&0183 &32 Nama eBook: Keutamaan Adab dan Sejarah Penulisannya Penulis: Syaikh ‘Abdul ‘Aziz bin Fathi as-Sayyid Nada Pengantar: Alhamdulillah, shalawat dan salam semoga senantiasa dilimpahkan kepada Nabi Muhammad , keluarga dan sahabatnya dan 2021. Chock 4, Alexandre Netto 2,3, Rafaela Fabri Rodrigues Pietrobom 2,3,5 and Krisa Page Van Meurs 42018. &0183 &32 Nicu Protocols Pgi Chandigarh November 7th, 2020 - AIIMS WHO NEONATAL PROTOCOLS 2014 PGI BLUE BOOK PATTERN AIIMS PG ENTRANCE AND PGI CHANDIGARH BY OUR SINCERE EFFORT nicu policy procedure hungrysharkworldhack co March 18th 2018 nicu orientation checklist pgi 22 36 chandigarh nicu protocol rnc nicu classes 2013 stable studyGabriel Fernando Todeschi Variane 1,2,3 *, Valerie Y.1Grupo Santa Joana, Division of Neonatology, São Paulo, BrazilABOUT TULANE-LAKESIDE (click photo for directions) Tulane-Lakeside is a busy place these days. Neonatal intensive care unit in chandigarh Ccf in neonates dr rajesh kumar md pgi dm neonatology. Bedi hospital best mother and child hospital chandigarh. Training mannual and training programme dr rajendra.Near infrared spectroscopy (NIRS) is useful in critically ill neonates as a trend monitor to evaluate the balance between tissue oxygen delivery and consumption, providing cerebral and somatic oximetry values, and allowing earlier identification of abnormalities in hemodynamics and cerebral perfusion. 5Neonatal Unit, Sociedade Beneficente Israelita Brasileira Hospital Albert Einstein, São Paulo, BrazilContinuous brain monitoring tools are increasingly being used in the neonatal intensive care unit (NICU) to assess brain function and cerebral oxygenation in neonates at high risk for brain injury. 4Division of Neonatal and Developmental Medicine, Stanford University School of Medicine and Packard Children's Hospital Stanford, Palo Alto, CA, United States 3Protecting Brains and Saving Futures Organization, São Paulo, Brazil 2Division of Neonatology, Department of Pediatrics, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
These four clinical scenarios demonstrate how simultaneous neuromonitoring with aEEG and NIRS provides important clinical information. We review the use of NIRS and aEEG in neonates and describe four cases where abnormal NIRS values were immediately followed by changes in brain activity as seen on aEEG allowing the impact of a hemodynamic disturbance on the brain to be correlated with the changes in the aEEG background pattern. Several studies have described correlations between aEEG and NIRS monitoring, especially in infants with hypoxic-ischemic encephalopathy (HIE), but few describe the combined use of both monitoring techniques in a wider range of clinical scenarios. Simultaneous use of both monitoring modalities may improve the understanding of alterations in hemodynamics and risk of cerebral injury. However, as aEEG records from a limited number of channels (usually central or parietal), seizures arising from other areas of the brain may not be detected. While EEG remains the gold standard for seizure detection, seizures can reliably be diagnosed by an experienced reader by review of both the compressed aEEG trace and raw EEG signal. AEEG displays both a limited-channel EEG recording and a compressed aEEG tracing that allows evaluation of cerebral background activity pattern over time and facilitates screening for seizures. Renal regional oxygen saturation (rSrO 2) values measured by placement of sensor on the posterior flank below the costal margin and above the iliac crest are usually 10–15% higher than cerebral saturations and are sensitive to compromise of systemic blood flow ( 8).Amplitude-integrated electroencephalography (aEEG) is a method for continuous monitoring of cerebral function at the bedside ( 9, 10). Cerebral fractional tissue oxygen extraction (cFTOE) is another useful measure of brain metabolism that reflects the balance between oxygen supply and oxygen consumption and can be calculated by the equation cFTOE = (SpO2 – rScO 2) / (SpO 2) ( 6, 7). A large multicenter study of preterm infants established cerebral saturation measures between 55 and 85% to be within 2 standard deviations of a median value of 71% ( 5). Several studies have described correlations between aEEG and NIRS monitoring, especially in infants with HIE, but few describe its utility in other clinical scenarios ( 11, 12). Simultaneous use of both NIRS and aEEG may allow better understanding of alterations in hemodynamics and risk of cerebral injury. The use of two channel EEG has improved seizure detection accuracy, and persistent pathological background activity has been associated with poor neurodevelopmental outcome in infants with hypoxic-ischemic encephalopathy (HIE) and in the preterm population ( 9, 10). Newer aEEG devices have seizure detection software, which may facilitate seizure detection ( 2, 9). The infant had severe encephalopathy (Sarnat stage III) on neurological exam performed at 2 h of life and therapeutic hypothermia was initiated. Laboratory values were significant for metabolic acidosis with serum pH of 6.9 and base deficit of −21. Case Presentation Case 1—Hypoxic Ischemic Encephalopathy (HIE)Term infant born via crash cesarean section due to cord prolapse. We then provide a narrative review of existing literature on simultaneous aEEG and NIRS monitoring in the neonate. Citra emulator on macReduced consumption of oxygen by injured cerebral tissue leads to a pattern of elevated rScO 2. This increased cerebral saturation may be explained as a result of secondary energy failure shortly after the primary injury. Initial rScO 2 was 75% however, at ~24 h of life, there was an abrupt and sustained increase of rScO 2 to 95%. AEEG monitoring began at 3 h of life and the background activity was continuous low voltage. During the 2nd day of life aEEG background pattern was discontinuous normal voltage with immature sleep wake cycles (SWC) and rScO2~65% ( Figure 3A). Somatic desaturation is often an early indicator of shock and ensuing cerebral desaturation and alterations in cerebral activity may persist until hemodynamic stability is restored.A 27-week gestation infant with birth weight 945 g was diagnosed with RDS and was clinically stable on continuous positive airway pressure (CPAP) after birth. After a fluid bolus and initiation of inotropes, the rScO 2 and rSrO 2 increased and was followed by a recovery in aEEG background activity to discontinuous normal voltage ( Figure 2). The decrease in renal saturation preceded cerebral desaturation by 40 min. Two site NIRS was used and a ~30% reduction in rSrO 2 was noted while the mean arterial blood pressure remained in the normal range for gestational age. The normal patterns for term and preterm infants have also been studied ( 16). Simultaneous monitoring of aEEG with loss of immature SWC suggests that PDA-related changes in oxygenation also impact cerebral function.Discussion Assessing Brain Oxygenation and Brain Function Using Simultaneous NIRS and aEEG NomenclatureThe use of aEEG for brain monitoring has been well-established in the context of HIE and cooling. An hsPDA is associated with increased pulmonary blood flow and decreased systemic blood flow causing low cerebral and renal saturations due to ductal steal. PDA closure on echocardiogram was confirmed. On the 5th day of life, rScO 2 increased to the normal range and this change was associated with return of immature SWC ( Figure 3C). Echocardiogram was performed and diagnosed a hemodynamically significant patent ductus arteriosus (hsPDA). Tekken 7 ppsspp gold iso downloadAs NIRS and aEEG have separately been investigated in previous clinical trials such as these, the two technologies are routinely used in NICUs worldwide however, the combined use of these brain monitoring techniques has had limited investigation. Results from this study successfully demonstrated the use of cerebral oxygenation monitoring to reduce the hypoxic and/or hyperoxic burden on the preterm brain ( 17).
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