Ahmad Fayez Bakr - Academia.edu (original) (raw)

Papers by Ahmad Fayez Bakr

Research paper thumbnail of What is the optimal gestational age for twin delivery

BMC pregnancy and childbirth, Jan 16, 2006

The question about outcome in twins delivered early versus late remains unanswered. The objective... more The question about outcome in twins delivered early versus late remains unanswered. The objective of this study was to evaluate the association of the timing of delivering twins and the perinatal outcome. A prospective cohort study was carried-out in Alexandria University Maternity Hospital. We planned to examine the records of twin deliveries over 2 years. The inclusion criteria were twin deliveries with gestational age at delivery at least 36 completed weeks. Twins of mothers with chronic illness and those with congenital anomalies were excluded. Perinatal outcome parameters (morbidity and mortality) were defined and evaluated. Out of 273 twin sets, 197 (72.2%) met the inclusion criteria. They were classified into 3 groups according to the gestational age at delivery. Neonatal morbidity and maternal complications were higher in those delivered earlier. Twins electively delivered had worse outcome than those delivered spontaneously. In the elective group, there was no difference in...

Research paper thumbnail of Severe respiratory distress in term infants born electively at high altitude

BMC pregnancy and childbirth, Jan 16, 2006

We studied the contribution of elective delivery to severe respiratory distress syndrome (RDS) in... more We studied the contribution of elective delivery to severe respiratory distress syndrome (RDS) in term babies born at high altitude. We prospectively studied the charts of term babies born in Taif Maternity Hospital (1640 m above sea level) between 1/1/2004 and 31/10/2004 who developed RDS and required mechanical ventilation. 8634 deliveries occurred from 37-<41 weeks; 13 (0.15%) had RDS requiring mechanical ventilation. Seven infants delivered at 37-<38 weeks, (OR for RDS = 26 95%CI -4.6 to 5.8), five delivered at 38-<39 weeks, (OR for RDS = 10 95%CI -4.9 to 5.4) and one delivered at >39 weeks. Six of 13 infants were electively delivered without documented lung maturity. Infants born at 37 and 38 weeks' gestation remain at significantly increased risk for severe RDS. Elective delivery is responsible for 50% of the potentially avoidable cases. Our data suggest that the altitude does not seem to influence the incidence of severe RDS in term infants born electively.

Research paper thumbnail of Oxygen concentration at the rear and front of bag-mask device during ventilation of neonate

Research paper thumbnail of Oxygen concentrations at the rear and front of the bag in bag valve mask devices during oxygenation of neonates

Resuscitation, 2005

To study the concentration of oxygen flowing passively from the front and the rear parts of diffe... more To study the concentration of oxygen flowing passively from the front and the rear parts of different brands of self-inflating bag valve mask ventilation devices at different oxygen flows and that flowing actively from the front part at different ventilation rates. Two devices were tested, the Ambu device in which the added oxygen enters at a right angle to the axis of the bag and the VBM in which the oxygen enters parallel to the axis of the bag and faces either a hole or a ridge in the intake valve. An oxygen analyzer was used to measure the oxygen concentration at different oxygen flow rates (2, 4, 6, 8 and 10 L/min) supplied by a 100% oxygen source. This was measured in both devices from the front and rear parts as step one. With active ventilation compressing the bag, oxygen concentration was measured from the front part. This was done at ventilation rates of 30 and 60 min(-1). Passive flow oxygenation. With the Ambu device, the oxygen concentration measured at the front part of the bag was 21% and that measured from the rear part was 100%, at all oxygen flow rates. With the VBM brand, in the first position with the oxygen source facing a hole (VBM-hole), the oxygen concentration was high at low flow rates and decreased with increased flow. Similar findings happened when measuring oxygen concentration from its rear part. With the oxygen source facing a ridge (VBM-ridge), the oxygen concentration measured from the front was directly proportional to the oxygen flow rate i.e. it increased with increasing flow. From the rear part, the oxygen concentration was near 100% at all flow rates. Active ventilation. Using the Ambu device, the oxygen concentration increased with increasing flow rate and reached 100% at 10 L/min flow. With VBM-hole, the oxygen concentration increased gradually with increasing flow but never reached 100%. With VBM-ridge, the performance was comparable to the Ambu. In all the situations, the oxygen concentration was higher when the ventilation was done at 30 min(-1) than at 60 min(-1). The Ambu device can provide 100% oxygen from its rear part even at low flow rates and 100% oxygen during active ventilation provided at least 10 L/min oxygen is used. The VBM is at a disadvantage when the oxygen source faces a hole; as the jet flowing in the bag causes a Venturi effect; which sucks air in from outside and dilutes the oxygen concentration provided. The ridge type does not have this problem. Ventilation at a rate of 30 min(-1) produced a higher oxygen concentration. The operator should be aware of the limitations of the device used.

