South African Journal of Child Health - Volume 2, Issue 4, 2008
Volume 2, Issue 4, 2008
Author Nonhlanhla P. KhumaloSource: South African Journal of Child Health 2 (2008)More Less
With the end of yet another year and the beginning of the next, I would first like to thank everyone who reviews manuscripts for SAJCH. We deeply appreciate the time and effort you freely give to improve the quality of the articles we publish, despite all your other many commitments (academic and otherwise). I would like to also thank all the authors who have submitted their work for review, and to invite new ones; no journal could survive without you! I am especially grateful for the submissions we receive from outside South Africa, of which there are two in this issue (Ashir and co-workers and Okeniyi, from Nigeria).
Author Johan SmithSource: South African Journal of Child Health 2 (2008)More Less
In this issue of SAJCH the study by Ballot and co-workers (p. 146) shows that although a non-invasive chest wall suspension splint could support a compliant, retracting chest wall, it was only as effective as head-box oxygen management of premature infants with respiratory distress syndrome (RDS) in avoiding invasive mechanical ventilation (MV). This finding is surprising, because the opposite would be expected; however, this lack of difference could be the effect of the very small number of participants in this study.
Author Lynette DennySource: South African Journal of Child Health 2, pp 142 –143 (2008)More Less
Cervical cancer is the commonest cancer cause of death among women living in developing countries, where 80% of new cases are diagnosed per year. In 2002 there were an estimated 493 000 new cases and 274 000 deaths from cervical cancer. Yet, in developed countries that have implemented mass, organised cytology-based screening programmes, cervical cancer is a relatively rare disease.
A pilot study to determine whether external stabilisation of the chest wall reduces the need for mechanical ventilation in preterm infantsSource: South African Journal of Child Health 2, pp 146 –151 (2008)More Less
Objectives. This was a pilot study to determine whether external stabilisation of the chest wall with a splint reduces the need for mechanical ventilation in preterm infants, within the first 7 days after study entry.
Design. This was a non-blinded prospective randomised controlled study. After consent was obtained, babies were randomised into a chest splint or control group.
Setting and time. The study was conducted in the neonatal units of Johannesburg and Chris Hani Baragwanath hospitals between January 2004 and December 2005.
Subjects. Preterm infants with a birth weight above 1 000 g with respiratory distress syndrome requiring more than 25% supplemental oxygen to maintain oxygen saturation above 90% during the first day of life.
Outcome measures. The primary outcome measure was the need for mechanical ventilation within 7 days of study entry; secondary outcome measures were survival at 30 days, air leak and intraventricular haemorrhage.
Results. There were 40 infants enrolled, 19 randomised to the chest splint group and 21 to the control group. Demographic characteristics were comparable, although the splint group required significantly more supplemental oxygen at enrolment. Four of the 19 infants in the splint group and 5 of the 21 controls required mechanical ventilation (not significant). There was no air leak in any of the study subjects during the study period. Twelve infants in each group had cranial ultrasound scans : there was one grade 3 intraventricular haemorrhage, one periventricular echodensity and one germinal matrix cyst in each group. Three of the 21 controls and 2 of the 19 splint group infants died within the first 30 days; no death was related to the chest splint. There were no local complications related to the chest splint, such as skin rash or pressure sores.
Conclusion. This small study did not demonstrate any reduction in the need for ventilation with the use of the chest splint. Use of the splint was not associated with any complications and therefore appears to be safe to use. Further studies with larger numbers are warranted.
Source: South African Journal of Child Health 2, pp 152 –154 (2008)More Less
Background. Opportunistic infections such as oral candidiasis (OC) in HIV-infected children are generally seen with severe depression of the CD4+ count.
Objectives. To evaluate usefulness of OC as a marker of disease progression in HIV-infected Nigerian children.
Method. Newly diagnosed HIV-infected children, antiretroviral therapy (ART)-naïve with oral lesions, attending a paediatric infectious diseases unit in Nigeria from July 2006 to June 2007 were enrolled. Clinical OC was registered if the attending physicians observed a pseudomembranous oral lesion. The Dynal beads technique (Dynal Biotech, Oslo, Norway) was used for CD4 counting. CD4 counts were categorised using the Centers for Disease Control and Prevention classification.
Results. The study population comprised 78 HIV-infected children aged 4 - 90 months (mean 20.54±7.23 months) with a male / female ratio of 1.05:1. The prevalence of OC was 20.5% (16 cases) in the study population. The median CD4 count of children with HIV-associated OC is within the severe immunosuppression level for age group, while all children without OC had median CD4 counts above the severe immunosuppression level for age group (p = 0.000). Reliability of OC as a surrogate marker of severe immunosuppression yielded a modest sensitivity, high specificity and positive predictive value (44.44%, 92.15% and 75%, respectively).
Conclusion. The high prevalence of OC in HIV-positive children was confirmed. The significant relationship of OC with severe immunosuppression suggests that in settings in which CD4 counts are not available, OC may be considered as a clinical surrogate for severe CD4 depletion. However, the absence of OC does not necessarily exclude severe immunosuppression.
