Evaluation and analysis of the Modified Finnegan Scoring System for assessment of neonatal abstinence syndrome.

OBJECTIVE: The Finnegan Neonatal Abstinence Scoring System (FNASS) is the most commonly used scoring system for neonatal abstinence syndrome (NAS) both in its original and modified versions, despite challenges related to tool length and observer bias. The purpose of this study was to determine the most frequent symptoms of NAS that led to score elevation and prompted initiation of drug therapy on the Modified Finnegan (MF). We also sought to identify vital sign changes associated with score elevation. DESIGN: We conducted a retrospective study of neonates diagnosed with NAS, based on ICD-9 codes and charge data for methadone administration. SETTING: The study setting was in a Level III Neonatal Intensive Care Unit. PATIENTS, PARTICIPANTS: Ninety patients with a total of 286 MF scores recorded from 2011 to 2015 met inclusion criteria. MAIN OUTCOME MEASURE(S): The primary outcome was overall occurrence for each specific component of the MF scoring tool during symptomatic periods. Secondary outcomes were vital sign changes. RESULTS: Among the MF elements, there were 13 components that were scored more often than others in symptomatic infants. Respiratory rate (RR) was elevated in infants with NAS, but other vital signs did not differ from age-specific norms. CONCLUSIONS: Of the various signs of NAS used to score the MF, few are frequently observed. Our study reinforces literature that proposes a shortened MF assessment tool. Experimental research will be needed to determine the efficacy of a shortened MF tool for diagnosing NAS.

Diclofenac rectal suppository: an effective modality for perineal pain.

OBJECTIVE: To determine the frequency of perineal pain after childbirth after a single dose of diclofenac rectal suppository. METHODS: This cross-sectional study was conducted at Shaikh Zayed Women Hospital, Larkana, Pakistan, from April to September 2014, and comprised patients who were admitted to the labour room for normal vaginal delivery. A single dose of rectal diclofenac suppository of 100mg was given to the patients delivered vaginally or by second-stage emergency Caesarean section. Post-partum pain was noted after 12 and 24 hours of the administration of analgesia. SPSS 16 was used for data analysis. RESULTS: Of the 169 subjects, 63(37.28%) were aged 20 years or less, 85(50.3%) between 21 and 30 years, and 21(12.43%) between 31 and 40 years. Frequency of perineal pain was predominantly mild in 95(56%) patients, moderate in 60(35.5%) and severe in 14(8.28%). CONCLUSIONS: The use of non-steroidal anti-inflammatory rectal suppositories was found to be a simple and highly effective modality of reducing the perineal pain.

Analysis of clinical characteristics, rationale, and management of critically ill obstetric patients transferred to ICU.

OBJECTIVE: To evaluate the clinical and demographic characteristics, rationale for transfer of critically ill obstetric patients to intensive care unit and their management therein. METHODS: The observational retrospective case series study was conducted at Shaheed Mohtarma Benazir Bhutto Medical University, Larkana, Pakistan, and comprised critically ill female patients transferred to intensive care unit from the department of Obstetrics and Gynaecology between August 2011 and June 2013. The data was collected on pre-designed proforma which included demographic characteristics of patients, their symptomatology and initial diagnosis, intervention in the department, continuing or subsequent complications/reasons for admission to intensive care unit, management and stay there and, finally, outcome. Data was analysed using SPSS 21. RESULTS: The mean age of 150 patients in the study was 30.3±5.047years,mean parity was 2.49±2.207.The most common condition affecting women and leading to their transfer to intensive care was eclampsia/pre-eclampsia in 80(53.33%) followed by bleeding disorders in 25(16.65%) and septic shock in 24(16%). The mean stay in intensive care was 4.47±2.53 days, and 38(25.3%) patients required ventilator support, while 112(74.7%) were managed with oxygen and inotropic support. The overall maternal mortality rate was 41(27.3%), which included 19(16.9%) patients managed without ventilator, and 22 (57.8%) managed with ventilator (p<0.05). CONCLUSIONS: Hypertensive and bleeding disorders were the main reasons for transfer of obstetric patients to intensive care unit, and maternal mortality was high among patients treated on ventilator support.