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Background & Objective: Self-extubation is reported as one of the most common adverse events in the adult intensive care units worldwide. We aimed to find out the incidence and determinants of self-extubation in surgical intensive care unit of our tertiary care hospital. Methodology: It was retrospective analysis of the data acquired from the hospital databases, about the patients who self-extubated during admission to surgical intensive care unit (SICU) of Aga Khan University Hospital, Karachi, Pakistan, during six calendar years, from January 01, 2010, through December 31, 2016. Data collection form was used to collect personal details, drugs used for sedation, sedation agitation score, pain score, nurse-patient ratio and the use of any restraint at the time of extubation. SPSS was used to analyze data applying the central limit theorem to calculate the mean and standard deviation for quantitative variables and the Chi-square test was conducted using a P < 0.05 for qualitative variables. Multivariate logistic regression analysis was performed to identify the independent risk factors for self-extubation Results: A total of 618 patients were admitted to the SICU who required mechanical ventilation during the study period. An overall 2.1% incidence of self-extubation was calculated with a documented thirteen self-extubation episodes. The mean age of patients was 38.46 ± 16.97 y with majority of them being males. Most, 9 (69.2%), of the patients were not restrained at the time of self-extubation. Nurse to patient ratio was 1:1. Majority of patients 7 (53.8%) were not on any sedative drug infusion and the mean sedation agitation score at that time was 4.46 ± 2.02 while mean pain score was 5.31 ± 2.72. Reintubation was performed in 10 (76.9%) of the patients, who had selfextubated. Conclusion: This study revealed that the incidence of self-extubation was 2.1% in SICU and there was strong correlation between absent physical restraint and self-extubation incidence during the weaning period. [ABSTRACT FROM AUTHOR]

Objective: To find out fetal and maternal factors linked with thrombocytopenia (TCP) among neonates admitted in neonatal intensive care unit (NICU) of a tertiary care hospital of South Punjab, Pakistan. Study Design: Cross-sectional study. Setting: The NICU of Sadiq Abbasi Hospital, Bahawalpur. Period: May 2022 to August 2022. Material & Methods: A total of 146 neonates of both genders admitted to NICU having TCP were analyzed. Neonatal TCP was categorized as mild (>100,000/ul to < 150,000/ul), moderate (>50,000/ul to 100,000/ul) and severe (<50,000/ul). Associations of baseline characteristics, fetal factors and maternal factors with categories of TCP were checked applying chi-square test considering p-value ≤0.05 as significant. Results: In a total of 147 neonates with TCP, 84 (57.5%) were male. Mean age was calculated to be 3.9±3.6 days while 109 (74.7%) neonates were aged between 1 to 3 days. Distribution of TCP categories showed that 78 (53.4%) neonates were having mild TCP, 43 (29.5%) moderate TCP whereas remaining 25 (17.1%) neonates were having severe TCP. Stratification of TCP with respect study variables showed that maternal anemia (p=0.0467), pre-term birth (0.0001) and sepsis (p<0.0001) among neonates were significantly linked with severity of TCP. Conclusion: Most neonates admitted to NICU were having mild to moderate degree of thrombocytopenia. Severe degree of thrombocytopenia was found among neonates with history of maternal anemia, pre-term birth and sepsis. [ABSTRACT FROM AUTHOR]

Objective: To find out fetal and maternal factors linked with thrombocytopenia (TCP) among neonates admitted in neonatal intensive care unit (NICU) of a tertiary care hospital of South Punjab, Pakistan. Study Design: Cross-sectional study. Setting: The NICU of Sadiq Abbasi Hospital, Bahawalpur. Period: May 2022 to August 2022. Material & Methods: A total of 146 neonates of both genders admitted to NICU having TCP were analyzed. Neonatal TCP was categorized as mild (>100,000/ul to < 150,000/ul), moderate (>50,000/ul to 100,000/ul) and severe (<50,000/ul). Associations of baseline characteristics, fetal factors and maternal factors with categories of TCP were checked applying chi-square test considering p-value =0.05 as significant. Results: In a total of 147 neonates with TCP, 84 (57.5%) were male. Mean age was calculated to be 3.9±3.6 days while 109 (74.7%) neonates were aged between 1 to 3 days. Distribution of TCP categories showed that 78 (53.4%) neonates were having mild TCP, 43 (29.5%) moderate TCP whereas remaining 25 (17.1%) neonates were having severe TCP. Stratification of TCP with respect study variables showed that maternal anemia (p=0.0467), pre-term birth (0.0001) and sepsis (p<0.0001) among neonates were significantly linked with severity of TCP. Conclusion: Most neonates admitted to NICU were having mild to moderate degree of thrombocytopenia. Severe degree of thrombocytopenia was found among neonates with history of maternal anemia, pre-term birth and sepsis. [ABSTRACT FROM AUTHOR]

