Esophageal perforation in neonates: a report of seven cases from Kuwait

Preterm neonates exposed to invasive procedures are at risk of esophageal perforation [EP]. We are reporting a series of seven cases of EP, which have occurred in the neonatal intensive care unit [NICU] of Farwaniya Hospital, Kuwait, over a period of nine years [1994-2002]. This gives an incidence of one in 8,118 live births and one in 278 NICU admissions. All patients were premature [below 32 weeks] and were exposed to various invasive procedures. Two cases had a tentative diagnosis of esophageal atresia at the time of presentation. Other five cases presented with a feeding tube in an ectopic position and air leak syndrome. All cases were managed conservatively. The perforations healed without any complication. The overall outcome was good as none of the mortality and morbidity was attributed to EP. Our objective in this report is to highlight the existence of this problem and emphasize the importance of its early diagnosis, management and prevention. Misdiagnosis might lead to unnecessary investigation and / or surgical intervention

Misuse of antimicrobial agents in neonatal units: a cross-sectional survey in Kuwait

To evaluate the justification for the use of antimicrobial agents and to verify the possibility of its misuse among inpatient neonates. A cross-sectional 1-day study was conducted. Two questionnaires A and B relating to inpatient neonates were filled by registrars working in the four neonatal units of the main regional hospitals [Maternity, Farwaniya, Adan, and Jahra]. The objectives of the study were not revealed to the registrars. Of the 119 patients, 57 [48%] were on antimicrobial agents, and the cultures yielded positive in 25/57 [44%]. The organisms were reported not to be susceptible to the antimicrobial agents in use in 19/25 [76%] of the cases, but it was continued in 4/19 [21%]. Antimicrobial agents were also continued in another 9/32 [28%] despite negative culture results. Misuse of antimicrobial agents was homogeneously observed at various levels in all neonatal units. This implies that urgent action should be taken to overcome this problem

Perinatal and neonatal mortality trends over fifteen years in Farwania hospital-Kuwait

Reviewing perinatal and neonatal mortality trends during the last fifteen years [1982-1996] revealed a gradual improvement in the reduction of these rates. The latest achieved perinatal mortality rates were 12.9 and 15.6 per 1000 total births and the neonatal mortality rates were 4.4 and 6.6 per 1000 total live births for the years 1995 and 1996 respectively. This improvement was interrupted by a period of deterioration during and following the Iraqi invasion in 1990. Although the impact of an improved neonatal service after the application of intensive care unit [NICU] facilities was documented by a statistically highly significant improvement in mortality rates as the two periods were compared before and after these facilities were in use, changes in mortality rates are far from being a unifactorial phenomenon. It would be very difficult to determine how much this event contributed to the observed changes in mortality pattern as other factors might have a significant role

Bacterial septicemia in farwania neonatal unit - Kuwait

A retrospective study was done over a two year period as a part of continuous surveillance of neonatal septicemia in Farwania Regional Hospital. The aim of this study was to identify the causative organisms and their antibiotic sensitivities in order to implement an antibiotic regime suitable for affected neonates. The study identified 99 culture-verified septicemia episodes in 94 neonates representing an incidence of 6.8 per 1000 live births. Gram positive cocci namely Streptococcus viridans and group B Streptococcus presented as the commonest organisms in very early and early onset infections [51.2%]. Gram negative bacilli : Kiebsiella pneumoniae [K. pneumoniae] and Escherichia coli [E. coli], were the major contributors to late onset sepsis [75%]. The antibiotic sensitivity pattern indicated limited resistance amongst the isolates in early infections making the use of simple broad spectrum antibiotics such as ampicillin and an aminoglycoside justifiable. Broader spectrum antibiotics such as third generation cephalosporins or imipenem are needed for acquired gram negative nosocomial infections. Despite early therapeutic intervention, the overall mortality was 26.6%. Gram negative septicemia and very low birth weight were high risk factors associated with high fatality