A. Y. Elzouki

Brachial plexus injuries in babies born in hospital: an appraisal of risk factors in a developing country.

The present study was undertaken to evaluate the magnitude of risk factors associated with brachial plexus in infants born in hospital in Benghazi. A total of 7829 babies were examined over a period of 6 months. Twenty-eight had brachial palsy, giving an incidence of 3.6 per 1000 livebirths. Significant (P less than 0.001) perinatal risk factors observed were maternal parity greater than or equal to 6, maternal diabetes, instrumental deliveries, shoulder dystocia and foetal macrosomia. Other risk factors observed included breech extraction, postmaturity and prematurity (P less than 0.02). Complete brachial plexus injury was seen in 12 cases and six infants had residual handicap on follow-up at 18-24 months.

Hepatitis C virus infection in two groups of paediatric patients: one maintained on haemodialysis and the other on continuous ambulatory peritoneal dialysis

Seropositivity to hepatitis C virus (HCV) was evaluated in three groups of Saudi children. One group (n = 18) was maintained on haemodialysis and another group (n = 21) on continuous ambulatory peritoneal dialysis (CAPD). The third group were community-based normal controls. The prevalence of antibody to HCV (anti-HCV) in children on haemodialysis (11.2%) was significantly higher than that in the control group (n = 220) (1.4%; p = 0.056). There was no significant difference in the prevalence of anti-HCV between children on CAPD (4.8%) and the control group (1.4%; p = 0.244). Among ten children on haemodialysis who were anti-HCV-negative 4 years earlier, two seroconverted and the seroconversion was not due to transfused blood but was most likely due to environmental contamination. This is the first report on the prevalence of anti-HCV in children maintained on CAPD. The results of the study emphasize the need for separate dialysis machines for anti-HCV-positive patients. It seems that CAPD therapy might reduce transmission of HCV but a large number of CAPD patients will need to be studied to confirm superiority to haemodialysis in this respect.

Perinatal outcome at Benghazi and implications for perinatal care in developing countries.

During the period January to December 1984 there were 434 perinatal deaths among 16,466 births in a developing North African country. The perinatal, still birth and early neonatal death rates were 263, 11.4 and 149 per 1000 respectively. The major causes of still births included antepartum hemorrhage, cord accidents, maternal diabetes mellitus and fetal malformations. The clinical causes of early neonatal death (within first seven days of life) were major congenital malformation (24.9%),hyaline membrane disease and aspiration syndrome(26.1%),birth asphyxia and injury(179%),very low birth weight (17.2%) and sepsis/meningitis (13.1%). The perinatal outcome in Libya is compared with other developing countries and strategies for reducing the high perinatal loss are discussed.

Coarctation of the aorta in the newborn: a clinical study.

The clinical findings and presentation in nine consecutive neonates in whom coarctation of the aorta was diagnosed over a period of two years were reviewed. Coarctation of the aorta constituted 16% of all infants with congenital cardiovascular malformations admitted to the Neonatal Intensive Care Nursery. The mean age on admission was 8.3 days. The admission findings included absent femoral pulses, 5; feeble femoral pulses, 4; differential blood pressure between upper and lower extremities, 9; congestive heart failure, 8; hypertension, 2; and failure to thrive, 1. Five of the infants died owing to refractory congestive heart failure at the mean age of 10.2 days. It is emphasized that palpation of the femoral pulse should be a routine examination in the neonatal period in order to detect coarctation of the aorta and that surgical intervention may be considered in cases refractory to medical management.

Congenital choanal atresia in North African infants.

Eleven cases of congenital choanal atresia seen over a period of 2 years are described. Its incidence in the community was 1 in 3100 births. Twenty-seven per cent of cases were missed at birth, suggesting an even higher incidence. The anomaly was significantly commoner in infants of younger mothers with less than four children (P less than or equal to 0.05). Maternal polyhydramnios was present in three cases (P less than or equal to 0.0001). The sex incidence was equivocal and three infants were of low birthweight. The atresia was bilateral in the majority of the cases, and associated congenital anomalies were present in five of the 11 infants. Five underwent surgery with no complications.

Erythrocyte glucose-6-phosphate dehydrogenase status of newborns and adults in eastern Libya.

One hundred and twenty cord and 320 venous blood samples were collected from Libyan newborns and adults respectively for the estimation of glucose-6-phosphate dehydrogenase (G-6-PD) activity by a screening technique and by quantitative estimation. The mean (S.D.) enzyme activity in the non-deficient neonates and adults was 1.13 (0.23) and 0.87 (0.21) IU/ml RBC/min respectively. The incidence of G-6-PD deficiency in the male population was 2.8%. The enzyme activity in the deficient male population ranged from 0-19.5%; none of them was symptomatic or had haematological abnormality. Of the female subjects 1.8% had enzyme activity of 50-65%. The frequency of enzyme deficiency appears to be low compared with that found in other Arab populations and is comparable with the incidence in other mediterranean countries.

Thanatophoric dwarfism in Libyan neonates — a report of 3 cases

Three cases of thanatophoric dwarfism are reported from Libya during a period of 16 months showing an incidence of 1:5600 total births. Polyhydramnios was associated with all the three cases and maternal diabetes in one. No known pattern of inheritance was found. One was stillborn and other two died within 30 minutes of birth. The detailed diagnostic features and differential diagnosis is described along with a brief review of literature.

Bacillus Alcaligenes fecalis septicemia and meningitis in the newborn

/tlcaligenes fecalis is a short Gramnegative bacillus of the family Achromobacter. It was isolated by Petruschk 1 from stale beer and the bacterium was named for its ability to produce an alkaline reaction in certain media. Although usually a harmless saprophyte in the intestinal tract of man, this organism may occasionally cause systemic infection in children and adults. 2- 6 However Alcaligenes.[ecaIis infection in the newborn infants is very infrequent with only four reports in the literature. 7-I0 We are describing an additional case of Alcaligenes fecalis septicemia and meningitis in a neonate.

Disseminated herpes simplex infection in a newborn-treatment with acyclovir

An eighteen days old neonate with primary disseminated herpes simplex infection (affecting skin, liver, bone marrow and lungs), who received intravenous acyclovir is presented with brief review of literature.