Point-of-admission neonatal hypoglycaemia in a Nigerian tertiary hospital: incidence, risk factors and outcome.

Background: Neonatal hypoglycaemia is a major metabolic problem. It may result in mortality or severe handicap among survivors. Many babies admitted for neonatal care are at high risk for hypoglycaemia. The present study set out to determine its point-of-admission prevalence, clinical presentation and outcome. Methods: Consecutive neonates who met the study criteria had plasma glucose determined at admission into the special care baby unit of Wesley Guild Hospital. Hypoglycaemia was defined as plasma glucose of ≤ 2.5mmol/L. Babies with and without hypoglycaemia were compared for risk factors, clinical features and outcome. Results: A total of 150 neonates were studied out of which 49 (32.7%) had hypoglycaemia. The mean age, 38.3 ± 71.6 in hours was significant ly lower among neonates with hypoglycaemia than those without hypoglycaemia [p = 0.006].Lowsocioeconomic class (p = 0.034), admission weight less t h a n 2500g ( p = 0.009 ) , hypothermia (p = 0.001) and preterm birth (p = 0.020) were significantly more common in babies with hypoglycaemia. Poor suck (p = 0.010), cyanosis (p = 0.020), convulsion (p = 0.040) and pallor (p = 0.048) were also more common among babies with hypoglycaemia. The mortality rate in babies with hypoglycaemia was 32.7%, higher than 18.8% in babies without hypoglycaemia but the difference was not statistically significant (p = 0.060). Conclusion: Hypoglycaemia is common among high-risk neonates and is often associated with morbidity and mortality. Routine monitoring of blood glucose is therefore recommended for this class of babiesKeyWords: Prevalence, Point-of-admission , Neonatal Hypoglycaemia, Morbidity and Mortality, Nigeria

Diagnostic value of procalcitonin in neonatal sepsis

Introduction: Neonatal sepsis is a major cause of mortality in developing countries. Accurate and quick diagnosis are difficult because clinical presentation are non-specific, bacterial cultures are time-consuming and other laboratory tests lack sensitivity and specificity. Serum procalcitonin (PCT) has been proposed as an early marker of infections in neonates.Objectives: This study investigated the value of PCT in the diagnosis of Neonatal Sepsis.Methods: Neonates undergoing sepsis evaluation at the Special Baby Care Unit, Federal Medical Centre, Abeokuta, Nigeria between January and April 2013 were included. Blood samples were obtained for white cell count, blood cultures, serum CRP and PCT analysis. Neonates were categorised into Proven Sepsis, Suspected Sepsis and Clinical Sepsis groups on the basis of laboratory findings and risk factors. A control group with no clinical and biological data of infection was also included. Predictive values and area under the receiver operating characteristic curve (AUC) of PCT were evaluated.Result: Of the 85 neonates, 19 (22.4%) had positive blood culture. PCT level was significantly higher in neonates in all sepsis groups in comparison with those in the control group (P< 0.05). At a cut-off of 0.5 ng/ml, the negative predictive value (NPV) of PCT was 80% and the positive predictive value (PPV) 39%. There were no significant statistical difference between the AUC values of PCT in Early onset and Late onset sepsis, as well between AUC in Preterm and term cases. A higher percentage of neonates who died (96%) had elevated PCT levels compared to those who survived (46%).Conclusion: These findings support the usefulness of the PCT in diagnosis of Neonatal sepsis.Keywords: Neonatal Sepsis, Diagnosis, Procalcitonin, Receiver Operating Characteristic Curv

Changes in preterm birth and stillbirth during COVID-19 lockdowns in 26 countries

