Bridging the Distance in the Caribbean: Telemedicine as a means to build capacity for care in paediatric cancer and blood disorders.

Over the past 50 years, survival for children in high-income countries has increased from 30% to over 80%, compared to 10-30% in low and middle income countries (LMIC). Given this gap in survival, established paediatric cancer treatment centres, such as The Hospital for Sick Children (SickKids) are well positioned to share clinical expertise. Through the SickKids Centre for Global Child Health, the SickKids-Caribbean Initiative (SCI) was launched in March 2013 to improve the outcomes and quality of life for children with cancer and blood disorders in the Caribbean. The six participating Caribbean countries are among those defined by the United Nations as Small Island Developing States, due to their small size, remote location and limited accessibility. Telemedicine presents an opportunity to increase their accessibility to health care services and has been used by SCI to facilitate two series of interprofessional rounds. Case Consultation Review Rounds are a forum for learning about diagnostic work-up, management challenges and treatment recommendations for these diseases. To date, 54 cases have been reviewed by SickKids staff, of which 35 have been presented in monthly rounds. Patient Care Education Rounds provide nurses and other staff with the knowledge base needed to safely care for children and adolescents receiving treatment. Five of these rounds have taken place to date, with over 200 attendees. Utilized by SCI for both clinical and non-clinical meetings, telemedicine has enhanced opportunities for collaboration within the Caribbean region. By building capacity and nurturing expert knowledge through education, SCI hopes to contribute to closing the gap in childhood survival between high and low-resource settings.

The neurodevelopmental abilities of very-low-birthweight children in Trinidad, West Indies.

Neurodevelopmental abilities of 33 very-low-birthweight (VLBW) Trinidadian children and randomly selected matched pairs of classmates who were of normal birth weight were tested in 1998 at ages 68-88 months, using the McCarthy Scales of Children's Abilities. The 1 min Apgar score was significantly lower in the VLBW children, 6.5 (SD 1.0) versus 7.7 (SD 1.27), P

Docosahexaenoic acid is selectively enriched in plasma phospholipids during pregnancy in Trinidadian women--results of a pilot study.

The fetal demand for docosahexaenoic acid (DHA) has to be satisfied by the mother. We determined the fatty acids in maternal plasma non-esterified fatty acid (NEFA), triacylglycerol (TAG) and phosphatidylcholine (PC), in a cross-sectional study of non-pregnant (n = 10), pregnant (n = 19), and postpartum (n = 9) women. There were lipid class-dependent differences in plasma polyunsaturated fatty acid (PUFA) concentrations between groups. During pregnancy, DHA was most highly enriched in PC, about 230%, with more modest enrichment for linoleic acid (LA) and arachidonic acid (AA), and no enrichment of alpha-linolenic acid (alpha-LNA). There was relative enrichment of LA, AA and alpha-LNA in TAG, but not of DHA. There was no specific enrichment of any PUFA in the NEFA pool. These data accord with the suggestion that the enrichment of alpha-LNA in TAG and of DHA in phospholipids reflects hepatic regulation of n-3 PUFA metabolism which potentially enhances the delivery of DHA to the placenta.

Neonatal bacterial septicaemia at the Mount Hope Women's Hospital, Trinidad.

This retrospective study to determine the incidence of bacterial septicaemia in neonates at the Mount Hope Women's Hospital, Trinidad during a 2-year period, 1996 to 1997, included all neonates whose blood or cerebrospinal fluid cultured positive for bacteria. There were 9866 live births (LB), 102 of whom were diagnosed with bacterial sepsis, an incidence of 10/1000 LB. Thirty-one neonates had a positive culture for group B Streptococcus, an incidence of 3/1000 LB. Gram-negative organisms accounted for 63% of positive cultures. There were three outbreaks of nosocomial infection, two caused by Enterobacter spp with mortality rates of 37% and 50% and one outbreak caused by Pseudomonas aeruginosa with a mortality rate of 25%. The overall mortality rate was 27% (27/102), 63% were boys and 58% were preterm. The incidence of neonatal bacterial sepsis of 10/1000 LB is the highest recorded for the Caribbean and indicates that infection might be an important cause of the high perinatal mortality rate.

