scholarly journals Fluid Supply and Feeding Practices in Cooled Asphyxiated Newborns

Children ◽  
2021 ◽  
Vol 8 (10) ◽  
pp. 899
Author(s):  
Mona Markus ◽  
Stamatios Giannakis ◽  
Maria Ruhfus ◽  
Anja Stein ◽  
Axel Heep ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Standard Treatment ◽  
Neurological Deficits ◽  
Large Variability ◽  
Abdominal Complications ◽  
Fluid Supply ◽  
Feeding Regimes ◽  
Term Newborns ◽  
Level I ◽  
Ischemic Encephalopathy

Therapeutic hypothermia (TH) for 72 h is the standard treatment to reduce neurological deficits in term newborns with hypoxic-ischemic encephalopathy. There is a large variability regarding nutritional supply during TH treatment in asphyxiated newborns. We performed a retrospective multicentre study in four level I (highest level of care in Germany) NICUs, including 135 asphyxiated term newborns undergoing TH. We analyzed enteral and parenteral nutritional supply during and after TH. We correlated nutritional supply with risk factors for encephalopathy, pH, Sarnat score, mechanical ventilation, seizures, and sedation. A total of 120 of 135 neonates received enteral nutritional supply within the first 24 h, and the majority of children were fully enterally fed within the first 10 days. The grade of encephalopathy and mechanical ventilation had a significant influence on the amount of enteral fluids (p = 0.01), whereas the pH and appearance of seizures did not affect the amount of nutritional supply significantly. Furthermore, we did not observe any correlation between enteral intake and abdominal complications such as necrotizing enterocolitis. We observed a large variability of feeding regimes in the four participating NICUs. Early enteral feeding among newborns undergoing TH was performed in each NICU and was well tolerated without increased rates of complications.

A combined a-EEG and MR spectroscopy study in term newborns with hypoxic–ischemic encephalopathy

2010 ◽  
Vol 32 (10) ◽  
pp. 835-842 ◽  
Author(s):  
Gina Ancora ◽  
Silvia Soffritti ◽  
Raffaele Lodi ◽  
Caterina Tonon ◽  
Sara Grandi ◽  
...  
Keyword(s):  
Mr Spectroscopy ◽  
Hypoxic Ischemic Encephalopathy ◽  
Spectroscopy Study ◽  
Term Newborns ◽  
Ischemic Encephalopathy

scholarly journals Outcome of Using Intravenous Immunoglobulin (IVIG) in Critically Ill COVID-19 Patients’: A ‎Retrospective, ‏Multi-Centric Cohort Study

2021 ◽  
Author(s):  
Mohammadreza Salehi ◽  
Mahdi Barkhori Mehni ◽  
Mohammadmehdi Akbarian ◽  
Samrand Fattah Ghazi ◽  
Nasim Khajavi Rad ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cohort Study ◽  
Treatment Group ◽  
Mortality Rate ◽  
Length Of Stay ◽  
Standard Treatment ◽  
Ivig Treatment ◽  
Icu Length Of Stay ◽  
Duration Of Hospitalization ◽  
Standard Treatment Group

Abstract Background: To access the effect of Intravenous immunoglobulin ‎‎(IVIG) in critically ill corona virus disease 2019 (COVID-19) patients.Method: In this retrospective matched cohort study, records of three tertiary centers with large number of COVID-19 admissions were evaluated and used. Based on treatment options, ‎patients were divided into two groups, standard COVID-19 treatment (109 patients) and IVIG treatment (74 patients) patients. Also, the effect of IVIG in different dosages was evaluated. Patients with IVIG treatment were divided into three groups of ‎low (0.25 gr/kg), medium (0.5 gr/kg), and high (1 gr/kg) dose. Data analysis was performed using independent t-test and ‎One-way analysis of variance (ANOVA) to compare the ‎outcomes between two groups, including duration of hospitalization, intensive care unit (ICU) length of stay, and mortality rate.‎Result: The duration of hospitalization in the IVIG group ‎were significantly longer than standard treatment (13.74 days vs. 11.10 days, p<0.05). There was not a significant difference between the two groups in ICU length of stay, number of intubated patients and duration of mechanical ventilation (P>0.05).‎ Also initial ‎outcomes in IVIG subgroups were compared separately with the standard ‎treatment group. The results indicated that only the duration of hospitalization ‎in the IVIG subgroup with medium dose is significantly longer than the standard ‎treatment group (P<0.01).Conclusion: Using IVIG is not beneficial for COVID-19 patients based on no remarkable differences in duration of hospitalization, ICU length of stay, duration of mechanical ventilation and even mortality rate.

