Mohamed Abdellatif

The patterns and causes of neonatal mortality at a tertiary hospital in oman.

OBJECTIVE To report the patterns and causes of neonatal death from a tertiary care neonatal intensive care unit over a period of four years. METHODS This is a retrospective cohort study where four years data (January 2006 - December 2009) of all inborn neonatal admissions and deaths were collected from the neonatal intensive care unit at Sultan Qaboos University hospital on predesigned forms. All out born admissions and deaths were excluded. The causes of neonatal death were classified using Wigglesworths classification. RESULTS The number of inborn live births during the study period was 10064 and the total number of inborn neonatal admissions was 1475. The total deaths (neonatal and post neonatal) at the neonatal intensive care unit was 73 (63 inborn and 10 out born). Among the inborn, five deaths were post neonatal deaths and hence, excluded from analysis. Among the remaining inborn neonatal deaths (n=58), 34 (59%) were males and 24 (41%) were females. The number of neonatal admissions increased over the years during the study period from 248 to 356, while the number of deaths also increased from 10 deaths in 2006, to 20 deaths in 2009. The primary causes of neonatal deaths were prematurity and its complications 52% (n=30). Lethal congenital malformations lead to 17 (29%) newborn deaths, specific diagnosis in 7 newborns (12%), and birth asphyxia in four (7%) of cases. CONCLUSION There was an increasing trend of neonatal admissions and deaths among inborn babies. Prematurity, with sepsis as its major complication and congenital malformations were the leading cause of neonatal mortality.

Changing Survival Rate of Infants Born Before 26 Gestational Weeks: Single-centre study

OBJECTIVES This study aimed to evaluate the changing survival rate and morbidities among infants born before 26 gestational weeks at the Sultan Qaboos University Hospital (SQUH) in Muscat, Oman. METHODS This retrospective study assessed the mortality and morbidities of all premature infants born alive at 23-26 gestational weeks at SQUH between June 2006 and May 2013. Infants referred to SQUH within 72 hours of birth during this period were also included. Electronic records were reviewed for gestational age, gender, birth weight, maternal age, mode and place of delivery, antenatal steroid administration, morbidity and outcome. The survival rate was calculated and findings were then compared with those of a previous study conducted in the same hospital from 1991 to 1998. Rates of major morbidities were also calculated. RESULTS A total of 81 infants between 23-26 gestational weeks were admitted to the neonatal unit during the study period. Of these, 58.0% were male and 42.0% were female. Median gestational age was 25 weeks and mean birth weight was 770 ± 150 g. Of the 81 infants, 49 survived. The overall survival rate was 60.5% compared to 41% reported in the previous study. Respiratory distress syndrome (100.0%), retinopathy of prematurity (51.9%), bronchopulmonary dysplasia (34.6%), intraventricular haemorrhage (30.9%) and patent ductus arteriosus (28.4%) were the most common morbidities. CONCLUSION The overall survival rate of infants between 23-26 gestational weeks during the study period had significantly improved in comparison to that found at the same hospital from 1991 to 1998. There is a need for the long-term neurodevelopmental follow-up of premature infants.

Multiple Enteric Duplication Cysts in a Twin Fetus : Diagnosis and management

Enteric duplication cysts are rare congenital anomalies of the gastrointestinal tract. These can be suspected if cystic lesions are noted in the fetal abdomen during an antenatal ultrasonogram. The differential diagnoses of fetal intra-abdominal cystic lesions include fetal omental cysts, fetal mesenteric cysts, meconium pseudocysts and fetal ovarian cysts. We report an antenatally diagnosed enteric duplication cyst in one of a set of twin fetuses which was managed successfully.

Diagnosis of Microvillous Inclusion Disease: A Case Report and Literature Review with Significance for Oman

Microvillous Inclusion Disease (MVID) is one of the congenital diarrheal disorders (CDD) caused by genetic defects in enterocyte differentiation and polarization. Its prevalence is higher in countries with a high degree of consanguinity. It causes severe, intractable secretory diarrhea leading to permanent and definitive intestinal failure with resultant dependency on parenteral nutrition (PN). Small bowel transplantation is the only curative treatment. The gold standard for diagnosis are the typical morphological abnormalities in small bowel biopsies on light and electron microscopy (EM). In recent times, histochemistry and immunohistochemistry have shown sufficient diagnostic accuracy replacing EM if the facility is unavailable or EM findings are inconclusive. We describe a neonate with CDD who was diagnosed to have MVID on the duodenal biopsy by morphohistochemical and immunophenotypic methods used for the first time in Oman. By utilizing such easy and accessible diagnostic methods, a rare genetic disorder could be diagnosed with certainty and the family could be counseled accordingly. With a high degree of consanguinity in the region, the prevalence of MVID in Oman needs to be identified once these patients are diagnosed by utilizing appropriate investigations. Care of such patients necessitates improving current parenteral nutrition services and addressing the future need for small bowel transplantation (SBTx), in Oman.

Interpreting Neonatal Growth Parameters in Oman: Are we doing it right?

