Short term outcome and predictors of survival among birth asphyxiated babies at a tertiary academic hospital in Enugu, South East, Nigeria

Background: Birth asphyxia (BA) is a preventable cause of cerebral insults in newborns. It is associated with high morbidity and mortality. Of the 120 million babies born in third world countries annually, it is estimated that about 3.6 million will develop BA.Objectives: We aimed to determine the short term outcome and predictors of survival among birth asphyxiated babies using Apgar score.Methods: This study was carried out in the Newborn Unit of Enugu State University Teaching Hospital. In-hospital deliveries (Inborn) and those from other centers (Out-born) with one minute Apgar score ≤ 6 were included. Interviewer administered questionnaire was used to collect data from caregivers. Information sought included gestational age (GA), birth weight (BW), Apgar score, place of delivery and outcome. Data was analyzed using SPSS. Bivariate and multivariate logistic regressions were done.Results: Of the 150 neonates, 61.3% survived. Majority of the dead were out-born. The difference was statistically significant (p < 0.001). The inborn were about 1.2 times (AOR = 1.22; 95% CI: 1.06-1.78) more likely to survive BA. Among low birth weights (LBWs), 73.9% died, 23.7% of normal weights and 14.3% of macrosomics died. The difference was statistically significant (p < 0.001). The normal weights were about 2 (AOR = 2.23, 95% CI: 1.76-6.25) and the macrosomics about 5 times more likely to survive BA than LBWs. Regarding GA, 78.8%, 17.2% and 18.2% of the pre-terms, term and post-dates died respectively. The difference was statistically significant (p < 0.001). The term babies were about 11 (AOR = 11.27; 95% CI: 4.02-31-56) and post -dates about 9 (AOR = 8.79; 95% CI: 1.43-54.04) times more likely to survive BA than preterms. Other significant factors were degree of asphyxia (p = 0.003), and parental education (p < 0.001).Conclusion: BW, GA, degree of asphyxia, place of delivery and parental education all predicts survival among birth asphyxiated newborns.Keywords: Newborn, birth asphyxia, Hypoxic Ischemic Encephalopathy (HIE) outcomes, predictors of survival

Short term outcome and predictors of survival among birth asphyxiated babies at a tertiary academic hospital in Enugu, South East, Nigeria

Background: Birth asphyxia (BA) is a preventable cause of cerebral insults in newborns. It is associated with high morbidity and mortality. Of the 120 million babies born in third world countries annually, it is estimated that about 3.6 million will develop BA. Objectives: We aimed to determine the short term outcome and predictors of survival among birth asphyxiated babies using Apgar score. Methods: This study was carried out in the Newborn Unit of Enugu State University Teaching Hospital. In-hospital deliveries (Inborn) and those from other centers (Out-born) with one minute Apgar score 64 6 were included. Interviewer administered questionnaire was used to collect data from caregivers. Information sought included gestational age (GA), birth weight (BW), Apgar score, place of delivery and outcome. Data was analyzed using SPSS. Bivariate and multivariate logistic regressions were done. Results: Of the 150 neonates, 61.3% survived. Majority of the dead were out-born. The difference was statistically significant (p < 0.001). The inborn were about 1.2 times (AOR = 1.22; 95% CI: 1.06-1.78) more likely to survive BA. Among low birth weights (LBWs), 73.9% died, 23.7% of normal weights and 14.3% of macrosomics died. The difference was statistically significant (p < 0.001). The normal weights were about 2 (AOR = 2.23, 95% CI: 1.76-6.25) and the macrosomics about 5 times more likely to survive BA than LBWs. Regarding GA, 78.8%, 17.2% and 18.2% of the pre-terms, term and post-dates died respectively. The difference was statistically significant (p < 0.001). The term babies were about 11 (AOR = 11.27; 95% CI: 4.02-31-56) and post-dates about 9 (AOR = 8.79; 95% CI: 1.43-54.04) times more likely to survive BA than preterms. Other significant factors were degree of asphyxia (p = 0.003), and parental education (p < 0.001). Conclusion: BW, GA, degree of asphyxia, place of delivery and parental education all predicts survival among birth asphyxiated newborns. DOI: https://dx.doi.org/10.4314/ahs.v19i1.29 Cite as: Uleanya ND, Aniwada EC, Ekwochi U, ND U. Short term outcome and predictors of survival among birth asphyxiated babies at a tertiary academic hospital in Enugu, SouthEast, Nigeria. Afri Health Sci. 2019;19(1). 1554-1562. https://dx.doi.org/10.4314/ahs.v19i1.2

