Changing patterns of blood borne sepsis in special care baby unit, Khoula Hospital

Infection is a frequent and important cause of morbidity and mortality in neonatal units all over the world. Over the years, there has been a shift in the microorganisms responsible for neonatal septicemia. This study aims to analyze the changing patterns of blood borne organisms in the neonatal unit. This retrospective study was undertaken at the neonatal intensive care unit of Khoula Hospital in Muscat, Sultanate of Oman to analyze the incidence of blood borne sepsis and its changing pattern from 1997-2000. Out of a total 2181 admissions to the neonatal intensive care unit, 71 [3.25%] babies had positive blood culture. A reduction in the incidence of blood borne sepsis with changing patterns of organisms was seen over the period of four years with incidence of Group B Streptococcus declining from 34% in 1997-1998 to 17.8% in 1999-2000 and the incidence of CONS [Staphylococcus epidermidis] increasing from 20% in 1997-1998 to 35% in 1999-2000. Overall, due to survival and prolonged hospitalization of extremely low birth weight babies who need frequent invasive procedures, and the use of powerful antibiotics, the incidence of Staphylococcus epidermidis which was previously thought to be non pathogenic has increased over the years in neonatal intensive care units

Trends and causes of perinatal mortality in Muscat region

Despite improvements in antenatal care, the perinatal mortality in the Sultanate of Oman remains high compared to the developed countries. This study was aimed at the identification of rates, causes and risk factors affecting the perinatal mortality at Khoula Hospital in Muscat region. The study covered 100 stillbirths and 60 neonatal deaths from January 1999 through December 2001, out of a total of 10,896 babies born in this hospital during this period. The still birth rate was 10.7 per thousand births and early neonatal death rate was 5.5 per thousand live births with an overall perinatal mortality rate of 16.2 per 1000 births. The major risk factors identified were maternal morbidity in the form of diabetes, toxemia and hypertension, rural hospital care and male sex. 39% stillbirths were fresh and 59% babies weighed more than 2 kilograms. 48% were of more than 37 weeks gestation. 77% mothers were between 20 to 35 years of age. 68% mothers had more than 6 antenatal visits and 76% mothers visited for antenatal care in the first trimester with 88% visiting the hospital at least once during the last 4 weeks of pregnancy. The main reasons for early neonatal deaths were gross prematurity, pulmonary hypoplasia secondary to congenital renal anomalies, and multiple congenital anomalies with 25% babies weighing less than 750 grams. Conclusions: Stillbirths occur with equal frequency in all age groups of mothers in our region. There is a trend towards a decrease in the still birth rate, which is the main contributor to a high perinatal mortality rate in this region. Improvements in antenatal care during the last 4 weeks of pregnancy in moribund mothers and icreasing support for the gross preterm babies will lead to a marked improvement in perinatal mortality rates

Fraser's syndrome clinical spectrum and anaesthetic considerations in neonatal period

Fraser's syndrome which is a rare autosomal recessive disorder characterised by cryptophthalmos, defect of auricle, genital anomaly and syndactyly was seen in a neonate. This baby had all the findings originally described by Fraser and earlier known as cryptophthalmos syndactyly syndrome. The baby was taken for coloboma repair and then subsequently for syndactyly release after one month. On both occasions, anaesthetists had difficulty in intubating the baby due to laryngeal stenosis which is a rare association of Fraser's syndrome. The ultimate prognosis of such babies is poor due to multisystem involvement and as there is defect not only of eyelid formation but also associated ocular anomaly, the likelihood of achieving adequate visual perception is small

Meckel gruver's syndrome

Meckel Gruber's Syndrome, which is a rare autosomal recessive disorder characterised by occipitaI encephalocele, cleft lip and palate, microcephaly, hypoplastic or polycystic kidneys, was noted in 2 neonates at S.C.B.U.,Khoula Hospital. Both these babies were referred from Sur region and within a period of 5 months, but did not have any familial relation. Being a multisystem disorder, these patients seldom survive for few weeks to months and ultimately die due to severe central nervous defects or renal defects. Antenatal diagnosis of this condition with ultrasonic delineation of encephalocele or polycystic kidneys is possible. Also elevated levels of alpha fetoprotein may give a clue to the diagnosis