... otoacoustic emissions (TEOAEs), evaluated with the Celesta 503 Cochlear Emission Analyzer (Ma... more ... otoacoustic emissions (TEOAEs), evaluated with the Celesta 503 Cochlear Emission Analyzer (Madsen Elec-tronics, Norway), as described by Levi et al;5 ... un-dergo auditory screening at the age of 7-9 months (a modification of the screening test described by Ewing and Ewing ...
Thirty-two percutaneous subclavian venous catheters were inserted in critically ill, low birthwei... more Thirty-two percutaneous subclavian venous catheters were inserted in critically ill, low birthweight (less than 1500 gm) neonates. No complication occurred secondary to insertion. The total number of catheter-patient days was 754 days, with the average duration of a single catheter being 23.5 days. The incidence of primary catheter-related clinical sepsis was 3.1%. The safety and bedside feasibility of the procedure, as well as long catheter duration make it the best option for long-term venous access in this unique group of patients.
Journal of Perinatology Official Journal of the California Perinatal Association, May 1, 2008
To evaluate the association between parents' ethnic/religious affiliation (secular Jewish... more To evaluate the association between parents' ethnic/religious affiliation (secular Jewish, religious Jewish, ultra-orthodox Jewish, Muslim Arabs) and survival of premature infants with severe intraventricular hemorrhage (IVH). Survival of 102 infants (birth weight<or=1500 g) born at the Hadassah hospitals in Jerusalem from 1 January 1996 through 31 December 2005, who sustained severe IVH and who survived over 48 h, was assessed in relation to their parents' ethnic/religious affiliation and accounting for relevant clinical and demographic variables. There were 38 cases of demise among 72 infants with IVH grade IV (52.8%), and 4 among 30 infants with IVH grade III (13.3%). In a multivariate logistic regression analysis accounting for relevant perinatal variables, the odds for mortality compared to the reference Arab group was significantly lower only with regard to ultra-orthodox patients (odds ratio, OR=0.06; 95% confidential interval, CI=0.00 to 0.80; P=0.033). In a logistic and in the Cox stepwise regression analyses with religion as forced in variable, comparing infants with IVH grade IV of religious and ultra-orthodox Jewish families with those of secular Jewish families, the OR/hazard ratio (HR) for mortality were OR=0.10; 95% CI=0.01 to 0.06; P=0.017, and HR=0.37; 95% CI=0.16 to 0.85; P=0.019, respectively. No significant difference between the groups was demonstrated when infants with IVH grade III were analyzed apart. Parental religious affiliation may be influential on the outcome of premature infants with severe brain damage.
A case of propylene glycol intoxication in a premature infant is reported. The infant went into a... more A case of propylene glycol intoxication in a premature infant is reported. The infant went into a state of coma after treatment for burns with antiseptic dressings. Cessation of the topical treatment resulted in complete recovery. An exceptionally high level of the dressings' solvent, propylene glycol, found in the urinary chromatogram, was believed to be the causative agent. It is suggested that topical preparations containing propylene glycol should not be used in premature infants during the first weeks of life.
Page 1. Developmental Assessment of Prematurely Born Children Exposed to Antenatal Corticosteroid... more Page 1. Developmental Assessment of Prematurely Born Children Exposed to Antenatal Corticosteroids Ilan Arad MD and Ruben Bromiker MD ... French and co-workers [21] followedsingleton infants born at <33 weeks gestation until 3 years of age. ...
Elevated cord blood levels of interleukin-6 and N-terminal pro-brain natriuretic peptide were ass... more Elevated cord blood levels of interleukin-6 and N-terminal pro-brain natriuretic peptide were associated with neonatal complications; however, simultaneously obtained values have not been compared to date. To study the association of cord blood levels of IL-6 and NT-proBNP with perinatal variables of premature infants and examine the relationship between the obtained values. Cord blood IL-6 (89 samples) and NT-proBNP (66 samples) levels obtained from infants delivered before 32 weeks of gestation were analyzed for associations with perinatal variables and possible correlation between both samples. Lower gestational age, no antenatal exogenous steroids, low Apgar scores at 1 minute and delivery at a high birth order, were all associated with more infants having elevated IL-6 levels (P = 0.02, P = 0.03, P = 0.03 and P = 0.001, respectively). None of the infants with necrotizing enterocolitis (n=6) had high IL-6 levels (P = 0.01). Increased NT-proBNP levels were associated with low Apg...
