Prune belly syndrome (PBS) is a rare congenital anomaly of uncertain etiology. Many associations of PBS with other malformations were previously reported, but only few cases of the association with VACTERL have been described. We report a rare case of a Moroccan new born with PBS and complete VACTERL association. The cause of this association is still unknown, but a common etiology is possible, especially when for the two syndromes, a defect in mesodermal differentiation, in early first trimester, has been suggested.

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Background: Neonatal jaundice (NNJ) is a major cause of morbidity and mortality among neonates in Nigeria and exchange blood transfusion (EBT) is a common modality of its treatment in Ebonyi State University Teaching Hospital (EBSUTH), Abakaliki. This communication aims to audit this service. Materials and Methods: A 3-year retrospective review of the case files of all neonates that had EBT for NNJ at the new born special care unit of EBSUTH. Result: Two hundred and thirty seven (17.25%) out of 1374 neonatal admissions had NNJ. EBT was performed for 40 (16.9%) of them. The commonest indications for EBT were low birth weight/prematurity, ABO blood group incompatibility, sepsis and glucose 6 phosphate deficiencies. The mean serum bilirubin at which EBT was done was 28.3 mg/dl. The EBT was uneventful in 36 cases while in four (10%) cases there were reported adverse events. Seven neonates (17.5%) died after the procedure and documented causes of death include bilirubin encephalopathy, respiratory failure, and septic shock and disseminated intravascular coagulopathy. Conclusion: There is high rate of EBT use in the management of severe neonatal hyperbilirubinemia with significant morbidity and mortality in this study site. There is need to review the contribution of factors such as late presentation in the hospital to this and proffer solutions to it.

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Antley-Bixler syndrome (ABS) is rare form of craniosynostosis of both autosomal dominant and autosomal recessive inheritance. We are reporting a female term appropriate for gestational age newborn with clinical features of frontal bossing, brachycephaly, proptosis, synostosis of radioulnar joints, hemangioma over nose and philtrum, hydrocephalus suggestive of ABS.

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Context: Jejunoileal atresia (JIA) is a common abnormality. The outcome is conditioned by several variables. Nutritional problems, and long-term sequelae are described among those who survive. Aim: To correlate the type of JIA and its management to the outcome and long-term quality of life. Settings and Design: Forty-three cases over a 17-year period (1992-2009). Perinatal data, management, and outcome were extracted from the clinical notes. The cases that had survived were contacted to get information about their present condition. Materials and Methods: Morbidity and mortality were matched to maturity, birth weight, mode of diagnosis, type of JIA, associated anomalies, and management and duration of parenteral nutrition. Growth and quality of life in 34 cases were evaluated via a telephone interview at a minimum of one year from surgery. Statistical analysis: Fisher test, Linear regression test, Kruskal-Wallis test, Dunn's comparison test. Results: Male/Female ratio was 25/18 and median birth weight was 2.644 g. Prenatal diagnosis was recorded in 34%. Six patients (14%) had associated anomalies. Primary surgery was resection and anastomosis in 88% and temporary stoma in 12%. Length of the resected bowel ranged from 3 to 65 cm. Whenever multiple atresia was found, the bowel length was saved by multiple anastomosis. Three dehiscences and three adhesive obstructions required a reoperation. Two patients (4%) died due to a central catheter-related sepsis. Prenatal diagnosis did not influence the outcome and was associated with a higher rate of Cesarean deliveries. Interview, at a median of nine years, showed normal growth in 85%. One case of short bowel syndrome is still on parenteral support at 22 months. Conclusions: Preserving bowel length and reducing the recourse to stoma is the key to good outcome and growth. Sequelae are correlated with the type of atresia and length of residual bowel; however, they decrease their severity with time.

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Birth injuries especially to humerus are rare in Caesarean sections as compared to vaginal deliveries. But in some difficult extractions even with expert care, injury may be sustained by the newborn. This is a report of a case of birth trauma induced fractures of both humerus during Caesarean section.

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Background: Gestational diabetes mellitus (GDM) affects up to 10% of all pregnancies and results in significant maternal and neonatal morbidities. Objectives: Our main objective was to investigate retrospectively the rate of neonatal intensive care unit (NICU) admissions and significant neonatal complications in pregnant mothers with gestational diabetes. Materials and Methods: A retrospective cohort study was conducted. The medical records of King Khalid University Hospital (KKUH) were reviewed from January till December 2007. All pregnant women with GDM along with their offsprings were included and matched with healthy pregnant women. The primary outcome was the rate of NICU admission, hypoglycemia, birth weight and length of hospital stay. Results: A total of 766 mothers (419 GDM mothers and 347 controls) with their term babies were included. Infants born to GDM mothers had significantly higher risk of NICU admissions [OR 2.7 (95% CI 1.5, 4.9), P value 0.0004], longer hospital stay and higher rates of hypoglycemia. Newborns of GDM mothers had higher rates of perinatal distress and macrosomia; however, the difference did not reach statistical significance. Conclusion: GDM remains a significant morbidity to newborns resulting in increased intensive care admission, prolongation of hospital stay and higher rates of neonatal hypoglycemia. More efforts to assure early recognition and strict sugar control during pregnancy are still needed.

