Acute respiratory disorders in the newborn: a survey at the Mt Hope Women's Hospital, Trinidad

This retrospective study was undertaken to determine the incidence of acute respiratory disorders (ARD) in newborns delivered at the Mount Hope Women's Hospital (MHWH) from January 1 to December 31, 1994. The study also examined the relationship between incidence rates and maternal and neonatal parameters. Hyaline membrane disease (HMD), transient tachypnoea of the newborn (TTN), meconium spiration syndrome (MAS), persistent foetal circulation (PFC) and pulmonary infection (PI) were identified as ARDs among 5,062 live newborns using standard diagnostic criteria. Overall, 174/5062 neonates were diagnosed with ARD to give an incidence of 3.4 percent (104 males and 70 females). The commenest ARD was PI (39 percent) followed by HMD (29 percent). The incidence of ARD in preterm infants was 20.6 percent (100/486) and 1.1 percent (48/4363) in full term neonates. HMD occurred mainly in the preterm and low birth weight babies. TTN and PI were found in all gestational age groups. Asphyxia was present in 9.8 percent (17/174) at 1 minute and in 10.9 percent (19/174) at 5 minutes. It was more common in babies who developed HMD and PFC. Forty one percent of babies with ARD required assisted ventilation. There were 58 (33 percent) deaths. More than half of those ventilated died (55 percent), 2/3 of those with airleaks, and all those with IVH died Mortality was significantly associated with asphyxia at both 1 and 5 minutes of age. There was significantly greater mortality among neonates with HMD as compared to the other ARDs.(AU)

Neurological complications in the child due to maternal cocaine use

Major clinical disorders have been associated with fetal in utero exposure to cocaine and although factors such as prematurity, other drugs or alcohol used concomitantly, infections and a chaotic environment may all be contributory, the abuse of cocaine has been associated with several neurological complications. Perry et al. (1984) demonstrated a "down-regulation" of placental neurotransmitter receptors in infants with intrauterine exposure to drugs of abuse. Abnormalities or depletion of receptor sites in the fetal brain interfere with normal respiratory control, causing more frequent periods of apnea, and an increase in sudden infant death syndrome (SIDS) in infants of cocaine using mothers has been reported by some authors but not by others. Mahalik et al. (1980) proposed that vasoconstruction secondary to increased catecholamines, and the resulting hypoxia, was a probable contributing factor to the teratogenic potential of cocaine. Fetal vasoconstruction, hypoxia, placental vasoconstriction, abruptio placenta and teratogenicity of the drug itself all play a role in the pathogenesis of embryo-logical defects. The severity of problems is related to the time and extent of exposure. Intracerebral hemorrhages, cerebral infarctions and vasculitis have all been documented. We recently reported 3 infants with craniosynostosis. Other bony anomalies reported include skull defects exencephaly and encephalocele. We have also observed agenesis of the corpus callosum with porencephaly and Dandy-Walker variant malformation in one child. Neural tube defects and cortical atrophy have been observed. Small head circumferences, increased irritability with inability to calm the child, poor cuddling, hypertonicity, tremulousness, abnormal sleep patterns, overall poor stste regulation and attention deficit hyperactivity disorder with associated learning disability has been observed. Little is known of the potential long-term side effects of exposure to cocaine and more work in this area is needed. (AU)

Neonatal meningitis at Bustamante Hospital for Children: a retrospective study - abstract

Records of 36 neonates with meningitis were reviewed over a five-year period, between 1982 and 1986. The rate of neonatal meningitis was 18.5/1,000 neonatal admissions with a male predilection. Predisposing factors were identified in 30 per cent of neonates; late onset disease was the predominant type. Group B haemolytic streptococcus was the leading cause, followed by gram-negative bacteria. The long-term morbidity was 28 per cent; complications varied from mild, early onset seizures to permanent disability such as cerebral palsy. Seventy per cent of the complications arose in late onset disease type; gram-negative bacteria (60 per cent) were the predominant cause. The fatality rate was 3/36 (8 per cent) (AU)

