Indications for Blood Transfusion among Children in a Tertiary Hospital in North-Central Nigeria

Background: Anaemia is prevalent among children in our environment, often necessitating blood transfusions. Knowledge of the common reasons for blood transfusion and institution of preventive measures is likely to reduce transfusion rate in the region. We undertook a review of indications for blood transfusion in children at the Jos University Teaching Hospital, Jos. Nigeria, over a 1 year period. Methodology: The case notes of all children aged 1 month to 18 years who received blood transfusion in the unit were reviewed. The patients' biodata, underlying medical condition and the type of blood transfusion were among data analysed. Results: There were 956 paediatric admissions into the Emergency Paediatrics Unit of the hospital, 8.9% (85) had blood transfusions. Sickle cell anaemia (57.7%) and cancer related problems (17.6%) were the most common indications for blood transfusions. Malaria was an uncommon reason for blood transfusion. Conclusion: Blood transfusion is frequently indicated in the paediatric population in our setting, largely due to sickle cell anaemia and cancer related problems. Intensifying efforts at premarital screening and counselling targeted at sickle cell anaemia may reduce the prevalence of this disease, while environmental control may reduce cancer incidence and consequently minimize the need for blood transfusions among our children.Key Words Blood transfusion, sickle cell anaemia, childhood cancers

Acute bilirubin encephalopathy and its progression to kernicterus: current perspectives

Fatima Usman,1,2,* Udochukwu Michael Diala,3,4,* Steven M Shapiro,5–7 Jean Baptiste Le Pichon,5–7 Tina M Slusher8,9 1Department of Pediatrics, Bayero University Kano, Kano, Nigeria; 2Department of Pediatrics, Aminu Kano Teaching Hospital, Kano, Nigeria; 3Department of Pediatrics, University of Jos, Jos, Plateau State, Nigeria; 4Department of Pediatrics, Jos University Teaching Hospital, Jos, Plateau State, Nigeria; 5Department of Paediatrics, Children’s Mercy Hospital, Kansas City, MO, USA; 6Department of Paediatrics, University of Missouri-Kansas City, Kansas City, MO, USA; 7Department of Paediatrics, University of Kansas, Kansas City, MO, USA; 8Department of Paediatrics, Division of Global Healthy, University of Minnesota, Minneapolis, MN, USA; 9Pediatric Intensive Care Faculty, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN, USA *These authors contributed equally to this work Abstract: Acute bilirubin encephalopathy (ABE) remains a significant cause of morbidity and mortality throughout the world, especially in low-middle-income countries where it can account for up to 15% of neonatal death. The pathophysiology of this acute life-threatening event of infancy and its potential evolution to kernicterus remain poorly understood. In this review, we start by reviewing the terminology of hyperbilirubinemia and its clinical consequences, ABE and later kernicterus spectrum disorder (KSD). We then review the pathogenesis of ABE and discuss clinical factors that can contribute to its pathogenicity. We examine in detail the clinical correlates of ABE and KSD. We present a comprehensive approach to its diagnosis and conclude with a set of simple clinical interventions ranging between primary preventive and rehabilitative measures that may help reduce the incidence of this largely preventable disease. Keywords: acute bilirubin encephalopathy, neonatal jaundice, kernicterus, kernicterus spectrum disorder, low-middle-income countrie

Acute bilirubin encephalopathy and its progression to kernicterus: current perspectives

Fatima Usman,1,2,* Udochukwu Michael Diala,3,4,* Steven M Shapiro,5–7 Jean Baptiste Le Pichon,5–7 Tina M Slusher8,9 1Department of Pediatrics, Bayero University Kano, Kano, Nigeria; 2Department of Pediatrics, Aminu Kano Teaching Hospital, Kano, Nigeria; 3Department of Pediatrics, University of Jos, Jos, Plateau State, Nigeria; 4Department of Pediatrics, Jos University Teaching Hospital, Jos, Plateau State, Nigeria; 5Department of Paediatrics, Children’s Mercy Hospital, Kansas City, MO, USA; 6Department of Paediatrics, University of Missouri-Kansas City, Kansas City, MO, USA; 7Department of Paediatrics, University of Kansas, Kansas City, MO, USA; 8Department of Paediatrics, Division of Global Healthy, University of Minnesota, Minneapolis, MN, USA; 9Pediatric Intensive Care Faculty, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN, USA *These authors contributed equally to this work Abstract: Acute bilirubin encephalopathy (ABE) remains a significant cause of morbidity and mortality throughout the world, especially in low-middle-income countries where it can account for up to 15% of neonatal death. The pathophysiology of this acute life-threatening event of infancy and its potential evolution to kernicterus remain poorly understood. In this review, we start by reviewing the terminology of hyperbilirubinemia and its clinical consequences, ABE and later kernicterus spectrum disorder (KSD). We then review the pathogenesis of ABE and discuss clinical factors that can contribute to its pathogenicity. We examine in detail the clinical correlates of ABE and KSD. We present a comprehensive approach to its diagnosis and conclude with a set of simple clinical interventions ranging between primary preventive and rehabilitative measures that may help reduce the incidence of this largely preventable disease. Keywords: acute bilirubin encephalopathy, neonatal jaundice, kernicterus, kernicterus spectrum disorder, low-middle-income countrie

