Estimations of total serum testosterone levels in Nigerian term neonates at birth using anogenital distance measurements.

Background In genital anomalies, measurement of total testosterone is required but is expensive and technically difficult to assay. Therefore, the measurement of anogenital distance, which is non-invasive and cheap, could be used to estimate total serum testosterone in neonates. The objective if this study is to determine the relationship between total serum testosterone and anogenital distance and estimate total serum testosterone levels in term neonates using measurements of anogenital distance. Methods This was a prospective cross-sectional study. Consecutive healthy term neonates were recruited in the first 72 h of postnatal life. Anogenital distance was measured with a digital vernier calliper. Total serum testosterone was determined using enzyme linked immunoassay. Results A total of 240 term neonates comprising 124 (51.7%) males and 116 (48.3%) females were studied. The overall mean anogenital distance was 19.7 (7.7) mm and 26.5 (3.7) mm for males which was more than twice 12.4 (2.3) mm for females (t = 35.3, p < 0.001, 95% confidence interval [CI], 13-14). The overall mean total serum testosterone level was 267.1 (204.8) ng/dL; and 357.4 (241.7) ng/dL in males which was more than twice of 170.6 (80.7) ng/dL for females (t = 7.9, p < 0.001, 95% CI, 144-221). There was positive correlation between total serum testosterone and anogenital distance (r = 0.425, p < 0.001). The correlation was stronger in males than in females. The linear regression equation was as follows: total serum testosterone (ng/dL) = 44.3 + 11.3*AGD (mm) with 95% CI, 8-14. Conclusions The known value of anogenital distance could be used to estimate total serum testosterone levels in term neonates.

Serum Vitamin D, Calcium and Phosphate among children with pneumonia

Background:Vitamin D is partly responsible formaintainingcalcium and phosphatehomeostasisbut has been shown to have immune modulatory functions.Objective:To measure serumlevels of vitamin D, and plasma levels of calcium and phosphatein children with pneumonia and compare with those of apparentlyhealthy controls.Methods:A cross-sectional study involving seventy-six childrenwith pneumonia, matched with 76 apparently healthy controls.Results:There was no statistically significant difference in the mean serum vitamin D levels between the cases and the controls (t = 1.190, p = 0.236). The mean serum vitamin D level was significantly higher in childrenwith non-severe pneumonia than in those with severe pneumonia (t = 3.299, p =.002). Themean serum vitamin D level was higher among the controls than those with severe pneumonia (t = 2.674, p = 0.009).The mean plasmacalcium and phosphate levels in the controls were significantly higher than in the cases (t = 2.528, p = .013 and t = 4.594, p < .001 respectively). Plasmacalcium and phosphate levels did not vary with the severity of pneumonia. Pneumonia was independently associated with the occurrence of hypocalcaemia and hypophosphataemia (OR= 4.366, 95% CI = 1.851-10.295, p= 0.001; OR= 7.355, 95% CI = 1.545-35.027, p= 0.01 respectively). Conclusion:Children with severe pneumonia hadlower levels of vitamin D than those with the non-severe disease.Derangements in plasma levels of calcium and phosphateare common in children with pneumonia, and these abnormalities occur independently of low vitamin D levels

Filtered sunlight, solar powered phototherapy and other strategies for managing neonatal jaundice in low-resource settings.

Challenges in treating severe neonatal jaundice in low and middle-income country settings still exist at many levels. These include: a lack of awareness of causes and prevention by families, communities and even sometimes health care professionals; insufficient, ineffective, high quality affordable diagnostic and therapeutic options; limited availability of rehabilitation provision for kernicterus. Collectively these challenges lead to an unacceptably high global morbidity and mortality from severe neonatal jaundice. In the past decade, there has been an explosion of innovations addressing some of these issues and these are increasingly available for scale up. Scientists, healthcare providers, and communities are joining hands to explore educational tools, low cost screening and diagnostic options including at point-of-care and treatment modalities including filtered sunlight and solar powered phototherapy. For the first time, the possibility of eliminating the tragedy of preventable morbidity and mortality from severe NNJ is on the horizon, for all.

Pattern, etiological factors and determinants of mortality among sick newborns with seizures in Ilesa, Nigeria.

