Chloroquine resistant malaria in neonates.
OBJECTIVE
To analyze the clinical presentation, treatment given, and outcome of patients suffering from congenital and acquired malaria in neonatal period.


METHODS
Analytical study.


METHODS
Paediatrics Ward-2, QAMC/BVH, Bahawalpur for 02 years from October 2001 to October 2003.


METHODS
The study included 45 cases of neonatal malaria. Thirty cases of malaria, admitted during first ten days of life, diagnosed as congenital malaria, were kept in group A, while 15 cases admitted in the ward from the age of 11 to 28 days, labeled as acquired malaria, were named group B. The clinical features at the time of presentation were noted in each group from the charts having positive malarial parasite (M.P.) on thick and thin slides. The diagnosed cases were treated with the standard dose of chloroquine sulphate. Those patients who improved clinically as well as revealed no parasite on follow-up were labeled as chloroquine sensitive. On the other hand, patients showing poor clinical response with persistence of the parasites in the blood or initially disappearing but later again having a clinical disease with positive M.P. on follow-up, were labeled as chloroquine resistant. They were treated with quinine sulphate. Outcome was compared in both the groups regarding the pattern of chloroquine resistance and death/ survival. Data was collected on which Fischer's exact test of significance was performed to know the level of significance. P-value of < 0.05 was taken as statistically significant.


RESULTS
Low birth weight, severe hemolytic anemia with history of fever in the mother were main features in group A while in group B fever, anaemia and history of blood transfusion were marked features. In group A 76.66% were caused by Plasmodium (P.) falciparum. While in group B 60% were caused by Plasmodium vivax. In group A 26.66% were chloroquine resistant while 33.65% were chloroquine resistant in group B. The mortality was 16.66% in group A and 13.33% in group B.


CONCLUSIONS
Intrauterine growth retardation, hemolytic jaundice and history of fever in the mother in the last trimester of pregnancy in the congenital while fever, history of blood transfusion in the neonates in acquired malaria but pallor in both the groups, were important clinical features. Pattern of chloroquine resistance and mortality in both the groups was not statistically different.
Khichi
Qasim Khan
QK
Department of Paediatric Medicine, Unit II, BVH/Quaid-e-Azam Medical College, Bahawalpur. qasimkhichi@yahoo.com
Channar
Mohammad Saleem
MS
Wairraich
Mohammad Ihsan
MI
Butt
Ahsan
A
D000962:Antimalarials / Q000494:pharmacology*; D002738:Chloroquine / Q000494:pharmacology*; D004351:Drug Resistance; D006801:Humans; D007231:Infant, Newborn; D016778:Malaria, Falciparum / Q000188:drug therapy* / Q000209:etiology / Q000469:parasitology*; D016780:Malaria, Vivax / Q000188:drug therapy* / Q000209:etiology / Q000469:parasitology*; D016896:Treatment Outcome
D000962:Antimalarials; D002738:Chloroquine