An analysis of neonates with surgical diagnoses admitted to the neonatal intensive care unit at Charlotte Maxeke Johannesburg Academic Hospital, South Africa

Background. The burden of neonatal surgical conditions is not well documented in low- to middle-income countries (LMICs). These conditions are thought to be relatively common, with a considerable proportion of neonates admitted to the neonatal intensive care unit (NICU) requiring surgical intervention.Objectives. To review neonates with surgical conditions admitted to the NICU in our hospital setting.Methods. This was a retrospective, descriptive study of neonates with surgical conditions admitted to the NICU at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), South Africa, between 1 January 2013 and 31 December 2015. The characteristics and survival of these neonates were described using univariate analysis. The NICU at CMJAH is combined with a paediatric intensive care unit, to a total of 15 beds, and serves as a referral unit.Results. Of 923 neonates admitted to the NICU, 319 (34.6%) had primarily surgical conditions. Of these 319 neonates, 205 survived (64.3%). There were 125/319 neonates (39.2%) with necrotising enterocolitis (NEC), 55 of whom survived (55/125; 44.0%), making the presence of NEC significantly associated with poor outcome (p<0.001). Other significant predictors of poor outcome were the patient being outborn (p=0.029); the presence of late-onset sepsis (p<0.001), with Gram-negative organisms (p=0.005); and lesser gestational age (p=0.001) and lower birth weight (p<0.001). Major birth defects were present in 166/319 neonates (52.0%). The abdomen was the most prevalent site of surgery, with 216/258 procedures (83.7%) being abdominal, resulting in a mortality rate of 76/216 (35.2%).Conclusions. Neonates with major surgical conditions accounted for one-third of NICU admissions in the present study. The study highlights the considerable burden placed on paediatric surgical services at a large referral hospital in SA. Paediatric surgical services, with early referral and improvement of neonatal transport systems, must be a priority in planned healthcare interventions to reduce neonatal mortality in LMICs

Developmental outcome of very low birth weight infants in a developing country

Background: Advances in neonatal care allow survival of extremely premature infants, who are at risk of handicap. Neurodevelopmental follow up of these infants is an essential part of ongoing evaluation of neonatal care. The neonatal care in resource limited developing countries is very different to that in first world settings. Follow up data from developing countries is essential; it is not appropriate to extrapolate data from units in developed countries. This study provides follow up data on a population of very low birth weight (VLBW) infants in Johannesburg, South Africa. Methods: The study sample included all VLBW infants born between 01/06/2006 and 28/02/2007 and discharged from the neonatal unit at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH). Bayley Scales of Infant and Toddler Development Version 111 (BSID) 111 were done to assess development. Regression analysis was done to determine factors associated with poor outcome. Results: 178 infants were discharged, 26 were not available for follow up, 9 of the remaining 152 (5.9%) died before an assessment was done; 106 of the remaining 143 (74.1%) had a BSID 111 assessment. These 106 patients form the study sample; mean birth weight and mean gestational age was 1182 grams (SD: 197.78) and 30.81 weeks (SD: 2.67) respectively. The BSID (111) was done at a median age of 16.48 months. The mean cognitive subscale was 88.6 (95% CI: 85.69-91.59), 9 (8.5%) were < 70, mean language subscale was 87.71 (95% CI: 84.85-90.56), 10 (9.4%) < 70, and mean motor subscale was 90.05 (95% CI: 87.0-93.11), 8 (7.6%) < 70. Approximately one third of infants were identified as being at risk (score between 70 and 85) on each subscale. Cerebral palsy was diagnosed in 4 (3.7%) of babies. Factors associated with poor outcome included cystic periventricular leukomalacia (PVL), resuscitation at birth, maternal parity, prolonged hospitalisation and duration of supplemental oxygen. PVL was associated with poor outcome on all three subscales. Birth weight and gestational age were not predictive of neurodevelopmental outcome. Conclusion: Although the neurodevelopmental outcome of this group of VLBW infants was within the normal range, with a low incidence of cerebral palsy, these results may reflect the low survival of babies with a birth weight below 900 grams. In addition, mean subscale scores were low and one third of the babies were identified as "at risk", indicating that this group of babies warrants long-term follow up into school going age

A prospective observational study of developmental outcomes in survivors of neonatal hypoxic ischaemic encephalopathy in South Africa

