Methamphetamine abuse during pregnancy and its health impact on neonates born at Siriraj Hospital, Bangkok, Thailand.

To ascertain the impact of intrauterine methamphetamine exposure on the overall health of newborn infants at Siriraj Hospital, Bangkok, Thailand, birth records of somatic growth parameters and neonatal withdrawal symptoms of 47 infants born to methamphetamine-abusing women during January 2001 to December 2001 were compared to 49 newborns whose mothers did not use methamphetamines during pregnancy. The data on somatic growth was analyzed using linear regression and multiple linear regression. The association between methamphetamine use and withdrawal symptoms was analyzed using the chi-square. Home visitation and maternal interview records were reviewed in order to assess for child-rearing attitude, and psychosocial parameters. Infants of methamphetamine-abusing mothers were found to have a significantly smaller gestational age-adjusted head circumference (regression coefficient = -1.458, p < 0.001) and birth weight (regression coefficient = -217.9, p < or = 0.001) measurements. Methamphetamine exposure was also associated with symptoms of agitation (5/47), vomiting (11/47) and tachypnea (12/47) when compared to the non-exposed group (p < 0r =0.001). Maternal interviews were conducted in 23 cases and showed that: 96% of the cases had inadequate prenatal care (<5 visits), 48% had at least one parent involved in prostitution, 39% of the mothers were unwilling to take their children home, and government or non-government support were provided in only 30% of the cases. In-utero methamphetamine exposure has been shown to adversely effect somatic growth of newborns and cause a variety of withdrawal-like symptoms. These infants are also psychosocially disadvantaged and are at greater risk for abuse and neglect.

Neonatal group B streptococcal infection: incidence and clinical manifestation in Siriraj Hospital.

From 1996 to 2001, nineteen episodes of bacteremia due to group B Streptococci (GBS) were diagnosed in Siriraj Hospital, Mahidol University. The incidence of early onset group B streptococcal disease (EOD) was 0.27 cases/1,000 live births in 1996, and decreased to 0.10 cases/1,000 live births in 2001. The incidence of the late onset disease (LOD) was 0.05 cases/1,000 in 1996, and there has been none since 1998. All of the infants were inborn. Low birth weight was found in 53 per cent of the infants. Fifty-eight per cent of infants were male. Forty-seven per cent of the infants were born prematurely. None of the mothers had antenatal GBS screening. Only one mother received one dose of intrapartum antibiotic prophylaxis. No risk factor could be identified in 72 per cent of the mothers. EOD accounted for 79 per cent of all infants with GBS infections, with a mortality rate of 40 per cent. All of them died within the first 72 hours of life. Most EOD infants developed disease manifestations within 12 hours of life. Most common clinical manifestations were respiratory distress (74%), temperature instability (68%), cyanosis (63%), hypotension (42%) and lethargy (42%). Only one infant with EOD had meningitis. There were two infants in the LOD group; one of whom had cellulitis, and the other had meningitis. Neutropenia was noted in 42 per cent of all infants. Radiographic studies suggested a diffuse reticulogranular pattern or ground glass appearance in 38 per cent. The chest X-ray was interpreted as normal in 25 per cent of the infants. In conclusion, the incidence of GBS infection in newborn infants in Thailand is still very low but with a very high mortality. Prematurity accounts for almost half of the cases. Even though antepartum screening with intrapartum antibiotic chemoprophylaxis has been recommended in developed counties, its benefit and cost needs to be further investigated in Thailand.

Efficacy of empirical pharmacological therapy in clinically suspected Gastroesophageal Reflux (GER) in Extremely Low Birth Weight (ELBW) infants.

Prokinetic drugs and H2-receptor blocking agents are being used for suspected GER in ELBW (<1,000 grams) infants with apnea and bradycardia (unresponsive to methylxanthines) or feeding intolerance. Purpose: To evaluate whether anti-reflux therapy is effective in ELBW infants in improving the clinical signs for which the therapy was instituted. Methods: Clinical data of all ELBW infants admitted to NICU at Georgetown University Hospital in 1996, who received prokinetic drugs (cisapride or metoclopramide) and/or an H2 receptor blocking agent (ranitidine) were reviewed. The number of episodes and the frequency of intervention for apnea/bradycardia (As&Bs), and the number of trancutaneous oxygen desaturation episodes (O2 desats) were recorded for 72 hours before and after the institution of anti-GER therapy. Feeding intolerance was assessed by the ability to tolerate enteral feeding without significant gastric residue. The data (mean ฑ SD) were analyzed by paired t-test. Results: Twenty out of 68 infants received prokinetic drugs and/or ranitidine. Eighteen infants received anti-reflux therapy for apnea and/or bradycardia unresponsive to methylxanthines, and two infants for slow gastric emptying noted during a milk scan. The mean postnatal age and body weight at the time of therapy were 63 ฑ 37 days and 1,365 ฑ 486 grams respectively. Feeding tolerance did not change after anti-reflux therapy. There was no significant improvement in the number of apnea/bradycardia, desaturation episodes or the need for intervention after the medications was given. Conclusion: Pharmacological therapy for clinically suspected GER is prescribed frequently and appears to be of questionable efficacy in ELBW infants. As anti-reflux therapy may have serious side effects, its routine use in ELBW infants needs to be reassessed.