RESUMO
OBJECTIVE: To examine the feasibility of early and extended erythropoietin monotherapy after hypoxic ischaemic encephalopathy (HIE). DESIGN: Double-blind pilot randomised controlled trial. SETTING: Eight neonatal units in South Asia. PATIENTS: Neonates (≥36 weeks) with moderate or severe HIE admitted between 31 December 2022 and 3 May 2023. INTERVENTIONS: Erythropoietin (500 U/kg daily) or to the placebo (sham injections using a screen) within 6 hours of birth and continued for 9 days. MRI at 2 weeks of age. MAIN OUTCOMES AND MEASURES: Feasibility of randomisation, drug administration and assessment of brain injury using MRI. RESULTS: Of the 154 neonates screened, 56 were eligible; 6 declined consent and 50 were recruited; 43 (86%) were inborn. Mean (SD) age at first dose was 4.4 (1.2) hours in erythropoietin and 4.1 (1.0) hours in placebo. Overall mortality at hospital discharge occurred in 5 (19%) vs 11 (46%) (p=0.06), and 3 (13%) vs 9 (40.9%) (p=0.04) among those with moderate encephalopathy in the erythropoietin and placebo groups. Moderate or severe injury to basal ganglia, white matter and cortex occurred in 5 (25%) vs 5 (38.5%); 14 (70%) vs 11 (85%); and 6 (30%) vs 2 (15.4%) in the erythropoietin and placebo group, respectively. Sinus venous thrombosis was seen in two (10%) neonates in the erythropoietin group and none in the control group. CONCLUSIONS: Brain injury and mortality after moderate or severe HIE are high in South Asia. Evaluation of erythropoietin monotherapy using MRI to examine treatment effects is feasible in these settings. TRIAL REGISTRATION NUMBER: NCT05395195.
RESUMO
Background Congenital sensorineural hearing loss (SNHL) is one of the most common birth defects with an incidence ratio of 1:1000 live births in India. Imaging plays an important role in the evaluation of congenital SNHL. As there is a paucity of studies in the Indian setting to determine the prevalence of inner-ear abnormalities, this study attempts to throw light on the various inner-ear anomalies that are prevalent in our setup in the Northern part of Karnataka using high-resolution computed tomography (HRCT) temporal bone scan. Objectives The objectives of this study are estimation of the prevalence of inner-ear anomalies in children with congenital SNHL by employing a radiologic assessment of HRCT temporal bone scans and determination of the factors associated with the identification of these abnormalities like demographic factors and degree of hearing loss. Methods Children with congenital SNHL underwent clinical evaluation with history taking and general and ear examination. Otoacoustic emission (OAE) and brainstem evoked response audiometry (BERA) measurements were obtained. A radiological assessment by HRCT temporal bone scan was done. Using the classiï¬cation criteria of inner-ear malformations by Jackler and Sennaroglu as a reference, diagnostic standards were established in studying inner-ear malformations. Data were collected and entered in a Performa, which includes patient's demography, audiological findings, and radiological findings, and the results were analyzed. Data were entered into Microsoft Excel, and statistical analysis was carried out using IBM SPSS Statistics for Windows, Version 27 (Released 2020; IBM Corp., Armonk, New York, United States). Categorical variables were presented as frequency and percentage. Then the prevalence of inner-ear anomaly was estimated. Correlation between inner-ear anomaly and other factors was calculated using the Chi-square test. Results The prevalence of inner-ear anomalies identified in congenital SNHL by HRCT scan was as follows: 26.08% (12/46), 26.1% (24/92) of inner ears was anomalous, 23.9% of the cochlea was anomalous, 6.5% of the vestibule was anomalous, 5.4% of the vestibular aqueduct was anomalous, and 3.2% of the semicircular canal was anomalous. Cochlear aplasia, incomplete partition, common cavity, and cochlear hypoplasia were the anomalies found. Few cochleas had an abnormal cochlear height, though they appeared normal structurally. The dilated vestibule was the most common vestibular abnormality. There was a negative association found between the inner-ear anomaly in children with congenital SNHL who had a history of consanguineous marriage in their parents. Conclusion High-resolution temporal CT scanning could provide detailed information on the pathology of the inner ear in congenital SNHL, which can help in better planning the surgery for cochlear implantation and understanding the prognosis.
RESUMO
OBJECTIVE: Virtual bronchoscopy is a noninvasive technique which provides an intraluminal view of the tracheobronchial tree. This study aimed to evaluate this technique in comparison with rigid bronchoscopy, in paediatric patients with tracheobronchial foreign bodies undetected by plain chest radiography. METHODS: Plain chest radiography was initially performed in 40 children with suspected foreign body aspiration. Computed tomography virtual bronchoscopy was performed in the 20 in whom chest radiography appeared normal. Virtual bronchoscopic images were obtained. All patients underwent rigid bronchoscopy performed by an otolaryngologist blinded to the computed tomography virtual bronchoscopy findings, within 24 hours. Virtual bronchoscopic findings were then compared with the results of rigid bronchoscopy. RESULTS: In 12 patients, foreign bodies detected by virtual bronchoscopy were confirmed by rigid bronchoscopy. In one case, a mucous plug was perceived as a foreign body on virtual bronchoscopy. In another case, a minute foreign body was missed on virtual bronchoscopy. The following parameters were calculated: sensitivity, 92.3 per cent; specificity, 85.7 per cent; validity, 90 per cent; positive likelihood ratio, 6.45; and negative likelihood ratio, 0.089. CONCLUSION: In the presence of a positive clinical diagnosis and negative chest radiography, computed tomography virtual bronchoscopy must be considered in all cases of tracheobronchial foreign body aspiration, in order to avoid needless rigid bronchoscopy. Computed tomography virtual bronchoscopy is particularly useful in screening cases of occult foreign body aspiration, as it has high sensitivity, specificity and validity.
