Primary closure of a sternal cleft in the neonatal period.

Sternal cleft is a rare malformation of the midline fusion of the sternal bars; the most common form is the superior partial defect. Surgical correction with primary closure is the gold standard. It is recommended that the procedure be performed before 3 months of age because of the greater compliance and maximal flexibility of the thoracic wall.  These features ensure a safer repair with a low risk of complications and allow for a less extensive procedure that does not require the use of additional techniques. A midline incision is performed in the anterior thoracic wall, and the major pectoralis flaps are raised. The main surgical goal is to change the remaining sternum from a U to a V shape. Transfixing interrupted sutures are placed in the cartilaginous borders for midline closure. Hemodynamics and ventilation are monitored at this time. Closure is performed by layers.

Autopsy in a Neonatal Intensive Care Unit: pathological and clinical agreement

Abstract Objectives To evaluate neonatal autopsy rates at a tertiary hospital in southern Brazil ascertain the level of agreement between premortem and postmortem diagnosis. Methods The authors reviewed all neonatal autopsies performed over a 10-year period and described the percentage of neonates who died and underwent autopsy. The authors tested for agreement between autopsy findings and the cause of death as defined by the neonatologist. Agreement between clinical diagnosis and autopsy findings was classified using the modified Goldman criteria. Additional findings at autopsy were grouped by organ system. Linear regression and multiple comparisons were used for statistical analyses. Results During the study period, 382 neonates died at the Neonatal Intensive Care Unit (NICU). Consent to perform an autopsy was obtained for 73 (19.1%). The complete agreement between autopsy findings and the neonatologist's premortem diagnosis was found in 48 patients (65.8%). Additional findings were obtained at autopsy in 25 cases (34.2%). In 5 cases (6.9%), the autopsy findings contributed to subsequent genetic counseling. Seven autopsies (9.6%) revealed a diagnosis that would have changed patient management if established premortem. The autopsy rate increased by an average of 1.87% each year. Conclusion Despite a high level of agreement between clinical diagnosis and pathological findings, autopsies provided relevant data regarding the cause of death, providing additional clinical information to neonatologists and allowing genetic counseling of family members.

Autopsy in a Neonatal Intensive Care Unit: pathological and clinical agreement.

OBJECTIVES: To evaluate neonatal autopsy rates at a tertiary hospital in southern Brazil ascertain the level of agreement between premortem and postmortem diagnosis. METHODS: The authors reviewed all neonatal autopsies performed over a 10-year period and described the percentage of neonates who died and underwent autopsy. The authors tested for agreement between autopsy findings and the cause of death as defined by the neonatologist. Agreement between clinical diagnosis and autopsy findings was classified using the modified Goldman criteria. Additional findings at autopsy were grouped by organ system. Linear regression and multiple comparisons were used for statistical analyses. RESULTS: During the study period, 382 neonates died at the Neonatal Intensive Care Unit (NICU). Consent to perform an autopsy was obtained for 73 (19.1%). The complete agreement between autopsy findings and the neonatologist's premortem diagnosis was found in 48 patients (65.8%). Additional findings were obtained at autopsy in 25 cases (34.2%). In 5 cases (6.9%), the autopsy findings contributed to subsequent genetic counseling. Seven autopsies (9.6%) revealed a diagnosis that would have changed patient management if established premortem. The autopsy rate increased by an average of 1.87% each year. CONCLUSION: Despite a high level of agreement between clinical diagnosis and pathological findings, autopsies provided relevant data regarding the cause of death, providing additional clinical information to neonatologists and allowing genetic counseling of family members.

PtOEP-PDMS-Based Optical Oxygen Sensor.

The advanced and widespread use of microfluidic devices, which are usually fabricated in polydimethylsiloxane (PDMS), requires the integration of many sensors, always compatible with microfluidic fabrication processes. Moreover, current limitations of the existing optical and electrochemical oxygen sensors regarding long-term stability due to sensor degradation, biofouling, fabrication processes and cost have led to the development of new approaches. Thus, this manuscript reports the development, fabrication and characterization of a low-cost and highly sensitive dissolved oxygen optical sensor based on a membrane of PDMS doped with platinum octaethylporphyrin (PtOEP) film, fabricated using standard microfluidic materials and processes. The excellent mechanical and chemical properties (high permeability to oxygen, anti-biofouling characteristics) of PDMS result in membranes with superior sensitivity compared with other matrix materials. The wide use of PtOEP in sensing applications, due to its advantage of being easily synthesized using microtechnologies, its strong phosphorescence at room temperature with a quantum yield close to 50%, its excellent Strokes Shift as well as its relatively long lifetime (75 µs), provide the suitable conditions for the development of a miniaturized luminescence optical oxygen sensor allowing long-term applications. The influence of the PDMS film thickness (0.1-2.5 mm) and the PtOEP concentration (363, 545, 727 ppm) in luminescent properties are presented. This enables to achieve low detection levels in a gas media range from 0.5% up to 20%, and in liquid media from 0.5 mg/L up to 3.3 mg/L at 1 atm, 25 °C. As a result, we propose a simple and cost-effective system based on a LED membrane photodiode system to detect low oxygen concentrations for in situ applications.