The Israel Medical Association journal : IMAJ, 2003
Page 1. Developmental Assessment of Prematurely Born Children Exposed to Antenatal Corticosteroid... more Page 1. Developmental Assessment of Prematurely Born Children Exposed to Antenatal Corticosteroids Ilan Arad MD and Ruben Bromiker MD ... French and co-workers [21] followedsingleton infants born at <33 weeks gestation until 3 years of age. ...
The Israel Medical Association journal : IMAJ, 2010
Elevated cord blood levels of interleukin-6 and N-terminal pro-brain natriuretic peptide were ass... more Elevated cord blood levels of interleukin-6 and N-terminal pro-brain natriuretic peptide were associated with neonatal complications; however, simultaneously obtained values have not been compared to date. To study the association of cord blood levels of IL-6 and NT-proBNP with perinatal variables of premature infants and examine the relationship between the obtained values. Cord blood IL-6 (89 samples) and NT-proBNP (66 samples) levels obtained from infants delivered before 32 weeks of gestation were analyzed for associations with perinatal variables and possible correlation between both samples. Lower gestational age, no antenatal exogenous steroids, low Apgar scores at 1 minute and delivery at a high birth order, were all associated with more infants having elevated IL-6 levels (P = 0.02, P = 0.03, P = 0.03 and P = 0.001, respectively). None of the infants with necrotizing enterocolitis (n=6) had high IL-6 levels (P = 0.01). Increased NT-proBNP levels were associated with low Apg...
The Israel Medical Association journal : IMAJ, 2008
A substantial number of premature deliveries occur in hospitals lacking neonatal intensive care f... more A substantial number of premature deliveries occur in hospitals lacking neonatal intensive care facilities. We previously demonstrated a comparable outcome of very low birth weight infants delivered in a level II nursery to that of inborn infants delivered in our tertiary care center, but a similar comparison of extremely low birth weight infants has not been done. To compare the neonatal outcome (mortality, severe intraventricular hemorrhage/periventricular leukomalacia, bronchopulmonary dysplasia and intact survival) of inborn and outborn ELBW infants, accounting for sociodemographic, obstetric and perinatal variables. We compared 97 ELBW infants (birth weight < or = 1000 g) delivered between the years 2000 and 2004 in a hospital providing neonatal intensive care to 53 ELBW babies delivered in a referring hospital. A univariate model was first applied to examine the associations of the individual independent variables with the outcome variable, followed by a logistic stepwise r...
The Israel Medical Association journal : IMAJ, 2006
Maternal transport, rather than neonatal transport, to tertiary care centers is generally advocat... more Maternal transport, rather than neonatal transport, to tertiary care centers is generally advocated. Since a substantial number of premature deliveries still occur in hospitals with level I and level II nurseries, it is imperative to find means to improve their outcome. To compare the neonatal outcome (survival, intraventricular hemorrhage and bronchopulmonary dysplasia) of inborn and outborn very low birth weight infants, accounting for sociodemographic, obstetric and perinatal variables, with reference to earlier published data. We compared 129 premature infants with birth weights of 750-1250 g delivered between 1996 and 2000 in a hospital providing neonatal intensive care to 99 premature babies delivered in a referring hospital. In the statistical analysis, variables with a statistical significant association with the outcome variables and dissimilar distribution in the two hospitals were identified and entered together with the hospital of birth as explanatory variables in a log...
To assess the maternal recall of the neonatal discharge letter instructions with and without nurs... more To assess the maternal recall of the neonatal discharge letter instructions with and without nurse and mother signing the document in addition to the physician signature. Maternal recall of the discharge letter instructions was assessed by telephone interviews conducted 2-3 weeks following discharge. One hundred and nine mothers who signed the discharge letter following a change of information delivery policy at discharge were compared with 110 mothers who gave birth when their signature was not yet required. The impact of the discharge form on maternal recall was evaluated by stepwise regression analysis adjusted for obstetric, perinatal and demographic variables. Recall of specific instructions verified by the discharge notes and satisfactory understanding of the discharge letter as graded by the mother were higher among 109 mothers who signed the discharge letter (82% and 88%, respectively) than among 110 mothers who did not add their signature (58% and 73%, respectively), the di...
