Interpregnancy interval and the risk of preterm birth: a case-control study of infants born at Al-sadaqa general teaching hospital, Aden, Yemen

Background: Interpregnancy interval (IPI) is a known risk factor for preterm birth. The aim of this study was to assess the relationship between IPI and spontaneous preterm birth, and to identify the influence of confounding variables such as socioeconomic status, maternal age, and reproductive history.Methods: This is a hospital-based, case-control study conducted in the department of neonatology, Al-Sadaqa General Teaching Hospital, Aden, during June to September 2011. A case was defined as infant born spontaneously before 37 weeks of gestation and control was a next eligible infant born between 37-42 complete weeks of gestation. Comparison between groups was assessed by statistical analysis and odds ratio were calculated for confounding factors.Results: A total of 100 preterm (cases) and 100 full-term (controls) infants were evaluated for the effects of IPI. Intervals of both <12 months and 12-˂24 months were significantly associated with preterm births compared to control (37% vs 12% and 73% vs 46% respectively, all p<0.05). The risk of preterm birth was higher in association with low number of antenatal care visits (OR=10, 95% CI=1.62-61.46, p=0.018), younger women’s age (OR=8, 95% CI= 1.35-8.4, p=0.001), non-educated mother (OR=7.92, 95% CI=2.49-25.22, p=0.002) and gravid 2-3 (OR=6.5, 95% CI= 5.06-53.8, p=0.001). Significant risk was also observed among mother with low socio-economic status and residents of rural areas (all p<0.05).Conclusions: Short IPI is significant risk factors for preterm birth. This highlights the importance of counseling women in childbearing age to wait at least 24 months between delivery and subsequent conception

The impact of sickle cell disease severity on school performance in affected Yemeni children

Background: School difficulties are common in patients with sickle cell disease (SCD). The study aimed to assess the relationship between severity of SCD in children and their school absenteeism and achievement. Subjects and Methods: The sample included school-aged children (7–15 years old) with SCD who were enrolled from Hematology Clinic in Al-Sadaqa General Teaching Hospital, Aden, during 2013 through 2014. Data about school absence, academic score achievement, and grade retention were collected. Disease severity was assessed by frequency of clinical events and complications. Differences between groups were assessed by appropriate statistical analysis. Results: Sixty children were included for the study; their mean age was 11.5 ± 2.4 years and 51.7% were of the female sex. The number of days absent from school in a year ranged from 0 to 112 days, with a median (IQR) of 28 (14–45) days. Absence of more than 20 days in the previous academic year was reported in 60% of the children. Grade retention was reported in 45% of the children. Both school absence and grade retention were significantly correlated with age (r = 0.35, P = 0.006 and r = 0.32, P = 0.01, respectively). During the previous academic year, 48.3% of the children reported a below average final academic score. Severity assessment revealed that 65% of the children scored as severe. School absenteeism was significantly associated with disease severity score (r = 0.44, P < 0.001). Children with low academic achievement and those with grade retention had significantly higher disease severity score (all P < 0.05). Conclusion: This study suggests that disease severity has important influences on school attendance and performance. Interventions to modify disease severity and school absence might improve academic performance in the affected children

Glomerular hyperfiltration in Yemeni children with sickle cell disease

Background: Glomerular hyperfiltration (GH) is a common feature of sickle cell nephropathy (SCN) starting at infancy and represents an early marker of incipient glomerular injury and renal dysfunction. Methods: This study aimed to determine the prevalence and correlates of GH among children (&le; 16 years) with sickle cell disease (SCD) at their steady state, recruited over 6 months at the Pediatric Outpatient Clinic in Al-Sadaqa General Teaching Hospital, Aden, Yemen. Glomerular filtration rate (eGFR) was estimated using the Schwartz formula. Data on clinical history, anthropometry, blood pressure (BP) and laboratory investigations were collected. Results: Of 101 children (mean age 7.2 &plusmn; 3.9 years), 65 (64.4%) were males. The prevalence of GH was observed in 36 (35.6%) children, who were significantly older (10.7 &plusmn; 3.2 vs. 5.2 &plusmn; 2.7 years, p &lt; 0.001) and had a lower fetal Hb level (5 &plusmn; 3.3 vs. 9 &plusmn; 7.1, p = 0.02). All children were normotensive, but hyperfiltrating children showed significantly higher systolic (97.2 &plusmn; 7.3 vs. 89.7 &plusmn; 5.2 mmHg) and diastolic pressure (55.1 &plusmn; 5.0 vs. 49 &plusmn; 4.3 mmHg) (all p &lt; 0.001). Among evaluated children, 25.7% had hyperfiltration alone, whereas 9.9% had an associated microalbuminuria (MA), and no significant difference in eGFR between those with and without MA (158.4 &plusmn; 33.7 vs. 160.7 &plusmn; 29.8 ml/min/173m2, p = 0.84). Conclusion: This study demonstrated a relatively high prevalence of GH in Yemeni children with SCD that increased with age. Recognition of hyperfiltration and other early markers of nephropathy in this population could help to develop renal protective strategies to prevent progressive loss of kidney function