Fatal malformations in Jamaica

Babies with major malformations were identified during the Jamaica Perinatal Morbidity and Mortality Survey. They were in 96 (8.6 percent) of 1112 perinatal and neonatal deaths coming to necropsy and in 25 (2.35 percent) of 1085 other deaths. The central nervous system was not most commonly affected, followed by the renal, gastro-intestinal and cardiovascular system in decreasing order of frequency. Many infants had abnormalities in more than one system and 10 malfomation syndromes/sequences were identified. Although at the present time, major malformations make only a small contribution to perinatal and neonatal mortality in Jamaica, its importance will increase as there is a fall in deaths related to perinatal asphyxia, currently the major cause of perinatal mortality in Jamaica. Although many malformations are currently untreatable, it is important to take account of gastro-intestinal defects when planning surgical services for the newborn, since these are the most easily remediable (AU)

Perinatal mortality in Jamaica: the role of intrapartum asphyxia and birth trauma

Data from the Jamaican Perinatal Morbidity and Mortality Survey, 1986-1987, were analysed in order to examine the frequency of pathological markers of asphyxia and birth trauma amongst fresh stillbirths and neonatal deaths in babies coming to necropsy. A total number of 1112 necropsies were performed. There were 295 normally formed fresh stillbirths and 463 neonatal deaths, 264 of whom died on the last day of life. One hundred and seventy (57.6 percent) fresh stillbirths showed signs of asphyxia and 64 (21.7 percent) had evidence of birth trauma. Signs of asphyxia were common in all the birth weight groups in 1st day neonatal deaths, being least common in the 0-999g group (19.6 percent) and most common in those weighing 2500-3499g (48.7 percent). Birth trauma was most common in infants with birth weights of over 2500g. It is of great concern that a large proportion of mature fresh stillbirths and neonatal deaths in Jamaica show pathological evidence of intrapartum asphyxia or birth trauma at necropsy. The problems underlying these deaths and the methods of preventing them need urgent attention. (AU)

The perinatal mortality and morbidity study, Jamaica : final report

Aims to determine the perinatal mortality rate and the morbidity rate between 1986 and 1987 as perinatal conditions were the major causes of infant deaths in the 1980s. Assesses the real extent of the problem, the causes of death and seeks to identify the maternal, social and environmental factors predictive of fetal early infant death(AU)

Neonatal acquired immune deficiency syndrome (AIDS) - a case report and review - abstract

All physicians can expect to see more cases of neonatal AIDS as the incidence of HIV-positive individuals increases in the female population. We report the first case of congenital AIDS in the premature infant admitted to our Neonatal Intensive Care Unit. We present this case report to highlight some atypical clinical manifestations and also to point out the high risk posed to medical personnel in undiagnosed cases. Our patient was a black, female infant born at 28 weeks gestation to a 29-year old woman of East African origin. She was appropriate for gestation and did not have any of the typical features of the AIDS embryopathy. She manifested altered lymphocytes (T4/T8) ratio during the first month of life as well as thrombocytopenia and retinopathy. Diagnosis of AIDS was confirmed by hybridization techniques. Thrombocytopenia has been described in infants whereas "cotton wool retinopathy" has only been described in adults with AIDS. The onset of opportunistic infections at 6 weeks of age was earlier than most reported cases. However, failure to diagnose AIDS prior to delivery in our patient resulted in late institution of isolation techniques and hence increased risk to medical personnel. The advent of AIDS as a major health problem in the '80s led us to believe that Neonatal Units should develop protocols for handling HIV-positive pregnant women and newborns. Medical staff should also be educated to deal with this expected emergence of HIV-related cases. Educating, counselling, and screening women in the high risk categories prior to conception are of paramount importance in decreasing perinatal transmission. Modes of transmission, clinical manifestations, and prevention will be discussed (AU)

A review of 262 neonates with multiple congenital anomalies - abstract

The clinical records of 262 neonates with multiple congenital anomalies, born between January 1981 and May 1987 were reviewed. Diagnosis of syndromes were made from standard literature references, chromosomal analysis and other relevant investigations. There were 37,153 births at the Mt. Hope Women's Hospital during the period under review; 214 live born babies with multiple anomalies were identified; and 43 (20 percent) died in the neonatal period. There were 48 still-births with multiple anomalies. The incidence of multiple congenital anomalies was 0.7 percent; and 41 percent of babies remained undiagnosed. Down's Syndrome was diagnosed in 1:774 births and neural tube defect in 1:844 births. There were 20 babies with congenital rubella. The three main causes of anomalies were chromosone defects, neural tube defects and congenital infection. Compulsory rubella vaccination and prenatal screening for congenital anomalies are recommended (AU)

