Majeda S. Hammoud

Vitamin D status of mothers and their neonates in Kuwait.

Abstract Background : There has been a resurgence of nutritional rickets in children in many developing countries and some of the developed countries. Children between 6 and 18 months old are commonly affected. In order to find out the association between vitamin D and rickets we studied the vitamin D status of the neonates and their mothers in Kuwait.

Neonatal infections in Asia

Objective: To study the epidemiology (including incidence, antibiotic sensitivity and mortality) of neonatal unit infections in countries in Asia. Methods: One year prospective study of neonatal infections in eight neonatal units in Asia. Results: There were 453 episodes of sepsis affecting 394 babies. Mortality from neonatal sepsis was 10.4%, with an incidence of 0.69 deaths/1000 live births. Group B streptococcus was the most common early-onset organism causing 38% of episodes of early-onset (<48 h old) sepsis, with a rate of 0.51 episodes per 1000 live births and a mortality of 22%. Gram-negative bacillary early-onset sepsis occurred at a rate of 0.15 episodes per 1000 live births with a mortality of 12%. There were 406 episodes of late-onset sepsis. The incidence was high at 11.6 per 1000 live births, and mortality was 8.9%. Coagulase-negative staphylococcus caused 34.1% of episodes, whereas Staphlococcus aureus caused only 5.4%. Gram-negative bacilli caused 189 episodes (46.6%). Only 44% of Gram-negative bacilli were sensitive to both gentamicin and a third-generation cephalosporin, whereas 30% were resistant to both antibiotics. Meningitis occurred in 17.2% of episodes of late sepsis, with a mortality of 20%. Conclusions: The incidence of late-onset sepsis was higher in Asia than in resource-rich countries, but the organisms isolated and mortality were similar. Over half of all Gram-negative bacilli were antibiotic resistant.

Neonatal infections in China, Malaysia, Hong Kong and Thailand

Objective Neonatal sepsis is a major cause of neonatal deaths in Asia but data remain scarce. We aimed to investigate the causative organisms and antibiotic resistance in neonatal care units in China, Malaysia, Hong Kong and Thailand. Methods Prospective cohort study of neonatal sepsis defined as positive culture of a single potentially pathogenic organism from blood or cerebrospinal fluid differentiated into early-onset sepsis (EOS) occurring <3 days of birth and late-onset sepsis (LOS) ≥3 days after birth. Results During the study period, there were 963 episodes of neonatal sepsis. The incidence of EOS was 0.62 (95% CI 0.45 to 0.82) per 1000 live births or 4.91 (95% CI 4.22 to 5.68) per 1000 admissions while the incidence of LOS was 5.00 (95% CI 4.51 to 5.53) per 1000 live births or 21.22 (95% CI 19.79 to 22.77) per 1000 admissions. The incidence of Group B Streptococcus (GBS) sepsis was low but remained the most common single pathogen for EOS among inborn babies. Klebsiella spp. was the most common Gram-negative organism causing most deaths. The case-fatality was 7.0% (95% CI 3.9% to 12.0%) for EOS and 16.0% (95% CI 13.7% to 19.0%) for LOS, and was significantly different between participating units after adjusting for potential confounders. Of all Gram-negative organisms, 47%, 37% and 32% were resistant to third-generation cephalosporins, gentamicin or both, respectively. Conclusions The pattern of EOS in Asian settings is similar to that in industrialised countries with low incidence of GBS sepsis. The important features of neonatal sepsis in Asia are the burden of Klebsiella spp. and high level of antibiotic resistance. These should be addressed while developing measures to reduce neonatal mortality due to infection.

Incidence, aetiology and resistance of late‐onset neonatal sepsis: A five‐year prospective study

Aim:  Investigate the incidence, etiological pattern and the antimicrobial resistance of late‐onset neonatal infections over a period of 5 years.

Persistent candidemia in neonatal care units: risk factors and clinical significance

OBJECTIVES The prevalence and clinical significance of persistent candidemia among neonates are poorly understood. This study aimed to describe the rate and the clinical relevance of persistent candidemia over a 4-year period in Kuwait. METHODS A retrospective chart review of infants admitted to the Neonatal Care Unit of the Maternity Hospital in Kuwait between January 2007 and December 2010, who had a positive blood culture for Candida species, was conducted. Persistent candidemia was defined as the isolation of the same Candida species more than 6 days after the initiation of antifungal therapy, or death due to candidemia within 6 days of antifungal treatment. Stepwise logistic regression was used to investigate factors associated with persistent candidemia. RESULTS Of 89 neonates with a Candida infection, 54 (60.7%, 95% confidence interval 49.7-70.9%) had persistent candidemia. The case-fatality rate was 54% among those with persistent candidemia and 3% among those with non-persistent candidemia (p<0.001). Neonates with persistent candidemia were more likely to be female, have a central vascular catheter at diagnosis, and have a low platelet count. All isolated Candida species were susceptible to antifungal agents. CONCLUSIONS Persistent candidemia is common among neonates with a Candida infection and is associated with an increased risk of mortality. Drug resistance is unlikely to explain the persistent candidemia; host-related factors seem to be more important and hence could be used to identify those at risk in order to institute appropriate preventive and treatment measures.

