A 100 years ago, when neonatal intensive care units (NICUs) started to be well established, the race never stopped trying to add new regimens to improve neonatal survival. On the other hand, long term sequelae of medications used at NICUs were usually not sufficiently studied and left mostly unnoticed for many years by neonatologists. Here we are trying to understand & & shed the light on some of these sequelae in a trial avoid those sequelae while working on NICU candidates.
Lecture given at the 6th Conference for Nile Basin Pediatrics 2-5 December 2015, Hurgada, Egypt
A randomised, double-blind clinical trial was undertaken in order to assess the effectiveness of probiotics in
the prevention of necrotising enterocolitis (NEC) in newborns weighing <1500 g.
A randomised, double-blind clinical trial was undertaken in order to assess the effectiveness of probiotics in
the prevention of necrotising enterocolitis (NEC) in newborns weighing <1500 g.
Emergence delirium in children is a state of mental dissociation that occurs while recovering from anesthetic agents and manifests as disorientation, restlessness, irritability, screaming and involuntary activity. It usually evolves in the first half hour after awakening from anesthesia, often lasts up to 20 minutes and usually resolves on its own. Many factors have been suggested to play a potential role in the development of such an event. Post anesthesia agitation has been noted more often with the newer, less soluble, inhaled anesthetics, such as desflurane and sevoflurane, than with other volatile ones; however administration of other anesthetic agents can also cause this disturbing recovery phenomenon. Emergence delirium occurs more often in preschool children and seen frequently after head and neck surgeries like tonsillectomy, adenoidectomy, tongue tie release, strabismus surgery, nasal operations etc. Treatment is with pharmacological and environmental. Prevention may be the best treatment but no one medication is entirely effective.
Basic concepts in neonatal ventilation - Safe ventilation of neonatemohamed osama hussein
Lecture by by dr Muhammad Ezzat Abdel-Shafy MB.BCh, M.Sc Pediatrics Neonatology Sp. , Benha Children Hospital, provided during our Doctors neonatology workshop, 20th of January 2017
Emergence delirium in children is a state of mental dissociation that occurs while recovering from anesthetic agents and manifests as disorientation, restlessness, irritability, screaming and involuntary activity. It usually evolves in the first half hour after awakening from anesthesia, often lasts up to 20 minutes and usually resolves on its own. Many factors have been suggested to play a potential role in the development of such an event. Post anesthesia agitation has been noted more often with the newer, less soluble, inhaled anesthetics, such as desflurane and sevoflurane, than with other volatile ones; however administration of other anesthetic agents can also cause this disturbing recovery phenomenon. Emergence delirium occurs more often in preschool children and seen frequently after head and neck surgeries like tonsillectomy, adenoidectomy, tongue tie release, strabismus surgery, nasal operations etc. Treatment is with pharmacological and environmental. Prevention may be the best treatment but no one medication is entirely effective.
Basic concepts in neonatal ventilation - Safe ventilation of neonatemohamed osama hussein
Lecture by by dr Muhammad Ezzat Abdel-Shafy MB.BCh, M.Sc Pediatrics Neonatology Sp. , Benha Children Hospital, provided during our Doctors neonatology workshop, 20th of January 2017
One of lectures presented in our Port said fifth neonatology conference 23-24 October 2014, presented by prof Olfat Fawzy, M.D, M.Sc.,Professor of Endocrinology Al Azhar university
Lecture given during Port said fifth neonatology conference, 23-24 October 2014 by Dr.Osama Arafa Abd EL Hameed M. B.,B.CH - M.Sc Pediatrics - Ph. D. Consultant Pediatrician & Neonatologist Head of Pediatrics Department - Port-Fouad Hospital
Trophic feeding, by dr Amal Ahmed Khalil ,Port Said University, mohamed osama hussein
Trophic feeding is the practice of feeding small volume of enteral feeds in order to stimulate the development of the immature gastrointestinal tract of the preterm infant. This practice has also been termed as minimal enteral nutrition (MEN).
