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Nour BA, El-Rahman AMA, Hameed SAEAE, Mohsen N, Mohamed A, El-Bayoumi MA, Abdel-Hady HE. Lung and diaphragm ultrasound as predictors of successful weaning from nasal continuous positive airway pressure in preterm infants. Pediatr Pulmonol 2024; 59:1428-1437. [PMID: 38501314 DOI: 10.1002/ppul.26933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/02/2024] [Accepted: 02/12/2024] [Indexed: 03/20/2024]
Abstract
OBJECTIVE Assessment of the utility of lung and diaphragm ultrasound in the prediction of successful weaning from nasal continuous positive airway pressure (NCPAP) in preterm infants. STUDY DESIGN This prospective cohort study was conducted on preterm infants who were considered ready for weaning off NCPAP. Lung and diaphragm ultrasound were performed just before and 3 h after weaning off NCPAP. The primary outcome was to evaluate the accuracy of lung ultrasound (LUS) in predicting successful weaning from NCPAP. RESULTS Out of 65 enrolled preterm infants, 30 (46.2%) were successfully weaned from NCPAP to room air. The successful weaning group had higher gestational ages, lower incidences of previous invasive mechanical ventilation, and treated hemodynamically significant patent ductus arteriosus before the trial weaning. A LUS score of ≤6, measured before discontinuation of NCPAP, exhibited a predictive sensitivity of 80% and specificity of 75% for successful weaning (Area under the curve (AUC) = 0.865, ≤.001). When the LUS score was assessed 3 h after weaning from NCPAP, a cutoff point of ≤7 predicted successful weaning with a sensitivity and specificity of 90% and 60% respectively (AUC = 0.838, p ≤ .001). The diaphragmatic thickness fraction (DTF) was significantly lower in the successful weaning group. After adjustment for various factors, LUS score remained the only independent predictor of successful weaning. CONCLUSION LUS score before weaning from NCPAP has a good sensitivity and specificity for predicting successful weaning from NCPAP in preterm infants. Diaphragmatic excursion and DTF were not good predictors.
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Affiliation(s)
- Basma Ahmed Nour
- Neonatal Intensive Care Unit, Mansoura University Children's Hospital, Mansoura, Egypt
- Department of Pediatrics, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | | | | | - Nada Mohsen
- Neonatal Intensive Care Unit, Mansoura University Children's Hospital, Mansoura, Egypt
- Department of Pediatrics, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Adel Mohamed
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Sinai Health System, Toronto, Ontario, Canada
| | | | - Hesham Elsayed Abdel-Hady
- Neonatal Intensive Care Unit, Mansoura University Children's Hospital, Mansoura, Egypt
- Department of Pediatrics, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Ghanem M, Zozaya C, Ibrahim J, Lee S, Mohsen N, Nasef N, Mohamed A. Correlation between early postnatal body weight changes and lung ultrasound scores as predictors of bronchopulmonary dysplasia in preterm infants: A secondary analysis of a prospective study. Eur J Pediatr 2024; 183:2123-2130. [PMID: 38363393 DOI: 10.1007/s00431-024-05464-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 01/20/2024] [Accepted: 01/31/2024] [Indexed: 02/17/2024]
Abstract
Recent research links early weight changes (EWC) with bronchopulmonary dysplasia (BPD) in preterm neonates, while lung ultrasound score (LUS) has shown promise in predicting BPD. We aimed to explore the correlation between LUS and EWC as markers of extravascular lung edema and to investigate the correlation between LUS and EWC in preterm infants with respiratory distress syndrome regarding future BPD development. This secondary analysis of a prospective study involved infants ≤ 28 weeks gestation. Enrolled infants underwent lung ultrasound assessment on postnatal days 3, 7 and 14, measuring LUS. EWC was computed on the same time points. Infants were classified as either having BPD or not. Descriptive statistics, correlation coefficient, and area under the receiver operating characteristic (AUROC) curve analysis were utilized. Of 132 infants, 70 (53%) had BPD. Univariate analysis revealed statistically significant differences in LUS and EWC at days 3, 7, and 14 between BPD and no-BPD groups (p < 0.001). A statistically significant but weak positive correlation existed between LUS and EWC (r0.37, r0.29, r0.24, and p < 0.01) at postnatal days 3, 7, and 14, respectively. AUROC analysis indicated LUS having superior predictive capacity for the need for invasive mechanical ventilation at day 14 as well as the later BPD development compared to EWC (p < 0.0001). CONCLUSION In a cohort of extreme preterm infants, our study revealed a positive yet weak correlation between LUS and EWC, suggesting that EWC was not the major contributing to the evolving chronic lung disease. WHAT IS KNOWN • Recent evidence links Early Weight-Changes with bronchopulmonary dysplasia in preterm neonates. • Lung ultrasound score has shown promise in early prediction of the subsequent development of bronchopulmonary dysplasia in preterm infants. No studies have examined the correlation between Early Weight-Changes and Lung ultrasound score in preterm infants during first 2 weeks after birth. WHAT IS NEW • Our study demonstrated a positive and statistically significant correlation between early LUS and EWC, indicating their potential role as early predictors for the subsequent development of BPD in extreme preterm infants. • The weak correlation between the two parameters may stem from the possible restricted influence of EWC, given that it may not be the primary factor contributing to the evolving chronic lung disease.
