Ectopia cordis : a report of two cases in Cameroon

This article reports two cases of ectopia cordis in two children aged one day and twenty months respectively. A one day old newborn had complete thoracic ectopia cordis associated with an internal cardiac defect and severe thoracic and abdominal wall malformations. The centre does not have the facilities to manage complex congenital defects and prior to being transferred to a cardiac centre, the neonate died on the second day of admission. A 20-month old baby had partial ectopia of the heart and a defect in the abdominal wall. He had no major congenital cardiac defect and has remained clinically stable with no life threatening symptomspeer-reviewe

Neonatal azithromycin administration to prevent infant mortality: study protocol for a randomised controlled trial.

IntroductionBiannual mass azithromycin distribution to children aged 1-59 months has been shown to reduce all-cause mortality. Children under 28 days of age were not treated in studies evaluating mass azithromycin distribution for child mortality due to concerns related to infantile hypertrophic pyloric stenosis (IHPS). Here, we report the design of a randomised controlled trial to evaluate the efficacy and safety of administration of a single dose of oral azithromycin during the neonatal period.Methods and analysisThe Nouveaux-nés et Azithromycine: une Innovation dans le Traitement des Enfants (NAITRE) study is a double-masked randomised placebo-controlled trial designed to evaluate the efficacy of a single dose of azithromycin (20 mg/kg) for the prevention of child mortality. Newborns (n=21 712) aged 8-27 days weighing at least 2500 g are 1:1 randomised to a single, directly observed, oral dose of azithromycin or matching placebo. Participants are followed weekly for 3 weeks after treatment to screen for adverse events, including IHPS. The primary outcome is all-cause mortality at the 6-month study visit.Ethics and disseminationThis study was approved by the Institutional Review Boards at the University of California, San Francisco in San Francisco, USA (Protocol #18-25027) and the Comité National d'Ethique pour la Recherche in Ouagadougou, Burkina Faso (Protocol #2018-10-123). The findings of this trial will be presented at local, regional and international meetings and published in open access peer-reviewed journals.Trial registration numberNCT03682653; Pre-results

Feeding interventions for growth and development in infants with cleft lip, cleft palate or cleft lip and palate.

BACKGROUND: Cleft lip and cleft palate are common birth defects, affecting about one baby of every 700 born. Feeding these babies is an immediate concern and there is evidence of delay in growth of children with a cleft as compared to those without clefting. In an effort to combat reduced weight for height, a variety of advice and devices are recommended to aid feeding of babies with clefts. OBJECTIVES: This review aims to assess the effects of these feeding interventions in babies with cleft lip and/or palate on growth, development and parental satisfaction. SEARCH STRATEGY: The following electronic databases were searched: the Cochrane Oral Health Group Trials Register (to 27 October 2010), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 4), MEDLINE via OVID (1950 to 27 October 2010), EMBASE via OVID (1980 to 27 October 2010), PsycINFO via OVID (1950 to 27 October 2010) and CINAHL via EBSCO (1980 to 27 October 2010). Attempts were made to identify both unpublished and ongoing studies. There was no restriction with regard to language of publication. SELECTION CRITERIA: Studies were included if they were randomised controlled trials (RCTs) of feeding interventions for babies born with cleft lip, cleft palate or cleft lip and palate up to the age of 6 months (from term). DATA COLLECTION AND ANALYSIS: Studies were assessed for relevance independently and in duplicate. All studies meeting the inclusion criteria were data extracted and assessed for validity independently by each member of the review team. Authors were contacted for clarification or missing information whenever possible. MAIN RESULTS: Five RCTs with a total of 292 babies, were included in the review. Comparisons made within the RCTs were squeezable versus rigid feeding bottles (two studies), breastfeeding versus spoon-feeding (one study) and maxillary plate versus no plate (two studies). No statistically significant differences were shown for any of the primary outcomes when comparing bottle types, although squeezable bottles were less likely to require modification. No difference was shown for infants fitted with a maxillary plate compared to no plate. However, there was some evidence of an effect on weight at 6 weeks post-surgery in favour of breastfeeding when compared to spoon-feeding (mean difference 0.47; 95% confidence interval 0.20 to 0.74). AUTHORS' CONCLUSIONS: Squeezable bottles appear easier to use than rigid feeding bottles for babies born with clefts of the lip and/or palate, however, there is no evidence of a difference in growth outcomes between the bottle types. There is weak evidence that breastfeeding is better than spoon-feeding following surgery for cleft. There was no evidence to suggest that maxillary plates assist growth in babies with clefts of the palate. No evidence was found to assess the use of any types of maternal advice and/or support for these babies

Quantitative ultrasound applied to metacarpal bone in infants.

