Burden of Early Life Obesity and Its Relationship with Protein Intake in Infancy: The Middle East Expert Consensus / 대한소아소화기영양학회지

Adequate nutrition in early life is proposed to shape a child’s future health by launching the growth trajectory in the proper direction, which helps to avoid negative metabolic programming effects. Protein intake during infancy and early childhood is of great importance, as it plays a key role in infant metabolic programming and the future risk of obesity. Breastfeeding provides the best nutrition in early life, with many benefits tailored for the baby, including the appropriate quantity and quality of proteins. Considering the high prevalence of childhood, and subsequent adult, obesity in the region, a virtual Middle East expert consensus meeting was held to discuss an effective approach for managing childhood obesity. Leading pediatric experts from Bahrain, Egypt, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates participated in the meeting. The experts discussed, debated, and agreed on certain directions, including the importance of educating parents, endorsing breastfeeding, and ensuring optimum quantity and quality intake of proteins in early life.This expert consensus may serve as the starting point for healthcare professionals in the region who are interested in shaping a healthy future for the generations to come.

Interpreting neonatal growth parameters in Oman: are we doing it right?

Objectives: This study aimed to compare reference anthropometric measures of Omani neonates with the international standard growth charts of the World Health Organization [WHO] in order to determine the appropriateness of these growth charts to assess the growth of Omani neonates

Methods: This cross-sectional study included all healthy full-term Omani neonates born between November 2014 and November 2015 at the Sultan Qaboos University Hospital, Muscat, Oman. Birth weight, length and head circumference measurements were identified and compared to those of the 2006 WHO growth charts

Results: A total of 2,766 full-term neonates were included in the study, of which 1,401 [50.7%] were male and 1,365 [49.3%] were female. Mean birth weights for Omani males and females were 3.16 +/- 0.39 kg and 3.06 +/- 0.38 kg, respectively; these were significantly lower than the WHO standard measurements [P <0.001]. Similarly, the mean head circumferences of Omani males and females [33.8 +/- 1.27 cm and 33.3 +/- 1.26 cm, respectively] were significantly lower than those reported in the WHO growth charts [P <0.001]. In contrast, mean lengths for Omani males and females [52.0 +/- 2.62 cm and 51.4 +/- 2.64 cm, respectively] were significantly higher than the WHO standard measurements [P <0.001]

Conclusion: The WHO growth charts might not be appropriate for use with Omani neonates; possible alternatives should therefore be considered, such as national growth charts based on local data

Factors responsible for the prolonged stay of surgical neonates in intensive care units

The length of hospital stay [HS] for patients is a major concern due to its social, economic and administrative implications; this is particularly important for neonates admitted to intensive care units [ICUs]. This study aimed to determine the factors responsible for prolonged HS in surgical neonates. This retrospective study was conducted at Sultan Qaboos University Hospital, in Muscat, Oman. The medical records of 95 neonates admitted to the neonatal ICU who underwent general surgical procedures between July 2009 and June 2013 were reviewed. Mann-Whitney U and Pearson's Chi-squared tests were used for non-parametric numerical and categorical variables, respectively. A multiple regression analysis was performed to find a relationship between the variables and to detect the most important factor responsible for prolonged HS. A P value of <0.05 was considered statistically significant. Gestational age, birth weight, number of days on a ventilator and postoperative morbidity were associated with prolonged HS. Furthermore, the age of neonates at first full enteral feed was associated with increased HS using both independent and multiple regression analyses. Prolonged HS can occur as a result of many factors. In this study, a number of factors were identified, including low gestational age, low birth weight, increased number of days on a ventilator and postoperative morbidity. Additionally, neonate age at first full enteral feeds also correlated with increased HS. Further research on this topic is suggested to explore this correlation in more detail and to inform future practices

Changing survival rate of infants born before 26 gestational weeks: single-centre study