Objectives This study aimed to compare reference anthropometric measures of Omani neonates with the international standard growth charts of the World Health Organization (WHO) in order to determine the appropriateness of these growth charts to assess the growth of Omani neonates. Methods This cross-sectional study included all healthy full-term Omani neonates born between November 2014 and November 2015 at the Sultan Qaboos University Hospital, Muscat, Oman. Birth weight, length and head circumference measurements were identified and compared to those of the 2006 WHO growth charts. Results A total of 2,766 full-term neonates were included in the study, of which 1,401 (50.7%) were male and 1,365 (49.3%) were female. Mean birth weights for Omani males and females were 3.16 ± 0.39 kg and 3.06 ± 0.38 kg, respectively; these were significantly lower than the WHO standard measurements (P <0.001). Similarly, the mean head circumferences of Omani males and females (33.8 ± 1.27 cm and 33.3 ± 1.26 cm, respectively) were significantly lower than those reported in the WHO growth charts (P <0.001). In contrast, mean lengths for Omani males and females (52.0 ± 2.62 cm and 51.4 ± 2.64 cm, respectively) were significantly higher than the WHO standard measurements (P <0.001). Conclusion The WHO growth charts might not be appropriate for use with Omani neonates; possible alternatives should therefore be considered, such as national growth charts based on local data.

Neonatal Outcome of Abdominal Wall Defects at a Tertiary Center in Oman

Objective: The aims of this paper are, to evaluate the birth prevalence some of the epidemiological risk factors and neonatal outcomes of newborns with gastroschisis and omphalocele. Methods: This retrospective descriptive study was conducted between January 2010 and December 2015 at the Sultan Qaboos University Hospital (SQUH) neonatal intensive care unit (NICU). Results: Ten cases of omphalocele and two cases of gastroschisis were examined. The birth prevalence of gastrsochisis and omphalocele was 1.39 in 10000 and 0.28 in 10000 respectively. Antenatal diagnoses were available in six cases (50%). Fifty percent of the cases were inborn. Eight (66.67%) infants were delivered by caesarean section. The median gestational age and birth weight for newborns with gastroschisis at birth were 35 weeks and 2100 g, respectively; for newborns with omphalocele, these values were 37 weeks and 2583 g respectively. The median maternal age for mothers of newborns with gastroschisis was 22.5 y; for mothers of babies with omphalocele, the mean age was 28 y. The median times to full feeding for newborns with gastroschisis and omphalocele were 19 days and 6 days, respectively. The median length of stay in the neonatal unit for newborns with gastroschisis was 35 days; for newborns with omphalocele, the duration was 8.5 days. Fifty percent of all patients exhibited intrauterine growth retardation (IUGR). Primary surgical closure was performed in 10 (83.33%) patients. Associated cardiac anomalies were detected in seven babies (58.33%). Chromosomal anomalies were only documented in two patients with omphalocele. Mortality was documented in three infants (25%). Conclusion: There were more admissions for patients with omphalocoele in comparison with gastroschisis with low birth prevalence compared to reports from western countries. The majority of patients were delivered by cesarean section. Mortality occurred only among patients with omphalocele.

Maternal and Neonatal Factors Influencing Preterm Birth and Low Birth Weight in Oman: A Hospital Based Study

Background : Preterm births (PTB) and low birth weight (LBW) - the two distinct adverse pregnancy outcomes - are the major determinants of perinatal survival and development. The purpose of this study was to determine the incidence of LBW and PTB and identify the maternal and neonatal risk factors influencing them. Methods : Data for the study come from a cross-sectional retrospective study conducted at the maternity ward of Sultan Qaboos University Hospital (SQUH) in Oman during the period between November 2011 and February 2012. Data on 534 singleton live births that occurred during the study period were extracted from hospital record. Descriptive statistics, bivariate analysis and multivariate logistic regression model were used for data analysis. Results : The incidence of PTB and LBW were observed to be 9.7% and 13.7% respectively. Half (51.8%) of the LBW babies were PTB and 48.2% of the LBW babies were of term births. Differences and similarities were noted for the risk profile for PTB and LBW. Risk factors specific to PTB were maternal age, previous pregnancy loss, and infant’s length, while birth interval, maternal weight and BMI during pregnancy, and gestational age were the risk factors unique to LBW. ANC visit, infant’s gender, Apgar score, and head circumference of infants were the common significant risk factors influencing both LBW and PTB. Conclusions : The incidence of PTB and LBW are moderately high in Oman. They are associated with different risk factors. A greater understanding and modification of identified risk factors would help reduce the incidence of PTB and LBW in Oman.

Management of necrotizing enterocolitis: experience at a tertiary care hospital in Oman

IntroductionNecrotizing enterocolitis (NEC) is the most common surgical emergency in the neonatal intensive care unit. The aim of this study was to determine the incidence of NEC and identify the factors predicting the surgical management and also to determine the mortality due to NEC at our tertiary care neonatal unit in Oman. Materials and methodsThe parameters studied included sex-based differences, gestational age at birth, birth weight, maternal risk factors, patient risk factors, age when feeding was started, type of feed, age when signs of NEC appeared, presence of any antecedent associations, clinical features, radiological features, blood investigations, requirement of surgery, surgical findings, and outcome. ResultsThe study included 14 male and 12 female neonates. The mean gestational age at birth was 29.8±3.7 weeks (range: 25–38 weeks). The mean birth weight was 1348.4±774.1 g (range: 610–3900 g). The total incidence of NEC was 2.28%, whereas its incidence in neonates with birth weight less than 2500g was 4.47%. Surgical management was carried out for 11 (42.3%) patients. The mean platelet count in patients managed surgically was significantly lower compared with those managed conservatively (106.5 vs. 218.1 cells/&mgr;l of blood, P<0.05). Similarly, the mean C-reactive protein level was also higher in patients managed surgically compared with those managed conservatively (104 vs. 54 mg%, respectively, P<0.05). Five of 26 (19.2%) patients died during the course of treatment. ConclusionThe incidence and mortality rate of NEC in Oman is similar to that in other countries. Low platelet counts and high C-reactive protein levels are the factors that can predict the need for surgical management.