DETERMINANTS OF OUTCOME OF NEONATAL SURGICAL EMERGENCIES IN GOMBE: A 3-YEAR RETROSPECTIVE REVIEW.

Background: Mortality associated with neonatal surgical emergencies is high, due to late presentation and delayed surgical intervention in developing countries. The aim of this study is to determine factors associated with poor outcome of neonatal surgical emergencies at a Federal Teaching Hospital Northeastern Nigeria. Methods: A retrospective study of 85 neonates aged 1-28 days was carried between June 2019-May 2022. Records of the neonates with surgical emergencies were retrieved and analyzed with the SPSS Version 20. Results: A total of 85 neonates, 55 (64.8%) males and 30(35.3%) females were analyzed. The average duration of symptoms at presentation is about 5.3-day range 1-10days. About 51(60.0%) neonates presented after 24 hours of life 34(40.0%) within 24 hours of life, out of which were 12(35.3%) neonates with gastroschisis presenting after 8hours with severe hypothermia axillary temperature of 32.1o Celsius. The 46 (90.2%) neonates presenting after 24hours of life had travelled distances of 50-100Kms to get to the hospital, out of which about 31(67.4%) arriving the following day, with about 9(29.0%) who had gastroschisis noticed to be lifeless at presentation. Overall, about 26(30.6%) died due to late presentation, delayed surgical intervention and lack radiant warmers. Conclusion: Late presentation delayed surgical intervention are common causes of mortality in neonates with surgical emergencies in Gombe.

RELATIONSHIP BETWEEN ANTHROPOMETRIC INDICES AND LEFT VENTRICULAR MASS IN CHILDREN WITH SEVERE ACUTE MALNUTRITION IN GOMBE STATE, NIGERIA.

Introduction: Severe acute malnutrition (SAM), which is diagnosed through anthropometric measurement, causes cardiac muscle wasting and this has been linked to increased mortality. Objective: This study aimed at determining the relationship between anthropometric indices and left ventricular mass (LVM) in children with SAM in Gombe State. This is to determine if anthropometric indices can be used to estimate/predict LVM in these children. Methods: One hundred and thirty-two children with SAM aged 6 to 36 months were recruited from all the five primary health care centres that offer community management of acute malnutrition in Gombe State. Their anthropometric indices (weight, height, mid-upper arm circumference (MUAC), body surface area (BSA), body mass index (BMI) and weight-for-height Z score (WHZ) were measured/derived). Their left ventricular indices were also measured using two dimensional echocardiography. Results: The mean weight, height, MUAC, BSA and BMI were 5.5+1.2kg, 69+6.1cm, 10.2+0.9cm, 0.33+0.05m2 and 11.6+1.4kg/m2, respectively. The mean LVM was 17.7+7.1g. Weight, BSA, height, BMI and MUAC had significant positive correlation with LVM [r = 0.55, r=0.53, r = 0.43, r = 0.3 and r = 0.3(p=0.001)], respectively. The determination coefficients(R2) of anthropometric indices with LVM were 0.30, 0.284 and 0.187 for weight, BSA and height, respectively. However, in multiple regression model, no anthropometric index was significantly associated with LVM. Conclusion: Some of anthropometric indices had direct linear relationship with LVM but none of them can be used to estimate/predict LVM in children with SAM in Gombe State.

CASE FATALITY RATE OF CHILDHOOD TUBERCULOSIS: EXPERIENCE FROM FEDERAL TEACHING HOSPITAL GOMBE: A TWO DECADE REVIEW.