Research paper thumbnail of Prophylactic theophylline to prevent renal dysfunction in newborns exposed to perinatal asphyxia—a study in a developing country

Pediatric Nephrology, 2005

Renal damage frequently complicates perinatal asphyxia. Renal vasoconstriction due to adenosine m... more Renal damage frequently complicates perinatal asphyxia. Renal vasoconstriction due to adenosine metabolite leads to a fall in glomerular filtration rate (GFR) and filtration fraction. This might be inhibited by the nonspecific adenosine receptor antagonist, theophylline. This study was designed to determine whether theophylline could prevent and/or ameliorate renal dysfunction in term neonates with perinatal asphyxia. We randomized 40 severely asphyxiated term infants to receive intravenously a single dose of either theophylline (5 mg/kg; study group: n=20) or placebo (control group: n=20) during the first hour of life. Fluid intake, urine output, serum creatinine, creatinine clearance, GFR, urinary b2 microglobuin (b2 M) and sodium excretion were recorded during the first 5 days of life. The two groups were comparable. No significant difference was reported regarding mechanical ventilatory support, respiratory complications and seizures. Severe renal dysfunction was significantly higher in the control group. Serum creatinine values were less, and creatinine clearance and GFR were significantly higher in the theophylline group from the second day onwards. b2 M excretion was significantly less in the theophylline group, while sodium excretion and hematuria showed no significant difference. Prophylactic theophylline treatment, given early after birth, has beneficial effects in reducing the renal involvement in asphyxiated full-term infants, with no significant changes in central nervous system involvement.

Research paper thumbnail of Combining Pulse Oximetry and Clinical Examination in Screening for Congenital Heart Disease

Pediatric Cardiology, 2005

The objective of this study was to evaluate combined pulse oximetry and clinical examination as a... more The objective of this study was to evaluate combined pulse oximetry and clinical examination as a screening method for congenital heart disease (CHD) in asymptomatic newborns. Asymptomatic newborns were screened for CHD using pulse oximetry and clinical examination before their discharge from the nursery. Oxygen saturation ‡94% was considered normal. Echocardiography was done for newborns with abnormal readings and for those with significant murmurs. Data concerning undetected cases were collected from the pediatric referral hospital. A total of 5211 cases were screened. Echocardiographic evaluations were done based on low pulse oximetry in five cases and on murmur detection in ten others. The sensitivity of the combined method of screening was 77%, whereas it was 31% for oximetry alone and 46% for clinical examination alone. Specificity was 100% for all methods. The positive predictive value of the combined tool was 66.7%. We conclude that combining pulse oximetry and clinical examination can enhance the clinicianÕs ability to detect life-threatening CHD in a timely manner. This screening method should become a part of the discharge plan for every newborn.