Acute respiratory disorders in the newborn: a survey at the Mt. Hope Women's Hospital, Trinidad

This retrospective study was undertaken to determine the incidence of acute respiratory disorders (ARD) in newborns delivered at the Mount Hope Women's Hospital [MHWH] from January 1st to December 31st, 1994. The study also examined the relationships between incidence rates and maternal and neonatal parameters. Hyaline membrane disease (HMD)m trabsuebt tachypnea of the newborn (TTN), meconium aspiration syndrome (MAS), persistent foetal circulation (PFC) and pulmonary infection (PI) were identified as ARDs among 5,062 live newborns using standard diagnostic criteria. Overall, 174/5,062 neonates were diagnosed with ARD to give an incidence of 3.4 percent (104 males and 70 females). The commonest ARD was PI (39 percent) followed by HMD (48/4363) in full term neonates. HMD occurred mainly in the preterm and low birth weight babies. TTN and PI were found in all gestational age groups. Asphyxia was present in 9.8 percent (17/174) at 1 minute and in 10.9 percent (19/174) at 5 minutes. It was more common in babies who developed HMD and PFC. Forty one percent of babies with ARD required assisted ventilation. There were 58 (33 percent) deaths. More than one half of those ventilated died (55 percent), 2/3 of those with asphyxia at both 1 and 5 minutes of age. There was significantly greater mortality among neonates with HMD as compared to the other ARDs.

Breastfeeding management

This review was done as a ready guide for the practicing health worker to support and promote breastfeeding. A lot of specific data on breastfeeding are available but these are scattered and sometimes inaccessible. The goal of this review is to provide practical information for the management of the individual mother and infant

Perinatal implications of meconium stained liquor

Antepartum passage of meconium remains a common perinatal problem in the Caribbean and the purpose of this study was to examine this problem in all babies born at the Mount Hope Women's Hospital(MHWH), Trinidad, during the period January 1 to December 31, 1991.The medical records of all 5,397 live births at the MHWH during the study period were retrospectively reviewed. Those with meconium staining of the amniotic fluid (graded as slight or old and thick) were identified both by using the ICD code and by examination of the medical records. Maternal, perinatal and neonatal data were collected and analysed using EPI-INFO software programme. Meconium staining of the amniotic fluid was present in 336 live births, giving a prevalence of 6.2 percent of live births which is low compared to values reported in other studies. There was no significant ethnic differences among women who had MSL and 81.3 percent were aged <32 years within a mean of 26.4 years. The majority were primiparous (46.4 percent) and 97 percent had antenatal care. The 3 commonest maternal problems in the 336 women with MSL were foetal distress(23.9 percent), hypertension in pregnancy(14.9 percent) and postdatism (10.4 percent). Birth weight of babies ranged from 1,040 4,960g with a mean of 3,258g, 8 percent were <2,500g and 9.8 percent were >/_4,000g. 86.3 percent were term 10.7 percent were post-term and 3.0 percent were preterm. One and 5 minute Apgar scores of <7 percent were found in 45.5 percent and 12.2 percent of babies, respectively. Neonatal problems were encountered in 146/336 neonates (43.8 percent) and respiratory distress was the commonest (72 or 49.3 percent). Meconium aspiration syndrome (MAS) was diagnosed in 15 babies (4.5 percent) to give an incidence of 2.8/1000 live births and was associated only with the presence of old and thick meconium in the amniotic fluid. There were 6 (40 percent) deaths among the 15 with MAS. These findings clearly indicated the need for improvement in the delivery room management of mother and foetus and early neonatal care. These needs can be met through an increase in staff complement, regular in-service training and an adequate supply of consumables and proper planned maintenance of equipment