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Affiliation(s)
- Mohab Ghanem
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
- Department of Pediatrics, Mount Sinai Hospital, 600 University Avenue, Toronto, ON, ON, M5G 1X5, Canada
| | - Carlos Zozaya
- Department of Neonatology, Hospital Universitario La Paz, Madrid, Spain
| | - Jenna Ibrahim
- Department of Pediatrics, Mount Sinai Hospital, 600 University Avenue, Toronto, ON, ON, M5G 1X5, Canada
| | - Seungwoo Lee
- Department of Pediatrics, Mount Sinai Hospital, 600 University Avenue, Toronto, ON, ON, M5G 1X5, Canada
| | - Nada Mohsen
- Department of Pediatrics, Mansoura University, Mansoura, Egypt
| | - Nehad Nasef
- Department of Pediatrics, Mansoura University, Mansoura, Egypt
| | - Adel Mohamed
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada.
- Department of Pediatrics, Mount Sinai Hospital, 600 University Avenue, Toronto, ON, ON, M5G 1X5, Canada.
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Zhu F, de Oliveira CB, Mohsen N, Kharrat A, Deshpande P, Mertens L, Jain A. Challenges in clinical identification of right ventricular dysfunction in preterm infants with persistent pulmonary hypertension of the newborn. Early Hum Dev 2024; 190:105942. [PMID: 38306954 DOI: 10.1016/j.earlhumdev.2024.105942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/20/2023] [Accepted: 01/11/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND Right ventricular dysfunction, typically qualitatively diagnosed (Q-RVd) in preterm infants, requires echocardiography which is not always acutely available. We aimed to identify clinical indices of Q-RVd in very preterm infants (gestational age, GA <32 weeks) with persistent pulmonary hypertension of newborn (PPHN) and examine the reliability and validity of Q-RVd. METHODS Forty-seven infants with mean ± SD GA of 26.8 ± 2.7 weeks who had targeted neonatal echocardiography (TNE) ≤72 h old, during PPHN, were retrospectively studied. Three standard TNE clips were reviewed by two blinded assessors, and infants categorized as Q-RVd if moderate-severe RVd was diagnosed on ≥2 clips. Cardiopulmonary clinical indices at TNE and quantitative RV functional markers were compared between Q-RVd vs. no-RVd groups. Potential quantitative RVd definitions examined by classifying each measurement as "low" or "normal" using published data. Inter-rater agreement for Q-RVd assessed using Kappa statistics. RESULTS Mean age at TNE was 25.3 ± 20.4 h with Q-RVd diagnosed in 19(40 %) infants. Q-RVd group demonstrated higher peak oxygen requirements (96 ± 9 % vs. 84 ± 16 %, p < 0.01); however, no clinical parameters at TNE differentiated the groups. Quantitative measures were lower in Q-RVd patients, confirming classification validity. Among tested quantitative definitions, low RV stroke volume was associated with lower systolic blood pressure (41±7 vs. 47±9 mmHg, p = 0.02) and higher shock index (4.02±0.80 vs. 3.44±0.72, p = 0.02). Kappa for Q-RVd was 0.55 (95%CI 0.32-0.77). CONCLUSIONS The non-specific nature of clinical markers of RVd in preterm infants with PPHN necessitates echocardiographic diagnosis of RVd. Studies should examine prognostic relevance of RVd and establish outcome-based quantitative definitions in preterm infants.