BACKGROUND: Neonatal seizures contribute significantly to newborn morbidity and mortality particularly in developing countries including Nigeria. Unfortunately the countries with high incidence of neonatal seizures often lack the facilities to adequately diagnose, monitor and prognosticate the condition. OBJECTIVE: We set out to determine the factors at presentation that predict death among babies admitted with clinically identifiable seizures. METHODS: We prospectively observed consecutive neonatal admissions over a nine month period at the Wesley Guild Hospital, Ilesa, Nigeria. Babies with seizures were identified based on clinical observation. Perinatal history, examination and laboratory findings were compared between babies with seizures who survived and those that died. Multivariate regression analysis was used to determine the predictors of mortality. RESULTS: Over a nine month study period, a total of 340 babies were recruited out of which 55 (16.7 percent) had clinically identifiable seizures. Fifteen (27.3 percent) of the 55 babies with clinically identifiable seizures died; while 20 (7.0 percent) of the 285 babies without seizures died. Clinically identifiable neonatal seizures contributed to 42.9 percent of the overall mortality in the neonatal unit during the study period. The risk factors for mortality among the babies with seizures were clinical seizures in the first 24 hours of life, birth asphyxia co-existing with hyponatraemia and presence of cerebral oedema (P < 0.05). The independent determinant of mortality among babies with clinical seizures was cerebral oedema (OR = 4.025; 95% CI 1.342-26.956; P = 0.019). CONCLUSION: We conclude that clinically identifiable neonatal seizures contribute significantly to neonatal mortality and presentation within 24 hours of delivery, birth asphyxia and cerebral oedema increased the risk of death in babies with seizures.

Irradiance readings of phototherapy equipment: Nigeria.

Phototherapy devices (n = 63) at twelve nurseries in Nigeria were evaluated. Irradiance was measured using the BiliBlanket Meter II. Irradiance readings ranged from 0.5 to 18.4 µW/cm(2)/nm; phototherapy units varied widely, including locally made units, reconditioned machines, and modern equipment. Imported "intact" machines with all blue bulbs had higher irradiance readings than locally made devices using primarily daylight bulbs (2.5-18.4 µW/cm(2)/nm vs 0.5-4.2 µW/cm(2)/nm). The distance between infant and phototherapy units ranged from 45 to 60 cm, far exceeding the recommended distance of about 10 cm. Only 6% of the machines provided irradiance of >10 µW/cm(2)/nm. None delivered intensive phototherapy (irradiance ≥ 30 µW/cm(2)/nm). Phototherapy devices in developing countries should be assessed for irradiance, and the infant be placed at a distance of about 10 cm from the device. Phototherapy devices with adequate irradiance would reduce the need for exchange blood transfusion and the burden of acute bilirubin encephalopathy in developing countries.

Why we are still doing so many exchange blood transfusion for neonatal jaundice in Nigeria.

BACKGROUND: Since exchange blood transfusion (EBT) is associated with serious complications, phototherapy has been made more powerful to reduce the need for EBT in the developed world. This study was undertaken to determine the indications for EBT in neonatal jaundice (NNJ) at our unit and what proportion of EBTs was possibly avoidable. METHODS: All the babies who had EBT for hyperbilirubinemia over a three-year period were included. Age, sex, weight, place of delivery, blood group of baby and mother, other investigations, management, and the outcome of the babies were recorded. RESULTS: Of the 1686 babies admitted to the neonatal unit, 90 (5.3%) had EBT. Fourteen (15.6%) were inborn while 76 (84.4%) were out-born babies. Fifty-six (62.2%) babies were admitted primarily for NNJ while 34 (37.8%) developed NNJ during admission. Thirty-six (40.0%) of the babies had phototherapy for more than 24 hours prior to EBT either because they were of very low birthweight or NNJ was detected very early and therapy was so commenced. Sixty-eight (75.6%) babies had single EBT while the remaining 22 (24.4%) had two sessions of EBT. Factors associated with severe NNJ in babies requiring EBT included low birthweight (<2500 g, 44.4%), ABO incompatibility (30.0%), glucose-6-phosphate dehydrogenase deficiency (34.4%) and septicemia (26.1%). Twenty-seven (30.0%) of the neonates developed features of kernicterus: 26 before admission while 1 during admission; all except one were delivered outside the hospital. CONCLUSIONS: The EBT rate in our center was high. With more effective phototherapy, EBT could be avoided in most of the babies who initially had phototherapy for more than 24 hours before EBT and repeated EBT sessions. Health education of the population at risk, especially pregnant women, and early referral at the primary health care level will reduce the burden of severe NNJ.