Research paper thumbnail of Effect of Predelivery Vaginal Antisepsis on Maternal and Neonatal Morbidity and Mortality in Egypt

Journal of Women's Health, 2005

Objective: The objective of this study was to determine if cleansing the birth canal with an anti... more Objective: The objective of this study was to determine if cleansing the birth canal with an antiseptic solution at delivery reduces infections in mothers and their newborn babies. Methods: Women giving birth in the University Hospital, Alexandria, and their newborns were studied. No intervention for 3 months was followed by 3 months of intervention. Intervention consisted of manually wiping the maternal birth canal with a 0.25% chlorhexidine solution at admission and at every vaginal examination before delivery. Babies were also wiped with chlorhexidine. Results: The study enrolled 4415 women and 4431 newborns. The nonintervention phase comprised 2128 mothers and 2138 newborns, and 2287 mothers and 2293 babies were enrolled in the intervention phase. There were no adverse reactions related to the intervention among the mothers or their children. There was no difference in the overall number of neonatal admissions in both groups, but the admissions because of infection, deaths, and mortalities from infection were significantly less in the intervention group. Among mothers receiving the intervention, admissions, deaths, and infections were significantly reduced. Conclusions: Cleansing the birth canal with chlorhexidine reduced neonatal and maternal postpartum infections. The safety, simplicity, and low cost of the procedure suggest that it should be considered standard care for the reduction of infant and maternal morbidity and mortality.

Research paper thumbnail of The Rear or the Front in Bag and Mask Oxygenation of the Neonates

Journal of Tropical Pediatrics, 2006

Research paper thumbnail of Intravenous Lines-related Sepsis in Newborn Babies Admitted to NICU in a Developing Country

Journal of Tropical Pediatrics, 2003

Research paper thumbnail of Normal Values of Pulse Oximetry in Newborns at High Altitude

Journal of Tropical Pediatrics, 2005

The aim of the study was to establish normal values of pulse oximetry saturation, respiratory rat... more The aim of the study was to establish normal values of pulse oximetry saturation, respiratory rate, heart rate, and blood pressure in healthy newborns at high altitude. Vital signs and oximetry saturation readings were collected from healthy term newborns at birth, at 1 h, and at 24 h of life. These were analyzed and compared with reference ranges at sea level. This study was carried out at altitudes of 1640 m above sea level in Taif city, Saudi Arabia. A total of 6011 term newborns were examined at birth and 1 h and 4274 were examined at 24 h of life. At birth, the mean SpO 2 was 68.6 per cent and 60.3 per cent from the right upper and lower limbs, respectively. Mean SpO 2 was 94.3 per cent and 95.4 per cent at the age of 1 and 24 h, respectively. These values were significantly lower than those reported at sea level. The mean respiratory rate, heart rate, and mean blood pressure at 24 h were 45.7/min, 149.7/min, and 46.9 mmHg, respectively. It is concluded that pulse oximetry saturation for newborn babies is lower at higher altitudes than at sea level. This effect is observable at altitudes of 1600 m above sea level. Cutoff levels lower than those used at sea level should be adopted when dealing with newborns living at high altitudes.

Research paper thumbnail of Fetal Pulse Oximetry and Neonatal Outcome: A Study in a Developing Country

Journal of Perinatology, 2005

The aim of this cohort, prospective study was to compare the diagnostic value of intrapartum feta... more The aim of this cohort, prospective study was to compare the diagnostic value of intrapartum fetal pulse oximetry (FPO) with that of fetal scalp blood gas (FSBG) for an abnormal neonatal outcome in cases with abnormal fetal heart rate (FHR) tracings. METHODS: Fetal oxygen saturation was continuously monitored with Nellcor N-400 FPO during labor. Simultaneous FSBG determinations were obtained. The results were analyzed in relation to umbilical arterial cord blood pH and neonatal outcome. Studied FPO cutoff levels were 30 and 40% hemoglobin saturation and that of FSBG pH was 7.2. RESULTS: During the study, there were 9825 deliveries; 415 had abnormal FHR. Only 150 fulfilled the whole screening panel. When the outcome variable was umbilical arterial pH, the positive predictive values of the three methods (FPO30, FPO40, FSBG) were 57, 61 and 65% and the negative predictive values were 43, 39 and 35% respectively. The sensitivity of FPO30 was highest (75%). Considering abnormal neonatal outcome, again the sensitivity was also highest for FPO30 (89%). The sensitivity of FSBG was 82%. The specificity of the three methods were 53, 49 and 38% respectively. CONCLUSION: The diagnostic value of intrapartum FPO compares favorably with FSBG. FPO seems to be a reliable and less invasive tool and may decrease unnecessary interventions and unnecessary fetal scalp blood sampling in cases of suspected fetal distress. The FPO cutoff of 30% saturation defined by previous studies appears to be appropriate.

