Characteristics of the Obstetric Population in a Saudi Maternity Hospital

ABSTRACT. Mothers who delivered in a large Maternity hospital and who represented a large proportion of the obstetric population in Riyadh are described. The mothers were characterized by a high material standard of living, by adequate energy reserves at confinement, by a low rate of pregnancy complications and preterm birth, and by the absence of smoking and of hard physical work during pregnancy. The mothers were also, however, characterized by pregnancies occurring at the extremes of the reproductive age, by short birth intervals, by short maternal stature, by low educational attainment, by poor utilization of antenatal services and by a high rate of previous infant loss, that is by characteristics previously found to consitute riskfactors for adverse perinatal outcome.     

Effect of passive smoking on growth and infection rates of breast-fed and non-breast-fed infants

Background:  The aim of the present study was to determine the effect of passive tobacco smoking on growth and infection rate of infants, and to evaluate whether breast-feeding might be protective against harmful effects of cigarette smoke.
Methods:  A cross-sectional study on 254 6–7-month-old infants was carried out. A questionnaire was given to mothers; and infants' head circumference, bodyweight, height, and urinary cotinine levels were measured.
Results:  Multivariate analysis of factors influencing lower respiratory tract infections showed that smoking mothers increased the rate by 9.1-fold; breast-feeding decreased it by 3.3-fold; formula feeding at birth increased it by a factor of 15.2; another smoker at home increased it by a factor of 40.1. Multivariate analysis of factors influencing upper respiratory tract infections showed that smoking mothers increased the rate by a factor of 23; early formula feeding increased it by a factor of 62; breast-feeding decreased it by a factor of 5; smoking fathers increased it by a factor of 15. Multivariate analysis of factors influencing otitis media found that smoking mothers and fathers increased it by a factor of 9.4 and 6.15, respectively, and breast-feeding decreased it by a factor of 5.4.
Conclusion:  Tobacco smoke exposure of infants has negative consequences on growth, otitis media, and upper and lower respiratory tract infections. Breast-feeding promoted the growth of infants who were passively exposed to tobacco smoke and protected them against infections. Smoking should not be permitted in households with infants. When this is impossible, breast-feeding should be promoted to protect the infants against the health hazards of passive smoking.     

Nebulised fenoterol compared with metered aerosol.

The effect of nebulised fenoterol was compared with that of a similar dose administered by metered aerosol in 14 children, aged 7 to 17 years with moderately severe asthma. The initial response to fenoterol delivered by metered aerosol or nebuliser was the same, but a second dose by nebuliser after a dose by metered aerosol produced maximum potential bronchodilatation which was not seen when a second dose by metered aerosol was given after that by nebuliser. Administration of a bronchodilator by nebuliser does seem advantageous in the treatment of some children.     

Heat-Accelerated Fixation and Rapid Dissection of the Pediatric Brain at Autopsy: A Pragmatic Approach to the Difficulties of Organ Retention

We investigated whether it is possible to accelerate the examination of a pediatric brain at autopsy and thus facilitate its return to the body before a fueral without compromising the quality of the neuropathologic examination. Accelerated fixation and next-day dissection of the brain was performed in selected cases over a 2-year period by using a microwave histologic tissue processor (MicroMed T/T MEGA, Milestone, Sorisole, Italy). Direct comparison of the histolotic appearance and immunohistochemical reactivity of 2 cases, 1 fixed by conventional methods and 1 fixed with the accelerated method, was performed in a blinded fashion by a specialist neuropathologist. Examination of rapidly fixed brain by conventional thin coronal sections was readily achieved. There was no appreciable difference between tissue sections stained with hematoxylin and eosin and prepared from conventional formalin-fixed cortical and cerebellar brain tissue and that fixed by rapid heat acceleration. Immunocytochemical studies were not adversely affected by the accelerated heat-fixation process of tissue. Heat-accelerated fixation is a potential method of speeding up the examination of the brain at autopsy without unduly compromising the quality of the neuropathologic examination. pyblished online December 6, 2004     

