Pregnancy outcome in homozygous sickle cell disease: observations from the Jamaican Birth Cohort.

OBJECTIVE: To document pregnancy outcome in homozygous sickle cell (SS) disease and in age-matched controls with a normal haemoglobin genotype followed from birth for up to 45 years. METHODS: A total of 100 000 consecutive non-operative deliveries screened for sickle cell disease at the main Government maternity hospital in Kingston, Jamaica between 1973 and 1981 detected 311 (149 female) babies with SS disease who were matched by age and gender with 250 (129 female) controls with an AA haemoglobin phenotype. These individuals have been followed from birth with prospective assessment of menarche and detailed documentation of all pregnancies. RESULTS: There were 177 pregnancies in 71 SS patients and 226 pregnancies in 74 AA controls. Mothers with SS disease had more spontaneous abortions (adjusted relative risk [aRR] 3.2, 95% CI 1.6-6.1), fewer live births (aRR 0.7, 95% CI 0.6-0.9) and their offspring were more likely to have a gestational age <37 weeks (aRR 2.1, 95% CI 1.1-3.7) and low birthweight <2.5 kg (aRR 3.0, 95% CI 1.6-5.3). They were more prone to acute chest syndrome (aRR 13.7, 95% CI 4.1-45.5), urinary tract infection (aRR 12.8, 95% CI 1.3-125.9), pre-eclampsia/eclampsia (aRR 3.1, 95% CI 1.1-8.8), retained placenta (aRR 10.1, 95% CI 1.1-90.3), sepsis (Fisher's Exact test 0.04) and pregnancy-related deaths (Fisher's Exact test 0.02). Four of five deaths were attributable to acute chest syndrome. There was no genotypic difference in pregnancy-induced hypertension or postpartum haemorrhage. CONCLUSION: Pregnancy in SS disease carries risks for both mother and child. The variable characteristics of pregnancy-related deaths complicate their prevention. TWEETABLE ABSTRACT: Pregnancy in SS disease compared with controls showed increased abortions and stillbirths, fewer live births and maternal deaths in 7% patients.

Pneumococcal disease burden, clinical presentations and vaccine coverage in the Jamaican population.

BACKGROUND: Pneumococcal serotypes circulating in any population vary over time and between countries and impacts the effectiveness of pneumococcal vaccination. OBJECTIVE: This study investigated the epidemiology of pneumococcal disease in Jamaica. METHODS: Streptococcus pneumoniae isolates (n= 349) along with demographic and clinical information were collected from patients presenting at the 4 major hospitals in Jamaica over a 2-year period. Serotyping was done using latex agglutination tests and the Quellung reaction assay. RESULTS: Invasive pneumococcal disease (IPD) incidence was 45.4/100,000 in children under 5 yrs and 16.3/100,000 in adults over 65 yrs. Thirteen serogroups were identified among the 120 isolates subjected to grouping; the most common being serogroups: 19 (22/120,18.3%), 6 (20/120,16.7%), 14 (20/120,16.7%), 23 (18/120,15.0%), 3 (11/120,9.2%) and nontypeable (8/120,2.3%). The estimated vaccine coverage rates for the PCV7 and PCV13 vaccines in children less than 5 yrs were 82.5% and 88.7% respectively. The 23-valent PPV23 provided 100% coverage rate in adults over 65 yrs and 82.9% coverage rate for the entire population. CONCLUSIONS: Pneumococcal vaccine coverage rates in Jamaica are comparable to those reported in certain developed countries and higher than in other developing countries. The high incidence of IPD in the paediatric population indicates that routine vaccination would be beneficial.

The Doctor of Medicine (Paediatrics) Programme at The University of the West Indies, Mona at 45 years, 1972-2017 / El programa de Doctor en Medicina (Pediatría) de la Universidad de West Indies, Mona tras 45 Años, 1972-2017

ABSTRACT The Doctor of Medicine (DM) in Paediatrics Programme began in 1972 in Jamaica and was the first four-year clinical residency programme to be offered at The University of the West Indies (UWI). The DM Paediatrics programme trains residents for four-years and equips them after completion to practice as consultant paediatricians. Over the forty-five years of offering this programme, 237 students have been enrolled and 159 students have successfully completed the course. Over ninety per cent of the graduates are Caribbean nationals. Graduates from the DM Paediatrics programme at Mona are currently serving in Jamaica and other Caribbean countries, the United States of America (USA), Canada, Australia and the United Kingdom. Approximately, 24% have pursued subspecialty training and 60% work in a hospital-based setting while 30% work in private practice and 27% in academia and research. There are some of these that combine hospital ward work with academia and research. The DM (Paediatrics) Programme at the UWI, Mona, has achieved its mandate of providing paediatricians for Jamaica and the Caribbean and is committed to continue to train paediatricians to meet existing paediatric healthcare needs in Jamaica and the Caribbean.