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Affiliation(s)
- Faith Zhu
- Department of Paediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Paediatrics, University of Toronto, Ontario, Canada
| | - Caio Barbosa de Oliveira
- Department of Paediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Paediatrics, University of Toronto, Ontario, Canada
| | - Nada Mohsen
- Department of Paediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Paediatrics, University of Toronto, Ontario, Canada; Department of Pediatrics, Mansoura University, Mansoura, Egypt
| | - Ashraf Kharrat
- Department of Paediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Paediatrics, University of Toronto, Ontario, Canada
| | - Poorva Deshpande
- Department of Paediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Paediatrics, University of Toronto, Ontario, Canada
| | - Luc Mertens
- Department of Cardiology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Amish Jain
- Department of Paediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Paediatrics, University of Toronto, Ontario, Canada.
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Mohsen N, Solis-Garcia G, Jasani B, Nasef N, Mohamed A. Accuracy of lung ultrasound in predicting extubation failure in neonates: A systematic review and meta-analysis. Pediatr Pulmonol 2023; 58:2846-2856. [PMID: 37431954 DOI: 10.1002/ppul.26598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 06/06/2023] [Accepted: 07/03/2023] [Indexed: 07/12/2023]
Abstract
OBJECTIVE To systematically review and meta-analyze the diagnostic accuracy of lung ultrasound score (LUS) in predicting extubation failure in neonates. STUDY DESIGN MEDLINE, COCHRANE, EMBASE, CINAHL, and clinicaltrials.gov were searched up to 30 November 2022, for studies evaluating the diagnostic accuracy of LUS in predicting extubation outcome in mechanically ventilated neonates. METHODOLOGY Two investigators independently assessed study eligibility, extracted data, and assessed study quality using the Quality Assessment for Studies of Diagnostic Accuracy 2 tool. We conducted a meta-analysis of pooled diagnostic accuracy data using random-effect models. Data were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We calculated pooled sensitivity and specificity, pooled diagnostic odds ratios with 95% confidence intervals (CI), and area under the curve (AUC). RESULTS Eight observational studies involving 564 neonates were included, and the risk of bias was low in seven studies. The pooled sensitivity and specificity for LUS in predicting extubation failure in neonates were 0.82 (95% CI: 0.75-0.88) and 0.83 (95% CI: 0.78-0.86), respectively. The pooled diagnostic odds ratio was 21.24 (95% CI: 10.45-43.19), and the AUC for LUS predicting extubation failure was 0.87 (95% CI: 0.80-0.95). Heterogeneity among included studies was low, both graphically and by statistical criteria (I2 = 7.35%, p = 0.37). CONCLUSIONS The predictive value of LUS in neonatal extubation failure may hold promise. However, given the current level of evidence and the methodological heterogeneity observed, there is a clear need for large-scale, well-designed prospective studies that establish standardized protocols for lung ultrasound performance and scoring. REGISTRATION The protocol was registered in OSF (https://doi.org/10.17605/OSF.IO/ZXQUT).
