Factors associated with intraventricular hemorrhage among preterm neonates in Aminu Kano teaching hospital.

BACKGROUND: Intraventricular hemorrhage (IVH) is a severe complication among preterm neonates which can result in hydrocephalus, cerebral palsy, behavioural disorders, learning disabilities, or death. It is important to identify the factors associated with IVH in order to prevent these neurological consequences and reduce the resultant burden of neurological disease. Aim: To determine the factors associated with IVH among preterm neonates. DESIGN: The study was prospective cross-sectional in design. SUBJECTS AND METHODS: Ninety-nine preterm neonates who were < 37 completed weeks of gestation were recruited consecutively from the Special Care Baby Unit of a Tertiary Hospital. Transfontanelle ultrasonography was used to detect IVH and the factors associated with IVH were classified into: neonatal, maternal (prenatal), and clinical factors. Data were analyzed using SPSS version 16.0 for windows. Chi-squared test and Fisher's exact probability test were used as appropriate. The level of significance was set at P < 0.05. The association between these factors and IVH was evaluated by univariate and multivariate logistic regression analyses. RESULTS: Among the 99 preterm neonates studied, 36 (36.4%) of them were between 28 and 31 weeks of gestation, whereas 63 (63.6%) were between 32 and 36 weeks of gestation. In univariate analysis, the factors found to be associated with IVH were lower gestational age <32 weeks gestation, low Apgar score of <3 in 1 and 5 min, respectively, outborn status of neonates, lower social class, need for respiratory support, and blood transfusion. However, the lower gestational age (odds ratio [OR]: 10.9, 95% confidence interval [CI]:1.95-61.04) and respiratory support (continuous positive airway pressure (CPAP)) [OR: 52.24; CI: 3.40-721.84] were retained as significant predictors of IVH in the multivariate logistic regression model. CONCLUSION: The lower gestational age and respiratory support (CPAP) are independent predictors for IVH. Prevention of preterm delivery and improvement in interventions of neonatal care (CPAP) are necessary to prevent the risk for IVH especially in the early preterm neonates.

Nasal Bubble CPAP: One Year Experience in a Neonatal Unit of a Tertiary Health Facility in Northwestern Nigeria.

AIMS AND OBJECTIVES: Nasal bubble continuous positive airway pressure (NBCPAP) respiratory support, though decades old, is beginning to gain popularity in developing countries including Nigeria. We reviewed neonates who benefitted from NBCPAP, to describe the demographics and outcome of NBCPAP respiratory support in newborns admitted to the neonatal unit of Ahmadu Bello University Teaching Hospital (ABUTH), Zaria, over a one year period. MATERIALS AND METHODS: The study is a descriptive observational review of all neonates who required NBCPAP respiratory support in the neonatal unit of ABUTH Zaria. Data was extracted from a specifically designed proforma used to obtain information on each neonate throughout the period of admission. RESULTS: Twenty babies received NBCPAP respiratory support during the period of study. Seventeen (85%) of the neonates were successfully weaned off CPAP while three (15%) failed CPAP. Three neonates developed complications with two having CPAP belly syndrome and the third had facial swelling which resolved spontaneously after 6 hours. Overall, seven (41%) of the neonates who were successfully weaned off CPAP were discharged home. CONCLUSION: MajorityofnewbornswhorequirerespiratorysupportwillbenefitfromNBCPAP therefore, this method of respiratory support should be popularized and neonatal units in the country should be supported to efficiently offer the service.

Outcome of Extremely Low Birth Weight Babies in Zaria; A Ten-Year Review.

BACKGROUND: Survival among extremely low birth weight (ELBW) babies (birth weight below 1000grams) in resource limited settings is still very low. The study aimed to determine the correlation between materno-foetal factors and outcome in this category of neonates. STUDY DESIGN: A retrospective study in which patients' records admitted into the Neonatal Unit of Ahmadu Bello University Teaching Hospital between January 2005 and December 2014 were retrieved. Information on neonates weighing < 1000 g were extracted and analyzed. Survival at discharge was the primary outcome. RESULTS: The overall survival rate of extremely low birth weight babies was 18%. Mortality in ELBW neonates weighing less than 750g was 100%. Factors that were significantly predictive of survival were birth weight, parity and duration of hospital stay with p-values of 0.014, 0.039 and 0.025 respectively CONCLUSION: The survival rate of ELBW babies remains low in our resource constrained setting. Focus should be on preventing preterm deliveries and as well equipping newborn care providers and newborn units with the necessary skills and materials respectively to enable implementation of evidence based interventions to improve newborn survival.