Neonatal resuscitation, by Dr Osama Hussein, president of Port said neonatology society. Presented in the NICU nursing workshop, organized by Nursing syndicate in Suez canal & Sinai in cooperation with Port said university college of nursing & Port said neonatology society, December,2014 Port said
Neonatal mechanical ventilation by dr Osama Hussein, president of Port said neonatology society. Presented in the NICU nursing workshop, organized by Nursing syndicate in Suez canal & Sinai in cooperation with Port said university college of nursing & Port said neonatology society, December,2014 Port said
Normal newborn care, by Dr Amal Khalil, Dean of Nursing college, Port said University, Port said. Presented in the NICU nursing workshop, organized by Nursing syndicate in Suez canal & Sinai in cooperation with Port said university college of nursing & Port said neonatology society, December,2014 Port said
Therapeutic hypothermia for neonatal hypoxic-ischemic encephalopathyMCH-org-ua
International conference «Actual approaches to the extremely preterm babies: International experience and Ukrainian realities» (Kyiv, Ukraine, March 5-6, 2013)
By Prof. ATEF DONIA Professor of Pediatrics Al Azhar University
The role of reactive oxygen species (ROS) in pathogenesis of common disorders of the preterm infant.
The unique susceptibility of premature infants to oxidative stress. Potential for therapeutic interventions using enzymatic and/or non-enzymatic antioxidants
Intrauterine drug exposure and nas newest10 17 14ErikaAGoyer
NATIONAL PERINATAL ASSOCIATION CONFERENCE 2014 - Intrauterine Drug Exposure and the Management of Neonatal Abstinence Syndrome
- Evelyn Fulmore, Pharm. D., McLeod Regional Medical Center
Of the 415 children in the study (195 girls and 220 boys; mean [SD] age, 363.0 [8.3] days), a consistent association between craniofacial shape and prenatal alcohol exposure was observed at almost any level regardless of whether exposure occurred only in the first trimester or throughout pregnancy. Regions of difference were concentrated around the midface, nose, lips, and eyes. Directional visualization showed that these differences corresponded to general recession of the midface and superior displacement of the nose, especially the tip of the nose, indicating shortening of the nose and upturning of the nose tip.
Differences were most pronounced between groups with no exposure and groups with low exposure in the first trimester (forehead), moderate to high exposure in the first trimester (eyes, midface, chin, and parietal region), and binge-level exposure in the first trimester (chin).
CONCLUSIONS AND RELEVANCE Prenatal alcohol exposure, even at low levels, can influence craniofacial development. Although the clinical significance of these findings is yet to be determined, they support the conclusion that for women who are or may become pregnant, avoiding alcohol is the safest option.
Intrauterine Drug Exposure and the Management of Neonatal Abstinence SyndromeErikaAGoyer
Intrauterine Drug Exposure and the
Management of Neonatal Abstinence Syndrome:
The participant will be able to: Identify the impact of
poly-drug exposure and NAS in the neonate; describe
the current pharmacologic therapies used to manage
NAS in the neonate and identify short and long term
outcomes in the neonate with intrauterine drug
exposure.
Efficacy and safety of two doses of oral midazolam as premedication in paedia...iosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
EMERGENCY AGITATION IN PAEDIATRICS.pptx,with audio.an MS discussion in zagazig medical school.DEXMETIDOMEDIONE AND KETAMINE FOR EMERGENCY AGITATION IN KIDS.
Preterm neonates often develop hyperbilirubemia leading to jaundice. Parents must understand that bilirubin is a neurotoxin which may damage brain cells.
Teratogenicity and the drugs causing itTheDReamer3
brief description about the concept of teratogenicity, brief history , drugs that cause the malformations,studies & screening tests related to it, regulations, guidelines and recent updates.
By dr Rabab Hashem, MRCPCH, pediatrician at El Nasr hospital Port said.
Cranial sonography is the most widely used neuroimaging procedure in premature infants. US helps in assessing the neurologic status of the child, since clinical examination and symptoms are often nonspecific. It gives information about immediate and long term prognosis.