Aim. To provide bone status assessment in infancy using quantitative ultrasound (QUS) applied to second metacarpus.Methods. 103 healthy term infants and 3 patients with rickets, aged ≤ 12 months, underwent metacarpal QUS evaluation using QUS DBM Sonic Aurora IGEA (MO, Italy), which measures speed of sound (mcSOS) and bone transmission time (mcBTT).Results. In the total sample, median (interquartile range) of mcSOS was 1640.00 (26.0) m/s and mcBTT 0.82 (0.21) µs. Moreover, reference values for age were obtained based on estimation of the lower and upper percentiles. We observed a statistical significant difference between groups of age for mcSOS (p = 0.016). In a multiple linear regression model, we found a relation between age at enrolment and mcSOS (β = −0.608; p = 0.000) and mcBTT (β = −0.819; p = 0.001). A positive correlation between mcSOS and mcBTT has been observed (r = 0.631; p = 0.000). All the patients with rickets showed values of mcSOS and mcBTT lower than the 10th percentile.Conclusion. Our findings show that this new simple technique appears to be a promising tool for monitoring bone mineral status in pediatric clinical practice and in early life. Furthermore, it could be considered a useful method to investigate and to monitor the role of different factors on programming of bone health and it should be tested as a new method for monitoring subjects with rickets during therapy

Long-acting injectable aripiprazole in pregnant women with schizophrenia: a case-series report

Antipsychotic long-acting formulations (LAI-AP) have emerged as a new therapeutic choice to treat patients presenting a severe mental disorder. Despite that, to date, there is a lack of safety data and studies regarding the use of LAI-AP formulations in pregnant women. Here we present the first six-case series of pregnant women with schizophrenia treated with aripiprazole-LAI reported in the literature. All patients remained psychopathologically stable through pregnancy and the postpartum period, and all of them were in treatment with aripiprazole-LAI. To date, all infants remain healthy with normal developmental milestones, without the presence of congenital malformations or adverse effects. Lack of information on safety data regarding the use of new antipsychotic formulations remains important in treating women with mental illness who desire to become pregnant. Further studies in this clinical population with a larger number of patients included remains necessary

Tidal Volume (TV) post-process obtained with electrical impedance tomography on a group of chronic obstructive pulmonary disease (COPD) patients. Use of adjust equations

Equations used to estimate ventilation out of EIT images, validated on healthy volunteers show a significant bias and a larger variance when were applied on a COPD patients group. The differences in estimation values were found to be highly correlated with anthropometric parameters. Two groups of 13 and 4 COPD male patients (FEV1/FVC<70% and FVC ≥ 80%) were used in this study. We have measured different anthropometric parameters like age, weight, height and skinfolds. The EIT system (TIE4sys) and a pneumotach were simultaneously connected to monitor tidal volume. The main anthropometric parameters values of 13 COPD patients were: age: 67±9 years, height: 1.65±0.05 m, weight: 72±11 kg, BMI: 26.4±3.3; and the subscapular skinfold thickness was 23±9mm. The mean tidal volume estimated with TIE4sys and the pneumotach were: 0.580±0.212 L and 0.774±0.173 L r = 0.861 (p<0.01). The mean difference was 0.196±0.096 L (p<0.01). On this group we have found out an adjust equation and we have validated it on an independent group of 4 COPD patients. The equation was Diff=-1478+15.6(weight). The mean tidal volume values obtained with pneumotach and TIE4sys on the second group of COPD patients (M:4) were: 0.798±0.395 L and 0.732±0.327 L. The mean of the differences was 0.066±0.114L. The differences of determinations estimated with pneumotach and TIE4sys can be attributed to changes of anthropometric characteristics like subscapular skinfold.Peer ReviewedPostprint (author’s final draft

The evolution of lung function in newborn screened preschool children with cystic fibrosis

Most morbidity in cystic fibrosis (CF) is due to progressive pulmonary disease. Recently, small molecule therapies targeting the basic defect of the cystic fibrosis transmembrane conductance regulator protein have been developed, and newborn screening (NBS) for CF allows intervention before irreversible lung damage occurs. Unless the evolution of pulmonary function in young children is known, the optimal age of starting new therapies or enrolling CF NBS children into interventional trials is unclear. The London Cystic Fibrosis Collaboration has studied CF NBS infants longitudinally from diagnosis, as well as a contemporaneous group of matched healthy controls, and reported lung function was normal in the NBS CF group at two years of age. This thesis reports the preschool follow-up of the same infants, and describes the evolution of lung function to six years of age. The primary hypothesis was that lung function would remain within the normal range. Secondary aims were to compare preschool pulmonary function to that measured in children diagnosed with CF a decade earlier, and to describe which measures in NBS infants could predict preschool lung function. 67 preschool children with CF and 41 healthy controls underwent multiple breath washout (MBW), specific airway resistance and spirometry measurements. Lung Clearance Index (LCI), measured by MBW, was abnormal in CF NBS preschool children, but was better than children diagnosed with CF a decade earlier. The most significant predictor of abnormal preschool lung function was LCI at two years of age. Contrary to the hypothesis, compared to contemporaneous controls, lung function deteriorates at preschool follow-up in CF NBS children managed with standard UK care. As two year LCI was a significant predictor of later decline, implying that the root causes of decline were before this age, disease modifying therapies and interventional trials should be targeted before two years of age

