Diagnosis and treatment of bacterial meningitis in the newborn

Background: Bacterial meningitis in the newborn is globally renowned for high mortality. The associated morbidities also include audiologic, motor, visual and mental deficits.Objective: To highlight the peculiarities in the current diagnostic andmanagement strategies in newborn meningitis.Methods: Relevant literature on the subject published only in Englishlanguage or translated to English language was searched manually and electronically. The Medline, PUBMED and HINARI were searched for the period between 1966 and 2012. The following key words were used during the search: newborn/neonatal , bacter ial / pyogenic meningitis, central nervous system infections, antibiotics, dexamethasone and fluidrestriction.Results: The pattern of bacterial aetiology and mortality differ betweenthe developed and developing world. The usefulness of bacteriologic culture in the diagnosis of meningitis can be improved with serologic method like polymerase chain reaction. Widespread resistance of pathogens may be threatening the use of penicillins and gentamicinfor empirical treatment of newborn meningitis. No sufficient evidence presently supports the current practices of fluid restriction, prolonged duration of antibiotic treatment and non-use of adjuvant steroid therapies in the newborn.Conclusion: Efforts to reduce the incidence of newborn meningitis cannot be separated from the prevention of newborn sepsis generally. In addition, more controlled trials are required in the developing world with respect to the various aspects of management of newborn meningitis, particularly fluid management and the use of adjuvant steroids

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 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

Maternal knowledge and care.seeking behaviors for newborn jaundice in Sagamu, Southwest Nigeria

Background: Delay in the presentation of infants with jaundice at the hospital is a reason for the persistence of the severe forms of jaundice.Objective: The aim was to determine the influence of maternal knowledge on newborn jaundice on their care-seeking practices.Methods: In a cross-sectional survey, mothers whose infants presented with significant hyperbilirubinemia were assessed for knowledge about jaundice in relation to their care seeking behaviors.Results: Out of 98 mothers, 57.1% had good knowledge on newborn jaundice. Most of the mothers with good knowledge had tertiary education (P = 0.004), had good care-seeking behavior for newborn jaundice (P = 0.027) and their infants did not develop kernicterus (P = 0.0001). Mothers with tertiary education also had significantly better performances on the knowledge and care-seeking evaluation scales.Conclusion: Maternal knowledge on newborn jaundice, as well as tertiary maternal education, influenced appropriate care-seeking behavior for infants with jaundice and reduced the risk of complications.Key words: Health care-seeking behavior, maternal knowledge, neonatal jaundice, neonatal mortalit

Evidence-based treatment of neonatal infections in developing settings

No Abstract

Kwashiorkor- is it a dying disease?

Objective. To review the occurrence of kwashiorkor before and after the establishment of the Diarrhoea Training Unit at a Nigerian tertiary hospital in 1992.Design. A retrospective hospital-based analytical study was undertaken. Groups of subjects were compared using odds ratios (95% confidence intervals) and regression analysis.Setting. The paediatric wards of the Wesley Guild Hospital, Ilesa, Nigeria.Subjects. The number of children admitted with kwashiorkor, measles,  gastroenteritis and marasmus between 1983 and 1991 (group I) was compared with similar data for the period 1993 - 2002 (group 2).Results. There was a 30.4% reduction in the total admissions between  these periods, while incidences of  kwashiorkor, measles, gastroenteritis and marasmus fell by 70%, 55%, 57.4% arid 55.8% respectively. Reduction in number of kwashiorkor cases between groups 1 and 2 was significantly related to the reduced incidence of  measles (p = 0.000002) and gastroenteritis (p = 0.000003). The total number of admissions was correlated with the number of measles (r = 0.623 and 0.573 forgroup 1 and 2) and kwashiorkor cases (r =- 0.412 and 0.233 for groups 1 and 2).Conclusion. The incidence of kwashiorkor has fallen in Ilesa, Nigeria. Given the relatively low HIV prevalence rate in the country during the study period, better management of diarrhoeal diseases, including measles, may have accounted for this drastic fall

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

Relationship between age and location of the apex beat among apparently healthy Nigerian children