Childhood Obesity and Academic Achievement among Male Students in Public Primary Schools in Kuwait

Objective: The aim of this study was to investigate the association between childhood obesity and student academic performance in the classroom setting. Subjects and Methods: A multi-stage cluster random sampling was used to select a representative sample of 1,213 fifth-grade students in male public schools. Height and weight were measured using a standard protocol. Overweight was defined as BMI ≧85th but <95th percentile, while obesity as ≧95th BMI percentile, using growth charts provided by the Centre for Disease Control and Prevention (2000). Data on each student’s academic performance and sociodemographic factors were extracted from school records. Of the 1,213 students, 147 were absent on the day the survey was conducted. Therefore, the analysis was based on 1,066 students. Of the 1,066 students, 67 did not have previous school records because they were new in the school; hence the association between school performance and obesity was based on 999 students. Results: The prevalence of obesity was 186 (17.4%, 95% CI: 15.2–19.9%) while the prevalence of overweight was 232 (21.8%, 95% CI: 19.3–24.4%). There was no significant association between obesity and academic performance after adjusting for sociodemographic factors. Parental education was the most important predictor for high academic performance in the classroom setting. Conclusion: There is no association between obesity and academic performance in the classroom setting among boys in Kuwait. With the lack of evidence of a relationship between childhood obesity and academic performance, using high performance as a measure of success in prevention initiatives cannot be justified.

Randomized clinical trial comparing two natural surfactant preparations to treat respiratory distress syndrome

Objective: Natural surfactant preparations have been shown to reduce the severity and mortality of respiratory distress syndrome (RDS) in preterm infants. The objective of this study was to compare the efficacy of two natural surfactants, namely SF-RI 1 (Alveofact®) and barectant (Survanta®), on the incidence of chronic lung disease (CLD) and other associated complications of RDS in preterm infants.Methods: Preterm infants with RDS requiring artificial ventilation were randomly selected to receive an initial dose of either Alveofact or Survanta. The two treatment groups were tested for variation in gas exchange, ventilatory settings and neonatal complications such as CLD and mortality.Results: After 5 days the Survanta-treated infants had a lower fraction of inspired oxygen (FiO2) compared with the Alveofact-treated infants. There were no differences in the ventilatory settings. More infants in the Survanta group were extubated at 3 days and fewer required the use of postnatal steroids. Less CLD and duration of oxygenation were experienced by the Survanta-treated group.Conclusions: Improved oxygenation and reduced ventilatory requirements were greater with Survanta compared to Alveofact, which in turn was associated with a trend towards a lower incidence of serious pulmonary complications.

Pattern and etiology of culture-proven early-onset neonatal sepsis: a five-year prospective study

OBJECTIVES To investigate the incidence of early-onset neonatal sepsis and identify the main pathogens over a 5-year period in Kuwait. METHODS Blood samples were collected from all infants with any clinical or laboratory feature suggestive of sepsis, at the main maternity hospital in Kuwait. Cases of early-onset neonatal infection were defined as culture of a single potentially pathogenic organism from blood or cerebrospinal fluid from infants younger than 7 days of age, in association with clinical or laboratory findings consistent with infection. RESULTS The overall incidence of early-onset neonatal infection was 2.7 (95% confidence interval (CI) 2.3-3.2) episodes per 1000 live-births. The case-fatality was 13.1% (95% CI 8.6-18.9%). Group B Streptococcus (GBS) accounted for 17.6% of infections among infants younger than 7 days (incidence 0.48 per 1000 live-births), but 38.1% of infections in the first 2 days of life. Neither the incidence of early-onset infection by GBS nor by Escherichia coli changed significantly over the study period. CONCLUSIONS Although the incidence of GBS infections was relatively low, GBS accounted for most early-onset infections. Intrapartum antibiotic prophylaxis against GBS should be strengthened. There was no evidence to suggest that early-onset infection due to non-GBS organisms such E. coli has increased in the last 5 years.

Birthweight percentiles by gestational age in Kuwait

Abstract. Our aim is develop a curve for singleton birthweight based on accurately calculated gestational age. A retrospective analysis of all singleton live births from 22–44 completed weeks of gestation during the period from September 1998 to December 2000 in the two largest birth birth centers in Kuwait was conducted. Neonates with major congenital anomalies and those with unrecorded gestational age were excluded from the study population. Total population and gender-specific birthweight percentiles according to gestational age were developed after smoothening of growth curves. A total of 35,768 births were included in the development of the birthweight curve. Percentiles of birthweight for all population and by gender are presented. There was significant difference in birthweight among different ethnic groups in this population. At term, 9.8% of births are smaller than the 10th percentile and 10.0% are larger than the 90th percentile. Plotting birthweight in our population on percentile curves derived from the United States or United Kingdom would generally overestimate small for gestational age newborns and underestimate large for gestational age newborns. We conclude that the diagnosis of clinically significant birthweight abnormalities depends on the fetal growth curve used. A population specific curve of fetal growth dated by ultrasonography would provide a reliable reference for birthweight distribution.

Knowledge, misconceptions, and future intentions towards breastfeeding among female university students in Kuwait.

A cross-sectional study using a self-administered questionnaire was conducted on female university students (N = 1106) to explore their knowledge and misconceptions on breastfeeding. Most participants recognized the benefits of breastfeeding, but only a few were aware of the recommendation for exclusive breastfeeding in the first 6 months of life. Misconceptions were common; 66%, 60%, and 55% of participants thought mothers should temporarily stop breastfeeding if they had a fever, skin rash, or sore throat, respectively. Approximately 20% thought mothers should stop breastfeeding if the child had diarrhea, vomiting, or skin rash. Support of breastfeeding in public places was low, but 38% supported breastfeeding in female prayer rooms in public places. Efforts should be made to correct common misconceptions on breastfeeding and increase the support of breastfeeding in public places among university students. Female prayer rooms that exist in all public places in Kuwait can be used to promote breastfeeding in public places in Kuwait.