Introduction: Tuberculosis (TB) was the leading cause of death from an infectious agent worldwide, until the Coronavirus (COVID-19) pandemic, ranking above HIV/AIDS. Nigeria ranks 6th among the 30 TB high-burden countries (TB, TB/HIV, DRTB) and 1st in Africa. The estimated case fatality rate (CFR) of TB in Sub-Sahara Africa (SSA) is 15%. Objective: To review the Tuberculosis case fatality rate (TCFR) in children diagnosed with TB from 2000-2019 in Federal Teaching Hospital Gombe. Methodology: All cases of Tuberculosis (TB) diagnosed in children using ICD 10 classification were retrieved and analyzed. These included deaths from TB. The mainstay of TB diagnosis was clinical using TB Score (81%), Gene Xpert was 7%, and AFB was 10%. Results: 26,716 children were admitted; 383 had TB out of which 208(54.3%) were males and 175 (45.7%) females. TB constituted 1.4% of Paediatric admissions. Children 0 -5 years constituted 46.7% (179/383) of cases and 11 - 18 years were 31.3% (120/383). Fulani, Hausa, and Tangale constituted 43.6% (167), 21.1% (81), and 6.8% (26) of TB cases respectively. TB admissions were highest between 2015 and 2019 (31.8%). TB adenitis was the most common extrapulmonary TB. Tuberculosis/HIV co-infection accounted for 103(27%), out of which 74% (44) died. Overall TCFR was 15.6%; TCFR was 16.3% in males and 14.8% in females. The TCFR was 46.7% in 0-5yrs; 15% in 6-9yrs and 38.3% in 10-18yrs.Fulani had the highest CFR (11.9%). Tuberculosis CFR was highest between 2010-2014 (30.0%) and lowest in 2005-2009 (21.6%). Conclusion: The Tuberculosis CFR is comparable to SSA CFR.

REVEALING THE VARIED REALITY OF MALARIA-RELATED DEATHS IN CHILDREN ACROSS GENDER, AGE, AND ETHNICITY IN FEDERAL TEACHING HOSPITAL GOMBE OVER 20 YEARS: AN ESSENTIAL EPIDEMIOLOGIC IMPERATIVE.

Introduction: Nigeria recorded 31% of 619,000 malaria deaths globally and accounts for 25-30% of all childhood mortality in the country. Few studies in Nigeria, have reported malaria's case fatality rate over a long period. Objective: To determine Malaria Case Fatality Rate among Children admitted from 2000-2019. Methodology: All severe malaria cases and deaths amongst children aged 0-18 over the last two decades were analysed using ICD-10. The diagnosis was based on clinical and microscopic findings. Results: 26,716 children were admitted, 2494 (9.3%) were diagnosed with malaria and 209 died. Malaria constituted 5.3% (209/3956) of all childhood mortality. Males constituted 58.9 % (1468/2494) while 65% (1642/2494) were aged 0-5 years. Of the malaria admissions, Fulani and Hausa constituted 948(38%) and 438(17.6%) respectively. Admissions were highest in October (15%) and in 2012 (9.6%). The overall malaria CFR was 8.3%; 8.8% in Females (91/1026) and 8.03% in Males P-value <0.05 (X2=54.735); 8.6% in children aged 0-5years, 8.2% in 6-10 years and 7.4% in 11-18 years, P-value <0.05 (X2=893.164). CFR was highest in April (11.4%)and lowest in November (5.2%). Kanuri and Igbo had CFR of 70% and 38.4% respectively while it was lowest in Tera tribe (4.3%), P-value<0.05. The CFR was highest in the year 2004 (22%), 3.5% in 2000 and 2006. Over the years, case fatality rate was 15.9% between 2000-2004, 6.1% from 2005-2009. Between 2010-2015, it was 7.3% and 8.5% from 2016-2019. Conclusion: This study revealed the deadly reality of severe malaria with increased CFR among females, aged 0-5 and the Kanuri tribe.

PATTERN OF RENAL DISEASES AMONG CHILDREN ATTENDING PAEDIATRIC NEPHROLOGY CLINIC, FEDERAL TEACHING HOSPITAL, GOMBE.

