South African Journal of Child Health - Volume 6, Issue 1, 2012
Volume 6, Issue 1, 2012
Author D.F. WittenbergSource: South African Journal of Child Health 6 (2012)More Less
The cycle of life in training institutions of all kinds is punctuated by assessments and examinations. For many students, the short-term goal of passing the test and being promoted to the next level is more important than the stated aim of gaining knowledge, skills and attitudes for a professional career. For trainers and institutions, likewise, the pass rate may become the goal. Where the value of pass or fail is more a judgement call than a mathematically defined quantity, it becomes subjectively possible to modify the definition of 'pass' to fit the pass rate!
Source: South African Journal of Child Health 6, pp 3 –9 (2012)More Less
Blood gas sampling is part of everyday practice in the care of babies admitted to the neonatal intensive care unit, particularly for those receiving respiratory support. There is little published guidance that systematically evaluates the different methods of neonatal blood gas sampling, where each method has its individual benefits and risks. This review critically surveys the available evidence to generate a comparison between arterial and capillary blood gas sampling, focusing on their relative accuracy and complications, as well as briefly mentioning the management of such complications. This evidence-based summary and guidance should help inform best practice in the neonatal intensive care unit, and minimise the exposure of babies to unnecessary and potentially serious risk.
The most accurate and non-invasive method of measuring oxygenation is oxygen saturation monitoring. Indwelling arterial catheters are a practical, reliable and accurate method of measuring acid-base parameters, provided they are inserted and maintained with the proper care. Capillary blood gas sampling is accurate, and a good substitute for radial 'stab' arterial puncture, avoiding many of the complications of repeated arterial puncture.
Source: South African Journal of Child Health 6, pp 10 –11 (2012)More Less
Objective. The HemoCue is a point-of-care analytical system for haemoglobin concentration (Hb) measurement. Point-of-care testing has been validated in hospitals and outpatient departments to assist with urgent patient management by providing rapid laboratory test results.
Method. In this prospective study we compared the analytical performance of the HemoCue with that of the Advia 120 haematology analyser with regard to accuracy, precision and linearity in the measurement of Hb in neonates and infants.
Results. Samples from 44 patients were analysed by both instruments and the results compared using difference plots. The mean Hb value for the HemoCue (11.8 g/dl; range 4.8 - 18.7) was comparable to that for the Advia (11.8 g/dl; range 5.2 - 19.2). The Bland-Altman difference plot revealed good agreement. Bias between the two methods was small and the imprecision was within acceptable limits. Hb measurement was linear in the range 4.8 - 20 g/dl.
Conclusion. In neonates and infants, the diagnostic accuracy of the HemoCue point-of-care device is comparable with that of the Advia 120 analyser. In neonatal and paediatric units, where the volume of blood available is limited and turnaround time critical, an appropriately quality-assured HemoCue can replace standard haematology analysers in the measurement of Hb.
Source: South African Journal of Child Health 6, pp 12 –16 (2012)More Less
Objectives. To describe the noise levels of popular hand-held, tabletop, crib and close-to-the-ear toys for children between the ages of birth and 3 years in South Africa.
Design. A quantitative, non-experimental, descriptive research design was employed for this study.
Subjects. Twenty toys, 5 from each of 4 categories, were chosen from a popular toy store in South Africa. The noise levels of these toys were measured using a sound level meter in a quiet room. The frequency spectra of the noise were analysed and compared with current international standards relating to toy safety.
Results. The majority of toys adhere to the current American Society for Testing and Materials (ASTM) International standards for toy noise. Frequency spectra analysis revealed that the loudest continuous noise levels for all toys were recorded at the frequencies that are the most important for hearing speech.
Conclusions. There is a need to develop standards for the maximum sound output of toys, and compulsory introduction of warnings about the noise levels of toys on the packaging and adherence to ASTM International standards for toy manufacturers are recommended.
