South African Journal of Child Health - Volume 2, Issue 1, 2008
Volume 2, Issue 1, 2008
Author Nonhlanhla P. KhumaloSource: South African Journal of Child Health 2 (2008)More Less
Both locally and internationally many people have campaigned tirelessly not only for the declaration of a special World Autism Day but also for increased awareness about the autism spectrum of disorders. It is interesting that a woman has been recognised for her outstanding effort in this endeavour.
Author L. MubaiwaSource: South African Journal of Child Health 2, pp 6 –7 (2008)More Less
The classic features of infantile autism of extreme social isolation, pathological need for sameness and mutism or non-communicative speech were originally described by Kanner in 1943. The diagnostic terminology used to label children with this complex disorder can be confusing.
Of rain men and snowcakes : the presentation, pathology, aetiology and management of autistic spectrum disorder : reviewSource: South African Journal of Child Health 2, pp 8 –12 (2008)More Less
Over the past two decades, both the prevalence and our understanding of autism have increased exponentially. Autism encompasses a group of behaviourally defined developmental disorders, collectively known as autism spectrum disorder (ASD), which appear to be caused by the impact of environment during early life on genetically induced susceptibility. As paediatricians are consulted first by most parents of children with developmental delay, they should be able to discuss the pathology, aetiology and management of the disorder. Although much remains to be understood, research over the last 20 years has shown that this disorder is treatable, and that early medical / biomedical and behavioural intervention greatly improves the quality of life and outcomes of children with ASD.
Source: South African Journal of Child Health 2 (2008)More Less
There can be no doubt that South Africa is a very violent society. The murder rate of approximately 67 per 100 000 is one of the highest in the world, more than 8 times the world's average. Discussions around the dinner table at home and at work often include the latest crime statistics. There are websites providing daily updates on crime in neighbourhoods.
A survey of the management of idiopathic thrombocytopenic purpura in South Africa : do we need guidelines for developing countries?Source: South African Journal of Child Health 2, pp 15 –18 (2008)More Less
Introduction. Idiopathic thrombocytopenic purpura (ITP) is the most common bleeding disorder of childhood.
Aim. To describe the management of ITP in South Africa.
Methods. A survey was sent to 410 doctors in the country, describing four different scenarios in children newly diagnosed with ITP and soliciting responses concerning the diagnosis and management.
Results. Steroids were the first line of choice in treating ITP. Anti-D immunoglobulin was not considered in the management, and most practitioners would perform a bone marrow aspiration even if no treatment with steroids would be given. The vast majority of the patients would be treated in hospital.
Conclusions. This is the first study done in South Africa (and in Africa), and it shows a great variation in the management of children with newly diagnosed ITP. Prospective studies in developing countries where various constraints to health care delivery exist are required to produce evidence-based recommendations for this patient group.
Newborn screening for classic galactosaemia and primary congenital hypothyroidism in the Nkangala district of Mpumalanga province, South AfricaSource: South African Journal of Child Health 2, pp 19 –22 (2008)More Less
Objectives. The main objective of this work was to establish the incidence of classic galactosaemia and primary congenital hypothyroidism in newborns in the Nkangala district of Mpumalanga. In the process a cost-effective protocol for neonatal screening of both diseases was developed.
Study design and setting. Blood spot specimens were collected from a third (1 012 out of 3 297) of newborn infants in the Nkangala district of Mpumalanga province from June to November 2005. The specimens were subsequently screened for classic galactosaemia and hypothyroidism using metabolite quantification assays. Galactose-1-phosphate uridyltransferase (GALT) enzyme activity assays were also performed to confirm the reliability of the total galactose assays. The real-time polymerase chain reaction (PCR) was used to detect commonly occurring mutations in the GALT gene that cause galactosaemia. Thyroidstimulating hormone (TSH) levels were evaluated as a diagnostic metabolite for primary congenital hypothyroidism.
Subjects and outcome measures. Informed consent was obtained from the babies' parents before commencement of screening. Total galactose levels above 0.9 mg/l and TSH concentrations above 25.1 mU/l were considered to indicate galactosaemia and hypothyroidism, respectively. A decrease in the total financial input on the screening protocol was evaluated for significance in cost reduction.
Results. The prevalence of hypothyroidism was found to be 0.1%, while none of the newborns presented with classic galactosaemia. There was an up to 20% reduction in direct input costs of screening when our protocol was applied.
Conclusion. Cost-effective newborn screening is possible when classic galactosaemia and congenital hypothyroidism are screened for simultaneously. Cumulative disease frequency plots confirm the already established fact that hypothyroidism tends to occur at higher frequencies than classic galactosaemia.
Source: South African Journal of Child Health 2, pp 23 –25 (2008)More Less
Background. Appropriate resuscitation techniques are crucial to the survival of newborn infants.
Objective. To assess knowledge of nurses in western Nigeria about neonatal resuscitation.
Method. A cross-sectional survey of the nurses attached to secondary health facilities in western Nigeria was done using a closed-ended questionnaire that tested evaluation and appropriate action aspects of neonatal resuscitation.
Results. One hundred and seventy-nine nurses were interviewed. Of these, 72.6% had worked in the labour room and the special care baby unit within the last 5 years while only 14.0% had attended neonatal resuscitation training course within the last 5 years. Similarly, 31.8%, 53.1%, 58.1% and 35.2% had access to radiant warmers, ambu-bags, suction machine and oxygen delivery units, respectively. The knowledge of the respondents was better for evaluation than for appropriate action (95.5% v. 49.7%).
Conclusion. The knowledge of the respondents about appropriate actions to be taken during neonatal resuscitation was poor. Frequent and intensive courses on neonatal resuscitation are highly desired.
Neonatal cholinergic syndrome - organophosphate poisoning or herbal medicine intoxication? : case reportSource: South African Journal of Child Health 2, pp 26 –27 (2008)More Less
A rare case of diaphragmatic paralysis due to isolated phrenic nerve palsy in a neonate : case reportAuthor Narongsak NakwanSource: South African Journal of Child Health 2, pp 28 –29 (2008)More Less
Isolated phrenic nerve palsy is a rare result of birth injury, and carries a high respiratory morbidity if complicated by diaphragmatic paralysis. I report an unusual case of phrenic nerve palsy in a neonate delivered by vacuum extraction, with no shoulder dystocia or brachial plexus injury, and challenge the conventional understanding of the true incidence, pathogenesis and proper management of this condition.
Source: South African Journal of Child Health 2, pp 30 –31 (2008)More Less
Humeral fractures in children are relatively common. A history of trauma or suspicion of non-accidental injury will often lead the clinician to a cause. However, a number of other pathologies that can result in fractures should also be considered, particularly when there are additional associated symptoms. A case is presented of a 1-month-old child who was found to be irritable, constantly crying and barely using his upper limbs. Radiographs demonstrated a fracture of the right humerus along with a number of characteristic bone lesions that suggested a diagnosis of congenital syphilis.