Maternal experiences of caring for an infant with neurological impairment after neonatal encephalopathy in Uganda: a qualitative study

Purpose: The study investigated maternal experiences of caring for a child affected by neurological impairment after neonatal encephalopathy (NE) (“birth asphyxia”) in Uganda. Methods: Between September 2011 and October 2012 small group and one-on-one in-depths interviews were conducted with mothers recruited to the ABAaNA study examining outcomes from NE in Mulago hospital, Kampala. Data were analysed thematically with the aid of Nvivo 8 software. Findings: Mothers reported caring for an infant with impairment was often complicated by substantial social, emotional and financial difficulties and stigma. High levels of emotional distress, feelings of social isolation and fearfulness about the future were described. Maternal health-seeking ability was exacerbated by high transport costs, lack of paternal support and poor availability of rehabilitation and counselling services. Meeting and sharing experiences with similarly affected mothers was associated with more positive maternal caring experiences. Conclusion: Mothering a child with neurological impairment after NE is emotionally, physically and financially challenging but this may be partly mitigated by good social support and opportunities to share caring experiences with similarly affected mothers. A facilitated, participatory, community-based approach to rehabilitation training may have important impacts on maximising participation and improving the quality of life of affected mothers and infants. Implications for Rehabilitation Caring for an infant with neurological impairment after NE in Uganda has substantial emotional, social and financial impacts on families and is associated with high levels of emotional stress, feelings of isolation and stigma amongst mothers. Improved social support and the opportunity to share experiences with other similarly affected mothers are associated with a more positive maternal caring experience. High transport costs, lack of paternal support and poor availability of counselling and support services were barriers to maternal healthcare seeking. Studies examining the feasibility, acceptability and impact of early intervention programmes are warranted to maximise participation and improve the quality of life for affected mothers and their infants

Determinants of Mortality Among Low Birthweight Infants During Hospitalization in Karangasem District Hospital

Background and purpose: Infant mortality rate in Indonesia is still high and is largely related to low birthweight (LBW) infants. Previous studies reported the socio demographic and clinical factors as determinants of mortality of LBW infants, but rarely examined factors related to their health services. This study aimed to determine the demographic, clinical and health services as determinants of mortality of LBW infants during hospitalization.Methods: This study was a retrospective using cohort data of medical record of LBW infants in Karangasem Hospital since January 2012 to October 2014. Logistic regression was done to determine the relationship between demographic, clinical and health services factors with LBW infants' mortality.Results: The proportion of mortality among LBW infants during hospitalization was 12.12%. Most parents (64.6%) live in good access to health services. The proportion of female infants (51.4%) was higher than male. LBW infants who were born in hospital (85.7%) greater than born outside hospital. Vaginal delivery (75.3%) was greater than C-section. Preterm infants (57.1%) was greater than at term with median of birthweight was 2100 grams. Proportion of asphyxia, respiratory distress syndrome (RDS), sepsis, hypoglycemia and hypothermia, respectively 24.1%, 4.66%, 0.78%, 7.92% and 3.73%. Variables associated with LBW mortality were increasing of 50 grams of birthweight, asphyxia, RDS and referred infants.Conclusion: The mortality of LBW infants during hospitalization was 12.12% with increasing of 50 grams of birthweight, asphyxia, RDS and referred infants found as determinant factors

Maternal experiences of caring for an infant with neurological impairment after neonatal encephalopathy in Uganda: a qualitative study.

PURPOSE: The study investigated maternal experiences of caring for a child affected by neurological impairment after neonatal encephalopathy (NE) ("birth asphyxia") in Uganda. METHODS: Between September 2011 and October 2012 small group and one-on-one in-depths interviews were conducted with mothers recruited to the ABAaNA study examining outcomes from NE in Mulago hospital, Kampala. Data were analysed thematically with the aid of Nvivo 8 software. FINDINGS: Mothers reported caring for an infant with impairment was often complicated by substantial social, emotional and financial difficulties and stigma. High levels of emotional distress, feelings of social isolation and fearfulness about the future were described. Maternal health-seeking ability was exacerbated by high transport costs, lack of paternal support and poor availability of rehabilitation and counselling services. Meeting and sharing experiences with similarly affected mothers was associated with more positive maternal caring experiences. CONCLUSION: Mothering a child with neurological impairment after NE is emotionally, physically and financially challenging but this may be partly mitigated by good social support and opportunities to share caring experiences with similarly affected mothers. A facilitated, participatory, community-based approach to rehabilitation training may have important impacts on maximising participation and improving the quality of life of affected mothers and infants. Implications for Rehabilitation Caring for an infant with neurological impairment after NE in Uganda has substantial emotional, social and financial impacts on families and is associated with high levels of emotional stress, feelings of isolation and stigma amongst mothers. Improved social support and the opportunity to share experiences with other similarly affected mothers are associated with a more positive maternal caring experience. High transport costs, lack of paternal support and poor availability of counselling and support services were barriers to maternal healthcare seeking. Studies examining the feasibility, acceptability and impact of early intervention programmes are warranted to maximise participation and improve the quality of life for affected mothers and their infants

