Prevalence, perceptions and practices surrounding neonatal breast enlargement - a South East Nigerian experience

Background: Newborns are often brought to the emergency room or outpatient department with a history of swelling of one or both breasts. Further inquiry usually reveals attempts at intervention, in form of massage, application of herbs and even scarification. These lead to increased morbidity such as abscess formation and cellulitis.Objective: To document prevalence of, and perceptions about neonatal breast enlargement in newborns and interventions if any in south east Nigeria.Results: Neonatal breast enlargement was present in 50.8% of the target population with females 53.1%and males 46.9%. There were attempts at treatment in 5% of patients and the common interventions were: use of hot water to massage the breasts as well as use of rubs/balms. Family members had  significant influence on the decision to intervene. (Mothers/in-laws 58.3%, neighbours 39.6%). Most mothers did not have any idea of the possible cause and some were alarmed on noticing the swelling.Conclusion: Since neonatal breast enlargement is prevalent in our environment and the tendency to intervene is high, health education will prevent this and thus the complications of intervention like abscess formation and sequelae in adult life. Also reassurance of mothers will help them to relax and take care of their babies optimally.Key words: Breast enlargement, Neonate, Massage, Blood-lettin

Childhood nephrotic syndrome as seen at the Federal Medical Centre, Umuahia, Nigeria

Background: Nephrotic syndrome still remains one of the commonest indications for paediatric renal consult worldwide. The Nephrology unit in our centre is a young one. This study reviews the cases of nephrotic syndrome we managed over a three year period. Aim and Objective: To document its prevalence among other renal cases, pattern of presentation, response to steroid and associated mortality. Methodology: This was a retrospective review of all cases of nephrotic syndrome at our centre from July 2010 to June 2013. Data reviewed were age at presentation, gender, duration of illness, presenting features, laboratory test results, response to steroid and outcome. Results: There were 22 patients. This gave a prevalence rate of 68.8% out of the 32 renal cases seen within this period. There were 14(63.6%) males and 8(36.4%) females with a M: F of 1.8:1. The age range of the patients was 4-15 years with a mean age of 9.68±2.93 years and a peak age of 8-9 years. 3 patients (13.6%) died while on admission; 13(59.1%) patients were followed up while 6(27.3%) were lost to follow up. Out of those followed up, 4(30.8%) were sensitive to steroid, while 9(69.2%) were steroid resistant. Conclusion: Nephrotic syndrome is the commonest renal disorder in our centre, occurring more in males than in females; majority being the steroid resistant types, and also associated with significant mortality.Keywords: Nephrotic syndrome, Steroid resistant, Poor outcome, Umuahia, Nigeri

Improvised Peritoneal Dialysis on a 5 year old girl: Experience with Double lumen Haemodialysis Catheter in South East, Nigeria

Background: The incidence of acute kidney injury (AKI) in children worldwide has remained unacceptably high, especially in the developing nations. The associated mortality is very significant, and this is mainly due to unavailability of renal replacement therapy (RRT). In the face of current global economic crises, improvised peritoneal dialysis (PD) remains a more feasible RRT for children with AKI in resource limited centres.Case diagnosis: A 5 year old girl was referred to us with a history of fever, gastroenteritis, oliguria, unconsciousness and seizure. Her creatinine was 1020 μmol/L, urea 55.1mmol/L, and Bicarbonate of 15 mmol/L. A diagnosis of AKI with uraemic encephalopathy was made. Treatment/Result: She was offered peritoneal dialysis using temporary haemodialysis (HD) catheter and fortified Ringers lactate solution with a good outcome.Conclusion: While efforts should be intensified towards making standard PD catheters/fluids available and affordable for the developing nations, improvised PD could be used as an alternative in more resource poor health facilities. HD catheters can be successfully improvised as PD catheters if HD is not feasible, and standard PD catheter unavailable.Key words: Improvised, Peritoneal Dialysis, Haemodialysis Catheter, South East Nigeria