South African Journal of Child Health - Volume 1, Issue 2, 2007
Volume 1, Issue 2, 2007
Source: South African Journal of Child Health 1 (2007)More Less
Newspaper journalists choose headlines that will grab as many people's attention as possible - not surprising, of course; this translates to revenue. But a picture of multiple little white crosses, allegedly indicating a mass grave for 43 neonates, near an East London hospital (Sunday Weekend Argus, 15 July 2007) should disturb us. Especially if the report suggests that it's not a once-off : 'batches of up to 45 babies ... buried every month'. The article reports that Deputy Minister of Health Nozizwe Madlala-Routledge 'is outraged by the problems at Frere Hospital', which include 'acute staff shortages ... '. There are even claims that 'very small babies ... [are] sometimes regarded as still born'.
Source: South African Journal of Child Health 1, pp 50 –52 (2007)More Less
It was not hard to decide on the 'hot topic' for this second issue of SAJCH, particularly as the HIV/AIDS conference had just ended in Durban. In spite of the amount of money and effort that is going into reducing the number of new cases, the epidemic seems to progress unabated. The operative word in that last sentence, 'seems', is based on surrogate measures of infection such as rising infant mortality rates, non-accidental deaths in young adults, and teenage pregnancy rates - in addition to actual recently reported incidences.
Author Mmakabelo A. KrugSource: South African Journal of Child Health 1 (2007)More Less
To the Editor : Thank you for your recent editorial 'Who determines culture? (SAMJ 2007; 97 : 385) Indeed, language carries thinking and the concepts of how we understand life, the community and ourselves. The HIV epidemic needs strong primary prevention programmes for children and adolescents and improved PMTCT programmes. Both need powerful communication. For this I suggest a pro-African language approach.
Source: South African Journal of Child Health 1, pp 54 –57 (2007)More Less
Child abuse has been researched extensively and causes are usually found to arise from a large spectrum of psychological, socio-economic and cultural factors. This article evaluates infant abuse from an evolutionary perspective. It compares brain growth and neurological development of human infants with that of other primates, and relates these findings to infant abuse. The extra-uterine brain development in the early years of childhood, together with the greater vulnerability of the child as a result of immature neuro- and motor development as well as an 'unprotected and growing brain', may be an overlooked but important evolutionary reason for human infant abuse.
Source: South African Journal of Child Health 1, pp 58 –62 (2007)More Less
In 1991 a cut-off weight of 1 000 g and/or 28 weeks' gestation for neonatal intensive care unit (NICU) admission was decided on by attending neonatologists at a Priorities in Perinatal Care Conference. These recommendations were not based on published evidence. At the time there were few data on the outcome of babies born in the public sector who received NICU.
Aim. The aim of this study was to describe the demographic data (mother and baby) and outcomes of babies admitted to a tertiary NICU.
Methods. During 1992 - 1996 (1992 cohort) and 1999 - 2000 (1999 cohort) two cohorts of babies treated in the NICU at Tygerberg Hospital, Western Cape, South Africa, were studied. Demographic data were collected prospectively on all admissions with a birth weight of less than 1 501 g and a gestational age of less than 32 weeks. Outcome data were survival, days of ventilation and NICU stay.
Results. There were 455 babies in the 1992 cohort and 272 in the 1999 cohort. The mothers' mean income was R892 per month and was higher in the 1999 cohort. The 1999 cohort comprised significantly smaller babies, at a mean birth weight of 1 119 g v. 1 198 g. The mean gestational age in the 1999 cohort was lower (29.2 v. 30.3 weeks), but so was the mortality rate (21.6% v. 26.1%). The main differences between the survivors and non-survivors were in their birth weight and gestational age and the mean income of their mothers. The mean number of ventilation days needed by these infants was low at 8.5 days, with an average stay in the NICU of 13 days.
Discussion. Babies admitted to an NICU have a good chance of survival at a low mean number of ventilation and NICU days. The increase in survival in the 1999 cohort, in spite of low income, is in keeping with international trends and underlines the good short-term outcome of these small babies.
Source: South African Journal of Child Health 1, pp 64 –67 (2007)More Less
Objective. To determine the risk factors for mortality in neonatal seizures.
Methods and design. A prospective study of consecutive newborn babies with seizures admitted to a Nigerian hospital between January and December 2006. Multiple regression analysis was used to determine the risk factors for mortality among consecutive neonates admitted with seizures.
Results. Seventy-eight babies were studied. Thirty-six of these (46.1%) had seizures within the first 24 hours of life. The mean age at onset of seizure was 85.4 ± 106.1 hours. The leading aetiologies included hypocalcaemia 65.4%), hypoxic-ischaemic encephalopathy (HIE) (60.3%) and hypoglycaemia (50.0%). Severe anaemia occurred in 56.4% of babies. Most (85.9%) had multiple aetiologies while no aetiology was identified in 5.1%. The mortality rate was 43.6%. Significant risk factors for mortality included duration of seizure longer than 24 hours (p = 0.019), hypoglycaemia (p = 0.001) and severe anaemia (p = 0.004). The co-existence of HIE with hypoglycaemia and hypocalcaemia was also more significantly associated with mortality (p = 0.03) than each of hypoglycaemia and hypocalcaemia co-existing with HIE separately.
Conclusion. The prevention of fatal neonatal seizures should start with good intrapartum care, prompt detection and correction of hypoglycaemia and anaemia and early control of seizures.
Predictors of survival in infants with congenital diaphragmatic hernia - systemic oxygenation status versus dynamic compliance of the respiratory systemSource: South African Journal of Child Health 1, pp 68 –72 (2007)More Less
Objective. To compare whether early measurement of blood gases and/or dynamic compliance of the respiratory system (CRSdyn) predicts outcome in high-risk infants with unilateral congenital diaphragmatic hernia (CDH).