Hypoglycemia and Risk Factors for Death in 13 Years of Pediatric Admissions in Mozambique

Hypoglycemia is a life-threatening complication of several diseases in childhood. We describe the prevalence and incidence of hypoglycemia among admitted Mozambican children, establishing its associated risk factors. We retrospectively reviewed clinical data of 13 years collected through an ongoing systematic morbidity surveillance in Manhica District Hospital in rural Mozambique. Logistic regression was used to identify risk factors for hypoglycemia and death. Minimum community-based incidence rates (MCBIRs) for hypoglycemia were calculated using data from the demographic surveillance system. Of 49,089 children < 15 years hospitalized in Manhica District Hospital, 45,573 (92.8%) had a glycemia assessment on admission. A total of 1,478 children (3.2%) presented hypoglycemia (< 3 mmol/L), of which about two-thirds (972) were with levels < 2.5 mmol/L. Independent risk factors for hypoglycemia on admission and death among hypoglycemic children included prostration, unconsciousness, edema, malnutrition, and bacteremia. Hypoglycemic children were significantly more likely to die (odds ratio [OR] = 7.11; P < 0.001), with an associated case fatality rate (CFR) of 19.3% (245/1,267). Overall MCBIR of hypoglycemia was 1.57 episodes/1,000 child years at risk (CYAR), significantly decreasing throughout the study period. Newborns showed the highest incidences (9.47 episodes/1,000 CYAR, P < 0.001). Hypoglycemia remains a hazardous condition for African children. Symptoms and signs associated to hypoglycemia should trigger the verification of glycemia and the implementation of life-saving corrective measures

Pattern and determinants of blood transfusion in a Nigerian neonatal unit

Objective: To determine the pattern and determinants of blood transfusion in a Nigerian neonatal unit.Materials and Methods: Newborn babies who required blood transfusions between January and December, 2008, were studied. The sex, age, and weight at the first transfusion, clinical conditions, indications for transfusion, and the outcome were analyzed with bivariate and multivariate methods.Results: A total of 402 neonates were hospitalized and 112 (27.9%) had blood transfusion; 61.9% had exchange transfusion, 66.1% had red cell transfusion, and 8% had plasma transfusion. There were 251 transfusions with a rate of 4.8 transfusions per week. Blood transfusions were done for severe jaundice (55.4%), severe anemia (40.2%), and bleeding disorders (4.4%). Weight &lt; 2.5 kg, outside delivery, and jaundice were independent determinants of neonatal transfusion.Conclusion: The blood transfusion rate in this facility was remarkably high. Improved standard of newborn care and infrastructural support are required to reduce the transfusion rate

Progress in pediatrics in 2015: choices in allergy, endocrinology, gastroenterology, genetics, haematology, infectious diseases, neonatology, nephrology, neurology, nutrition, oncology and pulmonology

This review focuses key advances in different pediatric fields that were published in Italian Journal of Pediatrics and in international journals in 2015. Weaning studies continue to show promise for preventing food allergy. New diagnostic tools are available for identifying the allergic origin of allergic-like symptoms. Advances have been reported in obesity, short stature and autoimmune endocrine disorders. New molecules are offered to reduce weight gain and insulin-resistance in obese children. Regional investigations may provide suggestions for preventing short stature. Epidemiological studies have evidenced the high incidence of Graves' disease and Hashimoto's thyroiditis in patients with Down syndrome. Documentation of novel risk factors for celiac disease are of use to develop strategies for prevention in the population at-risk. Diagnostic criteria for non-celiac gluten sensitivity have been reported. Negative effect on nervous system development of the supernumerary X chromosome in Klinefelter syndrome has emerged. Improvements have been made in understanding rare diseases such as Rubinstein-Taybi syndrome. Eltrombopag is an effective therapy for immune trombocytopenia. Children with sickle-cell anemia are at risk for nocturnal enuresis. Invasive diseases caused by Streptococcus pyogenes are still common despite of vaccination. No difference in frequency of antibiotic prescriptions for acute otitis media between before the publication of the national guideline and after has been found. The importance of timing of iron administration in low birth weight infants, the effect of probiotics for preventing necrotising enterocolitis and perspectives for managing jaundice and cholestasis in neonates have been highlighted. New strategies have been developed to reduce the risk for relapse in nephrotic syndrome including prednisolone during upper respiratory infection. Insights into the pathophysiology of cerebral palsy, arterial ischemic stroke and acute encephalitis may drive advances in treatment. Recommendations on breastfeeding and complementary feeding have been updated. Novel treatments for rhabdomyosarcoma should be considered for paediatric patients. Control of risk factors for bronchiolitis and administration of pavilizumab for preventing respiratory syncytial virus infection may reduce hospitalization. Identification of risk factors for hospitalization in children with wheezing can improve the management of this disease. Deletions or mutations in genes encoding proteins for surfactant function may cause diffuse lung disease

