Importance of micronutrient supplementation in children with congenital heart defects in Nigeria

The prevalence of congenital heart defects is increasing globally. Improvements in surgical techniques have resulted in increased life expectancy for individuals with heart defects. In developing countries, it is not unusual to find children with simple congenital heart defects presenting with complications (nutritional and non-nutritional) due to delay in surgical correction. Data on nutritional deficiencies in children with heart diseases are rare, more so, those on micronutrient deficiencies. Macro- and micronutrient deficiencies are common among children with un-operated congenital heart defects, especially in those on chronic diuretic therapy. It is pertinent that the need for studies on the prevalence of micronutrient deficiencies and effects of micronutrient supplementation in these children be emphasized.  Therefore, the objective of this paper is to highlight the importance of micronutrient supplementation in children with un-operated congenital heart defects in Nigeria

Neonatal hypothermia in sub-Saharan Africa: A review

Background: Hypothermia is a major factor in neonatal morbidity and mortality in developing countries. High prevalence of hypothermia has been reported widely even from warmer tropical countries. In spite of the World Health Organization’s recommendation of maintenance of warm chain in newborn care, hypothermia continues to be a common neonatalcondition which has remained under-recognized, under-documented, and poorly-managed.Objective: This review aims at providing the incidence of and risk factors for neonatal hypothermia as well as provides a pathophysiological overview and management options for neonates with the condition in sub-Saharan Africa.Materials and Methods: All available published literature on neonatal hypothermia was searched electronically and manually. The principal electronic reference libraries and sites searched were PubMed, Embase, Ajol, Cochrane Reference Libraries and Google Scholar. The search terms used included ’neonatal hypothermia,’ ‘Cold stress in newborn’ ‘thermal care of the newborn,’ ’neonatal thermogenesis,’ ‘neonatal cold injury,’ among others. Pertinent books and monographs were accessed. Data in formats inaccessible to the reviewer were excluded.Result and Conclusion: Neonatal hypothermia is a major condition of public health importance in countries of sub- Saharan Africa. Awareness of the burden of the disease is still low in some communities. Risk factors for neonatal hypothermia in the region include poverty, home delivery, low birthweight, early bathing of babies, delayed initiation of breastfeeding and inadequate knowledge among health workers. Low-tech facilities to prevent heat losses and provide warmth are available in sub-Saharan Africa and are thus recommended as well as continuous efforts at sensitizing caregivers on the thermal needs of newborns.Key words: Neonatal hypothermia, neonatal thermogenesis, sub-saharan africa, thermal car

Rate of isolation of streptococcus species from children with bacterial infections: an indication for introduction of streptococcal vaccines

Background: Streptococcus species are among the commonest bacterial causes of childhood morbidity in developing countries. Streptococcal diseases in children have not been as well characterized in Nigeria as it has been in industrialized countries. The rudimentary nature of public health surveillance makes the true epidemiology of the disease difficult to ascertain. The predominance of Streptococcus pneumoniae in the causation of invasive diseases has led to the advocacy of inclusion of pneumococcal vaccine in the National Programme on Immunization. However, local data critical to inform on vaccine deployment are scarce, thus the need for the present study. Objective: To study the rate of isolation of Streptococcus species from children aged zero to 15 years, with suspected bacterial infections. Materials and Methods: Laboratory records of results of bacteriological studies of samples from children with suspected bacterial infections in University of Abuja Teaching Hospital from January 2008 through December, 2010 were retrieved and analyzed for bacterial growth. Data analysis Version 3.5.1. Statistical significance was set at p < 0.05. Results: A total of 2,247 samples were received during the study period. Of the 1,242 bacteria isolated, 502 (40.4%) were Staphylococcus aureus, 232 (18.7%) were Escherichia coli and 146 (11.8%) were Streptococcus species: 78 were isolated from blood, 9 from sputum, 11 from throat swabs and 28 from other sites while urine and eye swabs had 10 each. One hundred and six (72.6%) of the streptococci were from children aged 5 years and below. Most of the Streptococci (88.1%) were untyped. Among the 17 Streptococcal isolates typed, 10 were Streptococcus pneumoniae and three were group B Streptococcus. Conclusion: Streptococcal infections remain an important cause of severe disease in children in Nigeria. The use of effective, safe and affordable vaccine could significantly reduce morbidity from these infections, thus suggesting the need for more studies to conclude on streptococcal vaccine deployment.Key words: Streptococcal infections, Nigeria, Streptococcal vaccine

