Obstetric fracture of the femur during cesarean section in a preterm baby: A case report

Introduction: Obstetric fractures or Birth fractures are rare events following childbirth. Although fracture of the femur is a relatively uncommon injury, it is the most common fracture of the lower extremity in the newborn. Since evolution of cesarean section rates in Africa, it is one of the most commonly practiced modes of delivery for breech. We described one case of fracture of the femur at cesarean section treated at Adlucem hospital in bonabéri-Douala (Cameroon). Case report: A 2.1 kg male infant was delivered by lower segment cesarean section for breech presentation. Clinical and radiological examination showed shaft fracture of femur with good evolution. Discussion: Fractures of the long bones are associated with cesarean section, breech delivery with assistance and low birth weight. Femoral fractures are the most associated long bones fracture with cesarean section. Conclusion: The clinical and paraclinical diagnosis is simple and the management is mostly non-operative. It is important to explain to the parents and especially to the mother the benignity of the lesion.

Anatomic accuracy, physiologic characteristics, and fidelity of very low birth weight infant airway simulators

Background Medical simulation training requires realistic simulators with high fidelity. This prospective multi-center study investigated anatomic precision, physiologic characteristics, and fidelity of four commercially available very low birth weight infant simulators. Methods We measured airway angles and distances in the simulators Premature AirwayPaul (SIMCharacters), Premature Anne (Laerdal Medical), Premie HAL S2209 (Gaumard), and Preterm Baby (Lifecast Body Simulation) using computer tomography and compared these to human cadavers of premature stillbirths. The simulators’ physiologic characteristics were tested, and highly experienced experts rated their physical and functional fidelity. Results The airway angles corresponded to those of the reference cadavers in three simulators. The nasal inlet to glottis distance and the mouth aperture to glottis distance were only accurate in one simulator. All simulators had airway resistances up to 20 times higher and compliances up to 19 times lower than published reference values. Fifty-six highly experienced experts gave three simulators (Premature AirwayPaul: 5.1 ± 1.0, Premature Anne 4.9 ± 1.1, Preterm Baby 5.0 ± 1.0) good overall ratings and one simulator (Premie HAL S2209: 2.8 ± 1.0) an unfavorable rating. Conclusion The simulator physiology deviated significantly from preterm infants’ reference values concerning resistance and compliance, potentially promoting a wrong ventilation technique. Impact Very low birth weight infant simulators showed physiological properties far deviating from corresponding patient reference values. Only ventilation with very high peak pressure achieved tidal volumes in the simulators, as aimed at in very low birth weight infants, potentially promoting a wrong ventilation technique. Compared to very low birth weight infant cadavers, most tested simulators accurately reproduced the anatomic angular relationships, but their airway dimensions were relatively too large for the represented body. The more professional experience the experts had, the lower they rated the very low birth weight infant simulators.

Enterobacter Asburea in Intravenous Infection in Neonatal Born

Introduction: Enterobacter asburiae (E. asburiae) is a facultative anaerobic rarely isolated in neonatal care; the nosocomial infections continue to be a serious problem, associated with increased mortality rates, immediate and long-term morbidity, prolonged hospital stays, and increased cost of care, because of resistant of this specie. Objective: it’s un nosocomial infection of blood, that the first time it’s determined in neonatal hospitalization CHU Mohamed VI Marrakech. Observation: We report in this subject a case of a preterm baby had a septicemia secondary to enterobacter asburea it’s the first time this mirogerme founded in CHU, resulting from contaminated intravenous fluid hospitalized in neonatal care unit, in CHU Mohamed VI Marrakech Conclusion: the case reported in this work pushes us to deepen investigations concerning the resistance and the clinical evolution of the affected patients.

Severe coronavirus disease 2019 pulmonary disease in very low birth weight preterm babies

Severe coronavirus disease 2019 (COVID-19) in neonates is considered a rarity due to vertical transmission and most of the affected babies are asymptomatic. Here, we describe two severe cases of very low birth weight (VLBW) preterm babies in sick newborn care unit (SNCU) due to horizontal transmission. Case 1 describes a VLBW preterm baby (29 weeks) weighing 1300 g who was undergoing care in SNCU. He developed classical symptoms of cold in the form of nasal congestion with mild rhinorrhea, fever, and cough followed by severe prolonged hypoxia with full recovery. Case 2 describes another VLBW preterm (27.3 weeks) weighing 1175 g who was suffering from severe progressive hypoxia around same time. He was initially responsive to oxygen therapy but succumbed to refractory hypoxia later on. We conclude that severe COVID-19 pulmonary disease can occur in few unfortunate VLBW preterm neonates

Assessment of Hypoxemia using Downes Score in Neonates with Respiratory Distress

Respiratory distress in newborn is a common problem leading to hypoxemia. Pulse oximetry is the tool for measuring oxygen saturation noninvasively and blood gas analysis is the gold standard for oxygen monitoring. Downes score can be used as an alternative to assess respiratory distress clinically and determine the need of oxygen supplementation when these facilities are not available. This study was done to evaluate the validity of Downes score to assess hypoxemia in newborn with respiratory distress. This is a cross sectional descriptive study conducted from June 2020 to February 2021 in Neonatal Intensive Care Unit of Nepal Medical College Teaching Hospital. Oxygen saturation of newborn with respiratory distress was measured by pulse oximetry. At the same time the neonate was assessed for respiratory distress clinically using Downes score. Downes score and oxygen saturation measured by pulse oximetry were compared. Hypoxemia was defined as oxygen saturation less than 90% in term/ post term newborn and less than 88% in preterm baby. Similarly, neonate was considered to be hypoxic when Downes score was ≥5. The accuracy of Downes score was assessed by its sensitivity and specificity in detecting hypoxemia. Altogether 121 neonates were included in the study. Sensitivity and specificity of Downes score of 5 was 94.12% and 93.10% respectively. In conclusion, Downes score can be used as a clinical diagnostic means for assessing hypoxemia in neonates with respiratory distress