DISSEMINATED ARTHRITIS AND OSTEITIS BY CANDIDA ALBICANS IN A TWO MONTH OLD INFANT RECEIVING PARENTERAL NUTRITION

Abstract. The case of a two-month-old female infant, who after a severe diarrhoea treated with prolonged intravenous infusion in peripheral veins alternated with total parenteral feeding, developed a Candida albicans septicemia (accompanied by disseminated intravascular coagulation syndrome) is reported. The course of her disease was also complicated by multiple foci of osteoarthritis in both knees, in the left hip and in several long-bones. Radiographically the foci of Candida osteitis appeared as fine erosion of the cortex and minute round areas of osteolysis in the spongiosa, surrounded by a rim of perifocal sclerosis. During the acute stage of Candida sepsis a transitory cellular immunodeficiency was present. Treatment of Candida infection by 5-fluorocytosine was followed by complete recovery.     

Intrauterine Intussusception and Ileal Atresia Presenting as Acute Perforation

ABSTRACT. A case is reported of a girl born by caesarean section at 28 weeks gestation who developed an acute perforation of the ileum due to intussusception 11 days after birth. This was treated successfully by resection of the affected segment of ileum and by performing a temporary ileostomy followed by end-to-end anastomosis. She made a complete recovery. This case also demonstrates the difficulty of early diagnosis of intussusception in the neonatal period.     

THREE CASES OF DISSEMINATED INTRAVASCULAR COAGULATION

Disseminated intravascular coagulation (DIC) was a complication in 3 patients with different primary diseases. The probable initiation of the DIC was a thromboplastic active tumor, a laceration wound at cesarean section with amniotic embolism in the foetus and probable endotoxin release in a newly kidney biopsied patient with subacute glomerulonephritis. The DIC was interrupted in the first patient by extirpation of the tumor, in the other two by treatment with heparin in spite of bleeding tendency. The diagnosis can be strongly suspected by demonstrating a decrease of the fibrinogen content combined with a diminished number of platelets. A normalization of the condition can occur after interruption of the intravascular clotting by treatment with heparin.     

Nurse-led newborn resuscitation in an urban neonatal unit

Aim: To determine the safety and efficacy of neonatal nurses attending at‐risk deliveries. Methods: An audit of 2 years of delivery attendance by neonatal nurses at an urban hospital. Attendance also by a paediatrician if expected birth weight <2 kg, gestation < 35 weeks, twin pregnancy, foetal distress or any anomaly anticipated to seriously affect the newborn's health. Results: About 3021 deliveries were attended, 2228 (74%) by a neonatal nurse, 776 (25%) by a neonatal nurse and a paediatrician and 17 (1%) by a paediatrician. Twenty‐three children required intermittent positive pressure ventilation via endotracheal tube and/or cardiac massage. All but five of these were deliveries where both a neonatal nurse and a paediatrician were present. Three of these five deliveries had foetal tachycardia. There were 33 deliveries managed by the neonatal nurse alone where the 1‐min Apgar was three or less. All achieved a 10‐min Apgar of seven or greater. Over the study interval, the proportion of deliveries attended only by a neonatal nurse increased and intensity of resuscitation administered decreased. Conclusion: Appropriately trained neonatal nurses can safely resuscitate newborns. Addition of foetal tachycardia to the indications for paediatrician attendance identifies infants likely to require more resuscitation.     

Documentation of spontaneous reduction of childhood intussusception by ultrasound

Spontaneous reduction of a presumed ileo-colonic intussusception was demonstrated by ultrasound examination followed by a barium enema. No premedication or anesthetic had been given to the child. This case illustrates the possible natural history of intussusception rarely confirmed by imaging studies. Intussusception is the most common abdominal emergency of early childhood [1]. Diagnosis and therapy is usually performed with a contrast enema. If unsuccessful, surgical reduction is indicated. We wish to report a case of spontaneous reduction of a presumed ileocolonic intussusception. This was initially diagnosed by ultrasound examination, but had spontaneously reduced by the time a barium enema was performed.     

