Frequency and Outcome of Retinopathy of Prematurity at Tertiary Care Hospital in Pakistan.

OBJECTIVE: To describe the frequency and outcome of Retinopathy of prematurity (ROP). STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Ophthalmology Department, Shifa International Hospital (SIH) Islamabad from May 2014 to December 2019. METHODOLOGY: All preterm infants with gestational age ≤35 weeks and/or birth weight ≤2000g were included while those born at greater than 35 weeks of gestation and having a gestational weight more than 2000g were excluded from this study. Studied variables included gender, gestational age, birth weight, form and duration of supplemental oxygen, systemic diseases, presence or absence of ROP, ROP stage, treatment, and outcome. RESULTS: Six hundred and twenty-two met the inclusion criteria out of whom 316 were screened. The majority (n=202, 64%) of the screened infants were males. Supplemental oxygen was given to 244 (77.2%) infants. The mean gestational age was 31.94 ± 2.2 weeks. The mean birth weight was 1632 ± 446 g. ROP was diagnosed in 10 (3.2%) infants with stage 1 in 3 (0.9%) infants, stage 2 in 1 (0.3%), stage 3 in 5 (1.5%), and stage 4B in 1 (0.3%) infant. In the infants diagnosed with ROP, mean gestational age was 30.4 ± 2.9 weeks, and mean birth weight was 1393 ± 416 g. ROP regressed spontaneously in 3 infants with stage 1 and 1 infant with stage 2 disease. Infants with stage 3 disease also had disease regression after treatment with intravitreal Ranibizumab (n=3) or intravitreal Bevacizumab (n=2) injection along with concurrent laser photocoagulation (n=1). The infant with 4B ROP underwent bilateral vitrectomy with the complete attachment of retina on follow-up. CONCLUSION: There was a low frequency of 3.2 % of ROP reported in this study. The infants diagnosed with ROP had favorable outcomes following timely treatment of this dreadful disease. KEY WORDS: Retinopathy of prematurity, Eye, Retina, Supplemental oxygen, Screening.

Use of colistin for the treatment of multi drug resistant isolates in neonates.

OBJECTIVE: To determine the impact of using colistin for multidrug-resistant organisms in neonates. METHODS: This retrospective study was conducted at the Shifa International Hospital, Islamabad, Pakistan, and comprised microbiological data of babies from January 2010 to October 2012.The data was reviewed to identify the babies infected with multidrug-resistant organisms and who had received colistin therapy. SPSS 16 was used for data analysis. RESULTS: Of the 30 neonates, 24(80%) were males and 6(20%) were females. Besides, 16(53.3%) neonates were preterm babies (< 37 weeks gestation). Two or more risk factors for multidrug-resistant organisms were present in 13(44%) babies. Mechanical ventilation was found in 26(87%) neonates and prior prolonged use of antibiotics in 7(23%). The commonest pathogen isolated was Acinetobacter, in 22(73%) cases. All isolates were susceptible to colistin but pan-resistant to multiple antibiotics, including cephalosporins, amikacin, meropenem and piperacillin/tazobactam. Colistin therapy was used for bacteraemia in 2(7%) cases, clinical sepsis 18(60%), pneumonia 2(7%) and tracheitis 8(26.7%). Moreover, 15(50%) neonates received both intravenous and aerosolised colistin while 9(30%) received aerosolised therapy alone. CONCLUSIONS: Colistin therapy was well tolerated in neonates for the treatment of multidrug-resistant organisms.

Clinical spectrum, management and outcome of neonatal candidiasis.

