corosurf; II gr.--16 babies treated with Exosurf; III gr.--24 control babies without surfactant. The results show that in spite of relatively lower gestational age and higher incidence of inborn infection in group I, Curosurf treated babies spend shortest time on mechanical ventilation and oxygen therapy showing lower incidence of BPD, IVH and mortality rate.
Asunto(s)
Recien Nacido Prematuro , Recién Nacido de muy Bajo Peso , Surfactantes Pulmonares/uso terapéutico , Síndrome de Dificultad Respiratoria del Recién Nacido/terapia , Estudios de Casos y Controles , Humanos , Recién Nacido , Oxígeno/uso terapéutico , Respiración Artificial , Estudios Retrospectivos , Factores de TiempoRESUMEN
The persistent pulmonary hypertension syndrome is a heavy and very often a lethal complication in the neonatal period. It is more common in full-term infants with perinatal asphyxia, meconium aspiration or inborn infection. We discuss two clinical cases of newborns, delivered by Caesarian section in the 38th week of gestation without history of prenatal asphyxia or inborn infection. The main clinical symptom was a progressive lung failure that finally lead to mechanical ventilation. Both infants had clinical symptoms of pulmonary hypertension and intracranial hemorrhages (proved by ultrasound). During autopsy, bilateral pneumonia and intracranial hemorrhages were found in both infants and in one of them meconium aspiration and suprarenal gland hemorrhages were proven. In conclusion we may say that the diagnosis of persistent pulmonary hypertension is often very difficult and the conventional methods of mechanical ventilation and medicament treatment cannot always prevent the infant's lethal outcome.
Asunto(s)
Recien Nacido Prematuro , Síndrome de Circulación Fetal Persistente/diagnóstico , Síndrome de Circulación Fetal Persistente/terapia , Enfermedades de las Glándulas Suprarrenales/diagnóstico , Enfermedades de las Glándulas Suprarrenales/patología , Resultado Fatal , Femenino , Humanos , Recién Nacido , Hemorragias Intracraneales/diagnóstico , Hemorragias Intracraneales/diagnóstico por imagen , Masculino , Síndrome de Aspiración de Meconio/diagnóstico , Oxígeno/uso terapéutico , Respiración Artificial , UltrasonografíaRESUMEN
Recent advances in neonatal medicine made reality the survival of newborn babies of extremely low weight and gestational age. This often provokes ethical problems in relation to high death rate, morbidity and neuro-developmental seguels. On the other hand it is usually impossible at birth to predict the presence and severity of future problems. We present the cases of three babies, where in spite of the most unfavourable factors connected to mother's condition, foetus and newborn, three healthy children were raised up. Their characteristics at birth are: 650 g--30 gestational weeks; 560 g--29 gestational weeks; 600 g--29 gestational weeks. In all of them intensive resuscitation and mechanical ventilation are started immediately after birth, two of them received prophylactic surfactant. Little by little, the problems arising from extremely low birth weight, faded away. All babies had grade I-II IVH which were totally resorbed. The first baby is three years old at the moment with were totally resorbed. The first baby is three years old at the moment with adequate for her age mental and neurologic development. The other two babies, resp. 9 and 3 months of age, are also developing normally. In conclusion, the possibilities for survival and raising up of babies of extremely low weight and gestational age are definitely increasing, requiring high qualification staff, modern technics and very large funds for diagnostics, monitoring and treatment.
Asunto(s)
Recién Nacido de muy Bajo Peso , Femenino , Estudios de Seguimiento , Humanos , Recién Nacido , Recién Nacido Pequeño para la Edad Gestacional , Masculino , Oxígeno/uso terapéutico , Pronóstico , Surfactantes Pulmonares/uso terapéutico , Respiración ArtificialRESUMEN
The purpose of this prospective work is to communicate the experience with preinduction treatment with Folly's catheter on the Pelvic score (Ps), labor and neonatal outcome in 52 cases in 27 to 34 wg, preterm premature labor and unfavourable cervix. The first control group consist of 24 pregnancies with the same characteristics but with favourable cervix at the begging of labor induction and the second control group include 31 cases with spontaneous premature labor. The Folly's catheter is introduced through the cervical canal and the bulb inflated with 75 ml of sterile normal saline. After the Foley's catheter dropped out the Ps is reassessed and proceed with oxytocin infusion. In the first control group with favourable cervix the induction of labor is only with oxytocin via infusion pump. More than half of all patients are treated with with tocolysis. The results show that for the period of tocolysis and/or PPROM there is significant improvement of the Ps (from 0.90 +/- 0.9 to 2.35 +/- 1.5). The change in the Ps doesn't depend on the g.w., the length of tocolysis or on the initial Ps. The balloon catheter improve the Ps from 2.35 +/- 1.5 to 6.24 +/- 1.3 for y period of 3 h 20 min (2 h 40 min to 4 h, 95% confidence). After the Foley catheter dropped out the duration of labor with oxytocin infusion is 6 h (5 to 7 h, 95% confidence) and is not different from this in the control groups. The time for the catheter to drop out, the achieved Ps and especially the effacement of the cervix are essential features in the prognosis of the difficulties in the labor process and the neonate state.