Arun Nair - Academia.edu (original) (raw)
Papers by Arun Nair
JPMA. The Journal of the Pakistan Medical Association, 2004
Saudi medical journal, 2004
1. Saudi Med J. 2004 Oct;25(10):1501-2. A simplified bedside method for estimating glomerular fil... more 1. Saudi Med J. 2004 Oct;25(10):1501-2. A simplified bedside method for estimating glomerular filtration rate in term neonates. Manzar S, Nair AK, Pai MG, Al-Khusaiby SM. Neonatal Intensive Care Unit, Royal Hospital, Muscat, Sultanate of Oman. shabihman@hotmail.com. ...
Indian pediatrics, 2004
To study the efficacy and complications of low dose indomethacin in the reduction of major intrav... more To study the efficacy and complications of low dose indomethacin in the reduction of major intraventricular hemorrhage (IVH) in very low birth weight (VLBW) babies. prospective randomized controlled trial (interim analysis) Level III neonatal intensive care unit of a perinatal tertiary care center. Newborn babies with birth weights between 750-1250 g were randomized into indomethacin or control groups. They were further stratified into two birth weight groups 750-999 g and 1000-1250 g for subgroup analysis. 3 doses of indomethacin were administered to the indomethacin group at the dose of 0.1 mg/kg/dose intravenously. The control group did not receive any specific intervention other than standard neonatal intensive care. The primary outcome measure was the occurrence of IVH and the secondary outcome measures were necrotising enterocolitis, symptomatic patent ductus arteriosus (PDA), bleeding episodes, renal failure, chronic-lung disease and death. Out of 115 eligible newborn babies,...
Journal of Tropical Pediatrics, 2003
The relationship between glucose-6 phosphate dehydrogenase (G6PD) deficiency and jaundice in the ... more The relationship between glucose-6 phosphate dehydrogenase (G6PD) deficiency and jaundice in the newborn period is well recognized. However, there is concern about the increasing incidence of kernicterus being reported worldwide, especially due to unrecognized G6PD deficiency and early discharge from hospital after birth. We report a case series of kernicterus from a setup where the high prevalence rate of G6PD deficiency is known. Fourteen cases of kernicterus were seen during a time period of 6 years, 71 per cent of them had G6PD deficiency. Recent literature is reviewed and possible preventive measures in the light of current information and practices are suggested.
BMC Pediatrics, 2014
Standardised parenteral nutrition formulations are routinely used in the neonatal intensive care ... more Standardised parenteral nutrition formulations are routinely used in the neonatal intensive care units in Australia and New Zealand. In 2010, a multidisciplinary group was formed to achieve a consensus on the formulations acceptable to majority of the neonatal intensive care units. Literature review was undertaken for each nutrient and recommendations were developed in a series of meetings held between November 2010 and April 2011. Three standard and 2 optional amino acid/dextrose formulations and one lipid emulsion were agreed by majority participants in the consensus. This has a potential to standardise neonatal parenteral nutrition guidelines, reduce costs and prescription errors.
Archives of Disease in Childhood - Fetal and Neonatal Edition, 2004
to be contaminated both clinically and in a negative repeated culture. In one infant, blood cultu... more to be contaminated both clinically and in a negative repeated culture. In one infant, blood culture was positive for Staphylococcus aureus, and Enterococcus grew from culture of the urine in the other. Most admissions (83%) were between June and early October, which are the warmest months of the year in this area. In this low risk group of infants, only two patients had serious bacterial infection. Compatible with the findings of Maayan-Metzger et al, 1 the results of our study support dehydration as the main cause of fever during the first week of life. As most of our cases occurred during summer and early autumn, environmental temperature may have an additive effect in this population.