The Israel Medical Association journal : IMAJ, 2004
The Fetal Inflammatory Response Syndrome and Associated Infant Morbidity Ilan Arad MD and Zivanit... more The Fetal Inflammatory Response Syndrome and Associated Infant Morbidity Ilan Arad MD and Zivanit Ergaz MD Department of Neonatology, Hadassah University Hospital, Mount Scopus, Jerusalem, Israel ... Lancet 1988;ii:240±5. 14. Lyon A. Chronic lung disease of prematurity. ...
Rectal temperature of 126 term infants was measured on admission to the nursery following variabl... more Rectal temperature of 126 term infants was measured on admission to the nursery following variable periods of stay with the mother in the delivery room. Fifty-nine infants who wore woolen hats after delivery had higher rectal temperature than 67 infants whose head was covered by loosely applied cotton diapers (36.5+/-0.5 degrees C vs. 36.3+/-0.5 degrees C, respectively; p=0.03). Among them there were fewer infants who were admitted with rectal temperature 36 degrees C (12 vs. 26, respectively; p=0.03). In multiple regression analyses accounting for head covering with woolen hats, birth weight, gender, delivery room temperature and length of stay with the mother, only birth weight and head covering with woolen hats were significantly associated with rectal temperature at arrival in the nursery (p=0.002 and 0.03, respectively), and only head covering with cotton diapers was significantly associated with rectal temperature 36 degrees C (p=0.03). Our data imply that covering heads of te...
Parental adjustment following the death of a premature singleton or multiple birth infant has hit... more Parental adjustment following the death of a premature singleton or multiple birth infant has hitherto been studied by mailed questionnaires or telephone survey. In the present study, using an in-depth personal interview, grief reactions and adjustment patterns of nine families who lost a singleton premature infant (&#39;Single Group&#39;) were compared with those of nine families who lost one of a premature multiple birth cohort (&#39;Multiple Group&#39;). The interview was conducted 1-4 years after the death of the infant and evaluated specific areas or &#39;scales&#39; of life adjustment, including individual feelings, relationship between husband and wife, and functioning at home and at work. There was no significant difference between the paternal and maternal level of adjustment of the two groups in any of the studied scales. A positive correlation was found between maternal and paternal grief reaction of the same family in the scales of individual feelings (r = 0.65), relationships between husband and wife (r = 0.70), and functioning at home (r = 0.57). Comparing the father&#39;s scale with the mother&#39;s scale revealed a significant difference only in the area of &#39;individual feelings&#39;. The gestational age, maternal bonding during hospitalisation of the infant and the parental attendance at the event of death were significantly associated with the process of parental adjustment. The results of this study support previous reports of similar parental reactions following the demise of a premature singleton or multiple birth infant. Since societal environment may not recognise the need for consolation of these families, care, compassion, and sensitivity should be encouraged in dealing with these parents at the time of their infant&#39; death, and for a long time thereafter.
