Perfecting temporary pacemakers in a developing country.

INTRODUCTION: Transvenous pacemakers are used to temporarily pace heart in emergent situations. This study was conducted to analyze the current success rate of temporary pacemaker insertion in our institution and discover causes for failure to improve the technique. METHODOLOGY: A retrospective cohort study was conducted of 263 patients from 2006 to 2016 who underwent TPM insertion at Aga Khan University Hospital, Karachi. RESULTS: The success rate for the procedure was 97.7%, with one mortality caused by the pacemaker. No significant risk factor was found for the failure of TPM. CONCLUSION: There was no significant effect of anatomical site or technique on the failure of TPM insertion. However, with better training and higher experience of the residents, the complications and rate of failures can be reduced.

Factors Leading To Meconium Aspiration Syndrome in Term- and Post-term Neonates.

Background Meconium aspiration syndrome (MAS) is considered a major cause of respiratory morbidity. It is a common issue encountered in the delivery room and newborn nursery. There is a need to identify the factors that lead to MAS to develop strategies to screen such patients at an early stage to decrease the mortality and morbidity. The objective of this study was to determine the factors leading to MAS in neonates delivered at ≥37 weeks of gestational age. Methods A cross-sectional study was conducted through non-probability consecutive sampling technique at Liaquat University Hospital, Hyderabad from August 2016 to February 2017. All neonates at ≥37 weeks of gestation with meconium-stained amniotic fluid (MSAF) detected during delivery were included in this study after obtaining informed consent from their parents. The demographic and factors related to MAS were recorded through predesigned proforma and analyzed using SPSS version 22. Mean and standard deviation were determined for quantitative variables whereas frequency and percentages were calculated for qualitative variables. Results Overall 136 neonates were included in the study. The mean gestational age was 38 ± 1.43 weeks. The major factors for MAS were detected as fetal distress (67.0%, n = 91), non-reassuring fetal heart rate (54.0%, n = 73), cesarean birth (48.0%, n = 65), intrauterine growth restriction (IUGR; 17.0%, n = 23), and post maturity (12.0%, n = 16). Conclusion We conclude that the major factors for MAS are fetal distress, non-reassuring FHR tracing, cesarean birth, IUGR, and post maturity. Screening of such patients at an early stage may minimize morbidity and mortality related to MAS.