jaundice in neonate, by Dr Nagwa Rizk, pediatric department, Nursing college, Port said University, Port said. Presented in the NICU nursing workshop, organized by Nursing syndicate in Suez canal & Sinai in cooperation with Port said university college of nursing & Port said neonatology society, December,2014 Port said
Care of neonate, by Dr Mona Abo zid, pediatric department Nursing college, Port said University, Port said. Presented in the NICU nursing workshop, organized by Nursing syndicate in Suez canal & Sinai in cooperation with Port said university college of nursing & Port said neonatology society, December,2014 Port said
Normal newborn needs, by Dr Rehab Hany, pediatric department, Nursing college, Port said University, Port said. Presented in the NICU nursing workshop, organized by Nursing syndicate in Suez canal & Sinai in cooperation with Port said university college of nursing & Port said neonatology society, December,2014 Port said
One of lectures presented in our Port said fifth neonatology conference, 23-24 October 2014 by Prof Mohamed El Sawy, Prof in Pediatric department , faculty of medicine, Ain Shams university
One of lectures given during our Port said fifth neonatology conference, 23-24 October 2014 given by dr Dr El Sayed Khalaf MD Pediatrics,Consultant Pediatric and Neonatology
Hypoxic ischemic insult, by prof Ayman Galhom, ass prof neurosurgery, Suez ca...mohamed osama hussein
A lecture given by dr Ayman Galhom, assistant professor neurosurgery, Suez canal university, during Port said fourth neonatology conference, at 24-25 October, 2013. This lecture was a discussion of the pathophysiology & management of hypoxic ischaemic insult to an infant in PICU
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
NVBDCP.pptx Nation vector borne disease control program
Long term sequelae of nicu medications
1. Long term
sequelae of NICU
medications
By M Osama Hussein, MD
Neonatology consultant,
Port Said, EGYPT
2. One of the hardest
things for a parent is to
watch their child be
sick, and that difficulty
is only amplified when
their little patient is a
newborn who’s landed
in a neonatal intensive
care unit (NICU).
3. CNS
Recent clinical trial from
an Australian birth cohort
suggests a single
anesthesia exposure as
a neonate or infant may
increase the risk for
language and abstract
reasoning deficits later in
life. Olsen & Brambrink,
2013.
Anesthesia
Recent clinical trial from
an Australian birth cohort
suggests a single
anesthesia exposure as
a neonate or infant may
increase the risk for
language and abstract
reasoning deficits later in
life. Olsen & Brambrink,
2013.
4. CNS
The rule of sub cellular
organelles, such as
mitochondia, in the
pathophysiology of
neonatal anesthesia
exposure was recently
revealed. Forcelli, 2015.
Anesthesia
The rule of sub cellular
organelles, such as
mitochondia, in the
pathophysiology of
neonatal anesthesia
exposure was recently
revealed. Forcelli, 2015.
5. Antiepileptic
The Neurodevelopmental
Effects of Antiepileptic
Drugs were studied to
determine if differential
long-term effects exist
across four commonly
used AEDs
(carbamazepine,
lamotrigine, phenytoin,
and valproate). Cohen et
al, 2013.
The Neurodevelopmental
Effects of Antiepileptic
Drugs were studied to
determine if differential
long-term effects exist
across four commonly
used AEDs
(carbamazepine,
lamotrigine, phenytoin,
and valproate). Cohen et
al, 2013.
6. Antiepileptic
Adaptive Behavior
Assessment System-
Second Edition (ABAS-II)
was in the low average
level
Emotional/behavioral
functioning on the
Behavior Assessment
System for Children
(BASC) was also in the low
average level.
Adaptive Behavior
Assessment System-
Second Edition (ABAS-II)
was in the low average
level
Emotional/behavioral
functioning on the
Behavior Assessment
System for Children
(BASC) was also in the low
average level.
7. Antiepileptic
Valproate during
pregnancy had
significantly lower General
Adaptive Composite
scores than the
lamotrigine
and phenytoin groups.
Valproate during
pregnancy had
significantly lower General
Adaptive Composite
scores than the
lamotrigine
and phenytoin groups.
8. Antiepileptic
A significant dose-related
performance decline in
adaptive functioning was
seen for both valproate
and phenytoin.
A significant dose-related
performance decline in
adaptive functioning was
seen for both valproate
and phenytoin.
9. Antiepileptic
Children whose mothers
took valproate had
significantly more atypical
behaviors and inattention
than those in the
lamotrigine
and phenytoin groups.
Children whose mothers
took valproate had
significantly more atypical
behaviors and inattention
than those in the
lamotrigine
and phenytoin groups.
10. Antiepileptic
Based upon BASC parent
and teacher ratings of
attention span and
hyperactivity, children of
mothers who took
valproate during their
pregnancy were at a
significantly greater risk
for a diagnosis of ADHD.