Ovarian cysts in infants : indications for intervention and advantages of the minimally invasive methodAuthor Martin L. Van NiekerkSource: South African Journal of Child Health 2, pp 155 –157 (2008)More Less
Introduction. The incidence of diagnosed neonatal ovarian cysts has increased markedly with widespread use of ultrasonography. This article describes a laparoscopic approach to the management of 11 infants with large ovarian cysts at the Kloof MediClinic hospital in Pretoria The single-port technique was used; 7 patients underwent laparoscopic salpingo-oophorectomy for necrotic ovaries due to torsion, and 4 underwent deroofing of uncomplicated cysts.
Aim. To review the clinical indications for surgical intervention and results of the minimally invasive technique used for infants with large ovarian cysts.
Patients and methods. This is a retrospective review of the medical records of infants who underwent laparoscopic intervention for an ovarian cyst between 2004 and 2008.
Results. Between 2004 and 2008 laparoscopic surgery was performed on 11 infants with ovarian cysts. In 7 cases torsion was already present, which necessitated salpingo-oophorectomy. Four patients had uncomplicated cysts which needed only to be deroofed. There were no complications, and all patients were discharged on the second postoperative day.
Source: South African Journal of Child Health 2, pp 158 –160 (2008)More Less
Telepaediatrics, which has the potential to improve paediatric care if expert knowledge is not locally available, involves transfer of information between two or more locations, to aid diagnosis or management and / or to allow continuing professional development and education. Developed nations first introduced telemedicine. Later developing countries with different needs, levels of expertise and infrastructure often applied it in a modified manner. Teleradiology and / or tele-education / distance learning were usually the first applications of telemedicine and telepaediatrics is a more recent form of telemedicine. Developing country paediatrics typically involves primary health care (PHC) providers who deal with more serious morbidity and a greater proportion of the population than those in developed countries. Nurses provide PHC in most rural areas in South Africa and other developing countries, where telemedicine may improve PHC, as has already been seen in South African pilot schemes outlined below. In general telepaediatrics benefits from previous telemedicine experience, such as that gained by some developed nations with sparsely populated, remote areas, where means of communication are simple and socio-economic conditions poor.
Author John Akintunde OkeniyiSource: South African Journal of Child Health 2, pp 162 –164 (2008)More Less
Background. Cardiac tamponade in Nigerian children remains poorly researched.
Objective. To review the frequency, cause and outcome of cardiac tamponade at Wesley Guild Hospital, Ilesa, Nigeria.
Method. Retrospective audit of all children older than 1 month diagnosed with cardiac tamponade over a 7-year period (2001 - 2007) at the children's emergency room (CHER).
Results. Of the 8 813 CHER admissions, 16 (0.2%) children (11 boys and 5 girls) had cardiac tamponade. The most common causes were Staphylococcus aureus pericarditis (6 cases), blunt chest injury (4 cases) and tuberculous pericarditis (3 cases). The overall mortality rate was 62.5%. The case fatality rates were 100%, 66.7% and 33.3% for cadiac tamponade caused by trauma, tuberculosis and staphylococcal pericarditis, respectively.
Conclusion. Although rare, cardiac tamponade is a life-threatening emergency requiring prompt intervention to prevent death. The major cause is infective pericarditis. Large prospective studies would better estimate the disease burden and elucidate risk factors.
Sildenafil in the management of neonates with PPHN : a rural regional hospital experience : case reportAuthor Arnold L. EngelbrechtSource: South African Journal of Child Health 2, pp 166 –169 (2008)More Less
Introduction. Persistent pulmonary hypertension of the newborn (PPHN) can occur as a primary or secondary neonatal emergency and remains a serious management challenge with a high mortality rate. The failure of a rapid fall in pulmonary vascular resistance in the early postnatal period that characterises PPHN can progress into a vicious pulmonary vasoconstrictive cycle if not promptly managed. In the past 5 years sildenafil citrate (Viagra; Pfizer), with its selective pulmonary vasodilator properties, has emerged as a potential treatment modality for PPHN.
Objectives and methods. To describe our experience with the use of sildenafil in 2 non-ventilated neonates with moderate to severe PPHN. The patients were managed at Worcester Hospital, a rural regional hospital in the Western Cape, South Africa.
Results. In both cases the addition of sildenafil to the treatment regimen resulted in : (i) a significant increase in haemoglobin oxygen saturation as measured by pulse oximetry; (ii) ability to wean the fraction of inspired oxygen; and (iii) avoidance of mechanical ventilation and referral to a tertiary intensive care unit.
Conclusion. Sildenafil appears to be beneficial in the treatment of PPHN and its use can be considered in the management of selected cases, even in a resource-limited setting; however, this still needs to be validated by more controlled studies.
Source: South African Journal of Child Health 2, pp 170 –171 (2008)More Less
Ortner syndrome, or cardio-vocal syndrome, is a clinical entity characterised by hoarseness (secondary to left-sided recurrent laryngeal nerve palsy) caused by cardiovascular disease. It has been reported in up to 12% of patients with aortic aneurysms. Vocal cord palsy is rarely reported in paediatric patients with cardiac pathology. A reason for the paucity of data in paediatric cardiac patients could be due to the focus on patient survival rather than secondary complications of the disease and its treatment. Most cases have been described in adults, and to the best of our knowledge this is the youngest patient mentioned in the literature.