N Mahdhaoui

Faculté de Médecine Ibn El Jazzar de Sousse, Susa, Sūsah, Tunisia

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Publications (28)8.94 Total impact

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    ABSTRACT: Congenital pulmonary lymphangiectasis (CPL) is a rare condition in neonates characterized by abnormal dilatation of the lymphatics draining the interstitial and subpleural spaces of the lungs. Diagnosis is difficult in the neonatal period because respiratory features and radiological findings are not specific of the disease. Definitive diagnosis of CPL can be made only by pathologic examinations. We report a case of a male near-term neonate presenting with severe respiratory distress at birth. The initial chest X-ray showed frosted glass-like infiltrates with air bronchogram suggesting a maternofetal infection or respiratory distress syndrome. The infant required mechanical ventilation and chest tube insertion for right then bilateral pneumothorax. The child died 15 days later in spite of optimal high-frequency ventilation, bilateral pneumothorax drainage, and hemodynamic support. Autopsy revealed features consistent with the diagnosis of CPL. Although CPL is very rare, we should be aware that it is a possible cause of severe unexplained respiratory distress in neonates.
    Archives de Pédiatrie. 04/2012; 19(4):408–412.
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    ABSTRACT: Arterial thromboses are rare in newborns, mostly caused by arterial catheters. Neonatal arterial thrombosis occurring in other contexts is much rare. We report arterial thrombosis, not caused by catheterisation in 4 neonates hospitalised in the neonatology department of the Farhat Hached de Sousse hospital in Tunisia. The diagnosis of arterial thrombosis was made based on signs of ischemia in 2 patients affected by thrombosis of the iliac arteries. The symptoms were less clear: anuria associated with arterial high blood pressure in 1 patient affected by thrombosis of the abdominal aorta and by anuria with melena in a newborn with aortic and mesenteric thrombosis. Diagnosis was confirmed by Doppler sonography in 3 patients and based on autopsy data in 1 patient. A delay to consultation was noted in 3 patients, whose outcome was fatal. The progression was favourable after thrombolysis and anticoagulation using heparin in 1 patient with major aortic thrombosis. A review of the literature on the epidemiological, clinical, therapeutic and outcome data of the arterial thrombosis in the newborn child is provided.
    Archives de Pédiatrie. 04/2012; 19(4):413–418.
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    ABSTRACT: Congenital pulmonary lymphangiectasis (CPL) is a rare condition in neonates characterized by abnormal dilatation of the lymphatics draining the interstitial and subpleural spaces of the lungs. Diagnosis is difficult in the neonatal period because respiratory features and radiological findings are not specific of the disease. Definitive diagnosis of CPL can be made only by pathologic examinations. We report a case of a male near-term neonate presenting with severe respiratory distress at birth. The initial chest X-ray showed frosted glass-like infiltrates with air bronchogram suggesting a maternofetal infection or respiratory distress syndrome. The infant required mechanical ventilation and chest tube insertion for right then bilateral pneumothorax. The child died 15 days later in spite of optimal high-frequency ventilation, bilateral pneumothorax drainage, and hemodynamic support. Autopsy revealed features consistent with the diagnosis of CPL. Although CPL is very rare, we should be aware that it is a possible cause of severe unexplained respiratory distress in neonates.
    Archives de Pédiatrie 02/2012; 19(4):408-12. · 0.36 Impact Factor
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    ABSTRACT: Laryngeal cyst is a rare but generally benign lesion in the larynx. It may cause stridor and life-threatening airway obstruction in early infancy. We report the case of a neonate who developed respiratory distress 24h after birth in relation with materno-fetal infection. Airway obstruction was then suspected because of stridor. A laryngeal mass was discovered at the time of intubation. The infant experienced a nosocomial infection and died on day 14 of life before any surgical treatment. Autopsy concluded in an epiglottic congenital laryngeal cyst.
    Archives de Pédiatrie 02/2012; 19(4):425-8. · 0.36 Impact Factor
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    ABSTRACT: Arterial thromboses are rare in newborns, mostly caused by arterial catheters. Neonatal arterial thrombosis occurring in other contexts is much rare. We report arterial thrombosis, not caused by catheterisation in 4 neonates hospitalised in the neonatology department of the Farhat Hached de Sousse hospital in Tunisia. The diagnosis of arterial thrombosis was made based on signs of ischemia in 2 patients affected by thrombosis of the iliac arteries. The symptoms were less clear: anuria associated with arterial high blood pressure in 1 patient affected by thrombosis of the abdominal aorta and by anuria with melena in a newborn with aortic and mesenteric thrombosis. Diagnosis was confirmed by Doppler sonography in 3 patients and based on autopsy data in 1 patient. A delay to consultation was noted in 3 patients, whose outcome was fatal. The progression was favourable after thrombolysis and anticoagulation using heparin in 1 patient with major aortic thrombosis. A review of the literature on the epidemiological, clinical, therapeutic and outcome data of the arterial thrombosis in the newborn child is provided.
