Consecutive Infants Research Articles

Assessment of the center of pressure line aids to detect subtle deformities after clubfoot treatment

The Ponseti method has become accepted worldwide as the treatment of choice for nonoperative management of clubfoot. However, there has been no research on whether casting should begin in the newborn period (≤ 30 days old) or later (> 30 days but < 1 year old) or on whether the length of the foot at the beginning of casting is predictive of the outcome of therapy. Therefore, we conducted an investigation to compare outcomes in patients started on casting therapy in the newborn period or later. Outcomes were based on Pirani and Diméglio scores. The study population was comprised of 40 clubfeet in 29 consecutive infants with no associated neuromuscular disease, who underwent Ponseti treatment. The median follow-up was 34 months (range, 20-47 months). Casting began in the newborn period on 26 feet of 18 patients (newborn group), and after 1 month of age on 14 feet of 11 patients (older infant group). Final Diméglio scores were significantly worse for the patients whose casts were applied in the newborn period, compared with those who had the first cast applied at a time >30 days postpartum (P = .04). Infants with feet ≥8 cm in length at the start of cast treatment had better final Diméglio scores than those with feet <8 cm. Our findings suggest that casting according to the Ponseti method should begin in infants older than 1 month of age, or with an involved foot ≥8 cm in length.

Intake, bioavailability, and absorption of iron in infants aged 6 to 36 months: an observational study in a Brazilian Well Child Clinic

Abstract Background Preventing the development of iron deficiency anemia during infancy requires the appropriate complementary foods with high energy, nutrient density, and adequate iron content, as well as high nutrient bioavailability. We aimed to evaluate iron intake, bioavailability, and absorption from foods, in healthy infants and toddlers at a Well Child Clinic. Methods This observational, cross-sectional, descriptive study evaluated 96 consecutive infants and toddlers, 6 to 12 months of age (group I) and 13 to 36 months of age (group II) that were brought for regular pediatric visits and introduced to complementary foods. Quantitative 24-h dietary recalls were obtained, and iron intakes quantified for lunch and dinner. Iron bioavailability and absorption were calculated and analyzed by Monsen’s and FAO/WHO’s methods according to enhancing factors: meat, poultry, and fish (MPF) and vitamin C. Results There were no significant differences in demographic, clinical, and anthropometric variables between groups. Vitamin C intake was not different between groups, but MPF was significantly lower in group I. The proportion of children with recommended RDA iron intake was lower (p &lt; 0.05) in group I (16 %) than that in group II (47 %). Group I had lesser MPF intake and iron absorption and a higher proportion of children with low bioavailability in lunch and dinner when compared to group II (p &lt; 0.05). Conclusions Inclusion of low-cost meat, especially chicken meat and vitamin C-rich foods, at the same meal, both in lunch and dinner, would be of particular advantage to ensure an adequate intake of bioavailable iron during complementary feeding.

Gait poorly explain satisfaction rate reported of the parents after clubfoot treatment in children

The Ponseti method has become accepted worldwide as the treatment of choice for nonoperative management of clubfoot. However, there has been no research on whether casting should begin in the newborn period (≤ 30 days old) or later (> 30 days but < 1 year old) or on whether the length of the foot at the beginning of casting is predictive of the outcome of therapy. Therefore, we conducted an investigation to compare outcomes in patients started on casting therapy in the newborn period or later. Outcomes were based on Pirani and Diméglio scores. The study population was comprised of 40 clubfeet in 29 consecutive infants with no associated neuromuscular disease, who underwent Ponseti treatment. The median follow-up was 34 months (range, 20-47 months). Casting began in the newborn period on 26 feet of 18 patients (newborn group), and after 1 month of age on 14 feet of 11 patients (older infant group). Final Diméglio scores were significantly worse for the patients whose casts were applied in the newborn period, compared with those who had the first cast applied at a time >30 days postpartum (P = .04). Infants with feet ≥8 cm in length at the start of cast treatment had better final Diméglio scores than those with feet <8 cm. Our findings suggest that casting according to the Ponseti method should begin in infants older than 1 month of age, or with an involved foot ≥8 cm in length.