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Affiliation(s)
- Nada Mohsen
- Department of Pediatrics, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Gonzalo Solis-Garcia
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Bonny Jasani
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Nehad Nasef
- Department of Pediatrics, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Adel Mohamed
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Mount Sinai Hospital, Toronto, Ontario, Canada
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Mohsen N, Nasef N, Ghanem M, Yeung T, Deekonda V, Ma C, Kajal D, Baczynski M, Jain A, Mohamed A. Accuracy of lung and diaphragm ultrasound in predicting successful extubation in extremely preterm infants: A prospective observational study. Pediatr Pulmonol 2023; 58:530-539. [PMID: 36324211 DOI: 10.1002/ppul.26223] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/28/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Chest ultrasound has emerged as a promising tool in predicting extubation readiness in adults and children, yet its utility in preterm infants is lacking. Our aim was to assess the utility of lung ultrasound severity score (LUSS) and diaphragmatic function in predicting extubation readiness in extremely preterm infants. STUDY DESIGN In this prospective cohort study, preterm infants < 28 weeks gestational age (GA) who received invasive mechanical ventilation for ≥12 h were enrolled. Chest ultrasound was performed before extubation. The primary outcome was lung ultrasound accuracy for predicting successful extubation at 3 days. Descriptive statistics and logistic regression were done using SPSS version 22. RESULTS We enrolled 45 infants, of whom 36 (80%) were successfully extubated. GA and postmenstrual age (PMA) at extubation were significantly higher in the successful group. The LUSS was significantly lower in the successful group compared to failed group (11.9 ± 3.2 vs. 19.1 ± 3.1 p < 0.001). The two groups had no statistically significant difference in diaphragmatic excursion or diaphragmatic thickness fraction. Logistic regression analysis controlling for GA and PMA at extubation showed LUSS was an independent predictor for successful extubation (odd ratio 0.46, 95% confidence interval [0.23-0.9], p = 0.02). The area under the receiver operating characteristic curve was 0.95 (p ˂ 0.001) for LUSS, and a cut-off value of ≥15 had 95% sensitivity and 85% specificity in detecting extubation failure. CONCLUSION In extremely preterm infants, lung ultrasound has good accuracy for predicting successful extubation. However, diaphragmatic measurements were not reliable predictors.
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Affiliation(s)
- Nada Mohsen
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Mount Sinai Hospital, Toronto, Ontario, Canada.,Department of Pediatrics, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Nehad Nasef
- Department of Pediatrics, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohab Ghanem
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Telford Yeung
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Mount Sinai Hospital, Toronto, Ontario, Canada.,Department of Pediatrics, Windsor Regional Hospital Metropolitan campus, Windsor, Ontario, Canada
| | | | - Carmen Ma
- Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Dilkash Kajal
- Mount Sinai Hospital, Toronto, Ontario, Canada.,Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | | | - Amish Jain
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Adel Mohamed
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Mount Sinai Hospital, Toronto, Ontario, Canada
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Yeung T, Mohsen N, Ghanem M, Ibrahim J, Shah J, Kajal D, Shah PS, Mohamed A. Diaphragmatic Thickness and Excursion in Preterm Infants With Bronchopulmonary Dysplasia Compared With Term or Near Term Infants: A Prospective Observational Study. Chest 2023; 163:324-331. [PMID: 35963296 DOI: 10.1016/j.chest.2022.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 07/29/2022] [Accepted: 08/02/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Diaphragmatic atrophy associated with mechanical ventilation is reported in pediatric and adult patients, but a similar association has not been described in preterm infants with bronchopulmonary dysplasia (BPD). RESEARCH QUESTION Does BPD impact the diaphragm thickness (DT) and diaphragm excursion (DE) in infants born before 32 weeks' gestation compared with healthy late preterm or term infants? STUDY DESIGN AND METHODS In this prospective observational case-control study, DT at end of expiration (DTexp), DT at end of inspiration (DTins), DT fraction (DTF), and DE (DE) were assessed using bedside ultrasound. Two groups were compared: infants with BPD (patients) and healthy, postmenstrual age-matched infants (control participants). To account for variations in body size between groups, diaphragmatic measurements were expressed as a ratio of body surface area (BSA). Statistical analyses were conducted using SAS software version 9.4 (SAS Institute, Inc.). RESULTS We enrolled 111 infants, including 56 preterm infants with BPD (mean ± SD study age, 37.7 ± 1.7 weeks) and 55 healthy control participants (mean ± SD study age, 38.1 ± 1.5 weeks). DTexp and DTexp to BSA ratio were significantly lower in the BPD group compared with the healthy control group (mean ± SD, 1.3 ± 0.4 mm vs 1.5 ± 0.4 mm [P = .01] and 7.1 ± 1.4 mm/m2 vs 7.8 ± 1.8 mm/m2 [P = .03]). DTF and DE were significantly higher in the BPD group vs the healthy control group (mean ± SD, 61.8 ± 26.0 vs 43.3 ± 19.7 [P < .01] and 6.0 ± 1.7 mm vs 4.4 ± 1.6 mm [P < .01], respectively). INTERPRETATION In infants with BPD, DTexp was significantly lower, whereas DTF and DE were significantly higher, compared with healthy, age-matched control participants. Future studies are required and should focus on describing the evolution of diaphragmatic dimensions in preterm infants with and without BPD. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT04941963; URL: www. CLINICALTRIALS gov.