Journal of Paediatrics and Child Health, 2019
Background: The Queensland Family Cohort (QFC) study will be a longitudinal study which aims to u... more Background: The Queensland Family Cohort (QFC) study will be a longitudinal study which aims to understand the biological mechanisms that drive disease risk within 10,000 families across Queensland. To test the feasibility of a 10,000 birth family cohort, we aimed to understand the enrolment rate in a pilot study (200 families) birthing at the Brisbane Mater Mothers' Hospital. Methods: Pregnant individuals interested in Mater Research Projects were contacted between 12-20 weeks gestation via phone, email or SMS. If willing, they were sent patient information and followed up after 48 h to allow for examination of the study information. Enrolment occurred over the phone, or during an appointment, and families were only excluded if partners, if one was present, did not consent. Results: Three hundred eligible families were pre-screened. To date 53 families have enrolled (17.7%). Consenting pregnant participants had a median age of 32 years (21-45), with 43 public sector families (81%); 10 private sector families (19%). The majority of pregnant recruits were Australian born (60%) with the remainder born in other countries (n = 13). Three families withdrew after commencement and 103 families (34%) declined participation due to time commitments. Conclusions: Our data shows a promising total recruitment of 25% for the pilot study. Enrolment for phase two of the pilot may be improved by patient information digestibility, partner communication, and QFC study communications.
The Journal of pediatrics, Jan 3, 2018
To evaluate the costs of using dextrose gel as a primary treatment for neonatal hypoglycemia in t... more To evaluate the costs of using dextrose gel as a primary treatment for neonatal hypoglycemia in the first 48 hours after birth compared with standard care. We used a decision tree to model overall costs, including those specific to hypoglycemia monitoring and treatment and those related to the infant's length of stay in the postnatal ward or neonatal intensive care unit, comparing the use of dextrose gel for treatment of neonatal hypoglycemia with placebo, using data from the Sugar Babies randomized trial. Sensitivity analyses assessed the impact of dextrose gel cost, neonatal intensive care cost, cesarean delivery rate, and costs of glucose monitoring. In the primary analysis, treating neonatal hypoglycemia using dextrose gel had an overall cost of NZ$6863.81 and standard care (placebo) cost NZ$8178.25; a saving of NZ$1314.44 per infant treated. Sensitivity analyses showed that dextrose gel remained cost saving with wide variations in dextrose gel costs, neonatal intensive care...
Saudi Medical Journal, 2004
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Saudi Medical Journal, Aug 1, 2004
1. Saudi Med J. 2004 Aug;25(8):1120-1. Changing survival statistics among extreme premature infan... more 1. Saudi Med J. 2004 Aug;25(8):1120-1. Changing survival statistics among extreme premature infants in Oman. Manzar S, Nair AK, Pai MG, Al-Khusaiby SM. Department of Child Health (Neonatal Intensive Care Unit), Royal ...
Saudi Medical Journal, Sep 1, 2004
The present growth chart used in the Sultanate of Oman does not contain centile measurements for ... more The present growth chart used in the Sultanate of Oman does not contain centile measurements for infants born at 26-weeks of gestation. With the increased survival of these premature infants, there is a growing need to develop such a chart. The present study was conducted with the aim to look at the anthropometric measurements (weight, length and head circumference) of Omani premature infants born at 26-weeks of gestation and to develop centile charts for these measurements. The study was conducted at the Special Care Baby Unit (SCBU) of the Royal Hospital, one of the major perinatal institutions in Muscat, Oman. A computerized database is maintained for all the admissions from 1996. We extracted the required anthropometric data for all 26-week gestation premature Omani infants admitted to SCBU from January 1996 to November 2003. A total of 49 babies were admitted during that period. Out of these, 43 had complete information on the growth parameters, including birth weight, length and head circumference. These parameters were noted down and by using the statistical package, an analysis was performed to get the normal distribution curve. By using the Microsoft Excel program, graphs were generated for all the 3 growth parameters. The mean birth weight for the premature infants born at 26-week gestation was noted to be 908 +/- 156 grams, with length and head circumference of 33.5 +/- 2.5 and 24.5 +/- 1.7 centimeters. The normal distribution curve was obtained with minimal skewing. We were able to generate centile charts of the anthropometric measurements for Omani infants born at 26-weeks of gestation. The next step is to collect the national data from other institutions in Oman and then incorporate it into the present growth chart to make the charts more valid, reliable and applicable.
