Kyla Marks

Neonatal seizure recognition – Comparative study of continuous-amplitude integrated EEG versus short conventional EEG recordings

OBJECTIVES This study aims to detect seizures by amplitude-integrated electroencephalography (EEG) (aEEG) as compared with conventional EEG (cEEG) by clinicians with different levels of expertise. METHODS Simultaneous 10 min aEEG/cEEG recordings were time-locked and assessed for seizure activity. aEEG was assessed by a neonatologist, a fellow and a medical student and cEEG by two child neurologists and a neonatologist. RESULTS A total of 265 paired epochs from 38 simultaneous recording were assessed. Forty-one seizure episodes were diagnosed in 31 epochs in the cEEG recordings of 10 infants. Sensitivity and specificity ranged from 68% to 84% and from 71% to 84%, respectively, per detection of epochs with seizures and from 71% to 84% and from 36% to 96% per detection of individual seizures. No agreement was found between the observations of the student, and those of the fellow or neonatologist. Substantial agreement was found between the fellow and neonatologist. Before cEEG was commenced, seizures were detected by aEEG in 22 infants. CONCLUSIONS aEEG has high sensitivity and specificity in the hands of experienced users. Inexperienced new users may have a high rate of misdiagnosed seizures. Early recording of high-risk infants can help in the early diagnosis and treatment of seizures. SIGNIFICANCE Diagnosis and treatment of seizures in aEEG should be carried out by experienced users and should be supplemented with cEEG when available.

Successful treatment of infective endocarditis with recombinant tissue plasminogen activator

OBJECTIVES In a prospective study, we examined the effect of treatment with recombinant tissue plasminogen activator (r-TPA) on survival and morbidity in a series of high-risk children with infectious endocarditis (IE) after prolonged treatment with indwelling catheters. We hypothesized that r-TPA is an adjunctive therapy for dissolution of infected thrombi in drug-resistant IE. STUDY DESIGN In the prospective 3-year study (1998-2001), we identified high-risk children with chronic illness and prolonged treatment with indwelling catheters who developed IE and overwhelming sepsis. Patients were allocated to receive r-TPA after persistent and enlarging intracardiac vegetations and failure to respond to conventional medical management. Complications associated with treatment, survival, and cardiac morbidity were observed. RESULTS Seven infants were treated prospectively with r-TPA. All infants responded promptly to treatment, with resolution of the intracardiac vegetations within 3 to 4 days of commencement and without any adverse complications. All patients survived without long-term cardiac morbidity. CONCLUSION Recombinant tissue plasminogen activator may offer a safe alternative to surgical intervention in the high-risk infant with IE.

Risk factors for early sepsis in very low birth weight neonates with respiratory distress syndrome

Aim: To identify maternal and neonatal factors that increase suspicion of early sepsis in Very Low Birth Weight neonates with respiratory distress syndrome.

Prematurity, ethnicity and personality: risk for postpartum emotional distress among Bedouin-Arab and Jewish women

Background: Mothers of preterm infants are at high risk for postpartum emotional distress. This risk is further increased for women from ethnic minority groups due to specific stressors such as lack of social support, low socioeconomic status and restricted access to health providers and facilities. Objective: This study focused on postpartum emotional distress among Bedouin-Arab mothers, an understudied ethnic minority group living in Israel. Specifically, we examined how premature birth, ethnicity and personality interact in placing Bedouin-Arab and Jewish mothers at risk for postpartum emotional distress. Methods: Participants included 156 mothers of preterm infant (48 Bedouin; 108 Jewish) and 177 mothers of full-term infants (55 Bedouin; 122 Jewish). Measures included maternal reports of emotional distress (i.e. depression symptoms and parental role alteration stress) and the personality trait of self-criticism. Results: Bedouin mothers of preterm infants experienced the highest level of depression symptoms and parental role alteration stress compared to all other mothers. Furthermore, although no group difference was found in self-criticism, Bedouin mothers were more vulnerable to the negative effect of self-criticism than Jewish mothers. Vulnerability to self-criticism varied between the full-term and preterm groups, and in the context of depression or parental role alteration stress. Conclusion: Results are discussed with regard to the unique characteristics of the Bedouin society and the social status of Bedouin women. Clinical implications stressing the need for culturally sensitive adjustments that should be implemented in NICU environment are suggested.