Ipsilateral Fractures of the Talus and Calcaneus

1996 ◽  
Vol 17 (11) ◽  
pp. 701-705 ◽  
Author(s):  
Paul Gregory ◽  
Thomas DiPasquale ◽  
Dolfi Herscovici ◽  
Roy Sanders
Keyword(s):  
Standard Treatment ◽  
Talus Fracture ◽  
Treatment Regimens ◽  
Combined Injury ◽  
Joint Surfaces ◽  
Articular Damage ◽  
Talar Fractures ◽  
Level I ◽  
Both Bones

Nine ipsilateral fractures of the talus and calcaneus were treated at Tampa General Hospital between 1991 and 1994 and entered into the trauma registry of this level I trauma center. During this same period, a total of 78 talar fractures and 334 calcaneal fractures were entered into the registry. The patients who sustained this rare combined injury were studied retrospectively to characterize the fractures that occurred, examine the treatments instituted, and determine outcomes. Four patients had severe intra-articular damage of the subtalar joint surfaces and underwent either primary or delayed arthrodesis. This subgroup of patients was followed for an average of 39 months (range, 25–45 months), and all had excellent or good outcome as assessed by the Maryland Foot Score. Three patients had nondisplaced or avulsion-type fractures of both bones, which were treated with immobilization. These all healed well. One patient had a Hawkins type 2 talus fracture with an extra-articular avulsion fracture of the Achilles tendon. This patient did well with open reduction and internal fixation of both fractures. The final patient had a crushed lower extremity in association with her hindfoot injury, which resulted in primary below-knee amputation. In general, we believe each individual fracture in this combined injury can be addressed with standard treatment regimens.

scholarly journals Altered plasma-type gelsolin and amyloid-β in neonates with hypoxic-ischaemic encephalopathy under therapeutic hypothermia

2018 ◽  
Vol 39 (7) ◽  
pp. 1349-1354
Author(s):  
Isabel Benavente-Fernandez ◽  
Juan J Ramos-Rodriguez ◽  
Carmen Infante-Garcia ◽  
Gema Jimenez-Gomez ◽  
Alfonso Lechuga-Sancho ◽  
...  
Keyword(s):  
Therapeutic Hypothermia ◽  
Amyloid Beta ◽  
Brain Injuries ◽  
Standard Treatment ◽  
Amyloid Β ◽  
Neonatal Deaths ◽  
Neonatal Complication ◽  
Learning Impairment ◽  
Ischemic Encephalopathy

Hypoxic-ischemic encephalopathy (HIE) is a severe neonatal complication responsible for ∼23% of all neonatal deaths. Also, 30–70% of these patients will suffer lifetime disabilities, including learning impairment, epilepsy or cerebral palsy. However, biomarkers for HIE screening, or monitoring disease progression are limited. Herein, we sought to evaluate the clinical usefulness of plasma-type gelsolin (pGSN) and amyloid-beta (Aβ) 40 and 42 as prognostic biomarkers for HIE. pGSN has been previously suggested as a feasible marker in other brain injuries and amyloid-beta 40 and 42 are classically assessed in neurodegenerative diseases. However, to our knowledge, they have not been previously assessed in HIE patients. We have analyzed plasma pGSN and Aβ 40 and 42 levels in 55 newborns (16 controls, 16 mild and 23 moderate-severe HIE) at birth, during 72 h of therapeutic hypothermia, a gold-standard treatment for HIE, and 24 h after hypothermia. Aβ levels were lower in HIE patients, and pGSN levels were progressively reduced in mild and moderate-severe HIE patients. The fact that pGSN reductions could predict the severity of HIE and significantly correlated with the time to undergo hypothermia supports the prognostic value of plasmatic pGSN. Further studies are warranted to investigate the role of pGSN in neonatal HIE.