Research paper thumbnail of Measurement of reticulocyte hemoglobin content to diagnose iron deficiency in Saudi children

European Journal of Pediatrics, 2006

Iron deficiency and iron deficiency anemia are common conditions in children, especially in devel... more Iron deficiency and iron deficiency anemia are common conditions in children, especially in developing countries. It is often difficult for the pediatrician to know which indices should be used in the diagnosis of these conditions in children. Reticulocyte hemoglobin (Hb) content (CHr) has been shown to be an accurate indicator of anemia, however whether its use suits the situation in developing countries or not is unclear. The aim of this study was to evaluate the value and effectiveness of using CHr as a method to diagnose iron deficiency and iron deficiency anemia in Saudi children. The samples for the study were collected from 305 children suspected to have anemia. Complete blood count, transferrin saturation (Tfsat), ferritin, circulating transferrin receptor (TfR) and CHr were measured. Three groups were defined, iron deficiency (Tfsat &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;20%, Hb &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;11 g/dL; n=120), iron deficiency anemia (Tfsat &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;20%, Hb &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;11 g/dL; (n=73) and controls (Tfsat &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;20%; n=112). The anemic group had significantly lower macrocytic anemia (MCV), mean corpuscular hemoglobin (MCH) and CHr. All of the variables in the anemia group were significantly lower than those of the control group except for the ferritin level. Compared to the control group, the iron deficiency group also showed significantly lower values except for transferrin receptor and the ferritin levels. CHr levels of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;26 pg correlated well with anemic states. CHr together with a complete blood count may provide an alternative to the traditional hematologic or biochemical panel for the diagnosis of iron deficiency and iron deficiency anemia in young children and is cost-effective in developing countries. A CHr cut-off level of 26 pg is considered to be a reasonable indicator of anemic states.

Research paper thumbnail of Rectal sunflower seed bezoar

Research paper thumbnail of What is the optimal gestational age for twin delivery

BMC pregnancy and childbirth, Jan 16, 2006

The question about outcome in twins delivered early versus late remains unanswered. The objective... more The question about outcome in twins delivered early versus late remains unanswered. The objective of this study was to evaluate the association of the timing of delivering twins and the perinatal outcome. A prospective cohort study was carried-out in Alexandria University Maternity Hospital. We planned to examine the records of twin deliveries over 2 years. The inclusion criteria were twin deliveries with gestational age at delivery at least 36 completed weeks. Twins of mothers with chronic illness and those with congenital anomalies were excluded. Perinatal outcome parameters (morbidity and mortality) were defined and evaluated. Out of 273 twin sets, 197 (72.2%) met the inclusion criteria. They were classified into 3 groups according to the gestational age at delivery. Neonatal morbidity and maternal complications were higher in those delivered earlier. Twins electively delivered had worse outcome than those delivered spontaneously. In the elective group, there was no difference in...

Research paper thumbnail of Severe respiratory distress in term infants born electively at high altitude

BMC pregnancy and childbirth, Jan 16, 2006

We studied the contribution of elective delivery to severe respiratory distress syndrome (RDS) in... more We studied the contribution of elective delivery to severe respiratory distress syndrome (RDS) in term babies born at high altitude. We prospectively studied the charts of term babies born in Taif Maternity Hospital (1640 m above sea level) between 1/1/2004 and 31/10/2004 who developed RDS and required mechanical ventilation. 8634 deliveries occurred from 37-<41 weeks; 13 (0.15%) had RDS requiring mechanical ventilation. Seven infants delivered at 37-<38 weeks, (OR for RDS = 26 95%CI -4.6 to 5.8), five delivered at 38-<39 weeks, (OR for RDS = 10 95%CI -4.9 to 5.4) and one delivered at >39 weeks. Six of 13 infants were electively delivered without documented lung maturity. Infants born at 37 and 38 weeks' gestation remain at significantly increased risk for severe RDS. Elective delivery is responsible for 50% of the potentially avoidable cases. Our data suggest that the altitude does not seem to influence the incidence of severe RDS in term infants born electively.