It has been suggested that impairment of placental perfusion prior to delivery may manifest in ea... more It has been suggested that impairment of placental perfusion prior to delivery may manifest in early postnatal increase of creatinine values. We hypothesized that the smaller of a discordant set of twins would have a higher initial plasma creatinine value and decided to measure early plasma creatinine levels in discordant twins in order to evaluate whether this value may serve as an index of impaired placental perfusion. Plasma creatinine, urea nitrogen and blood hematocrit values were simultaneously measured in 35 sets of twins during the first day of life. The sets of twins were divided into 2 groups according to birth weight difference. Thus, 18 sets of discordant twins with birth weight difference greater than 15% comprised the GT group and 17 sets of twins with birth weight difference less than or equal to 15% comprised the LE group. The differences between the values obtained within each group were analyzed using the Wilcoxon Signed Rank test. In the GT group the mean plasma creatinine level of the smaller twins was significantly higher than the level of the larger ones (p = 0.03), but there was no statistically significant difference between values obtained in twins of the LE group. The mean plasma urea level was higher in the larger twins of both groups, however only the difference in the GT group was statistically significant (p = 0.01). The mean hematocrit of the smaller twins was higher in both groups, but only the difference in the LE group was statistically significant (p = 0.02). Generally, there was a negative correlation between gestational age and early creatinine values. These results apparently support the notion that prenatal exposure to impaired placental perfusion may compromise the creatinine clearance of the fetus and result in higher early creatinine values. Since the creatinine values in our growth-retarded twins were within the normal range, no distinguishing line for evidence of a uterine-placental compromise could be drawn. Whether a certain early plasma creatinine value is suggestive or indicative of an intra-uterine hypoxic-ischemic insult, should be determined by documented instances of severe fetal compromise prior to delivery.
To determine the underlying etiology, associated malformations, clinical course, and prognostic s... more To determine the underlying etiology, associated malformations, clinical course, and prognostic significance of congenital chylothorax. A retrospective analysis of 11 neonates admitted to our neonatal intensive care unit with congenital chylothorax between January 2000 and June 2008. The post-discharge clinical and developmental course was evaluated by a telephone survey performed in July 2008. Antenatal diagnosis was established in 9 out of 11 infants by ultrasound examination; 5 had intrauterine pleural drainage. Eight infants had either structural or chromosomal abnormalities. The postnatal treatment included mechanical ventilation, drainage of pleural fluid and feeding with enriched medium chain triglyceride formula. Somatostatin was administered in one case. Six patients developed nosocomial infections. Two patients died after resolution of the chylothorax from deteriorating renal failure. Seven patients were traced for follow up and six of them achieved age appropriate developmental milestones. The recovery from chylothorax and future prognosis were dependent on the underlying etiology. Chylothorax was often a secondary event, with apparently favorable clinical and developmental prognosis when the underlying or/and associated condition was treatable.
... otoacoustic emissions (TEOAEs), evaluated with the Celesta 503 Cochlear Emission Analyzer (Ma... more ... otoacoustic emissions (TEOAEs), evaluated with the Celesta 503 Cochlear Emission Analyzer (Madsen Elec-tronics, Norway), as described by Levi et al;5 ... un-dergo auditory screening at the age of 7-9 months (a modification of the screening test described by Ewing and Ewing ...
Thirty-two percutaneous subclavian venous catheters were inserted in critically ill, low birthwei... more Thirty-two percutaneous subclavian venous catheters were inserted in critically ill, low birthweight (less than 1500 gm) neonates. No complication occurred secondary to insertion. The total number of catheter-patient days was 754 days, with the average duration of a single catheter being 23.5 days. The incidence of primary catheter-related clinical sepsis was 3.1%. The safety and bedside feasibility of the procedure, as well as long catheter duration make it the best option for long-term venous access in this unique group of patients.
Journal of Perinatology Official Journal of the California Perinatal Association, May 1, 2008
To evaluate the association between parents&#39; ethnic/religious affiliation (secular Jewish... more To evaluate the association between parents&#39; ethnic/religious affiliation (secular Jewish, religious Jewish, ultra-orthodox Jewish, Muslim Arabs) and survival of premature infants with severe intraventricular hemorrhage (IVH). Survival of 102 infants (birth weight&lt;or=1500 g) born at the Hadassah hospitals in Jerusalem from 1 January 1996 through 31 December 2005, who sustained severe IVH and who survived over 48 h, was assessed in relation to their parents&#39; ethnic/religious affiliation and accounting for relevant clinical and demographic variables. There were 38 cases of demise among 72 infants with IVH grade IV (52.8%), and 4 among 30 infants with IVH grade III (13.3%). In a multivariate logistic regression analysis accounting for relevant perinatal variables, the odds for mortality compared to the reference Arab group was significantly lower only with regard to ultra-orthodox patients (odds ratio, OR=0.06; 95% confidential interval, CI=0.00 to 0.80; P=0.033). In a logistic and in the Cox stepwise regression analyses with religion as forced in variable, comparing infants with IVH grade IV of religious and ultra-orthodox Jewish families with those of secular Jewish families, the OR/hazard ratio (HR) for mortality were OR=0.10; 95% CI=0.01 to 0.06; P=0.017, and HR=0.37; 95% CI=0.16 to 0.85; P=0.019, respectively. No significant difference between the groups was demonstrated when infants with IVH grade III were analyzed apart. Parental religious affiliation may be influential on the outcome of premature infants with severe brain damage.
