Samia Kacem

Plasma arachidonic and docosahexaenoic acids in Tunisian very low birth weight infants: status and association with selected neonatal morbidities

To study plasma arachidonic acid (AA) and docosahexaenoic acid (DHA) status in Tunisian very low birth weight (VLBW) infants and their association with selected neonatal morbidities. A total of 709 VLBW infants and 339 term infants were included. Plasma fatty acids were analyzed using capillary gas chromatography. VLBW infants had significantly (p < 0.001) lower plasma AA (9.44 ± 2.12 vs. 10.8 ± 2.10) and DHA (2.56 ± 0.89 vs. 3.46 ± 1.09) levels, but higher n-6:n-3 ratio (5.58 ± 1.22 vs. 5.17 ± 1.46) than term infants. In VLBW infants, plasma AA and DHA were related to gestational age (r = 0.156; p = 0.001 and r = 0.134; p = 0.003, respectively), birthweight (r = 0.242; p < 0.001 and r = 0.181; p < 0.001, respectively) and head circumference (r = 0.138; p = 0.005 and r = 0.108; p = 0.027, respectively). Infants with respiratory distress syndrome have decreased plasma AA and DHA and those with intraventricular hemorrhage have decreased plasma AA and n-6:n-3 ratio. Sepsis was associated with decreased DHA levels. Plasma long chain polyunsaturated fatty acids status is low in VLBW infants. These deficits may enhance the risk of common neonatal morbidities, rendering their prevention and correction greatly warranted.

Retinol and Alpha-tocopherol in the Colostrum of Lactating Tunisian Women Delivering Prematurely: Associations with Maternal Characteristics.

BACKGROUND This study aims to assess vitamin A and E concentrations in the premature colostrum of lactating Tunisian women and to identify maternal characteristics that may affect these concentrations. METHODS Human colostrum was obtained from 105 mothers who gave birth prematurely in the Centre for Maternity and Neonatology of Tunis (Tunisia). Retinol and alpha-tocopherol were analyzed in the colostrum and in plasma by high-performance liquid chromatography. RESULTS Retinol and alpha-tocopherol concentrations were 57.5 ± 50.1 μg/dL and 1222 ± 772 μg/dL in the colostrum, respectively, and 51.7 ± 20.0 μg/dL and 1351 ± 772 μg/dL in plasma, respectively. Concentrations of each vitamin in the colostrum were positively correlated with their respective concentrations in plasma (r = 0.415, p = 0.001 for retinol and r = 0.392, p = 0.003 for alpha-tocopherol). In multivariate analysis, colostrum vitamin A was associated with plasma vitamin A and preeclampsia, while colostrum vitamin E was associated with plasma vitamin E, gestational age, and preeclampsia. CONCLUSION In Tunisian women, colostrum vitamin A and E levels are close to the average values reported in the literature. The levels are too low to cover the needs of very low birth weight (VLBW) infants, particularly in women with plasma vitamin deficiencies, preeclampsia, or very premature delivery. Given the undeniable beneficial effects of human colostrum, whenever feasible, VLBW infants should be fed colostrum. Infant vitamin A and E requirements should be met by milk fortification or supplementation.

Protein S Deficiency Presenting with Hemorrhage in a Term Neonate

Unexplained bleeding symptoms in otherwise healthy full-term usually present a diagnostic challenge for treating physicians requiring prompt and accurate laboratory investigations to ensure appropriate treatment and possibly avoid long-term morbidity. We report a case of a term neonate with severe protein S deficiency manifested by systemic hemorrhage and multiple organ failure at 9 days of age. We review how protein S influences the coagulation and the fibrinolytic pathways, discussing therapeutic approaches of neonates with purpura fulminans.

Testicular Torsion in Neonate: A Rare Pathology

A case of neonatal testicular torsion is reported. The clinical course showed the appearance of enlarged testes and swollen and purplish penis in 6th hour of life. Surgical exploration revealed a bilateral extraravaginal testicular torsion which is a very rare entity.

Arthrogryposis Multiplex Congenital: Case Report

Arthrogryposis is a syndrome that can be, seen in different diseases that have in common the existence of multiple joint stiffness. Once the diagnosis poses, the prognosis will depend on the severity of the clinical presentation and its precocity of installation. Management depends on the etiology, which makes the treatment different from one case to another. In cases of suspected Arthrogryposis, practitioners should have attention to amniotic fluid quantity, fetal motricity, swallowing movements and research an amyotrophy or abnormalities of the extremities. We report a particular case of antenatal diagnosis of Arthrogryposis with excess amniotic fluid.

Neonatal Perforation of Meckel Diverticulum: About Two Cases

Two cases of neonatal perforation of Meckel’s diverticulum (MD) are reported. The clinical course showed the appearance of pneumoperitoneum successively at 20 h and the 7th day of life. Laparotomy revealed Meckel’s perforation, which was associated with meconium peritonitis in the second case. Although rare, MD should be kept in mind as one cause of gastrointestinal perforation in neonate.