Zahra Marrakchi

Prevalence of vitamin D deficiency in mothers and their newborns in a Tunisian population

To assess vitamin D status in mothers and their newborns and identify predictive factors of vitamin D deficiency.

Apport de la procalcitonine dans le diagnostic précoce de l’infection materno-fœtale bactérienne. Étude prospective

UNLABELLED Early diagnosis avoiding unnecessary treatment of maternal-fetal bacterial infection remains one of the greatest challenges for obstetricians and pediatricians. To meet these objectives, many inflammatory mediators were used, including procalcitonin (PCT). The aim of our study was to determine the usefulness of PCT in early diagnosis and management of neonatal infection. SUBJECTS AND METHODS Over a period of 8 months, all living newborns with highly suspected maternal-fetal bacterial infection who were to receive antibiotic treatment according to our neonatal unit protocol were included in this prospective study. Serum PCT concentrations were determined at birth and after 12h of life using a specific immunoluminometric assay. Two distinct populations were defined based on clinical, biological, and bacteriological criteria: group 1: infected neonates, and group 2: noninfected neonates. STATISTICAL METHODS We compared PCT means in different groups and determined the cut-off value correlated with maternal-fetal bacterial infection by analyzing the receiver operating characteristics curve (ROC). RESULTS A total of 130 neonates were included in the study: 38 (29%) were classified in group 1 with 29 possible infections and 9 defined infections, including 5 cases of septicemia. The average PCT at birth in group 1 was significantly higher than in group 2 (3.52 ± 8.19 ng/ml vs 0.43 ± 0.73 ng/ml; P<0.001). The PCT threshold value at birth found by the ROC curve with the highest sensitivity (71.1%) and highest specificity (62%) was 0.215 ng/ml. The negative predictive value (NPV) was 83.8%, making it possible to avoid unnecessary treatment in the majority of the cases. The PCT threshold value within 12h of birth was 3.78 ng/ml, for a sensitivity of 89.5% and 1 NPV of 94.4%. CONCLUSION PCT is a valuable biological examination because it can be administered early, it is sensitive, and it has a NPV. These characteristics make PCT a biological argument that can be used in the initial decision on whether to administer antibiotics. Another study will be conducted to establish the cut-off value.

Risk factors for perinatal mortality in a Tunisian population

Age 20–24 8 (26.7) 25–29 9 (30.0) 30–34 9 (30.0) 35–39 3 (10.0) N39 1 (3.3) Parity 0 9 (30.0) 1 7 (23.3) 2–4 9 (30.0) 5 and above 5 (16.7) Financial independence Yes 19 (63.3) No 11 (36.7) HIV discordance Yes 18 (60.0) No 12 (40.0) Unwanted pregnancy Yes 8 (26.7) No 22 (73.3) Educational level At least primary education 8 (26.7) Secondary education and above 22 (73.3) Type of marriage Polygamy 2 (6.7) Monogamy 28 (93.3) Place of residence Urban 20 (66.7) Rural 10 (33.3)

Isolated anti-Ro/SSA thrombocytopenia: a rare feature of neonatal lupus

We report a rare case of isolated thrombocytopenia related to anti-Ro/SSA antibodies. The mother was followed for unlabeled familial thrombocytopenia. The mother had positive anti-Ro/SSA antibodies. She was asymptomatic without skin lesions or other criteria neither of systemic lupus erythematosus nor other connective tissue disease. Pregnancy was uneventful. The postnatal examination was normal. On the first day of life, blood cells count showed thrombocytopenia at 40 x 109/L. Within the second day of life, platelet level dropped to 20 x 109/L. The management of thrombocytopenia included platelet transfusion and human immunoglobulin infusion. On the fifth day of life, there has been a drop in platelet count to 10 x 109/L requiring renewed platelet transfusion and human immunoglobulin infusion. On the 10th of life platelets rate was stable around 60 x 109/L. The infant had no evidence of cardiac, dermatologic or hepatobilary involvement initially or throughout follow up.

Perinatal-lethal Gaucher disease presenting as hydrops fetalis

Perinatal-lethal Gaucher disease is very rare and is considered a variant of type 2 Gaucher disease that occurs in the neonatal period. The most distinct features of perinatal-lethal Gaucher disease are non-immune hydrops fetalis. Less common signs of the disease are hepatosplenomegaly, ichthyosis and arthrogryposis. We report a case of Gauchers disease (type 2) diagnosed in a newborn who presented with Hydrops Fetalis.

Acute neonatal appendicitis in a preterm

Acute neonatal appendicitis is very rare in the neonatal period. It is usually associated with comorbidity including prematurity. Symptoms are non-specific. The prognosis is marked by high risk of mortality and morbidity. Here, we report a case of preterm new born who presented with sepsis, apnoea, and digestive signs. The laparotomy revealed perforated appendicitis complicated with peritonitis.

Fetal cyst reveling retroperitoneal enteric duplication

Retroperitoneum is a very uncommon site of enteric duplication (ED). We report a new case of retroperitoneal ED cyst suspected in utero. Prenatal ultrasound showed an abdominal cystic mass. Noncommunicating retroperitoneal ED cyst measuring 70 mm × 30 mm was resected. Histopathologic examination confirmed the diagnosis.