A case of propylene glycol intoxication in a premature infant is reported. The infant went into a... more A case of propylene glycol intoxication in a premature infant is reported. The infant went into a state of coma after treatment for burns with antiseptic dressings. Cessation of the topical treatment resulted in complete recovery. An exceptionally high level of the dressings&#39; solvent, propylene glycol, found in the urinary chromatogram, was believed to be the causative agent. It is suggested that topical preparations containing propylene glycol should not be used in premature infants during the first weeks of life.
Page 1. Developmental Assessment of Prematurely Born Children Exposed to Antenatal Corticosteroid... more Page 1. Developmental Assessment of Prematurely Born Children Exposed to Antenatal Corticosteroids Ilan Arad MD and Ruben Bromiker MD ... French and co-workers [21] followedsingleton infants born at &lt;33 weeks gestation until 3 years of age. ...
Elevated cord blood levels of interleukin-6 and N-terminal pro-brain natriuretic peptide were ass... more Elevated cord blood levels of interleukin-6 and N-terminal pro-brain natriuretic peptide were associated with neonatal complications; however, simultaneously obtained values have not been compared to date. To study the association of cord blood levels of IL-6 and NT-proBNP with perinatal variables of premature infants and examine the relationship between the obtained values. Cord blood IL-6 (89 samples) and NT-proBNP (66 samples) levels obtained from infants delivered before 32 weeks of gestation were analyzed for associations with perinatal variables and possible correlation between both samples. Lower gestational age, no antenatal exogenous steroids, low Apgar scores at 1 minute and delivery at a high birth order, were all associated with more infants having elevated IL-6 levels (P = 0.02, P = 0.03, P = 0.03 and P = 0.001, respectively). None of the infants with necrotizing enterocolitis (n=6) had high IL-6 levels (P = 0.01). Increased NT-proBNP levels were associated with low Apg...
The Israel Medical Association journal : IMAJ, 2003
Page 1. Developmental Assessment of Prematurely Born Children Exposed to Antenatal Corticosteroid... more Page 1. Developmental Assessment of Prematurely Born Children Exposed to Antenatal Corticosteroids Ilan Arad MD and Ruben Bromiker MD ... French and co-workers [21] followedsingleton infants born at &lt;33 weeks gestation until 3 years of age. ...
The Israel Medical Association journal : IMAJ, 2010
Elevated cord blood levels of interleukin-6 and N-terminal pro-brain natriuretic peptide were ass... more Elevated cord blood levels of interleukin-6 and N-terminal pro-brain natriuretic peptide were associated with neonatal complications; however, simultaneously obtained values have not been compared to date. To study the association of cord blood levels of IL-6 and NT-proBNP with perinatal variables of premature infants and examine the relationship between the obtained values. Cord blood IL-6 (89 samples) and NT-proBNP (66 samples) levels obtained from infants delivered before 32 weeks of gestation were analyzed for associations with perinatal variables and possible correlation between both samples. Lower gestational age, no antenatal exogenous steroids, low Apgar scores at 1 minute and delivery at a high birth order, were all associated with more infants having elevated IL-6 levels (P = 0.02, P = 0.03, P = 0.03 and P = 0.001, respectively). None of the infants with necrotizing enterocolitis (n=6) had high IL-6 levels (P = 0.01). Increased NT-proBNP levels were associated with low Apg...
