South African Journal of Child Health - Volume 1, Issue 4, 2007
Volume 1, Issue 4, 2007
Author N.C. RollinsSource: South African Journal of Child Health 1, pp 132 –133 (2007)More Less
Source: South African Journal of Child Health 1, pp 135 –139 (2007)More Less
Objective. To analyse paediatric-specific goals and objectives in the HIV & AIDS and STI National Strategic Plan (NSP) for South Africa 2007 - 2011.
Methods. This paper reviews key interventions described in the NSP regarding HIV prevention, management and treatment in children under 14 years of age. A general overview of the plan and its implications for the health system was previously published.
Results. The NSP contains 4 priority areas, which were disaggregated into 19 goals. Each goal specifies several clearly worded objectives together with 5-year targets, and identifies lead agencies responsible for the achievement of these targets. Nine of the 19 goals (47%) address interventions which mention or affect children directly. Paediatric-specific objectives encompass HIV prevention and treatment, legislation, social security, education, mental health, and developmental monitoring. If implemented comprehensively, it will appreciably improve the country's chances of achieving Millennium Development Goal 4, i.e. the reduction by two-thirds of the mortality rate among children under 5 years of age by 2015. However, substantial resources are required to achieve the goals and objectives of the NSP, including legal and policy amendments.
Conclusion. The NSP is an important framework document, which should provide the necessary direction for addressing the paediatric HIV epidemic in South Africa.
Source: South African Journal of Child Health 1, pp 140 –144 (2007)More Less
Aim. The aim of this study was to describe the disease severity and clinical course and outcome of hospitalised HIV-infected children aged <6 months.
Methods. A retrospective case review was completed at Red Cross Children's Hospital (RCCH) during the middle of 2006. Perinatal management, disease severity and hospital outcomes were analysed. In a sub-analysis, the disease profile and outcome of admitted children aged less than and more than 6 months were compared over the latter 3 months of the study.
Results. Seventy-five out of 121 (43.86%) of all HIV infected children admitted over the study period were <6 months of age. Sixty-nine out of 72 (95.83%) of the children not receiving highly active antiretroviral therapy (HAART) at admission, qualified according to current WHO treatment criteria. The most frequent cause for admission was pneumonia (54.67%). The inpatient fatality rate was 28%, pneumonia being the most frequent cause of death (61.9%). Fifty-two out of 75 (69.33%) of the mothers reported having been tested for HIV during pregnancy. Thirty-four out of 37 (91.89%) who tested HIV-positive during pregnancy received prevention of mother-to child transmission (PMTCT) prophylaxis. Children with confirmed / presumed Pneumocystis jiroveci pneumonia (PJP) were less likely to have mothers who received PMTCT prophylaxis (18.51% v. 61.7%, p=0.0004), and less likely to be receiving cotrimoxazole prophylaxis (14.81% v. 46.81%, p=0.006) at admission. Children >6 months were more likely to be receiving cotrimoxazole prophylaxis (65.4% v. 31.1%, p=0.0008) and HAART (42.3% v. 6.7%, p=0.00007) at the time of admission. Of those not on HAART, 27 out of 30 (90%) had WHO stage 3 or 4 disease. Inpatient fatality in this group was 13.5%.
Conclusions. Young children constitute a sizeable proportion of the inpatient paediatric HIV workload. Comprehensive PMTCT interventions and earlier introduction of HAART may reduce morbidity, hospitalisation rates and mortality.
Source: South African Journal of Child Health 1, pp 146 –150 (2007)More Less
Background. Procalcitonin (PCT) has been used in the diagnosis of early-onset neonatal sepsis (EONS) in conjunction with other markers of infection, and levels are highest at the onset of infection and decline over time. This study evaluated whether an initial negative PCT level could be used to withhold antibiotics in neonates presenting with suspected EONS and whether PCT levels differed between premature and term babies.
Methods. Neonates undergoing evaluation for suspected sepsis in the Neonatal Unit, Johannesburg Hospital, within 24 hours of birth between July and September 2004 were included. Patients were categorised into various categories of infection using risk factors for infection, white cell count, platelet count, C-reactive protein and blood culture results. Babies were started on empiric parenteral antibiotics as per unit protocols. PCT was correlated with infection categories.