Research paper thumbnail of Oxygen concentration at the rear and front of bag-mask device during ventilation of neonate

Research paper thumbnail of Oxygen concentrations at the rear and front of the bag in bag valve mask devices during oxygenation of neonates

Resuscitation, 2005

To study the concentration of oxygen flowing passively from the front and the rear parts of diffe... more To study the concentration of oxygen flowing passively from the front and the rear parts of different brands of self-inflating bag valve mask ventilation devices at different oxygen flows and that flowing actively from the front part at different ventilation rates. Two devices were tested, the Ambu device in which the added oxygen enters at a right angle to the axis of the bag and the VBM in which the oxygen enters parallel to the axis of the bag and faces either a hole or a ridge in the intake valve. An oxygen analyzer was used to measure the oxygen concentration at different oxygen flow rates (2, 4, 6, 8 and 10 L/min) supplied by a 100% oxygen source. This was measured in both devices from the front and rear parts as step one. With active ventilation compressing the bag, oxygen concentration was measured from the front part. This was done at ventilation rates of 30 and 60 min(-1). Passive flow oxygenation. With the Ambu device, the oxygen concentration measured at the front part of the bag was 21% and that measured from the rear part was 100%, at all oxygen flow rates. With the VBM brand, in the first position with the oxygen source facing a hole (VBM-hole), the oxygen concentration was high at low flow rates and decreased with increased flow. Similar findings happened when measuring oxygen concentration from its rear part. With the oxygen source facing a ridge (VBM-ridge), the oxygen concentration measured from the front was directly proportional to the oxygen flow rate i.e. it increased with increasing flow. From the rear part, the oxygen concentration was near 100% at all flow rates. Active ventilation. Using the Ambu device, the oxygen concentration increased with increasing flow rate and reached 100% at 10 L/min flow. With VBM-hole, the oxygen concentration increased gradually with increasing flow but never reached 100%. With VBM-ridge, the performance was comparable to the Ambu. In all the situations, the oxygen concentration was higher when the ventilation was done at 30 min(-1) than at 60 min(-1). The Ambu device can provide 100% oxygen from its rear part even at low flow rates and 100% oxygen during active ventilation provided at least 10 L/min oxygen is used. The VBM is at a disadvantage when the oxygen source faces a hole; as the jet flowing in the bag causes a Venturi effect; which sucks air in from outside and dilutes the oxygen concentration provided. The ridge type does not have this problem. Ventilation at a rate of 30 min(-1) produced a higher oxygen concentration. The operator should be aware of the limitations of the device used.

Research paper thumbnail of Prophylactic theophylline to prevent renal dysfunction in newborns exposed to perinatal asphyxia—a study in a developing country

Pediatric Nephrology, 2005

Renal damage frequently complicates perinatal asphyxia. Renal vasoconstriction due to adenosine m... more Renal damage frequently complicates perinatal asphyxia. Renal vasoconstriction due to adenosine metabolite leads to a fall in glomerular filtration rate (GFR) and filtration fraction. This might be inhibited by the nonspecific adenosine receptor antagonist, theophylline. This study was designed to determine whether theophylline could prevent and/or ameliorate renal dysfunction in term neonates with perinatal asphyxia. We randomized 40 severely asphyxiated term infants to receive intravenously a single dose of either theophylline (5 mg/kg; study group: n=20) or placebo (control group: n=20) during the first hour of life. Fluid intake, urine output, serum creatinine, creatinine clearance, GFR, urinary b2 microglobuin (b2 M) and sodium excretion were recorded during the first 5 days of life. The two groups were comparable. No significant difference was reported regarding mechanical ventilatory support, respiratory complications and seizures. Severe renal dysfunction was significantly higher in the control group. Serum creatinine values were less, and creatinine clearance and GFR were significantly higher in the theophylline group from the second day onwards. b2 M excretion was significantly less in the theophylline group, while sodium excretion and hematuria showed no significant difference. Prophylactic theophylline treatment, given early after birth, has beneficial effects in reducing the renal involvement in asphyxiated full-term infants, with no significant changes in central nervous system involvement.

