ABSTRACT
Objective: The aims of this study were to determine the effectiveness (oxygenation), safety (hemodynamic status) and short term outcomes of intravenous iloprost (IVI) administration as a rescue therapy in severe persistent pulmonary hypertension of the newborn (PPHN). Design: Retrospective medical records review. Setting: Tertiary neonatal intensive care unit at Songklanagarind Hospital, Songkhla Province, Hat Yai, Thailand. Participants: Newborns who received IVI as an adjunctive therapy for treatment of severe PPHN, as defined by an oxygen index (OI) of >20 and without response to conventional therapies. Main Outcome Measures: The change of OI and alveolar-arterial oxygen difference before and after commencement of IVI. Results: 33 neonates with severe PPHN at a median gestation of 39 weeks and a baseline OI of 40 (range, 21-101) received IVI. The median OI and alveolar-arterial oxygen difference had a statistically significant decrease after 2 hours of treatment and continued to decline thereafter (P<0.05). All infants received one or more inotropic medications and volume expanders to provide blood pressure support with no statistically significant difference of blood pressure and heart rate before and after IVI treatment. The mortality rate was 15.2%, all of them had initially severe hypoxemia with a median OI of 53.6. Conclusions: IVI may be effective in improving oxygenation and should be considered as a rescue therapy for infants with severe PPHN, especially in a limited resource environment with no inhaled nitric oxide available. Systemic hypotension may be a cause for concern.
ABSTRACT
OBJECTIVES: Determine the prevalence and risk factor of neonatal hearing loss in the high-risk group. MATERIAL AND METHOD: A prospective descriptive study, using the criteria of "high-risk" as defined by the Joint Committee of Infant Hearing 1994, American Academy of Pediatrics, 465 newborn in Songklanagarind Hospital were screened with portable otoacoustic emissions (OAEs) before being discharged between July 1st, 2004 and December 31st, 2006. Based on the examinations, the results were divided into two groups, "pass" and "refer". The neonates who failed the screening test were referred for further checks with conventional OAEs and if they failed again, then the authors reassessed them with auditory brainstem responses (ABR). RESULTS: Four hundred fifty eight infants (98.5%) in the high-risk group passed the primary screen for both ears. One infant (0.21%) was confirmed with unilateral sensorineural hearing loss and three infants (0.64%) were confirmed with bilateral hearing impairment above 30 dB. Three infants (0.64%) were lost to follow up. High-risk factors of hearing loss in the present study included 226 infants from premature birth (48.6%), 159 infants exposed to ototoxic medications (34.2%), and 61 infants with respiratory distress syndrome that required mechanical ventilation for at least five days (13.1%). CONCLUSION: Otoacoustic emissions are a very quick and noninvasive technique, and suitable for hearing screening in infants.