Congenital tuberculosis: a case report

Congenital tuberculosis is insufficiently understood and has been rarely reported even in areas endemic for the disease. Unless a high index of suspicion is maintained, the diagnosis can be missed. A case of congenital tuberculosis is herein reported to illustrate the difficulty in identifying such infants and also to sensitize the medical practionner in TB endemic areas of the need for etiologic diagnosis in congenital pneumonias as well as for antenatal screening for TB in mothers at risk

Perinatal Presentation and Outcome of High Birthweight Infants in Zaria, Nigeria.

Background: Infants with high birth weight are candidates for birth trauma, birth asphyxia and sometimes, death. Perinatologists are therefore gradually beaming the search lights on the contribution of high birthweight delivery to perinatal morbidity and mortality. Objectives: To determine the prevalence presentation and outcome of high birthweight deliveries in Zaria. Methods: A retrospective review of records of babies delivered at Ahmadu Be l lo University Teaching Hospital , Zaria , weighing 4000 grams and above at birth, over a 4-year period was undertaken. Maternal and neonatal records were obtained from the delivery suite and neonatal unit respectively, between January, 2005 and December, 2008. Data were analyzed with EPI INFO version 3.5.1 and statistical significance was set at p<0.05. Results: Of the 3065 deliveries in the study period, 167 (5.5%) weighed 4000 grams and above, giving a prevalence of 54.5 per 1000 births. The male: female ratio was 1.2:1, mean birthweight was 4340±290 grams and 65.9% of them were delivered during the rainy season. High birthweight delivery was associated with high maternal age, high birth order and assisted delivery. Per inatal asphyxia , hypoglycaemia , hyperbilirubinaemia, sepsis and trauma were the common perinatal conditions in high birthweight babies. Perinatal mortality rate for high birthweight babies was 3.9 per 1000 total births and 71.9 per 1000 high birthweight deliveries. Conclusion: High birthweight deliveries in the present study had high perinatal morbidity and mortality. Antenatal prediction and generous use of Caesarian section could reduce the prevalent morbidity and mortality rates.Key Words: High birthweight, Presentation, Outcome

Pattern of Neurological Disorder Presenting At a Paediatric Neurology Clinic in Nigeria

Background:Neurological diseases account for more than 20% of the world's disease burden with majority of affected people living in Africa. However there is a paucity of literature on neurological disease in Africa.Methods:A retrospective review of 114 children with neurological problem seen at a paediatric neurological clinic in a 2-year.Results:Delayed developmental milestone, convulsion and inability to walk were the 3 most common reasons for referral to our Paediatric neurology clinic. Cerebral palsy (55.3%), Seizure disorder (26.3%) and postmeningitic complications (6.2%) were the common neurological disorder seen at our neurology clinic. The Paediatric outpatient department (POPD) of our hospital was the main source of referral for most cases (83.2%) and 71.1% of all patients resides within Zaria metropolis. The default rate from follow-up was higher among children with cerebral palsy compared to children with seizure disorder (58.7% vs. 13.3%, P\u3b1 0.001). Conclusion:Lack of adequate facilities for proper rehabilitation of children with cerebral palsy could have been the main reason for the high default rate from follow-up.Introduction:La maladie neurologique constitue plus de 20% de probl\ue8me de la maladie mondiale avec la majorit\ue9 du peuple impliqu\ue9 vivant en Afrique. M\ue9thodes: Une r\ue9trospective de 114 enfants avec des probl\ue8mes neurologiques vus au centre m\ue9dical neurologique p\ue9diatrique pendant 2 ans. R\ue9sultats: D\ue9veloppement r\ue9tard\ue9 d'\ue9v\ue9nement important, convulsion et l'impulssance de marcher \ue9taient les trois raisons les plus ordinaires pour envoyer un malade dans un centre m\ue9dical neurologique p\ue9diatrique. Palsie c\ue9r\ue9brale (55,3%), Trouble d'attaque (26,3%) et des complications postmeningitique (6,2%) \ue9taient des troubles neurologiques ordinaires vus dans notre centre m\ue9dical neurologique. Le service p\ue9diatrique des consultation externes (SPCE) de notre h\uf4pital \ue9tait la source majeur de renvoy pour la plupart des cas (83,2%) et 71,1% de tous les patients qui habitent dans un rayon de la m\ue9tropole du Zaria. Le taux de d\ue9faut \ue0 partir du soins post-hospitalier \ue9tait \ue9lev\ue9 parmi des enfants avec la palsie c\ue9r\ue9brale par rapport aux enfants avec le trouble d'attaque (58,7% Vs 13,3%, P < 0,001). Conclusion: La p\ue9nurie des am\ue9nagements ad\ue9quats pour une r\ue9\ue9ducation propre pour des enfants atteints de la palsie c\ue9r\ue9brale pourrait \ueatre la raison majeure pour un faux de d\ue9faut \ue9lev\ue9 \ue0 partir des soins post-hospitalier