Background. Neonatal hypoxic ischaemic encephalopathy (NHIE) is an important cause of long-term handicap in survivors. There is limited information on the burden of handicap from NHIE in sub-Saharan Africa.Objectives. To determine the developmental outcomes in survivors of NHIE in South Africa (SA).Methods. In this prospective observational study, the developmental outcomes in 84 infants who had survived hypoxic ischaemic encephalopathy (the NHIE group) were compared with those in 64 unaffected infants (the control group). The Bayley Scales of Infant Development version III were used for assessment of developmental outcomes.Results. Significant differences were found between the developmental outcomes of the two groups, with a significantly lower composite language score and higher proportions with language, motor and cognitive developmental delays in the NHIE group than in the control group. Cerebral palsy (CP) was present in 13 of the infants with NHIE (15.5%) and none in the control group (p&lt;0.001). CP was associated with developmental delay, and also with the severity of NHIE. Therapeutic hypothermia (TH) was administered in 58.3% of the study group, but although it was associated with lower rates of CP and developmental delay than in the group without TH, the only significant difference was for delay on the language subscale.Conclusions. Survivors of NHIE in SA are at risk of poor developmental outcomes.

A review of antenatal corticosteroid use in premature neonates in a middle-income country

Background. Antenatal corticosteroid (ANS) use in premature neonates has become a standard of practice. However, there is low ANS coverage in low- to middle-income countries (LMICs). Recent studies have questioned the efficacy of ANSs in such countries.Objective. To review the use of ANSs in preterm neonates at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), South Africa.Methods. This was a retrospective observational study of all neonates with a birth weight of 500 - 1 800 g born at CMJAH between 1 January 2013 and 30 June 2016. Neonatal and maternal characteristics of neonates exposed to ANSs were compared with those of neonates who were not exposed.Results. The ANS coverage of the final sample was 930/2 109 (44.1%). The mean (standard deviation (SD)) birth weight was 1 292.4 (323.2) g and the mean gestational age 30.2 (2.9) weeks. Attending antenatal care and maternal hypertension were associated with increased use of ANSs, whereas vaginal delivery was associated with decreased use. In neonates weighing &lt;1 500 g, the use of ANSs was associated with decreased mortality, decreased intraventricular haemorrhage and decreased patent ductus arteriosus. There was no association between ANSs and respiratory distress syndrome, necrotising enterocolitis, sepsis or need for respiratory support in all premature neonates, and no association with improved outcomes in those weighing ≥1 500 g.Conclusion. The benefits of ANSs in terms of neonatal morbidity in this study were not as marked as those published in high-income countries. A randomised controlled trial may be indicated in LMICs.

Solar-like oscillations with low amplitude in the CoRoT target HD 181906

Context: The F8 star HD 181906 (effective temperature ~6300K) was observed for 156 days by the CoRoT satellite during the first long run in the centre direction. Analysis of the data reveals a spectrum of solar-like acoustic oscillations. However, the faintness of the target (m_v=7.65) means the signal-to-noise (S/N) in the acoustic modes is quite low, and this low S/N leads to complications in the analysis. Aims: To extract global variables of the star as well as key parameters of the p modes observed in the power spectrum of the lightcurve. Methods: The power spectrum of the lightcurve, a wavelet transform and spot fitting have been used to obtain the average rotation rate of the star and its inclination angle. Then, the autocorrelation of the power spectrum and the power spectrum of the power spectrum were used to properly determine the large separation. Finally, estimations of the mode parameters have been done by maximizing the likelihood of a global fit, where several modes were fit simultaneously. Results: We have been able to infer the mean surface rotation rate of the star (~4 microHz) with indications of the presence of surface differential rotation, the large separation of the p modes (~87 microHz), and therefore also the ridges corresponding to overtones of the acoustic modes.Comment: Paper Accepted to be published in A&A. 10 Pages, 12 figure

Magnetic variability in the young solar analog KIC 10644253: Observations from the Kepler satellite and the HERMES spectrograph

The continuous photometric observations collected by the Kepler satellite over 4 years provide a whelm of data with an unequalled quantity and quality for the study of stellar evolution of more than 200000 stars. Moreover, the length of the dataset provide a unique source of information to detect magnetic activity and associated temporal variability in the acoustic oscillations. In this regards, the Kepler mission was awaited with great expectation. The search for the signature of magnetic activity variability in solar-like pulsations still remained unfruitful more than 2 years after the end of the nominal mission. Here, however, we report the discovery of temporal variability in the low-degree acoustic frequencies of the young (1 Gyr-old) solar analog KIC 10644253 with a modulation of about 1.5 years with significant temporal variations along the duration of the Kepler observations. The variations are in agreement with the derived photometric activity. The frequency shifts extracted for KIC 10644253 are shown to result from the same physical mechanisms involved in the inner sub-surface layers as in the Sun. In parallel, a detailed spectroscopic analysis of KIC 10644253 is performed based on complementary ground-based, high-resolution observations collected by the HERMES instrument mounted on the MERCATOR telescope. Its lithium abundance and chromospheric activity S-index confirm that KIC 10644253 is a young and more active star than the Sun.Comment: Accepted for publication in A&A, 12 pages, 8 figure