RESUMEN El Programa de Doctor en Medicina (DM) en Pediatría comenzó en 1972 en Jamaica y fue el primer programa de residencia clínica de cuatro años que se ofreció en la Universidad de West Indies (UWI). El programa DM de Pediatría entrena a los residentes durante cuatro años y los faculta después de su terminación para practicar como pediatras consultores. En los 45 años de este programa, 237 estudiantes han sido matriculados y 159 estudiantes han completado con éxito el curso. Más del 90 por ciento de los graduados son nacionales del Caribe. Los egresados del programa DM de Pediatría de Mona prestan actualmente sus servicios en Jamaica y otros países del Caribe, los Estados Unidos de América (EE. UU.), Canadá, Australia y el Reino Unido. Aproximadamente, el 24% han continuado su formación en subespecialidades; el 60% trabaja en el medio hospitalario, mientras que el 30% trabaja en la práctica privada; y el 27% en la academia y la investigación. Algunos de ellos combinan el trabajo en las salas de hospitales con la academia y la investigación. El programa DM (Pediatría) de UWI, Mona, ha logrado su mandato de proveer pediatras para Jamaica y el Caribe, y se compromete a seguir capacitando a pediatras para que satisfagan las necesidades de salud pediátrica existentes en Jamaica y el Caribe.

The Incidence of Cardiac Lesions among Children with Down's Syndrome in Jamaica - A Prospective Study.

OBJECTIVES: This study aimed to define the incidence of Down's syndrome and to describe the epidemiology of cardiac lesions in Jamaican children with Down's syndrome. METHODS: A prospective study was conducted on 53 infants during the period January 1, 2007 to December 31, 2007, at the Bustamante Hospital for Children, Kingston, Jamaica. A medical history, physical examination and echo Doppler was performed on each child. RESULTS: Forty-six thousand babies were born in Jamaica in 2007, of which 53 infants were diagnosed with Down's syndrome, giving an incidence of 1:868. Forty-two (79.2%) infants had congenital heart lesions. Of the 42 patients with cardiac lesions, 50% had an isolated cardiac lesion while 50% had multiple defects. The most common single defect was the atrioventricular septal defect found in 10 (24%) patients. The most frequent concomitant malformation was a patent ductus arteriosus, found in 16 (38.1%) of the patients. The median age of diagnosis with Down's syndrome was 0.14 weeks (interquartile range (IQR) 0 to 68 weeks). The median age of diagnosis with the cardiac lesion was 15.1 weeks (IQR 0 to 40.0 weeks). CONCLUSIONS: The incidence of Down's syndrome in Jamaica is similar to the reported international experience. The distribution of cardiac malformations is similar to other countries; however, the main difference is the higher incidence of congenital heart disease and a higher incidence of combined lesions.

The effect of antenatal factors and postnatal growth on serum adiponectin levels in children.

Low levels of serum adiponectin (i.e. hypoadiponectinaemia) are a marker of cardiometabolic risk in overweight children. It is not clear whether early-life factors may play a role in the development of hypoadiponectinaemia. We investigated whether antenatal factors and postnatal growth are associated with childhood adiponectin levels. This was an observational study in a birth cohort (Vulnerable Windows Cohort Study). Anthropometry was measured at birth, at 6 weeks, every 3 months up to 2 years and then every 6 months. Fasting glucose, insulin, lipids and adiponectin were measured at a mean age 11.5 years. Data on 323 children were analysed with age- and sex-adjusted multivariate analyses. The sizes of mother, placenta, fetus and newborn were not significantly associated with adiponectin levels. Current weight, body mass index (BMI), fat mass, waist circumference, glucose, insulin resistance [homeostasis model assessment of insulin resistance (HOMA-IR)], triglycerides and systolic blood pressure were inversely related to adiponectin (P < 0.05). Faster growth in BMI during late infancy and childhood was associated with lower adiponectin levels (P < 0.05). After adjusting for current waist circumference, faster growth in BMI during early infancy was positively associated with adiponectin (P < 0.01). Faster growth in BMI during childhood was inversely associated (P < 0.001). These associations were similar after adjusting for HOMA-IR. We concluded that antenatal factors are not determinants of childhood adiponectin levels. Faster growth in BMI during infancy is associated with higher levels, whereas faster rates during childhood are associated with hypoadiponectinaemia. Hypoadiponectinaemia is a marker of a more adverse cardiometabolic profile in Afro-Caribbean children.

The Jamaican fetus--overview of various studies.

