Mohammad Khassawneh

Diagnostic Markers for Neonatal Sepsis: Comparing C‐reactive Protein, Interleukin‐6 and Immunoglobulin M

This clinical study was conducted to evaluate the diagnostic value of C‐reactive protein (CRP), interlekin‐6 (IL‐6) and immunoglobulin M (IgM) in the early diagnosis of neonatal sepsis. The diagnostic values of each marker separately or in combinations were evaluated. The optimal cut‐off values of each marker in the diagnosis of neonatal sepsis were defined. Between December 2004 and March 2005, a total of 78 neonates at different ages with different diagnoses in a neonatal intensive care unit in North Jordan were enrolled. Patients were classified into ‘sepsis’ group, ‘probable sepsis’ group and ‘no sepsis’ group. Blood samples were collected for CRP, IL‐6 and IgM determination. A CRP value of 5 mg/l was the best among the three parameters with 95% sensitivity and 98% negative predictive value. Combination between parameters was helpful in enhancing the ability to diagnose sepsis. The best combination was CRP ≥ 5 mg/l and/or IgM of ≥20 mg/dl. We conclude that CRP, IL‐6 and IgM are helpful in the early diagnosis of Gram‐negative neonatal sepsis. However, CRP continues to be the best single test. The use of both CRP and IgM in combination was the most helpful in predicting Gram‐negative neonatal sepsis. We speculate a significant role of this combination in making decisions regarding antibiotics treatment and upgrading the level of medical care and observation in a setting where Gram‐negative micro‐organisms are causing the majority of neonatal infections.

Factors affecting intention to breastfeed among Syrian and Jordanian mothers: a comparative cross-sectional study

BackgroundBreastfeeding is considered the ideal method of infant feeding for at least the first six months of life. This study aimed to compare breastfeeding intention between Syrian and Jordanian women and determine factors associated with breastfeeding intention among pregnant women in these two countries.MethodsA cross-sectional design was used to collect data from1200 pregnant women aged 18 years and above (600 participants from each country). A self- administered questionnaire was used to collect data on socio-demographic characteristics and breastfeeding intention.ResultsIntention to breastfeed was reported by 77.2% of Syrian and 76.2% of Jordanian pregnant women. There was no significant difference in intention to breastfeed between Syrian women and Jordanian women. In both countries, women with a more positive attitude to breastfeeding, women with previous breastfeeding experience and women with supportive partners were more likely to intend to breastfeed. Syrian women with a monthly family income of more than US

Methylenetetrahydrofolate Reductase Polymorphisms C677T and A1298C as Maternal Risk Factors for Down Syndrome in Jordan

200, younger than 25 and primiparous or having one child were more likely to report an intention to breastfeed their infants. Jordanian women with an education level of less than high school and not living with their family-in-law were more likely to intend to breastfeed.ConclusionsIn Syria and Jordan, a more positive attitude to breastfeeding, previous breastfeeding experience and presence of supportive husbands are associated with intention to breastfeed. These factors should be considered when planning programs designed to promote breastfeeding in these two countries.

Clinical features of neonatal sepsis caused by resistant Gram-negative bacteria.

BACKGROUND The activity of the methylenetetrahydrofolate reductase (MTHFR) enzyme is regulated by the two polymorphisms C677T and A1298C, which reduce enzyme activity and result in hypomethylation of chromosomes that increase the risk of nondisjunction. These polymorphisms are suggested to be risk factors for Down syndrome (DS) in some populations. AIM The aim of this study was to test if C677T and A1298C polymorphisms are correlated to maternal risk of DS in Jordan. METHODS The proportions of C677T and A1298C polymorphisms were examined in 53 case mothers who delivered DS children and 29 controls. The median age of case mothers was 35 years when delivering their affected children. Polymerase chain reaction-restriction fragment length polymorphism was used for genotyping. RESULTS The frequency of MTHFR C677T allele in all DS mothers was 3.2-fold higher than in the controls (odds ratio [OR] = 3.12, 95% confidence interval [CI]: 1.303-7.677). Also, the proportion of 677T in the older case mothers was different from the controls, but was significantly higher in younger case mothers than in the controls (OR = 4.2, 95% CI: 1.61-10.97, p = 0.003). The proportions of 677CT and 677TT genotypes in younger cases are, respectively, 10- and 9-fold higher than in the controls. The proportions of MTHFR A1298C are significantly different among all case groups and the controls (χ(2) = 4.27, p = 0.127), but there was a significant difference between young case mothers and both older case mothers group and the controls (OR = 1.25, 95% CI: 0.405-3.85, p = 0.698). CONCLUSIONS There is strong association between MTHFRC677T and maternal risk of DS in Jordanian mothers younger than 35 years old and the MTHFR1298C allele has a lesser but additive risk effect in MTHFR677T/1298C compound heterozygotes.

Pitfalls in Measuring Cerebrospinal Fluid Glycine Levels in Infants With Encephalopathy

Background:  Clinical features and outcomes of neonatal sepsis caused by resistant Gram‐negative bacteria are not well described in Jordan. The aim of the present study was therefore to describe microbiology and clinical features, laboratory findings and outcomes of early‐ and late‐onset Gram‐negative neonatal sepsis.

