Pseudonormo- and Pseudohypernatraemia in sick neonates

Preventing pseudohyponatremia: Intralipid®-based lipemia cutoffs for sodium are inappropriate

BackgroundThe choice of dialysate sodium (DNa) for haemodialysis (HD) patients remains controversial, with some studies reporting that a lower DNa improves blood pressure control and reduces intradialytic weight gain. Studies on DNa depend on the alignment of programmed to delivered DNa. We wished to determine whether there were differences between programmed and delivered DNa.MethodsDialysate samples were obtained from three dialysis machines: Fresenius 4008H (F4008H) and 5008S (F5008S) and B-Braun hemodiafiltration (HDF) Dialog+(BB). DNa was measured by indirect ion-selective electrode (ISE), flame photometry (FP) and ion chromatography (IC) at different DNa concentrations.ResultsWe tested 18 F5008S, 18 F4008H and 31 BB machines over 153 HD treatments. The median measured minus programmed DNa was significantly greater with the BB machine [ISE, 7 (6–8); FP, 7 (6–8); IC, 6 (5–7)], followed by the F4008H [ISE, 5.5 (5–7); FP, 4 (2.25–5.75); IC, 4 (2–5)]and F5008S [ISE, 4 (2–5); FP, 1 (−1–1.75); IC, 1 (−0.5 to 2)] mEq/L (P < 0.05). At higher programmed DNa (140–145 mEq/L), measured DNa was greater for the BB and F4008 machines by all methods (P < 0.05), but only by ISE for the F5008 (P < 0.05).ConclusionsWe noted a systematic bias in DNa delivery with measured DNa being greater than that programmed by our HD machines. The magnitude of the bias varied between machines and with DNa. Our results may help explain the diverse results reported in studies of DNa.

ABSTRACTThe major extracellular electrolytes, sodium, and potassium are often requested together and form a large percentage of the requested tests in routine clinical chemistry laboratories. Two types of devices that use direct and indirect ion-selective electrode (ISE) methods are used in hospitals for electrolyte measurements: blood gas analyzers (BGA), which use direct ISE technology, and the indirect ISE method, which is often used in a central-laboratory autoanalyzer (AA).We aimed to summarize the current scientific knowledge based on whether the electrolyte test results, using Na and K test results obtained with BGA and an AA, can be used interchangeably.We searched Medline (PubMed), Google Scholar, and Web of Science up to 31st March 2018. In addition, references of the included studies were also examined.Fourteen studies with a risk of bias were included in the analysis. Limits of agreement differences were variable among BGA and AA sodium and potassium test results in clinical practice.The results of both BGA and AA measures should not be used interchangeably under the assumption that they are equivalent to each other.How to cite this articleUstundağ Y, Huysal K, Ozgunay ŞE, Turkoğlu AR. Interchangeability of Sodium and Potassium Result Values of Arterial Blood Gas with Laboratory Analyzer: Narrative Review. Indian Journal of Critical Care Medicine, January 2019;23(1):35-42.

Introduction: Serum electrolyte measurement, particularly sodium, potassium, and chloride, is among the most commonly ordered investigations in routine and emergency care. Rapid and accurate reporting is essential for timely clinical decisions. Most modern electrolyte analysers utilise Ion-selective Electrode (ISE) technology, available in two forms: direct ISE (dISE), which measures electrolytes in undiluted serum, and indirect ISE (iISE), which measures them after pre-dilution. These methodological differences may influence reported values. Aim: To compare the serum sodium, potassium, and chloride levels measured using dISE versus iISE methods. Materials and Methods: The cross-sectional study was conducted in the Clinical Biochemistry Laboratory, Government Medical College and Hospital, Chandigarh, India, from March 2024 to and June 2024. A total of 150 serum samples were obtained from the outpatients, inpatients, and Intensive Care Unit (ICU) patients. Paired serum samples available for simultaneous direct and iISE estimation were included. Deidentified residual samples were analysed and assigned a unique code. dISE was performed using the ABL800 FLEX (Radiometer) on undiluted serum, while iISE was performed using the Beckman Coulter AU5800 on prediluted serum; both followed the manufacturer’s calibration and two-level internal Quality Control (QC) protocols. Testing order was randomised, and paired measurements were completed within 30-60 minutes to avoid analyte instability. Statistical analysis included Bland–Altman plots to assess agreement and Spearman’s correlation to evaluate the association between the two methods. Analysis was stratified by clinically relevant electrolyte ranges, with p&lt;0.05 considered statistically significant. Results: dISE yielded significantly higher sodium and chloride levels than iISE. Subgroup analysis using clinically relevant thresholds demonstrated significant correlations for serum sodium ≤140 mEq/L, potassium ≥4.5 mEq/L, and chloride levels across both concentration groups (&gt;103 and &lt;103 mEq/L), with correlation coefficients of r=0.546, 0.870, 0.602, and 0.703, respectively (p&lt;0.0001). Conclusion: A significant difference was observed between dISE and iISE methods for serum electrolyte measurement, particularly within specific clinical ranges. These findings highlight the need for methodological consistency in electrolyte analysis, especially in emergency and critical care settings, to prevent misinterpretation and inappropriate clinical decisions arising from analytical variability.

