Prevalence and outcome of higher order multiple pregnancies in Lagos, Nigeria.

OBJECTIVE: To determine the prevalence and outcome of higher order multiple (HOM) pregnancies in Lagos, Nigeria. METHODS: The mode of delivery, gestational age, pregnancy and neonatal outcome of babies delivered from HOM pregnancies were reviewed retrospectively from the labor ward and theater registers, neonatal unit admission records and medical notes in a tertiary referral centre from April 2009 to March 2012. RESULTS: Twenty-two (15, 6 and 1 set of triplets, quadruplets and quintuplet, respectively) of 6521 pregnancies delivered during the period were HOM pregnancies giving a prevalence of 3.37/1000. All the 74 babies except 12 were delivered by cesarean section. There were 18 perinatal deaths giving a perinatal mortality rate of 243 per 1000. Overall mortality was significantly associated with no antenatal booking (21 versus 5, OR: 21.0, 95% CI: 2.1-72.3, p = 0.000), gestational age ≤30 weeks (21 versus 5, OR: 46.2, 95% CI: 11.2-189.9, p = 0.000) and birth weight <1000 g for live births (p = 0.000). Mode of delivery and number of fetuses >3 were however not significantly associated with mortality. CONCLUSION: Reduction of early preterm births by proper antenatal care and close feto-maternal monitoring of HOM pregnancies will significantly reduce the resultant immediate poor outcomes for these pregnancies and their newborns.

Prospective Audit of Perinatal Mortality among Inborn Babies in a Tertiary Health Center in Lagos; Nigeria

Background: The perinatal mortality rate remains an important indicator of maternal care and maternal health and nutrition; and also reflects the quality of obstetric and pediatric care available. The causes of most of the perinatal deaths are preventable; thus making it important to identify the risk factors in each health environment. Objective: The aim was to prospectively audit the perinatal mortality and associated risk factors in a tertiary health facility in a developing country. Materials and Methods: Data for all consecutive deliveries in the labor ward complex of Lagos University Teaching Hospital (LUTH) between June 2002 and November 2002 were obtained from the patients' record and by interviewing the mothers using a questionnaire. The babies were followed up for 7 days postdelivery. Results: There were 51 (8.5) perinatal deaths made up of 43 (7.1) stillbirths (15 fresh and 28 macerated) and 8 (6.1) early neonatal deaths giving a perinatal mortality rate of 84.6/1000. Maternal factors that significantly affected perinatal deaths were maternal age; parity; antenatal care booking and the hospital where the mother was booked for antenatal care; number of previous child deaths; and complications of pregnancy. Mode of delivery and complications of labor were the significant intrapartum factors. Fetal factors that influenced perinatal deaths were fetal presentation; birth weight; and Apgar scores at 1 and 5 min. When multiple logistic regression (multivariable analysis) of perinatal mortality on possible risk factors was done; only the Apgar score at 5 min; birth weight; and parity were significant risk factors. Conclusion: The study shows a high perinatal mortality rate with majority of perinatal deaths occurring before the delivery. Significant risk factors are a low Apgar score at 5 min; low birth weight; and high parity

Clinical presentation of congenital malaria at the Lagos University Teaching Hospital.

BACKGROUND: Congenital malaria has been increasingly documented in endemic regions. It is important to recognize those clinical features that are due to congenital malaria, which if undetected, might worsen the morbidity of the newborn. The aim of this study was to document the clinical presentation of neonates with congenital malaria born at the Lagos University Teaching Hospital and followed up for 28 days. METHODS: A total of 100 consecutive mothers and their newborns were recruited between August and October 2002 (during the rainy season) from the labour ward and followed up from birth to 28 days of age. Blood films from the placentae and babies were stained with Giemsa stain within 24 hours of collection. All parasitaemic babies that became symptomatic were screened for sepsis using acute phase responses and cultures. All data were entered into a prepared proforma. Symptoms were attributed to malaria when sepsis screening was negative. RESULTS: Congenital malaria was documented in 13.6% of babies at delivery. Jaundice, irritability and poor feeding were most common symptoms associated with congenital malaria. Irritability and poor feeding had positive predictive values (PPV) of 100% on Day 14. CONCLUSION: Babies who present with poor feeding and irritability on Day 14 of life should be screened for malaria in addition to the routine investigations for neonatal sepsis.

Early postnatal growth of preterm low birth weight, appropriately-sized infants.