Sex preference and interest in preconception sex selection: a survey among pregnant women in the north of Jordan

In encephalopathic infants, cerebrospinal fluid hyperglycinemia and elevated cerebrospinal fluid to plasma glycine ratio are considered pathognomonic of nonketotic hyperglycinemia. To evaluate the significance of cerebrospinal fluid hyperglycinemia and elevated cerebrospinal fluid to plasma glycine ratio in acutely encephalopathic infants, a retrospective chart review of all cases of isolated elevation of cerebrospinal fluid glycine levels at Arkansas Children’s Hospital from January 1995 to December 2000 was performed. Twenty-two patients (14 males) were included. The most common diagnosis was hypoxic ischemic encephalopathy (n = 8). Nine patients had elevated cerebrospinal fluid to plasma glycine ratio, which was transient in 7 patients. This study shows that elevated cerebrospinal fluid to plasma glycine ratio can be encountered in a variety of clinical conditions. The significance of this observation in light of the poor prognosis of nonketotic hyperglycinemia and the possible role of glycine in the mechanism of ischemic neuronal injury is addressed.

Treatment of Stenotrophomonas neonatal urinary tract infection with instillation of ciprofloxacin.

BACKGROUND Preconception sex selection for non-medical reasons is a controversial issue in bioethics. Little research has described preferences for preconception sex selection among Arab populations. This study describes the sex preference and interest in employing sex selection techniques among pregnant women in northern Jordan. METHODS A self-reported questionnaire was administered to 600 pregnant women in Irbid, Jordan. chi(2) test and binary logistic regression were used to examine the factors associated with interest in preconception sex selection. RESULTS In general, the interest in using sex selection was low. Women who preferred boys were more likely to be interested in sex selection, if paid for by the couple [odds ratio (OR) = 4.40, 95% confidence interval (CI): 1.75-11.11] or by health insurance (OR = 3.42, 95% CI: 1.94-6.06), or, if feasible, administered through oral medication (OR = 8.84, 95% CI: 5.05-15.63). Women with lower education were more likely to be interested in sex selection, if paid by health insurance (OR = 1.96, 95% CI: 1.10-3.45) and were more likely to believe that sex selection is legal (OR = 1.79, 95% CI: 1.06-2.86). Women who had no boys were more likely to be interested in sex selection, if paid by health insurance (OR = 1.94, 95% CI: 1.10-3.42) or, if feasible, through medication (OR = 3.03, 95% CI: 1.82-5.00). CONCLUSIONS The majority of participants were not in favor of using preconception sex selection. Those with a preference to have boys, with lower education, and those with an imbalanced family were more likely to be interested in using sex selection technology.

Neonatal mortality in Jordan: secondary analysis of Jordan Population and Family Health Survey (JPFHS) data

Stenotrophomonas maltophilia on the 47th day of life. Treatment with a full course of antibiotics using cotrimoxazole and imepenem did not clear this infection. The patient partially responded to a full course of treatment with intravenous (IV) ciprofloxacin, but Stenotrophomonas maltophilia grew 3 days after stopping treatment. At that time IV ciprofloxacin was used as well as locally instilled ciprofloxacin in the nephrostomy tube. The dose used in the instillation was 10 mg/kg (a total of 30 mg). The 30 mg was then diluted in 60 ml normal saline and divided into six doses. Each dose was instilled locally for 30 min once every 4 h for 14 days. This completely treated the infection. Patient tolerated this treatment with no apparent local irritation. In patients in this age group with nephrostoma, an approach using a combination of local and systemic antibiotics to treat UTI was successful. One might speculate whether in non-febrile infants local instillation of ciprofloxacin might be successful to eradicate UTI caused by resistant bacteria.

Effect of methotrexate on the survival of human lymphocyte cultures carrying MTHFR 677 (C>T) and MTHFR 1298 (A>C) mutations

Abstract Objective: This study aimed to analyze the 2009 Jordan Population and Family Health Survey (JPFHS) data to determine the level, trend, and distribution of neonatal mortality (NNM) in Jordan and determine its associated factors. Methods: Nationally representative data on NNM were extracted from the JPFHS data. Using multivariate analyses, the strength of associations between 12 clinical/sociodemographic variables and neonatal mortality were quantified after controlling for potential confounders. Results: The weighted NNM rate for 2005–2009 period was 16 deaths per 1000 live births, with the early NNM rate and late NNM rates were 10 deaths per 1000 live births and six deaths per 1000 live births, respectively. Fluctuations of NNM according to year of birth and geographic variations were noted. Risk of NNM increased among male newborns, as mother’s education level decreased, in mothers 40–49 years old, in multiple gestations-low birth weight neonates, and as birth interval was <3 years. Conclusions: The NNR rate for 2005–2009 period of 16 deaths per 1000 live births indicates that there are opportunities to decrease it. Risk factors of neonatal mortality with respect to predictors of death during first days of life and variables related to geographic variations require particular focus to improve the quality of obstetric and neonatal health services and to decrease neonatal mortality.

The psychosocial functioning of mothers of infants admitted to the neonatal intensive care unit in the north of Jordan

The correlations between the presence of MTHFR 677 (C>T) and MTHFR 1298 (A>C) mutations in human lymphocytes and the sensitivity of lymphocytes to methotrexate (MTX) were examined in cultures derived from 82 unrelated women, genotyped for these mutations by polymerase chain reaction–restriction fragment length polymorphism. Lymphocytes heterozygous for the mutant allele, MTHFR 677T, were significantly more sensitive to methotrexate than those carrying the homozygous wild-type allele, MTHFR677C, and those carrying either the mutant or the wild-type alleles in the polymorphic MTHFR 1298 site. In addition, the lymphocyte cultures carrying the mutant MTHFR 1298C allele were not different in their sensitivity to MTX from those cultures carrying the wild-type allele, MTHFR 1298A. This demonstrated that the polymorphic site MTHFR C677, but not MTHFR1298, could be considered as a useful pharmacogenetic determinant in planning and designing the effective personal MTX chemotherapeutic doses and regimes.