Thyroid function profile in cord blood and postnatal changes at 24 and 72hours in healthy term Nigerian neonates

Background: Studying the acute postnatal changes of newborn thyroid  function is essential for determining the best timing of screening for  congenital hypothyroidism. There is paucity of literature on neonatal  thyroid function and particularly the postnatal changes in Nigeria.Objectives: To describe the profile of thyroid function in cord blood and the postnatal changes at 24hours and 72hours in healthy term neonates  delivered in Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto.Subjects and methods: This was a prospective, descriptive and cross sectional study conducted over a six month period (between July-December 2009). Forty seven consecutively delivered healthy term neonates had their serum T3, T4, TSH assayed at birth, 24 and 72hours using the Enzyme linked immunosorbent assay (ELISA) technique. Data obtained are presented as mean, median and standard deviation (SD). Paired- t- testwas used for statistical inference.Results: The mean (SD) of the serum hormone concentrations in cord blood, and venous blood at 24hours and 72hours, respectively were as follows: T3, 0.58 (0.56) nmol/l, 1.15 (0.77)nmol/l, 0.83 (0.74)nmol/l; T4, 91 (83.1)nmol/l, 121.5 (106.4)nmol/l, 104.2 (84.2) nmol/l; and TSH, 5.95 (5.81)mU/l, 8.61 (8.34)mU/l, 2.52 (2.61) mU/ l.. The mean serum T3, T4 and TSH at 24hours were higher than cord blood levels (p<0.001, 0.03, 0.05 respectively). The mean serum T3 and T4 at 72hours, were higherthan cord blood levels (p = 0.07, 0.44), whereas TSH at 72hours was significantly lower than cord blood levels; (p<0.001).Conclusions: There was a rise, above cord level, of T3, T4 and TSH at 24hours, and a decline at 72hours, the latter being most marked in TSH. It is recommended that serum TSH taken at or greater than 72hours of life may be utilized for screening for congenital hypothyroidism in term babies,using postnatal age appropriate reference ranges. Serum T3, T4 should then be assayed for confirmation in all neonates with a positive TSH screening.Key words: Thyroid profile, postnatal changes, Term, Healthy neonates

Triceps skin fold thickness as a measure of body fat in Nigerian adolescents

Background: Skin fold thickness (SFT) at selected areas offers a simple method of subcutaneous fat assessment and provides a good estimate of obesity and body fat distribution. The triceps SFT has been shown to be one of the best and most popular sites for SFT measurement in children.Objective: To assess the body fat of school adolescents and to comparethe performance of triceps SFT with Bioelectrical impedance method in the detection of overweight (OW) and obesity (OB) among the subjectsMethods: The study was cross sectional; involving secondary schoolstudents within Sokoto metropolis. Subjects were selected by a multistagerandom sampling method. Harpenden skin fold caliper (ASSIST Creative Resources Ltd, LL13 9UG, UK) and Tanita Body fat scale (model UM-030, Tanita, UK Ltd; 2004) were used respectively to measure the triceps SFTand body fat content (%) according to the manufacturer’s instructions. Results: The mean triceps SFT values were 8.9mm (±4.7) for malesand 12.9mm (±4.6) for the females (p<0.001). Mean % BF values were8.2 ± 4.1% for the males, and 20.0 ± 6.8% for the females (p<0.001).The triceps SFT gave a prevalence of overweight of 2.5%, while that of obesity was 0.8%. With the BIA method, 2.5% of the subjects wereclassified as overweight and 1.7% as obese.Conclusion: Triceps SFT remain a fair surrogate for the assessment ofadiposity, the component of overweight that leads to pathology.Key words: Skin fold thickness, bioelectrical impedance analysis, body fat, obesity, adolescent

