Prevalence of Perinatal Asphyxia Using Apgar Scores and Cord Blood pH and the Relationship between the Two Methods: A Study of FMC Umuahia.

BACKGROUND: Perinatal asphyxia contributes significantly to neonatal morbidity and mortality. It occurs worldwide, and the Apgar score is the most widely used method of diagnosis. Recently, umbilical cord arterial pH has been reported as the most objective way to assess fetal acidosis at birth as it predicts the adverse outcome of perinatal asphyxia. It is imperative to establish the concordance between these two diagnostic methods to reinforce the practicality of the Apgar score as the preferred diagnostic tool for perinatal asphyxia in developing nations, such as Nigeria. AIM: To determine the prevalence of perinatal asphyxia by using the Apgar score and arterial cord blood pH and the relationships between these methods at the Federal Medical Center (FMC), Umuahia. MATERIALS AND METHODS: This cross-sectional study enrolled 245-term newborns. Perinatal asphyxia was diagnosed using both Apgar scoring and arterial cord blood pH measurements. Data obtained were analyzed using SPSS version 20 and a P value < 0.05 was considered significant. RESULTS: Perinatal asphyxia was reported in 33.1% and 31.4% by using the Apgar score and arterial cord blood pH, respectively. There was a moderate agreement between the two methods for diagnosing perinatal asphyxia (κ = 0.44), and no statistically significant difference was observed in the prevalence of perinatal asphyxia between these methods (McNemar's χ2 = 0.27, P = 0.699). Furthermore, a strong positive correlation was observed between the Apgar score at 1 and 5 minutes of life and arterial cord blood pH (rs = 0.87, P ≤ 0.001 and rs = 0.80, P ≤ 0.001 respectively). CONCLUSION: The prevalence of perinatal asphyxia by the two methods was high, and there was no significant difference between both methods of assessing perinatal asphyxia. Thus, the diagnosis of perinatal asphyxia can effectively be made using either the Apgar score or arterial cord blood pH, affirming the practicality and reliability of the Apgar score in resource-limited healthcare settings.

Prevalence and Pattern of Feeding Problems and Relationship to Motor Function Severity in Children with Cerebral Palsy in Umuahia.

BACKGROUND: Reports show that feeding problems in children with cerebral palsy (CP) significantly reduce nutritional intake and affect their nutritional status. OBJECTIVE: To determine the prevalence and types of feeding problems and its association with functional severity and nutritional status in children with cerebral palsy. METHODS: This cross-sectional study involved 169 children with CP aged 1 - 17 years seen at the Neurology clinic of Federal Medical Centre, Umuahia. Gross motor skills were described using Gross Motor Function Classification System (GMFCS).Nutritional status was determined and classified based on WHO Child Growth Standards. Data was analyzed using SPSS version 20.0. RESULTS: Feeding problem was seen in 39.1% of the subjects, with spitting out food (57.6%), prolonged feeding time (45.5%) and choking (16.7%) being the most common types. Malnutrition occurred in 37.3% of patients. Feeding problems were significantly associated with functional severity (χ2 = 52.06 and p < 0.001) and proportion of feeding problems increased with increasing functional severity. All the subjects with functional severity level V (100%) had feeding problems. There was no statistically significant association between nutritional status and feeding problems (χ2 = 0.77 and p = 0.38), although the proportion of feeding problems was highest (44.3%) in the underweight subjects. CONCLUSION: The prevalence of feeding problem in children with CP is 39.1%. There was no association between feeding problems and nutritional status. Feeding problem was however significantly associated with functional severity. Therefore there is need for routine evaluation for feeding problems in children with CP to prevent complications.

