Al-Azhar University, Al-Azhar Pediatric SocietyAl-Azhar Journal of Pediatrics1110-777419220160601ROLE OF HEAD COVERING AS A PROPHYLACTIC TOOL FOR PHOTOTHERAPY INDUCED HYPOCALCEMIA162016327908110.21608/azjp.2016.79081ENEhab Ibrahim I. SorourTarek El SayyadJournal Article20200325<strong><em>Background</em></strong>: Hyperbilirubinemia is the most common abnormal physical finding in the first week of life and is observed in approximately 60% of term infants and 80% of preterm infants <strong>(Stoll and Piazza, 2007).</strong><br /> Melatonin stimulates secretion of corticosterone which decreases calcium absorption by bones. Phototherapy leads to inhibition of pineal gland via transcranial illumination, resulting in a decline in melatonin level and as a result, hypocalcemia develops <strong>(Karamifar et al., 2002). </strong><br /> The aim of the study was to determine the effect of covering the head of infants during phototherapy on phototherapy induced hypocalcemia in jaundiced newborns.<br /> <strong><em>Methodology:</em></strong> We conducted a comparative case control study at neonatal intensive care unit of Al Hussein hospital,(Al Azhar University in Cairo) starting from April 2014 to December 2014.This study included 100 full term neonates with symptoms, signs and laboratory findings of neonatal indirect hyperbilirubinemia treated with phototherapy. Apart from jaundice, their physical examination was completely normal.<br /> Calcium level was measured on admission and after 48 hours of phototherapy.<br /> We designed a hat with a dark color that can cover all the head including the occipital area, ears and neck to prevent passage of light. The hat was used from admission and for 48 hours of treatment with phototherapy.<br /> Neonates were randomized and divided into two groups: group (A) 50 infants under the routine phototherapy without hats and group (B) 50 infants using hats that cover occipital area. A comparative study was made between these groups to determine the effect of hat in prevention of phototherapy induced hypocalcemia.<br /> <strong><em>Results</em></strong>: In this study, we found that 19 infants (19 %) of both groups developed hypocalcemia after 48 hours of starting phototherapy. There was significant statistical difference between the incidence of hypocalcemia in group A (without hats) which were 13 infants (26%) and group B (with hats) which were 6 infants (12 %)(p= 0.031).<br /> <strong><em>Conclusion:</em></strong> We conclude that, phototherapy induced hypocalcaemia can be prevented by covering newborn head during phototherapy.<br /> <strong><em>Recommendations:</em></strong> We recommend that neonates should be regularly evaluated for total serum calcium levels 48 hours after continuous exposure to phototherapy and should be managed accordingly; also all neonates with phototherapy should cover their heads using hats during treatment to prevent phototherapy induced hypocalcaemia.Al-Azhar University, Al-Azhar Pediatric SocietyAl-Azhar Journal of Pediatrics1110-777419220160601TRANSCATHETER CLOSURE OF VENTRICULAR SEPTAL DEFECTS IN INFANTS AND CHILDREN163316497908210.21608/azjp.2016.79082ENReyadh A. ElgindyHala M. AghaHala S. HamzaSherief H. Abdel RahmanKhaled M. SalehJournal Article20200325<strong>Objectives</strong>: The objective of this study was to evaluate the safety and efficacy of the transcatheter approach to correct congenital ventricular septal defects (VSDs) in a prospective clinical trial.<br /> <strong>Background</strong>: VSD is a common congenital heart disease in children. Surgical closure of VSD is a well-established therapy but requires open-heart surgery with cardiopulmonary bypass. Although the transcatheter approach is associated with significant incidence of complete artioventricular block, it may provide a less invasive alternative.<br /> <strong>Methods and results</strong>: Implantation of transcatheter devices was attempted in 30 patients (pts.) with congenital VSDs aged 1 to 14years from November 2013 to November 2014 and follow up for one year. The following anatomic types were present: 11 muscular, 19 perimembranous, single in 26, two in one and multiple in three, Mean VSD size was 6.6 mm (range 3–14), fluoroscopy time 51 min (range 13-107). Devices implanted were Amplatzer duct Occulder<em>I</em> (<em>ADOI</em>) in12, Amplatzer duct Occulder<em> II (ADOII) </em>in8,<em> Amplatzer muscular VSD</em> in 5,<em> PFM</em> in 3 and<em> Cribriform septal occlude</em>r in 1 case. Procedure was successful in 25 cases (83.3%). Complications: device embolization in one case (surgical retrieval), unstable device in two pts., minor rhythm disturbances in 2 pts., complete heart block (cAVB) in one pt. NO deaths. All patients were Symptoms free and gaining weight one year after closure.<br /> <strong>Conclusion</strong> Transcatheter closure of congenital VSDs offers encouraging results.<br /> <strong>Recommendation:</strong> More experience and long-term follow-up are mandatory to assess safety and effectiveness of this procedure as an alternative to conventional surgeryAl-Azhar University, Al-Azhar Pediatric SocietyAl-Azhar Journal of Pediatrics1110-777419220160601BRAIN MRI AND MRS IMAGING FOR DIAGNOSTIC EVALUATION OF BILIRUBIN ENCEPHALOPATHY IN THE NEWBORN165016627908310.21608/azjp.2016.79083ENHisham Ahmad AlyHussein MontaserJournal Article20200325<strong><em>Background & purposes:</em></strong>MR examination of infants with kernicterus shows abnormal changes in signal intensity in various parts of the brain, including the globus pallidus and subthalamic regions. The purpose of this study was to see if the MR spectroscopic profiles of infants with hyperbilirubinemia and symptoms of kernicterus provide new insights into the pathophysiology of bilirubin and early diagnosis of bilirubin encephalopathy.
