A retrospective study of birthweights, the incidence, and possible aetiology of low birthweight in 31,490 Nigerian children, delivered in two hospitals at Ibadan, is reported. The important findings were: (a) mean birthweights for males (3,000 gm), and for females (2,880 gm) in a non-teaching hospital were significantly higher than 2,980 gm and 2,860 gm for males and females respectively in the teaching hospital; (b) the mean birthweights for boys were significantly higher than those for girls in both hospitals; (c) these mean birthweights, though generally higher than previous reports from Nigeria, were significantly lower than those for North American Caucasian and Negro babies, and of babies of three different racial groups in Malaysia. Other interesting, though expected findings were: (a) a high incidence of low birthweight (15.5 per cent) and (b) a high incidence of small for dates babies (60 per cent). It is suggested that since birthweights, the incidence of low birthweight and its aetiology are vital in the planning of health care in any country, a prospective study involving many urban and rural areas of the country and including factors known to influence birthweight should be undertaken.
Transient abnormal myelopoiesis (TAM) occurs in approximately 10% of neonates with Down syndrome. In most cases it resolves spontaneously. Life threatening complications such as cardiopulmonary and liver diseases have been described. We present here two cases which suggest that management of TAM in selected cases will have to be more aggressive.
Orofacial clefts are one of the most common congenital malformations among newborns. The two main types of oral clefts are cleft lip with or without cleft (CLP) and cleft palate alone (CP). Cleft is an abnormal ssure in an anatomical structure that is normally fused. Cleft lip is the congenital failure of the maxillary and medial nasal processes to fuse, forming a ssure in the lip. Cleft palate is the congenital failure of the palate to fuse properly, forming a ssure in the roof of the mouth (Mossey, 2009).clefts are one of the most common congenital malformations among newborns. The two main types of oral clefts are cleft lip with or without cleft (CLP) and cleft palate alone (CP). Cleft is an abnormal ssure in an anatomical structure that is normally fused. Cleft lip is the congenital failure of the maxillary and medial nasal processes to fuse, forming a ssure in the lip. Cleft palate is the congenital failure of the palate to fuse properly, forming a ssure in the roof of the mouth (Mossey, 2009).
INTRODUCTION: There is a pressing need to better understand the complex biochemical pathways that lead to the pathogenesis of obesity. Increased oxidative stress and decreased antioxidant capacity have been identified to be associated with obesity. Therefore, the objectives of this study were to determine the plasma total antioxidant capacity (TAC) levels of Malaysian subjects and to evaluate its potential association with obesity and related anthropometric measurements.
METHODS: Plasma TAC of 362 multi-ethnic Malaysian subjects from the Kampar Health Clinic (138 males, 224 females; 124 ethnic Malays, 152 Chinese, 86 Indians; 192 non-obese, 170 obese) was measured using Trolox equivalent antioxidant capacity (TEAC) 96-well plate assay.
RESULTS: Plasma TAC was significantly lower in obese subjects (M +/- SE = 292 +/- 10.4 micromol/L) compared to non-obese subjects (397 +/- 8.58 micromol/L), whereas it was significantly higher in males and those in the 21-30 age group. Those with salty food preference and practising a strict vegetarian diet also had significantly higher plasma TAC. However, no association was found for other dietary habits (coffee intake) and lifestyle factors (physical activity, smoking). Plasma TAC was also significantly negatively correlated with diastolic blood pressure, waist and hip circumferences, weight, body mass index, total body fat, % subcutaneous fat, visceral fat level, resting metabolism and % skeletal muscle.
CONCLUSION: Plasma TAC was found to be associated with obesity, strict vegetarian practice, salty food preference and all obesity anthropometric indicators, except systolic blood pressure and pulse rate. Obese people have decreased plasma TAC indicating a compromised systemic antioxidant defence and increased oxidative stress.
Study site: Klinik Kesihatan Kampar, Perak, Malaysia
Auditory neuropathy is defined by the presence of normal evoked otoacoustic emissions (OAE) and absent or abnormal auditory brainstem responses (ABR). The sites of lesion could be at the cochlear inner hair cells, spiral ganglion cells of the cochlea, synapse between the inner hair cells and auditory nerve, or the auditory nerve itself. Genetic, infectious or neonatal/perinatal insults are the 3 most commonly identified underlying causes. Children usually present with delay in speech and language development while adult patients present with hearing loss and disproportionately poor speech discrimination for the degree of hearing loss. Although cochlear implant is the treatment of choice, current evidence show that it benefits only those patients with endocochlear lesions, but not those with cochlear nerve deficiency or central nervous system disorders. As auditory neuropathy is a disorder with potential long-term impact on a child's development, early hearing screen using both OAE and ABR should be carried out on all newborns and infants to allow early detection and intervention.
Meliodosis is an infectious disease encountered mainly in tropics. It is not an uncommon problem in Malaysia especially in areas with agricultural activities. Although it can occur in all age groups, there have been few reported cases in children. Men are more commonly affected than women due to outdoor activities. Neonatal cases have been reported in Hawaii and Thailand. These infants presented with neonatal sepsis or meningitis. The mode of transmission to these infants has not been elucidated. This is the report of such a case first reported in Hospital Tengku Ampun Afzan, Kuantan.
AIM: Glucose-6-phosphate dehydrogenase (G6PD) deficiency is a recognised cause of severe neonatal hyperbilirubinaemia, and identifying which infants are at risk could optimise care and resources. In this study, we determined if G6PD enzyme activity (EA) and certain gene variants were associated with neonatal hyperbilirubinaemia requiring phototherapy during the first week after birth.