The Israel Medical Association journal : IMAJ, 2008
A substantial number of premature deliveries occur in hospitals lacking neonatal intensive care f... more A substantial number of premature deliveries occur in hospitals lacking neonatal intensive care facilities. We previously demonstrated a comparable outcome of very low birth weight infants delivered in a level II nursery to that of inborn infants delivered in our tertiary care center, but a similar comparison of extremely low birth weight infants has not been done. To compare the neonatal outcome (mortality, severe intraventricular hemorrhage/periventricular leukomalacia, bronchopulmonary dysplasia and intact survival) of inborn and outborn ELBW infants, accounting for sociodemographic, obstetric and perinatal variables. We compared 97 ELBW infants (birth weight < or = 1000 g) delivered between the years 2000 and 2004 in a hospital providing neonatal intensive care to 53 ELBW babies delivered in a referring hospital. A univariate model was first applied to examine the associations of the individual independent variables with the outcome variable, followed by a logistic stepwise r...
The Israel Medical Association journal : IMAJ, 2006
Maternal transport, rather than neonatal transport, to tertiary care centers is generally advocat... more Maternal transport, rather than neonatal transport, to tertiary care centers is generally advocated. Since a substantial number of premature deliveries still occur in hospitals with level I and level II nurseries, it is imperative to find means to improve their outcome. To compare the neonatal outcome (survival, intraventricular hemorrhage and bronchopulmonary dysplasia) of inborn and outborn very low birth weight infants, accounting for sociodemographic, obstetric and perinatal variables, with reference to earlier published data. We compared 129 premature infants with birth weights of 750-1250 g delivered between 1996 and 2000 in a hospital providing neonatal intensive care to 99 premature babies delivered in a referring hospital. In the statistical analysis, variables with a statistical significant association with the outcome variables and dissimilar distribution in the two hospitals were identified and entered together with the hospital of birth as explanatory variables in a log...
To assess the maternal recall of the neonatal discharge letter instructions with and without nurs... more To assess the maternal recall of the neonatal discharge letter instructions with and without nurse and mother signing the document in addition to the physician signature. Maternal recall of the discharge letter instructions was assessed by telephone interviews conducted 2-3 weeks following discharge. One hundred and nine mothers who signed the discharge letter following a change of information delivery policy at discharge were compared with 110 mothers who gave birth when their signature was not yet required. The impact of the discharge form on maternal recall was evaluated by stepwise regression analysis adjusted for obstetric, perinatal and demographic variables. Recall of specific instructions verified by the discharge notes and satisfactory understanding of the discharge letter as graded by the mother were higher among 109 mothers who signed the discharge letter (82% and 88%, respectively) than among 110 mothers who did not add their signature (58% and 73%, respectively), the di...
The Israel Medical Association journal : IMAJ, 2004
The Fetal Inflammatory Response Syndrome and Associated Infant Morbidity Ilan Arad MD and Zivanit... more The Fetal Inflammatory Response Syndrome and Associated Infant Morbidity Ilan Arad MD and Zivanit Ergaz MD Department of Neonatology, Hadassah University Hospital, Mount Scopus, Jerusalem, Israel ... Lancet 1988;ii:240±5. 14. Lyon A. Chronic lung disease of prematurity. ...
Rectal temperature of 126 term infants was measured on admission to the nursery following variabl... more Rectal temperature of 126 term infants was measured on admission to the nursery following variable periods of stay with the mother in the delivery room. Fifty-nine infants who wore woolen hats after delivery had higher rectal temperature than 67 infants whose head was covered by loosely applied cotton diapers (36.5+/-0.5 degrees C vs. 36.3+/-0.5 degrees C, respectively; p=0.03). Among them there were fewer infants who were admitted with rectal temperature 36 degrees C (12 vs. 26, respectively; p=0.03). In multiple regression analyses accounting for head covering with woolen hats, birth weight, gender, delivery room temperature and length of stay with the mother, only birth weight and head covering with woolen hats were significantly associated with rectal temperature at arrival in the nursery (p=0.002 and 0.03, respectively), and only head covering with cotton diapers was significantly associated with rectal temperature 36 degrees C (p=0.03). Our data imply that covering heads of te...