Saudi Medical Journal, May 1, 2005
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Saudi medical journal, 2005
Appropriate fetal brain growth depends upon the cerebral blood flow (CBF). Different congenital h... more Appropriate fetal brain growth depends upon the cerebral blood flow (CBF). Different congenital heart defects (CHDs), due to the difference in anatomy and physiology, alter the intrauterine CBF. Thus, variable brain growth is expected in different CHDs that is reflected by variability in the head circumference (HC) at birth. The present study was carried out to compare the HC of babies born with transposition of great arteries (TGA) and hypoplastic left heart syndrome (HLHS) in comparison to normal control. The data on the HC of neonates with TGA and HLHS were extracted from the computer database then compared with the control group. During the period from January 1996 to December 2003, a total of 7396 neonates were admitted, out of which 639 (8.6%) were admitted with the diagnosis of the CHD. After correcting for gestational age and non-availability of HC measurements, 236 infants were excluded. Out of the remaining 403 term appropriate for gestational age (AGA) infants, 46 had TGA...
Journal of Perinatal Medicine, 2005
Meconium peritonitis is a sterile chemical peritonitis caused by peritoneal seeding of meconium f... more Meconium peritonitis is a sterile chemical peritonitis caused by peritoneal seeding of meconium from an antenatal gastrointestinal perforation. We report a 32-week preterm female neonate who developed meconium peritonitis due to bowel perforation, secondary to a twisted left fallopian tube mass, which was excised and confirmed by histopathology. This association has not been reported earlier. The infant also developed transient central diabetes insipidus, a very rare condition in a preterm neonate.
Archives of Disease in Childhood - Fetal and Neonatal Edition, 2004
Developmental care is the use of a range of medical and nursing interventions to decrease the str... more Developmental care is the use of a range of medical and nursing interventions to decrease the stress of preterm neonates in neonatal intensive care units. This article reviews the theory underlying such interventions and research based data in different scientific fields, including neuroscience, developmental and family psychology, medicine, and nursing. The conclusion is that more research is needed.
Journal of Perinatal Medicine, 2005
A coiled nasogastric tube in a newborn Figure 2 Plain radiograph of chest and abdomen showing nor... more A coiled nasogastric tube in a newborn Figure 2 Plain radiograph of chest and abdomen showing normal passage of the nasogastric tube. Figure 1 Plain radiograph of chest and abdomen showing coiled nasogastric tube at 9 th thoracic vertebral level with normal bowel gas pattern.
Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, 2004
To determine the influence of the cause of pulmonary hypertension in neonates on overall outcome.... more To determine the influence of the cause of pulmonary hypertension in neonates on overall outcome. Analytical study. Special Care Baby Unit (SCBU) at Royal Hospital in Muscat, Sultanate of Oman, from July 1998 to June 2003. All neonates with the diagnosis of pulmonary hypertension, based on history, clinical examination and 2-D echocardiogram were reviewed with respect to the cause of hypertension (primary or secondary), birth weight, Apgar score, gender, inborn/outborn and outcome. According to the outcome, neonates were divided into two groups, group A (survived) and group B (expired). Both groups were compared for described variables using Statistical Package for Social Sciences, version 7.5 for Windows and Epi Info version 6. Out of 37 neonates with pulmonary hypertension, Group A comprised of 22 neonates while group B had 15 neonates, giving a mortality of 40 % (15/37). The mean birth weight between the two groups showed no significant differences, 3088 +/- 479 gram and 2962 +/-...