This study aimed to evaluate the changing survival rate and morbidities among infants born before 26 gestational weeks at the Sultan Qaboos University Hospital [SQUH] in Muscat, Oman. This retrospective study assessed the mortality and morbidities of all premature infants born alive at 23-26 gestational weeks at SQUH between June 2006 and May 2013. Infants referred to SQUH within 72 hours of birth during this period were also included. Electronic records were reviewed for gestational age, gender, birth weight, maternal age, mode and place of delivery, antenatal steroid administration, morbidity and outcome. The survival rate was calculated and findings were then compared with those of a previous study conducted in the same hospital from 1991 to 1998. Rates of major morbidities were also calculated. A total of 81 infants between 23-26 gestational weeks were admitted to the neonatal unit during the study period. Of these, 58.0% were male and 42.0% were female. Median gestational age was 25 weeks and mean birth weight was 770 +/- 150 g. Of the 81 infants, 49 survived. The overall survival rate was 60.5% compared to 41% reported in the previous study. Respiratory distress syndrome [100.0%], retinopathy of prematurity [51.9%], bronchopulmonary dysplasia [34.6%], intraventricular haemorrhage [30.9%] and patent ductus arteriosus [28.4%] were the most common morbidities. The overall survival rate of infants between 23-26 gestational weeks during the study period had significantly improved in comparison to that found at the same hospital from 1991 to 1998. There is a need for the long-term neurodevelopmental follow-up of premature infants

Multiple enteric duplication cysts in a twin fetus

Enteric duplication cysts are rare congenital anomalies of the gastrointestinal tract. These can be suspected if cystic lesions are noted in the fetal abdomen during an antenatal ultrasonogram. The differential diagnoses of fetal intra-abdominal cystic lesions include fetal omental cysts, fetal mesenteric cysts, meconium pseudocysts and fetal ovarian cysts. We report an antenatally diagnosed enteric duplication cyst in one of a set of twin fetuses which was managed successfully

patterns and causes of neonatal mortality at a tertiary hospital in Oman

To report the patterns and causes of neonatal death from a tertiary care neonatal intensive care unit over a period of four years. This is a retrospective cohort study where four years data [January 2006 - December 2009] of all inborn neonatal admissions and deaths were collected from the neonatal intensive care unit at Sultan Qaboos University hospital on predesigned forms. All out born admissions and deaths were excluded. The causes of neonatal death were classified using Wigglesworth's classification. The number of inborn live births during the study period was 10064 and the total number of inborn neonatal admissions was 1475. The total deaths [neonatal and post neonatal] at the neonatal intensive care unit was 73 [63 inborn and 10 out born]. Among the inborn, five deaths were post neonatal deaths and hence, excluded from analysis. Among the remaining inborn neonatal deaths [n=58], 34 [59%] were males and 24 [41%] were females. The number of neonatal admissions increased over the years during the study period from 248 to 356, while the number of deaths also increased from 10 deaths in 2006, to 20 deaths in 2009. The primary causes of neonatal deaths were prematurity and its complications 52% [n=30]. Lethal congenital malformations lead to 17 [29%] newborn deaths, specific diagnosis in 7 newborns [12%], and birth asphyxia in four [7%] of cases. There was an increasing trend of neonatal admissions and deaths among inborn babies. Prematurity, with sepsis as its major complication and congenital malformations were the leading cause of neonatal mortality.

Spontaneous resolution of fetal and neonatal ascites after birth

Fetal ascites is an uncommon abnormality usually reported in relation to non- immunological causes. The prospect for fetal and neonatal mortality is high, particularly when the ascites develops before 24 weeks of gestation. The diminution of severe fetal ascites without intrauterine management, especially with an uncomplicated neonatal outcome, is unusual. We report a case of isolated fetal ascites detected at 20 weeks' gestation. All investigations carried out were normal. Consecutive ultrasound examination showed ascites at 20 weeks' gestation. A follow-up ultrasound examination at 6 months of age revealed complete recovery from the ascites. Spontaneous resolution of fetal ascites, with a good prognosis, can occur in cases with an idiopathic aetiology

Breast-Feeding Protects Infantile Diarrhea Caused by Intestinal Protozoan Infections

This study investigated the effect of breast-feeding in protection against protozoan infection in infants with persistent diarrhea. Infants were classified into 2 groups; 161 breast-fed infants and the same number of non-breast-fed infants. Microscopic examinations of stool were done for detection of parasites and measuring the intensity of infection. Moreover, serum levels of IgE and TNF-alpha were measured by ELISA. Cryptosporidium spp., Entamoeba histolytica/Entamoeba dispar, Giardia lamblia, and Blastocystis sp. were demonstrated in infants with persistent diarrhea. The percentage of protozoan infections was significantly lower in breast-fed infants than that in the non-breast-fed infants. The levels of IgE and TNF-alpha were significantly lower in the breast-fed group than in the non-breast-fed group. There were significant positive associations between the serum levels of IgE and TNF-alpha and the intensity of parasite infection in the breast-fed group. It is suggested that breast-feeding has an attenuating effect on the rate and intensity of parasite infection.