Acute Kidney Injury Following Cardiac Surgery in Neonates and Young Infants: Experience of a Single Center Using Novel Perioperative Strategies.

Acute kidney injury (AKI) following cardiac surgery is a serious complication with a reported incidence of 30% to 50%. This study sought to determine the prevalence and risk factors for AKI among neonates and young infants undergoing repair of cardiac defects at an institution using novel perioperative strategies. A retrospective analysis of 102 consecutive infants (<2 months) undergoing repair of cardiac defects on cardiopulmonary bypass formed the study group. Cardiac diagnoses were stratified according to the Society of Thoracic Surgeons Congenital Heart Surgery (STAT) mortality categories. The prevalence of AKI within 72 hours was defined according to the three-stage Acute Kidney Injury Network criteria. Novel bypass strategies to preserve renal function included maintenance of higher hematocrit and high flow rates on cardiopulmonary bypass despite systemic hypothermia, and avoidance of albumin and milrinone in the perioperative period. Mean age was 24 ± 19 days. Eighteen patients were less than 7 days of age at the time of surgery. Patient distribution according to STAT categories was as follows: 1 (n = 21), 2 (n = 12), 3 (n = 22), 4 (n = 28), and 5 (n = 19). The incidence of stages 1, 2, and 3 AKI in the population was 8% (n = 9), 2% (n = 2), and 0% (n = 0), respectively. On multivariate analysis higher STAT category was the only significant risk factor for AKI. Current incidence of AKI following cardiac surgery in young infants at our institution is low. Novel perioperative strategies may have contributed to the low observed incidence of AKI in our patient population. Increased complexity of heart disease was a risk factor for AKI.

7. Long term results of quadrangular autologous pericardial patch reconstruction of the pulmonary artery during arterial switch operation on post-

The aim of this retrospective study is to evaluate the technique of Quadrangular Fresh Autologous Pericardial Patch for the reconstruction of the pulmonary artery in Arterial Switch Operation (ASO) to prevent the post-operative pulmonary artery stenosis (PAS). A total of 287 consecutive infants with transposition of great arteries were treated with ASO in our center between January 2000 and September 2014. The mean age was (7.76 days) and mean weight was (3.67 kg). The new pulmonary arterial root was reconstructed with a fresh quadrangular autologous patch. The technique includes extensive mobilization of both pulmonary artery branches and direct suturing of the parch to 2/3 of the annulus of the new pulmonary artery trunk first, and then reconstruction finish by the re-suspension of the posterior commissure of the new pulmonary valve inside the patch. Patients were examined using trans-thoracic echocardiography consecutively at discharge form the hospital, and at 3–6 months and yearly after discharge. The mean follow up time was 78 months. The early mortality was 5.19% (17 patients), and there were no late mortality. The highest mortality was reported during the beginning of the pediatric surgical program. The mortality for the last 100 patients was 1%. The pressure gradient across the pulmonary valve in 249 patients (87%, was less than 20 mmHg. Mild pulmonary stenosis (pressure gradient of 20–40 mmHg) was present in 32 patients (11.14%) and moderate pulmonary stenosis with gradient 40–60 mmHg was manifested in 4 patients (1.39%). Reconstruction of the new Pulmonary artery during the ASO, using the quadrangular autologous fresh pericardial patch, is effective and reproducible in reducing the incidence of post-operative pulmonary stenosis.

Dexmedetomidine is Associated with an Increased Incidence of Bradycardia in Patients with Trisomy 21 After Surgery for Congenital Heart Disease.