CONTEXTE: Les rapports montrent que les problèmes d'alimentation chez les enfants atteints de paralysie cérébrale (PC) réduisent de manière significative l'apport nutritionnel et affectent leur statut nutritionnel. OBJECTIF: Déterminer la prévalence et les types de problèmes d'alimentation et leur association avec la sévérité fonctionnelle et le statut nutritionnel des enfants atteints de paralysie cérébrale. MÉTHODES: Cette étude transversale a porté sur 169 enfants atteints de paralysie cérébrale âgés de 1 à 17 ans et vus à la clinique de neurologie du Centre médical fédéral, Umuahia. Les capacités motrices brutes ont été décrites à l'aide du système de classification de la fonction motrice brute (GMFCS), l'état nutritionnel a été déterminé et classé selon les normes de croissance de l'enfant de l'OMS. Les données ont été analysées à l'aide de SPSS version 20.0. RÉSULTATS: Des problèmes d'alimentation ont été observés chez 39,1 % des sujets, les plus fréquents étant les régurgitations (57,6 %), le temps d'alimentation prolongé (45,5 %) et l'étouffement (16,7 %). La malnutrition est apparue chez 37,3 % des patients. Les problèmes d'alimentation étaient significativement associés à la sévérité fonctionnelle (÷2 = 52,06 et p < 0,001) et la proportion de problèmes d'alimentation augmentait avec la sévérité fonctionnelle. Tous les sujets présentant un niveau de sévérité fonctionnelle V (100%) avaient des problèmes d'alimentation. Il n'y avait pas d'association statistiquement significative entre l'état nutritionnel et les problèmes d'alimentation (÷2 = 0,77 et p = 0,38), bien que la proportion de problèmes d'alimentation était la plus élevée (44,3 %) chez les sujets présentant une insuffisance pondérale. CONCLUSION: La prévalence des problèmes d'alimentation chez les enfants atteints de PC est de 39,1%. Il n'y avait pas d'association entre les problèmes d'alimentation et l'état nutritionnel. Les problèmes d'alimentation étaient cependant significativement associés à la sévérité fonctionnelle. Il est donc nécessaire de procéder à une évaluation systématique des problèmes d'alimentation chez les enfants atteints de PC afin de prévenir les complications. Mots clés: Infirmité motrice cérébrale, Sévérité fonctionnelle, Problèmes d'Alimentation, Nutrition, Umuahia.

Micronutrient Levels in Children with Cerebral Palsy in Abia State, Nigeria.

BACKGROUND: Micronutrients are essential for growth and development and their deficiencies are reported in children with cerebral palsy who have attributes that predispose them to such nutrient deficiencies. There are few studies on micronutrients status of CP children in our sub-region. OBJECTIVE: To investigate micronutrient status of children with cerebral palsy and compare values with those of controls. METHODS: One hundred and sixty- nine children with CP and 169 controls were enrolled consecutively. Clinical features were documented using Gross Motor Functional Classification System to assess severity. Venous blood was collected for micronutrient levels measurement. Student's t test, Chi-square test and bivariate analysis were used as appropriate. Multiple linear regression was used to identify clinical antecedents of any deranged micronutrient. RESULTS: The serum zinc, calcium and vitamin D levels were lower in the subjects compared with the controls (p <0.001).There was significant association between the serum levels of the micronutrients and age in the subjects (<0.05). Serum zinc level was associated with socioeconomic class in both subjects and controls (p < 0.001, 0.001 respectively). Serum zinc and calcium were significantly low in 69.7% and 15.2% of subjects with feeding problems respectively. Age, gender, socioeconomic class and feeding problems had significant independent effect on serum zinc levels of the subjects. CONCLUSION: Serum levels of zinc, calcium and vitamin D are significantly low in children with CP. Age, socioeconomic class and feeding problems independently influenced the serum zinc level in the subjects. Periodic assessment of children with CP to identify those who might need specific intervention is advocated.

Caregivers' willingness-to-pay for a topical anesthetic cream for minor medical procedures in children.

BACKGROUND: Topical anesthetic cream (TAC) is not in use in pediatric practice in Sub-saharan regions. Knowledge of Caregivers' willingness-to-pay (WTP) for the cream is necessary for its deployment. OBJECTIVE: To determine the WTP for TAC for minor pediatric painful procedures. MATERIALS AND METHODS: The study was a questionnaire-based conducted in two tertiary health institutions in southeast Nigeria. WTP was elicited using the contingent valuation method. The respondents were caregivers to children that attended out-patient clinics and in-patient. Data analysis was by Statistical Package for the Social Sciences software (SPSS) and STATA11. RESULTS: Majority (94%) of the respondents were willing to pay for TAC. The mean maximum WTP was US$8.31. Multivariate analysis showed no statistically significant association between many variables with WTP for TAC. CONCLUSIONS: Their average WTP was higher than the market price of topical anesthetic cream. Therefore, there is a good prospect for TAC if deployed in Nigeria.