Electromagnetic transition form factors of negative parity nucleon resonances

We have calculated the transition form factors for the electromagnetic excitation of the negative parity resonances of the nucleon using different models previously proposed and we discuss their results and limits by comparison with experimental data.Comment: 13 pages, 6 figures, to be published on Journal of Physics

The solar-like CoRoT target HD 170987: spectroscopic and seismic observations

The CoRoT mission is in its third year of observation and the data from the second long run in the galactic centre direction are being analysed. The solar-like oscillating stars that have been observed up to now have given some interesting results, specially concerning the amplitudes that are lower than predicted. We present here the results from the analysis of the star HD 170987.The goal of this research work is to characterise the global parameters of HD 170987. We look for global seismic parameters such as the mean large separation, maximum amplitude of the modes, and surface rotation because the signal-to-noise ratio in the observations do not allow us to measure individual modes. We also want to retrieve the stellar parameters of the star and its chemical composition.We have studied the chemical composition of the star using ground-based observations performed with the NARVAL spectrograph. We have used several methods to calculate the global parameters from the acoustic oscillations based on CoRoT data. The light curve of the star has been interpolated using inpainting algorithms to reduce the effect of data gaps. We find power excess related to p modes in the range [400 - 1200]muHz with a mean large separation of 55.2+-0.8muHz with a probability above 95% that increases to 55.9 +-0.2muHz in a higher frequency range [500 - 1250] muHz and a rejection level of 1%. A hint of the variation of this quantity with frequency is also found. The rotation period of the star is estimated to be around 4.3 days with an inclination axis of i=50 deg +20/-13. We measure a bolometric amplitude per radial mode in a range [2.4 - 2.9] ppm around 1000 muHz. Finally, using a grid of models, we estimate the stellar mass, M=1.43+-0.05 Msun, the radius, R=1.96+-0.046 Rsun, and the age ~2.4 Gyr.Comment: 12 pages, 15 figures, accepted for publication in A&

Asteroseismology from multi-month Kepler photometry: the evolved Sun-like stars KIC 10273246 and KIC 10920273

The evolved main-sequence Sun-like stars KIC 10273246 (F-type) and KIC 10920273 (G-type) were observed with the NASA Kepler satellite for approximately ten months with a duty cycle in excess of 90%. Such continuous and long observations are unprecedented for solar-type stars other than the Sun. We aimed mainly at extracting estimates of p-mode frequencies - as well as of other individual mode parameters - from the power spectra of the light curves of both stars, thus providing scope for a full seismic characterization. The light curves were corrected for instrumental effects in a manner independent of the Kepler Science Pipeline. Estimation of individual mode parameters was based both on the maximization of the likelihood of a model describing the power spectrum and on a classic prewhitening method. Finally, we employed a procedure for selecting frequency lists to be used in stellar modeling. A total of 30 and 21 modes of degree l=0,1,2 - spanning at least eight radial orders - have been identified for KIC 10273246 and KIC 10920273, respectively. Two avoided crossings (l=1 ridge) have been identified for KIC 10273246, whereas one avoided crossing plus another likely one have been identified for KIC 10920273. Good agreement is found between observed and predicted mode amplitudes for the F-type star KIC 10273246, based on a revised scaling relation. Estimates are given of the rotational periods, the parameters describing stellar granulation and the global asteroseismic parameters $\Delta\nu$ and $\nu_{\rm{max}}$.Comment: 15 pages, 15 figures, to be published in Astronomy & Astrophysic

Investigating the properties of granulation in the red giants observed by Kepler

More than 1000 red giants have been observed by NASA/Kepler mission during a nearly continuous period of ~ 13 months. The resulting high-frequency resolution (< 0.03 muHz) allows us to study the granulation parameters of these stars. The granulation pattern results from the convection motions leading to upward flows of hot plasma and downward flows of cooler plasma. We fitted Harvey-like functions to the power spectra, to retrieve the timescale and amplitude of granulation. We show that there is an anti-correlation between both of these parameters and the position of maximum power of acoustic modes, while we also find a correlation with the radius, which agrees with the theory. We finally compare our results with 3D models of the convection.Comment: 4 pages, 1 figure. To appear in the ASP proceedings of "The 61st Fujihara seminar: Progress in solar/stellar physics with helio- and asteroseismology", 13th-17th March 2011, Hakone, Japa