Cohen et al, 2013.
Based upon BASC parent
and teacher ratings of
attention span and
hyperactivity, children of
mothers who took
valproate during their
pregnancy were at a
significantly greater risk
for a diagnosis of ADHD.
Cohen et al, 2013.
11. Sedatives & analgesics
In 348 neonatal intensive
care units, 31 % of
deceased received a
sedative or analgesic till
the day of death; opioids
were most frequently
administered, (27%).
In 348 neonatal intensive
care units, 31 % of
deceased received a
sedative or analgesic till
the day of death; opioids
were most frequently
administered, (27%).
12. Sedatives & analgesics
Increasing gestational age,
increasing postnatal age,
invasive procedure within 2
days of death, more recent
year of death, mechanical
ventilation, inotropic
support, and antibiotics on
the day of death were
associated with exposure
to sedatives or analgesics.
Increasing gestational age,
increasing postnatal age,
invasive procedure within 2
days of death, more recent
year of death, mechanical
ventilation, inotropic
support, and antibiotics on
the day of death were
associated with exposure
to sedatives or analgesics.
13. Sedatives & analgesics
Administration of opioids
and benzodiazepines
increased during the
study period that may be
driven by severity of
illness. Zimmerman et al,
J Pediatrics, 2015
Administration of opioids
and benzodiazepines
increased during the
study period that may be
driven by severity of
illness. Zimmerman et al,
J Pediatrics, 2015
14. Sedatives & analgesics
Almost half of the
neonates admitted to
intensive care units
receive sedatives or
analgesics in a study
conducted in 30 Spanish
neonatal units. Alvarez et
al, 2015
Almost half of the
neonates admitted to
intensive care units
receive sedatives or
analgesics in a study
conducted in 30 Spanish
neonatal units. Alvarez et
al, 2015
15. Sedatives & analgesics
At 5-7 years of age,
neuropsychological
outcomes,
morphometrics, adaptive
behavior, parent-rated
behavior, motivation, and
short-term memory were
measured in NICU
graduates who were given
Morphia as analgesic.
At 5-7 years of age,
neuropsychological
outcomes,
morphometrics, adaptive
behavior, parent-rated
behavior, motivation, and
short-term memory were
measured in NICU
graduates who were given
Morphia as analgesic.
16. The overall IQ and academic
achievement did not differ
between the morphine &
placebo groups, but head
circumference
of morphine treated children
was approximately 7%
smaller & body weight was
approximately 4% less
Sedatives & analgesics
The overall IQ and academic
achievement did not differ
between the morphine &
placebo groups, but head
circumference
of morphine treated children
was approximately 7%
smaller & body weight was
approximately 4% less
17. The short-term memory
task, morphine treated
children exhibited
significantly longer choice
response latencies than
placebo children.
Sedatives & analgesics
The short-term memory
task, morphine treated
children exhibited
significantly longer choice
response latencies than
placebo children.
18. Morphine treated children
had more social problems.
These results are strongly
suggestive of long-lasting
effects of
preemptive morphine analge
sia.
Ferguson et al, 2013
Sedatives & analgesics
Morphine treated children
had more social problems.
These results are strongly
suggestive of long-lasting
effects of
preemptive morphine analge
sia.
Ferguson et al, 2013
19. In very preterm children who
undergo mechanical
ventilation, morphine is
important, yet morphine may
adversely affect internalizing
behaviours at school age.
Rangers et al, 2014
Sedatives & analgesics
In very preterm children who
undergo mechanical
ventilation, morphine is
important, yet morphine may
adversely affect internalizing
behaviours at school age.
Rangers et al, 2014
20. Repeated morphine
administration during the
neonatal period followed by re-
exposure to morphine
produces considerable
anxiolytic-like behaviour.
Gholami et al, 2014
Sedatives & analgesics
Repeated morphine
administration during the
neonatal period followed by re-
exposure to morphine
produces considerable
anxiolytic-like behaviour.
Gholami et al, 2014
21. Midazolam should be
avoided in preterm
neonates, due to the
concerning incidence of
brain injury in randomized
trial.
McPherson, 2012
Sedatives & analgesics
Midazolam should be
avoided in preterm
neonates, due to the
concerning incidence of
brain injury in randomized
trial.