    Archives de Pédiatrie 02/2012; 19(4):413-8. · 0.36 Impact Factor
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    ABSTRACT: Ectopic intrathoracic kidney is a very rare congenital anomaly, which is often asymptomatic and discovered incidentally on chest radiography. Diagnosis of this ectopia in the neonatal period is extremely rare. We report the case of a female infant admitted for mild respiratory distress at birth in relation with maternofetal infection in whom a right posterior opacity on chest x-ray was diagnosed as intrathoracic kidney by sonography and chest CT scan. Diaphragmatic hernia could not be confirmed at this stage. At 2 months, the presence of air blebs on chest x-ray performed for viral bronchiolitis confirmed an associated right Bochdalek hernia. The infant, although asymptomatic, underwent surgery. The intrathoracic kidney was reduced into the abdominal cavity at the time of surgery. The postoperative course was uneventful and renal function was normal.
    Archives de Pédiatrie 08/2011; 18(10):1103-6. · 0.36 Impact Factor
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    ABSTRACT: Incontinentia pigmenti (IP) is a rare affection inherited as X-linked dominant disease. It is usually lethal in male infants. IP can affect ectodermal tissues such as the skin, teeth, eyes, bones, and the central nervous system. Skin lesions occur mostly during the neonatal period and are characterized by a classic progression in 4 stages leading to hyperpigmentation. We report on the case of a female neonate presenting on the 3rd day of life with seizures without obvious cause, in which the diagnosis of IP was made 1 week later when skin lesions appeared.
    Archives de Pédiatrie 07/2011; 18(10):1095-9. · 0.36 Impact Factor
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    ABSTRACT: Congenital cutaneous candidiasis presenting at birth is very uncommon and is due to intra-uterine infection. The systemic form has to be considered when cutaneous signs are associated with sepsis symptoms. CASE REPORT: A female infant was born by vaginal delivery at 35 weeks' gestation to a mother whose pregnancy had been complicated by urinary tract infection treated 3 days before delivery. The infant was admitted because of respiratory distress. Clinical features consisted of respiratory retraction signs associated with hepatomegaly and rash on the trunk. The white blood cell (WBC) count was 50 × 10(9)/L and C-reactive protein was negative. Maternofetal bacterial infection was suspected and intravenous antibiotics were prescribed. Over the next 6h, macules appeared on the trunk, back, and limbs, which changed after 24h into papulovesicular lesions over the trunk, back, limbs, palms, and scalp. Congenital candidiasis was suspected, confirmed by cultures from vesicle swabs and maternal vaginal discharge. The systemic form was considered because of respiratory distress requiring oxygen therapy for 4 days, hepatomegaly, elevated WBC count, and chest X-ray infiltrates. The infant was started on intravenous systemic antifungal therapy (fluconazole, 6 mg/day). Treatment was continued for 3 weeks. The rash resolved by desquamation after about 1 week and hepatomegaly disappeared. The infant remained well at follow-up.
    Archives de Pédiatrie 02/2011; 18(3):303-7. · 0.36 Impact Factor
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    ABSTRACT: Incontinentia pigmenti (IP) is a rare affection inherited as X-linked dominant disease. It is usually lethal in male infants. IP can affect ectodermal tissues such as the skin, teeth, eyes, bones, and the central nervous system. Skin lesions occur mostly during the neonatal period and are characterized by a classic progression in 4 stages leading to hyperpigmentation. We report on the case of a female neonate presenting on the 3rd day of life with seizures without obvious cause, in which the diagnosis of IP was made 1 week later when skin lesions appeared.
    Archives De Pediatrie - ARCHIVES PEDIATRIE. 01/2011; 18(10):1095-1099.
  • Journal of dermatological science 02/2010; 57(2):144-6. · 3.71 Impact Factor
  • Archives De Pediatrie - ARCHIVES PEDIATRIE. 01/2010; 17(1):74-76.
