South African Journal of Child Health - latest Issue
Volume 10, Issue 4, 2016
Author Amisha KanjiSource: South African Journal of Child Health 10, pp 192 –192 (2016)More LessReview of published literature related to early hearing detection and intervention (EHDI) services in South Africa (SA) between 1995 and 2014 has highlighted progress in terms of the journey toward implementation of paediatric hearing screening services. However, in contrast to developed contexts, there are very few outcome studies from developing countries such as SA that support the efficacy of EHDI. This dearth of evidence from developing countries may be due to the lack of integrated, national EHDI programmes.
Source: South African Journal of Child Health 10, pp 194 –198 (2016) http://dx.doi.org/10.7196/SAJCH.2016.v10i4.1145More LessPersistent pulmonary hypertension of the newborn is a neonatal emergency with a high mortality rate in spite of several advances in the management thereof. The underlying pathophysiology is complex and multifactorial. The gold standard of treatment is inhaled nitric oxide, yet up to a third of patients will not respond to standard treatment. This article reviews treatment modalities available, as well as the evidence to support the use of these treatment options.
Outcome of very-low-birth-weight babies managed with nasal continuous positive airway pressure, with or without surfactant, in a high-care nurserySource: South African Journal of Child Health 10, pp 199 –206 (2016) http://dx.doi.org/10.7196/SAJCH.2016.v10i4.1096More Less
Background. Very-low-birth-weight (VLBW) infants who require nasal continuous positive airway pressure (NCPAP) are managed in neonatal intensive care units (NICUs) in developed countries, while in low-resource settings this is not always possible. The failure rate of NCPAP provided outside NICUs is not well known.
Objectives. To determine the failure rate, assessed as the need for invasive medical ventilation (iMV) and mortality on NCPAP in VLBW infants managed in a high-care nursery (HCN) within the first 72 hours of life.
Methods. Records of VLBW infants managed with NCPAP, at Chris Hani Baragwanath Hospital, were reviewed for infant characteristics, need for iMV and mortality on NCPAP. Clinical risk index for babies (CRIB) was calculated for each infant. Comparisons were made between those who needed iMV and those who did not, and between survivors and non-survivors on NCPAP.
Results. A total of 325 VLBW infants were managed with NCPAP in the HCN. Mean (standard deviation) birth weight was 1 120 (184)g, 98.5% were of gestational age (GA) <34 weeks and 14.9% were small for GA (SGA). Thirteen percent died while on NCPAP and 33% of survivors required iMV – an overall failure rate of 43%. Factors associated with iMV were high CRIB score (p<0.001), lower Apgar score (p=0.013), lower PaO2 (p=0.022) and high base deficit (p=0.034). Those who died were more likely to have extremely low birth weight (p<0.001), lower GA (p<0.001), high CRIB score (p<0.001) and base deficit (p<0.001). On multivariate analysis, the predictors for need of iMV were low Apgar score (p=0.033), SGA (p=0.042) and CRIB score (p=0.005), while that of mortality on NCPAP was birth weight.
Conclusion. Although failure rate of NCPAP in VLBW infants managed in HCN is high, a significant proportion of VLBW infants benefit from this intervention.
Source: South African Journal of Child Health 10, pp 207 –210 (2016) http://dx.doi.org/10.7196/SAJCH.2016.v10i4.1116More Less
Background. Paediatric endoscopy is now standard care in the developed world for the management of gastrointestinal (GI) disorders. However, in developing countries endoscopy remains an underutilised tool.
Objective. To determine the indications and the spectrum of endoscopic findings in children seen at the Lagos University Teaching Hospital, Nigeria.
Methods. The indications for upper GI endoscopy and endoscopic findings in children ≤16 years old, referred for the procedure from June 2013 to June 2016, were documented. The endoscopic yield in these children was also determined.
Results. In total 71 children were referred for upper GI endoscopy during the study period. There were 35 boys and 36 girls aged 3 months to 16 years. The indications for upper endoscopy were recurrent abdominal pain in 37 (52.1%), upper GI bleeding in 17 (23.9%), recurrent vomiting in 7 (9.9%), dyspepsia in 5 (7.0), heartburn in 2 (2.8%), dysphagia in 1 (1.4), portal hypertension in 1 (1.4) and ingestion of corrosives in 1 (1.4%) of the subjects. Endoscopic findings were as follows: gastritis 19 (26.8%), hiatus hernia in 13 (18.3%), gastric erosions in 12 (16.9%), oesophageal varices 6 (8.4%), duodenitis in 4 (5.6%), gastric ulcer in 3 (4.2%), gastric polyp in 2 (2.8%). The overall endoscopic yield was 60.2%.
Conclusion. There is a need to increase the awareness of the role of paediatric endoscopy in the diagnosis and treatment of GI disorders in developing countries. Recurrent abdominal pain still remains a relevant indication for the procedure. The need to develop training programmes for paediatric endoscopy and paediatric gastroenterology in general in developing countries cannot be overemphasised.