This study aimed to evaluate adverse cardiac events using dexmedetomidine in infants with trisomy 21 and those without (controls) and examined potential risk factors in infants after cardiovascular surgery. We conducted a single-center retrospective cohort study. The medical records of 124 consecutive infants who had undergone cardiovascular surgery between April 1, 2013, and October 31, 2015, were enrolled. Clinical characteristics, usage of dexmedetomidine, and perioperative medications were analyzed. Adverse cardiac events were assessed with the Naranjo score and World Health Organization-The Uppsala Monitoring Centre (WHO-UMC) criteria. In total, 124 consecutive infants (30 patients and 94 controls) met the inclusion criteria. Eight of 30 (26.7%) patients with trisomy 21 and 12 of 94 (12.8%) controls experienced adverse cardiac events (i.e., hypotension, transient hypertension, and bradycardia) during dexmedetomidine with median Naranjo score of 6, and causality categories of WHO-UMC criteria were "certain" or "probable." Of those, the incidence of bradycardia occurred at a higher rate in patients with trisomy 21 than in controls (P=0.011). Multiple logistic regression analysis revealed that the presence of trisomy 21 was an independent risk factor for adverse cardiac events of dexmedetomidine after cardiovascular surgery (odds ratio 4.10, 95% CI 1.17-11.19, P=0.006). Dexmedetomidine is associated with an increased incidence of bradycardia in patients with trisomy 21 after surgery for congenital heart disease. Physicians using dexmedetomidine should know a great deal about the characteristics of patients with trisomy 21, and hemodynamic monitoring should be closely observed.

Rapid, Non-Invasive Urine Collection is Feasible in Infants Up To 12 Months Old

Abstract BACKGROUND: In non-toilet trained children, collection of non-contaminated urine specimens for culture is done by urethral catheterization or suprapubic aspiration,both invasive procedures, or by clean-catch technique, which is time-consuming. A rapid, non-invasive method of urine collection from neonates has been recently described:a stimulated clean-catch technique, with an 87% success rate within 5 minutes (Herreros et al, Arch Dis Child 2013; 98:27-29). OBJECTIVES: To determine: 1) the success rate in obtaining urine specimens within 5 minutes from infants (birth-12 months) via this stimulated clean-catch method; and 2) the time to collection of a urine specimen, via the stimulated clean-catch method. DESIGN/METHODS: Subjects were consecutive infants requiring a urine specimen for urinalysis and/or urine culture, identified by nursing or medical staff in either the inpatient or outpatient areas of a regional hospital. Verbal consent was obtained from the parent or guardian. 10- 60 minutes after a feeding, the infant’s genitalia were cleaned, and a stimulated clean-catch urine collection was attempted. The method consists of holding the infant under the axillae, with legs dangling, and stimulating voiding by rapidly tapping the suprapubic area for 30 seconds, then gently massaging in a circular pattern over the paralumbar area bilaterally for 30 seconds. The tapping and massage are repeated alternately until the infant voids, and the urine is collected “mid-stream”. RESULTS: Urine collection was attempted 51times, from 43infants, and was successful within 5 minutes in 37of 51attempts (72%). In infants 0-30 days old, the success rate was 64% (14 of 22 attempts). In infants 31-90 days old, the success rate was 93% (14 of 15 attempts). In infants 3-6 months old, the success rate was 67% (4 of 6 attempts). In infants 6-12 months old, the success rate was 63% (5 of 8attempts). The time to successful urine collection was recorded in 26cases, with both a median and a mean time of 85seconds. In 77% of the successful collections, the urine was obtained within 2 minutes. CONCLUSION: The stimulated clean-catch method of urine collection is useful in infants up to 1 year of age. In most cases of successful urine collection, the infant will void within 2 minutes.

Risk of recurrence of retinopathy of prematurity after initial intravitreal ranibizumab therapy.

We report our experience with the use of intravitreal ranibizumab for the treatment of retinopathy of prematurity (ROP). A retrospective review was performed on 138 consecutive infants screened at a single centre over 18 months. Intravitreal ranibizumab was offered in selected cases requiring treatment, such as aggressive posterior ROP or poor mydriasis. 2 eyes of 1 infant received intravitreal ranibizumab alone and 8 eyes of 5 infants received combined intravitreal ranibizumab and laser therapy. 3 out of 8 eyes treated initially with intravitreal ranibizumab monotherapy had persistent disease requiring laser therapy, and 3 out of 5 eyes with initial regression suffered disease recurrence at a mean of 7.6 weeks post-injection. 2 eyes treated first with laser followed by intravitreal ranibizumab had disease regression without recurrence. Our cohort demonstrate a significant rate of persistent disease and recurrence in ROP eyes treated initially with intravitreal ranibizumab monotherapy, which is greater and earlier than that reported for intravitreal bevacizumab in the BEAT-ROP study. Intravitreal ranibizumab may be useful as an initial treatment in selected cases of ROP when laser therapy as first line is suboptimal. However, close monitoring is important and adjunctive laser therapy may subsequently be needed in a majority of cases.

