Oral sucrose and a pacifier for pain relief during simple procedures in preterm infants: a randomized controlled trial.

BACKGROUND AND OBJECTIVES: Previous randomized trials of the analgesic effects of sucrose, glucose, and a pacifier in term neonates have shown that the pacifier resulted in lower pain scores than glucose or sucrose, but the pacifier with and without sucrose did not differ. The current study was designed to assess the analgesic effect of pharmacologic (sucrose, water) and a non-pharmacologic measures (pacifier) in preterm infants and to find whether there is any synergism between these intervention in relieving pain during painful procedures. PATIENTS AND METHODS: In this double-blind, randomized, controlled study, 36 preterm infants (mean 31 weeks gestational age, range 27 to 36 weeks) were randomly allocated to six different regimens (0.5 mL sterile water with pacifier, 0.5 mL sterile water without pacifier, 0.5 mL sucrose 24% with pacifier, 0.5 mL sucrose 24% without pacifier, pacifier alone and control group) during a stay in intensive care of up to 15 days. Pain scores were measured with the Premature Infant Pain Profile (PIPP), a validated behavioral acute pain scale. RESULTS: Of all the regimens, the lowest pain scores occurred with the use of 24% sucrose solution combined with pacifier. The mean pain score for the combination of sucrose with pacifier was 0.7 as compared to 1.4 for the sterile water with pacifier group (P<.05). CONCLUSION: The synergistic effect of the combination of sucrose and non-nutritive sucking was clinically effective and safe in relieving the pain of simple procedures such as venipuncture or heel stick in preterm and term infants, but further research is needed on these interventions alone and in combination with other behavioral interventions in neonates.

Survival of 2 extreme preterm neonates with cardiac tamponade as a complication of percutaneous central venous catheterization.

We report 2 extreme preterm neonates who developed cardiac tamponade secondary to perforation of the myocardium by the percutaneous silastic central venous catheters, which were inserted for parental nutrition. Percutaneous pericardiocentesis was performed and pericardial effusion was aspirated, later proved by analysis to be total parental nutrition. The lines were removed and the patients successfully resuscitated and survived, both were sent home in good condition.

Ascites as first presentation of ventriculo-peritoneal shunt infection in a neonate.

Infection is a common complication of ventriculoperitoneal shunts, and ascites is one of the rare manifestations of shunt infection. We report a neonate in whom shunt infection is presented only by ascites. The causative organism, coagulase negative staphylococci, was detected only in the cerebrospinal fluid although peritoneal fluid analysis was consistent with infection. Our patient shows the importance of considering shunt infection when unexplained ascites is the first and only manifestation in neonates with ventriculoperitoneal shunts.

A Saudi Patient with an Interstitial Deletion of Short Arm of Chromosome 3 (p13 to p21) and its Association with Joubert's Syndrome Features.

We report a case of 4 weeks old girl with a de novo interstitial deletion of the short arm of chromosome 3 (p13-p21) and clinical findings typical of proximal 3p deletion together with heart defects, choanal atresia, ear anomalies, central nervous system anomalies, renal anomalies and associated Joubert's syndrome (JS). Family history is unremarkable and parenteral chromosomes were normal. The clinical manifestations of the patient are compared with those of 11 patients previously described with a proximal 3p deletion. The additional JS features associated with this syndrome were described. This is the first case report in English literature describing 3p deletion associated with additional JS features.

Congenital Neurofibromatosis in a Saudi Neonate who Presented with Neck Mass, Esophageal and Airway Obstruction.

We are presenting a case of a neonate presented with a neck mass, airway and esophageal obstruction, the tumor has a brain extension; treated with partial surgical excision; the pathological studies revealed plexiform Neurofibromatosis. The patient also has café au lait spots.