À propos d’un cas de syndrome de Münchhausen par procuration à expression psychiatrique

The factitious disorder by proxy or syndrome of Münchhausen by proxy is the production of symptoms to a child by a mistreating adult who wishes to play the sick role through this child. This syndrome is a child abuse where the care system is instrumented. The medical profession becomes itself maltreating by scheduling more and more invasive additional examinations: the mortality would be 5 %. The symptoms most frequently presented to the paediatricians are sleep apneas and convulsions. The disease by proxy questions the clinicians in front of its unusual form and its absence of anatomoclinical parallelism. If all somatic symptoms were described, forms of artificial disorder by proxy with psychiatric expression are probably underestimated. After a review of the literature on the syndrome of Münchhausen by proxy on one hand and its psychiatric expression on the other hand, we shall explain a clinical case illustrating this atypical presentation. The psychotic symptoms adduced by the mother were able to be thwarted during an observation in protected environment which is ended the medical nomadism. The diagnostic of factitious disorder by proxy is very complex. The child can present an authentic psychiatric disorder establishing a differential or tangled diagnosis. On the other hand, the complications are numerous. The victim can develop psychological aftereffects of this child abuse like behavioural problems. The child can even secondly participate to the presentation of the symptoms in a morbid alliance with the simulated parent. We shall return on diagnostic and therapeutic measures of care to offer to the maltreated child but also to the parent too, whose psychopathological determiners will be useful to clarify.     

Simultaneous occurrence of foetal and neonatal alloimmune thrombocytopenia and neonatal neutropenia due to maternal neutrophilic autoantibodies: a case study and review of the literature

Foetal and neonatal alloimmune thrombocytopenia (FNAIT) and neonatal neutropenia caused by maternal autoantibodies against neutrophils are rare disorders. We describe a newborn with severe thrombocytopenia and intracerebral bleeding caused by maternal anti-HPA-3a alloantibodies and mild neutropenia caused by maternal autoantibodies against HNA-1b. This appears to be the first case of simultaneous occurrence of these two conditions. CONCLUSION: This case report and review of the literature demonstrate that anti-HPA-3a antibodies can be overlooked by standard assays.     

Coagulation inhibitors

A number of types of coagulation inhibitors can be seen in autoimmune states. These inhibitors can produce hypocoagulability by at least three mechanisms: by acting as a circulating anticoagulant; by the production of a functionally abnormal procoagulant; or, by the occurrence of an isolated reduction in the plasma level of a coagulation factor. The most common is the circulating anticoagulant which acts by either neutralizing a specific blood coagulation factor or by interfering in some fashion with coagulation factor interactions. The different types of coagulation inhibitors, their laboratory, and clinical manifestations are discussed.     

Complications of chest thump for termination of supraventricular tachycardia in children

We report on two cases of mechanical termination of supraventricular tachycardia by chest thump which were followed by serious complications. In a 3-year-old boy with an otherwise normal heart, incessant supraventricular tachycardia was converted to sinus rhythm by a single precordial thump. This, however was followed by thrombo-embolic infarction of the left-sided middle cerebral artery. In another case of a 9-year-old girl, recurrent episodes of supraventricular tachycardia were associated with Ebstein anomaly of the tricuspid valve. Chest thump was successful in terminating supraventricular tachycardia but induced a short run of ventricular tachycardia which terminated itself and was then followed by sinus rhythm. It is concluded that even a slight precordial thump implies undetermined risks in the acute management of supraventricular tachycardia in children and should therefore be abandoned in favour of other methods.     

Cardiovascular effects of electrical stimulation of the forebrain in the fetal lamb.

Modified stereotaxic techniques were applied to fetal lambs during the latter third of gestation. Electrical stimulation in the region of the hypothalamus in 10 acute experiments was associated with three patterns of arterial blood pressure and heart rate changes: a pressor-tachycardia response; a pure tachycardia response (abolished by propranolol); and a pure bradycardia response (abolished by atropine). The pressor-tachycardia response was examined in detail in 13 chronic preparations (115-135 days of gestation at operation). The systolic arterial blood pressure increase was never greater than 35 mm Hg and was probably blunted by the large noninnervated placental circulation. This pressure increase was abolished by phentolamine and was thus mediated by stimulation of alpha-adrenergic receptors. The initial tachycardia was prevented by propranolol and was due to beta-adrenergic stimulation. The tachycardia was followed in a few seconds by a bradycardia, abolished by atropine and possibly a vagal baroreflex. The pressor-tachycardia response was accentuated in two lambs who were delivered spontaneously and were studied after birth. These studies indicate that a suprabulbar neural framework exists in the fetal lamb for influencing the cardiovascular system from as early as 90 days of gestation.     

