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