la réanimation néonatale et les malformations cardiaques à ...€¦ · presented by dr. ibrahim...
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la Réanimation Néonatale et les
malformations cardiaques à l’hôpital de Sainte Famille de Bethlehem - 2012
Presented by Dr. Ibrahim A. ABU ZAHIRA
Neonatologist – Holy Family Hospital – Bethlehem Pediatric cardiology Hadassah - Jerusalem
Plan I- General data about the deliveries, alive babies, admitted
babies to NICU January-December 2012. II- Admissions to our NICU (INBORN). III- Admissions to our NICU (OUT-BORN). IV- Congenital Heat Diseases: 1- Number & Percentage from the total admissions 2- PDA details (according to _ birth Wt & _ Treatment V- Conclusion and plan for the future
I. General data about the
deliveries, alive babies &
admitted babies to NICU
(January-December 2012)
General data about the deliveries, alive babies, admitted babies to NICU from January to December 2012
Descrip)on Total
№ofdeliveries 3166
№oftotalalivebabies 3272
Total№ofadmissiontoourNICU 450
№ofadmission(Inbornbabies) 423
№ofadmission(Transferredbabiesfromotherhospitals)
27
%ofadmissions(inborn)/totaldeliveries 13.4%
%ofadmissions(inborn)/totalalivebabies 12.9%
II. ADMISSIONS (INBORN)
Admissions (inborn) according to mode of delivery/month
Mode of delivery/month
January
February
March
April
May
June
July
Aug
September
October
Novem
ber m
breber
Decem
ber bre
Total
NVD 9 20 26 16 8 20 24 13 11 9 13 15 184
Vaccum 2 2 2 1 2 1 1 0 0 1 1 2 15
forceps 0 1 1 0 0 0 0 1 0 0 0 0 3
Elective C/S 16 6 12 15 4 4 21 12 5 14 14 8 131
Emergency C/S 10 9 11 8 14 5 1 8 12 4 2 6 90
Total 37 38 52 40 28 30 47 34 28 28 30 31 423
Mode of delivery for inborn babies
NVD C/S elective C/S emergency Vaccum Forceps
184
131
90
153
Mode of delivery for inborn babies NVD
C/Selec)ve
C/Semergency
Vaccum
Forceps
Admissions (inborn) according to GA
GA (weeks) Number (№=)
(%) of (inborn) admissions from the total admissions
(№=423)
≤25 7 1.7 %
58%
26-27 6 1.4 %
28 11 2.6 %
29-32 81 19.1 % ***
33-35 104 24.6 % **
36 35 8.3 %
37-40 153 36.2 % *
≥ 40 26 6.1 %
Total 423 100 %
≥37weeks 33-36weeks
29-32weeks
≤28weeks
179
139
81
2442,332,9
19,1 5,7
Admissions(inborn)accordingtoGA(№&%)
№ %
314
13
26
35
56
4148
35
46
3531
20
128
Admissions(inborn)accordingtobirthweight(gm)
N/℅=(56/13.2)
Mode of Ventilation & Surfactant therapy
Description Total Percentage of
total (n=423) Mode of ventilation
IPPV 95 22.5 %
Nasal CPAP 99 23.4 %
Nasal Intubation 6 1.4 %
HFV 3 0.7 %
№ babies received surfactant 59 14 %
• 27babiestransferredtoourNICUfromotherhospitals;
• 6%ofthetotaladmissionstoourNICU
III. ADMISSIONS (OUT-BORN)
NVD C/S elective
C/S emergency
15
10
2
Outborn babies according to mode of delivery
26-27wks4%
33-35wks11%
36-37wks33%
38-40wks41%
≥40wks11%
Outborn babies according to GA
1 1 2
5 5
3
1
3 3
2
1
OutbornbabiesaccordingtoBWt
27
1
7
15
4 41 2 4 2
621
The main Reasons for Admission from the outside
OUTBORN / Description
Total №
Percentage of total (n=27)
Mode of ventilation
IPPV 7 25.9 %
Nasal CPAP 5 18.5 %
№ babies received surfactant 4 14.8 %
Level (I) Level (II) Level (III)
Concerning the level of care
2
13 12
IV. Congenital Heart Diseases
( C H D )
14caseswerediagnoseuponadmissionas
CHDbutduringthehospitalisa)onwehad
thefollowingdata:
CHD
Congenital Heart Disease (CHD)
№ ℅
PDA 51 11.3 VSD 8 1.8
ASD II 3 0.7 Interruption of the aortic arch
1 0.2
Truncus arteriosus 1 0.2
Pulmonary artery from aorta 1 0.2 Situs inversus totalis 1 0.2 Pulmonary stenosis 1 0.2
0
5
10
15
20
2551
83 1 1 1 1 1 1
Diagnosed CHD at HFH -2012
Details of cases of Patent ductus Arteriosus (PDA):
Details of cases of Patent ductus Arteriosus (PDA):
Weight (grams)
Number (№)
Percentage from total for
the specific item (%)
≤ 1000 11 22 %
1001-1500 17 33 %
>1500 23 45 %
Total 51 11.3 %
PDATreatment:
• 24/51 babies received Ibuprofen, i.e. 47 % of all the cases of PDA. • 18 PDA were closed by Ibuprofen only, i.e. ( the treatment with Ibuprofen only was effective in 75%) • 6 babies who continued to have PDA upon discharge ( 3 of them have PDA as part of complex heart disease and
no treatment was given).
• Two (n=2) babies underwent a surgical ligation.
• Nineteen (n=19) were closed spontaneously with
symptomatic treatment by fluid restriction and
oxygen- therapy.
PDA Treatment:
The direction of Other
CHD
• Because we don t have a Surgical Cardiology Center in West-Bank
So All other CHD were
transferred to Israel for surgical interventions (to Hadassah,….) via our cardiologists.
Conclusionsandplanforthefuture
• The necessity of the continuous education for the
medical team (the neonatologists , pediatricians,
residents and midwifes and nurses) where there is a
maternity centers and even in the private clinics
→ the majority of CHD discovered at birth or in
the first 2 weeks after birth
• The necessity for further Pediatric Cardiologists with good communication between them(teams).
• Prenatal diagnosis of CHD and the transfert in utero
to the cardiologic Centers for best treatment.
MERCI
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