McPherson, 2012
22. Parenteral fentanyl might
have lasting growth and
behavioral changes when
used as an analgesic in
neonatal period. Catre et al,
2012
Sedatives & analgesics
Parenteral fentanyl might
have lasting growth and
behavioral changes when
used as an analgesic in
neonatal period. Catre et al,
2012
24. It has been shown that SMX-
TMP does not directly cause
neonatal kernicterus, yet it
does not rule out any other
toxicity that could be caused
by SMX-TMP.
Thyagarajan and Deshpand
e, 2014
Sulfamethoxazole Trimethoprim
It has been shown that SMX-
TMP does not directly cause
neonatal kernicterus, yet it
does not rule out any other
toxicity that could be caused
by SMX-TMP.
Thyagarajan and Deshpand
e, 2014
25. Caffeine is the preferred
first-line of treatment of AOP
with less adverse events
compared to theophylline.
Yet RCTs are needed to
assess the safety and
efficacy of high-dose
caffeine especially on long-
term neurodevelopmental
outcomes. Abdel Hady et al,
2015
Caffeine citrate
Caffeine is the preferred
first-line of treatment of AOP
with less adverse events
compared to theophylline.
Yet RCTs are needed to
assess the safety and
efficacy of high-dose
caffeine especially on long-
term neurodevelopmental
outcomes. Abdel Hady et al,
2015
26. HC exposure for >7 days is
associated with worse
performance in fine motor skills
in the first year of life, while
cumulative HC exposure
negatively impacts receptive
and expressive language skills
in the first year and motor skills
in the second year of life . Patra
et al, 2015
Hydrocortisone
27. Long- term
amiodarone exposure (for
SVT & junctional
reciprocating tachycardia
treatment ) was indirectly
related to
neurodevelopmental
delay. Mikovic et al, 2010
Amiodarone
28. Since the late 1980s
recombinant human
erythropoietin (r-Epo) has
been studied as an
alternative to packed red
blood cell (RBC) transfusion
for the treatment of anemia
of prematurity in very low
birth weight (VLBW, <1500
grams) infants
Eye
29. It was found that early EPO
administration improves
white matter development in
preterm infants. Gorman et
al, 2015
It was studied as one of new
therapeutic modalities for
hypoxic-ischemic
encephalopathy. Rogers et
al, 2015
Eye
30. In a Cochrane review it was
stated that a statistically
significant increased risk of
ROP (any grade) and a
similar trend for ROP
stage > 3 was found with
EPO use especially when
early administered. Aher &
Ohlsson. Cochrane Neonatal
Group, 2013
Eye
31. Eur J Pediatr. meta-analysis
indicated that
EPO treatment is not
associated with the
development of ROP in
preterm infants. Xu et al, 2014
Eye
32. A retrospective study was
published in the Eye journal
performed in the Department of
Neonatology, Townsville
Hospital, North Queensland in
688 preterm neonates, it was
stated that EPO therapy
appears to increase the risk of
development and worsening of
ROP. Kandasamy et al, 2014
Eye
33. GIT
drugs containing sodium
alginate have been linked
to bezoar formation and
to adverse events due
aluminum’s toxicity.
Sorbie et al, 1984
Tsou et al,1991.
Klish et al, 1996.
34. GIT
Na alginate treatment for
gastroesophageal reflux
disease
in preterm infants seem
to be safe and effective.
Atasay et al, 2010.
35. GIT
Ranitidine therapy is
associated with an
increased risk of
infections, NEC, and fatal
outcome in VLBW
infants. Caution is
advocated in the use of
this drug in neonatal age.
Canani, 2012.
36. AZITHROMYCIN & ERYTHROMYCIN
Ingestion of
oral azithromycin and
erythromycin places young
infants at increased risk of
developing infantile
hypertrophic pyloric stenosis
IHPS.
37. AZITHROMYCIN & ERYTHROMYCIN
This association is strongest
if the exposure occurred in
the first 2 weeks of life, but
persists although to a lesser
degree in children between 2
and 6 weeks of age
Eberly et al 2015
38. Cardiac
prokinetic agents, such
as domperidone was
used cautiously lately,
whereas cisapride has
been withdrawn due to
its remarkable cardiac
adverse effects.
Corvaglia et al, 2013.
39. Cardiac
Despite the widespread
use of β2-agonists,
their safety has been
questioned.
