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Kuwait City, Kuwait

Wani V.B.,Al Bahar Ophthalmology Center | Al Sabti K.,Al Bahar Ophthalmology Center | Al Sabti K.,University of Sfax | Kumar N.,Al Bahar Ophthalmology Center | And 7 more authors.
Clinical Ophthalmology | Year: 2013

Purpose: The purpose was to report the structural, visual, and refractive outcomes of infants treated for retinopathy of prematurity (ROP) with laser and to identify the risk factors for unfavorable outcomes. Materials and methods: The charts of infants with severe ROP treated by diode laser in a tertiary center during the period April 1999 to November 2003 were reviewed. Treated infants were followed up for fundus examination, visual acuity assessment, and cycloplegic refraction. Data regarding ocular risk factors, like zones of ROP and the extent of extraretinal proliferations, and data regarding various systemic risk factors were collected. A minimum follow up of 6 months was needed for inclusion in the study of structural outcome. A minimum follow up of 24 months was needed for the study of visual and refractive outcomes. The outcomes measured were: rate of unfavorable structural outcome, unfavorable visual outcome (visual acuity, <20/40), and high myopia (myopia ≥ 5 diopters). The ocular and systemic risk factors were studied for their significance in the development of unfavorable outcomes. Results: Two hundred seventy eyes of 148 infants were treated for severe ROP, out of which 20 eyes (7.4%) had unfavorable structural outcome. Visual data were available for 149 eyes of 81 infants, of which 70 eyes (47%) had unfavorable visual outcome. Refractive data were available for 131 eyes of 72 infants, and high myopia was present in 23 (17.6%) eyes. Zone I disease was the significant risk factor for unfavorable structural (P< 0.0001), unfavorable visual outcome (P = 0.03), and for high myopia (P< 0.0001). Lower postconceptional age at treatment was significant for unfavorable structural outcome (P = 0.03) and high myopia (P< 0.0001). Presence of sepsis (P = 0.029) and extraretinal proliferation ≥ 6 hours were significant for unfavorable structural outcome (P = 0.002). Conclusion: ROP in zone I was the most significant risk factor for all the unfavorable outcomes. Laser-treated ROP infants need long term follow up. © 2013 Wani et al, publisher and licensee Dove Medical Press Ltd.

Hammoud M.S.,Kuwait University | Al-Taiar A.,Kuwait University | Thalib L.,Kuwait University | Al-Sweih N.,Kuwait University | And 2 more authors.
Journal of Paediatrics and Child Health | Year: 2012

Aim: Investigate the incidence, etiological pattern and the antimicrobial resistance of late-onset neonatal infections over a period of 5 years. Methods: Longitudinal audit of neonatal sepsis from January 2005 to December 2009, in the main maternity hospital in Kuwait. Late-onset neonatal infection was defined as the culture of a single potentially pathogenic organism from blood or cerebrospinal fluid from an infant older than 6 days in association with clinical or laboratory findings consistent with infection. Results: The overall incidence was 16.9 (95% confidence interval: 15.8-18.0) episodes per 1000 live births. The commonest pathogen was coagulase-negative Staphylococcus, 339 (35.7%), while Klebsiella was the most common gram-negative infection, 178 (18.8%). Escherichia coli, Enterococcus and Enterobacter spp were each responsible for 6% of all infections. Candida caused 104 (11.0%) infections. The general pattern of infection remained unchanged over the study period. Case fatality was 11.7% (95% confidence interval: 9.7-13.9%) and was high for Pseudomonas (18.4%) and Candida (22.1%) infections. Approximately 24 and 20% of Klebsiella infections were resistant to cefotaxime and gentamicin, respectively, while 28 and 24% of Escherichia coli infections were resistant to cefotaxime and gentamicin, respectively. Conclusion: The incidence of late-onset infection in Kuwait is high, resembling that in resource-poor countries. The high incidence coupled with low case fatality provides an example for settings where tertiary care is introduced without strict measures against nosocomial infections. Prevention against nosocomial infections in neonatal units has the potential to further reduce neonatal mortality in these settings. © 2012 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