BACKGROUND: Postnatal growth monitoring is useful in assessing the health ofpreterm babies but their growth patterns have not been sufficiently studied in Africans. AIM: To describe the growth achievements ofpreterm, low birth weight, appropriately-sized, Nigerian infants. STUDY DESIGN: The subjects were prospectively recruited from two centers Olabisi Onabanjo University Teaching Hospital (January 1994 to June 1995) and Havana Specialist Hospital (June 1995 to June 1997). The weight, length and occipito-frontal circumference of 89 preterm, low birth weight, appropriate-for-dates infants were monitored from birth until 53 post-conceptual weeks. Growth velocities were compared with 46 term infants. RESULTS: Initial weight loss, age at regaining birth weight and growth rate in the early postnatal weeks were inversely related to gestational age. Subsequent weight gain was directly related to gestational age. Between birth and 40 weeks post conception, growth rates for different gestational age groups were 129 to 207 g/week (weight), 0.78 to 0.93 cm/week (length) and 0.62 to 0.65 cm/week (head circumference). After 40 weeks, the corresponding rates were 188 to 238 g/week, 0.86 to 0.96 cm week and 0.48 to 0.50 cm/week, respectively. Head growth demonstrated a faster catch-up than weight and body length in that order. The observed growth rates were slower in some respects than Caucasian figures but faster than reported for the Japanese. CONCLUSION: Study subjects had growth patterns within previously defined ranges. The better profile of western babies is probably related to better infrastructure while the advantage over Asian babies is probably racial.

A study on pediatric nosocomial methicillin-resistant Staphylococcus aureus in Lagos; Nigeria

This work was undertaken to determine the incidence of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infections in children at a tertiary hospital and the antibiotic susceptibility profiles of MRSA compared with methicillin-sensitive (MSSA) strains. From 1994 to 1995; 4;981 admissions in the neonatal intensive care; paediatric surgical; general paediatric; and the well-baby wards of the Lagos University Teaching Hospital were prospectively monitored for nosocomial S. aureus infections. Antibiotictesting was performed on a total of 175 isolates of S. aureus obtained from 169 patients with nosocomial infections (NI) using a disk diffusion method and by E test (AB Biodisk; Sweden). In total; nosocomial MRSA infection was identified in 96 (1.9) patients; rates recorded for patients in the various wards as stated above were 4.2; 3.2; 0.5 and 0 respectively. Correspondingly; the rate of nosocomial MRSA amongst all S. aureus infections was 63.6; 44.7; 41.7 and 0; and 54.9 overall. All MRSA and MSSA were sensitive to ciprofloxacin and vancomycin. Clindamycin and rifampin (87-98) were also highly effective against MRSA and MSSA; 78.3 of MRSA and 91.7 MSSA were sensitive to fusidic acid. Gentamicin (70.9) and erythromycin (65.8) were also active on MSSA. Cotrimoxazole had low activity against all the strains. Following the high rate and multiresistant nature of nosocomial MRSA obtained in this study; there is need for intensive surveillance of such infections and initiation of stringent control measures in Nigeria and Africa at large.; 0.5 and 0 respectively. Correspondingly; the rate of nosocomial MRSA amongst all S. aureus infections was 63.6; 44.7; 41.7 and 0; and 54.9 overall. All MRSA and MSSA were sensitive to ciprofloxacin and vancomycin. Clindamycin and rifampin (87-98) were also highly effective against MRSA and MSSA; 78.3 of MRSA and 91.7 MSSA were sensitive to fusidic acid. Gentamicin (70.9) and erythromycin (65.8) were also active on MSSA. Cotrimoxazole had low activity against all the strains. Following the high rate and multiresistant nature of nosocomial MRSA obtained in this study; there is need for intensive surveillance of such infections and initiation of stringent control measures in Nigeria and Africa at large

The effects of birth interval on the birthweights of consecutive, same-sex term siblings.

OBJECTIVE: To investigate the effect of birth interval on the relationship between the birthweights of successive siblings. METHODS: The records of women who had delivered two consecutive, same-sex, live, singletons babies (1983 through 1997) in a private hospital were analysed. The intervals between the birth dates of the siblings were calculated. The first of the siblings was coded Set A and the second, Set B. The ratios of the birthweights (Set B/Set A) were calculated. Comparison of findings was made between various ranges of birth interval. RESULTS: The birth interval band 24-29 months was associated with the highest mean birthweight for Set B babies and the highest birthweight ratio (p=0.016). Set A babies weighing less than 3000 g were most likely to be outweighed by their Set B siblings (p=0.000001). CONCLUSION: Birth intervals of 24 to 29 months and small size of Set A babies were associated with most significant advantages in birthweight for Set B siblings.