<strong><em>Methods:</em></strong>This observational comparative study was done at Sayed Galal Univesity Hospital between June 2015 to December 2015. Eighteen newborns, with hyperbilirubinemia were divided into 2 groups; <strong>Group one: </strong>newborns with neonatal Hyperbilinaemia without encephalopathy (12 cases). <strong>Group two</strong>: newborns with neonatal Hyperbilinaemia and encephalopathy (NBE) diagnosed by BIND score (Bilirubin Induced Neurological Dysfunction Score) ( 6 cases). Brain MRI and MRS were done to both groups and the differences in imaging, clinical and biochemical data between both groups were evaluated statistically. Ethical committee approval and parent consent were obtained before the start of the study.
<strong><em>Results:</em></strong> In our study, one case only in group II had abnormal increased signal intensity in the globus pallidus on T1-weighed MRI. However, we clearly demonstrated abnormal metabolism in MRS study with a decreased NAA/ Cr (N Acetyl Aspartate/ Creatine), and Cho/Cr (Choline/Creatine) ratios in the basal ganglia in the 6 neonates of group II.
<strong><em>Conclusion</em></strong> <strong><em>and Recommendations: </em></strong>MRS is useful in the differential diagnosis of patients with NBE from patients with NH, especially when the symptoms of patients with NBE are subtle and MRI does not reveal clear obvious abnormalities.Al-Azhar University, Al-Azhar Pediatric SocietyAl-Azhar Journal of Pediatrics1110-777419220160601EPIDEMIOLOGICAL STUDY OF NUTRITIONAL STATUS AMONG CHILDREN IN ASSIUT GOVERNORATE166316747908410.21608/azjp.2016.79084ENAbd El Magid M. BayomiSabah Abdu HagrassJournal Article20200325<strong>B</strong><strong>ackground: </strong>Malnutrition is a major health problem, especially in developing countries. It affects almost 800 million people. Incidence rates vary among different continents of the world. PEM is undoubtedly the most serious nutritional problem affecting several thousand young children in Egypt. <strong>This study was aimed</strong> to find out the epidemiology of under- nutrition and PEM among children less than 5 years old. <strong>Patients and methods</strong>: a cross sectional randomized study was carried out on 1026 children of age group from one month to 5 years old. Ethical clearance was obtained and permission from respective authorities was also taken. The instrument used is a randomized method (simple random sample) from MCH centers and OPD of Al-Azhar University hospital in Assiut. History taking, physical examinations including nutritional assessment clinically and anthropometrically (using WHO growth charts) was done. Data was collected and statistically analyzed and represented in tables and figures. <strong>Results: </strong>we found that age of 17.1 % of studied children was less than one year, 21.4% aged 1 -2 years and 61.5 % of children aged 2 – 5 years, 54.7 % were females, 63.9 % were from rural areas and 54.5 % were from low social class families. The overall prevalence of under-nutrition was 35.5 %. The under-nutrition was more frequent among children less than 2 years of age (65.9 %), (p value < 0.001). Females were more suffering from under-nutrition (57.4 %), (p value 0.0491). More than 70 % of under-nourished children were from rural areas (p value 0.002). Children of first order of birth were more suffering from under-nutrition followed by those of 3rd and fourth order of birth. More than 80 % of under- nourished children were from low social class families (p value < 0.001). in our study we found a statistically significant differences between well and under-nourished children according to some clinical parameters (feeding, history of infections, hospital admissions, vaccinations and error in weaning), (p value < 0.0001), where under-nutrition was frequent among artificially fed children and those with error in weaning. Infections especially diarrheal diseases and frequent hospital admissions were major risk factors for under- nutrition. More than 58 % of under-nourished children were simple under- weight, 24 % stunted, 10.46 % wasted and 4.9 % wasted and stunted. Incidence of simple under-weight (58.8) was more than % of Marasmus (26.65 %). Kwashiorkor constitutes 11.82 % while incidence of