Early onset neonatal sepsis, rule out viral infection

This cross-sectional prospective study was an attempt to define the frequency of viral infections in early onset neonatal sepsis. It was conducted on 260 septic neonates with different diagnoses who had been admitted to Neonatal Intensive Care Unit, affiliated to Obstetric and Gynecology Department, Ain Shams University Hospitals throughout one year from November 2001 to October 2002. Their mean gestational age was 35.9 +/- 3.7 weeks, their mean birth weight was 2.4 +/- 1.08 kg and their mean postnatal age was 12.35 +/- 10.34 days. They included 148 males and 112 females. The results of this study revealed that 49 out of 260 septic neonates [19%] were diagnosed as virus infected using different cell cultures. Seven viruses were identified by indirect fluorescent antibody tests [IFA] which were in order of frequency; cytomegalovirus [5%], respiratory syncytial virus [3.4%], Echo-11 [3.1%], Echo-14 [2.7%], Coxsackie B5 [2.7%], mumps [1.2%] and parainfluenza type 3 [0.8%]. Most of virus infected cases presented with low Apgar score, low or very low birth weight, prematurity, jaundice, peticheal rash, in addition to signs of sepsis. Meanwhile, respiratory viruses [respiratory syncytial virus, parainfluenza virus] were the major pathogens among respiratory distressed infants, enteroviruses, cytomegalovirus and mumps were implicated in neonates with multiple congenital malformations. Cytomegalovirus was the most prevalent single virus isolated. Thirteen cases out of 260 septic neonates proved to be CMV positive. 77% were congenitally acquired, while 23% were postnatally acquired. These neonates presented with various clinical presentations, the most common were prematurity [85%], very low birth weight [62%], jaundice [54%] and hepatosplenomegaly [46%], meanwhile congenital malformations were recorded in 23% of cases [microcephaly, congenital hernia and congenital cataract]. Mortality rate was 46%. It is concluded from this study that viral infection is significantly implicated in the etiopathogenesis of neonatal sepsis. So, this study should raise the awareness of the neonatologists for the diagnosis and anticipation of the potential implications of virus infection on the subsequent growth and development of the newborn infants.

Growth and developmental status in chronic renal insufficiency in infancy and early childhood

This study was carried out to evaluate growth and developmental status of 60 infants with chronic renal insufficiency that occurred before the age of one year as a result of congenital renal disorder. All patients received standard treatment of CRF and patients on corticosteroids were excluded. Ten patients with ESRD underwent peritoneal dialysis. An adequate caloric intake was supplied to ensure proper weight for all patients. Clinical, skeletal, anthropometric, nutritional and developmental assessments were done for all patients. It was concluded that chronic renal insufficiency in infancy may have serious impacts on growth and development that may not be prevented by adequate nutrition

genetic study of the association of ear and oral anomalies

The study included 43 cases presenting with ear anomalies. All revealed associated oral anomalies. The pattern of association of ear and oral anomalies in each syndrome was studied for accurate phenotypic delineation of these syndromes. The cases represented 11 different genetic syndromes and were classified into seven groups, namely Cornelia de Lange, Smith Lemli Opitz [S.L.O.]. Seckel, Coffin-Siris, Treacher Collins, Rubinstein Taybi and other syndromes with deafness. The low set ear was a common finding in the Cornelia de Lange and the Coffin Siris syndromes. Hearing loss was present in some cases of both syndromes being conductive in Coffin Siris syndrome and variable in Cornelia de Lange syndrome. High arched palate was observed in both syndromes, lips were small "thin" in de Lange and large "thick" in Coffin Siris and philtrum was long in de Lange and short in Coffin Siris syndrome. Macroglossia was only observed in Coffin Siris and Mucopolysaccharidosis syndromes. Posteriorly rotated large ears were observed in both the S.L.O. and the Rubinstein Taybi syndromes. However, ears were protruding in S.L.P. and low set and cupped in Rubinstein Taybi. The palate was high arched in S.L.O., but Rubinstein-Taybi showed in addition narrow and cleft palate. High arched narrow palate was only present among the Rubinstein Taybi syndrome cases. Small ears with or absent lobule were common findings in Seckel syndrome associated with micrognathia. Small ears with malformed helices were constant in all cases of Treacher Collins syndrome and conductive hearing loss was common. This was associated with hypoplastic maxilla and mandible. Sensorineural hearing loss was present in the three cases with Warrdenburg syndrome and was associated with high palate in all. These associations might be explained on the basis of single gene defect causing each syndrome, but additionally we can not ignore the effect of environmental familial interaction during the period of ear and oral embryogenesis