Perinatally acquired tuberculosis in a neonate. a case report.

OBJECTIVES: To report a case of perinatal tuberculosis that appeared on the 21st day of life of an infant born to a mother with latent tuberculosis. CLINICAL PRESENTATION AND INTERVENTION: A preterm male infant was born by spontaneous vertex delivery at 33 weeks gestational age to a 33-year-old primiparous Philippine woman. The infant was well until the 21st day of life when he developed recurrent episodes of cyanosis and bradycardia. A chest radiograph showed infiltrates which were thought to be bacterial in origin. Blood, urine, and cerebrospinal fluid cultures were normal. Tracheal aspirate revealed acid-fast bacilli by Ziehl-Neelsen stain, later confirmed to be MYCOBACTERIUM TUBERCULOSIS by culture in Lowenstein-Jensen medium. The mother was later diagnosed as a case of tuberculosis with symptoms, signs and radiologic manifestation of hilar lymphadenopathy with mild pleural effusion and positive tuberculin skin test. Both infant and mother were treated with intravenous isoniazid, intravenous rifampicin, oral pyrazinamide, and intravenous pyridoxine. Both recovered. CONCLUSION: A preterm male infant perinatally acquired tuberculosis, most likely by inhalation of the bacteria during delivery. Both infant and mother responded well to antituberculous treatment.

Birthweight percentiles by gestational age in Kuwait.

Our aim is develop a curve for singleton birthweight based on accurately calculated gestational age. A retrospective analysis of all singleton live births from 22-44 completed weeks of gestation during the period from September 1998 to December 2000 in the two largest birth birth centers in Kuwait was conducted. Neonates with major congenital anomalies and those with unrecorded gestational age were excluded from the study population. Total population and gender-specific birthweight percentiles according to gestational age were developed after smoothening of growth curves. A total of 35768 births were included in the development of the birthweight curve. Percentiles of birthweight for all population and by gender are presented. There was significant difference in birthweight among different ethnic groups in this population. At term, 9.8% of births are smaller than the 10th percentile and 10.0% are larger than the 90th percentile. Plotting birthweight in our population on percentile curves derived from the United States or United Kingdom would generally overestimate small for gestational age newborns and underestimate large for gestational age newborns. We conclude that the diagnosis of clinically significant birthweight abnormalities depends on the fetal growth curve used. A population specific curve of fetal growth dated by ultrasonography would provide a reliable reference for birthweight distribution.

Ethnic variations in birthweight percentiles in Kuwait.

The objectives of this retrospective study were to assess the effect of ethnicity on birthweight percentiles and to compare ethnic-specific percentiles with other references. Analysis was made of 35 768 singleton live births from 22 to 44 completed weeks of gestation at two major obstetric hospitals in Kuwait, after exclusion of data with inaccurate gestational age, major congenital abnormalities, stillbirths, and outlying birthweights. The population included four major ethnic groups: Gulf Arabs, Mediterranean Arabs, Egyptians, and a group combining Indians and Southeast Asians. Total population and ethnic-specific smoothed birthweight percentiles according to gestational age were developed. Indians-Asians had the smallest birthweights, the highest prevalence of small-for-gestational-age (SGA) birthweights and the lowest prevalence of large-for-gestational-age (LGA) birthweights. On the contrary, Egyptians had the largest birthweights, the lowest prevalence of SGA birthweights and the highest prevalence of LGA birthweights. Plotting our birthweights on a reference from Canada resulted in a low prediction rate for SGA and a low sensitivity in identifying LGA of all ethnic groups. We conclude that interpretation of fetal growth and birthweight should involve locally derived and ethnically specific percentiles based on accurately calculated gestational age.