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Background: While anemia has been associated with severe outcomes in neonates, there is a lack of scientific data regarding the associated factors of this problem in newborn babies of Afghanistan; hence, this study was undertaken to fill that gap. The objective of this study was to evaluate the factors associated with anemia in neonates who were admitted to the Neonatal Unit. Methods: This analytic cross-sectional study with retrospective document review was conducted at the Neonatal Unit of the Maiwand Teaching Hospital in Kabul City, Afghanistan, in 2023. SPSS 26 and certain statistical methods were used to carry out the statistical analysis. Results: Of the 220 newborns enrolled in this study, anemia occurred in 26.8% of them. Based on gestational age, the occurrence rates of neonatal anemia within groups of term and preterm neonates were 23% and 41.3%, respectively. The occurrence of neonatal anemia was found to be 60% in extremely low birth weight, 41.2% in very low birth weight, 27.2% in low-birth-weight neonates, and 23.9% in normal birth weight neonates. The neonates in the anemic group versus the non-anemic group had a mean birth weight of (2516.18 ± 898.79 vs 2749.62 ± 766.02 g, P = 0.03, 95%CI= -691_-9.9), a mean gestational age of (35.47 ± 3.7 vs 37.4 ± 2.5 w, P = 0.04, 95% CI= -1.6_ -0.9), a mean age of (11.41 ± 6.39 vs 9.9 ± 6.88 days, P = 0.35, 95%CI= -1.6_4.6), a mean CRP level of (13.6 ± 7.6 vs 9.8 ± 5.6 mg, P = 0.01, 95%CI= 0.8_7.8) and a mean hemoglobin level of (11.1 ± 1.7 vs 17.3 ± 2.5 g, P = 0.04, 95%CI=-7.4_-5.1). There was a significant association between neonatal anemia and preterm birth (OR=2.4, P = 0.04, 95%CI=0.08_0.5), male sex (OR=2.4, P = 0.04, 95%CI= 0.1_0.3), neonatal sepsis (OR=2.5, P = 0.01, 95%CI= 0.1_ 0.6), cesarean delivery (OR=3.4, P = 0.00, 95%CI=1.7_6.5), maternal age greater than 35 years (OR=2.9, P = 0.03, 95%CI=0.04_0.6), no iron intake by the mother during pregnancy (OR=1.9, P = 0.002, 95%CI=1.1_3.4), antepartum hemorrhage (OR=4.7, P = 0.00, 95%CI=1.3_10.3), and poor household income (OR=2.6, P = 0.03, 95%CI=0.03_0.2). Conclusions: Newborns admitted to the Neonatal Unit had a significant prevalence of neonatal anemia. The highest occurrence rates were seen within groups of preterm and extremely low-birth-weight newborn babies. Neonatal anemia was found to be associated with lower mean neonatal birth weight and gestational age, as well as with preterm birth, male sex, a higher CRP level, neonatal sepsis, older maternal age, cesarean delivery, no maternal iron consumption, antepartum hemorrhage, and a poor household income.

Abstract Background Congenital right-side diaphragmatic eventration with atrial septal defect and cleft palate is a rare congenital anomaly. Case presentation We present a rare case of congenital right-sided diaphragmatic eventration along with atrial septal defect, cleft palate, pneumonia, and undernutrition in a 3-month-old Asian and Afghan girl. The clinical features were observed in the third month of life, and the diagnosis of these anomalies was established by the patient’s history, physical examination, chest X-ray, thoracic computed tomography, and echocardiography. Her condition was good after supportive treatment. Since the index case of diaphragmatic eventration was associated with congenital heart disease, cleft palate, and parental consanguinity, a genetic basis may have played an important role in the pathogenesis of this anomaly. Conclusion Eventration of the diaphragm may be diagnosed in early infancy, and genetic factors may contribute to its pathogenesis.