OBJECTIVE: To describe a series of studies conducted which investigated maternal nutrition and its effect on birth outcome. METHODS: Seven hundred and twelve women attending their first antenatal clinic visit at the University Hospital of the West Indies were invited to join a prospective study. The women were followed throughout their pregnancies and seen at 14, 17, 20, 25, 30 and 35 weeks gestation. At these visits, the mother's weight, height and triceps skinfold thickness were measured. Abdominal ultrasound was performed to determine placental and fetal growth. Birth and placental weight, head, chest, mid-upper arm and abdominal circumference, crown-rump and crown-heel length were measured. After delivery, mothers and their children were recruited into a longitudinal study of postnatal growth in which blood pressure was measured annually initially and then half yearly from age one year. RESULTS: The interrelationship of first trimester maternal weight, subsequent weight gain in pregnancy, placental weight in early pregnancy and fetal growth were reported. Placental volume was shown to be an earlier predictor of infant size, and placental volume and intrauterine life on birthweight and blood pressure in childhood showed a relationship to blood pressure at two to three years old. The ultrasound derived fetal growth curves for a Jamaican population was created. CONCLUSION: Maternal nutritional status has an important effect on fetal size and birthweight and fetal size has an effect on blood pressure in childhood, suggesting that the initiating events in programming of blood pressure occur early in pregnancy.

The Jamaican fetus: overview of various studies / El feto jamaicano: panorama de varios estudios

OBJECTIVE: To describe a series of studies conducted which investigated maternal nutrition and its effect on birth outcome. METHODS: Seven hundred and twelve women attending their first antenatal clinic visit at the University Hospital of the West Indies were invited to join a prospective study. The women were followed throughout their pregnancies and seen at 14, 17, 20, 25, 30 and 35 weeks gestation. At these visits, the mother's weight, height and triceps skinfold thickness were measured. Abdominal ultrasound was performed to determine placental and fetal growth. Birth and placental weight, head, chest, mid-upper arm and abdominal circumference, crown-rump and crown-heel length were measured. After delivery, mothers and their children were recruited into a longitudinal study of postnatal growth in which blood pressure was measured annually initially and then half yearly from age one year. RESULTS: The interrelationship of first trimester maternal weight, subsequent weight gain in pregnancy, placental weight in early pregnancy and fetal growth were reported. Placental volume was shown to be an earlier predictor of infant size, and placental volume and intrauterine life on birthweight and blood pressure in childhood showed a relationship to blood pressure at two to three years old. The ultrasound derived fetal growth curves for a Jamaican population was created. CONCLUSION: Maternal nutritional status has an important effect on fetal size and birthweight and fetal size has an effect on blood pressure in childhood, suggesting that the initiating events in programming of blood pressure occur early in pregnancy.

OBJETIVO: Describir una serie de estudios encaminados a investigar la nutrición materna y su efecto en el resultado del embarazo. MÉTODOS: Setecientos doce mujeres que asistían a su primera visita de la clínica prenatal en el Hospital Universitario de West Indies, fueron invitados a sumarse a un estudio prospectivo. Se realizó un seguimiento de las mujeres a lo largo de sus embarazos, con visitas en las semanas 14, 17, 20, 25, 30 y 35 de gestación. En estas visitas, se midió el peso, la altura y el grosor del pliegue cutáneo del tríceps. Se les realizó un ultrasonido abdominal con el fin de determinar el crecimiento placentario y fetal. Se midieron el peso al nacer y el peso de la placenta, la cabeza, el pecho, circunferencia del abdomen y la parte media superior del brazo, las longitudes céfalo-caudal y coronilla-talón. Después del parto, las madres y sus niños fueron reclutados para un estudio longitudinal de crecimiento postnatal en el que la presión sanguínea se mide anualmente, inicialmente y luego a mitad de año desde el primer año de edad. RESULTADOS: Se reportó la interrelación del peso materno en el primer semestre, el subsiguiente aumento de peso en el embarazo, el peso de la placenta al inicio del embarazo, y el crecimiento fetal. El volumen de la placenta resultó ser un predictor temprano del tamaño del infante, y el volumen de la placenta y la vida intrauterina en el peso al nacer, y la presión sanguínea en la infancia mostró una relación con la presión sanguínea a los dos hasta los tres años de edad. CONCLUSIÓN: El estado de la nutrición materna tiene un efecto importante en el tamaño del feto y el peso al nacer, y el tamaño del feto tiene un efecto sobre la presión sanguínea en la infancia, lo cual sugiere que los procesos que inician la programación de la presión sanguínea ocurren en una etapa temprana del embarazo.

Pattern of pregnancy weight gain in homozygous sickle cell disease and effect on birth size.