Cardiac arrest in infants, children, and adolescents: long-term emotional and behavioral functioning.

Very little is known about the psychological consequences of a cardiac arrest (CA) during childhood. Our aim was to assess long-term emotional and behavioral functioning, and its predictors, in survivors of CA in childhood. This long-term follow-up study involved all consecutive infants, children, and adolescents surviving CA in a tertiary-care university children’s hospital between January 2002 and December 2011. Emotional and behavioral functioning was assessed with the Child Behavior Checklist (CBCL), Teacher’s Report Form (TRF), and Youth Self-Report (YSR). Of the eligible 107 CA survivors, 52 patients, parents, and/or teachers filled out online questionnaires. Compared with normative data, parents and teachers reported significantly more attention and somatic problems (age range 6–18 years). Parents also reported more attention problems for age range 1.5–5 years. Twenty-eight percent of the children (n = 14) scored in the psychopathological range (i.e., for age range 1.5–18 years; p < 0.001) according to parent reports. Male gender, older age, and basic life support were significantly related to worse scores on the scales internalizing problems, externalizing problems, and total problems and subscale attention problems.Conclusion: Long-term deficits in attention and somatic complaints were reported. Attention problems after childhood CA can interfere with school performance. Long-term follow-up with neuropsychological assessment should be organized. What is known: • Critical illness has a significant influence on the presence of long-term emotional and behavioral problems. • Long-term emotional and behavioral problems have been described for various groups of critically ill children such as congenital heart disease, meningococcal septic shock, and neonatal asphyxia. What is new: • This is the first study that addresses long-term emotional and behavioral problems in a relatively large consecutive series of children and adolescents surviving cardiac arrest. • Long-term deficits in attention and somatic complaints were reported. Electronic supplementary materialThe online version of this article (doi:10.1007/s00431-016-2728-4) contains supplementary material, which is available to authorized users.

Laryngeal ultrasound and vocal fold movement in the pediatric cardiovascular intensive care unit.

Vocal fold motion impairment (VFMI) is a known sequela of cardiovascular surgery. The gold standard for the evaluation of vocal fold movement is flexible nasolaryngoscopy (FNL). Although safe, FNL does cause measurable physiologic changes. Noxious stimuli in cardiovascular intensive care unit (CVICU) neonates may cause imbalance between the pulmonary and systemic circulations and potentially circulatory collapse. The goals of this project were to determine the accuracy of laryngeal ultrasound (LUS) compared to FNL to identify VFMI in CVICU neonates and compare their physiologic impact. Case control. Prospective case-control study. Forty-six consecutive infants from the CVICU were recruited, 23 with VFMI and 23 without based on FNL findings. They then underwent LUS, which was subsequently reviewed by two pediatric radiologists blinded to the FNL results. Physiologic parameters were recorded before and after the procedures. Data analysis was performed with Cohen's kappa and Wilcoxon signed-rank test. Agreement between LUS and FNL was substantial (κ = 0.78). Laryngeal ultrasound had a sensitivity of 0.84 and specificity of 0.95 for identifying VFMI. In terms of physiologic impact, LUS caused statistically significantly less change in diastolic blood pressure (P = 0.01), pulse (P = 0.001), and O2 saturation (P = 0.004) compared to FNL. Arytenoid rotation could be seen clearly, and the vocal fold-arytenoid angle in abduction was most predictive of symmetry and movement (P = 0.17). However, it was difficult to determine vocal fold closure patterns with LUS. Laryngeal ultrasound is a comparable to FNL for evaluating vocal fold mobility with less physiologic impact. 3b. Laryngoscope, 127:167-172, 2017.