Introduction: Children present with a spectrum of renal diseases depending on age, sex, and geographic location among other factors. With the absence of a paediatric renal registry in Nigeria, this will provide part of the regional data necessary for the Nigerian renal registry. Methodology: A retrospective study where cases of renal diseases that presented in a nephrology clinic over a 2-year period were retrieved from the nurses' and doctors' records and analysed. Results: A total of 147 children were reviewed, male and female were 101 and 46 respectively with M: F being 2.2: 1. Mean age was 9.59 ± 4.58 years, age distribution were <5 years (23.0; 15.6%), 5-9 years (52; 35.4%) and ≥ 10 years (72.0; 49.0%). The majority (77.0; 52.4%) had low socioeconomic status. Majority (145; 98.6%) were acquired renal diseases while ectopic kidney (2.0; 1.4%) was the only CAKUT. Acute glomerulonephritis (49; 33.3%), urinary tract infections (37; 25.2%) and nephrotic syndrome (30.0; 20.4%) were the major acquired renal diseases. Acute kidney injury (AKI) and chronic kidney disease (CKD) were seen in 9 (6.1%) and 13 (8.8%) respectively. Urolithiasis, sickle cell nephropathy, and primary enuresis were seen in 5(3.4%) and 1 (0.7%) respectively. The mean age of children with CAKUT and acquired renal diseases were13.00 ±1.41 and 9.54±4.59 years (P=0.290) while that of AKI and CKD were 10.89±5.21 and 14.15±3.24 years respectively (P= 0.084). Conclusion: Childhood renal diseases increase with age and are more common among adolescents, especially the chronic forms. Regular screening and aggressive treatment are recommended in adolescents.

OBSTRUCTIVE UROPATHY FROM BILATERAL URETERIC CALCULI IN AN INFANT WITH DIARRHOEA DISEASE.

Introduction: Urolithiasis is the presence of mineral deposits in the urinary tract. It is rare in under-5 children and in Sub-Saharan Africa. Although metabolic abnormality is implicated in 50% of cases, infection, decreased urine volume and flow (dehydration state) have been implicated. We report a case of bilateral ureteric calculi in an infant with diarrhoea disease and dehydration. Case Report: A.S, is an 8-month-old male with prolonged loose, large-volume stool, large-volume vomiting, high-grade fever, body weakness, and peri-orbital swelling that progressed to generalized body swelling and absent urine for 2 days. He was conscious, afebrile (36.90C), pale with anasarca. Had distended abdomen with ascites. Dyspnea, coarse crepitation, and hypoxemia. Tachycardia (PR -180/min) Hypertensive (BP - 125/79mmHg). PCV - 20%, WBC - 24,000/l, platelet - 110,000/l. Creatinine (1030 umol/l), Urea - 30mmol/l, Multi drug resistant E.Coli. Bilateral Grade II nephritis, hydro-uretero-nephrosis, right pelvi-ureteric and left vesico-ureteric junction calculi. Managed for Diarrhoea disease complicated with Bilateral Obstructive uropathy secondary to Bilateral Ureteric Calculi. Had bilateral open ureteric exploration, ureterolithotomy, Stenting, intraoperative transfusion, antibiotics, analgesics, and IVF. 24-hr post-surgery: urine output (3.26ml/kg/hr): right stent (210ml), left stent (423ml) while urethral catheter (150ml), 742umol/l, Urea: 26mmol/l 48-hr post-surgery: Urine output 5.1ml/kg/hr (1224ml/24hr); Cr: 424umol/l, Urea: 16mmo/l 5 days post-surgery: Urine output 3.1ml/kg/hr (725ml/24hr); Cr: 47umol/l, Urea: 4.6 mmo/l, Patient was discharged home and currently on follow-up in paediatric nephrology and urology clinics. Conclusion: A high index of suspicion of obstructive uropathy in children with diarrhoea disease, and dehydration, who have developed acute kidney injury is recommended.

