Neonatal sepsis: Incidence, risk factors, common pathogens and antimicrobial pattern in a multiethnic population in Ajman, UAE

To determine the incidence, source of infection, impact of gestational age, pattern of delivery, birth weight, feeding pattern on the occurrence of neonatal sepsis and to assess the frequency of pathogens and their antibiotic susceptibility pattern. Medical record review based study was done during Jan-Dec 2011 at GMCH Ajman. Blood was collected aseptically before the administration of antibiotics from 255 sepsis suspected neonates for culture by BACTEC system. The microorganisms isolated were identified by Gram staining and biochemical test; these isolates were further subjected for antibiogram by Kirby-Bauer disc diffusion method. Analysis was performed on SPSS version 20. The neonates were from 28 nationalities, 82% were Asians. Male female ratio was 61: 59. The proportion of sepsis was 6.6%; of which male female ratio was 76:24. Of the 209 early onset sepsis [EOS] cases 8 were culture proven sepsis, and among the 46 late onset sepsis [LOS] cases 9 were culture positive. Of the culture proven cases, 65% were preterm and 35% were term neonates. Of which 53% were delivered by caesarian section and 47% by vaginal delivery. Thirty five percent were low birth weight, 47% were normal birth weight and 18% were overweight. Eighty eight percent were breast fed, 6% were breast fed along with infant formula and 6% were on IV fluids. Microorganisms isolated were Candida albicans, Staphylococcus species, Streptococcus species and Gram negative bacilli. Gram negative bacilli showed 100% susceptibility towards Amikacin, Augmentin and Ciprofloxacin. Gram positive cocci were 100% susceptible for Azithromycin, Ciprofloxacin and Chloramphenicol. The proportion of sepsis among the suspected neonates was 6.6% with male predominance. Mortality rate was 5.8% among the sepsis proven neonates. Multidrug resistance was not observed among the isolates. The response towards the prophylactic and therapeutic antibiotic regime was effective for the prognosis of sepsis

rare case of tyrosinemia presenting with abdominal distension with shock

Tyrosinemia type I is the most severe disease of the tyrosine catabolic pathway resulting from deficiency in fumaryl acetoacetate hydrolase [FAH] leading to elevation of tyrosine in liver, kidney and peripheral nerves. It is characterized by hepatic failure, cirrhosis, renal dysfunction, hepatocarcinoma, and neurologic crisis. The estimated prevalence of type I tyrosinemia worldwide is <1 in 100,000. We present a rare case of tyrosinemia presenting with abdominal distension and shock. A two-month old male child of 2[nd] degree consanguineous marriage was born prematurely and was small for gestation [SGA baby]. She was noted to have neonatal hyperbilirubinemia in the immediate neonatal period. Weight gain remained poor in spite of adequate feeding and supplementation. Persistent abdominal distension was noted, and anti-flatulence drugs were administered for the same, with no improvement noted. X-ray showed gaseous distension of abdomen. Tests for hypothyroidism and Hirschisprung disease were normal. The baby had persistent vomiting; ultrasonography was normal. After one month she developed cold clammy extremities with thread pulse, poor urine output persistent vomiting with significantly distended abdomen. Investigations revealed E-coli positive UTI for which appropriate antibiotics were started. However, the condition of the baby deteriorated and baby developed metabolic acidosis which was initially attributed to resistant E-coli sepsis. On investigating further, an elevated level of alpha fetoprotein [AFP] was noted. The other reports revealed significant coagulopathy and the algorithmic work up revealed tyrosinemia. Tyrosinemia type 1 should be differentiated from other causes of hepatitis and hepatic failure in infants

Progeroid syndrome of De Barsy with hypocalcemic seizures: a case report and review of literature

De Barsy et al first reported a rare cutaneo-oculo-cerebral malformation syndrome, now commonly referred as 'progerioid syndrome of de Barsy'. It is the constellation of progeria-like appearance, cutis laxa, intrauterine growth retardation, cornea clouding and hypotonia. We report a case of Debarsy syndrome in a neonate presented at birth with typical clinical features with hypocalcemic seizures. There are no previous reports among those of Afghani origin and this also is the first case reported from United Arab Emirates. There have been no reported cases of hypocalcemic seizures

Autoamputation of congenital hairy polyp in neonate with stridor and respiratory failure

Hairy polyp of the oronasopharynx is an uncommon developmental malformation that is most frequently seen as a pedunculated tumor in the neonate. Derived from the ectoderm and mesoderm, this benign tumor generally has been classified as dermoid. We describe a neonate with a hairy polyp originating from the right lateral pharyngeal wall causing significant respiratory distress with cyanosis and stridor immediately after birth. Symptoms in the neonate disappeared following autoamputation of the mass. To our knowledge, this is the third case described in literature, with full following autoamputation of a hairy polyp