BNT162b2 Vaccination during Pregnancy Protects Both the Mother and Infant: Anti-SARS-CoV-2 S Antibodies Persistently Positive in an Infant at 6 Months of Age

Vaccinations are the most important intervention for controlling the ongoing coronavirus disease (COVID-19) pandemic, caused by the SARS-CoV-2 virus. BNT162b2 is an mRNA-based vaccine, which is promising and safe for use during pregnancy, as it could help prevent SARS-CoV-2 infection and its complications during pregnancy. Other vaccines, such as influenza and Tdap (tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis) vaccines, provide significant protection for babies. Recent studies have shown that COVID-19 antibodies are present in newborns at birth, owing to maternal BNT162b2 vaccination during pregnancy; however, it is currently unclear how long these antibodies could protect infants from SARS-CoV-2 infection and its complications. Herein, we present the case of a preterm baby born at 33 weeks via an emergency cesarean section owing to maternal complications. The mother had received two doses of the BNT162b2 vaccine at 22 and 26 weeks of gestation. Positive anti-SARS-CoV-2 S antibodies were detected in the infant at 2 weeks, 6 weeks, 3 months, and 6 months of age. This is the first case report in which BNT162b2 vaccination during pregnancy yielded a persistent immune response in an infant at 6 months of age. The declining anti-SARS-CoV-2 S antibody titers noted at 6 months of age emphasize the need for the vaccination of children at this age.

Outcomes of Gestational Diabetes Mellitus in Pakistani Mothers: An Experience of a Tertiary Care Hospital

Objective: To assess the incidence and outcome of gestational diabetes mellitus (GDM) during pregnancy among sampleof Pakistani population. Study Designand Setting:This was an analytic case-control prospective study carried out at two centers (CMH Kharianand PNS Shifa Hospital Karachi) from 1st Jan till 30th July 2021. MethodologyPreviously healthy mothers were divided into three groups according to their risk of elevated glucose levelsgestational diabetes mellitus (GDM) during pregnancy. Associations between GDM eminence (exposure variable) andpregnancy-related, fetal, and neonatal outcomes were reviewed (i.e., mode of delivery, preterm baby, pregnancy-inducedhypertension, and fetal macrosomia, stillbirth, premature delivery etc. One way ANOVA was employed to compare thesignificant differences in different dependent variables amongst three groups. P Values of <0.05 were considered substantial. Results: A total of 120 patients were divided into 3 groups Group 1 (uncontrolled sugar group) who could not achieveadequate sugar control, Group II (adequate sugar control group)and Group III as control group (Non-Diabetic). The meanage in our population was 24 (+ 4.15) years most of study population 70% of mothers were under 25 years of age. Themajority (95%) of deliveries in the control group (Euglycemic) were uneventful, but poor fetal outcomes were noted ingroups 1 2 (documented to have elevated blood sugars,) especially in the group with Uncontrolled Sugar. GDM was positively associated with preterm birth, stillbirth and macrosomia. Conclusion: GDM is a prevalent disease in Pakistan and needs and has association with poor pregnancy outcomes. Urgent attention requires at individual and state level to reduce morbidity and mortality.

Placental chorioangioma: an unusual cause of neonatal cardiomyopathy

A late preterm baby presented with clinical and echocardiographic features of cardiomyopathy and cardiac failure soon after birth. After extensive metabolic, infective and genetic investigations, the likely cause was established to be due to multiple small placental chorioangiomas. While large placental chorioangiomas are associated with maternal, fetal and neonatal complications, small chorioangiomas are usually asymptomatic and diagnosed incidentally on placental histology. Our case demonstrates that multiple small chorioangiomas might behave like a giant chorioangioma, causing significant neonatal morbidity. This report also highlights the importance of assessing the placental histology where no identifiable cause for neonatal cardiomyopathy can be found.

Selected problems of prematurity and prematurely born child care

The evolution of perinatology and the progress of advanced methods of prenatal diagnosis have contributed to the rise of frequency of birth and survival of newborns with very low birth weight, born before 32 weeks of pregnancy. A three-tier perinatology care system in Poland, an increasingly outstanding knowledge of neonatologists, and newer and more advanced equipment for critical care therapy, all provide growingly safer conditions for the life and development of prematurely born children. Prematurity is not only a problem of the preterm baby, but poses a challenge for the family, notably the mother, who must face the challenges of care of the preterm baby. In this article, selected problems of prematurity and care of a preterm baby are presented. The most common causes of preterm birth incidence are reported. The mother’s situation after a preterm birth is defined. Based on the current literature, the profile of preterm babies and the EBM (Evidence-Based Medicine) paradigm, the rules for treatment and care for a preterm baby are presented.