Objectives: Neonatal sepsis is a known and significant contributor to newborn morbidity and mortality. We conducted this study to find out the efficiency of hematological scoring system (HSS) in predicting neonatal sepsis. Study Design: Prospective study. Setting: Neonatology Unit of Civil Hospital, Bahawalpur. Period: 1st July 2018 to 31st December 2018. Materials & Methods: A total of 100 neonates having high probability of sepsis were admitted and evaluated in NICU, Institution's pathological lab was the center for all the workups. Sensitivity, specificity, positive predictive values (PPVs) along with negative predictive values (NPVs) were calculated for different study parameters. P value < 0.05 was considered as significant. Results: Amongst a total of 100 neonates, 62 (62.0%) were males and 38 (38.0%) females. There were 32 (32.0%) preterm while 68 (68.0%) term neonates. Culture positive cases were found to be 33 (33.0%) whereas CRP was noted reactive in 62 (62.0%) cases. Neonatal age as preterm, culture positive neonates (p < 0.001) as well as CRP as reactive were found to be significantly associated with HSS > 5. Immature to total neutrophil ratio (I:T) as well as Immature to mature neutrophil ratio (I:M) had the highest sensitivity and specificity. Conclusion: HSS is a simple to use and efficient method that can be used to early diagnose and treat cases of neonatal sepsis. HSS has a high sensitivity as well specificity as high scores of HSS highlight sepsis. [ABSTRACT FROM AUTHOR]

Objective: To determine association of in-hospital outcome of AKI with etiology in newborns at a tertiary care hospital. Methods: This descriptive cross-sectional study was conducted at Department of Pediatric Neonatology, The Children's Hospital and Institute of the Child Health, Multan by using non-probability purposive sampling technique from June 2016 to June 2017. A total of 101 newborns diagnosed with acute kidney injury were registered. Etiological factors were assessed and these patients were followed till discharge to monitor in-hospital outcomes. Results: Of these 101 newborns, 75 (74.3%) were boys while 26 (25.7%) were girls. Mean age of these newborns was 7.59 ± 6.13 days (range; 1 day to 28 days). Mean age of the boys was 5.73 ± 7.20 days while that of girls was 6.77 ± 6.16 days. (p=0.515). Mean weight of these neonates was 2545.05 ± 600.42 grams (range; 1000 grams to 4000 grams). Mean serum potassium level was 4.94 ± 0.92 mgEq/L ranging from 3.1 mgEq/L to 7.0 mgEq/L. Mean urea level was 73.35 ± 27.65 mg/dl ranging from 18 mg/dl to 206 mg/ dl. Mean serum creatinine level was 1.98 ± 0.27 mg/dl, ranging from 1.6 mg/dl to 2.8 mg/dl. Mean serum sodium level was 145.72 ± 12.64 mgEq/L ranging from 126 to 166 mEq/L. Eighty one (80.2%) were term babies while 20 (19.8%) were pre-term babies. Of these 101 study cases, 29 (28.7%) delivered vaginally while 72 (71.3%) through cesarean section. Delayed crying was noted in 48 (47.5%), dehydration 13 (12.9%), sepsis in 36 (35.6%) and renal malformation in only 4%. Neonatal mortality in these patients was 15 (14.9%) while 86 (85.1%) were discharged from hospital after recovery. Conclusion: Acute kidney disease in newborns is associated with significant disease morbidity and mortality with asphyxia and sepsis are the main etiological factors responsible. It is predominantly more common in boys compared with girls. Mortality rate was high in our study and it was significantly associated with female gender. Mortality was also associated with elevated serum sodium and urea level. [ABSTRACT FROM AUTHOR]