Marasmic kwashiorkor was 2.74 %. A statistically significant differences between children of different age groups as regard incidence of types of under-nutrition, where simple under-weight was more prevalent among children aged 1-2 years old followed by children aged 2-5 years (p 0.021). Stunting (p value 0.452) and wasting (p value 0.025) was more prevalent among children less than one year of age, while combined wasting and stunting were more incidence among children aged 1-2 years old (p value 0.031). The incidence of Marasmus, Kwashiorkor and Marasmus Kwashiorkor were more incidences among children less than one year old, while simple under-weight more prevalent among children aged 2-5 years. A statistically significant difference between both sex as regard types of PEM, where simple under-weight and Marasmus Kwashiorkor were more prevalent among females, while Marasmus and Kwashiorkor were more prevalent among males. The overall incidence of under-nutrition among children from rural areas was 39% compared to those from urban areas (29.5 %). Marasmus, kwashiorkor and Marasmus kwashiorkor were more prevalent among children from rural areas. A statistical non-significant difference was found between children from urban and rural areas as regard incidence of simple under-weight (p value > 0.05).Al-Azhar University, Al-Azhar Pediatric SocietyAl-Azhar Journal of Pediatrics1110-777419220160601PLATELET PARAMETERS AS A PROGNOSTIC VALUE IN NEONATAL SEPSIS167516907908510.21608/azjp.2016.79085ENJournal Article20200325<strong>Background:</strong> Neonatal septicemia is one of the major health problems throughout the world. Despite improved neonatal care over the past decades, infections remain common and sometimes life-threatening in neonates admitted to the neonatal intensive care unit (NICU). Thrombocytopenia is also a common manifestation of neonatal septicemia. Neonatal septicemia requires rapid, accurate diagnosis and treatment for better prognosis. Thrombocytopenia occurs in early course of septicemia, therefore platelet count and its indices may be considered as early predictor for the diagnosis of septicemia.
<strong>Aim of the study:</strong> to find out the occurrence of thrombocytopenia, the mean platelet volume(MPV) and platelet distribution width(PDW) among the cases of probable and culture proven neonatal sepsis, and to ascertain whether any association is present between counts and mortality rate.
<strong>Patients and Methods:</strong> This study was comparative cross sectional study. It was conducted on 80 neonates with proven or probable neonatal sepsis admitted to NICU of Bab Alsheiryah Hospital (Al-AzharUniversity). The study carried out from May 2015 to February 2016. They were divided into 2 groups; group I consists of 26 neonates with culture proved sepsis neonatal sepsis and group II consists of 54 neonates with probable sepsis.For all neonates; History taking (to detect risk factors for sepsis), thorough clinical examination (to detect clinical signs of sepsis) and laboratory investigations (CBC, Platelets count, MPV, PDW, CRP and blood cultures) were done for all patients.
<strong>Results:</strong> Our results revealed that the most common risk factor of neonatal sepsis was PROM>18h. Also poor feeding was the most common symptom followed by respiratory distress. There was negative correlation between platelet count and CRP. In the current study there was reduction in the platelet count in died cases. Also mean platelet volume (MPV) and platelet distribution width (PDW) are significantly higher in cases with neonatal sepsis (p value = 0.001). There was no significant difference in the platelet count in cultural proved sepsis group and suspected sepsis (p value = 0.334). There was no significant difference between thrombocytopenic and non-thrombocytopenic group according to blood culture.
<strong>Conclusion:</strong> Thrombocytopenia is considered an early but nonspecific indicator of septicemia but other causes of neonatal thrombocytopenia should also be ruled out. Cases with thrombocytopenia have higher mortality rate. Low blood level of platelets are associated with bad prognosis, so follow up of levels of the platelets , MPV and PDW may act as a prognostic factors in neonatal sepsis.