40. Cardiac
Several studies have
reported an increased
incidence of cardiac
arrhythmias in patients
treated with these
agents.
41. Cardiac
Other studies have found
increased rates of
cardiovascular death
associated with the use
of oral and nebulized β2-
agonists such
as salbutamol.
Corvaglia et al, 2013.
42. Cardiac
Furosemide use in the
preterm carries the risk
of precipitation of
symptomatic patent
ductus arteriosus.
Pacifici et al, 2013.
43. Cardiac
Furosemide should be
used cautiously in
preterm babies to avoid
the risk of keeping the
ductus patent.
Abdel Hady et al, 2013.
44. Cardiac
Elective administration of
furosemide to any patient
with RDS should be
carefully weighed against
the risk of precipitating a
symptomatic PDA.
Cochrane review, 2011.
45. Prostaglandin E1 Alprostadil
Aneurysmal dilatations of
ductus & pulmonary
arteries.
Cerebral bleeding
Gastric outlet obstruction
secondary to antral
hyperplasia, yet it’s
mostly transient. Soyer et
al, 2014
Aneurysmal dilatations of
ductus & pulmonary
arteries.
Cerebral bleeding
Gastric outlet obstruction
secondary to antral
hyperplasia, yet it’s
mostly transient. Soyer et
al, 2014
46. Endocrinal system
Especially in
girls, neonatal
dexamethasone has a
programming effect on the
hypothalamus-pituitary-
adrenal-axis and on the
ability to adjust to the
environment. Wolbeek et
al, 2015
Especially in
girls, neonatal
dexamethasone has a
programming effect on the
hypothalamus-pituitary-
adrenal-axis and on the
ability to adjust to the
environment. Wolbeek et
al, 2015
47. Renal sequelae of neonatal
medications
Acute kidney injury is associated with high mortality in
preterm neonates. It is very important to identify, as quickly
as possible, all infants who are at high risk of developing
AKI. Stojanović et al, 2014
50. Aminoglycosides
Amikacin have an ototoxic effect that’s dose-dependent.
Preterm infants are especially susceptible. Engler et al, 2013
Amikacin have an ototoxic effect that’s dose-dependent.
Preterm infants are especially susceptible. Engler et al, 2013
51. Aminoglycosides
Other risk factors: prolonged therapy, malnutrition,
volume depletion, liver disease, preexisting renal
disease, K and Mg depletion. Girardi et al, 2015
52. Aminoglycosides
Other risk factors: concomitant exposure to other
nephrotoxic drugs such as amphotericin B, ciclosporin,
vancomicin and NSAIDs. Girardi et al, 2015
54. Glycopeptides
Teicoplanin was reported to cause nephrotoxicity yet
when dose is closely monitored it can be used safely in
neonates. Yamada et al, 2014
Teicoplanin was reported to cause nephrotoxicity yet
when dose is closely monitored it can be used safely in
neonates. Yamada et al, 2014
55. Beta-Lactams Cephalosporins
Cephaloridine and cephaloglycine are the only
cephalosporins capable of causing kidney damage
(involving the mitochondria) at therapeutic doses.
Roberts et al, 2014
Cephaloridine and cephaloglycine are the only
cephalosporins capable of causing kidney damage
(involving the mitochondria) at therapeutic doses.
Roberts et al, 2014
56. Beta-Lactams Cephalosporins
For all the other cephalosporins the renal damage can
occur only at extremely high doses, much greater than
the routine therapeutic doses. Roberts et al, 2014
For all the other cephalosporins the renal damage can
occur only at extremely high doses, much greater than
the routine therapeutic doses. Roberts et al, 2014
57. Antibiotic NICU use recommendations
Considerable inter-centre variability of dosage
regimens of antibiotics exists in NICUs.