A microfluidic system for detecting sodium ions (Na+) has been developed, incorporating a micro finger-pump chip and a micro-spectrometer platform to measure Na+ concentration in human serum. A small volume (10 μL) of serum sample is introduced into the microchip and reacted with a preloaded reagent mixture through a two-step finger-pump actuation process. The resulting purple complex is directed into the detection area of the chip and analyzed using the micro-spectrometer at wavelengths of 555 and 666 nm. The Na+ concentration is then inversely derived from the measured A555/A666 absorbance ratio using self-written software installed on a Raspberry Pi. The entire detection process is completed in just 3 min, offering a significant advantage in meeting clinical needs compared to the traditional reporting turnaround time of several hours in medical institutions. The experimental results indicate a linear relationship between the measured absorbance ratio and Na+ concentration within the range of 1-200 mM, with a correlation coefficient of R2 = 0.9989. Additionally, the detection results from 60 serum samples collected from chronic kidney disease (CKD) patients showed a strong agreement with those obtained using the conventional indirect ion-selective electrode (ISE) method, achieving a correlation coefficient of R2 = 0.9885 and an average recovery rate of 99.4%. In summary, the proposed system provides a practical, affordable, and rapid alternative to conventional Na+ detection methods, making it highly promising for point-of-care (POC) testing applications.

Background; Neonatal thrombocytopenia is one of the commonest hematological abnormality encountered in neonatal intensive care unit. Though thrombocytopenia is prevalent it is often overlooked assuming it will resolve spontaneously. However, if it is not detected and managed properly can result in devastating complications. Objective; To determine the frequency of thrombocytopenia in sick neonates admitted in neonatal intensive care unit (NICU). Material and Methods; A total 282 newborns admitted to NICU of department of Pediatrics, Nishtar Hospital, Multan were included in this cross-sectional were enrolled, their blood samples were taken for estimation of platelet count to diagnose thrombocytopenia and all the data was analyzed by SPSS. Results; Of these 282 study cases, 198 (70.2 %) were male patients while 84 (29.8 %) were female patients. Mean age of our study cases was 5.18 ± 3.69 days. Of these 282 study cases, 85 (30.1 %) belonged to rural areas and 197 (69.9 %) belonged to urban areas. Of these 282 study cases, 187 (66.3%) mothers were illiterate while 95 (33.3%) were literate. Preterm birth was noted in 116 (41.1 %) of our study cases. Of these 282 study cases, 188 (66.7%) were born through vaginal deliveries while 94 (33.3%) by cesarean section. Mean duration of disease was 2.34 ± 1.10 days and 241 (85.5%) had disease duration up to 3 days. Mean platelet count of our study cases was 156575.24 ± 50250.53 mm 3 and thrombocytopenia was present in 104 (36.9%). Conclusion; High frequency of thrombocytopenia was observed in sick neonates in our study. Thrombocytopenia was significantly associated with age, residential status, maternal literacy, preterm births, mode of delivery and disease duration. All the clinicians treating such patients should regularly monitor platelet count of all the patients admitted to NICU for early diagnosis and timely management to save them further complications. This will not only decrease disease morbidity but will also reduce mortalities in these patients. Keywords; Thrombocytopenia, sick neonates, Frequency. DOI : 10.7176/JMPB/52-11