Cranial Ultrasonography in Infantile Encephalitic Beriberi: A Useful First-Line Imaging Tool for Screening and Diagnosis in Suspected Cases.

Brain imaging is central to the diagnosis of infantile encephalitic beriberi. Because cranial sonography findings have not been described in infantile encephalitic beriberi, our aim was to investigate its role in the diagnosis of this condition. We performed a retrospective review of head sonography of infants (admitted between November 1, 2014, and March 31, 2015) who presented with encephalopathy. Cranial ultrasonography scans were studied for the alteration of echogenicity of the basal ganglia. Of the 145 consecutive infants who presented with encephalopathy, 58 had thiamine-responsive encephalopathy (infantile encephalitic beriberi) and 87 had encephalopathy due to other causes. Forty-eight of 145 infants with encephalopathy showed hyperechoic basal ganglia. A hyperechoic appearance of the basal ganglia on cranial ultrasonography was found to have a sensitivity of 71% (41/58) and a specificity of 92% (80/87) in diagnosing infantile encephalitic beriberi. The sensitivity of cranial sonography increased with age. It was a maximum of 93% (14/15) in the 5 months and older age group. Specificity was a maximum of 100% (18/18) in infants older than 5 months of age. Sensitivity was maximum in Wernicke encephalopathy at 90% (18/20) and least in the acidotic form at 43% (10/23). Follow-up showed gradual normalization of the hyperechoic appearance of the basal ganglia during 8 weeks in 26/41 (63%), with mild atrophy of the basal ganglia in 6/41 (15%) Hyperechogenicity of the basal ganglia on cranial ultrasonography is a sensitive finding for the diagnosis of infantile encephalitic beriberi in infants who present with Wernicke encephalopathy.

Incidence and outcome of preterm deliveries in Mother and Child Hospital Akure, Southwestern Nigeria

Background: Preterm birth contributes significantly to neonatal deaths. Its burden should be defined to enhance interventions especially in resource-limited settings with poor neonatal health indices. Objectives : To determine the incidence of preterm delivery in the Mother and Child Hospital, Akure, to investigate the outcome and explore the relationship between birth weight and neonatal survival. Method : Demographic and clinical features (gestational age, birth weight and outcome) of consecutive preterm infants were documented for one and a half years. Incidence of preterm birth was computed, using total birth as the denominator. Quarterly incidence of preterm birth was presented graphically. Univariate logistic regression analysis of birth weight as a predictor of preterm death was done. P value Results : Of 10,432 births during study period, 1,606 were preterm giving an incidence of preterm births of 15.4%. Among preterm infants, 1,449 (90.2%) had low birth weight (LBW), 123 (7.7%) very low birth weight (VLBW) and 34 (2.1%) extremely low birth weight (ELBW). Most (92.8%) preterm babies were discharged. Prematurity had a case fatality rate (CFR) of 5.6%. Compared to normal birth weight infants, ELBW babies were 250 times and VLBW infants 47.6 times more likely to die. Conclusions : Incidence of preterm delivery in the Mother and Child Hospital, Akure was 15.4%. The CFR of prematurity was 5.6%. ELBW had the highest percentage of deaths (70.6%)

Early management of neurologic clubfoot using Ponseti casting with minor posterior release in myelomeningocele: a preliminary report.

This study aimed to examine the results of manipulation and serial casting, followed by open Achilles lengthening combined, when necessary, with posterior release in the management of neurologic clubfoot in infants with myelomeningocele. This study was carried out prospectively with a minimum follow-up of 2 years on 24 consecutive infants (48 feet) with neurologic insensate feet. Manipulation and serial casting were performed, followed by open tendo Achilles lengthening with/without posterior capsulotomy of the ankle and subtalar joints. The Diméglio scoring system was used to assess the degree of deformity correction immediately postoperatively and the latest follow-up visits. The mean age of the patients at initial treatment was 5.9 (3-8) weeks. None of the patients was lost to follow-up. For 36 feet, the final range of scores was 5-6 and the deformities were grade II of moderate type. Only for seven of 48 feet the final scores were in the range 10-12, grade III, and severe type. Only three infants (5/48 feet) failed to show any improvement. We thus support this treatment for the management of insensate feet of infants with myelomeningocele soon after birth as most infants responded satisfactorily in terms of deformity correction and achieved plantigrade mobile feet that fit into orthotics.

