Twin birth order, birthweight and birthweight discordance: any relationship

Background: It is widely believed that in twin pairs, at birth, the first-born weigh more than the second-born but this concept has been challenged. Objective: To assess the truthfulness of this common concept that first-born twins are usually heavier than their second-born siblings at birth. Methods: In a series of 104 sets of live-born twins, the birth weights of first-born twins were compared with those of their second-born siblings, after controlling for gender. Their intra-pair birthweight differences were determined and twin pairs whose birthweight difference was 15% or more were designated as discordant. Results: Twin I was heavier than Twin II in 61.5% of cases while Twin II was heavier than Twin I in 28.9% of cases. Twins I and II had equal birthweights in 9.6% of cases. Comparing the mean birthweight of the first-born-male twin with that of second-born- male twin, it was 2515+427g (95% Confidence Interval, CI=2402-2628) versus 2432 +435g (95% CI=2321-2543) p>0.05. The mean birthweight of first-born-female twin was 2326+445g (95% CI=2214-2439) while that of the second-born-female twin was 2325+501g (95% CI=2197-2453) p>0.05. When the birthweight difference exceeded 750g, the probability that Twin I will be heavier than Twin II was 83.3% (5 of 6). Conclusion: Although the first-born twin was more often heavier than their second-born siblings, either could weigh more or less at birth. The larger the birthweight difference between growth-discordant twin pair, the greater the probability that the heavier twin would be delivered firs

Morbidity and mortality patterns of post-neonatal paediatric medical admissions in a large mission hospital in Benin City, Nigeria

This study was conducted to determine the morbidity and mortality pattern in children admitted into a mission hospital and to compare the results with those obtained from public hospitals. It was a retrospective study that reviewed the admission and outpatient attendance registers as well as the case records of all children aged between one month and 14 years admitted into St. Philomena Catholic Hospital (SPCH), Benin City, from 1st January 2000 to 31st December 2001. Out of the 8172 children seen at the paediatric outpatient clinic, 1210 (14.8%) were admitted; comprising of 646 (53.4%) males and 564 (46.6%) females. Under-fives accounted for 84.0% of these admissions. Slightly more cases were admitted during the wet season 632 (52.3%) than the dry season 578 (47.7%). Malaria and its complications (61.1%), gastroenteritis (16.6%) and acute lower respiratory tract infection (ALRTI) (8.7%) were the three commonest causes of childhood hospitalisation. Other causes include anaemia (3.7%), measles (3.6%) and febrile convulsion (3.3%). Overall, mortality rate was 4.1%, with under-fives accounting for 92.0% of these deaths. Mortality rate in under-fives was 18.0%, while mortality rate was 1.7 times higher in girls than boys. The commonest causes of death were malaria and its complications (52.0%), anaemia (18.0%), gastroenteritis (14.0%), measles (8.0%) and ALRTI (6.0%). High case fatality rates were found in cerebral malaria (27.8%), anaemia (20.0%), meningitis (20.0%) and measles (9.1%). The commonest cause of death among infants (excluding neonates) was gastroenteritis, while malaria-induced anaemia was the commonest cause of death among children aged 1-4 years. Malaria and its complications, gastroenteritis, ALRTI and severe anaemia are the most important causes of childhood morbidity and mortality in Benin City. Health interventions aimed at controlling these diseases should be strengthened if childhood morbidity and mortality are to be significantly reduced. Greater resources should be allocated to the health care needs of under-fives especially during the wet season

Congenital constriction band syndrome of the lower limb: report of a case that defies Patterson's classification

No AbstractKeywords: Amniotic band, congenital constriction band syndrome, Patterson's classificatio

Hypocalcaemia Occurring Within Forty-Eight Hours Of Birth In Term Infants With Severe Birth Asphyxia

In this cross-sectional study, total serum calcium of 31 term infants with 1-minute Apgar score of 3 or less was measured and compared with those of their counterparts with 1-minute Apgar score of 7 and above. The total serum calcium of severely asphyxiated infants who had sodium bicarbonate administered during resuscitation was compared with those of their counterparts without sodium bicarbonate therapy. Infants with birth asphyxia were examined serially from time of birth and compared with their counterparts without birth asphyxia. Overall prevalence of early-onset neonatal hypocalcaemia (total serum calcium < 1.75 mmol/L) among infants with severe birth asphyxia was 22.6%. Mean total serum calcium at the ages of 12, 24 and 48 hours were significantly lower among asphyxiated compared to non-asphyxiated infants (