Patients and methods. A retrospective study was performed at Tygerberg Children's Hospital between January 1992 and August 2001. High-risk infants with unilateral CDH, who presented with respiratory distress within 6 hours of birth, were included. Patients with other lethal congenital abnormalities were excluded. The first arterial blood gas value after endotracheal intubation was documented and the arterial-alveolar oxygen tension (a:A) ratio was calculated. CRSdyn was measured within 24 hours of birth. The ability of these measurements to predict outcome (survival or death during the newborn period) was determined.
Results. Seventeen of 40 infants with CDH were categorised as high risk and included in the study. Eight of them (47%) survived the neonatal period. The best single predictors of outcome were, in order, partial pressure of oxygen in arterial blood (PaO2), a:A ratio and dynamic compliance of the respiratory system standardised for body weight (CRSdyn/kg). The specificity and sensitivity at a PaO2 cut-off of 19.3 kPa were 7/8 (95% confidence interval (CI): 0.473 - 0.997) and 9/9 (95% CI: 0.634 - 1.000) respectively. Results for a:A ratio were cut-off 0.321, specificity 6/8 (95% CI: 0.349 - 0.968), and sensitivity 9/9 (95% CI: 0.634 - 1.000). Results for CRSdyn/kg were cut-off 0.259, specificity 6/8 (95% CI: 0.349 - 0.968), and sensitivity 9/9 (95% CI: 0.634 - 1.000). A linear discriminant function based on the 3 best single predictors was found to be no more effective than the first PaO2.
Conclusions. Early oxygenation status predicts outcome better than the CRSdyn/kg in infants with unilateral CDH. However, both measurements predict outcome with high accuracy.
Source: South African Journal of Child Health 1, pp 74 –77 (2007)More Less
Two hundred and forty-two records of children with cerebral palsy were reviewed with regard to the aetiology of their condition. The origin of the insult was prenatal in 70 (28.9%), perinatal/neonatal in 92 (38%), acquired in 51 (21%) and unclassifiable in 29 (11.98%). Cerebral malformations (15.7%) and stroke (5.7%) were the most frequent antenatal causes, while birth asphyxia (17.3%), encephalopathy of prematurity (17.7%) and to a lesser degree kernicterus (2%) constituted the most frequent perinatal causes. Acquired cerebral palsy, particularly secondary to nervous system infections (82%), constituted a significant proportion of cases. Spastic quadriplegia (40%) was the most common type of cerebral palsy. The predominance of cases of perinatal and acquired aetiology is in contrast to the antenatal preponderance reported in developed countries.
Author Tony WestwoodSource: South African Journal of Child Health 1, pp 78 –81 (2007)More Less
Objectives. To determine the incidence and prevalence of cystic fibrosis (CF) among populations of the Western Cape province of South Africa.
Design and subjects. Descriptive study using data from a database of CF cases and the 1996 Census.
Measures. CF births from 1987 to 1996 and known CF patients in 1996 were compared with Census birth data and population data, respectively.
Results. The very small numbers of black African CF patients precluded estimating the epidemiology in this group. The incidences of CF for coloured and white patients were 1 in 9 845 and 1 in 2 853 live births, respectively. There was under-ascertainment of cases in non-metropolitan areas. The prevalence of CF per 100 000 of the population was 2.6 and 11 for the coloured and white populations, respectively. The estimated number of persons with CF in these two groups in South Africa in 2001 was 571.
Conclusions. CF was more common in the coloured population and less common in the white population than previously estimated. Under-diagnosis occurred in non-metropolitan areas in both groups.
Delay in diagnosis of Duchenne muscular dystrophy may reduce benefit from new corticosteroid protocol : short reportSource: South African Journal of Child Health 1, pp 82 –84 (2007)More Less
About one-third of boys with Duchenne muscular dystrophy (DMD) have associated learning difficulties, particularly speech and language delay, and this may be the initial presenting complaint. Attention is often focused on behaviour and learning difficulties, and the progressive muscle weakness may not be noticed until the condition is advanced.
Now that corticosteroids have been established as the gold standard of care, delay in the diagnosis of DMD has become far more relevant because any delay may limit the benefit that can be gained from steroid therapy, since muscle strength that has been lost cannot be regained.
We present 3 cases of boys with unexplained learning difficulty in whom the diagnosis could have been made far earlier if a creatine kinase test had been done at presentation.
Author P.C. PotterSource: South African Journal of Child Health 1, pp 87 –92 (2007)More Less
Life-threatening allergies often present difficult diagnostic challenges to health practitioners managing children. They are a source of great anxiety to parents and children and require accurate assessment and careful management.
In recent decades there has been a real increase in true food and drug allergies affecting children across the age spectrum, from well-nourished ones to those infected with HIV.
Although the most severe life-threatening allergies in children most often result from food and drug hypersensitivities, severe allergic reactions with life-threatening consequences are also encountered after exposure to latex, insect venoms, vaccines, immunotherapy, certain aero-allergens and certain food and drug preservatives. In high-risk children life-threatening reactions may also follow exercise or exposure to cross-reacting allergens.
The principle of taking a careful history, details of the events and exposure before the reaction and before embarking on blood tests or other investigations, applies to all life-threatening allergies. There are a number of useful new diagnostic tests for evaluating life-threatening reactions. These include nonspecific tests, such as the mast cell tryptase test, and specific tests, including the Immunocap radio-allergosorbent test (RAST), cellular activated sulphido-leukotriene release test (CAST), titrated specific skin-prick testing and controlled challenge tests.
Assessment of risk, level of exposure, inadvertent exposure and prevention of subsequent reactions are important components of the comprehensive management of these children.