Should the routine approach to diarrhoea management be modified in an area of high prevalence of paediatric HIV infection?Source: South African Journal of Child Health 6, pp 17 –20 (2012)More Less
Background. Unthinking application of the routine diarrhoea management protocol in patients presenting with diarrhoea could risk possible co-morbidities such as HIV infection being ignored in an environment with a high prevalence of HIV infection. Furthermore, a patterned response to testing for HIV infection only those children in whom it is suspected on clinical grounds will lead to missed opportunities for HIV care.
Aims and methods. This was a retrospective review of patients admitted to Kalafong and Steve Biko referral hospitals to identify the impact of a high prevalence of HIV infection in the community on the routine management of diarrhoea.
Results. A total of 176 patients were included. HIV tests were performed on 99 patients, and HIV infection was therefore not considered as a co-diagnosis in 78 of 176 (44.3%) of patients with diarrhoea.
On admission, the group of children tested for HIV infection were similar to the other groups (not tested for HIV or HIV negative) in age, but showed differences in respect of duration of diarrhoea and preceding events prior to referral. More children tested for HIV infection also had clinical wasting, generalised lymphadenopathy or hepatomegaly compared with untested children (p<0.005). However, there were no differences in the proportion of tested children with prior antibiotics before referral, presence of co-morbid pneumonia or urinary infection.
Patients with diarrhoea were more likely to be tested for HIV if they were severely malnourished or clinically wasted, if they had hyponatraemia or hypokalaemia, and if they had hepatomegaly or lymphadenopathy. The presence of shock or severe dehydration on admission, or of co-morbid pneumonia, did not differentiate between those who were tested for HIV and those who were not.
There were statistically significant differences between those tested for HIV and those not tested in respect of outcome. Among the children tested for HIV, 24.2% of survivors had a prolonged hospital stay (more than 10 days), compared with 1.4% among those not tested (p<0.005). While more children in the group tested for HIV died in hospital (6.1% v. 2.6%), this did not reach statistical significance (p=0.466).
Conclusion. In this study, HIV testing was found to be predominantly based on clinical grounds at the time of admission. Because of considerable clinical overlap between diarrhoea patients with and without HIV infection, HIV co-infection cannot be reliably predicted on clinical features alone and must be actively excluded.
Effective ART is now available. All patients with diarrhoea must therefore be offered HIV testing to provide earlier access to appropriate management.
Source: South African Journal of Child Health 6, pp 21 –22 (2012)More Less
We describe a case of hyperimmunoglobulin E syndrome (HIES) associated with Sjogren's syndrome (SS) in a 10-year-old boy and provide a brief review of the literature. Although seen in adults, SS occurring after a primary immunodeficiency disease such as HIES has not previously been reported in a child.
Source: South African Journal of Child Health 6, pp 23 –25 (2012)More Less
Cystic echinococcosis is the larval cystic stage (echinococcal cysts) of a small taeniid-type tapeworm (Echinococcus granulosus) that may cause illness in intermediate hosts, generally herbivorous animals and people who are infected accidentally. Pulmonary hydatid cysts are typical, involving one lobe in 72% of cases, usually at the lung base. In the paediatric age group, boys are affected more commonly than girls. We present a case of isolated hydatid cyst of the lung in a 5-year-old boy from a nomadic cattle-rearing tribe.
Source: South African Journal of Child Health 6, pp 26 –27 (2012)More Less
Typhoid (enteric) fever is an endemic disease in many tropical countries, with diverse modes of presentation. The classic clinical manifestations are rarely seen nowadays owing to early diagnosis and institution of antibiotic therapy. Moreover, the epidemiology of the disease is constantly shifting, with some cases presenting with complications in the early part of the illness. Of all the complications reported in enteric fever, the neurological manifestations constitute an important but often under-diagnosed group. We report a 10-year-old girl with typhoid fever who presented with motor aphasia during the first week of illness, a complication that has not been reported previously.