Evaluation and Management of The Child with Failure to Thrive

In this review article, the definition, aetiology, evaluation, differential diagnoses, management, prevention and prognosis of failure to thrive are discussed. Failure to thrive (FTT) is a common problem in paediatric practice, affecting 5-10% of under-fives in developed countries with a higher incidence in developing countries. Majority of cases of FTT are due to a combination of nutritional and environmental deprivation secondary to parental poverty and/or ignorance. Many infants with FTT are not identified. The key to diagnosing FTT is finding the time in busy clinical practice to accurately measure and plot a child's weight, height and head circumference, and then assess the trend. In the evaluation of the child who has failed to thrive, three initial steps required to develop an economical treatment-centred approach are: (i) A thorough history including itemized psychosocial review, (ii) Careful physical examination and (iii) Direct observation of the child's behaviour and of parent-child interaction. Laboratory evaluation should be guided by history and physical examination findings only. Once FTT is identified in a particular child, the management should begin with a careful search for its aetiology. Two principles that hold true irrespective of aetiology are that all children with FTT need a high-calorie diet for catch-up growth (typically 150 percent of their caloric requirement for their expected, not actual weight) and all children with FTT need a careful follow up. Social issues of the family must also be addressed. A multidisplinary approach is recommended when FTT persists despite intervention or when it is severe. Overall, only a third of children with FTT are ultimately judged to be normal.Key words: Failure to thrive, growth deficiency, undernutrition

Vaccination default rates among children attending a static immunization clinic in Benin City, Nigeria

Immunization coverage among infants in Nigeria continues to be low despite availability of effective vaccines and accessibility of immunization clinics in urban areas. This study was conducted to determine the vaccination default rate and vaccine schedule that is most frequently defaulted. It also documented reasons for the defaults and suggested ways of minimising them. The immunization status of 174 children aged 9-11 months were determined by interviewing mothers regarding their children's immunization histories. Each child's immunization card was subsequently reviewed for confirmation. Overall default rate for the entire recommended series of vaccines was 26.7%. Measles vaccine was the most frequently defaulted. The commonest reason given by respondent mothers for defaulting immunization clinic appointments was the child's ill-health (37.5% of all cases). Immunization clinic appointment default rate is still high in Benin City, with measles vaccine being the most frequently defaulted. We therefore suggest ways of minimising vaccination clinic appointment defaults

Small-for-gestational age, ponderal index and neonatal polycythaemia: A study of their association with maternal hypertension among Nigerian women

Background/Objective: To examine the influence of maternal hypertension on rate of delivery of small-for-gestation age (SGA) infants, incidence of neonatal polycythaemia and mean ponderal indices of the resultant newborn infants. Methods: From the birth weights and lengths, the ponderal indices of SGA infants born to mothers with chronic hypertension were compared with those of their counterparts born to mothers with pregnancy-induced hypertension. In addition, the spun venous haematocrit values of 265 infants born to mothers whose pregnancies were complicated by hypertension were compared with those of 804 infants born to control mothers. Results: The rates of delivery of SGA infants were 82.0 and 54.7 per 1000 live births among hypertensive and normotensive mothers respectively (p>0.05). The prevalence of neonatal polycythaemia was 8.2% and 2.2% for infants of hypertensive and control mothers respectively (p<0.001). The rate of delivery of SGA infants was 18.6 times higher in mothers with chronic hypertension than in mothers with pregnancy-induced hypertension (p<0.001). SGA infants born to mothers with chronic hypertension had normal mean ponderal index (≥ 2.3) while their counterparts born to mothers with pregnancy-induced hypertension had low mean ponderal index (<2.3). The prevalence of neonatal polycythaemia was 52.9% and 5.0% in infants born to mothers with chronic hypertension and infant of mothers with pregnancy-induced hypertension respectively (p<0.001). Conclusion: Maternal hypertension is associated with an increased incidence of neonatal polycythaemia and delivery of SGA infants. This risk is dramatically higher in women with chronic hypertension. Chronic maternal hypertension causes proportionate foetal growth retardation while pregnancy-induced hypertension causes disproportionate foetal growth retardation