Source: South African Journal of Child Health 10, pp 211 –214 (2016) http://dx.doi.org/10.7196/SAJCH.2016.v10i4.1149More Less
Background. Omphalocoeles are associated with significant morbidity and mortality. The presentation varies greatly and management options differ accordingly. Limited literature exists regarding the varied presentation, associated congenital abnormalities and survival from a South African, or even an African perspective.
Objective. To describe the presentation of omphalocoeles, associated abnormalities and survival rates.
Methods. A retrospective epidemiological chart review of patients referred to the paediatric surgical service with newly diagnosed omphalocoeles, between January 2002 and December 2012. Data retrieved included patient demographics, perinatal history, HIV status, associated abnormalities, size of the omphalocoele, management and outcome.
Results. One hundred and fifty-four patients were diagnosed with an omphalocoele during the study period. There were 117 (75.9%) associated congenital abnormalities, 64 (41.5%) minor omphalocoeles (defined as <5 cm) and 66 (42.8%) major omphalocoeles (defined as >5 cm). Eleven patients (7.1%) had ruptured omphalocoeles. Beckwith-Wiedemann syndrome was the most commonly associated abnormality (37.6%), followed by cardiac defects (34.4%).
Conclusion. Omphalocoeles are associated with high numbers of congenital abnormalities. This further complicates management in a resource-poor environment. There is an increased association with Beckwith-Wiedemann syndrome compared with previous studies. This highlights the need to be vigilant with glucose monitoring and to prevent secondary, avoidable complications.
Management of acute diarrhoeal disease at Edendale Hospital : are standard treatment guidelines followed?Source: South African Journal of Child Health 10, pp 215 –220 (2016) http://dx.doi.org/10.7196/SAJCH.2016.v106i4.1177More Less
Background. Diarrhoeal disease (DD) is a major cause of childhood mortality in developing countries. In South Africa (SA), it ranks as one of the top five causes of under-5 mortality. Local and global guidelines on the management of acute DD are readily available. The Standard Treatment Guidelines (STGs) and Essential Drugs List for Hospital Level Paediatrics are a recognised standard of care for children in SA hospitals. However, children still die from this preventable disease.
Objective. To determine whether doctors adhered to standard treatment guidelines when treating children under 5 years of age presenting to Edendale Hospital in Pietermaritzburg, KwaZulu-Natal Province, with acute DD.Methods. The study was a retrospective clinical audit of individual patient records.
Results. One hundred and thirty-five patient records were reviewed. Forty-seven percent had a correct nutritional assessment, 41% were correctly assessed for shock and 27% for dehydration. Appropriate investigations were undertaken in 12%. Ninety-seven percent of patients had appropriate fluid plans prescribed. Zinc was prescribed in only 39% of patients, whereas 84% were appropriately not prescribed antibiotics and no patients received anti-diarrhoeal medication. In 90% of patients, the correct post-care patient referral was made, and 47% of caregivers were adequately advised about ongoing care of their children.Conclusion. This study identifies substantial non-adherence to the SA STGs for the management of young children with acute DD.
An audit of primary medical conditions in children admitted to the paediatric intensive care unit of Charlotte Maxeke Johannesburg Academic HospitalSource: South African Journal of Child Health 10, pp 221 –226 (2016) http://dx.doi.org/10.7196/SAJCH.2016.v10i4.1187More Less
Background. There is approximately one paediatric intensive care unit (PICU) bed per 22 800 children in SA, making PICU beds a very limited resource.
Objectives. To determine the spectrum of medical conditions in children admitted to a PICU, their outcomes, and to compare the number and outcomes of HIV-exposed/infected children v. HIV-unexposed children.
Methods. This was a retrospective chart review of children older than 28 days, admitted to Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) PICU for medical conditions from 1 January 2013 to 31 July 2014.
Results. There were 883 admissions; 518 (59%) were neonates and 234 (26.5%) were surgical patients, leaving a final sample of 131 (14.8%) children with medical conditions. The median age of children admitted was 3.8 months. Out of 131 children, 44 (34%) were HIV-exposed and 16 (12.2%) had a positive HIV polymerase chain reaction (PCR) result. Lower respiratory tract infections (LRTIs) accounted for two-thirds of all admissions at 84 (64.1%) and were significantly more common in HIV-exposed children (p=0.0005); 32 (24.4%) patients died. HIV-exposed children stayed 3 days longer (p=0.015), were ventilated for 4 more days (p=0.012) and were three times more likely to require high-frequency oscillatory ventilation (p=0.0005) than HIV-unexposed children. Mortality was similar between these two groups. Children confirmed HIV PCR-positive had a significantly longer duration of ICU stay (p=0.03) and ventilation (p=0.006) than those who were exposed but uninfected.
