South African Journal of Child Health - Volume 4, Issue 4, 2010
Volume 4, Issue 4, 2010
Author D.F. WittenbergSource: South African Journal of Child Health 4 (2010)More Less
The World Health Organization's definition of health as a state of physical, mental and social well-being implies for each person the ability and opportunity to function optimally within their individual context. By international consensus, children have a right to be helped to achieve such optimal functioning.
Bridging the gap between early identification and intervention in the paediatric population with hearing impairments : hot topicsSource: South African Journal of Child Health 4, pp 92 –94 (2010)More Less
The principles of early hearing detection and intervention (EHDI) state that hearing loss should be identified and amplification fitted by the age of 6 months. The fact that the first decade of life is the most crucial time for communication development and maximum learning provides a strong rationale for the provision of effective early intervention (EI) services at as young an age as possible. The need for EHDI has been well documented and professionals have come to realise that the development of communication skills begins in infancy, long before the emergence of the first words. Professionals have also realised the impact that delays in intervention have on a child's personal, social, academic and vocational growth, hence highlighting the need for comprehensive and efficacious services to this population. EI has dramatic benefits for the child with a hearing impairment, especially when compared with the profoundly negative effects associated with lack of it.
Hearing screening follow-up return rate in a very low birth weight project : a retrospective record reviewSource: South African Journal of Child Health 4, pp 95 –99 (2010)More Less
Objectives. To determine the follow-up return rate for a hearing screening programme implemented as part of a very low birth weight project (VLBWP).
Design. This was a retrospective, passive archival design. Data were collected from the VLBWP records and participant files from the Department of Audiology, Charlotte Maxeke Johannesburg Academic Hospital.
Setting. Charlotte Maxeke Johannesburg Academic Hospital, South Africa, a public sector hospital. Subjects. Eighty-six participants were included for retrospective analysis, consisting of 35 males and 51 females with a birth weight range of 680 - 1 500 g.
Outcome measures. Return rate for all neonates referred for follow-up oto-acoustic emissions screening.
Results. Of the 86 neonates who were referred for a follow-up screening, only 31.4% (27) returned for a repeat outpatient hearing screening appointment.
Conclusions. The follow-up return rate is significantly poor and may influence implementation of early hearing detection and intervention (EHDI). Efforts to improve the return rate should be intensified. These may involve parental education and counselling, as well as involvement of nursing staff and medical professionals in implementation of EHDI programmes. It may be possible to improve followup by aligning follow-up screening with the day of neonatal follow-up clinics in provincial hospitals where such services are available, including it in such clinics, or ensuring follow-up screening at immunisation clinics closer to where patients live.
Protocols for early audiology intervention services : views from early intervention practitioners in a developing countrySource: South African Journal of Child Health 4, pp 100 –105 (2010)More Less
Objectives. To identify the protocols and practices for audiology early intervention (EI) in Gauteng government hospitals, and determine whether these protocols comply with the principles for effective EI in audiology.
Methods and materials. Self-administered questionnaires were hand-delivered and distributed to participants in government hospitals in Gauteng.
Participants. Eighty-six professionals consisting of speech therapists and audiologists (N=20), paediatricians (N=33), ear, nose and throat specialists (ENTs) (N=7), and nurses (N=26) working in EI were included in the study.
Analysis of results. Findings were analysed via thematic content analysis which made it possible to determine the predominant themes with regard to EI protocols in government hospital settings. Additional quantitative descriptive statistics were also utilised to handle the data.
Results. Findings indicate inconsistent perceptions among the EI practitioners regarding the protocols implemented and that these may influence referrals and early management of children with hearing impairment. Delay of identification and diagnosis (later than 2 years of age) as well as delayed amplification were identified by audiologists. Factors contributing to lack of provision of EI services in audiology included inadequate referrals by professionals, lack of neonatal screening, and poor parental knowledge. Although the medical team believed that identification occurs at less than 6 months of age, they reported intervention to occur much later than identification. Principles of EI tested were generally perceived to be applicable to the South African context and in agreement with best practice in EI.
Longitudinal developmental profile of children from low socio-economic circumstances in Cape Town, using the 1996 Griffiths Mental Development ScalesSource: South African Journal of Child Health 4, pp 106 –111 (2010)More Less
Background. The Griffiths Mental Development Scales (GMDS) have not been standardised in South African children. Neurodevelopmental scores of infants from deprived environments decline with age, but there is no evidence on how young South African children from such backgrounds perform on serial assessments.
Aim. To describe the longitudinal developmental profile of infants from low socio-economic backgrounds at Tygerberg Children's Hospital by comparing the GMDS scores performed at 10 - 12 months and 20 - 22 months.
Methods. Infants born to HIV-uninfected women attending the public service programme were recruited from a vaccine study in Cape Town, South Africa. The GMDS 0 - 2 years and a neurological examination were performed between 10 and 12 months and between 20 and 22 months.
Results. Thirty-one infants (14 girls, 17 boys) were assessed. Their mean (standard deviation (SD)) age was 11.6 (0.8) months and 21.0 (0.5) months at the first and second assessments, respectively. The mean (SD) general quotient decreased significantly from 107.3 (11.7) to 95.0 (11.0) (p<0.001). All sub-quotients decreased significantly except for locomotor. The hearing and language sub-quotient was most affected, with a decrease in mean quotients from 113.0 to 93.2 (p<0.001). There was no evidence of intercurrent events to explain the decline.
Interpretation. Scores on the GMDS of this group of children from low socio-economic backgrounds were normal at 11 months and, other than locomotor, decreased significantly at 21 months, with language the most affected. Further research is needed to determine the specific reasons for the decline.
Possible drug reaction, eosinophilia and systemic symptoms (DRESS) syndrome in an infant from ingestion of Spirostachys africana complicated by measles co-infection : case reportSource: South African Journal of Child Health 4, pp 112 –113 (2010)More Less
Drug reaction with eosinophilia and systemic symptoms (DRESS) is an adverse syndromic reaction to medications that is rare in infants. The pathognomonic signs are a rash, often morbilliform, spreading from an oedematous face to the torso and extremities, hypereosinophilia and organ involvement.
Source: South African Journal of Child Health 4, pp 114 –144 (2010)More Less
A premature infant had been treated conservatively elsewhere for necrotising enterocolitis (NEC). The infant was referred to Chris Hani Baragwanath Hospital on day 33 of life with severe vomiting and sepsis. Abdominal radiographic findings were nonspecific, demonstrating no direct features of NEC or pneumoperitoneum (Fig. 1).
Diffuse bony involvement in disseminated BCG disease in a patient with possible severe combined immune deficiency (SCID) : case reportSource: South African Journal of Child Health 4, pp 116 –118 (2010)More Less
BCG (bacille Calmette-Guérin) vaccination is carried out worldwide to prevent tuberculosis. It is considered to be very effective and has an excellent safety profile, but complications do occur. These may range from erythema and abscess at the site of inoculation to extensive disseminated disease including regional and distant lymphadenopathy, lymphadenitis, musculoskeletal lesions and non-fatal and fatal disseminated infections, depending upon the immune status of the patient. Osteomyelitis is a rare but serious complication that may have a fatal outcome. We report a case of severe tuberculous osteomyelitis secondary to BCG vaccination in a child with possible severe combined immune deficiency.