  • Archives de Pédiatrie 11/2009; 17(1):74-6. · 0.36 Impact Factor
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    ABSTRACT: Introduction Suspected bacterial maternofetal infection is a relative frequent situation. Not all neonates should be admitted in neonatology department. Serial CRP seems to be an interesting tool in managing such neonates. Objective The authors expose the first Tunisian prospective study dealing with serial CRP value in diagnosing and managing MFI suspicion. Their purpose was to decrease the number of admitted neonates and antibiotic prescription. Patients and methods The study took place at Farhat Hached Hospital maternity (Sousse, Tunisia), prospectively in the time period between May 1st and september 30th 2005. Were enrolled both asymptomatic and symptomatic neonates with history of at least one obstetrical factor of potential MFI. Symptomatic neonates were immediately admitted after birth and treated with antibiotics. Asymptomatic neonates were leaved near their mothers in maternity and managed with CRP assessment on 24th life hour. Admission was decided and antibiotics prescribed in cases of positive CRP (> 20 mg/l) or when asymptomatic neonates became symptomatic. Discharge was allowed for asymptomatic neonates with negative 24 h CRP and clinical control later. MFI was finally considered in cases of 48 h positive CRP (the only criterion). Antibiotics withdrawal was decided in cases of negative CRP after 5 days antibiotics. Results This study included 775 neonates, among which 688 asymptomatic and 87 symptomatic. Serial CRP allowed reducing the number of treated neonates. MFI was considered in 107 neonates (13.8% of all neonates); 42% of neonates were not treated or treated less than 72 h. CRP permitted to discontinue antibiotics after 5 days in 93% of treated neonates. Nosocomial infection occurred in only 2.5% of hospitalised neonates. Neither readmission nor death has been observed. Conclusion This protocol seems to be simple and safe. It has been adopted by Tunisian neonatology study group in order to be nationally widespread.
    Journal de Pédiatrie et de Puériculture. 04/2009; 22(2).
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    ABSTRACT: Introduction Fever is a threatening sign in the neonatal period. The main objective is to rule out bacterial infection (BI). Management of a febrile neonate remains unclear with strategies varying from ambulatory care to admission with systematic empiric antibiotics. Objective The purpose of this study is to determine epidemiologic, clinical, complementary exams and etiological characteristics of neonates admitted for fever, and to study the predictive value of a simple tool: CRP in diagnosing and managing BI in the febrile neonate. Methods The study took place at Farhat Hached level III neonatology department between January 1st 2003 and December 31 2004. Were enrolled, all neonates admitted for fever defined by a rectal temperature greater or equal to 38 °C. All neonates underwent blood cell count and CRP on admission. BI was defined by a positive CRP greater than 20 mg/l with or without proved infection on blood, cerebrospinal fluid, and urine cultures or on chest X-ray findings. Results During the study period, 134 febrile neonates were evaluated. Fever represented 5.64% of all neonatal admissions. There were 87 boys and 47 girls (sex ratio = 1.8). Age at fever onset was less than 3 days in 65% of cases, between 4 and 10 days in 15% of cases and above 10 days in 20% of cases. Counselling delay after fever onset was less than 24 hours in 76% of cases. Temperature ranged from 38 to 39 °C in 75% of cases. Fever was the unique feature in nearly half patients. Complementary exams consisted in blood count and CRP in all cases. At least one blood culture was performed in 115 neonates (86%), urine analysis in 104 cases (77.6%), lumbar puncture in 82 cases (61.2%) and chest X-ray in 128 cases (95.5%). Antibiotics (cefotaxime + gentamicin) were started in 66 neonates (49.2%) and stopped within 48 hours in 19 neonates having negative CRP after 48-hour antibiotic treatment. BI occurred in 47 neonates (35%). Twenty-six neonates had maternofetal infection. Predictive value suggestive of BI was found with ill appearing patients and fever lasting for more than 24 hours in hospital. Conclusion Isolated neonatal fever has a bad BI predictive value. Every febrile neonate should be admitted for at least evaluation. Antibiotics are not systematic. Combining clinical features and CRP seems to offer a good alternative in managing fever without focus in neonates. Complete complementary exams including lumbar puncture should be performed before antibiotic starting.
    Journal de Pédiatrie et de Puériculture. 01/2009; 22(s 4–5).
  • Archives de Pédiatrie 12/2008; 15(12):1822-4. · 0.36 Impact Factor
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    ABSTRACT: Congenital epulis or congenital gingival cell tumour is a rare tumour in the neonate. It arises from the gingival mucosa. This benign condition can be life threatening when obstructive. In this report, a case of a male neonate, with features of obstructive congenital epulis arising from both maxillary and mandibular alveolar ridge, interfering with breast-feeding is described. Diagnosis was suspected clinically and confirmed by histology. Outcome was good after prompt surgery.
