DARUL SEHAT HOSPITAL

DR.SYEDA MALEEHA SHAKEEL

Senior Medical Officer
Darul Sehat Hospital
Darul Sehat Hospital

What is Journal
Club???
• A journal club is a form of
meeting regularly held among
health practitioners to discuss
recently published related
literature.
 UNDERSTAND THE KEEPING UP-TO-DATE TEACHING CRITICAL
ARTICLE WITH THE LITERATURE APPRAISAL SKILLS

OBJECTIVES

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PROMOTING PROVIDING PROMOTING SOCIAL
EVIDENCE BASED CONTINUING INTERACTION
MEDICINE (EBM) EDUCATION
 Sir William Osler of Montreal, Canada, is credited
with starting the first formal journal club in 1875
However Sir James Paget wrote of a similar group
of students at St. Bartholomew's Hospital in
History Of Journal London who read journals together from 1835 to
Club 1854. 
Osler founded the first journal club in the United
States at the Johns Hopkins Hospital around ten
years later (in 1889).

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 Sections Of Article

Introduction
Evidence-
(Title, Author, Abstract Study Design Methodology
Based
Aim)

Results Discussion Limitation Applicability Conclusion

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Author: M.L.Catano-Jaramillo , J.C.Jaramillo-Bustamante , I.D.Florez
• MEDICINA INTENSIVA :
Journel of the Spanish Society of Intensive and Critical Care medicines and
Coronary units and of Pan American and Iberian Federation of Societies of
Intensive and Critical Care Medicine.

• Systemic review :
 DARUL SEHAT HOSPITAL
Objective • To compare the safety & effectiveness of
Continuous Positive Airway Pressure

of the (CPAP) vs. High Flow Nasal Canula

(HFNC) to prevent therapeutic failure &
the need of invasive ventilation in children
study: with acute moderate-severe bronchiolitis
 • Study Design : A Systemic Review and Meta-
analysis.
• Search Strategy: MEDLINE, EMBASE, LILACS &
COCHRANE Central & gray literature in clinical trials
databases (www.clinicaltrials.gov ) till May 2020
• Keywords: Therapeutic failure , need for invasive
ventilation, adverse events,length of PCCU and of
hospital stay.

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 Introduction • One of the main causes of early neonatal death is
Perinatal Asphyxia. It refers to the disruption of
the exchange of breathing gases during and
delivery and the subsequent negative impact on
the fetus.

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 Perinatal
Asphyxia

Fetal Maternal

Uterine Placental

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DARUL SEHAT HOSPITAL
Why there is need of study??

• In view of conflicting results about the role OF INTRAVENOUS MAGNESIUM

in perinatal asphyxia & little research
• The goal of the current study was to establish that intravenous magnesium
sulphate therapy help in asphyxiated newborns by accelerating their
recovery and have better neurological outcomes after being discharged.

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 Study Design

• Study Type: 
 Randomised Control Trial
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• Study Population:
• 120 term neonates (60 study
group & 60 controlled group)
 INCLUSION CRITERIA EXCLUSION CRITERIA

Term Neonates History of maternal

magnesium administration prior
to delivery

Birth Asphyxia History of mother

receiving Pethidine,
Phenobarbitone which are likely
depress the baby

APGAR Score <7 at 1 minute of Obvious external

age congenital malformations
Risk Factors Age of mother
PIH
Antenatal Anemia 
Bleeding
Infection
History
M.O.D
PROM
Meconium
Intrapartum
stained liquor
Malpresentation
Cord prolapse
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 • Neonates were assigned with computer generated
random numbers (Investigator 1)
   in Study Group or Comparison Group
• Both group Were treated according to NICU Protocol   
Methodology for Birth Asphyxia
• Study group received Magnesium Sulphate
intravenous infusion at 250mg/kg/dose
(1ml/kg/dose in 20ml of 5% dextrose solution)
over 1 hour within 6 hours of birth
• 2 additional doses repeated after 24 hrs & 48 hrs.
• Clinical assessments were done by Investigator 2
• P Value <0.05 taken statistically significant
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RESULTS
 14

142 Exclusion criteria

120
Neonates screened Selected Neonates 
8

Refused by attendant/ LAMA

 Mode Of delivery
Assisted Vaginal Delivery
15%

Cesarean section
18%
Normal Vaginal Delivery
67%
P VALUE > 0.05%
P Value 0.068
P Value
0.0001
P Value
0.0001
P Value 0.233
P Value 0.029
P Value 0.001
P Value  0.0001
DISCUSSI
ON
• Comparisons of baseline parameters were similar in both groups before
intervention
• Loading dose of250mg/kg magnesium followed by 2 further infusions of
same dose with 24 hours apart
• Ensure Plasma concentration of Mg in neuroprotective range for 72 hours
• Neuroprotective range 2.4---5.0 Meq/L
• No adverse effects noted (similar to other studies)
• At 400mg/kg/dose, neuromuscular blockade, cessation of respiration &
loss of muscle tone noticed
• In Contrast to study, Ichiba H et al, found no difference in seizures
between 2 groups
• Conflicting result due to small sample size
• This study adds that neonates in study group recovered significantly
early in study group along with early initiation of feeding
• This study showed less number of neurological abnormalities at
discharge. (Similar Studies)
• Significantly more babies establish normal sucking reflex & feeding at
discharge.
• Mortality was less in present study.
 LIMITATION

UMBLICAL Cord pH
Base deficit
DWI
MRS
EEG
Lack of long term follow up to
assess sequelae
CONCLUSION
For term newborns with birth
asphyxia, intravenous
magnesium sulphate
administered within six hours
after delivery
 promotes early seizure
control
early recovery from aberrant
neurological symptoms
early initiation of feedings
reduced risk of neurological
abnormalities at discharge.
This Photo by Unknown author is licensed under CC BY-SA.