Acetaminophen (Paracetamol) Induces Hypothermia During Acute Cold Stress.

BACKGROUND Acetaminophen is an over-the-counter drug used to treat pain and fever, but it has also been shown to reduce core temperature (T c) in the absence of fever. However, this side effect is not well examined in humans, and it is unknown if the hypothermic response to acetaminophen is exacerbated with cold exposure. OBJECTIVE To address this question, we mapped the thermoregulatory responses to acetaminophen and placebo administration during exposure to acute cold (10 °C) and thermal neutrality (25 °C). METHODS Nine healthy Caucasian males (aged 20-24 years) participated in the experiment. In a double-blind, randomised, repeated measures design, participants were passively exposed to a thermo-neutral or cold environment for 120 min, with administration of 20 mg/kg lean body mass acetaminophen or a placebo 5 min prior to exposure. T c, skin temperature (T sk), heart rate, and thermal sensation were measured every 10 min, and mean arterial pressure was recorded every 30 min. Data were analysed using linear mixed effects models. Differences in thermal sensation were analysed using a cumulative link mixed model. RESULTS Acetaminophen had no effect on T c in a thermo-neutral environment, but significantly reduced T c during cold exposure, compared with a placebo. T c was lower in the acetaminophen compared with the placebo condition at each 10-min interval from 80 to 120 min into the trial (all p  0.05). CONCLUSION This preliminary trial suggests that acetaminophen-induced hypothermia is exacerbated during cold stress. Larger scale trials seem warranted to determine if acetaminophen administration is associated with an increased risk of accidental hypothermia, particularly in vulnerable populations such as frail elderly individuals

Echocardiographic findings in newborns and postneonatal infants undergoing preoperative evaluation for surgically correctable non-cardiac congenital malformations

Background: Congenital cardiac malformations could co-exist with surgically correctable non-cardiac congenital structural abnormalities. The occurrence of the two conditions portends increased anaesthetic risk and perioperative complications. Early recognition could favourably alter the post-operative outcome. Objectives: To describe the prevalence and pattern of congenital heart defects in young infants with extracardiac structural malformations. Methods: Consecutive newborns and postneonatal infants with congenital malformations being prepared for surgery were sent to the paediatric cardiology unit of University of Abuja Teaching Hospital for echocardiography and were recruited over a 30 moth period. A transthoracic echocardiography, following the guidelines of the American Society of Echocardiography, was used to evaluate the cardiac structures. Results: Of the 44 newborns and postneonatal infants with congenital non-cardiac malformations, 27 (61.4%) were males while 17 (38.6%) were females, giving a M:F ratio of 1.59:1. Gastrointestinal malformations constituted 47.7% of cases. Omphalocoele major and biliary atresias were the most common malformations seen. Seven babies had completely normal heart, five had isolated patent foramen ovale, thus giving a total of 12 babies with structurally normal hearts. Of the 32 babies with structural heart defects, 17 (53.1%) had single defect while 15 (46.9%) had two or more defects consisting of 26 acyanotic and 4 cyanotic defects. A total of 47 cardiac defects were seen. Forty-two (89.4%) of the heart defects were simple while 5(10.6%) were complex. Atrial septal defect 13,(27.7%), patent ductus arteriosus 14, (29.8%) and ventricular septal defect 7,(14.9%) were the commonest simple heart defects while atrioventricular septal defects predominate among the complex category Conclusions: Congenital structural abnormalities are common indications for surgical interventions in young infants. Recognition of co- existing structural cardiac abnormalities is essential in preoperative planning and may be a useful guide in averting untoward anaesthetic accident