Medical care of the newborn

This handbook is intended for junior paediatric and obstetric medical staff, nurses and medical students who are involved in providing care to the sick newborn. It is based on experience gained at Neonatal Centres, especially the Neonatal Unit at the Mount Hope Women's Hospital, Trinidad. It provides a practical approach to the diagnosis and management of the sick neonate who is often overwhelmed with multi-systemic problems. Emphasis has been placed on early identification of the neonate at risk and the prompt institution of therapeutic measures to reduce mortality and long germ morbidity. A significant reduction in neonatal mortality rate can be achieved without the use of ventilator care (CPAP and IPPV), provided there is a dedicated cadre of medical, nursing and support staff (AU)

Neonatal morbidity at the neonatal unit, Mount Hope Women's Hospital, Trinidad - abstract

Information on neonatal morbidity is not available in Trinidad and Tobago. Neonatal morbidity data on 1,701 babies admitted to the Neonatal Unit, Mount Hope Women's Hospital between June 1981 and May 1984 were analysed. One thousand six hundred and forty-five (9.8 percent of births) were admitted during the period under study; 56 of the admissions were delivered outside of Mount Hope Hospital; 883 (51.9 percent) were males and 818 (48.1 percent) were females. About one half of the total admissions were less than 2,500 grams and pre-terms. Half of the mothers were in the age range 21-30 years. The four most common conditions treated were respiratory distress (621 cases), sepsis (619 cases), jaundice (581 cases) and asphyxia (576 cases). Multiple pathology was the norm in ill neonates. Birth trauma occurred in 69 babies, predominantly in those over 3,500 grams, delivered by forceps or per vaginam. Congenital malformation (174 cases), convulsions (58) and other conditions were seen less frequently. Deaths were 8.8 percent of all admissions. Although these morbidity data may not be representative of the population as a whole, the results obtained indicate strategies for reducing neonatal morbidity in Trinidad and Tobago (AU)

Primary infantile haemangioendothelioma of the liver

A three-week-old female infant who was admitted to the University Hospital of the West Indies in severe congestive cardiac failure developed haematological abnormalities and died two days later. At autopsy, she was found to have multicentric haemangioendotheliomas of the liver. Intractable cardiac failure and haematological abnormalities are typical manifestations of this infantile vascular tumour of the liver which may obscure the diagnosis (AU)

Neonatal infection: an 18 month study of 307 newborns with a presumptive diagnosis of sepsis - abstract

It is important to define the pattern and extent of infection in the newly established Neonatal Department, Mount Hope Maternity Hospital, Trinidad, in order to provide appropriate treatment and management of neonatal sepsis and to monitor any changes which may be predictive of impending epidemics or unusual infection. Few such data are available in the Caribbean, although Barbados has recently reported on epidemics in their Neonatal Unit. In this prospective study, bacterial investigations were performed on all newborns who were suspected of having spesis within the first 24 hours of life. Preliminary data are reported for the period July 1st 1981, to December, 1982. A total of 7,834 deliveries were done during that 18-month period. Of the 7,713 live births, 3,825 were males (49.6 percent) and 3,888 were females (50.6 percent). A total of 307 (4 percent) neonates were suspected to having spsis within the first 24 hours of life, and swabs taken from the ear, eye, nose pharynx, and umbilicus, together with specimens of gastric aspirates, blood, urine and cerebrospinal fluid were submitted for bacteriological Laboratory. Of the 307 newborns screened, 51 (17 percent) had positive blood and/or cerebrospinal fluid cultures. This represents an infection rate of 0.7 percent of the total live births which is more than three (3) times higher than that reported in the literature. Streptococci accounted for 49 percent, Staphylococcus aureus for 31 percent, and gram-negative organisms for 20 percent of infections. Nine (9) of the 51 patients with proven septicaemia died within 48 hours of birth (18 percent case fatality rate) (AU)

The first case of congenital/connatal malaria from Guyana, South America

The first case of congenital/connatal malaria from Guyana, South America was discovered in the capital city of Georgetown. The infection of the mother was acquired during a visit to the North West, an area of exclusive vivax malaria and of increasing endemicity (AU)