Conclusion. There were 883 children admitted in 19 months to CMJAH PICU. A total of 15% of admissions were for medical conditions, two-thirds of which were for LRTIs. One-third of the children were HIV-exposed and had similar outcomes to their unaffected counterparts, although their duration of ventilation and length of stay were longer.
Source: South African Journal of Child Health 10, pp 227 –230 (2016) http://dx.doi.org/10.7196/SAJCH.2016.v10i4.1190More Less
Background. Neonatal jaundice remains a leading cause of preventable brain damage, mental handicap, physical disabilities and early death among infants. The high mortality and morbidity from neonatal jaundice is exacerbated by the poor understanding and mismanagement of this common neonatal problem by the general populace, leading to dangerous delays and complications.Objective. To assess the knowledge of pregnant women on the causative factors, treatment modalities and sequelae of neonatal jaundice.
Methods. Data were obtained from all consecutive women who attended the antenatal clinic of the Lagos University Teaching Hospital, Nigeria, from January 2013 to April 2013, using a pretested questionnaire focusing on knowledge of neonatal jaundice and its causes, treatment and complications.
Results. The study participants numbered 395, of whom 213 (53.9%) were within the age range of 30 - 39 years. Only 101 (25.6%) participants gave a correct definition of neonatal jaundice. The highest proportion of those who did not give a correct definition were from the lower socioeconomic groups V and IV (χ2=12.08, p=0.017). Participants who did not know the causes numbered 313 (79.2%), while 325 (82.2%) participants chose ineffective treatment options. Furthermore, 296 (74.9%) respondents, especially those with a low level of education, did not identify the complications correctly (χ2=12.61, p=0.006).
Conclusion. Women in the study showed inadequate knowledge of and misconceptions regarding neonatal jaundice, which must be addressed in order to reduce significantly the devastating consequences of this common condition. We advocate for improved female literacy and mass health enlightenment programmes.
Fatal Lemierre’s syndrome as a complication of chronic otitis media with cholesteatoma : case reportSource: South African Journal of Child Health 10, pp 231 –232 (2016) http://dx.doi.org/10.7196/SAJCH.2016.v10i4.1074More Less
Background. Lemierre’s syndrome is septic thrombophlebitis of the internal jugular vein, initiated by an infection of the head and neck region. This septic thrombophlebitis gives rise to septic microemboli that can disseminate throughout the body to form septic infarctions and abscesses, with the most frequent site being pulmonary.Methods. We discuss the case of a 14-year-old male with Lemierre’s syndrome as a complication of chronic middle ear infection.Results. The patient developed septic shock and microemboli, and subsequently died.
Conclusion. This case report illustrates that untreated chronic middle ear infection can lead to potentially fatal complications such as Lemierre’s syndrome, and emphasises the importance of timeous treatment of chronic middle ear pathology.
Intracardiac and intracerebral thrombosis associated with methylenetetrahydrofolate reductase A1298C homozygote mutation in paediatric steroidresistant nephrotic syndrome : case reportSource: South African Journal of Child Health 10, pp 233 –236 (2016) http://dx.doi.org/10.7196/SAJCH.2016.v10i4.1189More LessThromboembolic complications are a significant cause of morbidity and mortality in cases of nephrotic syndrome. Hereditary thrombophilias are also known to increase vascular thrombosis. We present a case that has been followed up for steroid-resistant nephrotic syndrome (NS) in which intracardiac and intracranial thrombosis subsequently developed. The patient was found to have a homozygote mutation in the methylenetetrahydrofolate reductase (MTHFR) gene as an additional risk factor for recurrent thrombosis. MTHFR mutation with NS was considered to have an important effect on the development of life-threatening thrombosis.
Source: South African Journal of Child Health 10, pp 237 –238 (2016) http://dx.doi.org/10.7196/SAJCH.2016.v10i4.1197More LessRosai-Dorfman disease is a rare disorder of systemic histioproliferation, first described in 1969 by Juan Rosai and Ronald Dorfman. It is characterised by massive lymphadenopathy, particularly of the head and neck region, and it is sometimes associated with extranodal involvement. This is the first case to be reported from our centre. We report a case of Rosai-Dorfman disease in a 12-year-old Nigerian boy who presented at the children’s outpatient clinic of the Federal Medical Centre, Owerri, Imo State, Nigeria, with a 5-year history of bilateral neck swelling, a 2-year history of groin swelling and a recurrent fever of over a year’s duration. An initial diagnosis of Hodgkin’s lymphoma was made. An excisional biopsy of the cervical lymph node was undertaken and the histology showed massive histiocytosis with emperipolesis, which confirmed the diagnosis of Rosai-Dorfman disease.Rosai-Dorfman disease, although a rare clinical entity, should be suspected in patients presenting with massive lymphadenopathy located especially in the neck and groin regions.