58. Antibiotic NICU use recommendations
Developmental pharmacokinetic–pharmacodynamic
studies are essential to establish evidence-based
dosage regimens for effective and safe administration
in neonates. Leroux et al, 2014
Developmental pharmacokinetic–pharmacodynamic
studies are essential to establish evidence-based
dosage regimens for effective and safe administration
in neonates. Leroux et al, 2014
59. Antifungals Amphotericin B
A nephrotoxic antifungal that’s widely replaced by the
less toxic other antifungals. Rhone et al, 2013
60. Antifungals Amphotericin B
The azoles (itraconazole, fluconazole, voriconazole),
the fluorinated pyrimidines (flucytosine), the
echinocandins (caspofungin, micafungin, anidulafungin
are much better tolerated Rhone et al, 2013
The azoles (itraconazole, fluconazole, voriconazole),
the fluorinated pyrimidines (flucytosine), the
echinocandins (caspofungin, micafungin, anidulafungin
are much better tolerated Rhone et al, 2013
61. Nonsteroidal Antiiflammatory Drugs
(NSAIDS)
The nephrotoxic effects of NSAIDs are related to their
mechanism of action: block of prostaglandin synthesis
with the inhibition of cyclooxygenase (COX) enzymes.
Xavier et al, 2010
64. Nonsteroidal Antiiflammatory Drugs
(NSAIDS)
Indomethacin is associated with more severe renal
adverse effects than ibuprofen. Immaturity increases
the frequency of adverse effects of indomethacin.
Pacifici, 2013
Indomethacin is associated with more severe renal
adverse effects than ibuprofen. Immaturity increases
the frequency of adverse effects of indomethacin.
Pacifici, 2013
65. Furosemide
Infants with low birthweight treated with chronic
furosemide are at risk for the development of intra-
renal calcifications. Pacifici, 2013
Infants with low birthweight treated with chronic
furosemide are at risk for the development of intra-
renal calcifications. Pacifici, 2013
66. Antifungal (Fluconazole)
Fluconazole have to be
used cautiously since it
may affect renal function
& raise transaminases.
Its rule as a prophylaxis
in premies was criticized.
Benjamine, 2014
Fluconazole have to be
used cautiously since it
may affect renal function
& raise transaminases.
Its rule as a prophylaxis
in premies was criticized.
Benjamine, 2014
67. Antifungal (Fluconazole)
Few cases were
presented with Toxic
epidermal necrolysis due
to fluconazole use in
NICU. Islam et al, 2014
Few cases were
presented with Toxic
epidermal necrolysis due
to fluconazole use in
NICU. Islam et al, 2014
68. Antiviral (Acyclovir)
Renal dysfunction with
increasing urea and
creatinine – risk increased
by dehydration, bolus
injection or other
nephrotoxic drugs.
Zappitelli et al, 2012
69. Vitamin D toxiciy
Vitamin D intoxication with
severe hypercalcemia is
rare in the neonatal and
infancy period & is related
mostly to overdosage but a
mechanisms of
hypersensitivity was also
reported. Hmami et al, 2014
Vitamin D intoxication with
severe hypercalcemia is
rare in the neonatal and
infancy period & is related
mostly to overdosage but a
mechanisms of
hypersensitivity was also
reported. Hmami et al, 2014
70. Angiotensin converting enzyme (ACE)
inhibitors
1 % of NICU patients were
found to suffer hypertension
and those are usually treated with
vasodilators (64.2%),
ACE inhibitors (50.8%),
calcium channel blockers
(24%), and alpha- and
beta-blockers (18.4%).
Blowey et al, 2011
1 % of NICU patients were
found to suffer hypertension
and those are usually treated with
vasodilators (64.2%),
ACE inhibitors (50.8%),
calcium channel blockers
(24%), and alpha- and
beta-blockers (18.4%).
Blowey et al, 2011
71. Angiotensin converting enzyme (ACE)
inhibitors
Renal impairment was
documented with Captopril
use in neonates and was
not dose related but
reversible.
Gantenbein et al, 2008
Renal impairment was
documented with Captopril
use in neonates and was
not dose related but
reversible.
Gantenbein et al, 2008
72. Angiotensin converting enzyme (ACE)
inhibitors
Neonates treated with
enalapril for either
hypertension or for a
cardiac disorder were
found to suffer a potential
renal impairment .
Russo et al, 2013
Neonates treated with
enalapril for either
hypertension or for a
cardiac disorder were
found to suffer a potential
renal impairment .
Russo et al, 2013
73. Angiotensin converting enzyme (ACE)
inhibitors
The premature neonates are
more likely to experience
ACEi-related renal failure than
their term counterparts .
Lindle et al, 2014
The premature neonates are
more likely to experience
ACEi-related renal failure than
their term counterparts .
Lindle et al, 2014