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Article
Acute Renal Failure in Neonates, Single Center Experience: Child's Central Teaching Hospital

Authors: Basil M. Hanoudi, Jessar S. Hasan --- Mahdi M. Murad
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2014 Volume: 13 Issue: 2 Pages: 257-261
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:Acute renal failure is an acute deterioration in the ability of the kidneys to maintain homeostasis of body fluids, electrolytes and is associated with acute decrease in the glomerular filtration rate that leads to retention of toxic metabolic end products. It’s incidence in hospitalized neonates is 8-24%. The main causes of acute renal failure in neonates are pre-renal in nature, intrinsic and post-renal mechanisms of failure are much rarer conditions.OBJECTIVE: To evaluate; types, associated predisposing factors, and short term outcomes of renal failure in neonates of neonatal unit in Child’s Central Teaching Hospital, and to compare the results with those reported in the literature.PATIENTS AND METHODS: A cross sectional study was carried out on 30 neonates with acute renal failure admitted to neonatal unit in Child’s Central Teaching Hospital during the period from 1st of June 2012 to 30th of November 2012.RESULTS: There were 43 cases diagnosed as renal failure out of 927 hospitalized neonates (4.63%).Thirteen cases were excluded according to the inclusion criteria, so only 30 cases were enrolled in this study. Male to female ratio was 1.7:1. Most of patients were term (86.7%). The prevalence of pre-renal, renal and post renal causes of acute renal failure were 76.6%, 16.7% and 6.7% respectively. The most common predisposing factors for acute renal failure in this study were sepsis (80%), perinatal asphyxia (10%), heart failure (3, 4%). Most patients had more than one predisposing factor. Among admitted neonates with renal failure, mortality rate was 16.7% and it was significantly higher in patients with sepsis (P<0.05).CONCLUSION: Early recognition of risk factors such as sepsis, perinatal asphyxia or, heart failure, and rapid effective treatment of contributing conditions will decrease acute renal failure in the neonatal period.


Article
The Role of C-Reactive Protein in Diagnosis of Neonatal Sepsis

Author: Sabah Hassan Alatwani
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2014 Volume: 11 Issue: 4 Pages: 906-911
Publisher: Babylon University جامعة بابل

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Abstract

Across-sectional study was conducted in Amara city hospitals during a period from March 2013 till February 2014. The study sample includes 88 neonates (43 with clinical features of septicemia and 45 neonates who were normal). Blood culture and C-reactive protein tests were done for all neonates. In comparison with the result of blood culture, the C-reactive protein test was found that 42 out of 45 neonates as true negatives, the remaining 3 neonates showing sepsis and were considered as false negative. While 32 out of 43 neonates were considered as true positive. Finally the study showed that the sensitivity of C-reactive protein examination was 74.4%, specificity was 93% , positive predictive value was 91% and negative predictive value was 79%, so the C-reactive protein had important role in detection of the neonatal sepsis and consider an supportive tool to gold standard (blood culture) test for diagnosis of septicemia.


Article
Identification of bacterial agentsand antimicrobial susceptibility of neonatal sepsis with patient,s outcome

Authors: Abdul-Kareem Mohammed Ali عبد الكريم محمد --- Lamia Abdul-Kareem لمى عبد الكريم --- Emad Japur Rashed عماد جبر رشيد
Journal: Al-Qadisiyah Medical Journal مجلة القادسية الطبية ISSN: 18170153 Year: 2014 Volume: 10 Issue: 17 Pages: 148-161
Publisher: Al-Qadisiyah University جامعة القادسية

