Background

Heme oxygenase-1 (HO-1), the inducible isoform of heme oxygenase, catalyzes the oxidative degradation of heme to biliverdin and thence to bilirubin. The human HO-1 gene promoter contains a GT-repeat length polymorphism that alters the level of gene transcription and may modulate neonatal hyperbilirubinemia. However, there is no report of HO-1 promoter polymorphisms in Thai neonates with hyperbilirubinemia.

Objectives

This study is aimed to examine the HO-1 (GT)_n promotor polymorphisms and clinical outcome of neonatal hyperbilirubinemia in northeastern Thai newborns.

Methods

A hundred and fifty eight leftover EDTA blood samples of neonates with hyperbilirubinemia were recruited for DNA extraction. The number of GT-repeats was determined by polymerase chain reaction (PCR) and fragment analysis and grouped into a short (S) allele (≤26 repeats) and long (L) allele (>26 repeats). Clinical data of all samples were collected from medical records by a pediatrician.

Results

The GT-repeat lengths of HO-1 promotor were highly polymorphic, ranging from 15 to 40. The two most frequent alleles had GT-repeat lengths of 23 and 30. The frequency of S and L alleles were 0.53 and 0.47, respectively. Although there was no statistical difference, the SS genotype demonstrated a trend of higher peak serum bilirubin (15.1±3.3, 14.3±2.1 and 14.7±1.8 mg/dL, respectively) and required a longer duration of phototherapy (38.4±18.1, 36.9±22.1 and 37.7±22.7 hr, respectively) than those of SL and LL genotypes.

Conclusion

The short GT-repeat is common among Thai neonates with hyperbilirubinemia. This polymorphism might modulate neonatal hyperbilirubinemia and need to be evaluated in a large cohort study.

Background

Glucose-6-phosphate dehydrogenase (G-6-PD) deficiency is the most common genetic enzyme disorder. The most devastating potential complication of G-6-PD deficiency in neonates is an acute hemolytic crisis which may result in severe hyperbilirubinemia and kernicterus. The molecular characterization of the G-6-PD mutations have been reported in various parts of Thailand.

Objectives

The objective of this study was to identify G-6-PD mutations in G-6-PD deficiency neonates at Srinagarind Hospital, Northeastern Thailand.

Methods

One hundred and four G-6-PD deficient neonates (58 males and 46 females) were subjected from routine screening for G-6-PD deficiency obtained from the Diagnostic Microscopy Unit, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University. Genomic DNA was extracted from peripheral blood leukocytes and investigated for molecular genotyping of G-6-PD mutations commonly found in Thailand (G-6-PD Viangchan, Canton, Union, Mahidol, Kaiping, Chiniese-4 and Chinese-5) by allele specific PCR. The PCR-RFLP were used to distinguish homozygous and heterozygous deficient females.

Results

The most common G-6-PD mutations were G-6-PD Viangchan 61 (58%), followed by G-6-PD Canton and Kaiping 14% and 12%, respectively. Other four G-6-PD mutations, G-6-PD Mahidol, Union, Chinese-5 and Chinese-4 were found with lower frequencies (5%, 4%, 3% and 2%, respectively).

Conclusion

This study demonstrated the molecular identification of G-6-PD mutations among northeastern Thai neonates and G-6-PD Viangchan was the most common mutation, consistent with previously reports from other parts of Thailand, PDR Lao and Cambodia. These finding reflect the common ancestral origin of the population and provide a basic knowledge and useful epidemiology of G-6-PD mutations in this populations.

Background

Opioids and benzodiazepines are widely used in PICU. Prolonged use of these drugs can lead to withdrawal syndrome. The incidence of withdrawal syndrome in critically ill children reached to 86-100% when exposure were more than 5 days. One of the risk factors was no weaning protocol.

Objectives

To establish the sedative weaning protocol and compare between the protocolized and the usual care weaning in high-risk critically ill pediatric patients.

Methods

Open-labeled RCT in tertiary-care hospital, children aged 1 month to 18 years required intravenous opioids or benzodiazepines at least 5 days were recruited. In phase1, we established the weaning protocol and did the pilot study. Then, the eligible subjects were randomly divided into the protocolized and usual care group. The primary objective was the prevalence of withdrawal syndrome assessed by WAT-1 every 8 hours compared between the groups.

Results

30 eligible patients (n=19 intervention group, n=11 control group) were enrolled. The prevalence of withdrawal syndrome was 84% and 81% of patients in intervention and control group, respectively. The percentage of withdrawal days was reduced from 35.63 (control group) to 17.79 (intervention group), p = 0.011. The duration of initial weaning in the intervention group was significantly shorter (p=0.026) and the cumulative dose of morphine solution for rescue therapy in intervention group was statistically lower than the control group (p = 0.011).