Background: Normal location of apex beat varies with age in children. Location of apex beat is an integral part of routine cardiovascular system examination in clinical practice. However, there is paucity of literature on apex beat location in Nigerian children. Objective: The aim of this study was to locate apex beat position in apparently healthy Nigerian children from birth to ten years, and to relate the location with age. Subjects and Methods: This was a cross sectional study carried out in Sagamu, Nigeria. A sample size of two hundred and thirty-seven was calculated from a previous study. Hence two hundred and thirty-seven apparently healthy Nigerian children who satisfied the inclusion criteria were enrolled for the study. Apex beat location in the intercostal space was determined and distance of apex beat from the midline, midclavicular line and nipple lines were measured. The measured distances were related to age using linear regression and Pearson correlation. Results: The mean distance of apex beat from the midline from birth to 10 years ranged from 2.3cm to 6.4cm. The distance of apex beat from the midline increased progressively with age. In children up to the age of three years, the apex beat was in the 4th left intercostals space. In 91.7%, 51.3% and 14.3% of children aged four, five and six years respectively, the apex beat was present in the 4th left intercostal space. Above six years, it was located in the 5th left intercostals space. Conclusion: The location of the apex beat from the midline was strongly related with age Thus, the distance of apex beat from the midline can be predicted from age in months.Keywords:  Apex beat, Children, Mid-clavicular line, Nigeria, Nipple lin

Mothers’ knowledge about birth asphyxia: The need to do more!

Background: Health education is an important tool required for reducing the burden of birth asphyxia in the developing world.Objective: The objective of this study was to assess the knowledge of mothers, who received health facility-based antenatal care during their last pregnancy, about birth asphyxia and relate their knowledge to their places of antenatal care.Materials and Methods: A cross-sectional survey of mothers of infants attending the Immunization clinic in a Nigerian Teaching Hospital was done between July and October 2010 using a close-ended questionnaire. Consecutively consenting mothers were enrolled into the study.Results: Out of 354 mothers, 56.5% received counseling about birth asphyxia during antenatal clinic visits in their last pregnancy; 85.5% of attendees of teaching hospital; and 26.4% of attendees of private antenatal clinics received counseling about birth asphyxia. Overall, 38.9% of the respondents had satisfactory knowledge about birth asphyxia;47.5% of teaching hospital attendees; and 28.1% of private clinic attendees had satisfactory knowledge about birth asphyxia. Lower socioeconomic status, lack of counseling, and nonattendance of teaching hospital antenatal clinic were associated with poor knowledge about birth asphyxia.Conclusion: Most of the mothers surveyed had poor knowledge about the risk factors and sequelae of birth asphyxia. The health system needs to improve health education of expectant mothers about birth asphyxia.Key words: Antenatal care, asphyxia, health educatio

Relationship between anthropometric parameters and the location of apex beat in children

Background: Childhood growth is characterized by changes in anthropometric parameters. The location of the apex beat may besimilarly influenced by growth.Objectives: The objective of this study was to determine any relationshipbetween the location of the apex beat and anthropometric parameters.Subjects and Methods: This crosssectional survey was carried out inSagamu, Nigeria. Apparently healthy children were randomly selected for the study. Apex beat location in the intercostal space was determined and distance from the midline was recorded. Weight and length/height were also recorded while Body Mass Index (BMI) and Body Surface Area (BSA) were calculated.Results: A total of 237 children aged 12 hours to 10 years were surveyed.The mean distance of the apex beat from the midline from birth to 10 years ranged from 2.3cm to 6.4cm. The mean distance of apex beat from the midline increased progressively with weight, height, chest circumference and BSA but not with BMI. Strong correlations were observed betweendistance of apex beat from the midline and weight (r = 0.850, p .0.001); height (r = 0.867, p .0.001); chest circumference (r = 0.833, p . 0.001); BSA (r = 0.862, p . 0.001) but not with Body Mass Index (r = 0.019, p = 0.774).Conclusion: The location of the apex beat in children was stronglyinfluenced by growth as suggested by anthropometric parameters.Key words: Anthropometry, apex beat, children, mid-clavicular line,nipple lin