Saudi medical journal, 2004
Nasal intermittent positive pressure ventilation (NIPPV) has widely been used in neonates to prev... more Nasal intermittent positive pressure ventilation (NIPPV) has widely been used in neonates to prevent extubation failure and apnea. This pilot study was carried out to look at the early use of NIPPV to avoid intubation. The study was carried out over a period of 3 months from August 2003 to October 2003 at the Royal Hospital, Muscat, Sultanate of Oman. The neonates with clinical signs of moderate to severe respiratory distress were given a trial of early NIPPV based on the avoid-intubation protocol. Inclusion, exclusion and failure criteria with general procedure were made clear to all medical and nursing staff and the protocol was posted in the unit for further time to time referral. A total of 16 neonates met the inclusion criteria for early NIPPV trial. Out of these, 13 (81%) had a successful NIPPV. The mean age of entry was 0.95 hours; however, the mean duration of NIPPV was 23 hours. No NIPPV related complications were noted in the study group. We concluded that NIPPV is an appr...
Acta Paediatrica, 1992
Over a three-year period, 12 infants received dextrose/insulin infusions for severe hyperkalaemia... more Over a three-year period, 12 infants received dextrose/insulin infusions for severe hyperkalaemia from a mean age of 24 h. The infants were born after 24 to 26 weeks of gestation and weighed 730 +/- 172 g (mean +/- SD) at birth. Serum potassium concentration ranged from 7.4 to 8.4 mmol/l (7.7 +/- 0.4 mmol/l; mean +/- SD). Four had cardiac arrhythmias. All infants showed an initial response, serum potassium concentration decreased below 6.5 mmol/l in 5 +/- 2 h. In two infants, rebound hyperkalaemia occurred and was resistant to treatment; both infants died, one during an exchange transfusion. In the other 10 infants, infusions were ceased at a mean postnatal age of 53 h. Hyperglycaemia was the major problem during infusion and was resistant to increases in insulin concentrations. Normoglycaemia was achieved in 10 infants. The hypertonic solution consisted of a dextrose/insulin ratio of 2.2 +/- 0.6 g/IU, which delivered glucose at a rate of 0.46 +/- 0.15 g/kg/h, in addition to the pre-existing stable maintenance glucose intake.
JPMA. The Journal of the Pakistan Medical Association, 2004
Saudi medical journal, 2004
1. Saudi Med J. 2004 Oct;25(10):1501-2. A simplified bedside method for estimating glomerular fil... more 1. Saudi Med J. 2004 Oct;25(10):1501-2. A simplified bedside method for estimating glomerular filtration rate in term neonates. Manzar S, Nair AK, Pai MG, Al-Khusaiby SM. Neonatal Intensive Care Unit, Royal Hospital, Muscat, Sultanate of Oman. shabihman@hotmail.com. ...
Indian pediatrics, 2004
To study the efficacy and complications of low dose indomethacin in the reduction of major intrav... more To study the efficacy and complications of low dose indomethacin in the reduction of major intraventricular hemorrhage (IVH) in very low birth weight (VLBW) babies. prospective randomized controlled trial (interim analysis) Level III neonatal intensive care unit of a perinatal tertiary care center. Newborn babies with birth weights between 750-1250 g were randomized into indomethacin or control groups. They were further stratified into two birth weight groups 750-999 g and 1000-1250 g for subgroup analysis. 3 doses of indomethacin were administered to the indomethacin group at the dose of 0.1 mg/kg/dose intravenously. The control group did not receive any specific intervention other than standard neonatal intensive care. The primary outcome measure was the occurrence of IVH and the secondary outcome measures were necrotising enterocolitis, symptomatic patent ductus arteriosus (PDA), bleeding episodes, renal failure, chronic-lung disease and death. Out of 115 eligible newborn babies,...
Journal of Tropical Pediatrics, 2003
The relationship between glucose-6 phosphate dehydrogenase (G6PD) deficiency and jaundice in the ... more The relationship between glucose-6 phosphate dehydrogenase (G6PD) deficiency and jaundice in the newborn period is well recognized. However, there is concern about the increasing incidence of kernicterus being reported worldwide, especially due to unrecognized G6PD deficiency and early discharge from hospital after birth. We report a case series of kernicterus from a setup where the high prevalence rate of G6PD deficiency is known. Fourteen cases of kernicterus were seen during a time period of 6 years, 71 per cent of them had G6PD deficiency. Recent literature is reviewed and possible preventive measures in the light of current information and practices are suggested.
