Psychological complications of childhood chronic physical illness in Nigerian children and their mothers: the implication for developing pediatric liaison services

<p>Abstract</p> <p>Background</p> <p>Pediatric liaison services attending to the psychological health needs of children with chronic physical illness are limited or virtually non-existent in Nigeria and most sub-Saharan African countries, and psychological problems complicate chronic physical illness in these children and their mothers. There exist needs to bring into focus the public health importance of developing liaison services to meet the psychological health needs of children who suffer from chronic physical illness in this environment. Sickle cell disease (SCD) and juvenile diabetes mellitus (JDM) are among the most common chronic physical health conditions in Nigerian children. This study compared the prevalence and pattern of emotional disorders and suicidal behavior among Nigerian children with SCD, JDM and a group of healthy children. Psychological distress in the mothers of these children that suffer chronic physical illness was also compared with psychological distress in mothers of healthy control children.</p> <p>Methods</p> <p>Forty-five children aged 9 to 17 years were selected for each group of SCD, JDM and controls. The SCD and JDM groups were selected by consecutive clinic attendance and the healthy children who met the inclusion criteria were selected from neighboring schools. The Youth version of the Computerized Diagnostic Interview Schedule for Children, version IV (C- DISC- IV) was used to assess for diagnosis of emotional disorders in these children. Twelve-item General Health Questionnaire (GHQ – 12) was used to assess for psychological distress in mothers of these children and healthy control children.</p> <p>Results</p> <p>Children with JDM were significantly more likely to experience DSM – IV emotional disorders than children with SCD and the healthy group (p = 0.005), while children with JDM and SCD were more likely to have 'intermediate diagnoses' of emotional disorders (p = 0.0024). Children with SCD and JDM had higher rates of suicidal ideation when compared to healthy control children and a higher prevalence of maternal psychological distress was found in their mothers when compared to the mothers of healthy children (p = 0.035).</p> <p>Conclusion</p> <p>The higher prevalence of emotional disorders and suicidal ideation among children with SCD and JDM points to a need for development of liaison services in pediatric facilities caring for children with chronic physical illness to ensure holistic approach to their care. The proposed liaison services would also be able to provide family support interventions that would address the psychological distress experienced by the mothers of these children.</p

Consensus statement on abusive head trauma in infants and young children

Abusive head trauma (AHT) is the leading cause of fatal head injuries in children younger than 2 years. A multidisciplinary team bases this diagnosis on history, physical examination, imaging and laboratory findings. Because the etiology of the injury is multifactorial (shaking, shaking and impact, impact, etc.) the current best and inclusive term is AHT. There is no controversy concerning the medical validity of the existence of AHT, with multiple components including subdural hematoma, intracranial and spinal changes, complex retinal hemorrhages, and rib and other fractures that are inconsistent with the provided mechanism of trauma. The workup must exclude medical diseases that can mimic AHT. However, the courtroom has become a forum for speculative theories that cannot be reconciled with generally accepted medical literature. There is no reliable medical evidence that the following processes are causative in the constellation of injuries of AHT: cerebral sinovenous thrombosis, hypoxic-ischemic injury, lumbar puncture or dysphagic choking/vomiting. There is no substantiation, at a time remote from birth, that an asymptomatic birth-related subdural hemorrhage can result in rebleeding and sudden collapse. Further, a diagnosis of AHT is a medical conclusion, not a legal determination of the intent of the perpetrator or a diagnosis of murder. We hope that this consensus document reduces confusion by recommending to judges and jurors the tools necessary to distinguish genuine evidence-based opinions of the relevant medical community from legal arguments or etiological speculations that are unwarranted by the clinical findings, medical evidence and evidence-based literature

Cerebral glucose metabolism measured by positron emission tomography in term newborn infants with hypoxic ischemic encephalopathy

Total and regional cerebral glucose metabolism (CMRgl) was measured by positron emission tomography with 2-(F-18) fluoro-2-deoxy-D-glucose ((18)FDG) in 20 term infants with hypoxic ischemic encephalopathy (HIE) after perinatal asphyxia. All infants had signs of perinatal distress, and 15 were severely acidotic at birth. Six infants developed mild HIE, twelve moderate HIE, and two severe HIE during their first days of life. The positron emission tomographic scans were performed at 4-24 d of age (median, 11 d). One hour before scanning, 2-3.7 MBq/kg (54-100 µCi/kg) (18)FDG was injected i.v. No sedation was used. Quantification of CMRgl was based on a new method employing the glucose metabolism of the erythrocytes, requiring only one blood sample. In all infants, the most metabolically active brain areas were the deep subcortical parts, thalamus, basal ganglia, and sensorimotor cortex. Frontal, temporal, and parietal cortex were less metabolically active in all infants. Total CMRgl was inversely correlated with the severity of HIE (p mol.min(-1).100 g(-1), 11 with moderate HIE had 26.6 (13.0-65.1) µmol.min(-1).100 g(-1), and two with severe HIE had 10.4 and 15.0 µmol.min(-1).100 g(-1), respectively. Five of six infants who developed cerebral palsy had a mean (range) CMRgl of 18.1 (10.2-31.4) µmol.min(-1).100 g(-1) compared with 41.5 (13.0-100.8) µmol.min(-1).100 g(-1) in the infants with no neurologic sequela at 2 y. We conclude that CMRgl measured during the subacute period after perinatal asphyxia in term infants is highly correlated with the severity of HIE and short-term outcome

Two-year outcomes for infants with low cord pH at birth

Abstract Objective: To determine the long-term outcome of infants born with cord pH ≤7.0 and no clinical evidence of asphyxia at birth. Design: Setting: Tertiary Referral Centre. A prospective matched cohort study was conducted. 51 term infants were recruited following singleton birth with venous cord pH ≤7.0.For each recruited baby a healthy baby with normal cord pH >7.20 was recruited matched for gestation, gender and mode of delivery. Ages and Stages Questionnaires (ASQ)(TM) and Health Screening Questionnaires (HSQ) were sent out at 24 months of age. Two independent assessors, blinded to the case assignment, reviewed intrapartum and neonatal events to look for clinical evidence of birth asphyxia among the cases. Result: From 102 infants recruited, 62 questionnaires (24 cases, 38 controls) were returned. 20 matched pairs with no clinical evidence of birth asphyxia were available for analysis. The groups were similar except in terms of birth weight; the p