DIAGNOSIS DISCLOSURE RATE AND ITS ASSOCIATIONS AMONG ADOLESCENTS LIVING WITH HUMAN IMMUNODEFICIENCY VIRUS IN GOMBE METROPOLIS, NIGERIA.

Introduction: Disclosure of Human Immunodeficiency Virus (HIV) status is one of the major challenges in the management of children and adolescents living with HIV (CALHIV). With the increasing number of adolescents living with HIV (ALHIV) and the peculiarities of the adolescent stage of development, there is a need for local data on the disclosure of HIV status among adolescents living with HIV in our area of practice. Objectives: To determine the prevalence of disclosure of HIV status and its associated factors among Adolescents living with HIV in Gombe Metropolis. Methodology: This was a cross-sectional descriptive study among 130 ALHIV aged 12-18 years, attending Antiretroviral Therapy (ART) clinics in Federal Teaching Hospital and State Specialist Hospital- Gombe who were recruited consecutively over 10 months. Disclosure of HIV status was assessed using a pre-tested semi-structured questionnaire in both the adolescents and their respective caregivers. Results: The prevalence of HIV status disclosure by caregivers' report and self-report was 66.2% and 63.1% respectively. Older adolescents' age and a higher level of education were significantly associated with disclosure (p value < 0.05). The commonest reason for disclosure was 'increasing curiosity' 23/130(26.7%) while 'being too young' was the commonest reason for non-disclosure 19/44(43.2%). About half 42/86(48.8%) of the disclosures were done by the mothers while 15/86(17.4%) disclosure processes were carried out by healthcare workers. Conclusion: The disclosure rate was relatively high among ALHIV in the Gombe Metropolis. Caregivers should be encouraged on early disclosure.

EPIDEMIOLOGIC TREND AND CASE FATALITY OF CHILDHOOD TETANUS IN FEDERAL TEACHING HOSPITAL GOMBE; A 20YEARS REVIEW.

Introduction: Tetanus is a vaccine-preventable disease, it remains a significant cause of morbidity and mortality in both neonatal and post-neonatal periods, especially in developing countries with limited health facilities and inadequate vaccination. The overall case fatality rate (CFR) is 13.2% globally, highest in the neonatal period and in sub-Saharan Africa. CFR is 64%, 47%, and 43% in Nigeria, Uganda, and Tanzania respectively. Objectives: To determine the Case Fatality Rate of Childhood tetanus in FTHG from 2000-2019. Methodology: All cases and deaths from tetanus amongst children aged 0-18 years in paediatric medical ward of FTHG over the last two decades diagnosed clinically and classified using ICD-10 were analysed. Results: 95 cases of tetanus out of 26,716 total admissions constituting 0.004%. There were 49 tetanus deaths out of 3956 total childhood deaths (0.012%) over the study period. Males constituted 66% (63/95). 30% (28/95) were aged 0-28 days; 23.1% (22/95) were adolescents. Fulani and Hausa constituted 37% (34/95) and 31% (29/95) respectively. Admission was highest in the dry season 52% (50/95 %). The overall tetanus CFR was 51.6%; 78% of deaths were in males (38/49), 30% in neonates, and 23% in adolescents. CFR was highest during the dry season (67.3%). Hausa and Fulani had CFR of 51% and 40% respectively. P-value <0.05 The CFR was 88% between 2000-2004, 72% from 2005-2009, 71% between 2010-2014 and 33% from 2015-2019. Conclusion: Tetanus CFR is still high among neonates and adolescents. Maternal tetanus vaccine and booster doses in children need strengthening.

IN-PATIENT PNEUMONIA BURDEN AND CASE FATALITY RATES IN CHILDREN OVER TWO DECADES IN FEDERAL TEACHING HOSPITAL, GOMBE (FTHG).

