Incidence of retinopathy of prematurity in very-low-birth-weight infants born at Kalafong hospital, Pretoria

Introduction. Retinopathy of prematurity (ROP) is a complication of prematurity, is diagnosed by ophthalmological screening of infants at risk (birth weight _ 1 500 g), and may lead to blindness. The incidence of ROP is under-reported in developing countries, including South Africa. Published data from the USA (CRYO-ROP) show that black infants have a lower incidence of threshold ROP than their white counterparts (3.2% v. 7.4%). Preliminary results of a screening programme initiated at Kalafong Hospital in 1999 are reported. Aim. To determine the incidence of ROP in infants with a birth weight of _ 1 500 g born at Kalafong Hospital. Patients and methods. Consecutive infants were enrolled at birth and screened for ROP 4 - 6 weeks later by indirect ophthalmoscopy. Repeat examinations were performed until vascularisation was complete or until the infant reached a postconceptional age of 40 weeks. Infants with stage 3 ROP who developed threshold disease were treated with cryotherapy or laser therapy. Results. One hundred and forty-five infants were enrolled over 10 months (15 February 1999 - 25 December 1999); of these 94 were screened. Of the remaining 51 infants, 24 died before screening and 27 were discharged before screening and were lost to follow-up. ROP was diagnosed in 23 of the 94 infants screened (24.5%). Stage 1 and 2 ROP occurred in 17 of the infants screened (18.1%) and stage 3 ROP in 6 (6.4%), of whom 4 (median birth weight 995 g, range 900 - 1 450 g) developed threshold ROP and were treated. Conclusions. The incidence of ROP in black very-low-birth-weight infants born at Kalafong Hospital is 24.5%. The incidence of threshold ROP is 4.3% (3.2% in infants _ 1 250 g) and correlates with published data from the USA. Infants with a birth weight _ 1 500 g should receive ophthalmological screening to diagnose stage 3 ROP timeously. (South African Medical Journal: 2002 92(12): 986-989

Vitamin D supplementation to prevent tuberculosis infection in South African schoolchildren: multicentre phase 3 double-blind randomised placebo-controlled trial (ViDiKids)

BACKGROUND: Relationships between vitamin D status, parathyroid hormone (PTH), bone mineral content (BMC) and fracture risk differ between children of White European vs. Black African ancestry. However, randomised controlled trials (RCT) to determine the influence of vitamin D supplements on BMC and fracture risk in African children are lacking.   METHODS: We conducted a sub-study nested within a Phase 3 RCT of weekly oral supplementation with 10,000 IU vitamin D3 in Cape Town schoolchildren aged 6-11 years. Sub-study outcomes were BMC at the whole body minus head and lumbar spine sites, determined by dual-energy x-ray absorptiometry (DXA), serum concentrations of 25-hydroxyvitamin D3 (25[OH]D3), PTH, alkaline phosphatase (ALP), C-terminal telopeptide (CTX) and procollagen type 1 N propeptide (P1NP). Incidence of fractures was a secondary outcome of the main trial.   FINDINGS: 1682 children of Black African ancestry attending 23 schools were enrolled in the main trial (829 vs. 853 randomised to vitamin D vs. placebo, respectively) of whom 450 also participated in the nested sub-study (228 vs. 222 randomised to vitamin D vs. placebo, respectively). In the sub-study population, end-trial serum concentrations of 25(OH)D3 were higher for participants allocated to vitamin D vs. placebo (adjusted mean difference [aMD] 39.9 nmol/L, 95% CI 36.1 to 43.6 nmol/L, P<0.001) and serum PTH concentrations were lower (aMD -0.55 pmol/L, 95% CI -0.94 to -0.17, P=0.005). However, no interarm differences were seen for BMC at the whole body minus head (aMD -8.0 g, 95% CI -30.7 to 14.7) or the lumbar spine (aMD -0.3 g, 95% CI -1.3 to 0.8), or for serum concentrations of alkaline phosphatase, CTX or P1NP (P≥0.28). In the main trial population, allocation to vitamin D vs. placebo did not influence the proportion of participants reporting one or more fractures (adjusted odds ratio 0.70, 95% CI 0.27 to 1.85, P=0.48).   INTERPRETATION: Weekly oral supplementation with 10,000 IU vitamin D3 for 3 years elevated serum 25(OH)D3 concentrations and suppressed serum PTH concentrations among Cape Town schoolchildren of Black African ancestry but did not influence BMC, serum concentrations of bone turnover markers or fracture risk

Global epidemiology of use of and disparities in caesarean sections : correspondence

