Improving the outcome of preterm babies in resource poor settings

No Abstract

Uncomplicated Caesarean Section: is Delayed Return to Oral Feeding Necessary?

OBJECTIVE: To asses the feasibility and practicability of resuming oral feeding six hours after caesarean section.  METHODS: Eighty five women undergoing primary caesarean section at proprietary hospital in Lagos Nigeria were randomised into two groups of commencement of oral feeding six hours after surgery and waiting for at least 24hours for bowel sounds to return.RESULTS: In 27(64.3%) of the 42 patients in the routine feeding group, normal bowel sounds were present about 24hours after the operation as against 37(86.0%) of 43 in the early feeding group(X2 = 5.41;p= 0.02 , OR = 3.43 ; 1.06 – 11.5). While 93.0%(40) of the patients in early feeding group had bowel motion within 48hours , only 69.0%(29) of the patients in the routine feeding group had bowel motion within same period( X2 = 6.50 ; p = 0.01). The percentage of mothers that were ambulant within 48hours were more in the early feeding group (83.7%) compared to the routine feeding group (61.9%) -X2 = 5.12; p = 0.02). The overall gastrointestinal morbidity among the early feeding group was higher (18.6%) compared to routine feeding group (11.9%) but the difference was not statistically significant(X2 = 0.13; p = 0.72, OR = 1.54; CI = 0.38 – 6.33). CONCLUSION: Early oral finding is not only feasible but practicable.Key words: Caesarean Section, Oral Feedin

Correlation of cardiac troponin T level, clinical parameters and myocardial ischaemia in perinatal asphyxia

Introduction: Resource limitation in developing countries may preclude access to cardiac troponin-T assay thereby necessitating reliance on clinical judgment for identification of hypoxic myocardial cellular injury.Objectives: To relate selected clinical signs with elevated serum cardiactroponin-T in asphyxiated term neonates.Methods: Asphyxia was identified by low umbilical arterial blood pH . 7.20 and low five minute Apgar score . 6 while controls were term, non.asphyxiated neonates. All babies were examined for heart rate,heart rhythm irregularities, peripheral pulse volume, respiratory rate,pallor, cyanosis, heart murmur and sensorium.Results: Thirty term, asphyxiated neonates and their matched controlswere studied. Central cyanosis, reduced pulse volume, pallor, depressedsensorium; tachycardia and tachypnea were all associated with increased odds ratios for abnormal cardiac troponin.T levels.Conclusion: Clinicians working in resource.limited health facilitiesshould have a high index of suspicion for myocardial cellular injurywhen these signs are elicited.Keywords: neonates, asphyxia, troponin-T, myocardial injur

Maternal and neonatal factors associated with mode of delivery under a universal newborn hearing screening programme in Lagos, Nigeria

<p>Abstract</p> <p>Background</p> <p>Emerging evidence from a recent pilot universal newborn hearing screening (UNHS) programme suggests that the burden of obstetric complications associated with mode of delivery is not limited to maternal and perinatal mortality but may also include outcomes that undermine optimal early childhood development of the surviving newborns. However, the potential pathways for this association have not been reported particularly in the context of a resource-poor setting. This study therefore set out to establish the pattern of delivery and the associated neonatal outcomes under a UNHS programme.</p> <p>Methods</p> <p>A cross-sectional study in which all consenting mothers who delivered in an inner-city tertiary maternity hospital in Lagos, Nigeria from May 2005 to December 2007 were enrolled during the UNHS programme. Socio-demographic, obstetric and neonatal factors independently associated with vaginal, elective and emergency caesarean deliveries were determined using multinomial logistic regression analyses.</p> <p>Results</p> <p>Of the 4615 mothers enrolled, 2584 (56.0%) deliveries were vaginal, 1590 (34.4%) emergency caesarean and 441 (9.6%) elective caesarean section. Maternal age, parity, social class and all obstetric factors including lack of antenatal care, maternal HIV and multiple gestations were associated with increased risk of emergency caesarean delivery compared with vaginal delivery. Only parity, lack of antenatal care and prolonged/obstructed labour were associated with increased risk of emergency compared with elective caesarean delivery. Infants delivered by vaginal method or by emergency caesarean section were more likely to be associated with the risk of sensorineural hearing loss but less likely to be associated with hyperbilirubinaemia compared with infants delivered by elective caesarean section. Emergency caesarean delivery was also associated with male gender, low five-minute Apgar scores and admission into special care baby unit compared with vaginal or elective caesarean delivery.</p> <p>Conclusions</p> <p>The vast majority of caesarean delivery in this population occur as emergencies and are associated with socio-demographic factors as well as several obstetric complications. Mode of delivery is also associated with the risk of sensorineural hearing loss and other adverse birth outcomes that lie on the causal pathways for potential developmental deficits.</p

Prevalence and clinical correlates of Microalbuminuria among children with Sickle cell Anaemia attending Lagos State University Teaching Hospital, Ikeja

No Abstrac