Eman Badran

Epidemiological characteristics of Candida species colonizing oral and rectal sites of Jordanian infants

BackgroundThere is evidence that Candida colonization contributes to increasing invasion of candidiasis in hospitalized neonates. Few studies investigated the epidemiology and risk factors of Candida colonization among hospitalized and non-hospitalized infants. This prospective study investigated the major epidemiological characteristics of Candida species colonizing oral and rectal sites of Jordanian infants.MethodsInfants aged one year or less who were examined at the pediatrics outpatient clinic or hospitalized at the Jordan University Hospital, Amman, Jordan, were included in this study. Culture swabs were collected from oral and rectal sites and inoculated on Sabouraud dextrose agar. All Candida isolates were confirmed by the Remel RapID yeast plus system, and further investigated for specific virulence factors and antifungal susceptibility MIC using E-test. Genotyping of C. albicans isolates was determined using random amplified polymorphic DNA (RAPD) analysis method.ResultsA total of 61/492 (12.4%) infants were colonized with Candida species by either their oral/rectal sites or both. Rectal colonization was significantly more detected than oral colonization (64.6% verses 35.4%), particularly among hospitalized infants aged more than one month. The pattern and rates of colonization were as follows: C. albicans was the commonest species isolated from both sites and accounted for 67.1% of all isolates, followed by C.kefyr (11.4%), each C. tropicalis and C. glabrata (8.9%) and C. parapsilosis (3.8%).A various rates of Candida isolates proved to secrete putative virulence factors in vitro; asparatyl proteinase, phospholipase and hemolysin. C. albicans were associated significantly (P < 0.05) with these enzymes than other Candida species. All Candida isolates were susceptible to amphotericin B and caspofungin, whereas 97% of Candida species isolates were susceptible to fluconazole using E-test.The genetic similarity of 53 C. albicans isolates as demonstrated by dendrogram revealed the presence of 29 genotypes, and of these one genotype accounted for 22% of the isolates.ConclusionThis study presents important epidemiological features of Candida colonization of Jordanian infants.

Major characteristics of Staphylococcus aureus colonizing Jordanian infants

Colonization of infants with methicillin‐resistant Staphylococcus aureus (MRSA) carries specific toxin genes. In particular, Panton–Valentine leukocidin (PVL) are a risk factor for subsequent infection during hospitalization. This prospective study investigated important epidemiological characteristics of Staphylococcus aureus colonizing the nares and intestines of Jordanian infants.

Etiologies, outcomes, and risk factors for epilepsy in infants: A case–control study

OBJECTIVES To determine the etiologies, outcomes, and risk factors for epilepsy in infants. PATIENTS AND METHODS This retrospective study included all children who had their first afebrile seizure between 1 and 12 months of age, and who were followed in the Child Neurology Clinic at the Jordan University Hospital from January 2004 to January 2006. Medical records were reviewed to collect demographic data and the clinical data pertaining to epilepsy. An age-matched control group of healthy children in a 1:2 ratio was included to determine the risk factors for epilepsy. For statistical analysis, SPSS, Version 13, was used. RESULTS Fifty-five patients were included in the study group and 111 were in the control group. Epilepsy was classified as follows: symptomatic in 24 (43.6%) children, probably symptomatic (cryptogenic) in 28 (50.9%) children, and idiopathic in 3 (5.5%) children. The etiologies of epilepsy in the symptomatic group included hypoxic-ischemic encephalopathy (n=11), cortical malformations (n=5), neurocutaneous syndromes (n=2), metabolic disorders (n=4), leukodystrophy (n=1), and craniosynostosis (n=1). Twenty-seven patients (49%) were seizure-free at their last follow-up visit for at least the last 6 months; only six patients (10.9%) continued to have normal development at the time of their last follow-up examination. The risk factors for epilepsy included parental consanguinity (P=0.0003), a family history of global developmental delay (P=0.0002), a family history of epilepsy (P=0.010), and a positive perinatal history (P=0.011). CONCLUSION This study emphasized that afebrile convulsions in infancy are rarely benign. Furthermore, consanguinity was shown to be a major risk factor for epilepsy.

Intrathoracic Displacement of Pleuroamniotic Shunt after Successful in utero Treatment of Fetal Hydrops Secondary to Hydrothorax

Background: Primary fetal pleural effusion can be associated with high perinatal morbidity and mortality, especially when it is associated with the presence of fetal hydrops. Pleuroamniotic shunting results in effective drainage and lung expansion which prolong the pregnancy and improve neonatal survival. Intrathoracic displacement of the shunt is a rare but a known complication of shunt insertion and can cause some infant morbidity. We present a case of successful antenatal treatment of primary fetal pleural effusion complicated with intrathoracic displacement of the shunt without any fetal and long-term infant morbidity. Case Report: Our case presented with severe bilateral fetal pleural effusion, causing fetal hydrops treated successfully by pleuroamniotic shunting at 25 weeks of gestation which was complicated by dislodgement of the shunt into the fetal chest documented by antenatal ultrasound at 30 weeks. There was no recurrence of fetal pleural effusion or other antenatal complication. After delivery there were no postnatal complications, so removal of the shunt was not considered, and clinical follow-up of the infant to the age of 12 months was uneventful. Conclusion: The complication of intrathoracic displacement of a pleuroamniotic shunt can be recognized antenatally by ultrasound. Since there are no postnatal pulmonary complications related to the presence of the shunt inside the infant chest, conservative management in these cases appears to be a safe approach.

