Neonatal screening for absolute lymphopenia

Background: Blood counts with manual differentials could diagnose nearly all cases of severe combined immune deficiency [SCID] at birth

Objective: The aim of this study was to outline the prevalence of neonatal lymphopenia among newborns of Obstetrics and Gynecology Hospital, Ain Shams University as an entry to neonatal screening for SCID

Methods: Complete blood counting [CBC] with manual differential was performed in the cord blood of 500 newborns. Absolute lymphopenia was considered if the count was less than 2500 lymphocytes/mm3. Parents of lymphopenic infants were advised not to give them any live attenuated vaccines before doing further investigations. The lymphopenic infants were followed up by another CBC after one month

Results: In the present study, absolute lymphopenia was found in 8 [1.6%] neonates at delivery. Among our series 44.4% were primigravida and 55.6% were multigravida. Also, 84 [16.8%] experienced pre-mature rupture of membrane, 89 [17.8%] reported maternal diseases and maternal drug intake was reported in 73 [14.6%]. Three neonates had congenital anomalies, one only experienced dysmorphic features and 8 [1.6%] had family history of unexplained death but these data could not be linked to the presence of lymphopenia in the studied sample. APGAR scores at 1 and 5 minutes were significantly lower in neonates with lymphopenia [p = 0.001]. A significant positive correlation was elicited between the absolute lymphocyte count [ALC] and maternal age, total leukocyte count, and HCT [p = 0.003, 0.001 and 0.031 respectively]. Also a significant negative correlation was found between ALC and gestational age, mean corpuscular hemoglobin and mean corpuscular hemoglobin concentration [p = 0.013, 0.003 and < 0.001 respectively]

Conclusion: Lymphopenia is not an uncommon finding among neonates at screening and is noted to be associated with a lower Apgar score. Serial counting and follow up is needed before considering the diagnosis of SCID

Study of the effect of maternal malnutrition and antenatal care on pregnancy outcome among women living in squatter areas of Cairo, Egypt

Adequate maternal nutrition and proper antenatal and natal care can prevent unfavorable outcome of pregnancy. The present study aims to assess the quality of antenatal care, to study the prevalence of some maternal nutritional health problems and to study their effect on the outcome of pregnancy among ever-married women in the childbearing period [15-49 years] in some squatter areas of Cairo Governorate. The study examined 1164 ever-married women in the childbearing period. The sample size was calculated according to each indicator required to be measured and according to the prevalence of the studied problems. Six unplanned poor areas of Cairo were chosen randomly. A questionnaire sheet was designed to collect data from ever married women in the childbearing period in the household. It contained information about pregnancy care and pregnancy outcome for the last five years. Weight and height were measured for the entire studied sample and detection of hemoglobin level was done for a subsample of 303 women. The results revealed that the percentage of women who received antenatal care [ANC] in their last pregnancy was 55.6% and the quality of ANC was mostly poor [62.9%] in all squatter areas. Around half of children in squatter areas were born at home [48.2%] and doctors assisted more than half [56.0%] of all deliveries whereas pregnancy or delivery complications were detected in 27.9%. The overall percentage of the unfavorable outcome of pregnancy [abortion, stillbirth and ectopic pregnancy] was 22.5%. The percentage of women who had body mass index [BMI] below 18.5 was 3.4% indicating chronic energy deficiency. There was a high prevalence of severe anemia among non-pregnant [10.5%] and pregnant women [10.3%] and all the studied squatter areas showed high prevalence of moderate anemia among pregnant [76.5%] and non-pregnant [61.5%] women. The study concludes that there are high prevalence of moderate and severe anemia and high percentage of obesity [35.2%], the quality of ANC is mostly poor [62.9%] in all squatter areas and that the significant risk factors affecting unfavorable outcome of pregnancy are: poor quality of ANC, low maternal age and height [