RESUMEN
OBJECTIVES: To identify and analyze the factors leading to extubation failure among very low birth weight infants in a specific tertiary care setting in Al Ain, emphasizing clinical and demographic variables. The study used medical data of Very Low Birth Weight (VLBW) infants admitted to the Neonatal Intensive Care Unit (NICU) from 1st January 2015 to 31st December 2019, and evaluated the incidence and risk factors associated with extubation failure. METHODS: Data was collected from the hospital's electronic records and tabulated in Excel sheets, with extubation failure defined as reintubation due to deterioration of respiratory condition within seven days post-extubation. The data was collected from the period of 1st January 2015 to 31st December 2019. Inclusion criteria included babies admitted to the NICU with a gestational age of ≤ 32 weeks, or of birth weight ≤1500 grams who were intubated within the first seven days of life. Results were analyzed using SPSS software, version 9.0 (SPSS Inc., Chicago) to determine the risk factors for extubation failure and short-term outcomes. RESULTS: Gestational age, birth weight, antenatal steroids, mode of delivery, number of Survanta® (beractant intratracheal suspension) doses, Positive End-Expiratory Pressure (PEEP), Mean Airway Pressure (MAP), Mean Arterial Pressure (Blood Pressure (BP)), and Infectious Diseases (ID) (indicated by a positive blood culture) were found to be the key predictors of extubation failure in very low birth weight infants at a tertiary care hospital in Al Ain. The most common reasons for reintubation were FiO2 > 50% (23.53%), followed by Respiratory Acidosis (20.59%). Other factors, including maternal chorioamnionitis, Apgar scores, indication for intubation, caffeine, and pre-and post-extubation laboratory values, comorbidities, and hemoglobin (Hgb), creatinine and sodium levels were found to have no effect on the success of extubations. CONCLUSIONS: The results of this research indicate that factors such as gestational age, birth weight, prenatal steroid use, delivery method, the quantity of Survanta® doses, PEEP, MAP, MAP (BP), and ID (+ve blood culture) were the primary determinants of unsuccessful extubation in VLBW babies at a tertiary healthcare facility in Al Ain. The predominant cause for needing reintubation was a FiO2 level above 50%, followed by Respiratory Acidosis. Additional ®®investigations are required to validate these findings and pinpoint other potential predictors of extubation failure within this demographic.
RESUMEN
This systematic review and meta-analysis aimed to assess the utility of near-infrared spectroscopy (NIRS) in predicting the perinatal outcomes of neonates with hypoxic-ischemic encephalopathy (HIE). We conducted a literature search on Medline via PubMed, Web of Science, Scopus, and CENTRAL Library. We included studies that utilized early NIRS monitoring to study the accuracy of NIRS in predicting the perinatal outcomes of neonates with hypoxic-ischemic encephalopathy. Nine studies that met our eligibility criteria were included. These studies were published between 2012 and 2023. In this meta-analysis, no significant differences in regional cerebral oxygen saturation (cSpO2) were found between normal and abnormal groups at 12 hours (MD = 0.21, 95% CI: -6.39 to 6.82, P = 0.95) and 24 hours (MD = -1.96, 95% CI: -6.95 to 3.03, P = 0.44). However, at 48 hours, cSpO2 was significantly lower in the normal group (MD = -4.9, 95% CI: -5.91 to -3.89, P < 0.00001). At 72 hours, our analysis revealed a significant difference with lower cSpO2 in the normal group (MD = -3.0, 95% CI: -5.5 to -0.5, P = 0.02). Regarding cerebral fractional tissue oxygen extraction (FTOE), no significant differences were observed at 12 hours (MD = 0.03, 95% CI: -0.02 to 0.09, P = 0.24). After 24 hours, the normal group exhibited lower FTOE (MD = -0.03, 95% CI: -0.04 to -0.01, P < 0.001), while after 48 hours, the normal group had higher FTOE (MD = 0.07, 95% CI: 0.04 to 0.10, P < 0.0001). Early cerebral NIRS monitoring is beneficial in predicting the outcomes of HIE in term neonates. Our analysis showed that several NIRS parameters, such as regional cSpO2 and cerebral FTOE, are significantly associated with adverse outcomes in the first 72 hours of birth.
RESUMEN
BACKGROUND: Parental anxiety about the impact of puberty/menses, particularly in girls with severe disability leads to seeking therapeutic pubertal suppression. We aim to explore maternal attitudes and reasons for seeking pubertal suppression. METHODS: Mothers of girls receiving gonadotropin -releasing hormone analogue therapy in Mafraq hospital, Abu Dhabi were enrolled in the study. A semistructured interview was conducted to ascertain possible reasons for delaying puberty. The study group was divided into girls with a disability with central precocious puberty (CPP) or normal puberty and girls without a disability presenting with CPP. RESULTS: 42 mother-daughter pairs were enrolled and divided into two groups; group A: 15 girls with CPP with no disability; group B: 27 girls with disability (10 had CPP (group B1) and 17 had normal pubertal timing (group B2)). Mothers in group A aimed to delay puberty, while in group B, 13 (48%) mothers desired to halt puberty and 7 (26%) requested permanent surgical intervention. Fear of short stature (15, 100%), inability to cope psychologically (10, 67%) and fear of peer rejection (9, 60%) were the main concerns in group A. In group B, mothers were concerned about menstrual hygiene management (25, 92.5%), fear of child abuse or unwanted pregnancy (15, 55%) and fear of inability to express pain/discomfort with menstruation (8, 30%). CONCLUSION: Mothers of girls with a disability commonly seek medical help to delay/halt puberty due to concerns about menstrual hygiene. Short final height was the main concern for girls without a disability. Culture and religion play an important role in puberty management in girls with a disability.