Decreased Superior Sagittal Sinus Diameter and Jugular Bulb Narrowing Are Associated with Poor Clinical Outcome in Vein of Galen Arteriovenous Malformation.

Few clinical and imaging findings are known to be associated with poor outcome in neonates and infants with vein of Galen arteriovenous malformations. In the present consecutive series of 35 patients, we evaluated both the diameter of the superior sagittal sinus at onset and the diameter of the jugular bulb on follow-up as potential factors related to poor outcome. Thirty-five consecutive neonates and infants who were prospectively collected in a single-center data base were included in this review. Outcome was assessed by using the Bicêtre Outcome Score. Both the absolute diameter of the superior sagittal sinus and its ratio to the biparietal diameter were measured at onset, compared with age-matched controls, and correlated to patient outcome. The diameter of the superior sagittal sinus at onset and its ratio to the biparietal diameter were significantly smaller in the vein of Galen arteriovenous malformation population compared with the matched population (P = .0001) and were correlated significantly with a risk of poor clinical outcome (P = .008). Development of jugular bulb narrowing was also related to poor clinical outcome (P < .0001). Decreased superior sagittal sinus diameter may reflect a decrease of cerebral blood flow due to cerebral arterial steal and intracranial hydrovenous disorders. This finding may be considered cerebral blood flow deterioration and thus taken into consideration in the management decisions for patients with vein of Galen arteriovenous malformations. Likewise, our data suggest that progressive jugular bulb narrowing may indicate earlier intervention to prevent severe narrowing.

Diagnostic accuracy of sub-mSv prospective ECG-triggering cardiac CT in young infant with complex congenital heart disease.

To explore the clinical value and evaluate the diagnostic accuracy of sub-mSv low-dose prospective ECG-triggering cardiac CT (CCT) in young infants with complex congenital heart disease (CHD). A total of 102 consecutive infant patients (53 boys and 49 girls with mean age of 2.9±2.4m and weight less than 5kg) with complex CHD were prospectively enrolled. Scans were performed on a 64-slice high definition CT scanner with low dose prospective ECG-triggering mode and reconstructed with 80% adaptive statistical iterative reconstruction algorithm. All studies were performed during free breathing with sedation. The subjective image quality was evaluated by 5-point grading scale and interobserver variability was calculated. The objective image noise (standard deviation, SD) and contrast to noise ratio (CNR) was calculated. The effective radiation dose from the prospective ECG-triggering mode was recorded and compared with the virtual conventional retrospective ECG-gating mode. The detection rate for the origin of coronary artery was calculated. All patients also underwent echocardiography before CCT examination. 81 patients had surgery and their preoperative CCT and echocardiography findings were compared with the surgical results and sensitivity, specificity, positive and negative predictive values and accuracy were calculated for separate cardiovascular anomalies. Heart rates were 70-161 beats per minute (bpm) with mean value of 129.19±14.52bpm. The effective dose of 0.53±0.15mSv in the prospective ECG-triggering cardiac CT was lower than the calculated value in a conventional retrospective ECG-gating mode (2.00±0.35mSv) (p<0.001). The mean CNR and SD were 28.19±13.00 and 15.75±3.61HU, respectively. The image quality scores were 4.31±0.36 and 4.29±0.41 from reviewer 1 and 2 respectively with an excellent agreement between them (Kappa=0.85). The detection rate for the origins of the left and right coronary arteries was 96 and 90%, respectively. The detection rates of the origins of left coronary artery and right coronary artery in all cases were 96% (78/81) and 90% (73/81), respectively. Twenty cases of conotruncal anomalies and ALCAPA were validated surgically and the accuracy of cardiac CT diagnosis was 95% (19/20). The overall deformity based sensitivity, specificity, positive predictive value and negative predictive value were 94.0.1, 99.9, 98.6, 99.5% respectively, by CCT, and 88.2, 99.9, 97.8, 99.0%, respectively, by echocardiography. Prospective ECG-triggering CCT with sub-mSv effective dose provides excellent imaging quality and high diagnostic accuracy for young infants with complex CHD.