Epidemiology and clinical outcome of candidaemia among Jordanian newborns over a 10-year period

This retrospective study includes all newborn patients with culture proved candidaemia who were admitted to the neonatal intensive care unit of Jordan University Hospital through the period January 1995 to June 2006. Among 24 patients included, 13 (54.2%) died. The incidence of candidaemia was 0.27%, the mean age at diagnosis 25.9 d and the mean gestational age at birth 34.6 weeks. Species most frequently isolated were Candida albicans (50%) and C. krusei (20%). Previous gastrointestinal pathology was present in 41.7% of the cases. A comparison of cases due to C. albicans with those due to other species of Candida revealed no statistical differences in terms of demographic factors, age at onset of disease, mortality, clinical manifestations or risk factors. Based on our results, empirical antifungal therapy should be considered in neonates who have gastrointestinal pathology and other risk factors.

Effect of Oral Diseases on Mothers Giving Birth to Preterm Infants

Objectives: To determine the association between preterm birth (PTB) and maternal oral diseases during pregnancy. Subjects and Methods: This prospective study was performed by the neonatal and dental departments at Jordan University Hospital. The study included 100 women who gave birth to preterm singleton infants (born less than 37 complete weeks from last menstrual period) between January and July 2009. The control group included an equal number of women who delivered singleton, full-term infants on the same day or the day after the women in the study. The mothers’ demographic data were collected using a questionnaire, and an oral examination was conducted for each participant. Statistical analysis was performed using SPSS for Windows release 16.0 (SPSS Inc., Chicago, Ill., USA). Factors related to PTB were studied in univariate and multivariate logistic regression analyses. Results: Significantly higher DMFT (decayed, missing, filled teeth) index scores, Silness and Loe plaque index scores and Mühlemann tooth mobility index scores were associated with PTB. Mothers who did not have prepregnancy dental checkups had a significantly higher incidence of PTB. Fewer mothers in the PTB group visited dentists during their last pregnancy compared with controls. Conclusions: Oral health, especially healthy periodontium, is one reliable indicator for predicting a safe pregnancy outcome.

Oral paracetamol versus oral ibuprofen for treatment of patent ductus arteriosus

Objective This study was performed to investigate the safety and efficacy of oral paracetamol versus oral ibuprofen in the treatment of patent ductus arteriosus (PDA) in premature infants. Methods Premature infants with PDA with a gestational age of ≤32 weeks or birth weight of ≤1500 g were included in this randomized study. Results A total of 120 premature infants fulfilled the inclusion criteria. Of these 120 infants, 34 fulfilled the treatment criteria and 22 were finally randomized. We found no significant difference in the mortality or primary closure rates between the two groups. We also found no significant difference in the short-term neonatal outcomes. Conclusions Either oral paracetamol or oral ibuprofen can be used safely and effectively to treat PDA in premature infants.

Clinical value of repeat blood cultures in neonatal patients receiving antibiotic treatment

Objective Retrospective database study to determine the clinical usefulness of repeat blood cultures in antibiotic-treated neonates. Methods Data regarding blood culture indication and findings for patients admitted to a neonatal intensive care unit (NICU) over a 2-year period were obtained from the hospital database. Repeat blood culture was defined as culture performed <7 days from initial testing in a patient receiving antibiotic treatment. Results Repeat cultures made up 21.3% of all blood cultures originating in the NICU (500/2352 cultures; 338 initial positive cultures; 210 patients). The most common indications for repeat culture were follow-up of clinically well babies with previous positive culture findings and the development of new symptoms. The majority of culture findings were negative (60.2%), with 7.2% indicating the presence of a new pathogen. Cultures repeated on day 5 were significantly more likely to reveal a new pathogen than those repeated on days 1–4. Conclusions Repeat blood cultures in neonatal patients who have developed new symptoms >4 days after initial testing may be beneficial. The use of repeat blood culture is not recommended for any other indication.

Intrauterine transmission of H1N1 disease: a theory that needs evidence!

Three pandemics of influenza in the 20th century have been described. Unfortunately, a little is known about the effect of those pandemics on newborn infants. We are reporting our experience with newborns born to mothers proved to have H1N1 illness perinatally, who presented with sepsis-like illness at birth or shortly after, and were treated as having H1N1 disease. This study will report on the clinical features, outcome and discuss diagnosis and treatment challenges and also the possibility of intrauterine H1N1 transmission. Our cases had good neonatal outcome, H1N1 intrauterine transmission still a possibility that needs further research efforts.

Fetal Intrauterine Transfusion Therapy: Neonatal Outcomes

Background and objectives: Intrauterine blood transfusion (IUT) performed for fetal anemia may be associated with adverse neonatal outcomes. This study aimed to describe the clinical outcome of surviving neonates treated with IUT in an area where detailed outcome on neonatal data is limited. Patients and methods: This prospective study included all living newborns treated with IUT at our institution between March 2004 and February 2011. During this period, 30 newborns with a mean gestation age of 35 weeks (range: 25-37 weeks) were admitted with various respiratory, hematological and gastrointestinal morbidities. Results: The survival rate on discharge was 93%. Severe fetal anemia (72.2%) was significantly associated with a low reticulocyte count at birth and the need for respiratory support after birth (P<0.05). The number of IUTs was significantly correlated with the duration of admission (P=0.034) and the presence of hyporegenerative late anemia (P=0.007), but not with other neonatal outcomes or with a low reticulocyte count at birth. Use of intravenous immunoglobulin was significantly associated with an increased rate of top-up transfusion for late anemia and a decreased duration of admission, with no additional positive effects. Conclusion: This study provides evidence on the types of potential neonatal morbidities after IUT therapy and their risk factors, and could be useful to clinicians treating fetuses with intrauterine transfusions and also for counseling parents.