Parental adjustment following the death of a premature singleton or multiple birth infant has hit... more Parental adjustment following the death of a premature singleton or multiple birth infant has hitherto been studied by mailed questionnaires or telephone survey. In the present study, using an in-depth personal interview, grief reactions and adjustment patterns of nine families who lost a singleton premature infant (&#39;Single Group&#39;) were compared with those of nine families who lost one of a premature multiple birth cohort (&#39;Multiple Group&#39;). The interview was conducted 1-4 years after the death of the infant and evaluated specific areas or &#39;scales&#39; of life adjustment, including individual feelings, relationship between husband and wife, and functioning at home and at work. There was no significant difference between the paternal and maternal level of adjustment of the two groups in any of the studied scales. A positive correlation was found between maternal and paternal grief reaction of the same family in the scales of individual feelings (r = 0.65), relationships between husband and wife (r = 0.70), and functioning at home (r = 0.57). Comparing the father&#39;s scale with the mother&#39;s scale revealed a significant difference only in the area of &#39;individual feelings&#39;. The gestational age, maternal bonding during hospitalisation of the infant and the parental attendance at the event of death were significantly associated with the process of parental adjustment. The results of this study support previous reports of similar parental reactions following the demise of a premature singleton or multiple birth infant. Since societal environment may not recognise the need for consolation of these families, care, compassion, and sensitivity should be encouraged in dealing with these parents at the time of their infant&#39; death, and for a long time thereafter.
It has been suggested that impairment of placental perfusion prior to delivery may manifest in ea... more It has been suggested that impairment of placental perfusion prior to delivery may manifest in early postnatal increase of creatinine values. We hypothesized that the smaller of a discordant set of twins would have a higher initial plasma creatinine value and decided to measure early plasma creatinine levels in discordant twins in order to evaluate whether this value may serve as an index of impaired placental perfusion. Plasma creatinine, urea nitrogen and blood hematocrit values were simultaneously measured in 35 sets of twins during the first day of life. The sets of twins were divided into 2 groups according to birth weight difference. Thus, 18 sets of discordant twins with birth weight difference greater than 15% comprised the GT group and 17 sets of twins with birth weight difference less than or equal to 15% comprised the LE group. The differences between the values obtained within each group were analyzed using the Wilcoxon Signed Rank test. In the GT group the mean plasma creatinine level of the smaller twins was significantly higher than the level of the larger ones (p = 0.03), but there was no statistically significant difference between values obtained in twins of the LE group. The mean plasma urea level was higher in the larger twins of both groups, however only the difference in the GT group was statistically significant (p = 0.01). The mean hematocrit of the smaller twins was higher in both groups, but only the difference in the LE group was statistically significant (p = 0.02). Generally, there was a negative correlation between gestational age and early creatinine values. These results apparently support the notion that prenatal exposure to impaired placental perfusion may compromise the creatinine clearance of the fetus and result in higher early creatinine values. Since the creatinine values in our growth-retarded twins were within the normal range, no distinguishing line for evidence of a uterine-placental compromise could be drawn. Whether a certain early plasma creatinine value is suggestive or indicative of an intra-uterine hypoxic-ischemic insult, should be determined by documented instances of severe fetal compromise prior to delivery.
To determine the underlying etiology, associated malformations, clinical course, and prognostic s... more To determine the underlying etiology, associated malformations, clinical course, and prognostic significance of congenital chylothorax. A retrospective analysis of 11 neonates admitted to our neonatal intensive care unit with congenital chylothorax between January 2000 and June 2008. The post-discharge clinical and developmental course was evaluated by a telephone survey performed in July 2008. Antenatal diagnosis was established in 9 out of 11 infants by ultrasound examination; 5 had intrauterine pleural drainage. Eight infants had either structural or chromosomal abnormalities. The postnatal treatment included mechanical ventilation, drainage of pleural fluid and feeding with enriched medium chain triglyceride formula. Somatostatin was administered in one case. Six patients developed nosocomial infections. Two patients died after resolution of the chylothorax from deteriorating renal failure. Seven patients were traced for follow up and six of them achieved age appropriate developmental milestones. The recovery from chylothorax and future prognosis were dependent on the underlying etiology. Chylothorax was often a secondary event, with apparently favorable clinical and developmental prognosis when the underlying or/and associated condition was treatable.
Uploads
Papers by Ilan Arad