Awareness of Nigerian Mothers on the Risk Factors, Prevention and Management of Seizures in Newborns

Objectives The study aimed to assess the awareness of mothers on the risk factors, prevention, and management of seizures in newborns. Materials &amp; Methods This descriptive cross-sectional study was conducted on 359 mothers using simple random sampling. The data were collected using questionnaires that included general awareness, awareness of the causes, risk factors, prevention, and management. The data collected were analyzed using frequencies and percentages. Null hypotheses were tested using chi-square at 0.05 level of significance Results Two hundred seventy-four mothers (76.3%) had high awareness of seizures in newborns, thirty-four (9.5%) had average awareness, and fifty-one (14.2%) had low awareness. Two hundred and seventythree mothers (76%) had high awareness of the risk factors, and eighty-six (24%) had low awareness, meaning that although some respondents had misconceptions, awareness of the risk factors and causes was good. Two hundred twenty-three (62.1%) respondents had high awareness of preventing seizures in newborns, while 136 (37.9%) had low awareness. The awareness of respondents on managing seizures in newborns is positive, as 291 (81.1%) had high awareness of managing seizures in newborns, while sixty-eight (18.9%) had low awareness. There was a significant relationship between age (p =0.000), marital status (p=0.018), level of education (p =0.000), and awareness of risk factors of seizures in the newborn Conclusion A high awareness of neonatal seizures was found among mothers because of their high educational level, although some still had some misconceptions. Improving maternal neonatal seizure awareness and appropriate educational interventions to correct misconceptions are needed

Pattern and determinants of newborn apnea in an under-resourced Nigerian setting

Objective: To determine the prevalence, distribution and determinants of newborn apnea in a resource-constrained setting.Design: Retrospective study.Materials and Methods: Newborn babies who had apnea during hospitalization between January and December 2008 were studied. The sex, age and body weight, clinical conditions, etiologies of apnea and outcome were recorded. Babies with and without apnea were compared using bivariate and multivariable analysis.Results: Out of 402 babies seen during the review, 78 (19.4%) had apnea. They comprised 59 preterm and 19 term babies. Forty (51.3%) had apnea at the point of admission while the remaining 38 (48.7) developed apnea after a mean interval of 118.5 &#177; 101.1 hours. Thirty-seven percent of preterms had idiopathic apnea. Etiologies included respiratory distress (50.0%), hypothermia (42.3%), and asphyxia (28.2%). Multivariate analysis showed that weight &lt;2.5kg, hypothermia, referred status and presence of respiratory distress were determinants of apnea. Case fatality rate was 82.2% among apneic babies.Conclusion: Apnea occurred commonly in this population of babies. Stringent efforts like ventilator supports for babies in respiratory distress, better perinatal care including thermoregulation are required to reduce the occurrence of the major risk factors for newborn apnea. The identified determinants can be used to draw up effective preventive measures in resource-poor settings

Frequency, Causes, and Findings of Brain CT Scans of Neonatal Seizure at Besat Hospital, Hamadan, Iran

How to Cite This Article: Eghbalian F, Rasuli B, Monsef F. Frequency, Causes, and Findings of Brain CT Scans of Neonatal Seizure at Besat Hospital, Hamadan, Iran. Iran J Child Neurol. 2015 Winter;9(1):56-63.AbstractObjectiveNeonatal seizures are the most common neurological symptoms and often signal an underlying serious neurologic condition. This study determines the frequency of neonatal seizure, predisposing factors, and brain computed tomography (CT) scan findings.Materials &amp; MethodsIn a descriptive cross-sectional study, we evaluated all neonates with seizures who had been hospitalized in Besat hospital from 2007–2012. All data were gathered with questionnaires and used to compare with statistical tests by SPSS (ver 16). Results141 (4.08%) neonates (M:F; 1:2.2) were diagnosed with neonatal seizures. From the total number of 3,452 neonatal hospitalization, 78% of neonates with seizures were less than 10 days old and 60.3% of infants were born from natural vaginal delivery. As the most common cause, hypoxic-ischemic encephalopathy in this study was associated with 31.3% (n=44) of neonatal seizures and with the highest mortality rate (n=6). Among admitted neonates with seizures, the overall mortality rate was 12.8% (18 cases). A total of 33.3% of patients (47 cases) had abnormal CT scan reports and 24.8% (35 cases) of patients were not evaluated with a CT scan. Hypoxic-ischemic encephalopathy (47%) and local ischemic changes (25.5%) were the most common findings in the CT scans of neonates with seizures.ConclusionThere was a significant correlation between neonatal seizures and delivery circumstances (p-value &lt; 0.05). Therefore, with improvement of obstetric and delivery circumstances, early detection of predisposing factors and other rare conditions, and rapid effective treatment of these contributing factors, the rate of neonatal seizure in this period can be reduced.ReferencesScher MS. 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