Congenital syphilis as a notifiable disease

A review of the notification of congenital syphilis at Johannesburg Hospital from 1 May 1991 to 30 April 1992 was conducted to evaluate the effect of the recently introduced notification programme. A total of 209 Wassermann reaction (WR)-positive mothers were delivered during this time; 12 pregnancies (5,7%) resulted in stillbirths and 8 (3,8%) in incomplete abortions, and there were 2 (0,96%) early neonatal deaths. Only 45 (21,5%) of this group of WR-positive mothers had received antenatal care, and of these 9 (20%) had had adequately documented treatment. There were thus 200 potentially notifiable cases of congenital syphilis according to the Centers for Disease Control classification, of which 24 (12,0%) were actually notified. The goals ofthe notification programme, namely to increase awareness of congenital syphilis among health care providers and to evaluate the extent of the problem accurately, are clearly not being Illet

Maternal booking status as a criterion for admission for neonatal intensive care

No Abstract

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 <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

Birth asphyxia - Presenting the case for' A stitch in time'

Objectives. To. review the current birth asphyxia and subsequent cerebral palsy (CP) rates at a teaching hospital in a developing country, and to place these rates within the context of the current caesarean section (CS) rate. To determine the number of cases of birth asphyxia that are preventable.Design. Retrospective, descriptiv.e study.Setting. Neonatal nursery and intensive care unit, Johannesburg Hospital.Methods. Maternal and mionatal records were reviewed for 48 babies weighing less than 1 800 g born between 1 January and 31 December 1997 with birth asphyxia. Outcome after discharge was determined from the neonatal follow-up notes until 31 March 1998.Results. Mortality in the group of birth-asphyxiated babies was 12.5%. The birth asphyxia rate was 6/1 000 live births, and the CP rate in the study group was 1.15/1 000 live births. The CS rate for the group was 29%, with an overall CS rate at the hospital of 20.5%. In 22 cases (46%) the cause of birth asphyxia was considered to have been preventable.Conclusion. The cr rate is considerably higher than that quoted for developed  countries, and a significant number of cases of birth asphyxia in the study were  preventable. In the face of the high birth asphyxia and cr rates, the CS rate appears to be inappropriately Iow. The CS rate should be audited in the context of the birth asphyxia and cr rates

Selection of paediatric patients for intensive care

No Abstract

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<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.The South African Medical Research Councilhttp://www.samj.org.zaam2021Immunolog

Editorials

Selective posterior rhizotomy in the treatment of spasticityPrevention ofcongenital syphilis by effective maternal screening at antenatal clinicsSome reasons for the failure to notify congenital syphilisTowards a future policy for transplantation in South AfricaThe neuroleptic malignant syndrome - still a conundrumHealthy cities for a future South Afric