Introduction: Pneumonia is the leading cause of death among children globally accounting for an estimated 1.2 million (18%) total deaths annually. The number of childhood-related deaths from pneumonia is approximately 2000-fold higher in developing than in developed countries. Nigeria contributes the highest of pneumonia-related deaths globally. Objectives: To determine the case fatality rates (CFR) of pneumonia from 2000-2019 in paediatric ward, FTHG. Methodology: All cases of pneumonia admissions and deaths in patients aged 0-18 years, using ICD-10 classification, were retrieved and analysed. The mainstay of diagnosis is clinical and/or radiographic features. Results: A total of 26,716 children were admitted during this period, 1151 had pneumonia (4.3%) and 118 died. Males constituted 647 (56.2%) and females 43.8% of the total pneumonia admissions. Children aged 0-5 years had the highest pneumonia admissions, followed by 6-9 years. Admissions were highest in the wet than the dry season. Pneumonia CFR was 10.2%; 10.9% in females and 9.7% in males. Under-5 constituted 84% (969/1151) of pneumonia admission with a CFR of 9.3%. CFR were 10.3% and 21% in 6-10 years, and 11-18 years respectively. The CFR between2000-2004 was 14.1%, 2005-2009:21.1%, 2010-2014:10.2% and 2015-2019:7.2%. Kanuri had the highest CFR of 56.2%.(P <0.05) Other ethnic groups were 29.4% in Waja, 25% in Tula, 21.4% in Igbo, 16.6% in Yoruba, 12.1% in Tangale, 10.2% in Hausa, 8.8%in Bolewa and 8.3% in Fulani. The CFR was highest in February20.2%. Conclusion: Pneumonia Case fatality is high.

Trends and Burden of Hepatitis B Viral Infection in Children and Adults in a Tertiary Health Facility in North East Nigeria Over a Fifteen-year Period.

BACKGROUND: Hepatitis B infection is endemic in Nigeria where greater than six percent of the general population are chronic carriers. Transmission predominantly occurs in infants and children when compared with adults. Viral hepatitis deaths are mostly due to chronic liver disease. Routine immunization against hepatitis B virus infection in Nigeria is still low. AIMS: We planned to describe the burden and trend of hepatitis B viral infection at Federal Teaching Hospital, Gombe. METHODOLOGY: This study was a retrospective cross-sectional descriptive study. The results of all hepatitis B surface antigen (HBsAg) tests using rapid chromatographic immunoassay performed at the Federal Teaching Hospital, Gombe (FTHG), Nigeria from January 2000 to December 2014 were retrieved and analyzed. RESULTS: Between 2000 and 2014, 23,611 individuals ranging from 2 months to 98 years of age were tested for HBsAg. A total of 13,136 (55.6%) were males and 10,475 (44.4%) were females. Among individuals tested for hepatitis B surface antigen, 18.9% (4,456) were positive. A total of 70.6% (3,147) were males and 29.4% (11,239) were females. Male sex was significantly associated with HBsAg positivity (P < 0.001). The mean HBsAg prevalence over the 15-year periods among males and females were 22% and 12%, respectively (P < 0.001). The mean yearly HBV prevalence was 17.5%, 17.2%, 19.6%, 15.5%, and 4.4% among age-groups 0-18 years, 19-25 years, 26-45 years, 56-65 years, and >65 years, respectively (P = 0.132). The proportion of HBsAg-positive individuals was highest in the year 2012 (28.7%) and lowest in 2014 (1.8%). CONCLUSION: There was an increasing trend in HBV testing and diagnosis in children and adults in our facility over the last 15 years. Health facility capacity for HBV treatment and care requires strengthening.

Rate, Indications and Outcome of Blood Transfusion in Neonates at Federal Teaching Hospital, Gombe, Nigeria.

