Læknaneminn - 01.04.2007, Blaðsíða 126

Verkefni 3. árs læknanema
one month. This is 40% of all children dying before the age
of five years. Of these neonatal deaths 99% occur in low-
income countries, and sub-Saharan Africa has the highest
rates. The main reasons for neonatal deaths are preterm
birth, severe infections and asphyxia. Low-birth weight is
also a risk factor. Simple, evidence-based low-cost
procedures and appropriate treatment when sick can
substantially reduce neonatal mortality.
The Icelandic International Development Agency
(ICEIDA) has since the year 2000 funded the construction
and functioning of Monkey Bay Community Hospital
(MBCH) in southern Malawi. The aim of the present study
is to describe and analyze care and treatment of neonates
in MBCH.
Materials and methods
Data was collected in the nursery department of MBCH.
Participants were divided in two study groups. For Group I,
information about treatment and care of neonates admitted
in the period March 13 to April 13, 2006 was obtained from
clinical records, registration books and from interviews
with mothers and health staff. For Group II, information
on neonates admitted in the period January 1, 2005 to
March 31, 2006 was obtained from registration books. All
information was extracted to specially designed forms for
the study, computerized in FileMaker Pro v8 and analyzed
in Excel and Access.
Results
Group I included 34 neonates. Of them 65% were
younger than one week old at admission and one out of
five with low birthweight (<2500 g). Median admission
weight was 3150 g (range 1800-4500 g), but weight was
not registered for 11 (32%) neonates. All, except one,
were exclusively breastfed; about 88% had initiated
breastfeeding within 24 hours from birth. Of the 29 who
had a registered reason for admission, 24 (83%) were
suspected to have neonatal sepsis. Temperature was not
measured at all in 22 (14%) out of 158 in-patient days. All
except one were prescribed gentamicin and all except six
benzylpenicillin as well. No neonate received prescribed
drugs both in the right dose according to recorded weight
and for the right period. Median time of internment was
five days (range 1-7). Diagnosis at discharge was neonatal
sepsis for 18 infants but diagnosis was not registered for
16 neonates (47%). Of the 34 neonates, 23 (68%) were
discharged in an improved state, six (18%) absconded and
two (6%) died.
Group II included 431 neonates. About half of them
(n=211) were admitted within their first week of life. For
those registered in the discharge book (85%), the median
length of stay was five days (range 1-14), and 95% of
them turned back home but 3% died in the nursery.
Conclusion
Breastfeeding confers protection to newborns and all
neonates in Group I, except one, were exclusively
breastfed. Most of the neonates were younger than one
week old at admission, and had live-threatening diagnosis.
Care and monitoring of sick, vulnerable neonates need to
be improved. Registration routines need thorough revision,
including weighing. Temperature should be measured
daily. Further, drug treatment of sick neonates must be
according to recommended practice; some received too
high doses while others received too low doses.
Key words: Neonate, Malawi, rural hospital, ICEIDA
Tvíblind slembirannsókn á virkni Scopoderm
forðaplásturs gegn ógleði og uppköstum eftir
kviðarholsspeglanir
Bjarki Örvar Auðbergsson1, Jón ívar Einarsson2, Aðalbjörn
Þorsteinsson1'3
Læknadeild HÍ1, Kvennadeild LSH2, Svæfinga- og
gjörgæsludeild LSH3
Inngangur: Ógleði og uppköst (ÓU) eru algeng eftir
skurðaðgerðir, sérstaklega kviðarholsspeglanir. Þar sem
sjúklingar útskrifast sífellt fyrr eftir aðgerðir eykst hættan
á að þeir fái ÓU eftir útskrift. Sjúklingar vilja jafnvel síður
upplifa ÓU en sársauka eftir aðgerð. Þó svo sjúklingar leiti
sér sjaldnast aðstoðar vegna þess eru ÓU ein algengasta
ástæða endurinnlagna eftir dagaðgerðir. Scopoderm for-
ðaplástur verkar í 72 klst og gæti því veitt lengri vernd
gegn ÓU eftir aðgerðir en önnur lyf. Ein rannsókn frá árinu
1990 sýndi að Scopoderm forðaplástur minnkaði mark-
tækt líkur á ÓU eftir kviðarholsspeglanir á konum. Sú nið-
urstaða þarfnast staðfestingar. Tilgangur rannsóknarinnar
er að kanna virkni Scopoderm forðaplásturs gegn ÓU eftir
kviðarholsspeglanir á konum.
Sjúklingar og aðferðir: Rannsóknin er tvíblind slemb-
irannsókn og þýðið er konur sem gangast undir kviðar-
holsspeglanir á Kvennadeild Landspítalans. Þátttakendur
verða alls 48. Þegar sjúklingar hafa gefið upplýst samþykki
er þeim skipt af handahófi í Scopoderm hóp og lyfleysu-
hóp. Scopoderm hópurinn fær virkan Scopoderm forðapl-
ásturen lyfleysuhópurinn færeins útlítandi plásturán virk-
ra efna. Plástrarnir eru settir á síðdegis daginn fyrir aðgerð
og sjúklingar bera þá í þrjá sólarhringa. Reynt er að hafa
lyfjagjöf í svæfingu sambærilega milli sjúklinga. Upplýs-
inga er aflað frá hverjum sjúklingi í þrjá sólarhringa eftir
aðgerð og spurt um ógleði, uppköst, líðan og hugsanlegar
aukaverkanir meðferðar. Einnig er skráð notkun verkja-
lyfja og lyfja gegn ógleði og uppköstum.
Niðurstöður: Búið er að innrita 32 konur í rannsóknina
af þeim 48 sem taka munu þátt. Meðalaldur þátttakenda
er 39 ár og meðal þyngdarstuðull (BMI) er 25 kg/m2. Ekki
var marktækur munur á dreifingu helstu áhættuþátta fyrir
ÓU eftir aðgerðir, þ.e. reykinga, sögu um ferðaveiki eða
fyrri sögu um ÓU í tengslum við aðgerðir. í Ijós kom mark-
tækur munur á tíðni ógleði milli hópanna en 10 af 17 þátt-
takendum í lyfleysuhópnum fundu fyrir ógleði á meðan 3
126 Læknaneminn 2007