A term, Malay male neonate, delivered by spontaneous vertex delivery, was found to have a huge carvenous hemangioma on the anterior chest wall. He developed respiratory failure on the second day of life. Having considered the various options possible, an emergency surgical excision was carried outat the age of 57 hours. The patient recovered after a stormy post-operative period.
The results of a 10-year study of intussusception seen in the General Hospital Kuala Lumpur is presented. Incidence among Indians was found to be the lowest in comparison to the other two major racial groups. In 63.5 percent of infants there was no pain. A large number of patients presented with diarrhoea (21.8 percent), constipation (31 percent) and abdominal distension. (43.7 percent). Overall mortality rate was high (14.4 percent). This could be attributed to late presentation (only 30.8 percent) of cases were seen within 24 hours of onset of symptoms) which also accounted for a higher resection rate. A high incidence of lead points (28.7 percent) was also seen. The usefulness of barium enema reduction in this country is discussed. Mainstay of management in the majority of cases is operation with adequate pre and postoperative care.
Sixty seven infants were admitted over a 10-year period from 1972 to 1981: 50 males and 17 females. A higher incidence of hypertrophic pyloric stenosis exists in West Malaysia than was previously recognised. However, it remains at less than one tenth of the Western figures. Among the three major races, the condition was commonest in Indians and least in Malays. Most cases presented between the ages of 3 to 8 weeks. Prolonged history of vomiting of more than 3 weeks occurred in 43.3 percent cases, usually among Malay and Indian patients. All patients were treated surgically with 1 death (1.5 percent). The usual postoperative complication was vomiting which occurred in 22.4 percent. Early presentation, adequate preoperative resuscitation and improved anaesthetic techniques can further reduce this mortality and morbidity.
Over the six-veer periodfrom. 1976 to 1981, there were 241 neonates referred to the U.K.M. Paediatric Surgical Unit, General Hospital, Kuala Lumpur for alimentary tract obstruction and 207 were operated on. The three commonest conditions were anorectal anomalies (91 cases), Hirschsprung's disease (31 cases) and oesophageal atresia (30 cases). Overall operatioe mortality was 28.0 percent. This was high when preoperative complications lihe gut perforation (88.9 percent) or pneumonia (61.9 percent) and associated severe anomalies (90.9 percent) or chromosomal abnormalities (66.7 percent) were present. Emphasis is placed on the establishment of early diagnosis and the significance of the green vomit and maternal hydramnios is highlighted, The need is felt for more specialised nurses and the creation of a separate neonatal ICU in this hospital.
A review of 24 children with posterolateral (Bochdalek) diaphragmatic hernia over a five-year period was carried out to highlight the problems of diagnosis and' management. Nine children were delivered in the Maternity Hospital Kuala Lumpur, giving an incidence of 1:10,000 live births which is half the expected incidence. Difficulty in diagnosis is apparent from the large number of initially misdiagnosed cases (29%) and those not detected
soon after birth (71% diagnosed after 24 hours). Less than half the babies had associated anomalies, commonest being malrotation and ipsilateral lung hypoplasia. Mortality (20.8%) appears to be related to the degree of lung hypoplasia and shunting, and the birthweight of the babies. Current evidence indicates that pulmonary hypertension is the main factor in the chain of events beginning with lung hypoplasia, which ultimately leads to their demise. Various methods to overcome this complication have been evolved which appear to give some hope for these high-risk infants.