Neonatal Bacterial Meningitis And Dexamethasone Adjunctive Usage In Nigeria

Objective: Neonatal bacterial meningitis is devastating, with attendant high mortality and neurological sequelae. We, therefore, aimed to delineate its current incidence, etiologic, clinical, laboratory spectra, and the effect of steroid therapy on the outcome. Methodology: Babies admitted from1992 to 1995 in the Special Care Baby Unit of the University of Maiduguri Teaching Hospital, Maduguri, Nigeria, with bacterial meningitis were studied prospectively. Neonatal bacterial meningitis was confirmed if the cerebrospinal fluid (CSF) microbiological, chemical, immunological and clinical criteria were satisfied. Detailed neurological follow-up was made. Result: Sixty-nine cases of neonatal bacterial meningitis were encountered, (25 were early-onset, and 44 late-onset); the incidence was 6.5/1000 live births. 22 Positive CSF cultures were grown in early-onset meningitis, and 28 in late-onset disease. Low birth weight showed higher risk of bacterial meningitis and it was significantly more likely in the preterm. X2=24.19, p = 0.000001). Gram-negative pathogens were more isolated (28/50, 56%); Escherichia coli (11) being the commonest, while of the Gram-positive pathogens Staphylococcus aureus was most predominant overall (13/50). Concomitant blood culture was positive in 39/50 (78%), inclusive of all 22 “definite” early-onset disease. The CSF WBC was minimally raised (25-30 x 106/L) in 11 (22%) of “definite” neonatal bacterial meningitis. Detection of unusual pathogens was noteworthy: N. meningitidis (2) and H.influenzae (2), contributing 0.6 and 2.2 per 1000 live births and admissions, respectively. Overall mortality was 24.6%. Of the forty survivors, 9(22.5%) had neurological sequelae: sensorineural hearing deficit (3), hydrocephalus (2), subdural effusion (2), hemiparesis (1), afebrile (recurrent) seizure (1), and there was reduced developmental quotients at 24 months follow-up in 33. Dexamethasone therapy decreased mortality significantly; p = 0.0004. Conclusion: The new information highlighted by this research includes the lack of Group B Streptococcus isolation, the finding of S. pneumoniae, N.meningitidis, H.influenzae and S. aureus as significant pathogens, usefulness of blood cultures in the detection of neonatal bacterial meningitis, increasing resistance of Gram-positive neonatal pathogens to cloxacillin, low CSF WBC, and the finding that the adjunctive use of dexamethasone significantly decreases case fatality and neurological sequelae. Nigerian Journal of Clinical Practice Vol. 11 (3) 2008: pp. 235-24

Pattern Of Childhood Tuberculosis In Sokoto, Northwestern Nigeria

Background: The incidence and mortality rate of tuberculosis (TB) has been on the decline until its recent resurgence worldwide, with Nigeria inclusive. Objectives: We, therefore, considered it worthwhile, for this area of the country, evaluating its prevalence/incidence. Furthermore, TB\'s main clinical features on presentation, variable forms, outcome and associated factors would be ascertained. Methodology: This was a 6-year retrospective study conducted in the Department of Paediatrics, Usmanu Danfodiyo University Teaching Hospital (between 1st December 1998 and 30th November 2004). All case files of children aged 3 months – 15 years of age with the diagnosis of any form of TB were retrieved from Medical Records Department. The data were analyzed in respect to age, gender, mode of presentation, history of BCG vaccination and evidence of its scar, main clinical findings, and results of investigations, complications, and outcome. Results: Ninety-nine (99) cases of TB were seen over the study period. Total patient on admission was 9,434, giving an overall prevalence rate of 1.1%, that is, about 1,100 per 100,000 populations. The male: female ratio encountered was 1.4: 1.0. Of the 99 cases, 45 (45.5%) were in age group 3months- 5years, 32 (32.3%) in >5years- 10years, and 22(22.2%) in >10 - 15.0 year-age-group. The main presenting features were cough, 55(55.5%), fever,53(53.5%) and weight loss 33(33.3%). The most predominant form of TB seen in this series was pulmonary involvement in 46(46.5%) of cases, followed next in rank by disseminated TB, 22(22.2%). The three commonest complications seen in this study were protein energy malnutrition (n= 21), severe anaemia (n=16) and pleural effusion (n=11). Majority of patients had short course anti-TB therapy with current drugs. The case-fatality rate identified was 10.1% (10/99). Fifty-three (53.5%) had complete course of the treatment and were normal thereafter, while 36 (36.5%) cases either signed against medical advice or defaulted from follow-up. Conclusion: Tuberculosis remains one of the major causes of mortality in Nigerian children, and it is, therefore, pertinent improving our socio-economic status, and diligently pursuing BCG vaccination of all children at stipulated periods. Sahel Medical Journal Vol. 11 (4) 2008: pp. 110-11

Serum copper levels of healthy infants in the first six months of lactation.

