[Infant of diabetic mother, new epidemiology in [le centre de maternite et de neonatalogie] Tunis]

We retrospectively studied all infants of diabetic mothers [IDM] [n=326] born in the "Centre de Maternite et de Neonatologie de Tunis [CMNT]" during 2001. The purpose was to establish the epidemiological trends of IDMs and to analyze main perinatal complications. IDM group was compared for some variables to a control one of infants of non diabetic mothers [INDM]. Gestational Diabetes represented 80.2% of all diabetic mothers. Systemic hypertension associated to or preceding pregnancy was noted in 33.1% of IDMs. Delivery by caesarian section occurred in 54% of cases in the IDM group vs 29% in INDM group [p=0.0001]. Fetal macrosomia was the most frequent complication in IDM group [41.1%]. Congenital malformations were noted in 3.4% of IDM group and were more frequent if diabetes was pregestational. Other complications were frequently noted in IDM group such as prematurity [30.1%], hypertrophic cardiomyopathy [8.5%]; respiratory distress [13.1%] which was dominated by transient tachypnea. Metabolic complications where represented by hypoglycemia and hypocalcaemia [32.6% and 22.6% respectively]. Hyperbilirubinemia was observed in 8.3% and in 1.2% respectively in IDM and INDM groups. Neonatal lethality was 4% and perinatal lethality was 5.5% in IDM group. Comparing our results to the first studies carried out in the 80s in the CMNT, we noted significant decrease, in term of perinatal morbidity and mortality. This was explained by extension of screening policies associated with the multidisciplinary management of diabetic mothers and their offspring

[Kawasaki disease. About 9 cases]

To analyze epidemiologic, clinical and evolutive profile of Kawasaki disease, we studied retrospectively 9 cases of children with Kawasaki disease fulfilled during ten years [1994 - 2003]. It is about 8 boys and 1 girl, aged from 4 months to 9 years [mean age at 3 years].5 patients fulfilled at least 5 major criterias of The illness and the four others presented an incomplete form We noted cardiac manifestations in 3 patients, neuromeningeal, renal and digestive symptoms in 5 cases for each one, articular in 2 cases and pulmonary in 1 case. Biologic inflammatory syndrome is present in all cases and high rate of platelets has been found in 6 cases/9. Aspirin with anti inflammatory dose has been instituted in 8 cases / 9. Intravenous immunoglobulin has been administrated in 6 cases /9. Cardiac manifestations have disappeared completely in the 3 cases. The outcome has been favorable for all cases. In conclusion, Kawasaki disease is unknown rather rare, incomplete or atypic forms are frequents and source of diagnostic delay. Early treatment permit to improve the prognosis of this disease