Analysis of factors related to the development of ventilator-associated pneumonia: use of existing databases

2000 ◽  
Vol 9 (5) ◽  
pp. 344-349 ◽  
Author(s):  
JF Byers ◽  
ML Sole
Keyword(s):  
Mechanical Ventilation ◽  
Length Of Stay ◽  
Odds Ratio ◽  
Demographic Data ◽  
Tube Feeding ◽  
Causative Organism ◽  
Trauma Patients ◽  
Ventilator Associated Pneumonia ◽  
Receptor Antagonists ◽  
Level I

OBJECTIVE: To investigate factors related to ventilator-associated pneumonia to assist in the development and implementation of prevention strategies. METHODS: A retrospective, descriptive design was used. Power analysis determined sample size. A consecutive sample of 120 patients admitted to the critical care units of a level I trauma center who were receiving mechanical ventilation was used. Data were obtained from clinical and financial databases. Variables included demographic data, causative organism of the pneumonia, medications, comorbid conditions, complications, duration of therapies, length of stay, and cost per case. RESULTS: The average patient was a 49-year-old man. The sample was 54.9% trauma patients, and the prevalence of ventilator-associated pneumonia was 16.7%. Significant factors included duration of intubation (r = 0.28, P = .005), mechanical ventilation (r = 0.26, P = .005), and tube feeding (r = 0.30, P = .001); trauma (phi = 0.24, P = .009); and use of histamine2 receptor antagonists (phi = -0.25, P = .006). The only variable that significantly increased the odds ratio for ventilator-associated pneumonia was trauma. The only variable that significantly decreased the odds ratio was use of histamine2 receptor antagonists. Patients in whom ventilator-associated pneumonia developed had a 16-day increase in length of stay (t = -2.68, P = .008), and a $29,369 increase in cost per case (t = -3.649, P = .000). CONCLUSIONS: These findings provide a baseline for discussions about potential changes in practice to help prevent ventilator-associated pneumonia.

scholarly journals Conservative Treatment of Acute Spontaneous Spinal Epidural Hematoma

1998 ◽  
Vol 25 (2) ◽  
pp. 159-163 ◽  
Author(s):  
Peter A. Pahapill ◽  
Stephen P. Lownie
Keyword(s):  
Epidural Hematoma ◽  
Standard Treatment ◽  
Surgical Intervention ◽  
Operative Therapy ◽  
Complete Recovery ◽  
Neurological Deficits ◽  
Spinal Epidural Hematoma ◽  
Spontaneous Spinal Epidural Hematoma ◽  
Spinal Epidural ◽  
Sustained Recovery

ABSTRACT:Background:In cases of acute spontaneous spinal epidural hematoma producing neurological deficits, emergency surgical evacuation is the standard treatment.Methods:Such a case is presented in which complete resolution of neurological deficits occurred without surgical intervention.Results:This is the fifth reported case of complete recovery in a patient managed conservatively. In most reports, significant and sustained neurological recovery had occurred within 12 hours of impairment of walking.Conclusion:In cases of acute spontaneous spinal epidural hematoma in which neurological deterioration is followed by early and sustained recovery, non-operative therapy may be considered.

Prognostic Markers in Term Infants with Hypoxic–Ischemic Encephalopathy: Comparative Analysis of MRI, EEG, and Apgar Scores

2017 ◽  
Vol 16 (01) ◽  
pp. 008-014 ◽  
Author(s):  
Elissa Yozawitz ◽  
Ajay Goenka
Keyword(s):  
Hypoxic Ischemic Encephalopathy ◽  
Neurological Deficits ◽  
Term Infants ◽  
Term Outcome ◽  
Apgar Scores ◽  
Long Term Outcome ◽  
Perinatally Acquired ◽  
Magnetic Resonance Imaging Mri ◽  
Poor Outcomes ◽  
Ischemic Encephalopathy

AbstractHypoxic–ischemic encephalopathy (HIE) is a frequent cause of perinatally acquired brain injury resulting in abnormal neurological consequences. In this retrospective study, we evaluated 68 neonates with clinical evidence of HIE to investigate the utility of magnetic resonance imaging (MRI), electroencephalography (EEG), and Apgar scores, individually and in combination, as predictors of long-term outcome. Six infants died during treatment, and 46 of the remaining 62 infants (74%) received follow-up neurological assessments at ages 6 to 24 months. The outcome was dichotomously classified as good (reflecting “normal development”) or as poor (reflecting “neurological deficits” based upon attainment of developmental milestones or death). Abnormal Apgar scores, MRIs, and EEGs had sensitivities of 50, 84, and 95% for predicting “neurological deficit.” Corresponding specificities were 85, 66, and 18%. However, the combination of abnormal Apgar scores, MRIs, and EEGs in predicting poor outcomes (i.e., “neurological deficits” or death) had sensitivity and specificity of 100%. In addition, the combination of abnormal Apgar scores, MRIs, and EEGs provided a positive predictive value of 100% in assessing poor outcome as compared with 73% (p = 0.2) for Apgar scores, 71% (p = 0.01) for MRIs, and 56% (p = 0.001) for EEGs.

Sign in / Sign up

Export Citation Format

Share Document