Coronary sinus cannulation via the femoral vein

Summary Cannulation of the coronary sinus has been usually accomplished by advancing a catheter through the brachial vein, subclavian vein, or internal jugular vein by venous cutdown or a sheath method. We here describe a technique for cannulation into the coronary sinus through the femoral vein by using a modified catheter. This catheter was easily inserted into the coronary sinus in all of 40 consecutive patients in whom it was attempted.     

Multi-system Coxsackievirus B-6 infection with findings suggestive of diabetes mellitus

A fatal case of Coxsackievirus B-6 (CBV-6) infection in a 4 1/2-year-old girl is reported. The disease was initially characterized by a severe meningoencephalitis and, successively, by the appearance of hyperglycaemia and glycosuria, concomitantly with complement-fixingislet cell antibodies (CF-ICA) and ICA, diarrhoea, electrolyte disorders, arrhythmia and decrease of the IgG levels, suggesting a multi-system involvement. CBV-6 was identified by isolation from stool and cerebrospinal fluid and by detection of specific IgM antibodies.     

Breathing patterns in term infants delivered by caesarean section

AIM: To compare the breathing patterns of infants born by elective caesarean section to those infants delivered by caesarean section after a failed trial of labour. METHODS: Healthy term infants born by caesarean section were studied. The study group (n = 13) had no trial of labour, whereas infants in the control group (n = 13) failed a trial of labour. Polysomnographic study was performed at 36 h of age. Heart and respiratory rate, type and duration of apnoeas, arterial oxygen saturation and lower limb movements were analysed. RESULTS: Term infants born by elective caesarean section had a shorter duration of pregnancy and weighed less. Their heart rate was faster, they had more mixed apnoeas, and during quiet sleep they had more central apnoeas of longer duration. CONCLUSION: Cardiorespiratory patterns in infants delivered by elective caesarean section are different from those delivered by caesarean section after a failed trial of labour.     

Ruptured Hydatid Cyst of the Interventricular Septum with Acute Embolic Pulmonary Artery Complications

Hydatid cysts located in the interventricular septum are especially rare but with the high risk for intracavitary rupture. We report a patient with acute pulmonary embolism caused by an isolated, ruptured hydatid cyst on the right side of the interventricular septum. Early diagnosis was made by echocardiography and positive serology. Pulmonary artery embolism was confirmed by angiography and the patient was operated on. Embolectomy was performed by removing multiple fragments of ruptured endocyst from the left pulmonary artery, followed by surgical closure of a cyst cavity. Prompt diagnosis and an appropriate surgical treatment prevented a potentially fatal outcome.     

Genetic counselling in cystic fibrosis

In a survey by questionnaire of 572 families with one or more children affected with cystic fibrosis 72% were found to have received genetic counselling. The mode of inheritance was correctly known by only 45% and either not known or incorrectly known by the others. About 75% expressed the wish for more information on the genetics of cystic fibrosis. The data indicate that genetic counselling in cystic fibrosis is not given or is ineffective in a high proportion of families. It is suggested that genetic counselling, backed up by a written resumé should be a regular part of the management of families with this disease. The genetic data are consistent with autosomal recessive inheritance at a single locus.     

The silent ductus arteriosus

Preterm infants at risk of developing a patent ductus arteriosus were followed sequentially by physical examination, echocardiographic determinations of the LA/AO ratio, and chest roentgenograms. The results show that a significant number of infants who have no clinical signs or symptoms of a PDA have large left-to-right shunts. The presence of this shunt was suggested by acute increase in left atrial size by ECHO determination and confirmed by retrograde single-film aortography. Clinical signs and symptoms often developed several days after documentation of the left-to-right shunt.