Congenital gangrene of the extremities in a newborn.

Gangrene of the extremities in the newborn is extremely rare at birth. Less than 100 cases have been reported worldwide. Its etiology is obscure in many cases; however, some factors have been associated with it in the newborn, which include vascular injury and embolism. We report a case of a baby with congenital bilateral lower limb gangrene caused by thromboembolic phenomenon from retroplacental hematoma following abruptio placentae and highlight the challenges of managing such condition in resource-poor setting.

Predisposing factors to neonatal septicaemia at ahmadu bello university teaching hospital, zaria Nigeria.

OBJECTIVES: The study aimed at identifying the risk factors for neonatal septicaemia in Zaria. PATIENTS AND METHODS: Consecutive newborns admitted into the Special Care Baby Unit of Ahmadu Bello University Teaching Hospital, Zaria with the presumptive test diagnosis of neonatal septicaemia between 25 May, 2004 and 31 May, 2005 were studied. History of events in the antenatal and neonatal periods was obtained and physical examination was done. Blood, urine, cerebrospinal fluid and swabs of body discharges were taken for culture and sensitivity studies. The data were analysed using Epi Info version 6 software. Associations were tested using Chi square, with Yates correction, or Fisher's exact tests where appropriate, while statistical significance was set at p < 0.05. RESULTS: A total of 211 neonates, consisting of 69 in-born and 142 out-born infants were studied. There were 122 (57.8%) males and 89 (42.2%) females; giving a male: female ratio of 1.4:1. Seventy-five (35.5%) of the newborns had bacteriologically proven septicaemia consisting of 54 (38.0%) of the outborn and 21 (30.4%) of the inborn babies (p = 0.3535); 42 males and 33 females (p = 0.8011). The male: female ratio of newborns with culture-proven septicaemia was 1.2:1. The predisposing factors that were associated with culture-proven septicaemia were lack of antenatal care (p = 0.0234), prolonged rupture of membranes (p = 0.0085), prolonged labour (p = 0.0032), preterm delivery (p = 0.0125) and perinatal asphyxia (p = 0.0078). CONCLUSION: The risk factors in neonates with septicaemia in this study emphasise the need for timely improvement in the implementation of existing public health strategies.

Relationship between age and serum lipids in malnourished and well-fed pre-school children in Zaria, Nigeria.

OBJECTIVE: The objective of this study was to evaluate the relationship between age and serum total cholesterol (TC) and triglyceride (TG) in malnourished and well-fed pre-school Nigerian children in Zaria, northern Nigeria. MATERIALS AND METHODS: Serum total cholesterol (TC) and TG concentrations were measured in 115 malnourished and 115 age- and gender-matched well-fed children aged one (1)-three (3) years. These consisted of 25, 30, 30 and 30 children with kwashiorkor, marasmic-kwashiorkor, marasmus and underweight, respectively with their corresponding age- and gender-matched well-fed children. There were 60 males and 55 females each of malnourished and well-fed children. Concentrations of TC and TG were measured by enzymatic colorimetric method using reagent kits supplied by HUMAN, Gesel Für Biochemical Und Diagnostica mbH (Wiesbaden, Germany). RESULTS: There was no correlation between age and serum TC in malnourished children (r = 0.0101, p = 0.9250), while the correlation was negative and significant in well-fed children (r = 0.3599, p = 0.3110). Similarly, there was no correlation between age and serum TG in malnourished chidren (r = 0.0605, p = 0.4623) but negative and significant correlation in well-fed children (r = 0.3210, p = 0.0001). CONCLUSION: The findings of this study demonstrate that in well-fed pre-school children, serum lipids decrease with advancing age and that this pattern was abolished in malnourished children. This contribution should be noted and considered when interpreting serum lipid results in children.

Body mass index of healthy Nigerian children.

BACKGROUND: To study the Body Mass Index of healthy Nigerian school children from different socio-economic backgrounds resident in Kaduna, northern Nigeria. METHOD: A cross-sectional prospective study of Body Mass Index was carried out on 3,802 healthy Nigerian school children aged 5 to 13 years resident in Kaduna, northern Nigeria. The subjects consist of 1,871 children from private schools (privileged) and 1,931 children from public schools (less privileged). The schools and pupils were selected by multi-staged clustersampling method. RESULT: Over 75% of the 'privileged' and the 'less privileged' children are from upper and lower socioeconomic classes respectively The mean Body Mass Index of the 'privileged' boys was 15.1 +/- 0.7 compared with 14.7 +/- 1.2 for the 'less privileged' boys. The corresponding mean Body Mass Index values for the 'privileged' and the 'less privileged' girls were 15.1 +/- 0.5 and 15.0 +/- 1.7 respectively. The difference in this index, between the boys as well as between the girls was statistically insignificant (p = 0.05 and 0.12 respectively). CONCLUSION: There was no statistical significant difference between the BMI of the 'privileged' and the 'less privileged' groups of children.