Infant feeding practices and maternal socio-demographic factors that influence practice of exclusive breastfeeding among mothers in Nnewi South-East Nigeria: a cross-sectional and analytical study

BACKGROUND: Malnutrition is an underlying factor in more than 50% of the major cause of infant mortality-Pneumonia, diarrhoeal disease and measles which account for 70% of infant mortality. Therefore, programs to promote adequate nutrition for age can help reduce mortality from these disease conditions and indispensible to achievement of MDG 4. AIM: To describe the feeding practices of infants below six months of age and determine maternal socio-demographic factors that influences the practice of exclusive breastfeeding (EBF) among mothers in Nnewi, south-east Nigeria. METHODS: Four hundred mother-infant pairs attending the infant welfare clinic of the Nnamdi Azikiwe University teaching hospital (NAUTH) during 2012 were consecutively recruited after meeting the study inclusion criteria. Data on breastfeeding were based on infant feeding practice in the previous 24 hours. Exclusive breastfeeding was defined as infant feeding with only breast milk. RESULTS: Awareness (95.3%) and knowledge (82.0%) of EBF was high among surveyed mother but the practice of EBF (33.5%) was very low. Positive attitude towards EBF practice was shown by many (71.0%) of surveyed mothers. EBF practice decreased with increasing infant age, OR 0.72 (95% CI 0.34, 1.51) for 1–2 months, OR 0.58 (95% CI 0.23, 1.44) for 3–4 months and OR 0.20 (95% CI 0.06, 0.73) for 5–6 months compared to infants < 1 month old. Maternal education, socioeconomic class, mode of delivery and infants first feed were retained as important maternal predictors of EBF practice after adjustment for confounders. Decreased likelihood of EBF practice was found among mothers of lower educational attainment, OR 0.33 (95% CI 0.13, 0.81), mothers who delivered through caesarean section, OR 0.38 (95% CI 0.18, 0.84), mothers of higher socio-economic status [(middle class, OR 0.46 (95% CI 0.22, 0.99) and upper class, OR 0.32 (95% CI 0.14, 0.74)] while increased likelihood of EBF practice was seen in mothers who gave their infants breast milk as their first feed, OR 3.36 (95% CI 1.75, 6.66). CONCLUSION: Knowledge and awareness does not translate to practice of EBF. More effort by health workers and policy makers should be directed to mothers along the fault lines to encourage the practice of EBF

Bacterial Isolates of Surfaces in the Neonatal Intensive Care Unit of Enugu State University Teaching Hospital, Parklane, Enugu, and Their Antibiotic Susceptibility Patterns

Introduction: The duration of admission in the hospital, mortality rates, and care costs is increased in Neonatal Intensive Care Unit (NICUs) by nosocomial infections(NIs). There is a need for routine and regular environmental sampling in NICUs. Methodology: This was a cross-sectional study conducted in the NICU of Enugu State University Teaching Hospital. The researchers collected samples for culture from equipment and hospital surfaces in the unit. Susceptibility testing was done for isolates by the agar diffusion method using standard nutrient agar 1 discs. Results: We observed bacterial growth in 58 (54.7%) samples from the 106 samples collected. Staphylococcus aureus 35 (55.6%) was the most common isolate cultured, followed by Escherichia coli 14 (22.2%) and then coagulase-negative Staphylococcus13 (20.6%).&nbsp; Among S. aureus isolates, 48.6% were methicillin-resistant S. aureus. Among the Gram-negative isolates, resistance was highest for ampicillin followed by meropenem. Conclusion: The most common isolates were S. aureus, coagulase-negative Staphylococcus, and E. coli. Health-care providers need improved hygiene standards to reduce the burden of NI. Keywords: Bacterial contamination, Neonatal Intensive Care Unit, Nigeria, susceptibility pattern

Evaluation of Physician Burnout Syndrome Among Pediatric Resident Doctors in Nigeria

