Neu-Laxova syndrome: a case report.

Neu-Laxova syndrome (NLS) is a rare lethal syndrome found in both consanguinous and non-consanguinous couple. This is characterized by terrible face with unusual craniofacial appearance with exophthalmos, spectrum of central nervous system malformation, like microcaphaly, hypoplastic cerebellum, cleft lip/palate, ichthyosis and oedema. The diagnosis is made on the basis of clinical parameter. We report a 4 hour old male term newborn with IUGR of Neu-Laxova syndrome presented with anencephaly, rudimentary cerebellum, exophthalmos of right eye, bilateral cleft lip and palate and cryptorchidism. Anencephaly and cryptorchidism are two recently reported findings of NLS. We are presenting this case in addition from Bangladesh to lend further support to those two new findings as component of Neu-Laxova syndrome. Outcome of this syndrome is not good. Most of the patients are died of infection within hours to days.

Comparison between CRP and IL-6 as early markers of neonatal sepsis.

Infection in neonates is difficult to identify solely on the basis of physical findings, because signs are not specific. C reactive protein (CRP) is an acute phase reactant which has been used in diagnosis of bacterial infection in neonates. IL-6 is a proinflammatory cytokine produced by monocytes and macrophages activated by bacterial infection. IL-6 can be detected in blood earlier than CRP during the course of bacterial infection. The objective of this study was to compare the usefulness of the level of interleukin-6 with CRP as early markers of neonatal sepsis. This was a queasy experimental study carried out in neonatal unit, Department of Pediatrics, Bangabandhu Sheikh Mujib Medical University (BSMMU) during the period of September 2005 to February 2006. Forty five cases of suspected septicemia were enrolled in the study and thirty healthy newborns were taken for comparison. On the 1st day of symptoms and 1st day of admission, complete blood count, blood for culture and sensitivity and interleukin-6 (IL-6) estimation were done. After 48-72 hours CRP was estimated. In suspected septic babies with high leukocyte count, IL-6 level was found to be raised with high sensitivity (85.71%), negative predictive value (95%). IL-6 was found to have high sensitivity (76.9%), specificity (73.68%), positive predictive value (80%) and negative predictive value (70%) in CRP positive suspected sepsis cases. So, the conclusion was that IL-6 is a very early marker of neonatal infection. IL-6 was mostly positive within 24 hours of onset of sepsis in comparison with other tests. So IL-6 is more useful than other markers for early detection of neonatal sepsis.

Neonatal sepsis-- a global problem: an overview.

Neonatal sepsis is one of the major health problems throughout the world. Every year an estimated 30 million newborns acquire infection and 1-2 million of these die. The present review provides updates regarding neonatal sepsis to help paediatricians to protect the newborn from this deadly problem. The onset of sepsis within first 48 hours of life (early onset sepsis) is frequently associated with pre and perinatal predisposing factors while onset after 48-72 hours of life (late onset sepsis) frequently reflects infection acquired nosocomially. Some literatures say that early onset disease presents in the first 5-7 days of life. Klebsiella pneumoniae is the leading pathogen causing neonatal sepsis in Bangladesh and neighbouring countries. Among many risk factors the single most important neonatal risk factor is low birth weight. Other main risk factors are invassive procedures in the postnatal period and inadequate hand washing before and after handling babies. Sepsis score is a useful method for early and rapid diagnosis of neonatal sepsis which was developed by Tollner U in 1982. Antibiotics should be given to most of the neonates suspected of infection. Ampicillin and gentamicin are the first drug of choice. In Bangladesh context sepsis score may be used as a good parameter for the early and rapid diagnosis of sepsis and that will guide the treatment plan. Clean and safe delivery, early and exclusive breastfeeding, strict postnatal cleanliness following adequate handwashing and aseptic technique during invasive procedure might reduce the incidence of neonatal sepsis. Prompt use of antibiotic according to standard policy is warranted to save the newborn lives from septicaemia.

Incidence of low birth weight in three selected communities of Bangladesh.

This prospective study was conducted in urban affluent, slum and rural communities of Bangladesh during Feb '94 to Feb '95. From each community, 250 pregnant mothers were recruited in the study and at the end total 660 live births were studied to determine the incidence and risk factors of low birth weight. Incidence of low birth weight was highest in urban slum (36.8%) followed by rural area (20.9%) and lowest in urban affluent community (18.3%). The area of residence had a significant influence on birth weight suggesting that environmental stress had detrimental effect on birth weight. Age, weight and height of mothers were also risk factor for low birth weight of their babies. Mothers of less than 20 years and more than 35 years, weighing less than 40 kg and having height less than 140 cm had the higher risk of giving birth to low birth weight babies. Incidence of low birth weight was highest (73.2%) among the primigravidae mothers and 36.8% among the mothers who had no antenatal check-up, but it was 15.9% among those who had check-up more than 7 times. The distribution of low birth weight babies was higher (48.2%) among the mothers who had never gone to school. To reduce the incidence of low birth weight, upliftment of socio-economic condition has got no alternative which is very much related to education level of the people. Emphasis should be given on mothers' education which is one of the influencing factors of birth weight of babies.

PIP: This study examines the incidence of low birth weight and its associated risk factors in different communities in Bangladesh. The study was conducted in urban affluent, slum, and rural communities during February 1994 to February 1995. A total of 660 live births gathered from Pubail, Kashimpur, Konabari union of Gazipur district and Dhaka City were studied. Sociodemographic data, obstetric data, and birth weight of babies were gathered. The results revealed that the incidence of low birth weight was highest in urban slum (36.8%) followed by rural area (20.9%) and the lowest in urban affluent community (18.3%). The area of residence was found to significantly influence infant birth weight, which suggest that environmental stress had detrimental effect on birth weight. Other risk factors related to low birth weight were maternal age, weight, and height. Furthermore, incidence of low birth weight was highest among primigravidas (73.2%) and 36.8% among mothers with no antenatal check-up but among those who had check-up more than 7 times, it was 15.9%. Results also indicate that mothers who had never gone to school have a higher low birth weight incidence.