An experience with off pump technique for repair of anomalous left coronary artery from pulmonary artery (ALCAPA)

BackgroundAnomalous origin of left coronary artery from pulmonary artery is a very rare disease with incidence of one every 300,000 live births. It has a high mortality of 80% in the first year of life.This observational study summarized our experience using the technique of subclavian arterial bypass without the use of cardiopulmonary bypass (CPB) for treatment of this coronary anomaly in pediatric population. The study aims to revive an earlier technique, with modifications, as an alternative to the existing coronary translocation. MethodsFrom 2009 till 2015, six consecutive infants were operated by a single surgeon using subclavian artery to left coronary artery bypass done off pump, to establish a two coronary circulation. ResultsFive patients had an improvement in their LV ejection fractions at the time of the last follow-up. Angiography done in two cases after 2 and 6 years after surgery revealed good flow in the left coronary artery and good growth in the length of subclavian artery. There was one surgical mortality in this series. ConclusionsThe technique of off pump subclavian arterial bypass for anomalous origin of the left coronary artery from the pulmonary artery is a viable alternative to the existing standard technique of coronary translocation. It essentially eliminates extracorporeal circulatory support or a left heart bypass that may be needed after coronary translocation. Also, the advantage of avoiding CPB, both in economic terms and also the adverse effects related to use of bypass in this very sick hearts, cannot be disregarded.

Screening for retinopathy of prematurity: a report from upper Egypt.

To detect the incidence of retinopathy of prematurity (ROP) in a tertiary referral neonatal intensive care unit in upper Egypt and to describe the obstacles faced during implementing the screening protocol for the first time. Consecutive infants were enrolled at birth and screened for ROP. We used the UK ROP guideline (May 2008) for infant selection, follow up and treatment. Repeat examinations were performed until retinal vascularisation was complete. Fifty-two infants were enrolled: 24 males and 28 females. Mean gestational age was 31.3wk (±2.8 SD) and mean birth weight was 1234.6 g (±221.1 SD). Incidence of ROP was 36.5% (stages 1, 2, 3 and 4a were 9.6%, 9.6%, 15.4% and 1.9% respectively), no stages 4b or 5 were found in this series. Six infants (11.5%) died during screening without ROP, 25 infants (48.1%) were discharged from screening with retinal vascularisation reaching zone III, 5 infants (9.6%) were treated with indirect diode with or without additional cryotherapy and 16 infants (30.8%) were lost to follow up. In this series gestational age rather than birth weight was found significantly correlated and predictive (P<0.05) with ROP stages. ROP in a single site in Upper Egypt appears to have comparable incidence to other areas worldwide. The main screening obstacle was missing cases due to the absence of a national ROP screening protocol.

Limitations in the Activity of Mobility at Age 6 Years After Difficult Birth at Term: Prospective Cohort Study.