OBJECTIVE: To assess pregnancy weight gain and newborn anthropometry in mothers with homozygous sickle cell (SS) disease and normal controls. METHODS: An eleven-year retrospective review at the University Hospital of the West Indies, Kingston, Jamaica, revealed 128 singleton deliveries in women with SS disease who were matched by maternal age and birth date with 128 controls with a normal AA phenotype. Restriction to those commencing antenatal care before 16 weeks gestation resulted in the final study group of 80 SS patients and 115 AA controls. Weight and height were measured at first antenatal visit and weight at 20, 25, 30, 35 and 38 weeks gestation. Longitudinal regression used mothers'weight as the outcome, genotype as a predictor and gestational age as a random effect. Regression analyses of maternal weight on childhood anthropometry were repeated in separate maternal genotypes. Neonatal indices included gestational age, birthweight, head circumference and crown-heel length. RESULTS: Mothers with SS disease had lower weight and body mass index at first antenatal clinic visit (p < 0.001). Total weight gain was 6.9 kg for SS women and 10.4 kg for AA controls (p < 0.001) and weekly weight gain 0.263 kg (95% CI 0.224, 0.301) and 0.396 kg (95% CI 0.364, 0.427) respectively. A significant relationship occurred between birthweight and maternal weight gain at 25-30 weeks gestation in AA controls but this relationship appears delayed in SS disease. CONCLUSION: Different patterns of maternal weight gain in SS mothers and normal controls may have significance for the lower birthweight in SS mothers.

Pattern of pregnancy weight gain in homozygous sickle cell disease and effect on birth size / Patrones de ganancia de peso gestacional y tamaño al nacer en los casos de anemia de células falciformes

OBJECTIVES: To assess pregnancy weight gain and newborn anthropometry in mothers with homozygous sickle cell (SS) disease and normal controls. METHODS: An eleven-year retrospective review at the University Hospital of the West Indies, Kingston, Jamaica, revealed 128 singleton deliveries in women with SS disease who were matched by maternal age and birth date with 128 controls with a normal AA phenotype. Restriction to those commencing antenatal care before 16 weeks gestation resulted in the final study group of 80 SS patients and 115 AA controls. Weight and height were measured at first antenatal visit and weight at 20, 25, 30, 35 and 38 weeks gestation. Longitudinal regression used mothers'weight as the outcome, genotype as a predictor and gestational age as a random effect. Regression analyses ofmaternal weight on childhood anthropometry were repeated in separate maternal genotypes. Neonatal indices included gestational age, birthweight, head circumference and crown-heel length. RESULTS: Mothers with SS disease had lower weight and body mass index at first antenatal clinic visit (p < 0.001). Total weight gain was 6.9 kg for SS women and 10.4 kg for AA controls (p < 0.001) and weekly weight gain 0.263 kg (95% CI 0.224, 0.301) and 0.396 kg (95% CI 0.364, 0.427) respectively. A significant relationship occurred between birthweight and maternal weight gain at 25-30 weeks gestation in AA controls but this relationship appears delayed in SS disease. CONCLUSION: Different patterns of maternal weight gain in SS mothers and normal controls may have significance for the lower birthweight in SS mothers.

OBJETIVO: Evaluar la ganancia de peso gestacional y la antropometría neonatal en madres con anemia de células falciformes (CF) homocigóticas y en controles normales. MÉTODO: Un examen retrospectivo de once años en el Hospital Universitario de West Indies West Indies, Kingston, Jamaica, reveló la ocurrencia de 128 partos únicos (e.d. de un solo bebé) en mujeres con la enfermedad de CF, que fueron comparadas sobre la base de la edad materna y la fecha de nacimiento, con 128 controles de fenotipo AA normal. A partir de restricciones a las gestantes que comenzaron el cuidado prenatal antes de las 16 semanas de gestación, se llegó finalmente al grupo de estudio de 80 pacientes con CF y 115 controles con AA. El peso y la altura se midieron en la primera visita prenatal, y el peso a las 20, 25, 30, 35 y 38 semanas de gestación. La regresión longitudinal usó el peso de las madres como resultado, el genotipo como predictor, y la edad gestacional como efecto aleatorio. Los análisis de la regresión de peso materno sobre la antropometría fueron repetidos en genotipos maternos separados. Los índices neonatales incluyeron la edad gestacional, el peso al nacer y la circunferencia cefálica. RESULTADOS: Las madres con la enfermedad de CF tenían más bajo peso e índice de masa corporal en la primera visita clínica prenatal (p < 0.001). La ganancia de peso total fue 6.9 kg para las mujeres con CF y 10.4 kg para los controles AA (p < 0.001) y la ganancia de peso semanal 0.263 kg (95% CI 0.224-0.301) y 0.396 kg (95% CI 0.364-0.427) respectivamente. Una relación significativa tuvo lugar entre el peso al nacer y la ganancia de peso materna en las semanas 25-30 de gestación en los controles AA, pero esta relación parece demorada en la enfermedad de CF. CONCLUSION: Los patrones diferentes de ganancia de peso materno en las madres con CF y los controles normales, pueden tener importancia significativa para las madres con CF.

