Pattern and determinants of blood transfusion in a Nigerian neonatal unit

Objective: To determine the pattern and determinants of blood transfusion in a Nigerian neonatal unit.Materials and Methods: Newborn babies who required blood transfusions between January and December, 2008, were studied. The sex, age, and weight at the first transfusion, clinical conditions, indications for transfusion, and the outcome were analyzed with bivariate and multivariate methods.Results: A total of 402 neonates were hospitalized and 112 (27.9%) had blood transfusion; 61.9% had exchange transfusion, 66.1% had red cell transfusion, and 8% had plasma transfusion. There were 251 transfusions with a rate of 4.8 transfusions per week. Blood transfusions were done for severe jaundice (55.4%), severe anemia (40.2%), and bleeding disorders (4.4%). Weight < 2.5 kg, outside delivery, and jaundice were independent determinants of neonatal transfusion.Conclusion: The blood transfusion rate in this facility was remarkably high. Improved standard of newborn care and infrastructural support are required to reduce the transfusion rate

The Influence of Method, Timing of Onset and Duration of Enteral Feeding on the Duration of Hospitalization of Newborn Infants in a Nigerian Special Care Baby Unit

Background: Feeding practices among high‑risk newborn babies have not been extensively studied in the resource‑constrained parts of the world. Aim: To describe the pattern of milk use among infants in a resource‑poor special care baby unit (SCBU) and relate these to the outcome of hospitalization. Subjects and Methods: Setting – SCBU of Olabisi Onabanjo University Teaching Hospital, Sagamu. Design – Prospective study of consecutively admitted inborn babies within the first 24 h of life. The data analyzed included the weight and estimated gestational age (EGA) of the babies, the age at the onset of and duration of feeds (breast milk and artificial milk [AM]). Results: Out of the 118 infants studied, (78.8%) 93/118 received breast milk and 16.1% (19/118) received AM. The mean age at the commencement of enteral feeding was 3.9 days. The age at the onset of suckling was negatively correlated with the EGA and body weight. The age at the onset and duration of enteral feeding were directly related to the duration of admission. Conclusion: More than three‑quarter of the infants hospitalized in the unit received breast milk, but commencement was mostly delayed beyond the 3rd day of life. The duration of admission may be related to the timing of onset and duration of milk use.Keywords: Artificial milk, Breastfeeding, Breast milk, Intravenous fluid therapy, Newborn feeding, Resource‑poor settin

Pattern and determinants of newborn apnea in an under-resourced Nigerian setting

Objective: To determine the prevalence, distribution and determinants of newborn apnea in a resource-constrained setting.Design: Retrospective study.Materials and Methods: Newborn babies who had apnea during hospitalization between January and December 2008 were studied. The sex, age and body weight, clinical conditions, etiologies of apnea and outcome were recorded. Babies with and without apnea were compared using bivariate and multivariable analysis.Results: Out of 402 babies seen during the review, 78 (19.4%) had apnea. They comprised 59 preterm and 19 term babies. Forty (51.3%) had apnea at the point of admission while the remaining 38 (48.7) developed apnea after a mean interval of 118.5 ± 101.1 hours. Thirty-seven percent of preterms had idiopathic apnea. Etiologies included respiratory distress (50.0%), hypothermia (42.3%), and asphyxia (28.2%). Multivariate analysis showed that weight <2.5kg, hypothermia, referred status and presence of respiratory distress were determinants of apnea. Case fatality rate was 82.2% among apneic babies.Conclusion: Apnea occurred commonly in this population of babies. Stringent efforts like ventilator supports for babies in respiratory distress, better perinatal care including thermoregulation are required to reduce the occurrence of the major risk factors for newborn apnea. The identified determinants can be used to draw up effective preventive measures in resource-poor settings

Socio-clinical factors related to the perinatal outcome of teenage pregnancies in a Nigerian teaching hospital