Results. The final analysis included 194 babies, 131 premature and 63 term; 145 had 'no infection', 47 'probable infection' and 2 'definite infection'. The mean PCT levels (and ranges) for the three categories were 1.6 ng/ml (range 0.5 - 37.5 ng/ml), 11.9 ng/ml (0.5 - 150.4) and 6.7 ng/ml (0.5 - 12.9), respectively. Using a cut-off of 0.5 ng/ml, the negative predictive value (NPV) of PCT was 80% and the positive predictive value (PPV) 39%. Increasing the cut-off of PCT had no effect on the NPV. Receiver operating characteristic (ROC) analysis had an area under the curve of 0.631.
Conclusions. The NPV of PCT on admission for suspected EONS is better than the PPV, but not sufficiently reliable to exclude sepsis, even when using higher cut-off values. PCT levels did not differ significantly between premature and term babies. ARTI
Source: South African Journal of Child Health 1, pp 151 –155 (2007)More Less
Objective. To determine the presence of bacterial and viral infectious agents in children with fever during anticancer chemotherapy treatment.
Design. Analysis of data obtained in a prospective cohort study.
Setting. The paediatric oncology unit at Tygerberg Children's Hospital, Stellenbosch University, Parow, Western Cape.
Subjects. All patients up to the age of 15 years who developed fever secondary to anticancer chemotherapy from 9 February 2000 to 9 April 2001.
Outcome measures. Viruses were isolated or antigens detected on venous blood samples, nasopharyngeal aspirates (NPAs), throat swabs, urine and faeces, where possible. Blood for aerobic and anaerobic culture was obtained from an indwelling intravenous catheter and / or a peripheral vein.
Results. Thirty-four patients were analysed for a total of 102 febrile episodes. Evidence of a viral and bacterial infection was found in 31 (30%) and 24 (24%) episodes, respectively. Within these, a combined viral and bacterial infection was demonstrated in 6 (6%) episodes. A total of 35 viral isolates were identified in 31 febrile episodes: herpes simplex virus 1 (HSV-1) (N=14), HSV-2 (N=2), cytomegalovirus (CMV) (N=10), rotavirus (N=5), adenovirus (N=2), para-influenza type 3 (N=1) and hepatitis B (N=1). The blood culture was positive in 24 febrile episodes. The absolute neutrophil count (ANC) on admission was below 0.5 x 109/l in 57 (56%) episodes and thus considered neutropenic. Infectious agents were more frequently identified in neutropenic (54%) than in non-neutropenic (40%) episodes and were more likely to be of bacterial (30%) than viral (15.5%) origin. However, this difference was not significant.
Conclusions. In addition to bacterial infections, viruses are clearly an important cause of fever in children receiving anticancer chemotherapy. Diagnostic tests for viral infections should be used more frequently, and could be of considerable value in evaluating fever and establishing appropriate therapy in these patients.
Source: South African Journal of Child Health 1, pp 156 –158 (2007)More Less
Several criteria determine the choice of technique for unilateral cleft lip and nose repair. The aim of the procedure is to correct the malformation with minimal scarring. In humanitarian missions cleft lip and nose repair is often performed on patients who have a relatively high risk of keloid scarring as a result of skin colour.
Author Aadil AhmedSource: South African Journal of Child Health 1, pp 159 –160 (2007)More Less
Neonatal tetanus is a rare, acute, occasionally fatal disease, the incidence of which has greatly diminished with routine immunisation. The radiological features are seldom encountered nowadays. Neonatal tetanus is still prevalent in some developing countries. We present a case of a neonate who developed some of the complications and radiological features described in cases of neonatal tetanus.
Tetanus is an acute, often fatal, disease caused by an exotoxin produced by the Gram-positive bacterium Clostridium tetani. It is characterised by generalised rigidity and convulsive spasms of the skeletal muscles. The incubation period ranges from 3 to 21 days - usually about 8 days.
Neonatal tetanus is a form of generalised tetanus that occurs without protective passive immunity. It usually occurs as a result of infection of the unhealed umbilical stump, particularly when the stump is cut with an unsterile instrument. With the advent of routine childhood immunisation, there has been a marked decrease in the incidence of tetanus. Neonatal tetanus, however, is still prevalent in some developing countries.
There are no laboratory findings characteristic of tetanus. The diagnosis is entirely clinical and does not depend on bacteriological confirmation.