To evaluate the accuracy and clinical usefulness of a heated CO2 electrode at 43° (Novametrix Medical Systems) for measurement of skin surface pCO2 (ssPCO2), we made 162 simultaneous determinations of ssPCO2 and arterial PCO2 (PaCO2). Arterial samples were drawn from an umbilical artery catheter, and the PaCO2 was measured within 3 minutes using an Instrumentation Laboratories Micro 13 and Model 326 temperature controller that was calibrated immediately before each measurement. PaCO2 values were corrected for any abnormal body temperatures. We obtained 2-19 paired samples per infant from 22 infants (gestational age=27-40 weeks) during the first 12 days of life. The skin electrode was calibrated every 4 hours by one investigator, and applied to the infant's chest or abdomen. Over a 4 hour period there was no significant drift of the electrode calibration and no significant change in ssPCO2-PaCO2 (Δ). Over the range PaCO2 26-78 torr, PaCO2 was linearly related to ssPCO2 (PaCO2=.371 ssPCO2+17.46) (r=.79). To pursue the factors which determine Δ, we performed step-wise multiple regression analysis revealing that the only significant independent variables were ssPCO2 and postnatal age [δ=.79 CO2 (torr)-1.2 age (days)-23.9 (r2=.86)]. Insignificant independent variables were blood pressure, gestational age, birthweight, hematocrit, or weight at age of study. Our data support that ssPCO2 using a heated electrode is an accurate non-invasive method of PaCO2 measurement in sick neonates.

Background: Lateral flow immunoassays (LFIAs) are able to achieve affordable, large scale antibody testing and provide rapid results without the support of central laboratories. As part of the development of the REACT programme extensive evaluation of LFIA performance was undertaken with individuals following natural infection. Here we assess the performance of the selected LFIA to detect antibody responses in individuals who have received at least one dose of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine. Methods: This was a prospective diagnostic accuracy study. Sampling was carried out at renal outpatient clinic and healthcare worker testing sites at Imperial College London NHS Trust. Two cohorts of patients were recruited; the first was a cohort of 108 renal transplant patients attending clinic following two doses of SARS-CoV-2 vaccine, the second cohort comprised 40 healthcare workers attending for first SARS-CoV-2 vaccination and subsequent follow up. During the participants visit, finger-prick blood samples were analysed on LFIA device, while paired venous sampling was sent for serological assessment of antibodies to the spike protein (anti-S) antibodies. Anti-S IgG was detected using the Abbott Architect SARS-CoV-2 IgG Quant II CMIA. A total of 186 paired samples were collected. The accuracy of Fortress LFIA in detecting IgG antibodies to SARS-CoV-2 compared to anti-spike protein detection on Abbott Assay Results: The LFIA had an estimated sensitivity of 92.0% (114/124; 95% confidence interval [CI] 85.7% to 96.1%) and specificity of 93.6% (58/62; 95% CI 84.3% to 98.2%) using the Abbott assay as reference standard (using the threshold for positivity of 7.10 BAU/ml) Conclusions: Fortress LFIA performs well in the detection of antibody responses for intended purpose of population level surveillance but does not meet criteria for individual testing.

Introduction: Jaundice is an important problem during neonatal period. When total serum bilirubin (TSB) level exceeds a critical limit, it crosses the blood brain barrier and results into bilirubin encephalopathy. The main aim of therapy for neonatal hyperbilirubinemia is prevention of bilirubin encephalopathy by phototherapy and/or exchange transfusion. The aims of this study were to evaluate the efficacy of exchange transfusion (ET) and observe the adverse events during and following three days of ET in neonates with hyperbilirubinemia. Materials and Method: Hospital based cross-sectional descriptive study. All neonates admitted to neonatal intensive care unit and /or paediatric wards of a tertiary- care centre between September 2010 to March 2012, requiring ET were enrolled. Results: A total of 139 ETs were performed in 120 neonates. The common causes were ABO incompatibility (30.8%), prematurity (30.8%), idiopathic (27.5%), Rh isoimmunization (6.7%) and cephalhematoma (4.2%). Mean pre- ET total serum bilirubin (TSB) was 24.2 mg% dL. There was 58% reduction in TSB in post ET and 31% net reduction in 6 hr post ET. Term and preterm neonates showed equal percentage of TSB reduction. Respiratory distress (10.8%) and bradycardia (6.7%) were the common adverse events during, and hypocalcemia (98.3%) and thrombocytopenia (34.2%) in 3 days following ET. The sick neonates had significantly higher incidence of thrombocytopenia (p= 0.031), respiratory distress (p=0.009), apnea (p&lt;0.001) and cardiorespiratory arrest (p&lt;0.001). Overall mortality was 4.2%, and non-survivors were mostly low birth weight, born outside the present hospital and had higher incidence of adverse events. Conclusion: Exchange transfusion is an effective intervention in reducing the serum bilirubin level. However, these neonates require monitoring of ionised calcium and thrombocytopenia. Sick neonates had higher incidence of adverse events than healthy and close clinical monitoring is needed to improve the outcome. DOI: http://dx.doi.org/10.3126/jnps.v34i1.9030 J Nepal Paediatr Soc 2014;34(1):7-13