OBJECTIVE: To identify clinical spectrum, management and outcome of neonatal candidiasis. METHODS: The retrospective study was conducted at the Shifa International Hospital, Islamabad, Pakistan, and comprised microbiological records of all the babies admitted to the Neonatal Intensive Care Unit from January 2009 to January 2014 that were reviewed to identify those with positive candida cultures. Medical records were analysed for demographic and clinical spectrum features, management and outcome. SPSS 16 was used statistical analysis. RESULTS: Of the total 1550 neonatal admissions, 560 (36%) had positive cultures, and, of them, candida was isolated in 49(8.8%) neonates. Among them, 13(26%) had candida albicans and the rest had candida species. Majority were males 34(70%), and preterm with 30(61%) being <37 weeks. The mean birth weight was 2000±873 grams. Mean age at admission was 6±7.6 days. Overall, 39(80%) had ≥2 risk factors. The commonest site of isolation was blood in 41(84%). Besides, 32 (65%) received fluconazole alone for treatment. Mean duration of anti-fungal therapy was 10±5 days (range: 1-21 days). Twelve (24%) neonates expired and the cause of death was candida sepsis in 10(20%) cases. Mortality was not significantly associated with gender, place of birth, gestation, risk factors, length of stay, prior antibiotic exposure or receipt of antifungal prophylaxis except those who were ≤1500 grams (p<0.05). CONCLUSIONS: Approximately one in ten at-risk neonates may develop candida sepsis with high mortality. Early institution of anti-fungal therapy may prove to be life-saving.

Recurrent meningitis in children.

Recurrent meningitis in children, although rare, results in an increased risk of acute complications and long-term morbidity. We did a retrospective case series to analyze the clinical presentation, predisposing factors, treatment and outcome of children with recurrent meningitis admitted at Shifa International hospital, Islamabad. All children presenting with recurrent meningitis from December 2006 to May 2011 were included in the study. There were a total of 8 children with a mean age of 6 +/- 2.97 years (2-10 years). Majority (87%) were males. There was an average of 4 +/- 4.92 (2-9) episodes of meningitis in each patient. Fever with vomiting was the most common (87%) presenting symptom, followed by seizures (62%) and headache (50%). The underlying etiology was confirmed on CSF analysis, computed tomography scan (CT) and magnetic resonance imaging (MRI). About half of them had history of head trauma. All responded to antibiotics and six needed surgery. On follow up, 2 (25%) children had some neurological impairment.

Etiology and outcome of inborn errors of metabolism.

OBJECTIVES: To study the clinical presentation, diagnostic workup and outcome of children presenting with suspected inborn errors of metabolism. METHODS: The cross-sectional study was conducted at the Shifa International Hospital, Islamabad, and included all patients diagnosed with the condition between January 2006 and June 2011. Medical records of the patients were reviewed to collect the relevant data. RESULTS: A total of 10 patients underwent diagnostic work-up. Majority 7 (70%) were males and 6 (60%) presented in the neonatal age group. Seizures and coma were the commonest presentations (n = 5; 50% each) followed by breathing difficulty (n = 4; 40%) and vomiting (n = 2; 20%). The commonest diagnoses were methyl malonic acidaemia (n=2; 20%), non-ketotic hyperglycinaemia (n=7; 10%), fructose 1,6 diphosphatase deficiency (n = 1; 10%), and biotinidase deficiency (n = 1; 10%). Mortality was high (n = 5; 50%) and half of the survivors had severe neurological impairment. CONCLUSION: The diagnosis of inborn errors of metabolism requires a high index of suspicion. These disorders have a high mortality and risk of long-term neurological disability.

A rare congenital cardiovascular abnormality presenting as respiratory distress in an infant.

Anomalous origin of left coronary artery from pulmonary artery (ALCAPA) is a rare congenital cardiovascular anomaly which presents in early infancy with congestive cardiac failure, sometimes precipitated by inter current respiratory tract infections. We report a case of an eight week old baby boy, with a short history of cough, difficulty in breathing, marked tachycardia and signs of respiratory distress. He was managed for bronchiolitis but eight hours later had major desaturation during feeding which needed intubation and mechanical ventilation. He improved over the next few hours and self extubated but after 12 hours needed reintubation and ventilation following a similar event of desaturation as observed previously. The chest x ray revealed cardiomegaly and diuretics were added in the on going management and he was gradually weaned off from the ventilator. The echocardiography examination revealed ALCAPA, resulting in myocardial ischaemia. Surgical revascularization was performed and baby was discharged after ten days on regular anti failure medication in a stable condition.

Life threatening hyperkalemia in a neonate with pseudo-hypoaldosteronism.

Pseudohypoaldosteronism type 1 is a rare disorder characterized by renal resistance to aldosterone which may present with a salt wasting crisis in infancy. We report a neonate with hyponatremia, severe dehydration and refractory life threatening hyperkalemia who was treated with dietary sodium chloride supplementation, potassium binding resins and fluid replacement therapy which proved to be lifesaving.