The effect of feto-maternal size and childhood growth on left ventricular mass and arterial stiffness in Afro-Caribbean children.

We hypothesized that maternal size, fetal size and childhood growth are associated with childhood blood pressure, left ventricular mass (LVM) and arterial stiffness. The Vulnerable Windows Cohort is a longitudinal study of 569 mothers and their offspring. Anthropometry was measured on each child at birth, at 6 weeks, once in 3 months upto 2 years and then every 6 months. Blood pressure and body composition were assessed in 185 children (age 11.5 years) and echocardiography performed. LVM was not associated with maternal size after adjustment for child's weight. LVM was significantly associated with faster growth in childhood and with current weight, fat mass and lean mass. Systolic blood pressure was not related to maternal, fetal or newborn anthropometry, but was positively associated with infant and childhood growth, as well as current body size and fat mass. The pulse pressure/stroke volume ratio (an index of arterial stiffness) was inversely associated with maternal size, placental volume at 20 weeks, fetal size at 35 weeks and childhood growth even after adjustment for current weight. In conclusion, LVM in childhood is positively associated with maternal height, child's current size and rate of growth. Arterial stiffness is inversely related to maternal, fetal and placental size as well as growth throughout childhood.

Asthma clinic attendance improves quality of life of Jamaican asthmatic children and their parents.

BACKGROUND: With the increasing incidence of paediatric asthma, there has been a corresponding increase in the physical, emotional and financial burden. This has led to a greater interest in determining the impact of asthma and its treatment on many aspects of patient functioning and wellbeing. AIM: To assess the usefulness of the Asthma Clinic established in Jamaica in 1997 by ascertaining whether there has been improvement in quality of life of children and care-givers who attend the clinic. METHODS: The quality of life of patients and their parents/care-givers before attending the Asthma Clinic of Bustamante Hospital for Children in Kingston, Jamaica was compared with that of 1 year afterwards. Parents or guardians were interviewed using the Pediatric Asthma Quality of Life Questionnaire which consists of three domains [symptoms (ten questions), emotional (eight questions) and activity (five questions)] and the Pediatric Asthma Caregiver's Quality of life Questionnaire which consist of two domains [emotional (nine questions) and activity (four questions)]. RESULTS: Quality of life improved in patients and their parents/care-givers in all domains. CONCLUSION: Attendance at an asthma clinic in Jamaica improved the quality of life of asthmatic children and their parents/care-givers.

Urinary tract infection in neonates with serious bacterial infections admitted to the University Hospital of the West Indies / Infección de las vías urinarias en neonatos ingresados con serias infecciones bacterianas en el Hospital Universitario de West Indies

OBJECTIVE: The aim of this study was to describe the epidemiology of urinary tract infection in neonates, with serious bacterial infections, admitted to the University Hospital of the West Indies. METHODS: Admission records of all neonates admitted to the neonatal unit of the University Hospital of the West Indies between January 1995 and December 2000 for sepsis evaluation were reviewed. Infants who had positive bacterial cultures were identified using laboratory records. Those satisfying the criteria for urinary tract infection were selected for detailed analysis. Demographic, clinical and laboratory data were collected using a pre-coded questionnaire. Descriptive analyses were performed. RESULTS: Fifty-one (38%) of 135 babies with positive bacterial isolates had confirmed urinary tract infection. Male: female ratio was 6:1. Common presenting features included fever (32%), poor feeding (30%) and irritability (22%). The mean white cell count was 14 ± 6.26. E coli and Klebsiella species were most frequently identified. Factors associated with a diagnosis of urinary tract infection included male gender (p < 0.001), age > 48 hours (p < 0.05) and a presenting complaint of poor feeding (p < 0.003). Imaging studies of the renal tract detected abnormalities in 5 (10.4%) neonates. CONCLUSIONS: Urinary tract infection is an important cause of serious bacterial infection in neonates affecting 1 in 3 babies with proven bacterial infection and may be the first indicator of underlying structural abnormalities. The absence of specific distinguishing clinical features makes it necessary to include urine cultures in the sepsis evaluation of neonates presenting with symptoms suggestive of sepsis.