The Wee Care Neuroprotective NICU Program (Wee Care): The Effect of a Comprehensive Developmental Care Training Program on Seven Neuroprotective Core Measures for Family-Centered Developmental Care of Premature Neonates

IntroductionEchocardiography is pivotal in neonatal care by providing valuable insights into cardiac function, anatomy, and hemodynamics. The ability of echocardiography to guide clinical decision-making is evident in its capacity to influence and change management strategies. Therefore, the goal of the current study was to know the prevalence of heart disease and the association between echocardiographic indications and neonatal outcomes and interventions.Materials and methodThis prospective cross-sectional study was conducted in the Neonatology Department, Datta Meghe Institute of Higher Education and Research, Sawangi, Wardha. Ill neonates admitted to the neonatal intensive care unit (NICU) were selected in a randomized manner, and echocardiography was performed. The decision was made on the indications for echocardiography, the echocardiographic findings, and any modifications to the clinical care. Mean differences were compared using an unpaired Student's t-test. A significant level is defined as a p-value of less than 0.05.ResultsOf all the ill neonates, heart disease was present in 60 (52.6%) neonates. The most frequent indication for echocardiography was respiratory distress in 39 (34.21%). In neonates with heart disease, 27(45%) had acyanotic heart disease, nine (15%) had cyanotic heart disease, and 24(40%) had miscellaneous heart disease. The mean appearance, pulse, grimace, activity, and respiration (APGAR) score at five minutes in neonates without heart disease was 9.05, and for those with heart disease, it was 8.95, with no statistically significant difference. Out of 114 neonates, the mean NICU stay of neonates without heart disease was 6.59 days, and those with heart disease was 9.95 days with a p-value of 0.0001, hence showing statistically significant differences. Out of all the 114 neonates, 57.89% underwent no intervention, 36.85% underwent medical intervention, and 5.26% underwent surgical interventions. Out of 114 neonates, 101 neonates were discharged, and 13 neonates were dead. Out of the 54 neonates with no cardiac abnormality, 50 (92.59%) were discharged, and four (7.41%) neonates were dead. Out of the 60 neonates with cardiac abnormality, 51 (85%) were discharged, and nine (15%) were dead, with a p-value of 0.203, showing no statistical significance between cardiac abnormality and neonatal outcome.ConclusionOur study emphasizes the pivotal role of echocardiography in the NICU for evaluating ill neonates. The findings underline the significance of early detection and precise diagnostic insights provided by echocardiography, contributing to tailored management strategies. The study highlights the transformative impact of echocardiography on clinical decision-making, facilitating timely interventions and improving overall neonatal care. Echocardiography is essential to improving outcomes for these susceptible newborns in the NICU as we continue to expand our knowledge of neonatal heart health.

This quality improvement initiative was undertaken in a tertiary care neonatal intensive care unit (NICU) to improve communication between the HCP and parents related to the sick neonates admitted in NICU as measured by increase in parental satisfaction score from base line (34.5%) to 80% in 3 months time. A team was formulated to evaluate the reasons for low parental satisfaction resulting from communication between HCP and the parents of sick neonates and to further plan strategies for improving the same. Multiple PDSA cycles were implemented. The results of the all PDSA cycles were discussed amongst team members. Satisfaction of parents related to communication with HCP increased to more than 80% in 3 months time followed by increase up to 90% in sustenance phase. Multiple simple feasible interventions led to improvement in communication between the HCP and parents as evident by increase in satisfaction score (40.8 ± 4.3 vs. 40.8 ± 4.3 vs. 91.3 ± 4.8, p &lt; 0.001). There was significant improvement in the satisfaction scores of the mothers on communication related to sick neonate in NICU at the end of intervention phase as well as in the sustenance phase. Multiple simple doable and feasible interventions had led to the improvement in communication between the HCP and parents hence improving the satisfaction of parents related to their communication with HCP.

