Hypoxic ischaemic encephalopathy at the Mount Hope Women's Hospital, Trinidad - abstract

Hypoxic Ischaemic Encephalopathy (HIE) is a clinical syndrome which develops following foetal distress and a poor response by the infant to the birth process. Severe HIE can lead to death and severe neurological abnormalities. The aim of this study was to determine the incidence and outcome of babies who developed HIE over two 3-year periods, 1982-1984 and 1990-1992, at the Mt. Hope Women's Hospital (MHWH), Trinidad. The records of all inborn babies admitted to the Neonatal Unit, MHWH, with a diagnosis of HIE were studied. Those with proven meningitis, hypocalcaemia, irritability and hypoglycaemia were also excluded. Information collected included maternal characteristics, labour, birth and infant development up to 1 year. The overall incidence for the two study periods was 3.85 per 1000 live births (1982-1984) and 5.19 per 1000 live births (1990- 1992), which was not statistically significant. There was no statistical difference with regard to maternal age, parity, gestation, ethnicity, marital status, antenatal problems, foetal distress, infant gender and Apgar scores at 1 and 5 minutes. Significantly more mothers had antenatal care and more babies developed normally during the second study period. Significantly more mothers had Stage 1 of labour lasting longer than 15 hours in the first study period. There was no difference in the proportion of babies who died during the two study periods and a significantly higher proportion of babies were normal up to one year in the second study period. Like the perinatal mortality rate, HIE did not change with time at the Mt. Hope Women's Hospital (AU)

Perinephric abscess mimicking fulminant hepatic failure

We describe a female diabetic patient who presented with features suggestive of hepatobiliary disease and who exhibited clinical signs of fulminant hepatic failure. Identification and drainage of a right perinephric abscess resulted in prompt resolution of both the physical signs and biochemical indices of liver disease. Infection remote from the hepatobiliary tree can mimic fulminant hepatic failure, and recognition of this unusual presentation of infection is important if dangerous delay in diagnosis and treatment is to avioded. (AU)