OBJETIVO: El propósito de este trabajo fue describir la epidemiología de la infección de las vías urinarias en neonatos con serias infecciones bacterianas, ingresados en el Hospital Universitario de West Indies. MÉTODOS: Se revisaron las historias clínicas de todos los neonatos ingresados en la Unidad Neonatal del Hospital Universitario de West Indies entre enero de 1995 y diciembre de 2000 para una evaluación de sepsis. Los infantes que presentaron cultivos bacterianos positivos, fueron identificados usando los registros de laboratorio. Aquellos que satisfacían los criterios de infección de las vías urinarias, fueron seleccionados para un análisis detallado. Se compilaron datos demográficos, clínicos y de laboratorio usando un cuestionario pre-codificado. Se llevaron a cabo análisis descriptivos. RESULTADOS: Cincuenta y uno (38%) de los bebés con aislados bacterianos positivos tuvieron infección confirmada de las vías urinarias. La proporción varón:hembra fue 6:1. Las características comunes que se presentaron, incluyeron fiebre (32%), pobre alimentación (30%) e irritabilidad (22%). El conteo promedio de leucocitos fue 14 ± 6.26. Las especies identificadas con mayor frecuencia fueron E coli y Klebsiella. Los factores asociados con un diagnóstico de la infección de las vías urinarias incluyeron género masculino (p < 0.001), edad > 48 horas (p < 0.05) y quejas en cuanto a pobre alimentación (p < 0.003). Los estudios de imágenes de las vías renales detectaron anormalidades en 5 (10.4%) neonatos. CONCLUSIONES: La infección de las vías urinarias es una causa importante de seria infección bacteriana en neonatos, que afecta a 1 de cada 3 recién nacidos con infección bacteriana demostrada, y puede ser el primer indicador de anormalidades estructurales subyacentes. La ausencia de características clínicas distintivas, hace necesario que se incluyan cultivos de orina en la evaluación de la sepsis en neonatos que se presentan con síntomas que sugieren la presencia de sepsis.

Urinary tract infection in neonates with serious bacterial infections admitted to the University Hospital of the West Indies.

OBJECTIVE: The aim of this study was to describe the epidemiology of urinary tract infection in neonates, with serious bacterial infections, admitted to the University Hospital of the West Indies. METHODS: Admission records of all neonates admitted to the neonatal unit of the University Hospital of the West Indies between January 1995 and December 2000 for sepsis evaluation were reviewed. Infants who had positive bacterial cultures were identified using laboratory records. Those satisfying the criteria for urinary tract infection were selected for detailed analysis. Demographic, clinical and laboratory data were collected using a pre-coded questionnaire. Descriptive analyses were performed. RESULTS: Fifty-one (38%) of 135 babies with positive bacterial isolates had confirmed urinary tract infection. Male:female ratio was 6:1. Common presenting features included fever (32%), poor feeding (30%) and irritability (22%). The mean white cell count was 14 +/- 6.26. E coli and Klebsiella species were most frequently identified. Factors associated with a diagnosis of urinary tract infection included male gender (p < 0.001), age > 48 hours (p < 0.05) and a presenting complaint of poor feeding (p < 0.003). Imaging studies of the renal tract detected abnormalities in 5 (10.4%) neonates. CONCLUSIONS: Urinary tract infection is an important cause of serious bacterial infection in neonates affecting 1 in 3 babies with proven bacterial infection and may be the first indicator of underlying structural abnormalities. The absence of specific distinguishing clinical features makes it necessary to include urine cultures in the sepsis evaluation of neonates presenting with symptoms suggestive of sepsis.

Obstruction of the duodenum by a preduodenal portal vein in situs inversus.

Mirror image transposition of abdominal and thoracic viscera is termed situs inversus. Duodenal obstruction in situs inversus is rare. A preduodenal portal vein, though not uncommon in situs inversus, rarely causes duodenal obstruction. Where obstruction by a preduodenal portal vein is diagnosed, a duodeno-duodenostomy is the recommended treatment. A duodenal diaphragm and other more common causes of duodenal obstruction should also be excluded in these patients.

The impact of antenatal care on pregnancy performance between adolescent girls and older women / Impacto del cuidado prenatal en el desenvolvimiento del embarazo entre niñas adolescentes y mujeres mayores

