South African Journal of Child Health - Volume 9, Issue 1, 2015
Volume 9, Issue 1, 2015
Author J.M. PettiforSource: South African Journal of Child Health 9 (2015) http://dx.doi.org/http://dx.doi.org/10.7196/SAJCH.940More Less
Perinatal and maternal health statistics are used extensively as markers for the effectiveness of health service provision in a country. Because of their importance in this role, several of the rates were incorporated into the Millennium Development Goals (particularly Goals 4 and 5). In Minister Trevor Manuel's forward to the Millennium Development Goals, Country Report 2013 compiled by Statistics South Africa (SA), he highlighted the lack of consensus on the actual levels of maternal mortality because of different data sources and methodology; however, he acknowledged that SA was lagging behind that particular target. The official 2010 figure was 269/100 000 live births, which is seven-fold greater than the 2015 goal of 38/100 000 live births. The report indicated that SA was unlikely to achieve its 2015 target for maternal deaths, but was likely to achieve the target of 100% of births being attended by skilled health personnel by 2015. According to Statistics SA, our infant mortality rate was 38/1 000 live births in 2010, with the 2015 target being 18/1 000 live births. Approximately 40% of our <5-year-old mortality is made up of neonatal deaths, therefore if SA is going to effectively reduce <5 mortality, it will have to substantially reduce its neonatal mortality rate.
The feasibility of determining the position of an endotracheal tube in neonates by using bedside ultrasonography compared with chest radiographs : researchSource: South African Journal of Child Health 9, pp 3 –5 (2015) http://dx.doi.org/http://dx.doi.org/10.7196/SAJCH.740More Less
Background. Neonates in our neonatal intensive care unit (NICU) receive a large amount of radiation with X-rays (XRs) being done daily, even more often with reintubation, repositioning of endotracheal tubes (ETTs) and confirmation thereof, which has been our NICU policy for many years.
Objective. To investigate the feasibility of determining the position of ETTs in neonates by using bedside ultrasonography (BUS), and to compare the results with those obtained from chest XR (CXR) findings.
Methods. A prospective, cross-sectional study was done on intubated neonates in the NICU at Universitas Academic Hospital, Bloemfontein, to determine the position of ETTs by using BUS.
Results. Thirty intubated patients included in this study had a median age of 13.5 days and a median weight of 1.6 kg. Ninety-three per cent of ETT placements were considered optimal when visualised by BUS, while 73.3% were considered to be placed optimally when CXR was viewed. When CXR and BUS findings were compared regarding optimal placing, the agreement was poor (κ=0.10; 95% confidence interval -0.2 - 0.4). In four patients, the distance from the aortic arch to the tip of the ETT was outside the expected range of 1.5 - 2.2 cm: in two patients it was <1.5 cm (6.7%) and in the other two >2.25 cm (6.7%). BUS measurements were done mainly in extended head (53.3%) or neutral (36.7%) position.
Conclusion. Although poor agreement between CXR and BUS findings was obtained, possibly because of handling of patients with secondary shifting of ETTs, BUS was found not to be comparable with CXR, but an alternative feasible method to determine the optimal position of ETTs in the trachea in neonates when using other reference points, with the added advantage of no radiation exposure.
Ventriculostomy infections at the paediatric neurosurgical unit at Dr George Mukhari Academic Hospital : researchSource: South African Journal of Child Health 9, pp 6 –8 (2015) http://dx.doi.org/http://dx.doi.org/10.7196/SAJCH.767More Less
Background. External ventricular drains (EVDs) are essential to the clinical management and care of patients with neurosurgical complications, but EVD use is routinely associated with concomitant infection, sometimes resulting in mortality.
Objective. To undertake an epidemiological study of ventriculostomy-related infections among paediatric neurosurgical patients at the Dr George Mukhari Academic Hospital, Pretoria, South Africa.
Methods. Retrospective analysis was conducted on the clinical records of 92 children admitted to the neurosurgical unit at the hospital between 2010 and 2013. Records were included in the study only if they were complete, legible and accurate. Data were collected on the following variables: age, gender, frequency of catheter change, cerebrospinal fluid (CSF) sampling, use of prophylaxis, microbiology, Glasgow Coma Scale, glucose, chlorine, and other clinical, chemical and laboratory parameters routinely observed as part of patients' work-ups.
Results. Two or more EVDs were placed on 45.7% (40) children, with a maximum of seven EVDs per child. Ventriculitis incidence was 28.3% (26 of 92). There was a significant association between the number of EVDs inserted and the incidence of ventriculitis (p=0.010). More frequent CSF sampling also increased ventricular-related infections (p=0.000), as did prolonged EVD retention (p=0.001). Using prophylactic antibiotics or impregnated catheters did not reduce ventriculitis incidence significantly.
Conclusion. Evidence supports adherence to strict sterilisation protocols and techniques when inserting EVDs. Catheters should not be retained for extended periods, and CSF sampling can be limited to once in 3 days. Routine use of antibiotic-impregnated EVDs and antistaphylococcal prophylaxis is still recommended.