Congenital malaria among inborn babies at a tertiary centre in Lagos, Nigeria.

Congenital malaria is increasingly reported among babies born to mothers continually residing in endemic areas. Given the high morbidity and mortality associated with malaria it is pertinent to determine its current status among newborns in Lagos, Nigeria. The aim was to determine the incidence of congenital malaria in newborn babies delivered at the Lagos University Teaching Hospital and also to determine the frequency of parasitaemia in their mothers and placentae. A cross-sectional study of mothers attending the antenatal clinic of the Lagos University Teaching Hospital was done. The Sociodemographic and clinical characteristics of mothers were documented. Samples of maternal, placental, cord and neonatal blood were taken and stained with Giemsa and examined for malaria parasites. Neonatal samples were examined at birth, on days 3, 7, 14 and 28. One hundred mothers and their placentae, as well as 104 babies and their cord blood were studied. The incidence of congenital malaria was 16/104 (15.3%) and parasite counts ranged from 47 to 1019/mul. Plasmodium falciparum was the predominant species. There was a strong association between placental, maternal, cord and neonatal parasitaemia. All the babies with congenital malaria had infected mothers, placentae and cords (p < 0.0001). In conclusion congenital malaria is not uncommon in Lagos nowadays, and there are relatively high rates of maternal, placental and cord blood parasitaemia. It is, therefore, recommended that babies born to mothers with malaria should be screened for congenital malaria.

Aerobic bacterial nosocomial infections in paediatric surgical patients at a tertiary health institution in Lagos, Nigeria.

This study was undertaken to determine nosocomial bacterial infections (NI) in surgical patients in a developing country using the detailed option of the Center for Disease Control (CDC) surgical patient surveillance technique. From 1994 - 1995. Paediatrics surgical patients at the Lagos University Teaching Hospital (LUTH) were prospectively monitored for NI at all body sites. Standard definitions of NI were used, and NI sites were categorised by type of operation. A total of 304 NI occurred in 245 out of 664 surgical patients investigated. SSI (77.3 %) and urinary tract infections (19.1%) were in preponderance. Seventy three per cent of SSI were superficial incisions, 20.5% organ/space and 6.8% deep incisions. The overall wound infection rate was 30.9%. The SSI rate for emergency surgery was 35.6% and 26.5% for elective procedures. Rates within each wound class were 20.2, 23.8, 51.9 and 52.8% respectively and 17, 37.6, 43.4 and 47. 1% for patients with ASA scores of I II III and IV in that order. The SSI rates for patients with scores of 0, 1, 2 and 3 were 20.4; 43.5, 57.1 and 75% respectively. Mean infection rates in the various wound classes were highly correlated with the number of risk factors present. Klebsiella pneumoniae (38. 7%), Escherichia coli (22.7%), Pseudomonas aeruginosa (16.8%) and Staphylococcus aureus (10. 7%) were the most common pathogens.

Outcome of low birth weight neonates in a tertiary health care centre in Lagos, Nigeria.

The records of all low birth weight (LBW) neonates admitted into the Neonatal Unit of the Lagos University Teaching Hospital (LUTH) from January 1997 to December 2001 were retrospectively analysed in order to determine the outcome and risk factors associated with mortality. There were 535 LBW admissions of which 411(76.8%) survived while 124(23.2%) died. The birth weight specific mortality rate for the < 1000g neonates was 818 per 1000, 451 per 1000 for the 1000-1499g, 216 per 1000 for the 1500-1999g, and 67 per 1000 for the 2000-2499g neonates (X2 = 127.70, p = 0.0001). Primary indications for admission were neonatal sepsis (25.2%), perinatal asphyxia (23.0%) and neonatal jaundice (19.6%) with case fatality rates of 20.0%, 34.1% and 10.5% respectively (X2 = 34.24, p = 0.00001). Death occurred within 48 hours of admission in 45.2% of subjects and by the 7th day, 72.6% had died (X2 = 70.07, p = 0.0001). Significant risk factors associated with mortality were birth weight [OR 4.24, 95% CI = 3.14-5.72] and category of LBW [OR 2.79, 95% CI = 1.65-4.69]. Sex, twinning, booking status and mode of delivery had no significant influence on mortality. Since the provision of adequate intensive care for these vulnerable infants remains a major challenge in countries with poor resources, efforts should be intensified to implement effective strategies for the reduction of low birth weight deliveries.