Preterm birth (PTB) is the leading cause of infant mortality worldwide. Changes in PTB rates, ranging from −90% to +30%, were reported in many countries following early COVID-19 pandemic response measures (‘lockdowns’). It is unclear whether this variation reflects real differences in lockdown impacts, or perhaps differences in stillbirth rates and/or study designs. Here we present interrupted time series and meta-analyses using harmonized data from 52 million births in 26 countries, 18 of which had representative population-based data, with overall PTB rates ranging from 6% to 12% and stillbirth ranging from 2.5 to 10.5 per 1,000 births. We show small reductions in PTB in the first (odds ratio 0.96, 95% confidence interval 0.95–0.98, P value <0.0001), second (0.96, 0.92–0.99, 0.03) and third (0.97, 0.94–1.00, 0.09) months of lockdown, but not in the fourth month of lockdown (0.99, 0.96–1.01, 0.34), although there were some between-country differences after the first month. For high-income countries in this study, we did not observe an association between lockdown and stillbirths in the second (1.00, 0.88–1.14, 0.98), third (0.99, 0.88–1.12, 0.89) and fourth (1.01, 0.87–1.18, 0.86) months of lockdown, although we have imprecise estimates due to stillbirths being a relatively rare event. We did, however, find evidence of increased risk of stillbirth in the first month of lockdown in high-income countries (1.14, 1.02–1.29, 0.02) and, in Brazil, we found evidence for an association between lockdown and stillbirth in the second (1.09, 1.03–1.15, 0.002), third (1.10, 1.03–1.17, 0.003) and fourth (1.12, 1.05–1.19, <0.001) months of lockdown. With an estimated 14.8 million PTB annually worldwide, the modest reductions observed during early pandemic lockdowns translate into large numbers of PTB averted globally and warrant further research into causal pathways

Changes in preterm birth and stillbirth during COVID-19 lockdowns in 26 countries.

Preterm birth (PTB) is the leading cause of infant mortality worldwide. Changes in PTB rates, ranging from -90% to +30%, were reported in many countries following early COVID-19 pandemic response measures ('lockdowns'). It is unclear whether this variation reflects real differences in lockdown impacts, or perhaps differences in stillbirth rates and/or study designs. Here we present interrupted time series and meta-analyses using harmonized data from 52 million births in 26 countries, 18 of which had representative population-based data, with overall PTB rates ranging from 6% to 12% and stillbirth ranging from 2.5 to 10.5 per 1,000 births. We show small reductions in PTB in the first (odds ratio 0.96, 95% confidence interval 0.95-0.98, P value <0.0001), second (0.96, 0.92-0.99, 0.03) and third (0.97, 0.94-1.00, 0.09) months of lockdown, but not in the fourth month of lockdown (0.99, 0.96-1.01, 0.34), although there were some between-country differences after the first month. For high-income countries in this study, we did not observe an association between lockdown and stillbirths in the second (1.00, 0.88-1.14, 0.98), third (0.99, 0.88-1.12, 0.89) and fourth (1.01, 0.87-1.18, 0.86) months of lockdown, although we have imprecise estimates due to stillbirths being a relatively rare event. We did, however, find evidence of increased risk of stillbirth in the first month of lockdown in high-income countries (1.14, 1.02-1.29, 0.02) and, in Brazil, we found evidence for an association between lockdown and stillbirth in the second (1.09, 1.03-1.15, 0.002), third (1.10, 1.03-1.17, 0.003) and fourth (1.12, 1.05-1.19, <0.001) months of lockdown. With an estimated 14.8 million PTB annually worldwide, the modest reductions observed during early pandemic lockdowns translate into large numbers of PTB averted globally and warrant further research into causal pathways

Fresh plasma transfusion in the care of critically ILL neonates

No Abstracts.Nigerian Medical Practitioner Vol.50(5)2006: pp.96-9

Prevention of neonatal tetanus: Much preached, less practiced!

Nigerian family with two consecutive perinatal deaths from neonatal tetanus is reported. The important role of missed opportunities in the failure of immunization programmes and the persistence of neonatal tetanus in the developing world is highlighted. Other important factors are also emphasised in order to reawaken a need for concerted effort towards the elimination of the disease.Keywords: immunization; missed opportunities; neonatal tetanus Nigerian Medical Practitioner Vol. 50 (2) 2006: pp 39-4