Abstract Background Necrotizing pneumonia is rare in children and is one of the most serious complications of a lung infection caused by antibiotic failure. We present a 12-year-old leukopenic child with a long-lasting lung infection, presenting as having a lung hydatid cyst, but diagnosing with necrotizing pneumonia in the right bilobed lung. Failure to medical treatment and ongoing leukopenia justified surgical intervention with positive results. Case presentation The patient was referred to our teaching hospital’s pediatric surgery department. He had previously been diagnosed with intestinal tuberculosis (TB) and received anti-TB treatment. On referral to our hospital, the patient was suffering from restlessness, frequent coughing, fever, vomiting, and diarrhea. Following the completion of the clinical work-up, a blood test revealed leukopenia (white blood cell count of 2100/microliter), a normal platelet count, and a lesion in the right lung. Computerized tomography scanning (CT-Scan) image reported a lung hydatid cyst. In the pediatrics ward, a broad-spectrum antibiotics regimen with triple-antibiotic therapy (linezolid, vancomycin, and metronidazole) was instituted and continued for a week with no response, but worsening of the condition. In the pediatric surgery ward, our decision for surgical intervention was due to the failure of medical treatment because of a pulmonary lesion. Our team performed right lung upper lobe anterior segment wedge resection due to necrotizing pneumonia and followed the patient 45 days post-operation with a reasonable result. Conclusion Living in remote rural areas with low resources and inaccessibility to proper and specialized diagnostic and treatment centers will all contribute to an improper diagnosis and treatment of lung infection. In total, all of these will increase the morbidity and mortality due to lung necrosis in the pediatric population, regardless of their age. In low-resource facilities, high-risk patients can benefit from surgical intervention to control the ongoing infection process.

Introduction and importance: Gaucher's disease (GD) or lysosomal storage disease, is one of the rare genetic disorders resulting from glucocerebrosidase deficiency. Clinical manifestations include a swollen belly (hepatosplenomegaly), bruising due to thrombocytopenia, anemia, fatigue, bone pain, and neurological involvement. Diagnosis is made by measuring the level of glucocerebrosidase enzyme in the blood, using dual energy X-ray absorptiometry (DXA), and performing genetic tests. For some types of GD, enzyme therapy is now available. Case presentation: A 5-year-old child with a high-grade fever and splenomegaly was admitted to our teaching hospital's pediatric surgery department. The patient had genetic screening in early childhood outside the country, confirming the diagnosis of GD. Following the appropriate anti-bacterial therapy, the patient underwent splenectomy for conditions such as splenomegaly, lack of enzyme replacement therapy, and the patient's susceptibility to trauma. Clinical discussion: GD is a rare disease that is frequently confused with thalassemia. If there are no visible signs and symptoms, the disease is overlooked and left untreated. Our clinical justifications for surgical operation (splenectomy) were splenomegaly, lack of enzyme replacement therapy (an integral part of gaucher's disease treatment), and prevention of splenic rupture (as a result of falling down due to child neglect, which is common in Afghanistan). During the 1-year post-operative follow-up, our patient experienced two episodes of high-grade fever, which were treated appropriately. Conclusion: Due to the rarity of GD, the disease is left untreated and undiagnosed for a long time, mainly in developing countries where definite diagnostic modalities are not readily available. Diseases with similar symptoms should always be considered in the differential diagnosis. Early enzyme replacement therapy is the key to improve the quality of life, but it is not available in developing nations.

Duplex collecting system is a urinary tract defect that represents a condition where upper and lower pole moieties fuse incompletely. Duplication could be complete or partial (Y-shaped ureter). We report two cases (complicated and uncomplicated) of unilateral duplicated collecting system with a Y-shaped ureter. The first (complicated) case was diagnosed as having kidney stone and treated surgically. The second (uncomplicated) case was diagnosed incidentally during a routine check-up. As there were no other associated urinary tract anomalies, our team advised the patient's parents to seek regular follow-up by a pediatric surgeon (for the development of possible urinary tract infection and calculus which are more prevalent in low-resource settings). Both patients were followed-up for six months in satisfactory condition.