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Affiliation(s)
- Telford Yeung
- Department of Pediatrics, University Health Network, University of Toronto; Department of Pediatrics, Mount Sinai Hospital, Toronto; Department of Pediatrics, Windsor Regional Hospital Metropolitan campus, Windsor, ON, Canada
| | - Nada Mohsen
- Department of Pediatrics, University Health Network, University of Toronto; Department of Pediatrics, Mount Sinai Hospital, Toronto; Department of Pediatrics, Mansoura University, Mansoura, Egypt
| | - Mohab Ghanem
- Department of Pediatrics, University Health Network, University of Toronto; Department of Pediatrics, Mount Sinai Hospital, Toronto
| | - Jenna Ibrahim
- Department of Pediatrics, Mount Sinai Hospital, Toronto
| | - Jyotsna Shah
- Department of Pediatrics, University Health Network, University of Toronto; Department of Pediatrics, Mount Sinai Hospital, Toronto
| | - Dilkash Kajal
- Department of Medical Imaging, University Health Network, University of Toronto; Department of Pediatrics, Mount Sinai Hospital, Toronto
| | - Prakesh S Shah
- Department of Pediatrics, University Health Network, University of Toronto; Department of Pediatrics, Mount Sinai Hospital, Toronto
| | - Adel Mohamed
- Department of Pediatrics, University Health Network, University of Toronto; Department of Pediatrics, Mount Sinai Hospital, Toronto.
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Mohsen N, Nasef N, Elkhouli M, Ghanem M, Dalby A, Yoon EW, Finan E, Shah PS, Mohamed A. Predictors of successful trial off continuous positive airway pressure and high flow nasal cannula in preterm infants <30 weeks' gestation: A retrospective study. Pediatr Pulmonol 2022; 57:1000-1007. [PMID: 35032109 DOI: 10.1002/ppul.25827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/18/2021] [Accepted: 01/11/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To identify the predictors of successful first trial off nasal continuous positive airway pressure (nCPAP). METHODS A retrospective cohort study of infants ≤29 weeks' gestation who required nCPAP for >24 h was conducted. Logistic regression was used to detect predictors for successful trial off nCPAP. Statistical analysis was performed using the SAS software. RESULTS A total of 727 infants were included in the analysis. Infants who were successful in their first trial off nCPAP (n = 313) were of higher gestational age (GA) and birth weight (BW), as well as a higher proportion of female infants, compared with those who were not successful (p < 0.01). When stratified by GA, a negative correlation was noted between GA and postmenstrual age at successful trial off nCPAP or high flow nasal cannula (HFNC) (r = 0.45, p < 0.01). Logistic regression analysis showed that GA (odds ratio [OR] 1.13, 95% confidence interval [CI] [1.03-1.24], p = 0.01) and percentage of time spent with an oxygen saturation over 89% in the 24 h preceding the trial off nCPAP (OR 1.08, 95% CI [1.05-1.11], p = 0.00) were independent predictors for successful trial off nCPAP. CONCLUSION Successful trial off nCPAP or HFNC in preterm infants is significantly associated with higher GA, BW, female gender, and the specific oxygen saturation histogram in the preceding 24-h period.