Khalil M.F.,Al Sabah Maternity Hospital | Raina A.,Al Sabah Maternity Hospital | Hammoud M.S.,Kuwait University
Kuwait Medical Journal | Year: 2012

We present one case of neonatal cardiac tamponade due to percutaneous jugular venous catheterization, a rare and potentially fatal complication. In neonates with central venous catheters, the incidence of pericardial effusion (PCE) with tamponade is 0.5 - 2%. Perforation usually has a delayed course and results from endothelial injury, caused by the fluids, which leads to necrosis and thrombosis. This fluid then diffuses transmurally across the myocardium into the pericardium. Even if the catheter tip is placed properly and checked immediately after placement, it can migrate, an incidence which implies that the position of the catheter be checked at least twice a week after insertion.

Hammoud M.S.,Kuwait University | Al-Taiar A.,Kuwait University | Fouad M.,Al Sabah Maternity Hospital | Raina A.,Al Sabah Maternity Hospital | Khan Z.,Kuwait University
International Journal of Infectious Diseases | Year: 2013

Objectives: The prevalence and clinical significance of persistent candidemia among neonates are poorly understood. This study aimed to describe the rate and the clinical relevance of persistent candidemia over a 4-year period in Kuwait. Methods: A retrospective chart review of infants admitted to the Neonatal Care Unit of the Maternity Hospital in Kuwait between January 2007 and December 2010, who had a positive blood culture for Candida species, was conducted. Persistent candidemia was defined as the isolation of the same Candida species more than 6 days after the initiation of antifungal therapy, or death due to candidemia within 6 days of antifungal treatment. Stepwise logistic regression was used to investigate factors associated with persistent candidemia. Results: Of 89 neonates with a Candida infection, 54 (60.7%, 95% confidence interval 49.7-70.9%) had persistent candidemia. The case-fatality rate was 54% among those with persistent candidemia and 3% among those with non-persistent candidemia (p < 0.001). Neonates with persistent candidemia were more likely to be female, have a central vascular catheter at diagnosis, and have a low platelet count. All isolated Candida species were susceptible to antifungal agents. Conclusions: Persistent candidemia is common among neonates with a Candida infection and is associated with an increased risk of mortality. Drug resistance is unlikely to explain the persistent candidemia; host-related factors seem to be more important and hence could be used to identify those at risk in order to institute appropriate preventive and treatment measures. © 2012 International Society for Infectious Diseases.

Wani V.B.,Al Bahar Ophthalmology Center | Kumar N.,Al Bahar Ophthalmology Center | Sabti K.,Al Bahar Ophthalmology Center | Sabti K.,Kuwait University | And 4 more authors.
Indian Journal of Ophthalmology | Year: 2010

Aims: The aim of the study was to report the incidence of retinopathy of prematurity (ROP) and severe ROP and identify the risk factors for their development in a large nursery in Kuwait. Materials and Methods: This was a retrospective, interventional, non-comparative, hospital-based study. Retrospective review of ROP records of premature babies having either birth weight of less than 1501 g or gestational age at birth of 34 weeks or less and born between January 2001 and August 2003. Statistical Analysis: By univariate and multivariate logistic regression analysis. Results: Out of the 599 babies studied, 38.9% developed ROP and 7.8% needed treatment for severe ROP. Multivariate analysis showed low birth weight (OR 13.753, 95% CI 3.66-51.54; ( P < 0.001), gestational age (OR 13.75, 95% CI 3.66-51.54; P < 0.001), surfactant (OR 1.72, 95% CI 1.04-2.83; P = 0.032) and stay in the intensive care unit for longer than 15 days (OR 2.25, 95% CI 1.05-4.85; P = 0.033) to be significant for the development of any ROP. Low birth weight (OR 22.86, 95% CI 3.86-134.82; P = 0.001), bacterial sepsis (OR 3.27, 95% CI 1.51-7.05; P = 0.002) and need for surfactant (OR 4.41, 95% CI 0.94 -20.56; P = 0.059) were found to be the risk factors for severe ROP needing laser treatment. Conclusion: The incidence of both any ROP and ROP needing treatment are comparable to other studies. Low birth weight is the most important risk factor for both any ROP and severe ROP.

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