Causes of global developmental delay in Children Welfare Teaching Hospital-Baghdad

There are wide ranges of causes behind global developmental delay in Iraqi children but most of these causes were not diagnosed as a result of unavailable diagnostic tools. To study the etiology of global developmental delay in Children Welfare Teaching Hospital / Baghdad. A descriptive study was done on 75 patients, their age range from 8 months to 5.5 years with global developmental delay, who consult Children Welfare Teaching Hospital/Baghdad, from 1[st] of May 2010 to 1[st] of October 2010. A full history, thorough physical examination, and developmental assessment according to Denver Developmental Scale two were done to all cases. A group of selected investigations including neuroimaging [CT and MRI], EMG, EEG, visual and hearing assessment, screen for metabolic diseases, and thyroid function test were done as needed for the diagnosis. A total of 75[preschool] patients with age range from 8 months to 5.5 years were studied; 45[60%] of them were males and 30[40%] were females, 9[12%] were preterm, 26[34.6%] were born with LBW, 3[4%] of patients acquired the infection with TORCH from their mothers [2[2.7%]CMV, 1[1.3%] toxoplasmosis], 8[10.7%] had their mothers complained from chronic diseases [hypertension and diabetes mellitus], 11[14.7%] suffered birth asphyxia, 2[2.7%] with high bilirubin level exceeding 20mg/dl, 2[2.7%] patients suffered RDS and 1[1.3%] suffered sepsis diagnosed by blood culture during neonatal period .Family history of developmental delay was reported in 11[14.7%] and consanguinity was reported in 46[61.3%] of cases, in 33[43.9%] no cause could be identified, CNS infections 9[12%], Down syndrome 7[9.3%], hypothyroidism 2[2.7%], intracranial hemorrhage 2[2.7%], infantile spasm 2[2.7%], phenylketonuria 2[2.7%], Myotonia Dystrophica 1[1.3%], and Seckel syndrome 1[1.3%]. Global developmental delay in pediatric practice has wide etiology. The majority of cases were not diagnosed because of deficient diagnostic tools like cytogenetic analysis. High percent of perinatal etiology raises the importance of good maternal and neonatal care. Under diagnosis of inborn error of metabolism due to lack of routine screening in neonatal period, aggravated the problem.

Kerosene poisoning in children

Accidental kerosene ingestion is the commonest cause of poisoning and its subsequent mortality and morbidity in children less than five year of age in developing countries. Low socio- economic status and frequent use of kerosene for cooking, lighting and heating are the major cause. To study the epidemiology, presentations and radiological appearance of kerosene poisoning in children. A prospective study comprised fifty patients, who were admitted with accidental kerosene poisoning into children welfare hospital in medical city complex /Baghdad. In the period from the 1[st] of January to the 31[st] of august 2008. History was taken from the relatives on a specially designed questionnaire. Every patient was examined completely concentrating on symptoms of cough, dyspnea, cyanosis, drowsiness, vomiting, and fever. Chest X-ray was done to every patient after 6-8 hours from the time of ingestion. White blood cell count was done to 39 patients within the 1[st] 24 hour of admission. Fisher's exact test was considered for the statistical analysis with a significance level of P< 0.05. Of the fifty admitted children, 86% of them aged between 1-3 years, 31[62%] were boys, the majority from poor and crowded families, and the kerosene ingested, in the majority, from small containers. The most common presentations were cough [96%], fever [94%] and dyspnea [80%].Vomiting which occurred in 90%, had a significant association with the development of pneumonitis the major radiological abnormality was right lower lobe infiltration in 16 patients [32%]. The major complication was pneumothorax, pleural effusion and respiratory failure. Fever appeared in 94% of the patients in the first 24 hours, lasting 2-7 days. Pneumonitis occurred in 42 patients who were diagnosed clinically and radiologically. All patients improved except one who died. All the kerosene poisoning was accidental, occurred in children under five year of age. Ignorance and poor storage of kerosene played a big role in the kerosene ingestion process. The respiratory system is the main target involved. Vomiting playing a role in the development of pneumonitis

G6PD deficiency and neonatal jaundice

Glucose-6- phosphate dehydrogenase [G6PD] deficiency is the most common human enzyme deficiency in the world, and a common cause of neonatal jaundice in Iraq. To study the burden of G6PD deficiency on the development of hyperbilirubinemia in neonates, and analyze some possible associated risk factors. A prospective study was conducted in the Neonatal Care Unit in Children Welfare Teaching Hospital in Medical City, Baghdad; from the 5th of August 2006 till 10th of March 2007. Hundred newborn babies with neonatal jaundice [clinically and biochemically] and another 100 newborns were not jaundiced [control group] were studied. A methemoglobin reduction test used to assay the activity of G6PD. In this study, 30 [30%] of neonates with jaundice had G6PD deficiency while only 8 [8%] had G6PD deficiency in nonjaundiced. Twenty four [80%] of the G6PD deficient were males and 6 [20%] were females. In both normal and G6PD deficient groups, reticulocyte counts were normal.. Glucose-6- phosphate dehydrogenase [G6PD] deficiency can lead to an increased risk of neonatal hyperbilirubinemia with significant number of patients required exchange blood transfusion 12 [40%]. We recommend to do cord blood G6PD screening and early detection of the enzyme deficiency in high risk populations with high prevalence such as our community, in order take approproate measures to prevent the complications of hemolysis and future problems of neonatal jaundice due to G6PD deficiency

Guillan Barre Syndrome clinical profile and the efficacy of different modalities of treatment

Seventy five patients with Guillain-Barre syndrome [GBS] admitted to 3 centers in Baghdad between January 2000 to June 2002 at ages 6months-15 years were studied for various clinical and cerebrospinal fluid aspect, complications.outcome of illness in different modalities of treatment [plasma pheresis, steroid therapy, supportive care]. It was found that 44 of them were males and 31 were females in ratio male:female 1.4:1. It was found that 60% of them had upper and lower limbs paralysis and 40% had only lower limbs paralysis. 76% had sensory changes, 33% had cranial nerves involvement, 20% had meningeal irritation, 68% had elevated protein in cerebrospinal fluid. Respiratory involvement was found in 28 patients [37%], 21 patients needed ventilatory support. Mortality rate was 4% [3 patients], all died in respiratory care unit [RCU] due to cardiac complications and secondary infections. Sixty percent of the patients had upper respiratory tract infection preceded the illness, 20% of patients had gastrointestinal problems, 2.67% of patients had history of DPT and oral polio vaccine, 10.67% of the patients had fever, 6.67% of the patients had no any previous pathology. Autonomic disturbances was found in 42.6% of the patients. Fifteen patients received plasma pheresis [recovery rate 93%].Twenty patients received steroids [recovery rate 75%, mortality rate 10%], 40 patients received supportive [recovery rate 88%,mortality rate 2%]

Slowly developing isoniazid poisoning

A 9-year-old girl suffering from nephrotic syndrome and pulmonary tuberculosis was given a dose of 700 mg of isoniazid three times daily for six days by her mother, with the intention to compensate for having terminated therapy without medical advice. She developed the general pattern of reactions characteristic of acute isoniazid overdose i.e. nausea and vomiting followed by stupor, hypereflexia and a bilateral Babinski's sign. A transient hepatic injury, illustrated by increased values of liver enzymes, was also present. The clinical picture, the course of the illness, the treatment and outcome are described