Objective:
There are minimal data available on nutrition after early repair of cleft lip and the factors influencing initiation of breastfeeding. This study assessed the impact of the length of ...surgery, length of ventilation support, and duration of hospital stay on breastfeeding rates after early cleft lip surgery.
Design:
This is a prospective observational cohort study comparing 2 hospitals providing early surgical repair of facial clefts from January 2014 to December 2016. Both hospitals are designated as Baby-Friendly Hospitals. Demographic and anthropometric data from mothers and newborns were recorded.
Setting:
Tertiary neonatal and pediatric surgery center.
Patients:
Hospital A: 61 newborns, Hospital B: 157 newborns.
Interventions:
Early (day 5 to 14) cheiloplasty in newborns with cleft lip or cleft lip and palate.
Main Outcome Measures:
Influence of duration of hospital stay, length of operation, and artificial ventilation on the rate of breastfeeding.
Results:
Significantly, more newborns were breastfed following early surgical repair of an isolated cleft lip compared to those with both cleft lip and palate, in both hospitals (hospital A 82% vs 0%, P = .0001, hospital B 66% vs 5%, P = .0001). Duration of hospital stay, length of operation, and duration of artificial ventilation did not significantly affect the rate of breastfeeding.
Conclusions:
The factors associated with early cleft lip repair (length of operation, length of ventilation support, and duration of hospital stay) do not affect breastfeeding rate.
The faunistic knowledge of the Diptera of Morocco recorded from 1787 to 2021 is summarized and updated in this first catalogue of Moroccan Diptera species. A total of 3057 species, classified into ...948 genera and 93 families (21 Nematocera and 72 Brachycera), are listed. Taxa (superfamily, family, genus and species) have been updated according to current interpretations, based on reviews in the literature, the expertise of authors and contributors, and recently conducted fieldwork. Data to compile this catalogue were primarily gathered from the literature. In total, 1225 references were consulted and some information was also obtained from online databases. Each family was reviewed and the checklist updated by the respective taxon expert(s), including the number of species that can be expected for that family in Morocco. For each valid species, synonyms known to have been used for published records from Morocco are listed under the currently accepted name. Where available, distribution within Morocco is also included. One new combination is proposed:
Assuania melanoleuca
(Séguy, 1941),
comb. nov.
(Chloropidae).
Abstract Objective In the children born with a cleft lip, surgery is the first step in correcting the inborn anomaly. In comparison with usually made 3-month surgery, benefits of the surgery in ...neonates have been reported: a very good wound healing, feeding facilitation, and good socialization of a child from neonatal age. The aims of the present study were to perform cheiloplasty in early newborns affected by the total cleft lip and palate (CLP) by the technique modified to search for optimum aesthetic result, and to assess the surgery outcome from qualitative and quantitative aspects. Methods The operations were performed by the same surgeon in 97 neonates 1–8 days old during 2005–2008. The original technique by Tennison was modified and used. Aesthetic outcome of the surgery was evaluated according to scar visibility, and the shape and symmetry of the lip and nose. The effect of cheiloplasty on the formation of the upper jaw segments was evaluated in a sample of unilateral CLP patients using the 3D-finite element scaling analysis (FESA). We compared 3D models of dental plaster casts made prior to lip surgery (in neonates under 8 days of age) and prior to palate surgery (at 12 months of age). Results Only the children in excellent health state and without an associated inborn defect were allowed to pass the operation. There were no per-operative complications (except the correction of tracheal tube position in several cases). The parents appreciated bringing home a neonate with no visible cleft. This aspect not only facilitated baby feeding, but had important positive psycho-social impact on the whole family. The wound healing and aesthetic effect of the cheiloplasty were very good. The scar was barely visible and lip and nose were symmetric in majority of children. After lip closure, the growth and approximation of jaw segments was observed. This aspect was also associated with incisors development in the anterior portion of the segment including premaxilla. Conclusions Our results show, that early neonatal lip surgery of CLP is promising technique with very good aesthetic results and important positive psychological impact on the child and its family.
Objective
To assess modelled facial development of infants with unilateral cleft lip (CL) and cleft lip and palate (UCLP) compared to controls up to two years of age.
Design and Participants
A total ...of 209 facial images of children (CL: n = 37; UCLP: n = 39; controls: n = 137) were obtained in four age categories (T0 = 0.2–0.5; T1 = 0.6–1.0; T2 = 1.1–1.5; T3 = 1.6–2.0 years) and were evaluated using stereophotogrammetry and geometric morphometry. All patients underwent lip surgery before T0, patients with UCLP underwent palatoplasty (T0, T1 before palatoplasty; T2, T3 after palatoplasty).
Results
In patients with CL, the forehead was significantly retracted (p ≤ 0.001), while the supraorbital and ocular regions were prominent (p ≤ 0.001). The oronasal region appeared convex (p ≤ 0.001). The lower lip and chin were non-significantly protruded. In patients with UCLP, a significantly retracted forehead and prominent supraorbital region were apparent (p ≤ 0.001). A retrusive oronasal region (p ≤ 0.001) was observed in the middle face. The chin was anteriorly protruded (p ≤ 0.01). No progression of deviations was found with increasing age. After the first year, a slight improvement in the morphological features became apparent. The shape variability of the clefts and controls overlapped, suggesting a comparable modelled facial development.
Conclusions
The facial morphology of individuals with cleft was comparable to the norm. Shape deviation was apparent in the oronasal region, forehead, and chin, which minimised with increasing age even in complete clefts.