BMC Pediatrics, 2014
Standardised parenteral nutrition formulations are routinely used in the neonatal intensive care ... more Standardised parenteral nutrition formulations are routinely used in the neonatal intensive care units in Australia and New Zealand. In 2010, a multidisciplinary group was formed to achieve a consensus on the formulations acceptable to majority of the neonatal intensive care units. Literature review was undertaken for each nutrient and recommendations were developed in a series of meetings held between November 2010 and April 2011. Three standard and 2 optional amino acid/dextrose formulations and one lipid emulsion were agreed by majority participants in the consensus. This has a potential to standardise neonatal parenteral nutrition guidelines, reduce costs and prescription errors.
Archives of Disease in Childhood - Fetal and Neonatal Edition, 2004
to be contaminated both clinically and in a negative repeated culture. In one infant, blood cultu... more to be contaminated both clinically and in a negative repeated culture. In one infant, blood culture was positive for Staphylococcus aureus, and Enterococcus grew from culture of the urine in the other. Most admissions (83%) were between June and early October, which are the warmest months of the year in this area. In this low risk group of infants, only two patients had serious bacterial infection. Compatible with the findings of Maayan-Metzger et al, 1 the results of our study support dehydration as the main cause of fever during the first week of life. As most of our cases occurred during summer and early autumn, environmental temperature may have an additive effect in this population.
Journal of Paediatrics and Child Health, 2019
Background: The Queensland Family Cohort (QFC) study will be a longitudinal study which aims to u... more Background: The Queensland Family Cohort (QFC) study will be a longitudinal study which aims to understand the biological mechanisms that drive disease risk within 10,000 families across Queensland. To test the feasibility of a 10,000 birth family cohort, we aimed to understand the enrolment rate in a pilot study (200 families) birthing at the Brisbane Mater Mothers' Hospital. Methods: Pregnant individuals interested in Mater Research Projects were contacted between 12-20 weeks gestation via phone, email or SMS. If willing, they were sent patient information and followed up after 48 h to allow for examination of the study information. Enrolment occurred over the phone, or during an appointment, and families were only excluded if partners, if one was present, did not consent. Results: Three hundred eligible families were pre-screened. To date 53 families have enrolled (17.7%). Consenting pregnant participants had a median age of 32 years (21-45), with 43 public sector families (81%); 10 private sector families (19%). The majority of pregnant recruits were Australian born (60%) with the remainder born in other countries (n = 13). Three families withdrew after commencement and 103 families (34%) declined participation due to time commitments. Conclusions: Our data shows a promising total recruitment of 25% for the pilot study. Enrolment for phase two of the pilot may be improved by patient information digestibility, partner communication, and QFC study communications.
The Journal of pediatrics, Jan 3, 2018
To evaluate the costs of using dextrose gel as a primary treatment for neonatal hypoglycemia in t... more To evaluate the costs of using dextrose gel as a primary treatment for neonatal hypoglycemia in the first 48 hours after birth compared with standard care. We used a decision tree to model overall costs, including those specific to hypoglycemia monitoring and treatment and those related to the infant's length of stay in the postnatal ward or neonatal intensive care unit, comparing the use of dextrose gel for treatment of neonatal hypoglycemia with placebo, using data from the Sugar Babies randomized trial. Sensitivity analyses assessed the impact of dextrose gel cost, neonatal intensive care cost, cesarean delivery rate, and costs of glucose monitoring. In the primary analysis, treating neonatal hypoglycemia using dextrose gel had an overall cost of NZ$6863.81 and standard care (placebo) cost NZ$8178.25; a saving of NZ$1314.44 per infant treated. Sensitivity analyses showed that dextrose gel remained cost saving with wide variations in dextrose gel costs, neonatal intensive care...