OBJECTIVE: To investigate pregnancy performance and newborn outcome between adolescents and older women receiving adequate and similar antenatal care. METHODS: Four hundred and twenty-five women attending the antenatal clinic at the University Hospital of the West Indies, Kingston, Jamaica, participated in a prospective study. Recruitment included women 19 years and younger (adolescents) and 20 years and older (older women). Anthropometric measurements of the women and their newborn were made. During the pregnancy, all admissions to hospital and the diagnoses were recorded. Neonatal admissions were also recorded. RESULT: Three hundred and sixty-one women each (84.9%) delivered a live infant of which 175 (87.5%) women were less than 20 years old and comprised the adolescent group and 186 (82.7%) of these women were 20 years and older and comprised the women in the older age group. Thirty-nine (9.2%) had early pregnancy losses; twelve among the adolescents (6%) and twenty-seven (12%) among the older women (p = 0.03). There was one intrauterine death and one stillbirth in the adolescent group and two intrauterine deaths and no stillbirth in the older group. The attendance rate at the antenatal clinic for both groups was high throughout the study with each group having greater than 96% attendance. There were 53 (26.5%) admissions among the adolescent girls and 70 (31.1%) admissions among the older women. This was not statistically significant. There was a significant difference in the occurrence of urinary tract infections where 17% of the adolescents had a urinary tract infection compared to 1% of older women (p < 0.0001). There was a lower Caesarean section rate among the adolescent. No significant difference between the number of neonatal admissions for the two groups (p = 0.19) was seen. CONCLUSION: This study showed that with similar and adequate antenatal care there were minimal differences in pregnancy performance between the two groups with...

OBJETIVO: Investigar el desempeño del embarazo y el resultado neonatal entre adolescentes y mujeres mayores que reciben cuidado prenatal similar y adecuado. MÉTODOS: Cuatrocientos veinticinco mujeres que asistían a la clínica de atención prenatal en el Hospital Universitario de West Indies, Kingston, Jamaica, participaron en un estudio prospectivo. El reclutamiento incluyó mujeres de 19 años y más jóvenes (adolescentes) y 20 años y mayores (mujeres mayores). Se hicieron mediciones antropométricas de las mujeres y sus recién nacidos. Durante el embarazo, se registraron todos los ingresos al hospital y los diagnósticos. También se registraron los ingresos neonatales. RESULTADO: Trescientos sesenta y uno mujeres (84.9%) dieron a luz a un infante vivo. De ellas, 175 (87.5%) eran menores de 20 años, incluido el grupo de adolescentes, en tanto que 186 (82.7%) tenían 20 años o más, y abarcaban las mujeres en el grupo etario de más edad. Treinta y nueve (9.2%) tuvieron pérdidas de embarazo tempranas - doce de entre las adolescentes (6%) y veintisiete (12%) de entre las mujeres mayores (p = 0.03). Hubo una muerte intrauterina y un parto de mortinato en el grupo de adolescentes, dos muertes intrauterinas y ningún parto de mortinatos en el grupo de más edad. La tasa de asistencia a la clínica de atención prenatal para ambos grupos fue alta a lo largo del estudio, teniendo cada de grupo una asistencia superior al 96%. Hubo 53 (26.5%) ingresos entre las adolescentes y 70 (31.1%) ingresos entre las mujeres de más edad. Esto no fue estadísticamente significativo. Hubo una diferencia significativa en la ocurrencia de infecciones del tracto urinario, donde el 17% de las adolescentes tuvieron una infección del tracto urinario en comparación con el 1% de las mujeres mayores (p < 0.0001). Hubo una proporción de cesáreas menor entre las adolescentes. No se observó diferencia significativa alguna entre el número de ingresos neonatales en los dos grupos (p = 0.19)...

Obstruction of the duodenum by a preduodenal portal vein in situs inversus

Mirror image transposition of abdominal and thoracic viscera is termed situs inversus. Duodenal obstruction in situs inversus is rare. A preduodenal portal vein, though not uncommon in situs inversus, rarely causes duodenal obstruction. Where obstruction by a preduodenal portal vein is diagnosed, a duodeno-duodenostomy is the recommended treatment. A duodenal diaphragm and other more common causes of duodenal obstruction should also be excluded in these patients.

Aicardi syndrome associated with anterior cephalocele in a female infant.

Aicardi syndrome is a triad of abnormalities that includes total or partial agenesis of the corpus callosum, chorioretinal lacunae, and infantile spasms. This syndrome was first described in 1965. A female infant with Aicardi syndrome associated with a nasoethmoidal cephalocele is described in this report. She presented with a history of unilateral nasal discharge since birth and seizures since age 1 week. She was microcephalic and there was visual impairment. A fleshy mass of the left nostril was noted. Ophthalmological evaluation revealed left exotropia, dysplastic optic discs and retina, 'morning glory' appearance of the left optic disc, and bilateral chorioretinal lacunae. Magnetic resonance imaging of the brain showed absence of the corpus callosum, dysmorphic changes of the lateral ventricles, a superiorly located third ventricle, heterotopic grey matter of the frontal lobes, a left nasoethmoidal cephalocele, and closed lip schizencephaly of the left frontal lobe. This female infant developed asymmetric infantile spasms at age 8 weeks. Surgical correction of the cephalocele was declined. She developed recurrent pneumonias secondary to aspiration of feeds and died at age 8 months during one of these events.