Conclusion

The prevalence of withdrawal syndrome was not significantly reduced by using this protocol. It showed the benefits to reduce percentage of withdrawal days, shorten initial weaning, shorten PICU stay, and reduce morphine solution for rescue therapy.

Background

Transfusion of any blood product is a frequent procedure in Newborn Intensive Care Units (NICU). Vital signs are observed frequently throughout transfusion. However there are a few studies about vital sign monitoring frequency in patients receiving blood products.

Objectives

In this study we aimed to monitor temperature, arterial tension and heart rate of newborns receiving any type of blood products.

Methods

In this prospective study, vital signs on 0, 15.,45., 75.minutes and one hour after transfusion of eritrocyte, fresh frozen plasma and trombocyte were recorded prospectively. If any product is transfused more than once, only the vital signs in the first transfusion of the patient were recorded.

Results

In 2018, 860 newborns were hospitalized and 109 of them received 805 blood products; most of the patients were preterm (n:54/119), postoperative congenital heart disease (n:33/119) and congenital malformations (n:19/119). Vital signs during 209 blood products (111 eritrocyte, 60 FFP and 38 thrombocyte suspension) were recorded. Only there was a statistically significant, but clinically nonsignificant (0.1◦C) increase in body temperature after eritrocyte and FFP one hour after transfusion, (p= 0.033 ve p= 0.018). There were no complication such as rash, urticer, tachycardia, flushing, tremor and hypotension.

Conclusion

Conclusion: Blood products seem safe in newborns. They have no significant effect on vital signs. As monitors are used for monitoring newborns in NICUs, frequent monitoring by nurses may be reduced during transusion.

Background

Perinatal asphyxia complicated by hypoxo-ischemic encephalopathy is an attack, with serious consequences in the neonatal period and remains a concern in low-income countries.

Objectives

This work aims to analyze the neonatal profile and prognosis of perinatal asphyxia in the neonatal department of Mohamed VI University Hospital of Marrakech.

Methods

This is a descriptive retrospective study from May 1st to November 30th, 2018, concerning term neonates hospitalized for perinatal asphyxia, in the neonatal department of the mother and child hospital.

Results

Perinatal asphyxia accounted for 15.3% of admissions. The sex ratio was 1.8. Amniotic fluid was abnormal in 56.8%. The general signs were dominated by respiratory distress and hypothermia with respectively 71.2% and 38.6% of cases. All neonates had neurologic manifestations dominated by archaic reflex abnormalities 95%, followed by hypotonia 96.4% and convulsions 33.3%. According to Sarnat's classification, stage 2 was dominant with 45.5%. Renal impairment was often transient 67% 27.2% had stage 2 neurological distress. The metabolic disorders were dominated by hypoglycemia 42.1% and hyperglycemia 17.3%. Transfontanellar and abdominal ultrasound were abnormal with 31% and 9%, respectively. The mortality rate was 5.4%.

Conclusion

Perinatal asphyxia remains a serious pathology. The high mortality recalls that it is imperative to reinforce the prevention by a preparation to an effective and satisfactory resuscitation.

Background

Each breastfeeding is unique, it requires a nuanced and personalized approach.

Objectives

Evaluate the rate of breastfeeding by primipares, report mothers' knowledge before delivery and the various difficulties encountered.

Methods

Our study had interested 60 primiparous women whose age ranged from 17 to 30 years, the delivery took place within the department of gynecology-obstetrics University Hospital Center Mohamed VI, Marrakech; Morocco.

Results

We found that 66.6% of the mothers interviewed expressed complete ignorance about the progress of breastfeeding, due to lack of information during pregnancy; 25% of mothers had a prior idea of breastfeeding from the messages conveyed by education, the social and family environment, while only 8.3% were informed during the follow-up of pregnancy by a health professional; 16.6% of women believed that breastfeeding is more beneficial than breastfeeding. All the women interviewed had hoped to have more precise information on this method of breastfeeding.

Conclusion

Based on our study, it appears that the majority of mothers are unaware of the benefits, the practice, and also the difficulties encountered in breastfeeding. Adequate and complete information during birth preparation will enable them to better manage this method of breastfeeding.

Background

This is a common and serious pathology especially in premature newborn.

Objectives

To study the clinical and paraclinical factors and to evaluate the incidence and etiologies of anemia in premature newborn .

Methods

Our retrospective study concerns 46 cases of premature newborns presenting anemia at the neonatal resuscitation department of the MOHAMMED VI University Hospital Center in Marrakech, from January 2017 to January 2018.

Results

The hospital incidence was 3.78%. The average gestational age was 32 weeks, and a birth weight of 1699 grams. The etiologies of prematurity were divided into unexplained prematurity (31%); maternal causes (28%). Maternal infection is by far the most common in this class (67%); fetal causes (25%) mainly twin (57%) and finally prematurity by utero-placental abnormalities (16%). mean Hb and Hte at birth were 10.82 g / dl and 32.18%, respectively. 30.4% of the premature newborn studied had received a martial treatment based on ferrous iron. 45.7% of premature newborn received one or more transfusions.