Serum lipid profile in malnourished Nigerian children in Zaria.

BACKGROUND/OBJECTIVE: There is paucity of data on the pattern of serum lipids in malnourished children in Zaria. Most of the reported studies were carried out in southern part of Nigeria. The overall objective of this study was therefore to measure serum lipids in children with PEM in Zaria with the view to recommending its use in them. SUBJECTS, MATERIALS AND METHODS: Serum lipids were measured in 115 children presenting with PEM and 115 age- and sex-matched well nourished controls aged 6-36 months .The malnourished children consisted of 25, 30, 30 and 30 children with kwashiorkor, marasmic-kwashiorkor, marasmus and underweight respectively. There were 60 males and 55 females. Serum total cholesterol(TC),high density lipoprotein cholesterol (HDL-C) and triglyceride(TG) were measured by enzymatic colorimetric methods of serum low density lipoprotein cholesterol(LDL-C) and very low density lipoprotein cholesterol(VLDL-C) were estimated using Friedewald formula. RESULTS: Serum TC, LDL-C and HDL-C levels were significantly lower (p<0.01, p<0.05 and p<0.001 respectively), while the ratio TC/HDL-C was significantly higher (p<0.001) in children with PEM than in their well-nourished counterparts. Concentrations of serum TG and VLDL-C were apparently but not significantly lower in children with PEM than in well-fed children (p>0.05).Serum levels of TC, LDL-C and HDL-C were significantly higher (p<0.001, p<0.001 and p<0.01 respectively) in oedematous PEM patients than in their non-oedematous counterparts. Serum TG and VLDL-C values were apparently but not significantly higher in oedematous PEM patients than in non-oedematous ones. CONCLUSION: There was a significant reduction in serum lipid concentrations in children with PEM. The study therefore suggests that measurement of serum lipids could be of importance in the assessment of childhood malnutrition.

Evaluation of serum lipid profile of under-five Nigerian children.

BACKGROUND: Serum lipid profile assay forms one of the special investigations in most chemical pathology laboratories worldwide. Several studies in children from different countries have shown that serum lipids exhibit age and geographical pattern of variation prior to puberty. This study was conducted to evaluate serum lipid profile in Nigerian children aged 6 to 36 months. METHODS: A total of 115 randomly selected apparently healthy children were studied. These consisted of 38, 40 and 37 children in groups I (6 to 12 months), II (13 to 24 months) and III (25 to 36 months) respectively. There were 60 male and 55 female children. Serum concentrations of total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), triglyceride (TG) were measured by enzymatic colorimetric method using reagent kits supplied by Human, Gesel Für Biochemica Und Diagnostica mbH (Wiesbaden, Germany). Serum low density lipoprotein cholesterol (LDL-C) and very low density lipoprotein cholesterol (VLDL-C) were subsequently estimated using Friedewald formula. RESULTS: The reference ranges and (Mean +/- SEM) of serum TC, LDL-C, HDL-C, TG, VLDL-C and TC/HDL-C for the total group of children were 1.55-5.42(2.89 +/- 0.12), 0.50-3.29(1.28 +/- 0.15), 0.45-2.77(1.12 +/- 0.14). 0.93-3.43(0.79 +/- 0.14), 0.17-0.72(0.35 +/- 0.14) mmol/L and 1.01-4.74(2.19 +/- 0.13) respectively. There were no sex differences in all these parameters. Serum levels of TC, LDL-C, HDL-C and TC/HDL-C in the 3 age groups were also statistically similar (p > 0.05). Concentrations of TG and VLDL-C were lower (p < 0.001) in group II than in I. These values were also significantly lower (p < 0.02) in group III than in I. Serum TG and VLDL-C in groups II and III were statistically comparable (p > 0.05). CONCLUSION: Serum concentrations of TC, TG and VLDL-C decrease with advancing age, with more marked decrease between first and second years of life. We hereby recommend that the reference values established in this study be utilized for the interpretation of serum lipid results in pre-school children in Nigerian hospitals and possibly elsewhere in Africa.

