Is there a relationship between neonatal ventilation and the development of childhood asthma in Barbadian children? - Poster abstract

OBJECTIVE: To determine whether infants given intermittent positive pressure ventilation (IPPV) has a higher incidence of asthma in the first 5 years of life, compared to children matched for birth weight but not given IPPV. METHODS: A retrospective cohort study was carried out on children of birth weight <2000 g born during 1994 at the Queen Elizabeth Hospital and admitted to the Neonatal Intensive Care Unit (NICU). Hospital records of 58/77 admissions were analyzed for variables including gender, date of birth, birth weight, clinically assessed gestation, apgar scores, requirement for IPPV and a diagnosis of respiratory distress syndrome (RDS). In addition, parents or guardians were contacted by telephone and a simple questionnaire about asthma diagnosis was administered. RESULTS: Sixteen patients received IPPV in this group and 42 did not. Surfactant was not used during this period. Of those received IPPV, 9 (56 percent) had a diagnosis of asthma/wheeze compared to 10 (13 percent) of the control cohort (p<0.05). Possible confounders were identified: birth weight, gestation, one-minute apgar score and a diagnosis of RDS (each p

Submersion injuries in the paediatric population in Barbados (1990-1996) - Poster abstract

OBJECTIVE: Drowning is the second leading cause of accidental death in the U.S.A., with near drowning accounting for a significant proportion of morbidity. In Barbados, there has been an increase in incidence of near drowning. The objective of this study was to document data for the Barbadian population. METHODS: The records of patients age 0-16 years who were admitted to the Queen Elizabeth Hospital during the period 1990-1996 were reviewed. Information on cases of drowning for the same period and age groups was obtained from the Coroner's Office. RESULTS: During the 7-year period of study, there was 27 near drowning and 19 drownings. The peak ages in both series were 11-16 years (adolescents). The male to female ratio was 3:1. For the near drownings 87 percent occurred in salt water. CONCLUSIONS: The peak incidence occurred during the summer months, June-Sept. However, no correlation between sea currents and tides could be made within the scope of this study. There was no documented evidence of any neurological deficit in the 24 cases of near drowning that were examined.(AU)

A review of accidental poisoning in Barbados (1981-1985) - abstract

A retrospective study was carried out of accidental poisoning in 348 children admitted to the Queen Elizabeth Hospital during the five-year period 1981-1985. The cases represent 4 per cent of admissions to the paediatric medical ward, with 56 per cent of the children being male and 43 per cent female. The mean age group was 13 months to 3 years, ranging from 6 months to 12 years. In the majority of patients, complications were mild or absent and no deaths were recorded. Most of the patients required only gastric decontamination and supportive treatment. The hospitalization cost over BD$130,000 in the five-year period. Thirty-four (34) per cent of the poisonings were due to medication prescribed for friends or family. Common household or garden products were involved in a similar number (33.0 per cent). Kerosene poisoning has declined in importance, but still accounts for 20 per cent of the cases; this contrasts with a previous study where kerosene poisoning was the most common type of poisoning. With the ever-increasing variety of toxic drugs and chemicals at present available, there is a greater need to continue to stress the prevention of accidental poisoning. This will decrease the likelihood of mortality amd morbidity involved in accidental ingestions, and likewise save hospital costs from a largely preventable disorder (AU)

Evaluation of the use of a paediatric intensive care unit in a small tertiary care hospital - Poster abstract

OBJECTIVE: The need for intensive care of the paediatric patient has been all established internationally. Worldwide the speciality continues to advance rapidly, but our region appears to have fallen behind in this area of care, which reflected in the fact that only full-time facility exists in the English-speaking Caribbean. This study evaluated the first fifteen months of operation of the Paediatric Intensive Care Unit (PICU) of the Queen Elizabeth Hospital. METHODS: A demographic profile of children using the unit was prepared and an audit on the utilization of the facilities was carried out. RESULTS: 181 children were studied, of whom 44.percent were female and 52.2 percent male. Barbadian nationals comprised 82.4 percent. The 6-11 year age group accounted for the majority of PICU admissions (33 percent and the 12-16 age group used the facility the least (17 percent). Of all admissions, 3.9 percent needed ventilation, with an average use of 2.2 beds were occupied per month. Of all the admissions, 3.9 percent needed ventilation, with an average use of 0.47 children per month. The spectrum of illness managed fell into eight clinical sub-specialities, with respiratory disease accounting for the majority of admissions (46.5 percent). The mortality rate was 8.9 percenrt of children, with cardiovascular illness accounting for 54 percent of deaths. CONCLUSIONS: The PICU at the Queen Elizabeth Hospital may be considered to adequately supply the current need for intensive care management of children outside of the Neonatal a model for those interested in setting up similar units elsewhere in the Caribbean.(AU)

Spontaneous rupture of the spleen

A 10 year old boy presented to the surgical serviceof the Queen Elizabeth Hospital with spontaneous rupture of the spleen and was later discovered to have chronic myeloid leukaemia. He has been in haematological remission for five years following splenectomy and oc-interferon therapy.(AU)

A review of accidental poisoning in Barbados: a new perspective, 1981-1985

A retrospective study is presented of accidental poisoning in 348 children who were admitted to the Queen Elizabeth Hospital during the 5-year period 1981-1985. The objectives of this paper are to review the current trends in accidental poisoning among children in Barbados and to assess whether there has been any significant decrease in this largely preventable problem since a previous review by one of the authors. A retrospective study of all the charts of children admitted for poisoning between 1 January 1981 and 31 December 1985 was made by reviewing the hospital charts of patients with a diagnosis of poisoning. The data analysed included: age, sex, poison involved, duration and cost of hospitilization, address (parish of origin), parental supervision, methods of treatment and laboratory or other investigations performed during admission. Complications or ill effects of the substances were also assessed and graded (AU)