Conclusion

Anemia can disrupt the growth of premature newborns and compromise their survival

Background

Knowledge of the blood grouping of the mother occupies a major importance during the neonatal period in order to prevent fairly serious pathologies, especially incompatibilities.

Objectives

To report the rate of mothers with known blood groupage.

Methods

Our study had attracted 120 women, whose age ranged from 18 to 42 years, the birth took place in the department of gynecology-obstetrics University Hospital Center Mohamed VI, Marrakech;Morocco.

Results

We revealed that 75% of the mothers surveyed were completely unaware of their blood grouping due to unattended pregnancy; the blood grouping of 16.6% of the mothers was identified but ignored by them; 8.3% of mothers were informed about their blood grouping,12.5% of women interviewed had a negative rhesus grouping that had already received anti-D.

Conclusion

This survey showed that the majority of mothers were unaware of their blood grouping for this reason it would be very useful to encourage follow-up of pregnancy.

Background

Diabetes Mellitus is the most common medical complication in pregnancy. It affects about 1 to 5% of all pregnancies. Diabetes in pregnancy is linked to several maternal and fetal/ neonatal complications.

Objectives

To determine the prevalence of perinatal morbidity and mortality pattern amongst infants of diabetic mothers.

Methods

A hospital-based retrospective cohort study performed at the University Hospital of Tripoli. Structured questionnaire used to collect relevant information and data from pre-registered medical records of 140 infants of diabetic mothers( IDMs) admitted to NICU (Januray 2013-December 2014). Maternal data were also retrieved from records( maternal parity, age, mode of delivery, maternal hypertension and management of DM). Data were coded and analyzed by using SPSS version 24. Statistical level of significance was set at a p-value of (<0.05).

Results

A total of 140 IDMs was included in the study, 118 cases born by Caesarian section(C/S), of which (63.6%) born by emergency C/S (EMC/S). The mean gestational age of IDMs was35.9±2.3 weeks and mean birth weight was3197±1042(g). The comments morbidities were respiratory distress (73.6%), hypoglycemia(45%), hypocalcemia (32.1%) macrosomia(23.6%), impaired fetal growth(13.6%)and hyperbilirubinemia(14.3%). Mortality rate was 13 (9.3%); 8 of them were had CHD (Table). Congenital anomalies account for (24.3%), congenital heart disease(CHD) was the most significant morbidity affecting the outcome(p-value= 0.0001).

Conclusion

CHD was the commonest neonatal morbidity and mortality amongst infants of diabetic mothers. The burden of IDMs is high in this study which gives an urgent message in a national base to decrease complications associated with IDMs.

Background

The hospitalization of the premature newborn is a difficult journey and anxiety for parents, studies on the experience of the mother are becoming more numerous, while that of the father remains little studied today.

Objectives

: To explore the experiences of the fathers of premature children and the psychopathological and social consequences of the birth of their children.

Methods

A qualitative and quantitative study was carried out at the Neonatology Department at the Mohammed VI University Hospital Center in Marrakech with 20 men whose premature babies are still hospitalized in neonatology departments.

2 questionnaires were administered: IES-R and EPDS, a semi-directive interview was also conducted.

Results

Highlighting several aspects such as the difficult experience of premature birth and hospitalization and the ambivalence of returning home. The importance of establishing a positive father-child relationship, social support and the versatility of the role of father. Premature birth has a less traumatic impact on fathers.

Conclusion

The results suggest the need to implement specific care for fathers which is lacking in Morocco

Background

Umbilical vein catheter infections are a major health problem for neonates hospitalized in a resuscitation unit.

Objectives

To identify risk factors for bacterial infections associated with umbilical vein catheters in neonates.

Methods

Our retrospective study was conducted between January 1, 2017 and January 31, 2018, including newborns hospitalized in the first 48 hours of life in the neonatal resuscitation department of the MOHAMMED VI University Hospital in Marrakech. .

