Perception of nonatal jaundice among women attending children out patient and immunization clinics of the UPTH Port Harcourt

No Abstract

Diphtheria in a 13 year old adolescent girl: Management challenges

Background: Diphtheria is an acute toxic infection which is associated with a high morbidity and mortality and can pose management challenges especially in the absence of proper diagnostic and therapeutic facilities.Case report: A.S. was a 13 year old girl who presented with fever of five days duration, dysphagia and neck swelling of 4 days duration and sore throat and hoarse voice of 3days duration. Her illness started a day after returning from a 4-day holiday youth camp. She received only oral polio vaccine immunization in childhood. Significant physical examinationfindings included a swollen neck, a greyish membrane covering the soft palate and uvula with haemorrhagic spots. The pharynx, anterior nares and the nasal turbinates were inflamed and erythematous. A working diagnosis of respiratory diphtheria was made. Throat swab microscopy showed club shaped Gram positive baccilli. Appropriate culture medium for C. diphtheriawas not available. She received intravenous crystalline penicillin and metronidazole and lateroral erythromycin in an isolated ward. On the 6th day of admission she developed cardiac and neurologic complications–bradycardia (PR=40bpm), hypotension (BP=70/40mmHg), drooling of saliva and paraparesis. Electrocardiography confirmed a complete heart block. She died on the 11th day of admission while efforts were being made to raise funds for a cardiac pace maker. Conclusion: Management of this vaccine preventable disease requires a high index of suspicion and diphtheria antitoxin should be made readily available

Serum zinc levels in HIV infected children attending the University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria.

Background: Zinc deficiency is common in the Paediatric age group but the extent of this disorder is unknown in HIV infected children in Nigeria prompting this study.Objective: To determine the prevalence of zinc deficiency in HIV seropositive children, and compare this with age and sex matched controls.Methods: A case control study of 70 HIV sero-positive and age and sex matched HIV sero-negative children was carried out in the University of Port Harcourt Teaching Hospital between 1st of June, 2009 and 31st of May, 2010. We collected demographic, clinical, haematological and biochemical parameters from cases and controls, and analysed these using SPSS 20.Results: Sixty percent of the subjects were zinc deficient as against 41.4% of the controls, p= 0.028. Subjects that were zinc deficient were more likely to be in higher HIV disease stages, p = 0.003, in lower socio-economic classes and aged less than 60 months. We conclude that there is a high prevalence of zinc deficiency in HIV sero-positive children and they should have zinc supplementation immediately they are diagnosed to reduce their morbidity and mortality.Key words: Zinc deficiency, HIV sero-positive, socio-economic statu

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Background: Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. // Methods: We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. // Findings: We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middle-income countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in low-income countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. // Interpretation: Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between low-income, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Myelomeningocoele in dizygotic twins

No Abstract

Foreign body ingestion in a neonate

Background: Foreign body ingestion is a very common event in the paediatric age group. There are however very few reports of foreign body ingestion in neonates. Aim: To report a case of ingestion of foreign body in a neonate. Case report: A neonate with thumb tack ingestion presented with respiratory distress. She had an emergency tracheostomy and subsequent extraction of the foreign body. She was extubated after four days and was discharged on the eighth day in good clinical condition. Conclusion: Foreign body ingestion in the neonate although very uncommon is possible. Paediatricians should therefore remember that an oesophageal foreign body may be a possible cause of respiratory distress in a neonate. Keywords: Neonate, Foreign body, IngestionPort Harcourt Medical Journal Vol. 2 (3) 2008: pp.271-27

Disseminated intravascular coagulopathy in a neonate: management challenges

No Abstract. Nigerian Journal of Medicine Vol. 16 (2) 2007: pp.177-18

Pattern, outcome and challenges of neonatal surgical cases in a tertiary teaching hospital

Background: Globally, the major causes of neonatal deaths are birth asphyxia, prematurity and severe infections. Little attention is paid to deaths contributed by surgically amenable conditions. This study was undertaken to determine the burden and types of surgical problems encountered in the neonatal period, their outcome and challenges encountered. Patients and Methods: This was a retrospective study. The case notes of all neonates admitted into the newborn unit of our centre between April 2002 and March 2010 with surgical conditions were retrieved and the following information extracted: Sex, diagnosis, age at presentation, surgical intervention and outcome.Results: Out of 7,401 neonates admitted within the study period, 460 (6.2%) had a surgical condition. Of the 1,657 babies that died within the same period, 196 (11.8%) of them were those with surgical conditions. Congenital abnormalities accounted for 408 (88.7%) of all the surgical cases. Intestinal obstruction 129 (31.6%), neural tube defects 101 (24.8%) and anterior abdominal wall defect 58 (14.2%) were the commonest congenital abnormalities, while fracture of the long bones following birth trauma 15 (28.8%) and perforated NEC 14 (26.9%) were the commonest acquired conditions. Surgery was performed in 166 (36.1%) and 98 (59%) had postoperative complications. Signifi cantly, more deaths occurred in preterms than in term babies (P = 0.003) and in those delivered outside the hospital than in in-born babies (P = 0.02). The major cause of death was infection in 92 (47%). Conclusion: Neonatal surgical conditions contributed signifi cantly to both neonatal admissions and overall neonatal mortality and thus highlights the need for investments in newborn surgical care in developing countries.Key words: Congenital abnormality, neonate, outcome, surgical condition

Evaluation of the effectiveness of the prevention of mother-to-child transmission(PMTCT)interventions in HIV-exposed children

No Abstract

Diarrhoea management: An evaluation of the appropirateness of the home treatment given by caregivers

Background: Diarrhoea often starts at home. Early and appropriate treatment by caregivers will go a long way towards reducing the morbidity and mortality from diarrhoea. Aim: To document how acute diarrhoea is managed at home by caregivers and to determine the appropriateness of such treatment. Methods: A prospective study of children less than 5 years with diarrhoea attending the Diarrhoea Training Unit (DTU) and Children Emergency Ward (CHEW) of the University of Port Harcourt Teaching Hospital (UPTH) was conducted using a structured questionnaire administered to the caregivers. Results: A total number of 250 children were recruited for the study.  Twenty-four (9.6%) children had blood in stool (dysentery) while 226(90.4%) had acute watery diarrhoea. Thirty-six (14.4%) gave oral rehydration therapy (ORT) as the only home treatment, 60 (24.0%) gave both drugs and  ORT,  while  151 (60.4%) gave drugs alone and 3 (1.2%) children received no treatment.   The drugs given included antibiotics in 188 (89.1%), adsorbents in 53 (25.1%), antiemetic in 12 (5.7%), antispasmodic in 8 (3.8%), antihelminthics in 7 (3.3%), and antacid in 6 (2.8%).  None of the cases with blood in the stool (dysentery) received the appropriate antibiotics.  Parental education and social class did not seem to have an effect on the appropriateness of the care given to these children. Conclusion: Diarrhoea management at home is inadequate in terms of low utilization of oral rehydration therapy, inappropriate administration of antibiotics for cases with bloody stool, and unnecessary use of antibiotics/antidiarrhoeals for acute watery diarrhoea.   Key words: Acute watery diarrhoea, Dysentery, Oral rehydration therapy (ORT), Drug