Non-syndromal, true congenital ankylosis of the temporomandibular joint: a case report / Anquilosis no-sindrómica, verdaderamente congénita de la articulación temporomandibular reporte de un caso

A case of a six-week old boy with bilateral congenital fibrous intra-articular ankylosis of the temporomandibular joint is presented The literature is reviewed and limitations to management are highlighted.

Non-syndromal, true congenital ankylosis of the temporomandibular joint: a case report.

A case of a six-week old boy with bilateral congenital fibrous intra-articular ankylosis of the temporomandibular joint is presented The literature is reviewed and limitations to management are highlighted.

Necrotizing fasciitis of the scalp in a neonate.

We report an 11-day-old baby who presented with necrotizing fasciitis of the scalp from which Escherichia coli was cultured. Treatment consisted of administration of parenteral broad-spectrum antibiotics and debridement. Skin grafting of the resulting scalp defect was not permitted by the parents. The wound healed with scar tissue over 3 months.

Use of nitrite dipstick test in the screening for urinary tract infection in children.

A prospective study of one hundred and eighty five children attending the paediatric units of Ahmadu Bello University Teaching Hospital, Zaria were evaluated for urinary tract infection (UTI) by culture, microscopy and nitrite dipstick test. There were 118 males and 67 females (M:F = 1:1:1). Positive urine culture with significant bacteria was found in 45 samples (24.3%). Urine microscopy for leukocyturia was significant in 55 urine samples. Significant leukocyturia correctly identified 23 of the 45 culture positive urine samples, giving a sensitivity of 51.1%. Nitrite dipstick test correctly identified 13 of the 45 urine samples with proven UTI (28.9% sensitivity). The positive and negative values were 72.2% and 80.8% respectively. The nitrite dipstick test was found to be less sensitive than significant leukocyturia in detecting UTI. It is concluded that although the urinary nitrite dipstick test has an excellent specificity, it is not sensitive enough as a routine screening test for urinary tract infection in children.

Predicting conception and safe delivery of a macrosomic baby.

Clinical data obtained prospectively from 98 neonates, 49 normal weight controls, and retrospectively from their mothers had revealed a low incidence of neonatal macrosomia and some important predictive indices of conception and safe delivery of such babies. All the macrosomic infants were singletons and above 37 weeks gestation. The incidence of macrosomia was 26 per 1,000 live births. Increasing maternal age (up to 28 years) parity (up to three) and height were positively correlated with the conception and safe delivery of a macrosomic baby. A maternal height of less than 1.64m was found to be associated with a higher risk of unsafe spontaneous vaginal delivery of a large infant. It is suggested that even in the developing countries all efforts should be made to confirm a diagnosis of foetal macrosomia before the onset of labour so that the mother can be properly assessed for the most appropriate method of delivery.

Efficacy of a 3-day oral regimen of quinine in an area of northern Nigeria with low-grade resistance of Plasmodium falciparum to chloroquine and sulphadoxine-pyrimethamine.

The efficacy in vivo of a 3-day oral regimen of quinine (30 mg/kg/day) was assessed in 34 children with falciparum malaria in an area of northern Nigeria with previously documented low-grade parasite resistance to chloroquine and sulphadoxine-pyrimethamine (SDX/PYR). By day 4, all 34 children were free of parasites. Mean parasite clearance time and fever clearance time were 2.7 and 1.7 days, respectively. However, on day 14, 5 (14.7%) children were again parasitaemic and 4 of them were clinically ill. They were again treated successfully with a standard course of oral chloroquine. No adverse drug effects were recorded. Of the 34 children, 9 parasite isolates were successfully cultured in vitro. EC50 and EC99 were 14.0 and 126.0 pmol per well respectively, indicating decreased parasite sensitivity but no resistance in vitro. In conclusion, the 3-day course of quinine was found to be an effective alternative to standard chloroquine treatment in the study area.

Antimalarial drug response of Plasmodium falciparum from Zaria, Nigeria.