Saudi Medical Journal, 2004
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Saudi Medical Journal, Aug 1, 2004
1. Saudi Med J. 2004 Aug;25(8):1120-1. Changing survival statistics among extreme premature infan... more 1. Saudi Med J. 2004 Aug;25(8):1120-1. Changing survival statistics among extreme premature infants in Oman. Manzar S, Nair AK, Pai MG, Al-Khusaiby SM. Department of Child Health (Neonatal Intensive Care Unit), Royal ...
Saudi Medical Journal, Sep 1, 2004
The present growth chart used in the Sultanate of Oman does not contain centile measurements for ... more The present growth chart used in the Sultanate of Oman does not contain centile measurements for infants born at 26-weeks of gestation. With the increased survival of these premature infants, there is a growing need to develop such a chart. The present study was conducted with the aim to look at the anthropometric measurements (weight, length and head circumference) of Omani premature infants born at 26-weeks of gestation and to develop centile charts for these measurements. The study was conducted at the Special Care Baby Unit (SCBU) of the Royal Hospital, one of the major perinatal institutions in Muscat, Oman. A computerized database is maintained for all the admissions from 1996. We extracted the required anthropometric data for all 26-week gestation premature Omani infants admitted to SCBU from January 1996 to November 2003. A total of 49 babies were admitted during that period. Out of these, 43 had complete information on the growth parameters, including birth weight, length and head circumference. These parameters were noted down and by using the statistical package, an analysis was performed to get the normal distribution curve. By using the Microsoft Excel program, graphs were generated for all the 3 growth parameters. The mean birth weight for the premature infants born at 26-week gestation was noted to be 908 +/- 156 grams, with length and head circumference of 33.5 +/- 2.5 and 24.5 +/- 1.7 centimeters. The normal distribution curve was obtained with minimal skewing. We were able to generate centile charts of the anthropometric measurements for Omani infants born at 26-weeks of gestation. The next step is to collect the national data from other institutions in Oman and then incorporate it into the present growth chart to make the charts more valid, reliable and applicable.
Saudi Medical Journal, May 1, 2005
RefDoc Bienvenue - Welcome. Refdoc est un service / is powered by. ...
Saudi medical journal, 2005
Appropriate fetal brain growth depends upon the cerebral blood flow (CBF). Different congenital h... more Appropriate fetal brain growth depends upon the cerebral blood flow (CBF). Different congenital heart defects (CHDs), due to the difference in anatomy and physiology, alter the intrauterine CBF. Thus, variable brain growth is expected in different CHDs that is reflected by variability in the head circumference (HC) at birth. The present study was carried out to compare the HC of babies born with transposition of great arteries (TGA) and hypoplastic left heart syndrome (HLHS) in comparison to normal control. The data on the HC of neonates with TGA and HLHS were extracted from the computer database then compared with the control group. During the period from January 1996 to December 2003, a total of 7396 neonates were admitted, out of which 639 (8.6%) were admitted with the diagnosis of the CHD. After correcting for gestational age and non-availability of HC measurements, 236 infants were excluded. Out of the remaining 403 term appropriate for gestational age (AGA) infants, 46 had TGA...
Journal of Perinatal Medicine, 2005
Meconium peritonitis is a sterile chemical peritonitis caused by peritoneal seeding of meconium f... more Meconium peritonitis is a sterile chemical peritonitis caused by peritoneal seeding of meconium from an antenatal gastrointestinal perforation. We report a 32-week preterm female neonate who developed meconium peritonitis due to bowel perforation, secondary to a twisted left fallopian tube mass, which was excised and confirmed by histopathology. This association has not been reported earlier. The infant also developed transient central diabetes insipidus, a very rare condition in a preterm neonate.