Diagnosis of microvillous inclusion disease: a case report and literature review with significance for Oman

Microvillous Inclusion Disease [MVID] is one of the congenital diarrheal disorders [CDD] caused by genetic defects in enterocyte differentiation and polarization. Its prevalence is higher in countries with a high degree of consanguinity. It causes severe, intractable secretory diarrhea leading to permanent and definitive intestinal failure with resultant dependency on parenteral nutrition [PN]. Small bowel transplantation is the only curative treatment. The gold standard for diagnosis are the typical morphological abnormalities in small bowel biopsies on light and electron microscopy [EM]. In recent times, histochemistry and immunohistochemistry have shown sufficient diagnostic accuracy replacing EM if the facility is unavailable or EM findings are inconclusive. We describe a neonate with CDD who was diagnosed to have MVID on the duodenal biopsy by morphohistochemical and immunophenotypic methods used for the first time in Oman. By utilizing such easy and accessible diagnostic methods, a rare genetic disorder could be diagnosed with certainty and the family could be counseled accordingly. With a high degree of consanguinity in the region, the prevalence of MVID in Oman needs to be identified once these patients are diagnosed by utilizing appropriate investigations. Care of such patients necessitates improving current parenteral nutrition services and addressing the future need for small bowel transplantation [SBTx], in Oman

Study of the alterations of total plasma homocysteine levels and atherogenic lipid profile in hypothyroidism

Hypothyroidism is associated with increased cardiovascular morbidity, which cannot be fully explained by the atherogenic lipid profile observed in these patients. Elevation of total plasma concentrations of homocystein [t-Hcy] is an important and independent risk factor for cardiovascular disease. Because hypothyroidism decreases hepatic levels of enzymes involved in the remethylation pathway of homocystein, we prospectively evaluated fasting t-Hcy in hypothyroid patients before and after recovery of euthyroidism. In the current study we examined 40 patients with peripheral hypothyroidism [12 with autoimmune thyroiditis, 10 with Graves’ disease, [treated surgically 0r carbimazole], 2 with toxic multinodular goiter [treated surgically], 12 surgically resected goiter, and 4 with idiopathic hypothyroidism] in comparison with those of 25 hyperthyroid patients and 25 euthyroid control subjects with the same age and sex attending the outpatient and the inpatient departments of general surgery, Mansoura University Hospital. In all cases, a detailed medical history was obtained and a thorough physical examination was performed with emphasis on the presence of symptoms / signs indicative of underlying thyroid disorders. In addition to plasma lipid parameters, thyrotropin [TSH], T3, T4 and t-Hcy levels were measured in a fasting blood samples. Fasting t-Hcy levels were higher in patients with hypothyroidism in comparison with those of hyperthyroid patients and euthyroid control subjects. Plasma t-Hcy in hypothyroidism was significantly correla ted with high TSH and lipoprotein [a] levels [r = 0.306, P = <0.01 and r = 0.476, P = <0.001, respectively]. The restoration of euthyroid state with levothyroxine therap [75 ug/day] was followed by a significant improvement of plasma lipid profile. Also, thyroid hormone replacement significantly decreased fasting t-Hcy. We confirmed the observation of hyperhomocysteinemia in hypothyroidism, which together with the elevated plasma lipoprotein [a] may contribute to an accelerated atherogenesis in these patients. As hypothyroidism may be a treatable cause of hyperhomocysteinemia, and as fasting t-Hcy is associated with a significant increased relative risk of coronary artery disease, measurement of t-Hcy to screen this dynamic association of cardiovascular riskfactors during hypothyroidism may be of interest