A difficult birth at term (DBAT) may manifest as fetal acidosis and low Apgar scores and is often referred to as "perinatal asphyxia," especially when infants show signs of neonatal encephalopathy (NE). In contrast to DBAT resulting in moderate-to-severe NE, which is associated with neurodevelopmental disorders, little is known about the prognosis of less severe forms of DBAT, with or without NE. The purpose of this study was to evaluate the International Classification of Functioning, Disability and Health, Children & Youth Version activity "mobility" and other neurodevelopmental sequelae in infants with DBAT at age 6 years. The index cohort (n=62; 35 boys, 27 girls) consisted of consecutive term infants with DBAT based on clinical criteria in a Dutch nonacademic hospital from 1999 to 2005. Neonatal encephalopathy was assessed according to the Sarnat grading system and excluded infants with severe NE. The matched reference cohort (n=81; 49 boys, 32 girls) consisted of healthy term infants. The primary outcome at 6 years was limited mobility (Movement Assessment Battery for Children score ≤15th percentile). Secondary outcomes included learning and behavioral problems and the presence of minor neurological dysfunction. Three children developed cerebral palsy and were excluded from analyses. Children with DBAT more often had limited mobility than children without DBAT (risk ratio [RR]=2.44; 95% confidence interval [95% CI]=1.16, 5.14). The risk of limited mobility rose with increasing severity of NE (mild NE: RR=3.38; 95% CI=1.40, 8.16; moderate NE: RR=4.00; 95% CI=1.54, 10.40), and manual abilities especially were affected (RR=4.12; 95% CI=1.40, 12.14). Learning problems, need for physical therapy, and complex minor neurological dysfunction were more common in children with DBAT than in children without DBAT. Term infants who develop mild or moderate NE following DBAT are at increased risk for limited mobility at age 6 years. Routine monitoring of neuromotor development in these children is warranted.

Plastibell circumcision of 2,276 male infants: a multi-centre study.

IntroductionThe World Health Organization's manual on male circumcision listed Plastibell technique as a well-proven paediatric method with respect to the results and complications. Although, literatures abound on its wide acceptability, there are few multi-centered reports from this environment. The objective was to evaluate the cases of infant circumcision by Plastibell device from two medical institutions.MethodsAll consecutive infants who had Classical Plastibell Circumcision (PC) at the Federal Staff Medical Centre, Abuja and the Lagos State University Teaching Hospital, Ikeja between February 2011 and June 2015 were included in this cross-sectional study. The procedures were performed by surgical registrars and medical officers after ninety minutes of topical anesthesia to the penis. Data harvested from the standard proforma were analysed using Statistical Package for Social Science 20.0 for window.ResultsA total of 2,276 infants had classical PC within the study period. Their ages at circumcision ranged from 4 days to 3 months with a mean age of 17 days. Majority of the boys were circumcised at second week of life (n=1,394,61.2%). All the cases were performed for religious (53%) and cultural (47%)reasons. The most common Plastibell size deployed was 1.3cm (n=1,040, 45.7%) while 1.6cm was the least commonly used ring (n=10, 0.4%). The mean time for device to fall-off was 6 days (range 4-12 days). There was no correlation between the age at circumcision and Plastibell size. We recorded an overall complication rate of 1.1% with postoperative bleeding leading the pack (n=12, 48%). No case of urethrocutaneous fistula was seen. We detected 17 cases (0.7%) of distal hypospadias in whom circumcisions were postponed till the time of hypospadias repairs.ConclusionThe main indication for infant circumcision in our environment was religious. The PC has good safety profile with few easily correctable early complications. Detailed attention to placement of ligature, selection of appropriate Plastibell size and adequate parental education are key to preventing post-procedure mishaps.

Acute Scrotum during the First Year of Life

Objective: The aims were to characterize spermatic cord torsion (SCT), to compare it with other causes of acute scrotum during the first year of life and to describe the distinctive features of each causative group. Material and Methods: Ninety-one consecutive neonates (44) and infants (47) were operated on for acute scrotum and the definitive diagnoses for the testicles thus confirmed. The duration of the symptoms and the physical findings were recorded. The histopathology of the removed testicles was studied and bacterial cultures were obtained from patients with epididymitis (ED). Results: Thirty-five boys (39%) had SCT, and incarcerated inguinal hernia (IH) and epididymitis were found in 22 (24%) and 21 (23%) cases, respectively. Torsion of the testicular appendage (TAT) was only seen once. A dark, hard testicle was observed in 91% of the SCT patients, but erythema and tenderness were infrequent. 30 out of 39 (77%) patients had SCT during the neonatal period, including 15 cases in which torsion had occurred prenatally. Only four testicles (11.4%) with SCT were salvaged. Conclusions: The cause of acute scrotum during the first month of life was mostly SCT, while ED was seen more frequently between the ages of 3 and 6 months. A dark, hard testicle was a common finding in the SCT patients, while swelling and erythema were typical of ED. Neonatal SCT has a poor prognosis.