METHODS: Newborn infants with G6PD deficiency and a group with normal results obtained by the fluorescent spot test were selected for analyses of G6PD EA and the 10 commonly encountered G6PD mutations in this region, relating these with whether the infants required phototherapy before discharge from the hospital in the first week.
RESULTS: A total of 222 infants with mean gestation and birth weight of 38.3 ± 1.8 weeks and 3.02 ± 0.48 kg, respectively, were enrolled. Of these, n = 121 were deficient with EA ≤6.76 U/g Hb, and approximately half (43%) received phototherapy in the first week after birth. The mean EA level was 3.7 U/g Hb. The EA had good accuracy in predicting phototherapy use, with area under the receiver-operating-characteristic curve of 0.81 ± 0.05. Infants on phototherapy more commonly displayed World Health Organization Class II mutations (<10% residual EA). Logistic regression analysis showed that deficiency in EA and mutation at c.1388G>A (adjusted odds ratio, 1.5 and 5.7; 95% confidence interval: 1.31-1.76 and 1.30-25.0, respectively) were independent risk factors for phototherapy.
CONCLUSION: Low G6PD EA (<6.76 U/g Hb) and the G6PD gene variant, c.1388G>A, are risk factors for the need of phototherapy in newborn infants during the first week after birth.
Study site: Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
Neonates are obligate nasal breather until they are at least two to five months old. Congenital nasal airway obstruction is one of the commonest causes of respiratory problem in newborn. Congenital nasal pyriform aperture stenosis (CNPAS) was first described by Brown et al in 1989  and is a rare cause of nasal airway obstruction which may clinically mimic choanal atresia.(Copied from article)
Objective: Immunisation is known to be an effective health intervention that protects children from infectious diseases. Of all children, infants are the most vulnerable if they experience a vaccine preventable disease. The aim of the study was to determine the immunisation status of hospitalised infants, to obtain the reasons of incomplete immunisation and to assess carers' knowledge on immunisation.
Methods: This was a cross-sectional study conducted in the Institute of Paediatrics at Hospital Kuala Lumpur over a 2-month period from June to August 2001. Data were collected through an interview using a structured questionnaire, with the carer of the infant. Questions pertaining to the immunisation status of the infant, reasons of incomplete immunisation and the carer's knowledge of immunisation were assessed.
Results: 115 infants were admitted during the study period; however, only 100 carers of the infants were available for an interview. The average age of the infants was 5.7 months. 22% of the infants had incomplete immunisation. 64% of them had missed more than one vaccine. The commonest missed vaccine was the 3'4 dose of diptheria-pertussistetanus (DP1) and polio vaccine. Reasons of incomplete immunisation include misconception on contraindication of immunisation perceived by both parents and health providers, missed appointment and communication breakdown with health facilities regarding appointment dates. The under-immunisation rate in the study population was 22%. The underimmunisation rate in the study population was 22%.
Conclusion: Health providers and the public need to be educated on the importance of immunisation and the associated valid contraindications.
Keywords: Infants, carer, under-immunisation, incomplete immunisation
Encephaloceles are rare embryological mesenchymal developmental anomalies resulting from inappropriate ossification in the skull through which herniate the intracranial contents of the sac. Occipital encephaloceles are described as giant when they are larger than the head from which they arise, and they pose a great surgical challenge. Herein, we present a case of a giant occipital encephalocele in a neonate with Chiari malformation Type 3 to highlight the problems encountered in its management and the outcome of the surgery.
This study aimed to determine the proportions of normothermic infants who remained normothermic, and hypothermic infants who became normothermic following the use of a heated water-filled mattress (HWM) in the labour room.
A case of neonatal meningitis caused by an unusual organism, Acinetobacter calcoaceticus var anitratus is reported. The source of the meningitis is probably a scalp abscess caused by the same organism. This patient was successfully treated with cotrimoxazole. Infections caused by Acinetobacter are rare and are briefly reviewed in this article
First six cases of neonatal group B beta-haemolytic streptococcal sepsis in GHKL & Maternity Hospital K.L. were reported and in one third, it was fatal. Five of the cases were 'early - onset' type and one was 'late - onset' type. While maternal infant transmission of the disease is important in the 'early - onset' type, environmental sources of infection are also significant. No gestational age or birthweight is spared from the disease. Finally, there are cases of 'early - onset' GBS sepsis presenting like hyaline membrane disease of the newborn and it is important to find ways to distinguish them which so far has not been satisfactory.
The relationship between the timing of maternal tetanus toxoid immunization and the presence of protective antitoxin in placental cord blood was investigated among women admitted to the obstetrical service of the University Hospital in Kuala Lumpur, Malaysia. The 1st dose was given between 13-39 weeks of gestation, with a median of 29 weeks. The 2nd dose was given an average of 4 weeks later. Protection was conferred on 80% or more of newborns whose mothers received their 1st tetanus toxoid injection 60 days or more before delivery. Protective levels were seen in all cord blood samples from infants whose mothers had received their 1st injection 90 days before delivery. Similarly,protective titers were found in 100% of cord blood samples when the 2nd maternal injection was give 60 days or more before delivery. There was no significant degree of protection when immunization was carried out less than 20 days before delivery. A single-dose schedule provided no protection when less than 70 days before delivery. Cord and maternal antiotoxin titers differed by no more than 1 2-fold dilution for almost all of the individual paired sera. A cord: maternal antitoxin ratio of 2 was more likely to occur with increasing time between the 2nd injection and delivery. Overall, these findings indicate that the 1st injection of a 2-dose maternal tetanus toxoid schedule should be given at least 60 days and preferably 90 days before delivery.