Wadah Khriesat

Management of intramedullary spinal cord abscess: experience with four cases, pathophysiology and outcomes

Intramedullary spinal cord abscess (ISCA) in children is extremely a rare infection of the central nervous system (CNS); and probably a devastating neurological condition. Clinical awareness of patients at risk is crucial for early diagnosis and intervention; as this entity is one of the treatable conditions of paraparesis. Association with congenital neuro-ectodermal abnormality in children is frequent. This pathology highlights the importance of complete neurological checks of infants as a part of their routine physical examination and early management of patients with congenital dermal sinus, prophylactic surgical resection of such a congenital anomaly is recommended by most authors to prevent serious infections of the CNS. However, once the abscess is established; immediate surgical drainage along side adequate antibiotics should be instituted. This may guarantee improving neurological outcome. In this communication, the authors present their experience with four cases of ISCA in children treated successfully with surgical drainage, intravenous antibiotics and neuro rehabilitation between 2001 and 2006 and discuss their results. We concluded that early diagnosis and treatment is essential; before a devastating mechanico-vascular insult of the spinal cord is established from rapid formation of the abscess and a swift expansion of the spinal cord within the limited intraspinal space.

Primary repair of a large incomplete sternal cleft in an asymptomatic infant with Prolene mesh

A cleft of the sternum is a rare congenital anomaly, often diagnosed as an asymptomatic condition at birth. We present a case of a large incomplete sternal cleft in a full-term baby boy. Surgical repair of the sternum with the use of Prolene mesh was performed during the neonatal period without cardiac compression.

Adopting western retinopathy of prematurity screening programs in eastern countries, are we screening properly?

Purpose: To describe retinopathy of prematurity (ROP) among Jordanian preterm infants and evaluate the efficacy of applying current Western screening guidelines for Jordanian preterms. Materials and Methods: In this retrospective, descriptive hospital-based study, we collected data on preterm infants who were referred by their neonatologist for ROP screening at King Abdullah University Hospital between July 2006 and June 2007. Guidelines suggested by the American Academy of Pediatrics were followed. Additionally, older preterms considered at risk for ROP by the neonatal intensive care unit were screened. Any neonate with stage 1 ROP or higher in either eye was considered a positive case of ROP. Results: Ninety-one preterms were included in the study. The median birth weight was 1390 gm (range,730-1980 gms) and the gestational age ranged from 26 to 35 weeks with 64.8% of preterms ≤ 32 weeks. ROP occurred in 28.6% of all patients, in 20% of infants with birth weight greater than 1500 gms and in 9.4% of preterms with gestational age ≥ 32 weeks. Six patients (6.6%) required laser treatment, two with low birth weight greater than 1250 gm and one was 33 weeks of age. Consanguinity was identified in 19.2% of infants with ROP while consanguinity in infants who did not develop ROP was 1.9%. This difference was statistically significant (P<0.05). Conclusion: ROP occurs in premature infants in Jordan with gestational age above 32 weeks and birth weight above 1250 gm. Future guidelines for screening should incorporate the current study outcomes. A prospective, population-based is required to set national guidelines for ROP screening in the Jordanian population and similarly for different populations worldwide. Consanguinity may play a role in ROP development and further genetic studies may aid in elucidating the pathogenesis of ROP.

Intrauterine Upper Limb Ischemia Associated with Fetal Thrombophilia: A Case Report and Review of the Literature

Neonatal extremity gangrene is rare, even rarer are those born with evidence of intrauterine vascular occlusion. Intrauterine limb ischemia has been attributed to several etiological factors which include thromboembolic disease occluding the arteries of the affected limb or compression of the limb during intrauterine life. In this report, we present a case of brachioradial arterial thrombosis associated with mild homocysteinemia and double heterozygosity of methylenetetrahydrofolate reductase 677C-T and factor V Leiden gene mutations. We suggest investigating the neonates and their mothers for possible genetic prothrombotic risk factors when they present with intrauterine thrombosis as this issue is important for management and counseling.