Effectiveness of the application of massage therapy and kinesitherapy by parents on premature neonates: a research protocol

Aim: The study aims to analyse the efficacy of massage therapy and kinesitherapy applied by parents of premature infants admitted to hospital. Background: Premature newborns suffer early somatic deprivation that has adverse effects on their growth and development and that also has a negative impact on the emotional state of their parents. Massage therapy and kinesitherapy is beneficial in alleviating somatic deficit and facilitates the bond between parents and newborns. Design: A quasi-experimental community intervention trial will be conducted in a neonatology unit. Methods: This study will compare the benefits of a 15-min massage protocol applied by parents with the usual medical and nursing care given by neonatal units for premature babies. The evaluation of neuromotor development will take place through the Spanish Premie-Neuro scale. The determination of weight, size, and head circumference will be based on the unit's usual procedures. Discussion: If the implementation of a massage therapy and kinesitherapy protocol is effective in promoting the growth and development of hospitalized premature infants, the results of this study could give an impetus for the inclusion of somatic stimulation in the usual nursing care given for preterm infants. Impact: Prematurity and its associated morbidity pose a major global public health problem. Somatic and kinaesthetic stimulation has beneficial effects on anthropometric and neuromotor development in preterm infants. The results will have a positive impact on premature neonates and their families, both during the hospitalization, and a positive socio-economic effect throughout their lives (education, work, disability).SIWe thank the Neonatal Care Unit of the León University Hospital for taking part in this project, as well as all the nurses who participated for their efforts and dedication in collecting data. We are especially grateful to the premature newborns and their family members who kindly contributed to this study with their participation

Papers on anthropology XIV

Eelkäija: Tartu Ülikooli toimetised. Antropoloogia-alaseid töid, ISSN 0207-4575http://www.ester.ee/record=b1339521*es

Risk factors for neonatal jaundice in babies presenting at the University of Benin Teaching Hospital, Benin City

Background: Jaundice is the yellowish discoloration of the skin, sclera and mucous membranes resulting from deposition of bilirubin. Neonatal jaundice is a leading cause of neonatal admissions in the first week of life and risk factors such as sepsis, prematurity, glucose-6-phosphate dehydrogenase enzyme deficiencies, use of native herbs and contact with naphthalene balls contaminated clothes have been identified for neonatal jaundice. Objective: To determine the risk factors for neonatal jaundice at University of Benin Teaching Hospital, Benin City. Methods: This retrospective study was conducted at the Special Care Baby Unit of the University of Benin Teaching Hospital, Benin City. Case notes of babies admitted from January 2006 to December 2008 were retrieved and information on biodata, gestational age, anthropometric values, potential risk factors, level of serum bilirubin at presentation and discharge, mode of treatment and outcome were extracted. Results: Of the 1784 babies admitted during the period, 472 (26.5%) were admitted for neonatal jaudice. Fifty seven percent of the babies with neonatal jaundice were delivered in UBTH (in-born babies), while 202 (42.8%) of the babies were born before arrival (out-born babies) in UBTH. The Male: Female ratio was 1.02:1. The mean age at presentation with jaundice was 3.43 &#177; 3.76 days of life. Outborn babies tended to present at an older age (6.08 &#177; 5.19 days) than in -born babies (2.47 &#177; 2.48 days). The mean serum bilirubin value in out-born babies (14.00 &#177; 4.58 mg/dL) was significantly higher than that observed among the in-born babies (9.35 &#177; 4.38 mg/dL: p = 0.000). The risk factors identified were use of mentholatum, naphthalene balls and native herbs in 40.0%, 16.7% and 7.0% respectively. ABO incompatibility was found in 7.6% of babies. No risk factor was identified in 36.3% of the babies. The case fatality rate in this study was relatively high particularly in association with sepsis, prematurity and asphyxia. Mortality was higher in out-born babies than in in-born babies (p= 0.00). Conclusion: Early presentation of babies and adequate management of sepsis and prematurity will reduce mortality associated with neonatal jaundice.Key words: In-born, jaundice, outborn, risk, sepsis