BACKGROUND: Blood transfusion is a lifesaving procedure with varying indications. Neonates, especially the extremely preterm are among the most frequent recipients of blood products. The indications could be from anaemia of prematurity or pathological causes such as haemolysis from ABO or rhesus incompatibility, neonatal sepsis and acute haemorrhage, among others. OBJECTIVE: To determine the rate, indications and outcome of blood transfusion in neonates at Federal Teaching Hospital Gombe, Nigeria. METHODOLOGY: The study was retrospective and included 96 neonates who received blood transfusion at the SCBU of Federal Teaching Hospital Gombe from January, 2015 to December, 2019. Data was extracted from patients' medical records and analysed using IBM SPSS statistics version 24. RESULTS: The prevalence of blood transfusion was 3.5% with top up blood transfusion being the most frequent, 63 (65.6%), form. Half of the patients, 48(50%), received fresh whole blood while 45 (46.9%) received packed red cells, other types of blood products accounted for 3.1%. The most common indication for exchange blood transfusion was severe hyperbilirubinaemia followed by severe anaemia. Similarly, severe anaemia and acute haemorrhage were the main indications for top-up transfusion. Seventy-four (77.1%) patients who received transfusion were discharged while 22 (22.9%) died. Blood transfusion was significantly related to the place of delivery and admitting unit. CONCLUSION: The rate of blood transfusion was low, severe hyperbilirubinaemia and severe anaemia were the main indications for blood transfusion in this study. Mortality among transfused neonates was high.

Spectrum of Congenital Malformations in Federal Teaching Hospital Gombe: A Ten-Year Review.

BACKGROUND: Congenital malformations remain a leading cause of death in the neonatal period. The incidences of Congenital Malformations have been reported in other parts of Nigeria but there is paucity of data on Congenital Malformations in North-Eastern Nigeria. This review aims to determine the prevalence and pattern of Congenital Malformations in Federal Teaching Hospital Gombe, Northeastern Nigeria. METHODS: A retrospective review of records of all patients admitted into the Special Care Baby Unit of Federal Teaching Hospital Gombe who had a diagnosis of Congenital Malformations over a period of ten years (May 29, 2000-May 29, 2010) was carried out. RESULTS: Out of the 3,744 admissions during the period, 219 had congenital malformations, but 4 patients did not have complete information and were excluded from analysis. Two hundred and fifteen (215) were analyzed giving a prevalence of 5.7%. Among the subjects, 131(60.9%) were male and 84 (39.1%) female giving a male to female ratio of 1.6:1. Majority 110 (51.2%) of patients with congenital malformations were of Fulani ethnic group, followed by Hausa 39(18.1%). Neural tube defects were the commonest 95 (45.1%), while abnormalities of the musculoskeletal system were the lowest 4(1.9%). Outcome of the patients managed revealed that 131(61.2%) were discharged, 51(23.8%) died while 32(15.0%) signed and left against medical advice. CONCLUSION: The findings suggest that congenital malformations are common in Gombe, Neural tube defects were the commonest congenital malformations seen in this study and Fulanis were the most affected.

Cohort event monitoring of patients treated for uncomplicated malaria with artemisinin-based combination therapies in selected hospitals and community pharmacies in Nigeria.

AIMS AND OBJECTIVES: The study was designed with the broad objective of determining the safety profile of artemisinin-based combination therapies amongst Nigerian population. PATIENTS AND METHODS: This was a cohort event monitoring (CEM) programme involving monitoring adverse events (AEs) in malaria patients treated with either artemether-lumefantrine (AL) or artesunate-amodiaquine (AA) in healthcare facilities in Nigeria. The study involved continuous enrolment of patients with malaria and treated with either AL or AA at the various sites until a total cohort of 600 patients were enrolled at each site. Patients were monitored from the onset of therapy, and on days 3 and 7 from the first day of treatment to identify AEs that may occur. RESULTS: A total of 6102 AEs were recorded in 10,259 patients monitored during the programme. Of 4896 patients who received AA, 4233 (86.5%) patients reported at least one AE while 1869 (34.8%) AEs out of 5363 patients who received AL were reported (P = 0.010). The predominant incidence of each specific AE reported in each group among the patients who received AA and AL includes body weakness 30.8%/7.5%, dizziness 10.3%/3.9%, restlessness 5.02/1.12%, vomiting 3.5/1.03% and drowsiness 3.1/1.5% for AA and AL, respectively. There were more AEs among patients with co-morbid conditions and patients in the younger age groups (9-<15 years), P = 0.000. CONCLUSIONS: Various types of AEs were seen and documented during the CEM programme. The findings suggested that the AA/AL monitored during this programme was generally safe and remarkably well tolerated among the Nigerian populations.