Outcome of live-born infants in Barbados requiring neonatal care, before and after the introduction of a neonatal intensive care unit - abstract

A review of the outcome of neonatal care over a 72-month period (November, 1987 - October, 1993) was retrospectively analysed. The study looked at the changing trends of survival, as influenced by the development of a neonatal intensive care unit (NICU) at the Queen Elizabeth Hospital in November, 1990. During the study period, 4,838 neonatal admissions were analysed; 57 percent were pre-NICU and 42.5 percent post-NICU. Significantly more babies were ventilated in the post-NICU era (p < 0.00001) and survival proportionately increased (p = 0.0027). Although there was no statistical difference in the overall survival in the two eras (p = 0.435), the data indicated that the very low birth weight babies and those ultimately ventilated survived longer in the NICU era (p = 0.0018). With increased survival of premature babies, and the impact of more sophisticated neonatal care, it is likely that one will see more significant trends in the unit-specific mortality. In addition, the surviving children must be carefully looked at to determine their neurodevelopmental outcome in a society with limited health resources (AU)

Evaluation of rapid screening assay for the direct detection of Haemophilus influenzae type b antigen in cerebrospinal fluid in paediatric meningitis

OBJECTIVE: To evaluate the use of a rapid antigen detection assay for detection of Haemophilus influenzae type b (Hib) antigen in cerebrospinal fluid (CSF) from children with meningitis. DESIGN AND METHODS: CSF specimens from children with meningitis were tested for bacterial antigens using latex agglutination (LA) tests and a novel rapid antigen test after all other investigations were completed. The analytical sensitivity of the antigen assays was compared using sterile CSF to which Hib was added. RESULTS: Hib meningitis was confirmed by culture in 4/10 (3.3 percent) of paediatric patients and in none of 29 neonates. The sensitivity and specificity of both LA and the rapid antigen test were 100 percent and 98.6 percent, respectively. The rapid screening assay also gave a positive result in a case of meningococcal meningitis. In CSF spiked with Hib, LA detected 4.2 x 10 5 cfu, while the rapid assay detected 100 cfu. CONCLUSIONS: Both LA and the rapid antigen assay detected all cases of Hib meningitis, but the analytical sensitivity of the rapid screening assay was much greater. Prospective studies of the rapid test for detection of other bacterial pathogens are required.(Au)

Aspergillosis in a patient with acute lymphoblastic leukaemia

A case is described of a three year old boy with acute lymphoblastic leukaemia (ALL) who presented initially with aspergillosis of the nasophgillosis of the nasopharynx. Fungal infection with Aspergillus species is not uncommon in immunosuppressed children, but this case is noteworthy in that the disease presented at the onset of therapy rather than during the phase of treatment with maximum immunosuppression following chemotherapy. This type of infection is usually associated with the treatment of acute non-lymphoblastic leukaemais (AMS) rather than ALL, and prolonged periods of neutropenia which results from aggressive treatment. This patient responded rapidly to treatment with amphotericin B, coincident with resolution of his neutropenia as the underlying disease was treated, eventually eradicating the fungus (AU)

Review of non-Hodgkin's lymphoma at the Queen Elizabeth Hospital (QEH) - abstract

To determine the immunophenotypes and review the clinical features of non-Hodgkin's lymphomas (NHL) seen at the QEH, Barbados, 1988-89. Twenty-seven cases were diagnosed; clinical charts were reviewed in 24 (19 Barbadian residents, 5 other Caribbean territories). Immunophenotyping was performed on paraffin blocks (UWI, Mona) in 22 cases. Human T-cell lymphoma virus type I (HTLV-1) antibody status was determined by ELISA in 20 cases at CAREC. Most patients had lymph node involvement with or without hepatosplenomegaly. There was one case each where the brain, the stomach and the ovary were the primary sites. Eight tumours were B-cell and 12 T-cell phenotype; results were inconclusive in 2 cases. Of the 12 patients with T-cell lymphomas (age range 3 to 75, median 59, 4 M, 4 F), 4 were seropositive (all females) for HTLV-1, representing cases of adult T-cell lymphoma/leukaemia (ATLL), of whom one patient had tropical spastic paraparesis, 7 were sero-negative and serostatus was unknown in 1. All patients with B-cell lymphomas age range 21-89, median 44, 6M, 2F) were HTV-1 sero-negative, while one patient with inconclusive immunotyping was sero-positive. In this small study, a trend towards T-cell immunophenotype predominace was observed. There is, however, a need for further studies (AU)

Childhood malignancies in Barbados (1985-1989): incidence and survival - abstract

The lack of frequency data on childhood malignancies in the Caribbean prompted this 5-year (1985-1989) retrospective study of childhood malignancy in Barbados. Case finding of malignancies in children <15-years-old attending the Queen Elizabeth Hospital, Barbados was undertaken by reviewing medical and other related records for the period of study. Health statistics for the island were obtained from the Statistics Department of the Ministry of Health. There were 44 cases of childhood malignancy of whom 15 died, representing about 0.3 to 1 per cent of all cancer deaths annually. The average annual incidence of childhood cancer for the 5-year-period was 143.5 per million children. Fourteen types of childhood malignancies were found, and the commonest types were brain tumours (27 per cent) and haematological cancers (27 per cent) (AU)