Results

100 newborns were included and 30 were diagnosed with bacteremia on umbilical venous catheter, the mean duration of catathérism was 8 days, the average length of stay was 22 days, the average birth weight was 1kg200. Of these, 13 were due to Meticillin-resistant coagulase-resistant Staphylococcus, 10 to Cephalosporin-resistant Klebsiella pneumoniae, 1 to Kluyvera intermedia and 6 to Enterobacter cloacae resistant to cephalosporins. In multivariate analysis the risk factors for infection were: birth weight, gestational age, transfusion; the duration of noninvasive ventilation, the duration of enteral nutrition

Conclusion

Host-related factors are likely to be important in the risk of infection acquisition in the newborn. Prevention remains difficult and the establishment of strict aseptic measures in the management of umbilical venous catheters should be preferred

Background

Imipenem-resistant Acinetobacter baumannii meningitis is a hospital-acquired infection, the treatment of which constitutes a real therapeutic challenge

Objectives

with a review of the literature, we report five cases of imipenem-resistant Acinetobacter baumannii neonatal meningitis

Methods

they were 5 newborns, admitted in nenatal care unit, University Hospital, Marrakesh

Results

five cases of imipenem-resistant Acinetobacter baumannii neonatal meningitis following ruptured myelomeningocele, treated with intravenous colistin with favorable results. In recent years, Acinetobacter baumannii has become a more and more commonly described pathogen in hospital-acquired infections. However, the cases of meningitis are mainly postoperative and are still not quite frequently described in the literature. Colistin appears to be preferably administered intravenously at a dose of 100.000 IU/kg/day.

Conclusion

Nosocomial meningitis is a rare, though severe, entity in the newborn and Acinetobacter baumannii is exceptionally implicated. The emergence of multi-resistant strains of Acinetobacter baumannii can sometimes be a therapeutic impasse. Colistin remains the ideal treatment choice for Acinetobacter baumannii meningitis, whether intravenously administered.

Background

Perinatal asphyxiation is one of the leading causes of neonatal death. Most associated risk factors can be prevented.

Objectives

To study the link between the mode of delivery and perinatal asphyxiation in our context.

Methods

Forward study carried out at the Neonatal Resuscitation Service University Hospital Center Mohamed VI Marrakech Morocco, during the period from 1 June to 30 November 2018. Twenty newborns were included in our study.

Results

Among all mothers: 75% of mothers were multiparous; 50% were followed; 25% had a pre-eclampsia; 10% had gestational diabetes. Deliveries in low childbirth were performed in 65% of mothers. Birth weight ranged from 3kg-3Kg500 in 13 newborns to more than 4kg in 7 newborns; 65% of newborns were born from low-pathway childbirth had perinatal asphyxiation (stage I: 23.07%) (Stage II:23.07%) and (Stage III:53.8%) according to SARNAT classification; 35% of newborns delivered by cesarean section had perinatal asphyxiation (Stage I:14.2%), (Stage II:28.5%) and (Stage III: 57 .1%). The transfontanellar ultrasound was performed in all cases, it was pathological in 84.6% of newborns.

Conclusion

Pregnancy follow-up and delivery planning will prevent this serious and common pathology in our context.

Background

Congenital giant lobar emphysema is a rare pulmonary malformation, characterized by progressive distension of a lobe due to an incomplete bronchial barrier. Antenatal diagnosis is possible.

Objectives

We report a case of giant lobar emphysema appeared since birth in a newborn hospitalized in Neonatal Intensive Care Unit hospital University Hospital Mohamed VI Marrakech Morocco

Methods

He was a newborn, hospitalized in his first day for respiratory distress.

Results

It was a new born admitted to its 24th day of life for a respiratory distress and cyanosis appeared since birth. The clinical examination had revealed tympanism of the left lung and a deviation of heart sounds on the right side. Chest X-ray revealed a hyperclarity of the left pulmonary field and a cardiomediastinal deviation to the right. The chest CT scan evoked emphysema of the left upper lobe.

Conclusion

a better knowledge of this entity with an antenatal diagnosis would allow a better management

Background

Immobility negatively affects muscle function, circadian rhythm, and potentially increases the risk of delirium. Early mobilization (EM) of critically ill adults has been found safe and effective.

Objectives

We evaluated the opinions and barriers of nurses and physicians to EM before and after implementation of an EM program.

Methods

A questionnaire was distributed to PICU nurses and physicians before (December 2017) and after (October 2018) implementation of an EM program. Descriptive statistics were used.

Results

Ninety-four (59.1%) and 71 (48.6%) members of the PICU staff completed the survey, respectively before and after implementation. During both periods, the general opinion was that early mobilization is beneficial for critically ill children. The largest perceived benefits were shorter durations of ventilation and PICU stay, lesser use of sedatives, and improved day-night cycle (80.3-100%) during both periods. Patients’ family satisfaction with EM had increased from 17% before to 32.4% after implementation. Before implementation, time constraint (64%), physiological instability (63%), risk of endotracheal tube dislocation (63%), loss of indwelling central venous catheter (60%), lack of equipment (53%), and increased workload (51%) were ranked as important barriers to EM. After implementation, only time constraint (73%), and risk of endotracheal tube dislocation (51%) were perceived as important barriers (p<0.001). Support of physical therapists for EM was perceived as significantly higher after implementation: 33% vs. 76% (p<0.001).

Conclusion

All nurses and physicians considered EM as important for critically ill children. Further, our research demonstrates that most of the perceived barriers had been resolved after implementation of EM.