Background: Medical practice and education are known to lead to emotional and mental exhaustion as well as physical tiredness among healthcare workers. This study analyzed the prevalence and factors associated with physician burnout syndrome (PBS) among resident doctors in paediatric across Nigeria. Methodology: This cross-sectional study was conducted among paediatric resident doctors across Nigeria using the public welfare questionnaire of the American Welfare Association comprising 28 questions related to sleep affectation, energy levels, personal relationships, professional relationships, quality of job environment, and work satisfaction. Results: 117 residents were enrolled with varying degrees of burnout. The mean PBS score was 75.3 ± 19.1 with minimum and&nbsp; maximum scores of 32 and 125, respectively. The prevalence of Grades 0, 1, 2, 3, and 4 PBSs was 3.7%, 4.9%, 28.1%, 42.7%, and 18.3%, respectively, while 63.4% of respondents exhibited signs of symptomatic PBS. The residents’ rank (P = 0.05) was significantly associated with the prevalence of symptomatic PBS, while age (P = 0.567), gender (P = 0.755), number of years in training (P = 0.411), marital status (P = 0.173), number of children (P = 0.974), religion (P = 0.09), and prior knowledge of PBS (P = 0.719) had no association with the development of symptomatic PBS among surveyed resident doctors. Conclusion: The prevalence of PBS is high among paediatric resident doctors. There is an urgent need for the postgraduate medical colleges in collaboration with the Ministry of Health to formulate programmes that will help to balance social and professional livesamong paediatric resident doctors in Nigeria. Keywords: Burnout, Nigeria, paediatric, physician

Ophthalmological Findings in Paediatric Non-Traumatic Coma in Enugu State University Teaching Hospital, Parklane, Enugu, Nigeria

The ophthalmological examination is a vital aspect of the central nervous system examination in comatose children. Several authors have documented different findings with disparities in their recommendations about making ophthalmological examination a routine in the management of the unconscious child. This study sought to evaluate the relevance of routine ophthalmological examination in the management of unconscious children admitted into the paediatric emergency room of Enugu State University Teaching Hospital, Parklane, Enugu, Nigeria. This was a prospective longitudinal study conducted from April 2018 to March 2019. Unconscious patients whose caregivers gave consent were recruited into the study. Traumatic causes of coma were excluded. Demographic features of the patients were obtained. The ophthalmologic examination and diagnoses were made by an ophthalmologist, while the emergency room pediatrician made clinical assessment and diagnoses.&nbsp;Sixteen unconscious children had ophthalmologic examinations done. The Glasgow coma scale scores ranged from 3 to 11, with a mean of 6.6±2.2. Thirteen (81.3%) of the children were classified as severe unconsciousness while the rest were moderate. The degree of unconsciousness was significantly associated with the outcome (?2 =16.0, P = 0.03). A total of six (37.5%) ophthalmologic diagnoses were made, which included cerebral malaria, degenerative myopia, orbital cellulitis, and exposure keratopathy. The presence of an abnormal ophthalmologic finding was not significantly associated with outcome (?2 =0.36, P = 0.55). Routine ophthalmologic examination may not be justified as a management protocol in unconscious children but may be considered in selected cases

Clinical Profile and Electrolyte Abnormalities in Hospitalized Under‑Five Children with Acute Gastroenteritis in a Tertiary Health Facility

Background: Electrolyte abnormalities constitute the leading causes of morbidity and mortality in younger children with acute gastroenteritis.The aim of the study was to determine the clinical profile and pattern of electrolyte abnormalities in under‑five children hospitalized for acutegastroenteritis from November 1, 2014, to January 31, 2015. Methodology: This was a cross‑sectional descriptive study among hospitalized under‑five children with acute diarrhea who were consecutively recruited from November 1, 2014, to January 31, 2015. Relevant clinical data were obtained, while the physical examination was done on all subjects. Serum electrolytes values were determined using the ion‑selective electrode system and compared with standard reference ranges. The data were analyzed using SPSS version 21.0 with the level of statistical significance set at P &lt; 0.05. Results: A total of 108 under‑five children were studied. The majority (101; 93.5%) were &lt;24 months of age, while 41 (38%) of low socioeconomic class background. Metabolic acidosis was the most common electrolyte abnormality followed by hyponatremia and hypokalemia occurring singly or in combination. The case fatality rate was 13 (12.0%). The electrolyte derangements associated with mortality were hypokalemia and acidosis: 11 (84.6%) each, 9 (69.2%) had hyperchloremia, while 6 (46.2%) were reported to have hyponatremia. Conclusion: Electrolyte derangements are common in under 5 years children with acute diarrhea with increased mortality in those with severe acute malnutrition. Proper health education is needed to ensure adequate nutrition and timely use of low‑osmolar oral rehydration solution as well as early referral of cases with persistent gastrointestinal losses in order to save lives. Keywords: Acute gastroenteritis, electrolyte abnormalities, under‑five childre