Archives of Disease in Childhood - Fetal and Neonatal Edition, 2004
Developmental care is the use of a range of medical and nursing interventions to decrease the str... more Developmental care is the use of a range of medical and nursing interventions to decrease the stress of preterm neonates in neonatal intensive care units. This article reviews the theory underlying such interventions and research based data in different scientific fields, including neuroscience, developmental and family psychology, medicine, and nursing. The conclusion is that more research is needed.
Journal of Perinatal Medicine, 2005
A coiled nasogastric tube in a newborn Figure 2 Plain radiograph of chest and abdomen showing nor... more A coiled nasogastric tube in a newborn Figure 2 Plain radiograph of chest and abdomen showing normal passage of the nasogastric tube. Figure 1 Plain radiograph of chest and abdomen showing coiled nasogastric tube at 9 th thoracic vertebral level with normal bowel gas pattern.
Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, 2004
To determine the influence of the cause of pulmonary hypertension in neonates on overall outcome.... more To determine the influence of the cause of pulmonary hypertension in neonates on overall outcome. Analytical study. Special Care Baby Unit (SCBU) at Royal Hospital in Muscat, Sultanate of Oman, from July 1998 to June 2003. All neonates with the diagnosis of pulmonary hypertension, based on history, clinical examination and 2-D echocardiogram were reviewed with respect to the cause of hypertension (primary or secondary), birth weight, Apgar score, gender, inborn/outborn and outcome. According to the outcome, neonates were divided into two groups, group A (survived) and group B (expired). Both groups were compared for described variables using Statistical Package for Social Sciences, version 7.5 for Windows and Epi Info version 6. Out of 37 neonates with pulmonary hypertension, Group A comprised of 22 neonates while group B had 15 neonates, giving a mortality of 40 % (15/37). The mean birth weight between the two groups showed no significant differences, 3088 +/- 479 gram and 2962 +/-...
Saudi medical journal, 2004
Nasal intermittent positive pressure ventilation (NIPPV) has widely been used in neonates to prev... more Nasal intermittent positive pressure ventilation (NIPPV) has widely been used in neonates to prevent extubation failure and apnea. This pilot study was carried out to look at the early use of NIPPV to avoid intubation. The study was carried out over a period of 3 months from August 2003 to October 2003 at the Royal Hospital, Muscat, Sultanate of Oman. The neonates with clinical signs of moderate to severe respiratory distress were given a trial of early NIPPV based on the avoid-intubation protocol. Inclusion, exclusion and failure criteria with general procedure were made clear to all medical and nursing staff and the protocol was posted in the unit for further time to time referral. A total of 16 neonates met the inclusion criteria for early NIPPV trial. Out of these, 13 (81%) had a successful NIPPV. The mean age of entry was 0.95 hours; however, the mean duration of NIPPV was 23 hours. No NIPPV related complications were noted in the study group. We concluded that NIPPV is an appr...
Acta Paediatrica, 1992
Over a three-year period, 12 infants received dextrose/insulin infusions for severe hyperkalaemia... more Over a three-year period, 12 infants received dextrose/insulin infusions for severe hyperkalaemia from a mean age of 24 h. The infants were born after 24 to 26 weeks of gestation and weighed 730 +/- 172 g (mean +/- SD) at birth. Serum potassium concentration ranged from 7.4 to 8.4 mmol/l (7.7 +/- 0.4 mmol/l; mean +/- SD). Four had cardiac arrhythmias. All infants showed an initial response, serum potassium concentration decreased below 6.5 mmol/l in 5 +/- 2 h. In two infants, rebound hyperkalaemia occurred and was resistant to treatment; both infants died, one during an exchange transfusion. In the other 10 infants, infusions were ceased at a mean postnatal age of 53 h. Hyperglycaemia was the major problem during infusion and was resistant to increases in insulin concentrations. Normoglycaemia was achieved in 10 infants. The hypertonic solution consisted of a dextrose/insulin ratio of 2.2 +/- 0.6 g/IU, which delivered glucose at a rate of 0.46 +/- 0.15 g/kg/h, in addition to the pre-existing stable maintenance glucose intake.