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Abstract

Background : Sepsis neonataroum is an important factor for morbidity and mortality in neonates. The incidence of neonatal bacterial sepsis depends on geographic area and may vary from country to country as well as within the same country. Objective: To identify the percentage of neonatal septicemia confirmed by positive blood cultures among 664 neonates admitted in neonatal care unit, and to identify the bacterial agents causing early and late neonatal sepsis and their antimicrobial susceptibility, and the outcome from neonatal septicemia. Patients and methods: The total number of patients(with clinical signs and symptoms suggesting sepsis) collected from neonatal care unit of AL-Kadimiya Teaching hospital from the 1st of January to the end of october 2011 were 664 neonates, and only 105 neonates who show signs and symptoms suggestive of septicemia that were confirmed by a positive blood culture were enrolled in this study. Data were collected include :Gestational age, Birth weight , Gender, Onset of sepsis, Place of delivery and also we followed up the subjects and recorded the outcome till discharge. Results: In this prospective study and from 664 neonate were admitted (total number of admission), positive blood cultures were obtained for 105 neonates (15.8%). Gram negative bacteria were the commonest causative agent in both early (66.7%) and late (56.9%) onset sepsis. Among neonates with sepsis, 33 patients (31.4%) had early onset and 72 patient (68.6%) had late-onset neonatal sepsis. The susceptibility of the isolated causative agent to selected antibiotics were the same in early and late onset sepsis. Over 70% of gram negative bacilli were resistant to both ampicillin and cloxacillin but show variable sensitivity to gentamicine and cefotaxime. Most of the isolated gram positive bacteria were sensitive to ampicillin, cloxacillin and cefotaxime but highly resistant to gentamicin. The death rate was 20.9%. Early onset sepsis, male gender, gestational age less than 37 weeks and birth weight less than 2500 gm were found to be significantly associated with death. Conclusions: Gram negative bacteria were the main cause of early and late-onset neonatal sepsis in our center and many of these isolated bacteria were resistant to the used antibiotics. Low birth weight neonates <2500 gm, gestational age < 37weeks, male gender and early onset sepsis were significantly associated with death. The death rate due to neonatal sepsis was higher compared with the other studies. Recommendations: Proper antenatal care and optimal obstetric management in early detection and treatment of mothers at risks together with minimizing invasive procedures of infants as much as possible and ideal nursery setup which includes adequate space for care of infants and aseptic equipments for monitoring.

العفن الولادي هو سبب مهم من أسباب الوفيات للأطفال حديثي الولاده.أن نسبة حدوث العفن الولادي البكتيري تعتمد على المنطقه الجغرافيه وقد تختلف من بلد ألى بلد وأيظا في البلد الواحد.الهدف من الدراسه لمعرفة نسبة حدوث العفن الولادي , البكتيريا المسببه للعفن الولادي المبكر والمسببه للعفن الولادي المتأخر وأيضا معرفة مدى أستجابتها للمظادات الحيويه ومعرفة نسبة حدوث الوفيات الناتجه من العفن الولادي في وحدة حديثي الولاده. لقد تم جمع المرضى من وحده حديثي الولاده في مستشفى الكاظميه التعليمي للفتره من الاول من كانون الثاني الى نهاية تشرين الاول لسنة 2011 م. كل المرضى الدين أدخلوا الى وحدة حديثي الولاده والذين لديهم العلامات والاعراض التي تدل على العفن الولادي والتي تم تأكيدها بواسطة زرع الدم الموجب تم أدراجها في هده الدراسه. المعلومات التي جمعت تشمل:عمر الجنين عند الولاده , الوزن عند الولاده , جنس المولود , تأريخ حدوث العفن الولادي , مكان الولاده , وكدلك تم متابعة المرضى وتسجيل النتيجه النهائيه للمرض. في هذه الدراسه ومن 664 مريض تم أدخالهم, كانت نتيجة زرع الدم موجبه ل105 حاله (15,8%). البكتيريا السالبه لصبغة الكرام كانت اكثر انواع البكتيريا المسببه لكل من العفن الولادي المبكر(66,7%) والعفن الولادي المتأخر(56,9%). أن من بين هؤلاء المرضى كانت هناك 33 حاله (31,4%) من عفن الدم المبكر و 72 حاله (68,6%) من عفن الدم المتاخر. أن استجابة البكتيريا للمضادات الحيويه التي جربت كانت متشابهه في حالتي العفن المبكر والعفن المتأخر في هذه الدراسه. أن أكثر من 70% من البكتيريا السالبه لصبغة الكرام كانت مقاومه لكل من الامبسيلين والكلوكساسيلين ولكن اظهرت استجابات متفاوته لكل من الجينتامايسين والسيفوتاكسايم. أن معظم البكتيريا الموجبه لصبغة الكرام اظهرت استجابه لكل من الامبيسيلين والكلوكساسيلين والسيفوتاكسايم بينما اظهرت مقاومه عاليه للجينتامايسين. أن نسبة الوفيات كانت 20,9%. أن العفن المبكر, الذكور, الولاده المبكره الاقل من 37 اسبوع و الوزن الاقل من 2500غرام عند الولاده كانت عوامل مصاحبه للوفاة . البكتيريا السالبه لصبغة الكرام كانت السبب الرئيسي للعفن الولادي المبكر والمتاخر في مركزنا وان العديد من البكتيريا المسببه كانت مقاومه للمظادات الحيويه المستخدمه. نوصي بالعنايه الجيده خلال اللحظات الاولى للولاده والمتابعه الافضل اثناء التداخلات الولاديه والكشف المبكر والعلاج اللازم للأم المصابه بالألتهابات مع تقليل التداخلات الجراحيه المساعده للولاده قدر المستطاع مع مراعاة ترك مسافات مناسبه بين الاطفال الحديثي الولادة واستخدام الادوات المعقمه عند المراقبه

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