    Archives de Pédiatrie 07/2008; 15(6):1083-6. · 0.36 Impact Factor
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    ABSTRACT: Renal involvement is frequent in neonates with perinatal asphyxia. It is correlated with the severity of neurological damage and seems to worsen the long-term neurological outcome. The aim of this study was to determine the incidence of renal failure after perinatal asphyxia, to precise the relationship between severity of cerebral damage and renal failure and to evaluate the place of renal damage in the short- and middle-term neurological outcome. We conducted a prospective study including 87 full-term neonates admitted in the neonatology department of F. Hached university hospital in Sousse (Tunisia) and suffering from hypoxic ischemic encephalopathy from 1st January 2003 to 30 June 2005. Renal function was assessed by measuring plasma urea and creatinine at age 48 h. Renal failure was defined by a level of creatinine above 90 micromol/l. Neurologic examination was performed on day 7. The survivors were followed up by the same senior after discharge. During the study period, 87 full-term neonates were admitted for hypoxic ischemic encephalopathy. The degree of neurological impairment was determined according to Sarnat classification: 1st stage 9 neonates (10,3%), 2nd stage 67 (77%) and 3rd stage 11(12,6%). Renal failure involved 15 neonates (17,2%) of whom 10 belonging to the 2nd stage group. Renal function outcome was favorable in all survivors with normalisation of plasma creatinine level between day 5 and day 15. Eight neonates died, of whom 3 with renal failure. Neurologic examination was abnormal in 36 out of 72 (50%) neonates without renal failure and in 9 of the 12 (75%) survivors with renal failure. Among the 12 neonates with renal failure, 7 had abnormal neurologic features at discharge. Neurologic assessment between 6 and 18 months was abnormal in 4/12 (33%) of neonates with renal failure versus 8/72(11%) of neonates without renal failure. Transient renal failure is commonly observed in perinatal asphyxia. Renal failure is correlated with neurologic severity. Renal function assessment using creatinine plasma level seems to be correlated with neurologic outcome. However, other tools appreciating renal function, namely tubular function, should be determined earlier in order to predict neurologic outcome after hypoxic ischemic encephalopathy.
    Archives de Pédiatrie 04/2008; 15(3):229-35. · 0.36 Impact Factor
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    ABSTRACT: Background Renal involvement is frequent in neonates with perinatal asphyxia. It is correlated with the severity of neurological damage and seems to worsen the long-term neurological outcome. Purpose The aim of this study was to determine the incidence of renal failure after perinatal asphyxia, to precise the relationship between severity of cerebral damage and renal failure and to evaluate the place of renal damage in the short- and middle-term neurological outcome. Population and methods We conducted a prospective study including 87 full-term neonates admitted in the neonatology departement of F. Hached university hospital in Sousse (Tunisia) and suffering from hypoxic ischemic encephalopathy from 1st January 2003 to 30 June 2005. Renal function was assessed by measuring plasma urea and creatinine at age 48 h. Renal failure was defined by a level of creatinine above 90 μmol/l. Neurologic examination was performed on day 7. The survivors were followed up by the same senior after discharge. Results During the study period, 87 full-term neonates were admitted for hypoxic ischemic encephalopathy. The degree of neurological impairment was determined according to Sarnat classification: 1st stage 9 neonates (10,3%), 2nd stage 67 (77%) and 3rd stage 11(12,6%). Renal failure involved 15 neonates (17,2%) of whom 10 belonging to the 2nd stage group. Renal function outcome was favorable in all survivors with normalisation of plasma creatinine level between day 5 and day 15. Eight neonates died, of whom 3 with renal failure. Neurologic examination was abnormal in 36 out of 72 (50%) neonates without renal failure and in 9 of the 12 (75%) survivors with renal failure. Among the 12 neonates with renal failure, 7 had abnormal neurologic features at discharge. Neurologic assessment between 6 and 18 months was abnormal in 4/12 (33%) of neonates with renal failure versus 8/72(11%) of neonates without renal failure. Conclusion Transient renal failure is commonly observed in perinatal asphyxia. Renal failure is correlated with neurologic severity. Renal function assessment using creatinine plasma level seems to be correlated with neurologic outcome. However, other tools appreciating renal function, namely tubular function, should be determined earlier in order to predict neurologic outcome after hypoxic ischemic encephalopathy.
    Archives De Pediatrie - ARCHIVES PEDIATRIE. 01/2008; 15(3):229-235.
  • Archives De Pediatrie - ARCHIVES PEDIATRIE. 01/2008; 15(12):1822-1824.
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    ABSTRACT: L’épulis congénitale ou tumeur gingivale à cellules granuleuses est une tumeur rare, propre à la période néonatale, prenant origine au niveau de la muqueuse gingivale du nouveau-né. Bien que la tumeur soit bénigne, elle peut mettre en jeu le pronostic vital dans les cas où elle est obstructive. Nous rapportons l’observation d’une épulis congénitale obstructive, entravant la succion chez un nouveau-né, particulière par sa survenue chez un garçon et sa double localisation maxillaire et mandibulaire. Le diagnostic suspecté cliniquement a été confirmé par l’histologie. L’évolution était favorable après exérèse chirurgicale au 2e j de vie.
    Archives De Pediatrie - ARCHIVES PEDIATRIE. 01/2008; 15(6):1083-1086.