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Myiasis is an infection of live mammalian tissue by the larvae of dipteran flies and commonly found in the tropics and subtropics. It usually infects domestic and wild animals, but sometimes also affects human. Umbilical cord myiasis in the neonatal period associated with sepsis is a rare occurrence with few reported cases in the literature. In this article, authors report a 7-day-old neonate from a rural area presented with neonatal sepsis due to umbilical myiasis caused by fly larval form of blow fly (Chrysomya megacephala).

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Although survival of extremely low birth weight (ELBW) infants dramatically improved over last decades, bronchopulmonary dysplasia (BPD) rate has not changed. The use of indomethacin prophylaxis in ELBW infants results in improved short-term outcomes with no effect on long-term outcomes. The addition of fluid restriction to the indomethacin prophylaxis policy could result in a reduction of BPD and improve long-term survival without neurosensory impairment at 18 months corrected age. To determine the effect of a policy of fluid restriction compared with a policy of no fluid restriction on morbidity and mortality in ELBW infants receiving indomethacin prophylaxis. The standard search strategy for the Cochrane Neonatal Review Group was used. This included search of OVID MEDLINE-National Library of Medicine, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 8, 2011). Additional search included conference proceedings, references in articles, and unpublished data. All randomized or quasi-randomized trials that compared fluid restriction and indomethacin prophylaxis vs. indomethacin prophylaxis alone in ELBW infants were included. Standard methods of the Cochrane Neonatal Review Group were planned to assess the methodological quality of the trials. Review Manager 5 software was planned to be used for statistical analysis. We found no randomized controlled trials to investigate the possible interaction between fluid restriction and indomethacin prophylaxis vs. indomethacin prophylaxis alone in ELBW infants. A well-designed randomized trial is needed to address this question.

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Objective: The study aimed to develop a national reference on birth weight-specific neonatal survival in the State of Qatar to facilitate parental counseling. Study Design: This was a retrospective, analytic, and comparative study. Materials and Methods: The birth weight-specific neonatal mortality data for the years 2003 and 2010, collected from the admission and discharge registers of the neonatal intensive care unit, were stratified using the stratifications given in Vermont Oxford Network (VON) 2007 annual report. Category-wise birth weight-specific mortality and relative risk (RR) of death were compared between Qatar data (2003 and 2010) and VON 2007 report. Results: Qatar's neonatal mortality rate (NMR) dropped from 5 of 1000 in 2003 to 4.4 of 1000 in 2010 (P=0.443) which was significant for birth weight categories 501-750 g and 751-1000 g (P=0.026 and P=0.05, respectively). Qatar's NMR in 2010 was significantly lower than VON's NMR during 2007 (P<0.001) though VON's NMR was significantly lower among birth weight categories 751-1000 g and 1001-1500 g (P=0.001 and P=0.003, respectively). The RR of mortality decreased with increasing birth weight. The decline was very sharp for birth weight categories between 500 and 1500g. The RR was 25 times higher in babies with birth weight less than 750 g as compared to babies with birth weight ≥ 2550 g, both in Qatar and VON data. For birth weight categories 751-1000 g and 1001-1500 g, the RR was twice in Qatar as compared to the VON report (16.8 versus 7.8, and 5.5 versus 2.7, respectively). Conclusions: Qatar's current overall and birth weight-specific NMRs are comparable with the VON report except in birth weight categories 751-1000 g and 1001-1500 g which were higher in Qatar. This needs further in-depth qualitative analysis.

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Purpose: To evaluate the impact of nurse-regulated feedings (NRFs) on growth velocity and weight gain of 1200-1500 g preterm infants. Subjects: Cohort 1: All preterm infants 1200-1500 g between 1997 and 2001 not on NRF protocol; Cohort 2: All preterm infants 1200-1500 g between 2003 and 2006 on NRF protocol. Both cohorts screened out for small gestation age, major congenital anomalies, intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), culture positive infection at birth, meningitis, and those requiring surgery. Materials and Methods: A before and after matched cohort study was conducted in the years 1997-2001 and 2003-2006, enrolling infants from Covenants Neonatal Intensive Care unit (Level III) using these studies screening protocol. Data on first 62 enrolling infants from both cohorts were used for this study. Both cohorts were matched using gestational age, birth weight, length of stay, initial length. A modified data tool collection set was used for collecting and analyzing nutritional data, this included intake (cal/kg/d, cc/kg/d, and total intake in cc) and route (initial parenteral feedings, mixed parenteral and enteral feedings, full enteral feedings), NRF, and non-NRF (NNRF). Data collection continued until discharge, initiation of adlib feeding, or greater than 50% of nutrition from breast. Discussion: Of the entire population sampled from 1997 to 2006, there were only 59 for NRF and 58 for NNRF. The mean growth velocity (g/kg/d) to reach full enteral feedings for both cohorts was insignificant (t=0.233; P=0.816). This suggested both groups were well matched up to the point of NRF institution for the 2003-2006 cohort years. Results: NRF had a 71% greater growth velocity than NNRF (P<0.001, t=6.618) at the time of discharge, initiation of adlib feeding, or greater than 50% of nutrition from breast. Conclusions: This study demonstrated that the NRF protocol offers a significant advantage in nutritional support than previous feeding regimens in this institution.

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