Methylated spirit versus 4% chlorhexidine gel in neonatal umbilical cord infection: A short report of a randomized, openlabelled, parallel-group trial

Background: Neonatal sepsis is a known leading cause of neonatal morbidity and mortality.Aim: To compare the efficacies of 96% methylated spirit and 4% chlorhexidine (CHX) gel in the treatment of umbilical stump of neonates.Method: This was a randomized, open labelled, parallel group trial of CHX gel and Methylated spirit for neonatal umbilical cord care in Jos, between 2/6/17 and 16/7/17. Inclusion criteria were term, newly born 0 to 6 hours old, with no known risk for sepsis and written informed parental consent. Eligible subjects were randomized to receive methylated spirit or 4% CHX gel. Outcome measures were cord separation time, omphalitis, neonatal sepsis and neonatal mortality by day 28.Results: A total sample of 51 of 58 met enrolment criteria. Thirtytwo (62.7%) where delivered in JUTH, 33(64.7%) were males with a mean birth weight of 3.7kg (CI 3.04 – 3.30). Mean cord separation times were 7.96 ± 4.07)days in the methylated spirit group vs 6.43 ± 3.13days in the CHX comparator group, (p=0.078). Omphalitis was0% vs2(8.3%) and NNS 2 (7.4%)vs2(8.3%) in methylated spirit and CHX treatment groups respectively. There was 1(3.7%) mortality in the methylated spirit treatment group.Conclusion: Methylated spirit and 4% CHX gel have comparable umbilical stump treatment efficacy. Methylated spirit may be a safe alternative in clinical settings where topical 4% CHX gel is unavailable or unsafe.Key words: Methylated spirit, 4% Chlorhexidine gel, mortality, Cord separation time, Neonatal sepsis, Omphaliti

Mortality attributable to third-generation cephalosporin resistance in Gram-negative bloodstream infections in African hospitals: a multi-site retrospective study

Background Bloodstream infections (BSI) caused by Enterobacteriaceae show increasing frequency of resistance to third-generation cephalosporin (3GC) antibiotics on the African continent but the mortality impact has not been quantified. Methods We used historic data from six African hospitals to assess the impact of 3GC resistance on clinical outcomes in Escherichia coli and Klebsiella pneumoniae BSI. We matched each bacteraemic patient to two uninfected patients. We compared outcomes between 3GC-susceptible and 3GC-resistant BSI and their respective uninfected controls using Cox regression models. Results For 1431 E. coli BSI patients, we matched 1152 (81%) 3GC-susceptible and 279 (19%) 3GC-resistant cases to 2263 and 546 uninfected inpatient controls. For 1368 K. pneumoniae BSI patients, we matched 502 (37%) 3GC-susceptible and 866 (63%) 3GC-resistant cases to 982 and 1656 uninfected inpatient controls. We found that 3GC-resistant E. coli had similar hazard ratios (HRs) for in-hospital mortality over their matched controls as compared to susceptible infections over their controls (ratio of HRs 1.03, 95% CI 0.73–1.46). Similarly, 3GC-resistance in K. pneumoniae BSI was not associated with mortality (ratio of HR 1.10, 95% CI 0.80–1.52). Estimates of mortality impact varied by site without a consistent pattern. Conclusions In a retrospective analysis, including the use of matched uninfected patients, there did not appear to be an impact of 3GC-resistance on mortality in E. coli or K. pneumoniae BSI in African hospitals, as compared with susceptible BSI with equivalent species. Better information on the actual use of antibiotics in treating infections in African hospitals would improve these impact estimates