Body composition in pregnancies of adolescents and mature women and the relationship to birth anthropometry.

OBJECTIVE: To investigate differences in body composition between adolescent girls and mature women during pregnancy and the relationship to newborn anthropometry. DESIGN: A prospective study. SETTING: The antenatal clinic at the University Hospital of the West Indies, Kingston, Jamaica. SUBJECTS: Four hundred and twenty-five women were invited to join the study. Three hundred and sixty-one women (84.9%) completed the study. INTERVENTIONS: Study participants were divided into two groups: adolescents and mature women, who were all less than 15 weeks pregnant and had no systemic illness at the time of entry into the study. A questionnaire was administered which retrieved information on demographics, age, marital status, menstrual history, parity, socio-economic status, medical history and smoking/drinking habits. Anthropometric measurements including weight, height, triceps, biceps, subscapular and suprailiac skinfolds, as well as blood pressure measurements and urine analysis were performed at the first antenatal visit and repeated at 15, 25 and 35 weeks gestation. Anthropometric measurements of the newborn were performed at birth. RESULTS: There were significant differences between anthropometry and skinfold thickness at the first antenatal visit between the adolescents and the mature women where the adolescents had lower measurements compared to the mature women. In the newborn anthropometry, the only significant difference seen was in the triceps skinfold thickness and the mid-upper arm circumference where the newborn of the adolescents had significantly smaller values (P=0.04; P=0.02, respectively). The percentage fat, fat mass and lean body mass were significantly lower in the adolescent compared to the mature women (P<0.0001), both at the first antenatal visit and at 35 weeks gestation. A greater gain was seen in these measurements throughout the pregnancy in the adolescents (P<0.0001). Linear regression analyses showed that the gain in lean body mass was the most important predictor of birth anthropometry. CONCLUSION: Body composition differs in pregnancy between adolescents and mature woman, and if adequate weight and lean body mass are attained, it impacts positively on birth size irrespective of age.

The impact of antenatal care on pregnancy performance between adolescent girls and older women.

OBJECTIVE: To investigate pregnancy performance and newborn outcome between adolescents and older women receiving adequate and similar antenatal care. METHODS: Four hundred and twenty-five women attending the antenatal clinic at the University Hospital of the West Indies, Kingston, Jamaica, participated in a prospective study. Recruitment included women 19 years and younger (adolescents) and 20 years and older (older women). Anthropometric measurements of the women and their newborn were made. During the pregnancy, all admissions to hospital and the diagnoses were recorded. Neonatal admissions were also recorded. RESULT: Three hundred and sixty-one women each (84.9%) delivered a live infant of which 175 (87.5%) women were less than 20 years old and comprised the adolescent group and 186 (82.7%) of these women were 20 years and older and comprised the women in the older age group. Thirty-nine (9.2%) had early pregnancy losses; twelve among the adolescents (6%) and twenty-seven (12%) among the older women (p = 0.03). There was one intrauterine death and one stillbirth in the adolescent group and two intrauterine deaths and no stillbirth in the older group. The attendance rate at the antenatal clinic for both groups was high throughout the study with each group having greater than 96% attendance. There were 53 (26.5%) admissions among the adolescent girls and 70 (31.1%) admissions among the older women. This was not statistically significant. There was a significant difference in the occurrence of urinary tract infections where 17% of the adolescents had a urinary tract infection compared to 1% of older women (p < 0.0001). There was a lower Caesarean section rate among the adolescent. No significant difference between the number of neonatal admissions for the two groups (p = 0.19) was seen. CONCLUSION: This study showed that with similar and adequate antenatal care there were minimal differences in pregnancy performance between the two groups with only an increased rate of urinary tract infections and a lower rate of Caesarean section in the adolescents.

Growth curves for normal Jamaican neonates / Curvas de crecimiento en los neonatos jamaicanos normales

The aim of this study was to provide standards for the assessment of birthweight, head circumference and crown-heel length for normal, singleton newborns of predominantly West African descent. Data were collected for 10 482 or 94of all recorded births in Jamaica during the two-month period September 1 to October 31, 1986. After editing procedures, data were available for 6178 (birthweight), 5975 (head circumference), and 5990 (crown-heel length). The data presented in tables and growth curves include birthweight, head circumference and crown-heel length for males and females separately, for gestational ages 30-43 weeks. Data sets from the University Hospital of the West Indies in 1990 and 1999 were used to explore the possibility of secular change over the period 1986-1999. In conclusion, these ethnic and gender-specific growth curves are based on the most extensive dataset currently available in Jamaica for babies of West African descent.