Transient neonatal diabetes or neonatal hyperglycaemia: A case report

Transient neonatal diabetes and neonatal hyperglycaemia both present in the neonatal period with features of hyperglycaemia, dehydration and weight loss. Differentiating these conditions clinically is difficult. We describe the case of a 13 day old female whom we managed recently who could have had either condition. Hyperglycaemia is not as commonly documented as would be expected for the frequency of neonatal disease and when it does occur, it will worsen neonatal morbidity and mortality. Blood glucose levels in babies ondextrose infusion should be monitored regularly in order to help individualiseglucose requirements

DEVELOPMENT OF IMPROVED SOLID HOSPITAL WASTE MANAGEMENT PRACTICES IN A NIGERIAN TERTIARY HOSPITAL

A pre-intervention situation analysis was conducted to assess Hospital Waste Management (HWM) practices, solutions were proffered for the observed inadequacies and advocacy was made to Hospital administration for which a number of interventional measures were instituted. A post interventional survey was conducted to identify the improvements in HWM and identify areas needing further attention using a structured questionnaire to collect 300 viable samples. Overall outcome includes introduction of HWM plan, establishment of Environmental unit, procurement of waste segregation practices, double chambered incinerator while evaluation of medical and health workers’ knowledge and practices showed that 144(48%) express satisfaction with HWM.  The profession of respondents has significant effect on the knowledge about HWM while the educational qualification was not independently associated with level of satisfaction and use of personal protective equipments while handling medical waste at p=0.05. It was therefore concluded that continuous training/ capacity development and provision of waste management materials remain essential for consolidating the gains made on HWM. http://dx.doi.org/10.4314/njt.v35i3.2

Glucose 6 phosphate dehydrogenase levels in babies delivered at the University of Ilorin teaching hospital.

Background: Glucose-6-phosphate dehydrogenase deficiency, an X-linked recessive disorder, is the most common enzymopathy producing disease in humans.It is known to cause severe neonatal hyperbilirubinaemia. Aims and Objectives: To determine G6PD levels in babies delivered at the University of Ilorin Teaching Hospital with a view to determining the prevalence of G6PDdeficiency. Methods: Samples of cord blood were collected at delivery, from 933 babies who met set criteria. Blood was assayed for G6PD levels using a quantitative in vitro test (RANDOX©). Results: A total of 348 (37.3%) of the 933 tested subjects had G6PD deficiency with enzyme activity of ≤ 2.8U/gHb. Glucose 6 Phosphate Dehydrogenase levels in female babies with normal enzyme levels were significantly higher than in male babies with normal enzyme levels (5.72 ± 2.45 U/gHb versus 4.99 ± 2.3 U/gHb, p = 0.002). Enzyme levels in babies with G6PD deficiency was comparable in both males and females (2.05 ± 0.60 u/gHb in females and 2.1 ± 0.66 U/gHb in males, p = 0.66). The prevalence of G6PD deficiency was comparable among males and females (p = 0.81 Χ²= 0.06, RR = 1.02 , CI = 0.9 0 < R R < 1.15 , OR=1.04). Conclusion: There is a high prevalence of G6PD deficiency in babies delivered at the University of Ilorin Teaching Hospital, and the enzyme deficiency appears to occur equally among the sexes.Key words: Glucose-6-phosphate, neonates, cord bloo

Intranasal Endoscopic Repair of Bilateral Choanal Atresia in a Male Newborn with Crouzon's Syndrome

No Abstract

Unusual occurrence of congenital hypothyroidism in a set of same sex triplets: challenges of diagnosis in a resource poor setting

Congenital hypothyroidism is the most common endocrinological disorder in children. Genetic and intrauterine factors have been implicated in its aetiology. The aim of this study was to describe an unusual occurrence of congenital hypothyroidism in a set of same sex triplets and challenges associated with the diagnosis. This is a review of a set of female triplets delivered at 34 weeks gestational age and noticed to have reduced activity, hypotonia and poor suck. On testing for thyroid hormones the patients were found to be hypothyroid. However this diagnosis was delayed until the 6th week of life as a result of difficulties in running the test. The subjects of the study were placed on thyroxine supplementation and have been doing well. Congenital hypothyroidism can occur in multiple order pregnancies and clinicians should have a high index of suspicion for its occurrence.Keywords: Congenital hypothyroidism; Triplets; Diagnosi