Polyorchidism is a rare birth defect of the male genital system characterized by the presence of extra testis on one or both sides. To date, more than a hundred cases have been reported in the literature. The problem is asymptomatic and comes across incidentally. The management of polyorchidism is conservative if there are no associated problems, but some authors suggest surgical treatment in individualized patients. We present a case of testicular duplication in a 6-year-old boy who presented with left-side cryptorchidism, confirmed by ultrasonography (US). We performed orchiopexy for both testes on the ipsilateral side, and the operation ended uneventfully.

Amyand hernia (AH) is defined as protrusion of appendix or its entrapment within the inguinal hernia sac. It occurs rarely and difficult to diagnose before operation. The cause of amyand hernia is unknown but pressure by the sharp edge of the internal ring may cause pressure necrosis, inflammation and consequently appendicitis. We present a case of 3 years old child with asymptomatic right sided inguinal hernia. On exploration, we found a long appendix (10 cm) with small olive like (1.5 cm) mass at its tip, so we performed appendectomy along with herniotomy. The patient tolerated the operation well and was discharged with satisfactory condition 48 hours post-operation.

Schizencephaly is a rare congenital anomaly of the brain secondary to neuronal migration defect, characterized by slit or cleft in the cerebral hemispheres running from the pia to lateral ventricles. From clinical pint of view most of the patients present with different level of motor and psychological disorders. Imaging (CT-Scan and MRI) plays a key role in the definite diagnosis by which associated central nervous system (CNS) anomalies (absence of septum pellucidum and corpus callosum dysgenesis) could be diagnosed as well. Here, we present a case of 22 months old aphasic child suffering from head enlargement. CT-Scan image revealed unilateral schizencephaly compressing lateral ventricles and causing ventriculomegaly. We applied ventriculoperitoneal shunt (V–P shunt). After one month follow-up and brain repeated CT-Scan image for confirmation, the size of brain ventricles considerably diminished.

Crossed renal ectopia (CRE) is a rare congenital anomaly in which both kidneys reside in one side. It could be detected incidentally or during the late stage when the kidney is functioning poorly or even being non-function. We report a case of 12 years old child with symptoms of right flank pain and dysuria due to urinary tract infection (UTI). We performed routine laboratory tests (blood and urine) along with whole abdominal Ultrasonography (US) and abdomenopelvic CT-Scan. Both kidneys were located in the right side joining in the upper and lower poles with both ureters draining separately in urinary bladder. No any other anomalies related to the kidneys (congenital obstruction and cystic anomalies) and other organ system were detected. We treated UTI appropriately and discharged the patient with advice.

Giant Encephalocele is a rare entity in which the central nervous system structures in any combination protrude through a defect in the skull and the size of the head is smaller than that of the deformity. A few cases are reported globally. It could be existed alone or in combination with other central nervous system (CNS) anomalies. We report a case of 4 months old child with giant encephalocele associated with hand deformity. She underwent excision of the sac and the patient is doing well after 3 months follow up.

Transverse testicular ectopia (TTE) is a rare congenital anomaly where both testicles are migrated in the same hemiscrotum or inguinal canal. The etiology is unknown and it has three types. Embryologically, several theories regarding the origin of TTE have been suggested including adhesion and fusion of developing Wolffian canals, aberrant gubernaculum, testicular adhesions, defective formation of the internal inguinal ring, and traction on the testis by persistent Mullerian structures. To date, more than 100 cases of TTE have been reported in the literatures. TTE with fused vas deferens is extremely rare. We present a case of 3 years old child referred for admission in our teaching hospital with right side inguinal hernia and left side undescended testis. After diagnosis with physical exam and ultrasonography, TTE was diagnosed and the child underwent inguinal herniotomy, ipsilateral orchiopexy and contralateral transseptal orchiopexy. The association of TTE with fused vas deferens is rare and transseptal orchiopexy is the procedure of choice for definite treatment.