Nisar A. Mir

Easily identifiable congenital malformations in children: Survey of incidence and pattern in 32,332 live born neonates.

Over a period of two years, 32,332 live-born infants were screened for the presence of identifiable congenital malformations. Congenital anomalies were present in 2.38% of all infants; major and minor malformations were present in 79% and 21% of the cases, respectively. Anomalies in general and chromosomal anomalies in particular were more common in multiparous women of advanced age. Anatomical organs most frequently affected were musculoskeletal and cardiovascular systems; talipes, chromosomal anomalies and congenital cardiac defects being the most common. The incidence of congenital anomalies in infants of diabetic mothers was 13.8% compared with 3% in the non-diabetic population (P=<0.01); multiple anomalies were present in 50% of the cases. Of a total of 770 infants born with malformations, 58 died during the early neonatal period with a mortality rate of 7.5% compared with an overall early neonatal death rate of 11.8/1000 live births.

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.

Brucellosis in pediatric patients: A review of 114 cases from Asir region.

Over a period of four years. 114 children (> 28 days to </= 12 years) with seropositive brucellosis were admitted to Khamis Mushayt Civil Hospital, constituting 1% of all pediatric admissions. History of contact with domestic animals and ingestion of raw milk was positive, and over 84% of the patients were from the rural areas of Asir. The male:female ratio was 1.2:1, over 59% were of </= 5 years of age. Common clinical features observed were fever (80.7%), hepatosplemomegaly (38%), arthropathies (29%), and anemia (34%). Over 36% of the children were undernourished. Serological identification of etiological agents revealed Abortus and melitensis (53.5%). Abortus (32.5%) and melitensis (14%). All patients were treated with a combination of rifampicin and septrin. There were no deaths, drug-induced hepatitis was observed in two cases. It would appear that brucellosis is one of the major causes of morbidity in the pediatric population located in the Asir region and there is an urgent need for an effective control program.

Anterior fontanelle size in Arab children: standards for appropriately grown full term neonates.

The anterior fontanelle (AF) size of 100 male and 100 female normal neonates, born by spontaneous vertex delivery following a normal pregnancy, was determined on the 3rd day of life, using standard methods. The mean AF size for boys was 2.92 (0.51) (range 1.04-4.4) cm and for girls 2.51 (0.74) (range 1.0-4.1) cm. The difference between the sexes is significant (P less than 0.001). There was no significant difference in the head circumference between the sexes. The study establishes normal values for anterior fontanelle size for appropriately grown, full term Arab male and female infants.

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.

Ventriculitis complicating pyogenic meningitis in neonates

Ventriculitis, was diagnosed in 17 cases of neonatal bacterial meningitis by positive culture and/or leucocytosis of ventricular fluid. Majority of the patients were female (14) and 13 were preterm. Maternal and/or obstetric complications were present in 82 per cent. Mean age of diagnosis of meningitis was 7·7±5·1 days. In all patients blood and CSF cultures were identical: E. coli (11), group B streptococcus (3), citrobacter-enterobacter (2) and pseudomonas (1). Six received systemic therapy and 11 were administered combined systemic and intraventricular therapy. Overall mortality rate was 23·5 per cent and eight of the 13 survivors were abnormal on follow up. Outcome was related to the duration to render the CSF sterile and to the interval between the diagnosis of meningitis and ventriculitis. The mortality was significantly lower in patients treated with combined systemic and intraventricular therapy.

Cyclopic malformation in infants of diabetic mothers

Two cases of cyclopic malformations are described among 450 infants of diabetic mothers during a period of four years. Both died within 30 min. of birth. Both belonged to unrelated Libyan families with absent consanguinity and family history. No chromosomal defect was found in either. A possible etiological association with uncontrolled maternal diabetes is discussed.