CLEFT LIP, ALVEOLUS AND PALATE IN AFRICAN NATIVES: AN UPDATE ON DEMOGRAPHICS AND MANAGEMENT OUTCOME.

BACKGROUND: Development of craniofacial structures is a complex process and disruption of any of the numerous steps can lead to development of oro-facial clefts. This is a surgically amenable anomaly as from early life that has had conflicting pattern of demographics reported by various researchers globally. There are several factors that are critical to the surgical outcome. OBJECTIVE: Study the demographics and the management outcome of cleft lip, alveolus and palate and highlight factors responsible for improved care in recent time. DESIGN: Descriptive cohort study. SETTING: Tertiary health institution. METHOD: All consecutive patients managed for cleft lip, alveolus and palate (CLAP) over 7years and 10months were studied. OUTCOME: Cleft lip, alveolus and palate repair was performed on 149 patients, January 1, 2001- December 31, 2008 with an incidence of 2.1/1000 live births. From this, 27 patients, averaging 4.5 patients per year were operated for the first 6 1/3 years while the remaining 122(81.9%) the next 1 1/2 years, averaging 81.6 patients yearly. Their ages ranged from 3 months - 60 years with 77 (51.7%) males and 72 (48.3.0%) females. Cleft lip was the main presentation in 108(72.5%) of which 72(66.7%) were left sided. Bilateral cleft lip were14 (9.4%). Five (3.4%) patients had associated anomalies out of which 3(60.0%) had CLAP while 2(40.0%) isolated cleft lip or palate. The technique for cleft lip repair was Millard's and Noordhoof's while palatal cleft was the two-flap palatoplasty with intravelar veloplasty. Success was recorded in 142(95.3%) with complication observed in 7(4.7%) patients. CONCLUSION: The rarity of cleft lip, alveolus and/or palate in the African native documented previously may no longer be tenable as observe in this study. Management outcome has improved owing to the collaboration with SmileTrain, USA, along with multidisciplinary approach.

Congenital bilateral fusion of the maxillomandibular alveolar processes with craniosynostosis: report of a rare case.

A rare congenital anomaly of maxillomandibular fusion with pectus excavatum and craniosynostosis in a neonate is presented. The child was kept alive by nasogastric tube feeding. A modification of classification of syngnathia is proposed. The aetiopathogenesis and difficulty in management in our environment are discussed.

Meconium peritonitis in Nigerian children.

BACKGROUND: Meconium peritonitis is a rare disease with a fatal outcome. In Nigeria and Africa, there are only the occasional case reports on the subject matter. METHODS: This is a 10-year retrospective study of all patients with meconium peritonitis treated at the University of Maiduguri Teaching Hospital, Maiduguri, Borno State, the Lagos University Teaching Hospital, Lagos State, Obafemi Awolowo University Teaching Hospitals complex, Ile-Ife, Osun State and the Federal Medical Centre Gombe, Gombe State, Nigeria. RESULTS: There were 10 neonates comprising 6 girls and 4 boys. The median age at presentation was 4 days (range 2-6 days). Six of the mothers of the children with meconium peritonitis had a supervised antenatal care and 4 had antenatal ultrasonography but meconium peritonitis was missed. The most common clinical presentation was abdominal distension at birth in 9 of 10 patients. The abdominal X-rays showed calcification and homogenous opacity in 4 patients and pneumoperitoneum in 2 patients. At laparotomy, all the patients had inflammatory adhesion bands and matted bowel loops. The generalized type was the commonest form observed (7 patients) and giant pseudocyst was noted in 2 patients. The commonest sites of perforation were the ileum in 4 patients and jejunum in 3 patients. In one patient the perforation had sealed at laparotomy. Intestinal obstruction was the commonest cause of meconium peritonitis in 7 of 10 patients. In the remaining 3 patients the cause is unknown. The commonest procedure performed was resection and anastomosis (4 patients). The mortality rate was high (50%). CONCLUSION: Our data revealed the rarity of meconium peritonitis and intestinal obstruction as the commonest cause. It is recommended that in patients with an unidentifiable cause a rectal biopsy should be done to rule out Hirschsprung's disease. Early diagnosis, proper operative procedure and meticulous post-operative care should improve their survival.