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Affiliation(s)
- Nada Mohsen
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada.,Department of Pediatrics, Mansoura University, Mansoura, Egypt
| | - Nehad Nasef
- Department of Pediatrics, Mansoura University, Mansoura, Egypt
| | - Mohamed Elkhouli
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Mohab Ghanem
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Allison Dalby
- Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Eugene Woojin Yoon
- Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Emer Finan
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Prakesh S Shah
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation (HPME), University of Toronto, Toronto, Ontario, Canada
| | - Adel Mohamed
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
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Elmowafi M, Mohsen N, Nour I, Nasef N. Prophylactic versus therapeutic caffeine for apnea of prematurity: a randomized controlled trial. J Matern Fetal Neonatal Med 2021; 35:6053-6061. [PMID: 33771081 DOI: 10.1080/14767058.2021.1904873] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Therapeutic initiation of methyxanthines for treatment of apnea in preterm infants was the standard policy. Caffeine therapy is beneficial for various outcomes of preterm infants. AIM To evaluate the efficacy of early prophylactic compared to routine therapeutic caffeine therapy on duration of oxygen support and other outcomes of preterm infants. METHODS In a randomized controlled trial including preterm infants < 32 weeks' gestation, prophylactic (in the first 72 h of life) versus therapeutic (only if apnea exists or infant requires mechanical ventilation) decision of caffeine was compared. The primary outcome was the duration of oxygen therapy. Secondary outcomes included duration of respiratory support modalities; bronchoplumonary dysplasia (BPD); necrotizing enterocolitis; intra-ventricular hemorrhage; retinopathy of prematurity; length of hospital stay (LOS); neonatal mortality; and caffeine side effects. RESULTS We enrolled 90 infants in the prophylactic and 91 infants in therapeutic groups respectively. Prophylactic caffeine decreased the duration of oxygen therapy [median and IQR of 28 (18-36) days versus 34 (23-51) days, p = .005 respectively]. Prophylactic caffeine significantly decreased the durations of respiratory support modalities, LOS, and incidences of mild to moderate BPD without reported effects on the incidence of severe BPD or other clinical outcomes compared to therapeutic caffeine. A significantly higher proportion of infants in the prophylactic caffeine group did not require mechanical ventilation during their NICU admission and a significant lower proportion required late mechanical ventilation compared to the prophylactic caffeine group. CONCLUSION Prophylactic caffeine decreased the duration of oxygen therapy, invasive and noninvasive ventilation, incidences of mild to moderate BPD, and LOS in preterm infants.
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Affiliation(s)
- Mohamed Elmowafi
- Neonatal Intensive Care Unit, Mansoura University Children's Hospital, Mansoura, Egypt
| | - Nada Mohsen
- Neonatal Intensive Care Unit, Mansoura University Children's Hospital, Mansoura, Egypt.,Departement of Pediatrics, Faculty of Medicine, University of Mansoura, Mansoura, Egypt
| | - Islam Nour
- Neonatal Intensive Care Unit, Mansoura University Children's Hospital, Mansoura, Egypt.,Departement of Pediatrics, Faculty of Medicine, University of Mansoura, Mansoura, Egypt
| | - Nehad Nasef
- Neonatal Intensive Care Unit, Mansoura University Children's Hospital, Mansoura, Egypt.,Departement of Pediatrics, Faculty of Medicine, University of Mansoura, Mansoura, Egypt
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Grada A, Karimkhani C, Colombara D, Drucker A, Phillips T, Mohsen N, Dellavalle R. 283 The global burden of decubitus ulcers, 1990-2015. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.03.359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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10
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El-Karaksy H, Anwar GH, El-Raziky MS, El-Hawary M, Hashem M, El-Sayed R, El-Shabrawi M, Mohsen N, Fouad H, Esmat G. Anti-HCV prevalence among diabetic and non-diabetic Egyptian children. Curr Diabetes Rev 2010; 6:388-92. [PMID: 20879976 DOI: 10.2174/157339910793499137] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2010] [Accepted: 05/14/2010] [Indexed: 12/13/2022]
Abstract
Our aim was to determine the prevalence of the HCV infection among children with type 1 DM as compared to a group of non-diabetic children attending the general outpatient clinics of the same hospital and investigate the possible risk factors. The study was carried out on 692 children with type 1 DM attending the Pediatric Diabetes Unit at Cairo University Pediatric Hospital, Egypt, and 1042 non-diabetic children attending the general outpatient clinics of the same hospital. They were screened for HCV antibodies using third generation ELISA. Anti-HCV antibody prevalence in diabetic children below 9 years of age was comparable to that of non diabetic children (2.5% vs. 1.4%; p=0.25). Diabetic children had higher exposure to medical care (p=0.04); all diabetics were exposed to daily insulin injections and daily blood glucose monitoring. Non-diabetics had higher exposure to razors used by others (p=0.05) and higher rate of traditional hair cutting (p=0.05). To conclude, the prevalence of anti-HCV in diabetic children below 9 years of age was comparable to non diabetic children of the same age group. Application of standard precautions for infection control could successfully limit spread of HCV infection in our Pediatric Diabetes Unit, in a country with high HCV load as Egypt.