Predictors of severe hemolysis in patients with glucose-6-phosphate dehydrogenase deficiency following exposure to oxidant stresses

BACKGROUND AND OBJECTIVES Glucose-6-phosphate dehydrogenase (G6PD) deficiency is a genetic enzymatic disorder that affects millions of people worldwide, and is a major health problem in Jordan. We studied factors that may predict severe hemolysis in children with G6PD deficiency. METHODS We reviewed the records of patients with low G6PD activity admitted to a teaching hospital be- tween 1996 to 2007. We collected demographic data, details of sign and symptoms, history and type of fava bean ingestion, blood and Rh group, history of neonatal jaundice, history and type of drug use, abdominal pain at admission and the results of tests for hemoglobin, white blood cells (WBC), and hepatic function. We classified patients into mild and severe groups based on hemoglobin levels at admission. RESULTS Of 428 children with G6PD deficiency, 79 (18%) were severe cases and 349 (82%) patients with mild disease. There were no statistically significant differences in most factors between the two groups. Factors that achieved statistical significance for severe hemolysis included younger age (P<.05), male gender (P<.05), higher alkaline phosphatase (ALP) (P<.05), presence of fever at admission (P<.01), presence of vomiting during the at- tack (P=.006), and a negative family history for G6PD deficiency (P=.005). CONCLUSIONS Severe hemolysis can be predicted during hemolytic episodes in children with low G6PD by young age, male gender, a negative family history of G6PD deficiency, the presence of fever and vomiting and a high ALP.

Aplasia cutis congenita associated with coarctation of the aorta: case report and review of the literature

A 1-day-old newborn boy was transferred from an outside hospital for evaluation and treatment of a skin defect and convulsions immediately noted after birth. He was born at 40 weeks’ gestation by a normal vaginal delivery to a 25year-old G1P1 mother. Apgar scores were 7 and 9 at 1 and 5 min, respectively. He had a birth weight of 3300 g, a length of 51 cm, and a head circumference of 35.5 cm. The pregnancy was uncomplicated and there was no record of birth trauma. The perinatal history was negative for intrauterine trauma or the use of antithyroid medications. There was no family history of a similar condition or cardiac malformation. On admission, the patient was notable for hypoactivity and poor feeding. Cutaneous examination demonstrated an irregularly shaped skin defect, measuring 5.5 cm in maximum length and 4 cm in maximum width, on the dorsal aspect of the distal half of the right forearm with an erythematous area surrounding the lesion. Initial cardiovascular examination was normal. No limb defects were observed and the rest of the examination was unremarkable. A complete blood count and standard biochemical profile, including ionogram, and kidney and liver function tests, yielded normal results. The plan was to manage the patient conservatively by applying antiseptic ointment to prevent infection and dryness. On the second day of life, the patient developed myoclonic convulsions lasting for 2 min with uprolling of the eyes. Electroencephalogram (EEG) showed diffuse severe suppression consistent with a diffuse encephalopathic process, with no epileptiform activity. Brain magnetic resonance imaging (MRI) showed extensive bilateral encephalomalacia replacing almost all brain tissue. There was a hypoplastic inferior cerebellar vermis. The patient was started on anticonvulsant medications. On the fifth day of life, the patient developed central cyanosis and rapid breathing. Examination revealed a heart rate of 180 beat/min, a respiratory rate of 75/min, and an oxygen saturation of 80% in room air. Chest X-ray showed cardiomegaly. Two-dimensional echocardiogram showed severe hypertrophy of the ventricles, a small left ventricular cavity, mild coarctation of the aorta, and mild patent ductus arteriosus. The patient was started on digoxin and furosemide. Chromosomal study revealed 46, XY normal male karyotype. At the age of 3 weeks, the wound had almost completely healed leaving a defect of 1 cm (Fig. 1). The patient was discharged home at the age of 6 weeks, with the cardiovascular and neurologic conditions stable on medications and the skin defect completely closed leaving an atrophic scarred area. At no time did the wound become infected. At the age of 8 months, the patient developed an acute chest infection that worsened his heart failure and died.