Because of a notable increase in age at delivery, the incidence of malignancy diagnosed during pregnancy has substantially increased. This review aims to summarize the literature and expert knowledge ...on gynecologic cancers diagnosed in pregnancy regarding epidemiology, examination and staging procedures, description of treatment modalities and management of gynecological malignancies with special interest in cervical and ovarian cancer. Thorough attention is paid to the surgery and chemotherapy administration for early-stage cervical cancer diagnosed during pregnancy.
Objective: To assess the plausibility of using the continuous glucose monitoring as a sole source of data for the screening of the neonatal hypoglycemia.
Study design: Infants of mothers with ...diabetes were screened for neonatal hypoglycemia (less than 2.5 mmol/l after 4 h of life). Initial measurement was performed using point of care analyzer. We applied continuous glucose monitoring system subsequently. Infants were monitored up to 5 days or until discharge.
Results: Out of 32 infants 11 had postnatal hypoglycemia resolved within 12 h of life. Two infants had hypoglycemia found due to continuous glucose monitoring after 24 h of life when sufficient feeding was established and they did not show any signs of hypoglycemia. We did not have any false negative measurements. No infant showed clinical signs of neonatal hypoglycemia.
Conclusions: Continuous glucose monitoring is plausible and safe to use for screening of neonatal hypoglycemia. It operates well within the range that is accepted as safe for neurodevelopment. In addition, it can be used after first day of life where regular screening ends. Limitation of this method is possible alarm negligence of caregivers.
Chronic pancreatitis is a common inflammatory disease of the pancreas. Mutations in the genes encoding cationic trypsinogen (PRSS1) and the pancreatic secretory trypsin inhibitor (SPINK1) are ...associated with chronic pancreatitis. Because increased proteolytic activity owing to mutated PRSS1 enhances the risk for chronic pancreatitis, mutations in the gene encoding anionic trypsinogen (PRSS2) may also predispose to disease. Here we analyzed PRSS2 in individuals with chronic pancreatitis and controls and found, to our surprise, that a variant of codon 191 (G191R) is overrepresented in control subjects: G191R was present in 220/6,459 (3.4%) controls but in only 32/2,466 (1.3%) affected individuals (odds ratio 0.37; P = 1.1 × 10−8). Upon activation by enterokinase or trypsin, purified recombinant G191R protein showed a complete loss of trypsin activity owing to the introduction of a new tryptic cleavage site that renders the enzyme hypersensitive to autocatalytic proteolysis. In conclusion, the G191R variant of PRSS2 mitigates intrapancreatic trypsin activity and thereby protects against chronic pancreatitis.
Background:Screening of neonatal hypoglycemia uses currently intermittent blood sampling. Continuous glucose monitoring (CGM) allows for tighter glucose control and better comfort for newborns and ...parents. CGM has previously been used in intensive care setting or blinded to clinicians. Our pilot study uses CGM in real time in rooming-in setting. Methods: CGM was attached within first two hours of life. Low glucose readings were verified to prevent overtreatment. Pairs of sensor readings and corresponding blood glucose measurements were assessed retrospectively. Neurodevelopmental evaluation was performed at 24 months. Results: 44 infants were enrolled. Three had verified hypoglycemia found due to CGM. No patient was below 2 standard deviations in any components of Bayley scales. Median scores were: Cognitive 100, language 86, motor 94. Conclusion: Use of CGM in a rooming-in environment is safe from clinical and neurodevelopmental point of view. Randomized trials are needed to evaluate superiority in longer term outcomes.
Objectives
To compare palatal growth changes in infants with complete unilateral (UCLP) or bilateral (BCLP) cleft lip and palate during the first year of life.
Materials and methods
Upper dental ...arches of 68 neonates with UCLP and BCLP were evaluated using 2D and 3D morphometry based on dental casts obtained in two age categories (T0 before early neonatal cheiloplasty—UCLP 4 ± 3 days, BCLP 6 ± 5 days; T1 before palatoplasty—UCLP 10 ± 2 months, BCLP 12 ± 3 months).
Results
Intensive palatal growth was manifested in both directions of the palate. Palatal growth in the anterior direction was not restricted, despite the intercanine (CC´) and anterior (LL´) widths being significantly narrowed in the BCLP group (CC´
p
= 0.019, LL´
p
= 0.009). The posterior dental arches were significantly enlarged (UCLP
p
≤ 0.001; BCLP
p
≤ 0.001). The negative effect of cleft severity on palatal length was not confirmed (
p
= 0.802). Variability of the palate was immense mainly in BCLP infants (T0); however, it decreased in both cleft types, confirming the formative effect of palatal growth leading to alveolar cleft closure (UCLP
p
≤ 0.001; BCLP
p
= 0.006 on the right, 0.005 on the left).
Conclusions
Both analyzed cleft groups (UCLP, BCLP) grew favorably during the first year of life, and the palatal growth was not limited in any direction
.
Clinical relevance
Geometric morphometry allowed a comprehensive analysis of the palate, which can contribute to the improvement of surgical methods.
Abstract
Objective: The newborns of diabetic mothers suffer from perinatal complications more frequently than the newborns of healthy women.
Methods: We used for 7 days a real time continuous glucose ...monitoring system (RT-CGMS) to monitor glucose homeostasis and manage glucose administration in a premature newborn of a diabetic mother.
Results: The boy was born at 35 + 5 gestational weeks with typical signs of diabetic fetopathy. RT-CGMS revealed 2 late hypoglycaemia episodes on the 2nd and 4th days. The sensor readings correlated well with glycaemia measured in the laboratory (r = 0.908, p = 0.005). To support conclusions of this case report, we attached the data of five other preterm newborns of diabetic mothers who were later successfully treated according to the RT-CGMS data as well.
Conclusions: This approach allows timely response to glycaemia instability and is applicable even in preterm infants.
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