Research paper thumbnail of Combining Pulse Oximetry and Clinical Examination in Screening for Congenital Heart Disease

Pediatric Cardiology, 2005

The objective of this study was to evaluate combined pulse oximetry and clinical examination as a... more The objective of this study was to evaluate combined pulse oximetry and clinical examination as a screening method for congenital heart disease (CHD) in asymptomatic newborns. Asymptomatic newborns were screened for CHD using pulse oximetry and clinical examination before their discharge from the nursery. Oxygen saturation ‡94% was considered normal. Echocardiography was done for newborns with abnormal readings and for those with significant murmurs. Data concerning undetected cases were collected from the pediatric referral hospital. A total of 5211 cases were screened. Echocardiographic evaluations were done based on low pulse oximetry in five cases and on murmur detection in ten others. The sensitivity of the combined method of screening was 77%, whereas it was 31% for oximetry alone and 46% for clinical examination alone. Specificity was 100% for all methods. The positive predictive value of the combined tool was 66.7%. We conclude that combining pulse oximetry and clinical examination can enhance the clinicianÕs ability to detect life-threatening CHD in a timely manner. This screening method should become a part of the discharge plan for every newborn.

Research paper thumbnail of Effect of Predelivery Vaginal Antisepsis on Maternal and Neonatal Morbidity and Mortality in Egypt

Journal of Women's Health, 2005

Objective: The objective of this study was to determine if cleansing the birth canal with an anti... more Objective: The objective of this study was to determine if cleansing the birth canal with an antiseptic solution at delivery reduces infections in mothers and their newborn babies. Methods: Women giving birth in the University Hospital, Alexandria, and their newborns were studied. No intervention for 3 months was followed by 3 months of intervention. Intervention consisted of manually wiping the maternal birth canal with a 0.25% chlorhexidine solution at admission and at every vaginal examination before delivery. Babies were also wiped with chlorhexidine. Results: The study enrolled 4415 women and 4431 newborns. The nonintervention phase comprised 2128 mothers and 2138 newborns, and 2287 mothers and 2293 babies were enrolled in the intervention phase. There were no adverse reactions related to the intervention among the mothers or their children. There was no difference in the overall number of neonatal admissions in both groups, but the admissions because of infection, deaths, and mortalities from infection were significantly less in the intervention group. Among mothers receiving the intervention, admissions, deaths, and infections were significantly reduced. Conclusions: Cleansing the birth canal with chlorhexidine reduced neonatal and maternal postpartum infections. The safety, simplicity, and low cost of the procedure suggest that it should be considered standard care for the reduction of infant and maternal morbidity and mortality.

Research paper thumbnail of The Rear or the Front in Bag and Mask Oxygenation of the Neonates

Journal of Tropical Pediatrics, 2006

Research paper thumbnail of Intravenous Lines-related Sepsis in Newborn Babies Admitted to NICU in a Developing Country

Journal of Tropical Pediatrics, 2003

Research paper thumbnail of Normal Values of Pulse Oximetry in Newborns at High Altitude

Journal of Tropical Pediatrics, 2005

The aim of the study was to establish normal values of pulse oximetry saturation, respiratory rat... more The aim of the study was to establish normal values of pulse oximetry saturation, respiratory rate, heart rate, and blood pressure in healthy newborns at high altitude. Vital signs and oximetry saturation readings were collected from healthy term newborns at birth, at 1 h, and at 24 h of life. These were analyzed and compared with reference ranges at sea level. This study was carried out at altitudes of 1640 m above sea level in Taif city, Saudi Arabia. A total of 6011 term newborns were examined at birth and 1 h and 4274 were examined at 24 h of life. At birth, the mean SpO 2 was 68.6 per cent and 60.3 per cent from the right upper and lower limbs, respectively. Mean SpO 2 was 94.3 per cent and 95.4 per cent at the age of 1 and 24 h, respectively. These values were significantly lower than those reported at sea level. The mean respiratory rate, heart rate, and mean blood pressure at 24 h were 45.7/min, 149.7/min, and 46.9 mmHg, respectively. It is concluded that pulse oximetry saturation for newborn babies is lower at higher altitudes than at sea level. This effect is observable at altitudes of 1600 m above sea level. Cutoff levels lower than those used at sea level should be adopted when dealing with newborns living at high altitudes.