OBJECTIVE: To establish the serum copper levels in Nigerian children in the first six months of lactation. DESIGN: A cross sectional study. SETTING: Jos University Teaching Hospital. MATERIAL AND METHODS: Serum copper levels were assessed in 120 healthy breast fed infants in the first six months of Lactation. Atomic absorption spectrophotometer was used for the analysis. RESULTS: The average serum copper level obtained is 1.60/ml. CONCLUSIONS: The mean serum copper level obtained is appropriate for the infants as no signs of copper deficiency were noted. Key Words: Breast fed infants, serum copper level. Tropical Journal of Medical Research Vol.8(1) 2004: 21-2

Zinc and copper levels of mature breast milk of healthy lactating mothers within the first six months of lactation

The breast milk contents of zinc and copper and the effect of lactation on them in the first six months of lactation were determined in a cross sectional study among 120 healthy lactating mothers attending the infant welfare clinics of Jos University Teaching Hospital Jos . The serum levels of these elements were also assessed during the period. The breast milk levels of zinc declined from 1.98ug/ml at one month to 0.60ug/ml at 6 months while copper levels declined from 0.28ug/ml to 0.13ug/ml during the same period. The serum levels of these elements remained fairly constant during the study period in spite of the decreasing breast milk values. Key Words: Breast milk, Progression of lactation, Zinc levels, Copper levels Journal of Biomedical Investigation 2004;2(1): 10-1

The birth weight of apparently healthy Nigerian newborns in Sokoto

Objective: To determine the birth weight of apparently healthy newborns delivered at Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria. Materials and Methods: This prospective study was carried out between July 1, 2003 and June 30, 2004. The criteria were booked mothers, mothers with regular menstrual cycles, availability of mother's last menstrual period ± report of an obstetric ultrasound scan and absence of first trimester vaginal bleeding. Maternal weight, height, birth order and socioeconomic status were also obtained. 253 babies were enrolled.Results: There were 131 males and 122 females giving a male: female ratio of 1.1:1. Gestational age by maternal dates ranged from 28 to 44 weeks. There was a consistent increase in mean values of weight as the gestational age increased. The mean (SEM) weight for 24 babies o

Congenital clinical malaria: Incidence, management and outcome as seen in the Usmanu Danfodiyo Univrsity Teaching Hospital, Sokoto in Nigeria

Objective: With paucity of documentation of congenital clinical malaria in the world literature, we therefore aimed to review its rates, presentation, management and out come of this problem in neonates at the Usmanu Danfodiyo University Teaching Hospital, Sokoto. Methodology: This prospective study was carried out in Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria over a 10- month period; (January 2006 to October, 2006). The study populations were the admitted neonates to the emergency paediatric unit and the Special Care Baby Unit that presented with fever and other clinical features suggestive of malaria and/or septicaemia. Diagnosis of malaria was by Giemsa stain on blood smears and that of septicaemia was by positive blood culture. Results: 162 babies [aged ≤28days] were admitted with fever amongst other clinical features during this period. 156 (96%) of the babies admitted, 82 (53%) were males, and 74 (47%) females, giving a M: F ratio of 1.2:1, and these were positive for malaria parasite alone. Of the babies with the specific morbidity of clinical neonatal malaria, 68(44%) were aged seven days or below, and were considered to be congenital. Our encountered incidence was high; 50 per 1000 live births. The mean (SD) birth weight was 2.76(0.28) kg, mean (SD) gestational age, 39.24 (1.18) weeks and mean (SD) temperature 38.4(0.5) 0 C. Plasmodium falciparum trophozoites were the only species observed in this study. There was no recorded case of transfusion malaria. The postnatal age group of 0-7 days was the commonest age group at which the neonates were admitted. The distribution of malaria density was in favour of malaria density (+), 39(57%). Fever was the commonest (100%) presentation followed by refusal of feeds (93%) and irritability (76%). Of the 68 babies in the study group, 32(47%) were delivered to pimiparas. The subjects were treated with arthemeter-lumenfantrine tablets for three days. No baby in the study group died. However, 6 babies that had both neonatal malaria and septicaemia died while, 5 babies that were negative for both malaria parasite and blood culture but with worsening clinical signs and persistent fever also died despite adequate treatment for possible septicaemia and malaria. Conclusion: Although no mortality occurred in congenital clinical malaria, however, a diverse pattern of morbidity was shown. There is the need for continuing health education to increase the awareness amongst pregnant mothers of the importance of ante natal clinic visits for prescription of malaria chemoprophylaxis. The efficacy of artemether-lumefantrine combination in the treatment of clinical congenital malaria is strongly highlighted. Sahel Medical Journal Vol. 10 (1) 2007: pp. 24-2