The goal of this research was to better understand the spatial characteristics and hot areas of heavy metal concentrations in the soil-rice system, which was critical for implementing heavy metal pollution prevention and control strategies. The amounts of heavy metals in soil-rice were determined using high-precision testing methods such as XRF, ICP-MS, and AFS based on the systematic collection of 285 pairs of soil-rice samples from Wanjiang Economic Zone, China. The Getis-Ord index, Kriging method, and geostatistical method were used to reveal the spatial distribution of heavy metal contamination hot spots in the soil-rice system. The results revealed that the average concentration of heavy metals in soil was Zn>Cr>Cu>Pb>Ni>As>Cd>Hg, whereas it was Zn>Cu>Ni>Cr>Cd>As>Pb>Hg in rice. The average concentrations of heavy metals in the soil were all well below the maximum allowable limit, except for Cd, which was slightly above the allowable limit. Only Cd and Ni concentrations in rice exceeded the maximum permitted limits. In soil, Cd, Hg, Pb, and Zn pollution hotspots were mostly found in the southeast, while Cr and Ni were mostly found in the northeast. An intriguing discovery was that there was a weak relationship between heavy metal concentrations in soil and rice and the spatial pattern of their distribution. The study’s findings offer a scientific foundation for establishing a long-term agricultural development strategy for the soil-rice system in the Wanjiang Economic Zone.

Extravasation or inadvertent infiltration of fluids into subcutaneous tissue from peripheral intravenous (IV) devices is a common adverse event in newborns. (1)(2) Although fluids occasionally extravasate from central venous lines, the complication is much more common from peripheral catheters, which are used widely in sick neonates. (3) This article focuses on extravasations from peripheral IV devices. Injury to the skin, even in a very immature neonate, results in an inflammatory response and heals by scar formation. (4) Although the scars from many of these injuries appear to improve with time, (5) tissue necrosis from extravasation injury could result in partial or complete skin loss, infection, and nerve and tendon damage, with the potential risk of permanent cosmetic and functional impairment. (6)(7)(8) The incidence of extravasations from Teflon® catheters has been reported to vary from 23% to 63%. (1) A recent survey of regional neonatal intensive care units in the United Kingdom recorded the prevalence of extravasation injury resulting in skin necrosis as 38 per 1,000 neonates, with 70% of these injuries occurring in infants of 26 weeks’ gestation or less. (2) The incidence of extravasation is related closely to the type of device used, insertion site, duration of therapy, infusate administered, patient activity, and gestational age. (1)(3)(9)(10) The fragility of the skin, particularly in the first 2 weeks after birth, and the lack of subcutaneous tissue in preterm neonates makes them uniquely susceptible to injury and skin loss. Extravasation may occur from the tip of the cannula or needle piercing the vessel wall. Alternatively, distal obstruction of the vein due to thrombosis or venoconstriction from irritation of the vessel wall may lead to increased back pressure and leakage from the entry point of the needle or …

Background We evaluated the analytical performance of four newly developed clinical chemistry assays [Creatinine, Uric Acid, Lactate, Lactate Dehydrogenase (LDH)] on the Abbott Alinity c and ARCHITECT c8000 system. These clinical chemistry assays incorporate a multianalyte calibrator, which has extended stability. For the enzyme assay LDH, both the multianalyte calibrator and a factor calibration are offered. Precision, linearity, method comparison and accuracy were assessed per CLSI guidelines. Sigma metrics were determined to examine the assay variability in relation to allowable performance limits. Methods Precision was assessed by measuring two levels of quality control material (Biorad Chemistry UA) and three pooled patient samples in replicates of five, twice per day, for five days. Method comparison was performed by measuring 134 serum/plasma specimens in duplicate on the new and current Alinity c or ARCHITECT methods. Linearity was evaluated using five to six levels of commercially available linearity material, measured in triplicate. Acceptability criteria were based on the Accreditation Canada Diagnostics (ACD) recommendations. Accuracy was determined in replicates of ten using external NIST standards. For assays where an external standard was not available, calibrators were used. The imprecision and bias from the target value were used to calculate the Sigma value. Total allowable error limits were obtained from the Clinical Laboratory Improvement Amendments (CLIA) and ACD guidelines. Results The results from the precision, accuracy, linearity, and method comparison studies are summarized in the table below. All the next generation chemistry assays demonstrated = 6 Sigma performance on the ARCHITECT and Alinity c systems based on CLIA guidelines. The performance of the factor calibration for the LDH assay was equivalent (data not shown). Conclusion The four next generation clinical chemistry assays (Creatinine2, Uric Acid2, Lactate2, Lactate Dehydrogenase2) demonstrated acceptable performance for precision, accuracy, linearity, and Sigma values on the Alinity c and ARCHITECT system. There was good agreement with the on-market Alinity c and ARCHITECT clinical chemistry assays.