Research paper thumbnail of Fetal Pulse Oximetry and Neonatal Outcome: A Study in a Developing Country

Journal of Perinatology, 2005

The aim of this cohort, prospective study was to compare the diagnostic value of intrapartum feta... more The aim of this cohort, prospective study was to compare the diagnostic value of intrapartum fetal pulse oximetry (FPO) with that of fetal scalp blood gas (FSBG) for an abnormal neonatal outcome in cases with abnormal fetal heart rate (FHR) tracings. METHODS: Fetal oxygen saturation was continuously monitored with Nellcor N-400 FPO during labor. Simultaneous FSBG determinations were obtained. The results were analyzed in relation to umbilical arterial cord blood pH and neonatal outcome. Studied FPO cutoff levels were 30 and 40% hemoglobin saturation and that of FSBG pH was 7.2. RESULTS: During the study, there were 9825 deliveries; 415 had abnormal FHR. Only 150 fulfilled the whole screening panel. When the outcome variable was umbilical arterial pH, the positive predictive values of the three methods (FPO30, FPO40, FSBG) were 57, 61 and 65% and the negative predictive values were 43, 39 and 35% respectively. The sensitivity of FPO30 was highest (75%). Considering abnormal neonatal outcome, again the sensitivity was also highest for FPO30 (89%). The sensitivity of FSBG was 82%. The specificity of the three methods were 53, 49 and 38% respectively. CONCLUSION: The diagnostic value of intrapartum FPO compares favorably with FSBG. FPO seems to be a reliable and less invasive tool and may decrease unnecessary interventions and unnecessary fetal scalp blood sampling in cases of suspected fetal distress. The FPO cutoff of 30% saturation defined by previous studies appears to be appropriate.

Research paper thumbnail of Measurement of reticulocyte hemoglobin content to diagnose iron deficiency in Saudi children

European Journal of Pediatrics, 2006

Iron deficiency and iron deficiency anemia are common conditions in children, especially in devel... more Iron deficiency and iron deficiency anemia are common conditions in children, especially in developing countries. It is often difficult for the pediatrician to know which indices should be used in the diagnosis of these conditions in children. Reticulocyte hemoglobin (Hb) content (CHr) has been shown to be an accurate indicator of anemia, however whether its use suits the situation in developing countries or not is unclear. The aim of this study was to evaluate the value and effectiveness of using CHr as a method to diagnose iron deficiency and iron deficiency anemia in Saudi children. The samples for the study were collected from 305 children suspected to have anemia. Complete blood count, transferrin saturation (Tfsat), ferritin, circulating transferrin receptor (TfR) and CHr were measured. Three groups were defined, iron deficiency (Tfsat &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;20%, Hb &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;11 g/dL; n=120), iron deficiency anemia (Tfsat &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;20%, Hb &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;11 g/dL; (n=73) and controls (Tfsat &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;20%; n=112). The anemic group had significantly lower macrocytic anemia (MCV), mean corpuscular hemoglobin (MCH) and CHr. All of the variables in the anemia group were significantly lower than those of the control group except for the ferritin level. Compared to the control group, the iron deficiency group also showed significantly lower values except for transferrin receptor and the ferritin levels. CHr levels of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;26 pg correlated well with anemic states. CHr together with a complete blood count may provide an alternative to the traditional hematologic or biochemical panel for the diagnosis of iron deficiency and iron deficiency anemia in young children and is cost-effective in developing countries. A CHr cut-off level of 26 pg is considered to be a reasonable indicator of anemic states.

Research paper thumbnail of Rectal sunflower seed bezoar