Renu Jain

Fracture of Lower Femoral Epiphysis in an Infant at Birth: A Rare Obstetrical Injury

We report a case of rare birth injury leading to physeal fracture after a routine cesarean delivery. Because plain radiographics are often normal, therefore these physeal fractures usually present a diagnostic challenge in the newborn. In this case, ultrasonography and magnetic resonance imaging were helpful in making an early accurate diagnosis. The infant received prompt treatment and the physeal fracture healed uneventfully. Physeal fractures should be included in the birth injuries following routine cesarean delivery.

Safety and efficacy of AS-1 red blood cell use in neonates.

Many Regional Blood Centers are providing AS-1(Adsol preservative) red blood cells (RBCs) as a standard product because of the extended shelf life (42 days). The use of AS-1 RBCs is concerning in neonates because of high exposure to dextrose, adenine and mannitol. We conducted this study to evaluate the safety and efficacy of AS-1 RBC use in neonates. We assigned one unit of AS-1 RBCs to each infant for small volume transfusions (15 ml/kg) for the life of the unit (42 days). The study was conducted for one year. The infants under 1500 g were included in the study. We measured the pre- and post-transfusion hematocrit, post-transfusion serum sodium, potassium, glucose, bilirubin and blood pH. We compared the average number of transfusions per patient and average blood donor exposure per patient using AS-1 RBC to CPDA-1 packed red blood cells (PRBC) use, data available for prior year. We monitored the blood transfusion reactions during the study period. The hematocrit increased significantly from 30.1 +/- 4.6 pre-transfusion to 38.3 +/- 4.9 post-transfusion. The post-transfusion serum bilirubin, blood pH, serum potassium, sodium and glucose remained within the normal range. In spite of an increase in the number of average transfusions per patient with AS-1 RBC (6.67 +/- 5.1), the average donor exposure (1.8 +/- 1.1) remained less than two donors. There were not any transfusion reactions reported during the study. In conclusion, the use of AS-1 red blood cells is safe for small volume transfusions in neonates.

How accurate is glucose analysis in the presence of multiple interfering substances in the neonate? (glucose analysis and interfering substances)

Whole blood glucose testing by reagent sticks is inaccurate at low plasma glucose concentrations and with varying hemalocrit. Both conditions are frequently seen in newborn infants. Therefore plasma glucose analysis is the preferred method for newborn glucose monitoring. We encountered unanticipated difficulties in plasma glucose measurement by the automated hexokinase method caused by the combinations of plasma free hemoglobin, bilirubin, and plasma triglycerides, which are frequently elevated in newborn plasma. We determined the adverse effects of various combinations of these interfering substances on glucose analysis by the hexokinase method and demonstrated that accurate analysis is possible by a 1:1 plasma dilution only at high plasma glucose levels but not at the more critical low plasma glucose concentration. The dilution reduced the number of repeat specimen required in newborns. But 1:1 plasma dilution overestimated the glucose levels at low plasma glucose values, and therefore this automated hexokinase method is not suitable for glucose analysis in the newborn. Glucose‐oxidase remains the method of choice for plasma glucose analysis in neonates. This information is important because using this hexokinase methodology, one might miss hypoglycemia in the newborn.

Decreasing blood donor exposure in the neonates by using dedicated donor transfusions

Critically ill infants receive frequent red cell transfusions for replacement of blood drawn for laboratory analysis and in treatment of symptomatic anemia. Since blood for multiple transfusions on a given day is typically obtained from one fresh RBC unit, each multiply transfused neonate is exposed to many donors increasing the risk of transfusion transmitted disease. We hypothesized that the number of donor exposures per infant would decrease by instituting DDTP and that more infants will be exposed to only a single donor. We started a Dedicated Donor Transfusion Program (DDTP) in our NICU. One unit of red cells is dedicated to each baby for the life of the unit (35 days). We compared the donor exposure in infants for one year, before and after DDTP. The infants were divided into three birth weight groups. Group I were infants < 1000 g; Group II infants were 1000-1500 g; Group III infants were > 1500g. The average number of transfusions per patient decreased significantly from 7.5 +/- 6.0 to 4.7 +/- 4.2 (P < 0.001) in Group I while it remained unchanged in Groups II and III. The Dedicated Donor Transfusion Program significantly reduced the donor exposure in NICU infants. The program also facilitated the reduction of the number of transfusions in the infants under 1000 g.

Hydrops fetalis in an interstitial deletion of chromosome 10.

We report the case of a premature neonate with ascites and dysmorphic facial features at birth. The chromosomal analysis showed an interstitial deletion of chromosome 10, that is, 46, XX, del(10)(q22.3q24.1). This is the first known case of a patient with interstitial deletion of chromosome 10 with symptoms of ascites and hydrops.

Time for a Change in Blood Transfusion Practices in Neonates - A Safe Change for the Better... † 1395

Time for a Change in Blood Transfusion Practices in Neonates - A Safe Change for the Better... † 1395

Benefits of Providing Home Care at the Community Hospital Level to High Risk Neonates by Using Specially Trained Nursing Staff 1029

Benefits of Providing Home Care at the Community Hospital Level to High Risk Neonates by Using Specially Trained Nursing Staff 1029

TOTAL BODY BONE MINERAL CONTENT (TBBMC) IN PRETERM INFANTS AT BIRTH USING DUAL ENERGY X-RAY ABSORPTIOMETRY (DEXA). 1856

TOTAL BODY BONE MINERAL CONTENT (TBBMC) IN PRETERM INFANTS AT BIRTH USING DUAL ENERGY X-RAY ABSORPTIOMETRY (DEXA). 1856