Jordanian obstetricians’ personal preference regarding mode of delivery

The personal preference of Jordanian obstetricians regarding mode of delivery in uncomplicated pregnancy with singleton cephalic presentation at term was surveyed by an anonymous structured questionnaire distributed at five conferences/scientific meetings on obstetrics and gynecology held in Jordan in 2007. The response rate was 70% (n = 315), and 22 (7%) of the respondents chose elective cesarean section (CS). Respondents <45 years seemed to be more in favor of elective CS than those ≥55 years (14.1% vs. 3.7%). In multivariate analysis, increased age was inversely associated with the odds of choosing elective CS (OR = 0.93, 95% CI: 0.88–0.99, p = 0.024) after adjusting for gender, sector, and duration of practice. The main reasons for preferring abdominal delivery were the fear of long‐term sequel (stress incontinence and anal sphincter damage) and the wish to preserve sexual function (86.4 and 50.0%, respectively). The majority of Jordanian obstetricians and gynecologists preferred vaginal delivery in uncomplicated pregnancy for themselves or their wives.

A Fat Overload after Fat Emulsion High Dose Infusion in an Infant

Intravenous fat emulsion (IVFE) is an integral part of the Parenteral Nutrition (PN), in infancy there is a limited data regarding acute toxicity and management regarding fat emulsion overdose. We are reporting an infant who received an accidental high dose of fat emulsion and was successfully treated with a single – volume exchange. In infant with fat emulsion overdose, rapid assessment and treatment should be undertaken immediately to prevent lifethreatening complication.

Breastfeeding Attitudes and Knowledge among Sixth Year Medical Students in Jordan

Background: Previous reports have demonstrated that counseling about breastfeeding can improve the rate and initiation duration of breastfeeding. However, those medical students are ill-prepared for this role. It is unclear whether medical students would provide the knowledge and skills necessary for effective breastfeeding promotion or not in Jordan. The aim of this study was to identify breastfeeding attitudes and knowledge among 6th year medical students in their final year at The Jordan University of Science and Technology (JUST). Methods: A 28-item self-administered questionnaire; containing three sections: knowledge (13 items) attitude (7 items) and demographic (3 items), were distributed randomly to medical students. The random sample consisted of 234 medical students who were in their final year. The questionnaire assessed both breastfeeding attitudes and knowledge. Results: The results were explained taking into consideration gender and being a parent. Mean attitude’s score for participants without children was 46.7 as compared to 44.0 for those with children. The results showed similar negative attitude toward breastfeeding among both male and female participants regardless of having children or not (p=0.35). This means that there were no significant difference in attitudes toward breastfeeding among male and female students whether they are having children or not. On the other hand, the mean knowledge score was 22.9 for male participants while it was 21.55 for female participants, indicating some degree of breastfeeding knowledge among participants (p=0.035). However, having personal experience with breastfeeding (self or partner) did not increased breastfeeding attitudes and knowledge (p=0.35 vs. p=0.93, respectively). Conclusions: Medical students have significant educational needs in the area of breastfeeding management and breastfeeding education. Further targeted training is needed to improve both breastfeeding attitudes and knowledge.

Oxygen saturation immediately after birth in healthy full-term neonates born below sea level

Objective: The aim of this study was to determine the normal pre- and post-ductal arterial oxygen saturation (SpO2) immediately after birth in neonates born 200 m below sea level. Methods: A descriptive study was carried out, between January and December 2014, at the Pediatric Department of Moath Bin Jabal Hospital in the Jordan Valley. The arterial SpO2of the right hand and right foot of one-hundred neonates was recorded by pulse oximetry. Results: The mean preductal values at 2 min of life were significantly higher than the postductal values (P < 0.05). After 5, 10, and 15 min, the differences were statistically insignificant. At 20 min, there was no difference. The pre- and post-ductal SpO2rates of ≥95% were reached after 8 and 10 min of life, respectively. Conclusions: This study showed that it takes 8 and 10 min for healthy neonates, born below sea level, to reach pre- and post-ductal SpO2of ≥95%, respectively.