Evaluation of Impact of Perinatal Factors on Time to First Meconium Passage in Nigerian Neonates

BackgroundDelayed meconium passage is usually a signal to congenital distal bowel dysfunction. Timing of meconium passage may vary depending on race, sex and several perinatal factors. Understanding the timing and associated perinatal factors in any given population will help in prompt diagnosis and adequate management of cases in that population.Objectives: To determine the timing of first meconium passage amongst Nigerian neonates, and evaluate the impact of various associated perinatal factors. Materials and MethodsA cross-sectional study using interviewer-administered questionnaires to obtain data from mothers of apparently normal infants attending the postnatal clinic of the University of Nigeria Teaching Hospital, Enugu, Nigeria. Data acquisition and analysis were done using SPSS version 20. A P-value of < 0.05 was adjudged statistically significant.ResultsThere were 276 male and 277 female infants. Mean birth weight was 3.4kg and mean gestational age at delivery 38.8weeks. The median age at presentation was 42days. Preterm deliveries were in 6.3%(32/510) and 3.7%(20/536) weighed less than 2.5kg at birth. Sixty-five percent (339/519) had spontaneous vertex delivery and 35%(180/519) had caesarean delivery. Passage of first meconium was within 24hours in 56.6%(307/543) and in 48hours 91.3%(496/543) had passed meconium. Fifty-four percent (54%, 288/537) commenced breastfeeding within 24hours and 85% (n=456/537) within 48hours. Exclusive breastfeeding was done in 61.5%(326/533) of subjects. Timing of first meconium passage was significantly affected by gestational age at delivery (p<0.001), mode of delivery (p<0.01), birth weight (p=0.02), first minute APGAR score (p<0.001), timing of commencement of breastfeeding (p<0.001) and feeding before breastfeeding is commenced (p = 0.02). ConclusionCompared to other studies, we found smaller proportion of neonates passing meconium in the first 24 hours. Term neonates, birth weight ≥ 2.5kg, spontaneous vertex delivery, high Apgar score, commencement of breastfeeding within 24 hours of birth, feeding before breastfeeding is commenced, are perinatal factors associated with earlier first meconium passage

Paediatric nephrectomy: Patterns, indications and outcome in a developing country

BackgroundPatterns of and indications for nephrectomy vary in different age groups, geographical locations and time periods. In some series nephrectomies were mainly for malignant conditions while in others they were predominantly for non-malignant conditions. Such data on patterns, indications, and outcomes of nephrectomy in children is limited in our environment.ObjectivesTo evaluate nephrectomy in childhood at the Sub-Department of Pediatric Surgery University of Nigeria Teaching Hospital, Ituku/Ozalla Enugu with a focus on pattern, indications, and outcome. Materials And MethodsMedical records of all patients aged ≤16years who had nephrectomy from January 2007 to December 2016 were studied with emphasis on age, sex, side of nephrectomy, duration of symptoms before presentation, indication for nephrectomy, in-hospital complications, length of hospital stay, in-hospital mortality. SPSS version 15 was used for data entry and analysis.ResultsThere were 52 nephrectomies in 32 males and 20 females. They were for 35 malignant and 17 non-malignant conditions. Most of the malignancies were Wilms tumour (34/35) while non-malignant conditions were late-presenting pelvi-ureteric junction obstruction (9), large multi-cystic dysplastic kidneys (4), renal trauma with pedicle avulsion (1), posterior urethral valve with atrophic kidney (1),duplex system with nonfunctioning upper pole moiety (2). Mean age at nephrectomy was 5.10±3.66 years (range 7 weeks to 16 years); 59% of the nephrectomies were on the left and 41% on the right. Mean duration of hospital stay was 31.78±16.59 days (range 7-66 days). In-hospital mortality rate was 5.8%. ConclusionsIn our unit, nephroblastoma is the main indication for pediatric nephrectomy and were the only indications in females; neglected pelvi-ureteric junction obstruction was the major non-malignant indication and occurred only in males; most nephrectomies were done in the age range of 1-5 years; nephron-sparing nephrectomy, major morbidity, re-operation are uncommon and in-hospital mortality from nephrectomy is still high at 5.8%

Childhood colostomies: patterns, indications and outcomes in a Nigerian University Teaching Hospital

Background: Most childhood colostomies are done for decompression or diversion in gastrointestinal tract congenital anomalies.Colostomy may be sited in the transverse or sigmoid colon as loop or defunctioning (divided) colostomies. Current pattern seems towards construction of more sigmoid and defunctioning colostomies. Aims: To evaluate the patterns, indications and outcomes of childhood colostomies. Patients and Methods: Retrospective chart review of all colostomies performed in children below 15 years from September 2010 to August 2020. Results: There were 104 colostomies (55males; 49females; 65 sigmoid; 39 transverse colostomies; 3 loop; 101 defunctioning colostomies. Anorecatal Malformation (ARM)was indication in 32 males and 41 females; age range 2 days to 13 years. Hirschsprung’s Disease (HD) was indication in 18 males and 4 females; age range 6 weeks to 15 years.In HD there were three loop colostomies (3/22) in transverse colon and 19 defunctioning colostomies (8 sigmoid, 11 transverse) while in ARM all 73 were defunctioning colostomies(P=0.01) In HD there were 14/22 transverse colostomies and 8/22 sigmoid colostomies while ARM had 24/73 transverse and 49/73sigmoid colostomies (P =0.013) In HD 91% colostomies were done beyond infancy while in ARM 93% were before one year(P<0.0001). Mortalities were notedin 1.9% patients. Conclusion: Commonest indication for colostomy is ARM. There are more defunctioning than loop colostomies, and more sigmoid than transverse colostomies. of most colostomies in ARM were during infancy while mostly beyond infancy in HD. Keywords: Childhood colostomies; oatterns; indications; outcomes

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Childhood colostomies: patterns, indications and outcomes in a Nigerian University Teaching Hospital

Background: Most childhood colostomies are done for decompression or diversion in gastrointestinal tract congenital anomalies.Colostomy may be sited in the transverse or sigmoid colon as loop or defunctioning (divided) colostomies. Current pattern seems towards construction of more sigmoid and defunctioning colostomies.&#x0D; Aims: To evaluate the patterns, indications and outcomes of childhood colostomies.&#x0D; Patients and Methods: Retrospective chart review of all colostomies performed in children below 15 years from September 2010 to August 2020.&#x0D; Results: There were 104 colostomies (55males; 49females; 65 sigmoid; 39 transverse colostomies; 3 loop; 101 defunctioning colostomies. Anorecatal Malformation (ARM)was indication in 32 males and 41 females; age range 2 days to 13 years. Hirschsprung’s Disease (HD) was indication in 18 males and 4 females; age range 6 weeks to 15 years.In HD there were three loop colostomies (3/22) in transverse colon and 19 defunctioning colostomies (8 sigmoid, 11 transverse) while in ARM all 73 were defunctioning colostomies(P=0.01) In HD there were 14/22 transverse colostomies and 8/22 sigmoid colostomies while ARM had 24/73 transverse and 49/73sigmoid colostomies (P =0.013) In HD 91% colostomies were done beyond infancy while in ARM 93% were before one year(P&lt;0.0001). Mortalities were notedin 1.9% patients.&#x0D; Conclusion: Commonest indication for colostomy is ARM. There are more defunctioning than loop colostomies, and more sigmoid than transverse colostomies. of most colostomies in ARM were during infancy while mostly beyond infancy in HD.&#x0D; Keywords: Childhood colostomies; oatterns; indications; outcomes.</jats:p