RESUMEN
Hearing impairment is one of the deleterious ramifications of neonatal hyperbilirubinemia, but its impact during the newborn period has not been well studied in Bangladesh. This prospective observational study was conducted during January 2016 to December 2017 in the Department of Neonatology and Otolaryngology-Head and Neck Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh to identify the relationship between hyperbilirubinemia requiring phototherapy or exchange transfusion with hearing impairment in term and late preterm neonates. Admitted term and late preterm neonates with hyperbilirubinemia requiring either phototherapy or exchange transfusion were taken as hyperbilirubinemia group. Neonates without hyperbilirubinemia from postnatal ward were taken as control. All newborn were screened with Distortion Product Otoacoustic Emissions (DPOAE) prior to discharge from hospital. A second screen was done in referred newborn after one month of first screen. A diagnostic Auditory Brainstem Response (ABR) was performed in both the ears prior to 3 months of postnatal age if referred in both 1st and 2nd screen. Total 264 neonates included in this study; 132 in the hyperbilirubinemia and 132 in the control group. In the hyperbilirubinemia group 74(56.06%) were male and 58(43.94) were female. Mean gestational ages in the hyperbilirubinemia group and control group were 36.95±1.60 weeks and 37.01±1.67 weeks respectively. Newborn in the hyperbilirubinemia group, 4(3.03%) had hearing impairment and none had hearing impairment in the control group. Peak Total Serum Bilirubin (TSB) 23mg/dl was found as best cut off value with a sensitivity of 100% and specificity of 93% for the development hearing impairment. Hearing impairment was significantly more frequent among newborn with TSB level >23mg/dl when compared to those having TSB level ≤23mg/dl (20% vs. 0.9%, p=0.009; OR=29, 95% CI 2.79, 301). Hearing impairment was associated with newborns with hyperbilirubinemia requiring phototherapy or exchange transfusion. Peak TSB level >23mg/dl can be predictive for the development of hearing impairment.
Asunto(s)
Pérdida Auditiva , Hiperbilirrubinemia Neonatal , Bangladesh , Bilirrubina , Femenino , Humanos , Lactante , Recién Nacido , Unidades de Cuidado Intensivo Neonatal , Masculino , FototerapiaRESUMEN
Bartter syndrome is an autosomal recessive disorder manifested by a defect in sodium-potassium-chloride transport in the thick ascending limb of Henle with different genetic origins and molecular pathophysiology. Bartter syndrome usually a common disease in children and in early infancy presented with persistent polyuria and associated with dehydration, electrolyte imbalance, and failure to thrive. Though prompt diagnosis and proper treatment of Bartter syndrome may improve the outcome, some children will progress to renal failure. We report a case of a 6 days-old male infant who was admitted in Neonatal Intensive Care Unit, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh on 26 April 2018 for prematurity and low birth weight. On subsequent follow up he developed electrolyte imbalance and failure to thrive. Laboratory studies revealed hyponatremia, hypochloremic metabolic alkalosis with severe hypokalemia. When excessive chloride losses appear to be renal in origin and the patient has normal blood pressure and high levels of serum renin and aldosterone were considered as Bartter syndrome. Molecular genetic studies are indicated to identify the primary genetic defect.
Asunto(s)
Alcalosis , Síndrome de Bartter , Hipopotasemia , Aldosterona , Bangladesh , Niño , Femenino , Humanos , Lactante , Masculino , EmbarazoRESUMEN
Neonatal sepsis (NS) is a life-threatening disorder and an important cause of morbidity and mortality in neonates. Blood culture, the gold standard for diagnosis of neonatal sepsis is costly, not available at all centres and test result not readily available. CRP is low cost diagnostic test for neonatal sepsis which is possible to perform at all centres and test result is easily available. We aimed to evaluate the usefulness of C-reactive protein (CRP) measurement to identify neonatal sepsis. We conducted this meta-analysis to investigate the diagnostic accuracy of the CRP in neonatal sepsis. The literature was searched in PUBMED, Cochrane Library, Google scholar and other Medical Databases using set search criteria. Each included study was evaluated by quality assessment of diagnostic accuracy studies (QUADAS) tool. Four investigators independently extracted the data and study characteristics, and disagreements, if any, were resolved by consensus. Meta-disc software was used to calculate the pooled sensitivity, specificity and summary diagnostic odds ratio (SDOR), I² or Cochrane Q to test heterogeneity. False positive report probability (FPRP) was calculated to confirm the significance of the results. Eleven studies (1557 neonates) were included in this meta-analysis. The pooled sensitivity and specificity of CRP were 71% and 86% respectively, which had moderate accuracy in the diagnosis of NS. The pooled diagnostic odds ratio (DOR) and area under curve (AUC) was 19.10 and 0.8535 (Q*=0.7845), respectively. The diagnostic threshold analysis showed that there was no threshold effect. Meta-analysis showed that CRP had a moderate accuracy (AUC=0.8535) for the diagnosis of NS. CRP is a helpful biomarker for diagnosis of NS. However, we should combine the results with clinical symptoms and signs, laboratory and microbial results.
Asunto(s)
Proteína C-Reactiva , Sepsis Neonatal , Área Bajo la Curva , Biomarcadores , Proteína C-Reactiva/análisis , Humanos , Recién Nacido , Sepsis Neonatal/sangre , Sepsis Neonatal/diagnósticoRESUMEN
Safe transportation is mostly an unnoticed neonatal health issue in Bangladesh and no documentation is available regarding the existing practices. So this study was intended to document transport status of the referred newborn to a tertiary care hospital. This observational study included 150 out born neonates over 12 months period transported from various places to NICU, Bangabandhu Sheikh Mujib Medical University (BSMMU) from May 2015 to April 2016. A structured data collection form was used to record information categorized into pre-transport, during transport and at admission. At admission detailed clinical assessment of the baby was done and recorded. Outcome was determined as discharge or death. Of 150 transported neonates, two-third were preterm 115(77%) & LBW 113(75%). Common indications for referral were prematurity and sepsis. Most of the patients were referred from private hospital 107(71%). Majority of newborns (86%) were referred from hospitals of Dhaka city while only 14% were referred from outside Dhaka. Referral notes were supplied in most of the cases 134(89%) but comprehensive information was obtainable only in 3 cases. Although main transport vehicle was ambulance 130(87%), medical personnel accompanied the sick baby only in 6(4%) of cases. The distance traveled was less than 10 kilometers (kms) in 95(63%) and more than 100 km in 10(7%) of enrolled neonates. Transport time was less than 1 hour in 72(48%), 1-6 hours in 66(44%) and more than 6 hours in 12(8%) of cases. Nearly two third of newborn were transported after office period, 107(72%). At admission 21(14%) babies had hypothermia, 8(7.62%) hypoglycemia, 16(11%), poor perfusion 28(19%), low saturation 27(18%). Hyperthermia & hyperglycemia were observed in 8(5%) & 7(5%) cases respectively. Of the total 150 babies referred, 17(11%) died. While comparing with discharged newborn, died newborn were more frequent sufferer of hypothermia (p value 0.007) and low saturation (p value 0.049) at admission. Premature, low birth weight and sick newborns are being transported despite lack of safe transport system.