Serum zinc levels in apparently healthy children in Nigeria: Are they acceptable

Introduction: Despite the importance of zinc in the human body, there is paucity of data on the zinc status of Nigerian children. The aim of this study was to determine the serum zinc levels of children attending the pediatric outpatient clinic of a tertiary hospital in South East Nigeria and to assess their need for routine zinc supplementation. Materials and Methods: One hundred children aged 5–60 months were recruited consecutively from the pediatric outpatient clinic. Their socioeconomic class (SEC) was assessed using the tool developed by Oyedeji. Physical examination was carried out to exclude malnutrition and/or liver disease. Samples were collected in the morning from nonfasting subjects and were analyzed using atomic absorption spectrophotometer. Serum zinc deficiency was defined as zinc level &lt;80 μg/dl. Results: The overall median (range) serum zinc level was 83.3ug/dl (60–105 µg/dl) while the median (mean rank) serum zinc levels among male and female subjects were 83.4 µg/dl and 84.2ug/dl, respectively (U = 1071.00; P = 0.228). A total of 26 (26%) apparently healthy children had low serum zinc levels. There was no association between gender and serum zinc levels (χ2 = 2.163; P = 0.141). A significant positive but weak relationship was found between SEC and zinc levels (r = 0.208, P = 0.038) but not between serum zinc levels and age of the children (r = 0.185, P = 0.065). Conclusion: A significant proportion of Under‑5s could have low serum zinc levels. Routine zinc supplementation may be necessary among this age group in Nigeria

Clinical evaluation of severe neonatal Hyperbilirubinaemia in a resource-limited setting: a 4-year longitudinal study in south-East Nigeria

Abstract Background Neonatal hyperbilirubinaemia is one of the commonest causes of hospital visit in the neonatal period. When severe, it is a leading cause of irreversible neurological and musculoskeletal disability. Prompt recognition and timely interventions are imperative for a drastic reduction in complications associated with severe hyperbilirubinaemia in newborns. Methods We report a 4-year descriptive and longitudinal study to determine the causes, clinical presentations and long-term outcomes in newborns admitted for severe neonatal jaundice. Methods: Newborns admitted and managed for severe neonatal jaundice at the Enugu State University Teaching Hospital during a 4-year period were enrolled and followed up for 2 years. Results A total of 1920 newborns were admitted during the study period and 48 were managed for severe hyperbilirubinaemia giving an in-hospital incidence rate of 25 (95% CI 18–32) per 1000 admitted newborns. The mean age of onset was 3.4 ± 0.5 days (range 1–8 days) and hospital presentation from time of first notice was 4.3 ± 0.4 days (range 1–9 days). The total and unconjugated admission serum bilirubin ranged from 7.1 to 71.1 (mean 26 ± 2.5 mg/dl) and 4.2 to 46.3 mg/dl (mean 18.3 ± 9.2) respectively. Earliest sign of severe hyperbilirubinaemia in newborns were: refusal to suck (15.2%) and depressed primitive reflexes (24.5%) while the commonest signs included high pitch cry (11.9%), convulsion and stiffness (6.9%) and vomiting (6.3%) in addition to the former signs. The major causes of severe hyperbilirubinaemia were idiopathic (33.3%), sepsis (35.3%), ABO incompatibility (17.6%) and glucose-6-phosphate dehydrogenase (G6PD) deficiency (11.8%). Long-term sequelae on follow-up included delayed developmental milestone attainment, postural deformities, visual and seizure disorders. Conclusions There is urgent need for continued education for mothers, families and healthcare workers on the danger newborns with jaundice could face if not brought early to the hospital for timely diagnosis and management

Use of probiotics in the management of acute watery diarrhoea in Nigerian children: How effective are S. Boulardii only preparations?

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