Nutritional rickets in young Nigerian children in the Sahel savanna.

OBJECTIVES: To determine the prevalence of clinical and biochemical rickets in an under-five out-patient population, relate the prevalence of biochemical rickets (BR) to the sociocultural characteristics of families and determine the response of nutritional rickets to vitamin D therapy. DESIGN: Prospective cross-sectional and retrospective case-series surveys. SETTING: Paediatric general out-patient and consultant clinics. SUBJECTS: One hundred and ninety eight out-patients and twenty two patients aged >1 to 60 months treated for nutritional rickets. INTERVENTIONS: Clinical examination, interview with mothers and determination of biochemical abnormalities of under-fives and management of patients with rickets using stosstherapy. MAIN OUTCOME MEASURES: Prevalence of BR and response to stosstherapy. RESULTS: Eight (4%) patients in the survey had clinical and biochemical rickets while 33 (17%) had biochemical rickets only; 92 (47%) other patients had isolated hypocalcaemia and/or hypophosphataemia. The prevalence of BR was higher in males (p <0.05), and increased with age (p <0.001). The prevalence was lower in families who were indigenous to the area (p <0.05), children of Moslem families (p <0.05) and children whose mothers were full-time housewives, unskilled or traders (p <0.01), and who lacked any formal western education (p = 0.157). Three of the seven evaluable patients who received stosstherapy responded late. CONCLUSION: The results support the hypothesis that deficiency or reduced availability of dietary calcium may be of at least equal importance with vitamin D deficiency in the aetiology of nutritional rickets in the Sahel savanna.

Observations on oral Sultamicillin/Unasyn CP-45 899 therapy of neonatal infections.

The use of an effective antimicrobial remains a problem in the neonate, thereby necessitating empiric combinations of parenteral agents. We therefore studied oral Sultamicillin's (Unasyn CP-45 899) efficacy and tolerability (dose = 50 mg/kg per day) in the treatment of serious infections in 27 neonates over an 18 month period. The study cohort comprised newborns with suspected or confirmed infections in the Special Care Baby Unit of a referral hospital. The infants with overwhelming/severe infections or proven/suspected renal, hepatic or hematologic disease; or known hypersensitivity to penicillins or any beta-lactams were excluded. There were 12 babies with skin and soft-tissue infections, although pneumonia [11] was most predominant in our series. Bacterial isolates were mainly Staphylococcus aureus, Escherichia Coli and Klebsiella pneumoniae with a beta-lactamase production rate of 88%. The clinical cure and improvement rates were 96.3 and 100%, respectively and the evaluable bacteriologic cure-rate was 93.8%. The mean (S.D.) duration of therapy was 7.4 (2.6) days (range, 4-14) with significant resolution of features occurring within a 48 h period (24 27 , P < 0.01). No serious adverse/side effects were seen as only one (3.7%) experienced mild loose stools. We show with these prospective observations (our cohort albeit small) that sultamicillin orally is efficacious, tolerable and safe for treating of mild to moderate infections in the newborn caused by both gram-positive and gram-negative pathogens.