Background: The incidence of teenage pregnancies is rising in most parts of the world. This is associated with a wide spectrum of complications inthe teenage mothers and their infants.Objective: To determine the social and clinical factors related toperinatal outcome of teenage pregnancies.Methods: A retrospective study of mothers aged < 20years managed at Olabisi Onabanjo University Teaching Hospital, Sagamu between 2008 and 2011 was done. Mothers aged 20 years and above were used as controls and comparisons were made using bivariate analysis.Results: The prevalence of teenage pregnancies was 1.3%. The mean age of the cases was 17.8 years (range of 16 - 19 years). Compared to the controls, significantly higher proportions of the cases had less than senior secondary education, were unmarried, with relatively younger spouseswho were mainly unemployed or employed as unskilled workers. In addition, teenage mothers were significantly more likely to havepreterm deliveries and babies with 1-minute Apgar scores <7. Stillbirthrate, early neonatal mortality rate and hospitalization rate were also higher among the cases. Poor perinatal outcome was more common among the cases in the lower socio-economic classes and those with low education.Conclusion: Socio-economic factors are directly or indirectly related to poor outcomes of teenage pregnancies.Key words: Perinatal mortality, Socio-economic factors, Stillbirth,Teenage pregnanc

Congenital Ichthyosis in a Nigerian preterm neonate: A case report and review of the literature

Congenital ichthyoses are relatively uncommon skin disorder s wi th worldwide occurrence. The ichthyoses are heterogenous disorders of keratinisation characterised by scaling of the skin of varying severity. This report describes a case of congenital ichthyosis in a preterm, male Hausa infant which happened to be the first case managed at the OOUTH, Sagamu. The infant was managed using stringent thermoregulation, optimal hydration, use of topical emollient and antibiotics. Although, the skin disorder resolved within fifteen days of treatment, the infant thereafter developed inguinoscrotal hernia and hydrocephalus necessitating surgical consult. The case is reported to highlight the good outcome of the cutaneous disorder following conservative management in a low-resource setting.Keywords: Collodion baby, Congenital ichthyosis , hydrocephalus, newborn, Sagam

Community-related factors militating against effective management of neonatal jaundice in resource-limited settings

Neonatal jaundice is a leading cause of neonatal admission and deaths in most parts of the low and middle income countries (LMICs). The burden of this condition is less significant in the developed world where the health system is efficient in the  prevention, early detection and prompt treatment of neonatal hyperbilirubinaemia. In the less developed parts of the world with high rates of out-of-hospital delivery,many affected babies often reach the health facility only when complications of  hyperbilirubinaemia have already set in. Such children go on to develop various neurologic deficits and serious handicapping conditions that adversely affect quality of life. Therefore, there is a gap in care that needs to be addressed in order to reduce the burden of neonatal hyperbilirubinaemia and its complications in the resource-constrained parts of the world. The gap is created by failure of early detection of jaundice in the newborn, poor perception of the potential seriousness of the condition and delay in seeking appropriate care. This review addresses the various factors contributing to this gap, including inadequate knowledge of mothers and healthcare providers at both the primary health care and general practice levels, as well as weak health system at the peripheral levels of health care. It also aims to highlight some of the measures which may be adopted to improve the knowledge and capability of significant participants in newborn care such as female education, mass media campaigns,  development of national guidelines for the management of neonatal jaundice, and the new concepts of knowledge translation and task analysis with the overall objective of strengthening the health system to appropriately manage newborn infants with hyperbilirubinaemia in developing countries of the world.Key words: Acute Bilirubin Encephalopathy, Care-seeking behaviour, Jaundice, Low and Middle Income Countries, Maternal Knowledge, Newborn care

Hypoxic Ischaemic Encephalopathy among Asphyxiated Nigeran Newborns

To compare the clinical presentation and immediate outcome of Hypoxic Ischaemic Encephalopathy among hospitalized asphyxiated newborns. Babies hospitalised with birth asphyxia in a Nigerian tertiary hospital were prospectively studied uding bivariate analysis. of 114 babies hospitalized with birth asphyxia, 41 (31.5%) had HIE. Most of the affected babies had Grade II HIE (75.6%) and were out-born (80.5%). A significantly higher proportion of the babies with HIE had seizures (P<0.001) and abnormal neurological features at the end of the first week of admission (P<0.001). The Case Fatality Rate among babies with HIE was 39.0% compared to 25.0% among those without HIE. Death occured among 25% of in-born encephalopathic babies compared to 43.8% of out-born. HIE was more severe and mortality higher among out-born babies. Prompt institution of care for asphyxiated babies may reduce HIE-related morbidities and mortality.Keywords: Asphyxia, Encephalopathy, Neurodevelopmental outcome, Newborn, Seizure

Deliberate self-harm resulting in gastric outlet obstruction; a case report

No Abstract. Nigerian Medical Practitioner Vol. 49(3) 2006: 56-5