Hospital University Sains Malaysia (HUSM) functions as the state referral centre and the only hospital for the state of Kelantan that can offer neonatal intensive care service. The deliveries in HUSM with grand multiparity, late booking and problems of late referrals resembles a hospital serving a semiurban rather than an urban community. A comparison between the year 1989 and 1991 showed marked improvement of perinatal mortality rate from 41.32 to 24.88, which is significantly better than the improvement achieved from 1987 to 1989 (46.0 to 41.32). This was possible due to a marked fall in the early neonatal mortality rate from 10.02 in 1989 to 5.45 in 1991 and fall in the stillbirth rate from 31.61 to 19.53.
A retrospective study of 54 neonates with Meconium Aspiration Syndrome (MAS) admitted to the Paediatric ICU Penang General Hospital from January 1989-December 1990 was carried out to determine if suction of the trachea at birth was performed in this group of patients. 63% were inborn and 27% outborn. The mean birth weight was 3.2 kg, 83% were ventilated, mean duration of ventilation was five days and the mortality was 24%. 63% had an Apgar Score of less than 5 at 1 min and 65% had thick meconium-stained liquor. Only 48% were intubated and suctioned at birth. Overall tracheal suction rate was low.
The spectrophotometric method of Ellman was used to determine cholinesterase (ChE) levels in plasma and whole blood in elderly patients and umbilical cord blood of newborn infants. The mean +/- SD for plasma and whole blood ChE levels were 2.24 +/- 0.58 micromol/min/ml and 4.38 +/- 0.65 micromol/min/ml respectively in a group of healthy elderly patients (n = 25). The mean +/- SD for plasma and whole blood ChE levels were 2.23 +/- 0.77 and 3.31 +/- 0.56 respectively in cord blood of healthy full term newborn infants (n = 25). In a group of healthy adult blood donors the general mean +/- SD for plasma and whole blood ChE have been shown to be 2.71 +/- 0.75 and 4.87 +/- 0.73 micromol/min/ml respectively. Statistical analysis revealed that the mean levels of plasma and whole blood ChE in elderly, newborn infants and adults were different (p < 0.001). However, there was no statistical difference between the mean level of plasma ChE in elderly and cord blood but each shared statistically significant difference when compared to the mean level in adults. The mean activity of whole blood ChE in the 3 groups was different from one another. Theoretically, decreased levels of ChE would suggest a careful assessment of drugs that are hydrolysed by ChE.
A preterm baby was born to a multiparous mother by emergency caesarean section at 36 weeks of gestation. Apart from a depression on the right temporo-parietal region measuring 3 cm x 3 cm x 0.5 cm, no other abnormality was noted. A CT scan of the brain excluded the presence of intracranial haematoma and pressure effect on the brain. Spontaneous reduction of the fracture without any adverse neurological sequelae suggests that these fractures can be managed conservatively in some instances.
A case of classical congenital diaphragmatic hernia is discussed. The rare right-sided classical type - incidence of 1 in 30,000 to 1 in 81,000 live births - and diaphragmatic eventration are often grouped together as Congenital Diaphragmatic Herniae. We had nine in 57,783 live births in ten years.
An immunization survey was carried out in early 1983 in a military community. The survey covered 192 children from 147 families. 98% had BCG scars. and 94% had completed their primary course of immunization against diphtheria, pertussis, tetanus and poliomyelitis. The acceptance rate for booster was however low. The time frame for the immunization was also not adhered to strictly. An immunization register has been started in all centres for recall of defaulters. Publicity has also been mounted to ensure all are aware of the immunization programme.
Seven infants with birth weights less than lS00g received total parenteral nutrition for seven to 16 days through the peripheral route, commencing within the first 24 hours of life. Excessive weight loss was prevented and the infants showed significant weight gain. The time required to regain the initial birth weight showed an improvement over that expected in conventionally managed infants. Metabolic and septic complications were minimal and easily manageable. The results demonstrate that the technique, when properly used, warrants consideration in feeding low birth weight infants incapable of tolerating enteral feeding.
Thanatophoric dwarfism is a severe form of neonatal shortlimbed skeletal dysplasia. Most infants are stillborn or die soon after birth. This disorder has well defined radiological features which distinguish it from the other forms of neonatal dwarfism. We report two cases where short limbs were detected on sonography and a diagnosis was made on antenatal radiographs and fetography.
The IgM-globulin levels were determined for 5,167 cord-sera of apparently normal infants and 281 sera of defective infants aged 4 months and younger. The significant level for IgM-globulin in neonates was found to be 20 mgm/dl (2 SD above mean of the normal) above which the level was regarded as abnormally raised. Significant levels of IgM-globulin were found in 0.2% (11/5, 167) ofnormal neonates and in 40.6% (114/281) of defective infants which is more than 200 times the normal value. Combining the normal and abnormal rates, an overall figure of 23 intrauterine infections per 1,000 live births were obtained for Malaysia. The advantages and disadvantages of the use of serum IgM-globulin elevations for the diagnosis of intrauterine infections were discussed.
Serum human prolactin (hPRL) levels in Malay women during pregnancy, intrapartum and immediately postpartum have been invest£gated by means of a double-antibody radioimmunoassay technique. There was a progressioe rise of serum prolactin concentration from 31.9 ± 10.4 ng/ml in the first trimester to 242.0 ± 24.6 ng/ml at 36 weeks pregnancy unth. the mean values during the second and third trimester of 118.9 ± 12.7 ng/ml and 214.7 ± 10.3 ng/ml respectively. During intrapartum the concentration of hPRL was 191.9 ± 26.9 ng/ml and ithat of immediately postpartum was 178.3 ± 14.5 ng/ml. Suckling of the breast within 6 hours postpartum has resulted in a minor elevation of prolactin level, and this could have been due to the greater basal prolactin level, and/or the ineffectiveness of suckling as a potent stimulus during this period.
Campylobacter Jejuni is being increasingly recognised as a cause of bacteraemia enteritis and two infants with this condition are described. Awareness of the organism. as a possible cause of septicaemia is important because it has special growth requirements and delay in the diagnosis can be detrimental in a disease which usually only responds to erythromycin, gentamicin and chloramphenicol.
Achondrogenesis is a lethal neonatal chondrodysplasia with extreme micromelia and marked discrepancy between the relatively large head and the decreased trunk length. The affected neonates are usually delivered prematurely, and are stillborn or die soon after birth. Polyhydramnios is frequently present. It is an inherited autosomal recessive disease. The radiographic features are diagnostic.
Over a seven month period in 1986, 164 (1.1%) of a total 15,131 neonates delivered in the Maternity Hospital, Kuala Lumpur were born to mothers with prolonged rupture of the fetal membranes. Septic work-ups were performed on 163 of these babies shortly after birth, 77 of them had no bacteriological, radiological or other clinical evidence of infection. The remaining 86 had additional history of illness. Nine of these 86 babies had proven infection: four with septicemia, one with meningitis and four others with congenital pneumonia. This study showed that neonates had risk of infection only when maternal history of prolonged rupture of the fetal membranes was associated with other clinical evidence of infection. However, even in this group of neonates at risk, 89.5% of them were not infected. Therefore, there is still a need to develop a simple, rapid, reliable and cheap laboratory method to help early identification of the infected from the non-infected neonates in order to prevent unnecessary antibiotic treatment and hospital stay.