The sensitivity of Zaria strains of Plasmodium falciparum to chloroquine, mefloquine, quinine and sulphadoxine/pyrimethamine was investigated 5 years after the appearance of in vivo/in vitro chloroquine resistance in urban Zaria. Infections in 36/43 children (83.7%) treated with chloroquine were sensitive while those in 7 (16.3%) were resistant. 8/13 isolates cultured (61.5%) were sensitive in vitro to chloroquine and 5 (38.5%) were resistant. Of the cultured isolates, 13/13 (100%), 12/13 (92.3%) and 5/7 (71.4%) showed mefloquine, quinine and sulphadoxine/pyrimethamine sensitivity, respectively. The results confirmed chloroquine and sulphadoxine/pyrimethamine resistance in urban Zaria and revealed emerging quinine resistance. Resistance to chloroquine and sulphadoxine/pyrimethamine is at RI level and chloroquine should continue to be the first-line drug for the treatment and prevention of P. falciparum infection in the Zaria area of northern Nigeria. We suggest that, while quinine serves as second-line drug, mefloquine should be reserved for infections resistant to chloroquine, quinine and sulphadoxine/pyrimethamine.

Culinary metaphors in Western medicine: a dilemma of medical students in Africa.

A study was conducted of African medical students in two schools to determine their level of understanding of some culinary metaphors in medicine, particularly those used in the description of certain paediatric conditions. The results showed that the vast majority of medical students and young resident doctors are not familiar with many of the European foods, fruits and beverages that are commonly used in medical textbooks to describe disease conditions. In describing disease, it is suggested that medical educators and authors in Europe should endeavour to use terms that are simple and universal. They should not assume universal knowledge of fruits and dishes available in their environment. Medical educators in Africa should also simplify the description by using appropriate terms.

Dysuria in infancy and childhood: an analysis of 42 children presenting in the paediatrics outpatients department.

Urinary tract infection (UTI) was the only pathology found among 42 children presenting at the paediatric outpatient department with pain or straining on micturition. 18 (42.9%) had cystourethritis proven bacteriologically. 3 of these had gonococcal urethritis and were all males aged less than 3 years. Four had vasical schistosomiasis. No definite diagnosis could be made in 24 (57.1%) cases. Only secondary symptoms of gross haematuria, urethral discharge and cloudy urine were of diagnostic value, others were not. Children without these specific secondary symptoms predominate and may or may not have urinary tract pathology. Urinary leucocyte count on native urine is a useful screening test to identify those to be further investigated.

PIP: Physicians followed 42 1-120 month old children who had visited the outpatient clinic at the Ahmadu Bello University Teaching Hospital in Zaria, Nigeria complaining of pain or who had to strain while urinating until they determined the cause of the urinary condition. They conducted this study to examine the clinical profile of children complaining of pain or strain while urinating. 38 presented with pain and 4 with strain. Physicians could not make a definite diagnosis for 24 children. They were able to diagnose urinary tract infection (UTI) in 42.8% (18), however. The causes of the urinary condition included bacterial (nongonococcal) UTI (26.2%), gonococcal urethritis (7.1%), and schistosomiasis (9.5%). Physicians found ova of Schistosoma haematobium in the 4 children, with much blood in their urine. Of the remaining 14 children, 13 children complained of pain. 3 boys 3 years old had urethral discharge caused by Neisseria gonorrhoeae infection. The urine of 12 children in the UTI group and 2 of the 24 no definite diagnosis group had significant leucocyturia (+or= 10 white blood cells/ml). Based on the results of this study, physicians should consider any child complaining of persistent pain as having a pathology in the urinary tract since pain was present in 13 of the 14 UTI cases. As for those patients who experience discomfort during micturition, physicians should further examine those with significant leucocyturia.

Chloroquine-resistant Plasmodium falciparum with reduced sensitivity in vitro to mefloquine and quinine in Zaria, northern Nigeria.

Thirty-six P. falciparum isolates collected from children with malaria were tested for their susceptibility to chloroquine, mefloquine and quinine in vitro using the WHO microtest system. 37% of the isolates grew in the presence of 1.6 mumol chloroquine 1(-1) blood, indicating resistance. The sensitivity to both mefloquine and quinine was markedly reduced. The inhibitory endpoints for quinine correlated with those for chloroquine and mefloquine, but no such correlation was found between chloroquine and mefloquine.

Resistance of Plasmodium falciparum to sulfadoxine-pyrimethamine combination in semi-immune children in Zaria, northern Nigeria.

The World Health Organization (WHO) extended field test was employed to assess the in vivo sensitivity of Plasmodium falciparum to sulfadoxine-pyrimethamine combination in 44 children in Zaria urban area. 36 children (82%) were fully sensitive to the drug and 8 (18%) were resistant at the RI level. 8 parasite isolates were obtained from the children and successfully cultured in vitro using the WHO microtest (mark II) system. The 8 isolates underwent schizogony at concentrations of 10,000 pmol sulfadoxine/125 pmol pyrimethamine per well, indicating in vitro resistance.