Acute Respiratory Infections in the Middle-Belt Region of Nigeria

Background: ARI continues to be a leeding cause of death among children globally beyond the year 2000. Close 12 million children under the age of 5years die each year in the developing countries, mainly from preventable causes and approximately 2.28 million (19%) were due to acute respiratory infections (ARI). It therefore became necessary to assess the present status of the disease in Nigeria to mastermind workable plans for reducing the mortality and morbidity burden.Methods: A designed pro-forma was used to collect and collate information from mothers or direct care givers of children at both hospital and community levels relating to family background, home setting, anthropometry, clinical presentation of ARI, previous medications, investigations, complications and outcomes of illness.Results: A total of 163 children were recruited for the study. One hundred and six had moderate and severe form of ARI while 57 had mild form. The in-patients accounted for 15.2% of all the admission within the study period.All children were under 12 years of age with male preponderance. Fast breathing, Tarchypnoea, Cough and Fever were the leading ways of presentations. The immunization coverage of study population by various antigens in the EPI were poor. Majority of the hospital children had pre-consultation antibiotics while none of the children from the rural community had pre-recruitment antibiotics. Streptococcus pneumoniae and Staphylococcus aureus were the leading organisms isolated with good sensitivity to Quinolones, Gentamycin and Cephalosporins. Heart failure was the leading complications. Mortality was 12.3% among the hospitalized patient and none among the community children.Conclusion: It was concluded that ARI is still a major cause of morbidity and mortality among children with opportunity for burden reduction.Keywords: Acute Respiratory Infection, present outlook, burde

Conference summary report of the 10th Annual General and Scientific Meeting of the Nigerian Society of Neonatal medicine (NISONM) held in Ibadan, Nigeria on 4th -7th July, 2017

The 10th Annual General and Scientific Meeting (AGSM) of the Nigerian Society of Neonatal Medicine (NISONM) took place in Ibadan, South -West Nigeria. The theme of the conference was: Imperatives in neonatal survival initiatives in Nigeria: The current state. The conference addressed a variety of topics relevant to newborn health from eminent speakers from across the globe. The four-day conference included preconference workshops and community mobilization/ health outreach in Lagelu local government area

Exposure to anti-malarial drugs and monitoring of adverse drug reactions using toll-free mobile phone calls in private retail sector in Sagamu, Nigeria: implications for pharmacovigilance

<p>Abstract</p> <p>Background</p> <p>Adverse drug reactions (ADRs) contribute to ill-health or life-threatening outcomes of therapy during management of infectious diseases. The exposure to anti-malarial and use of mobile phone technology to report ADRs following drug exposures were investigated in Sagamu - a peri-urban community in Southwest Nigeria.</p> <p>Methods</p> <p>Purchase of medicines was actively monitored for 28 days in three Community Pharmacies (CP) and four Patent and Proprietary Medicine Stores (PPMS) in the community. Information on experience of ADRs was obtained by telephone from 100 volunteers who purchased anti-malarials during the 28-day period.</p> <p>Results and Discussion</p> <p>A total of 12,093 purchases were recorded during the period. Antibiotics, analgesics, vitamins and anti-malarials were the most frequently purchased medicines. A total of 1,500 complete courses of anti-malarials were purchased (12.4% of total purchases); of this number, purchases of sulphadoxine-pyrimethamine (SP) and chloroquine (CQ) were highest (39.3 and 25.2% respectiuvely). Other anti-malarials purchased were artesunate monotherapy (AS) - 16.1%, artemether-lumefantrine (AL) 10.0%, amodiaquine (AQ) - 6.6%, quinine (QNN) - 1.9%, halofantrine (HF) - 0.2% and proguanil (PR) - 0.2%. CQ was the cheapest (USD 0.3) and halofantrine the most expensive (USD 7.7). AL was 15.6 times ($4.68) more expensive than CQ. The response to mobile phone monitoring of ADRs was 57% in the first 24 hours (day 1) after purchase and decreased to 33% by day 4. Participants in this monitoring exercise were mostly with low level of education (54%).</p> <p>Conclusion</p> <p>The findings from this study indicate that ineffective anti-malaria medicines including monotherapies remain widely available and are frequently purchased in the study area. Cost may be a factor in the continued use of ineffective monotherapies. Availability of a toll-free telephone line may facilitate pharmacovigilance and follow up of response to medicines in a resource-poor setting.</p