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Affiliation(s)
- H El-Karaksy
- Department of Pediatrics, Cairo University, Cairo, Egypt
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Ulivieri S, Nguyen JP, Keravel Y, Mencattini G, Lefaucheur JP, Mohsen N. Involvement of electrophysiological localization of the subthalamic nucleus in deep brain stimulation for Parkinson's disease. G Chir 2008; 29:335-338. [PMID: 18834563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
We studied the involvement of the electrophysiological localization of the subthalamic nucleus (NST) using a multi-unit recording technique by means of semi-microelectrode in a set of thirty Parkinson's patients who benefited from a bilateral stimulation of the NST and who were operated on under local or general anesthesia. The multi-unit recording technique by means of semi-microelectrodes appeared efficient, capable of improving the localization of the NST and leading to improvement in clinical results. We believe that the use of our technique will allow for time savings while providing good results, and that the choice of the angle of the trajectory will allow for improved localization of the NST and thus improved clinical results.
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Affiliation(s)
- S Ulivieri
- Department of Neurosurgery, Henri Mondor Hospital, Créteil-Paris, France
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El-Raziky MS, El-Hawary M, Esmat G, Abouzied AM, El-Koofy N, Mohsen N, Mansour S, Shaheen A, Abdel Hamid M, El-Karaksy H. Prevalence and risk factors of asymptomatic hepatitis C virus infection in Egyptian children. World J Gastroenterol 2007; 13:1828-32. [PMID: 17465475 PMCID: PMC4149961 DOI: 10.3748/wjg.v13.i12.1828] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To identify the prevalence, risk factors and manifestations of asymptomatic hepatitis C virus (HCV) infection in Egyptian children.
METHODS: Children at the age of 1-9 years were screened for HCV antibodies and alanine aminotransferase (ALT) levels. Every child with elevated ALT and/or detectable HCV antibodies was tested for HCV RNA by RT-PCR and compared with two negative controls for risk factors and signs and symptoms of liver disease.
RESULTS: We screened 1042 children, six of them had elevated ALT, negative HCV antibody and positive RNA, likely representing acute hepatitis C cases. Fifteen children were HCV seropositive, 5 of them were HCV RNA positive. Asymptomatic HCV infection was present in 2.02% (positive results for either HCV antibodies or HCV-RNA or both). Symptoms such as diarrhea, abdominal pain, history of fatigue and school absence because of illness and risk factors such as dental care were significantly more common among HCV positive cases than among controls. None of the HCV positive children was diagnosed as having signs of advanced liver disease upon clinical or ultrasonographic examination.
CONCLUSION: Asymptomatic HCV infection is detectable in 2.02% Egyptian children.
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Affiliation(s)
- M S El-Raziky
- Department of Pediatrics, Faculty of Medicine, Cairo University, 8 street No. 25, El-Mokattam, Cairo11585, Egypt.
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Affiliation(s)
- E M Scrimgeour
- Department of Medicine, College of Medicine, Sultan Qaboos University, PO Box 35, Al-Khod, Muscat, Oman.
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Fayn J, Rubel P, Mohsen N. An improved method for the precise measurement of serial ECG changes in QRS duration and QT interval. Performance assessment on the CSE noise-testing database and a healthy 720 case-set population. J Electrocardiol 1991; 24 Suppl:123-7. [PMID: 1552241 DOI: 10.1016/s0022-0736(10)80030-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- J Fayn
- Institut National de la Santé et de la Recherche Médicale, Hôpital Cardiologique, Lyon, France
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Rubel P, Fayn J, Mohsen N, Girard P. New methods of quantitative assessment of the extent and significance of serial ECG changes of the repolarization phase. J Electrocardiol 1988; 21 Suppl:S177-81. [PMID: 3216171 DOI: 10.1016/0022-0736(88)90089-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The authors present a method for optimally measuring variations in T wave shape and time intervals for the quantitative assessment of the significance of serial changes of the repolarization phase. The results, established on a healthy population, show the inadequacy of Bazett's formula, the constancy of maximum of T to the end of the T time interval, and good stability of the spatial T loops' morphotype. Residual intrasubject variability of corrected QT interval is mainly ascribable to physiologic, heart rate-independent changes in true onset of Q to a maximum of T time interval. The optimized mean quadratic deviation between two serial T loops is well correlated with changes in drug concentration.
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Affiliation(s)
- P Rubel
- Institut National des Sciences Appliquées Département Informatique, Villeurbanne, France
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