No abstract available.http://www.thelancet.comhj2020Paediatrics and Child Healt

Peripartum HIV infection in very low birth weight infants fed ‘raw’ mother’s own milk

BACKGROUND: HIV-exposed very low birth weight (VLBW) infants (≤ 1500 g) are considered at high risk of peripartum mother-to-child HIV transmission (MTCT). In the past, they received formula to prevent breast milk related HIV transmission. This denied them the benefits of breast milk, thus exposing the infant to the risk of necrotising enterocolitis (NEC). From 2010, ‘raw’ mother’s own milk (rMOM) has been recommended for term infants whose mothers’ received antenatal antiretroviral therapy (ART). At the same time, the infant received antiretroviral (ARV) prophylaxis as per the National Prevention of MTCT programme. OBJECTIVES: To determine the cumulative incidence of peripartum HIV infection by 4–6 weeks of age in HIV-exposed VLBW infants, who received rMOM and infant ARV prophylaxis. METHOD: A retrospective, observational audit over 3 years at a single institution was undertaken. The study population comprised HIV-exposed VLBW infants who received both nevirapine prophylaxis and rMOM from birth until discharge. A positive HIV-PCR by 4–6 weeks of life was used to confirm maternal to infant HIV transmission. RESULTS: Of the 80 eligible infants admitted between 2010 and 2013, 63 (79%) were exposed to antenatal ART. Seventy-eight (97.5%) tested HIV-PCR negative at 4–6 weeks. Of the two infants who tested positive, both presented with features of an acute HIV infection. The absence of MTCT in the remaining 78 infants given ARV prophylaxis and rMOM suggests that rMOM is an unlikely source of infection in the two infected infants. CONCLUSION: rMOM, in the presence of infant prophylaxis, was a safe feeding option for HIV-exposed VLBW infants. It should be strongly considered for these infants, as rMOM likely provides additional maternal and child benefits.https://sajhivmed.org.zapm2020Paediatrics and Child Healt

Non-indicated scheduled caesarean deliveries in low-risk pregnancies have harmful effects on gene expression and immune function

Medicalised birth is increasing on a global scale. Scheduled caesarean deliveries have become the most common delivery mode in the South African private sector despite evidence that a vaginal delivery is the safest delivery mode in low risk pregnancies. Interventions at childbirth occur at a critical time for epigenetic influence, the assembly of the neonatal microbiome and downstream immune development. The perinatal events that may affect epigenetic influence include iatrogenic premature delivery, distress, bypassing of the vagina, separation of the mother-infant dyad, formula feeds, admission to a neonatal intensive care unit and antibiotics. Caesarean section delivery is associated with a list of long-term immune consequences. A scheduled caesarean section delivery often represents the initial event that will precipitate a domino-effect of altered early life exposures. The purpose of this review is to emphasise the roles of the fetal epigenome and microbiome in long term health and to highlight the harmful effects of a scheduled caesarean delivery on their integrity.http://www.journals.co.za/content/journal/cacihj2021Paediatrics and Child Healt

Rationale, design, and baseline characteristics in Evaluation of LIXisenatide in Acute Coronary Syndrome, a long-term cardiovascular end point trial of lixisenatide versus placebo

BACKGROUND: Cardiovascular (CV) disease is the leading cause of morbidity and mortality in patients with type 2 diabetes mellitus (T2DM). Furthermore, patients with T2DM and acute coronary syndrome (ACS) have a particularly high risk of CV events. The glucagon-like peptide 1 receptor agonist, lixisenatide, improves glycemia, but its effects on CV events have not been thoroughly evaluated. METHODS: ELIXA (www.clinicaltrials.gov no. NCT01147250) is a randomized, double-blind, placebo-controlled, parallel-group, multicenter study of lixisenatide in patients with T2DM and a recent ACS event. The primary aim is to evaluate the effects of lixisenatide on CV morbidity and mortality in a population at high CV risk. The primary efficacy end point is a composite of time to CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for unstable angina. Data are systematically collected for safety outcomes, including hypoglycemia, pancreatitis, and malignancy. RESULTS: Enrollment began in July 2010 and ended in August 2013; 6,068 patients from 49 countries were randomized. Of these, 69% are men and 75% are white; at baseline, the mean ± SD age was 60.3 ± 9.7 years, body mass index was 30.2 ± 5.7 kg/m(2), and duration of T2DM was 9.3 ± 8.2 years. The qualifying ACS was a myocardial infarction in 83% and unstable angina in 17%. The study will continue until the positive adjudication of the protocol-specified number of primary CV events. CONCLUSION: ELIXA will be the first trial to report the safety and efficacy of a glucagon-like peptide 1 receptor agonist in people with T2DM and high CV event risk