Intrathoracic kidney in a child with literature review

Intrathoracic kidney (ITK) is an extremely rare congenital anomaly, often asymptomatic and discovered incidentally on chest radiography. Diagnosis in children is less frequent than in adults. It affects males more than females and is more common on the left side. Symptoms can be present if it is associated with diaphragmatic defect, herniation of abdominal contents or respiratory compromise. We report a case of a three-year-old boy with right ITK, diagnosed incidentally by chest radiography during treatment of lower respiratory tract infection and confirmed by chest computerized tomography scan

Blood Transfusion Frequency and Indications in Yemeni Children with Sickle Cell Disease

Background. Blood transfusion is an essential component in the care of patients with sickle cell disease (SCD), but it might be associated with serious acute and delayed complications. This study was aimed to describe red cell transfusion patterns and indications among hospitalized SCD children in a low-resource setting. Patients and Methods. A retrospective, descriptive study of all children (≤16 years) with SCD who received blood transfusion therapy during their hospital admissions in the pediatric department at Al-Sadaqa Teaching Hospital in Aden, Yemen, for a period of one year. Results. Out of 217 hospitalized children with SCD, 169 (77.9%) were transfused and received 275 RBC transfusion episodes. The mean age of transfused children was 6.9 ± 4.6 years and 103 (60.9%) were males, with a male/female ratio of 1.6 : 1 (p=0.004). Hemoglobin (Hb) levels were significantly lower in the transfused than in the nontransfused (Hb 5.5 ± 1.5 vs. 7.7 ± 1.5 g/dL, p=0.03). Pretransfusion Hb levels were ˂7.0 g/dL in 86.2% and ˂5.0 g/dL in 39.3% of patients. Single transfusion was given to 122 (72.2%) and 5 or more transfusions in 9 (4.15%) of patients on different occasions. Simple (top-up) transfusion was used in all transfusion events. Commonest indications for transfusion were anemic crises (41.1%), vasoocclusive crises (VOC) (13.8%), VOC with anemic event (11.3%), acute chest syndrome (8.7%), and stroke (7.3%). Conclusion. Intermittent blood transfusion remains a common practice for the management of children with acute SCD complications. Main indications were acute anemic crises, severe pain crises, ACS, and stroke. In limited resource settings, such as Yemen, conservative transfusion policy appears to be appropriate

Interpregnancy interval and the risk of preterm birth: a case-control study of infants born at Al-sadaqa general teaching hospital, Aden, Yemen

Background: Interpregnancy interval (IPI) is a known risk factor for preterm birth. The aim of this study was to assess the relationship between IPI and spontaneous preterm birth, and to identify the influence of confounding variables such as socioeconomic status, maternal age, and reproductive history.Methods: This is a hospital-based, case-control study conducted in the department of neonatology, Al-Sadaqa General Teaching Hospital, Aden, during June to September 2011. A case was defined as infant born spontaneously before 37 weeks of gestation and control was a next eligible infant born between 37-42 complete weeks of gestation. Comparison between groups was assessed by statistical analysis and odds ratio were calculated for confounding factors.Results: A total of 100 preterm (cases) and 100 full-term (controls) infants were evaluated for the effects of IPI. Intervals of both &lt;12 months and 12-˂24 months were significantly associated with preterm births compared to control (37% vs 12% and 73% vs 46% respectively, all p&lt;0.05). The risk of preterm birth was higher in association with low number of antenatal care visits (OR=10, 95% CI=1.62-61.46, p=0.018), younger women’s age (OR=8, 95% CI= 1.35-8.4, p=0.001), non-educated mother (OR=7.92, 95% CI=2.49-25.22, p=0.002) and gravid 2-3 (OR=6.5, 95% CI= 5.06-53.8, p=0.001). Significant risk was also observed among mother with low socio-economic status and residents of rural areas (all p&lt;0.05).Conclusions: Short IPI is significant risk factors for preterm birth. This highlights the importance of counseling women in childbearing age to wait at least 24 months between delivery and subsequent conception