Placental Plasmodium falciparum malaria infection: Operational accuracy of HRP2 rapid diagnostic tests in a malaria endemic setting

<p>Abstract</p> <p>Background</p> <p>Malaria has a negative effect on the outcome of pregnancy. Pregnant women are at high risk of severe malaria and severe haemolytic anaemia, which contribute 60-70% of foetal and perinatal losses. Peripheral blood smear microscopy under-estimates sequestered placental infections, therefore malaria rapid diagnostic tests (RDTs) detecting histidine rich protein-2 antigen (HRP-2) in peripheral blood are a potential alternative.</p> <p>Methods</p> <p>HRP-2 RDTs accuracy in detecting malaria in pregnancy (MIP >28 weeks gestation) and placental <it>Plasmodium falciparum </it>malaria (after childbirth) were conducted using Giemsa microscopy and placental histopathology respectively as the reference standard. The study was conducted in Mbale Hospital, using the midwives to perform and interpret the RDT results. Discordant results samples were spot checked using PCR techniques.</p> <p>Results</p> <p>Among 433 febrile women tested, RDTs had a sensitivity of 96.8% (95% CI 92-98.8), specificity of 73.5% (95% CI 67.8-78.6), a positive predictive value (PPV) of 68.0% (95% CI 61.4-73.9), and negative predictive value (NPV) of 97.5% (95% CI 94.0-99.0) in detecting peripheral <it>P. falciparum </it>malaria during pregnancy. At delivery, in non-symptomatic women, RDTs had a 80.9% sensitivity (95% CI 57.4-93.7) and a 87.5% specificity (95%CI 80.9-92.1), PPV of 47.2% (95% CI 30.7-64.2) and NPV of 97.1% (95% CI 92.2-99.1) in detecting placental <it>P. falciparum </it>infections among 173 samples. At delivery, 41% of peripheral infections were detected by microscopy without concurrent placental infection. The combination of RDTs and microscopy improved the sensitivity to 90.5% and the specificity to 98.4% for detecting placental malaria infection (McNemar's <it>X </it>²> 3.84). RDTs were not superior to microscopy in detecting placental infection (McNemar's <it>X </it>²< 3.84). Presence of malaria in pregnancy and active placental malaria infection were 38% and 12% respectively. Placental infections were associated with poor pregnancy outcome [pre-term, still birth and low birth weight] (aOR = 37.9) and late pregnancy malaria infection (aOR = 20.9). Mosquito net use (aOR 2.1) and increasing parity (aOR 2.7) were associated with lower risk for malaria in pregnancy.</p> <p>Conclusion</p> <p>Use of HRP-2 RDTs to detect malaria in pregnancy in symptomatic women was accurate when performed by midwives. A combination of RDTs and microscopy provided the best means of detecting placental malaria. RDTs were not superior to microscopy in detecting placental infection. With a high sensitivity and specificity, RDTs could be a useful tool for assessing malaria in pregnancy, with further (cost-) effectiveness studies.</p

Distal Renal Tubular Acidosis, an Uncommonly diagnosed Cause of Failure to Thrive: Report of Five Cases.

Five cases of distal renal tubular acidosis aged between 2½ weeks and 2½ months are described. The presenting features included lethargy, refusal to feed, high density of periodic respiration, vomiting and recurrent episodes of unexplained metabolic acidosis. A constant feature was failure to thrive despite caloric intakes in excess of normal requirements. The diagnosis of distal renal tubular acidosis (DRTA) was based on a urine pH>5.5 in a freshly voided urine despite concurrent or induced metabolic acidosis. All the babies responded dramatically to sodium bicarbonate supplement, as baking soda or bicarbonate of soda. The need for increased index of suspicion of DRTA in the evaluation of children in early infancy for failure to thrive and the simplicity of treatment using baking soda is discussed. Nigerian Journal of Paediatrics 2001; 28:21. pp. 21-2