Trends in perinatal health indices in the Amajuba District, KwaZulu-Natal, South Africa, 1990-2012 : researchAuthor T.I. Runsewe-AbiodunSource: South African Journal of Child Health 9, pp 9 –13 (2015) http://dx.doi.org/http://dx.doi.org/10.7196/SAJCH.782More Less
Background. In order to address the high perinatal mortality rate, South Africa (SA) commenced a number of interventions from 1995. These included the abolition of user fees, basic antenatal care, on-the-spot diagnosis and treatment of syphilis, and the prevention of mother-to-child transmission of HIV. However, there is a dearth of information on the long-term effect of these programmes on perinatal indicators in district hospitals, where most births and deaths occur.
Objective. To determine the levels and trends in maternal and neonatal indicators in Amajuba District, KwaZulu-Natal Province, SA, and to ascertain the dynamics of these indicators vis-à-vis the transformation of healthcare in SA.
Methods. The study location was Madadeni Hospital and its nine feeder maternity clinics. Information pertaining to all deliveries and their outcome from these health facilities from 1990 to 2012 was extracted from the clinical registers. Data were analysed using SPSS version 15.0 (IBM, USA). Quantitative variables were summarised as means, while qualitative data were expressed as proportions and percentages. The trends for each outcome variable for the entire study period (1990 - 2012) were analysed and presented as line graphs and tables.
Results. There were 154 821 live births and 4 133 stillbirths from 1990 to 2012. The overall mean values for stillbirth rate, perinatal mortality rate, neonatal mortality rate and maternal mortality ratio were 26.3 (standard deviation 5.6), 40.9 (9.6), 16.8 (4.7) and 114 (56.6), respectively. There was a general improvement in all the perinatal health indices in the early 90s, followed by a general worsening until the early 2000s, after which a consistent decline was noted.
Conclusion. The perinatal health indices in Amajuba District have followed a pattern similar to that found in the rest of SA: an increase during the late 90s to early 2000s, followed by a decline from the late second half of the first decade of this century.
Source: South African Journal of Child Health 9, pp 14 –17 (2015) http://dx.doi.org/http://dx.doi.org/10.7196/SAJCH.760More Less
Background. The causes of anaemia have regional variations, and further variation is expected among paediatric hospital patients. However, the prevalence of anaemia and its contributing risk factors among paediatric patients remain understudied in South-East Nigeria.
Methods. The study involved 286 anaemic (haemoglobin (Hb) ≤10 g/dL) and 295 non-anaemic preschool children attending a hospital outpatient department. A clinical research form was used to document demographic data, anthropometric measurements, disease details and packed cell volume. Common anaemia risk factors previously documented were studied. The prevalence rates of the independent variables were calculated and level of significance was determined, using χ2.
Results. The prevalence of anaemia was 49.2%, with the highest prevalence among children <12 months old (p=0.009). There was a significant association between anaemia and maternal education above primary education (p=0.01), but there was no association with socioeconomic status (p=0.7) or nutritional status (p=0.1). The prevalence of the major risk factors among anaemic children was: malaria parasitaemia 48.3% (p=0.03), iron deficiency 42.3% (p=0.001), glucose-6 phosphate dehydrogenase (G6PD) deficiency 24.8% (p=0.02), HIV seropositivity 13.3% (p=0.02), sickle cell anaemia 2.4% (p=0.3) and helminth infection 1.1% (p=0.32).
Conclusions. Malaria and iron deficiency remain common among ill children <5 years old who are anaemic. The treatment of these conditions should be considered when managing an anaemic ill child in order to reduce morbidity and mortality.
Source: South African Journal of Child Health 9, pp 18 –21 (2015) http://dx.doi.org/http://dx.doi.org/10.7196/SAJCH.777More Less
Background. The World Health Organization describes obesity as one of today's most blatantly visible - yet most neglected - public health problems. Sleep duration has been found to have an association with overweight and obesity in many studies, most of which have been conducted outside India. The prevalence of chronic partial sleep deprivation has increased dramatically in the past half century, in parallel with the rising epidemics of overweight and obesity. In addition, sleep per se has a special relevance in obesity.
Objective. This study was part of a larger study based on the Global School Health Survey, and was conducted in the 13 - 15-year-old age group. The study had two objectives: first, it enquired into sleep duration in the aforementioned adolescents and assessed whether this was adequate or inadequate; and second, it sought to evaluate and assess the relationship between sleep duration and the nutritional status of these adolescents, whether overweight or obese.
Methods. A cross-sectional study was conducted in all three schools affiliated to the Aligarh Muslim University Board of Examination. A pretested and prevalidated questionnaire was used to assess sleep duration, and anthropometry was done on all the students of these schools who fulfilled the inclusion criteria. AnthroPlus (World Health Organization, Switzerland) and SPSS (IBM, USA) version 20 were used for z-score and other statistical calculations, respectively.
Results. A total of 1 416 students were studied, of which 23.6% reported inadequate sleep duration. It was found that those with inadequate sleep had significantly higher odds of being overweight or obese, with an odds ratio of 1.56 (confidence interval 1.12 - 2.15). The inadequacy of sleep duration was also associated with a higher body mass index for age z-score (0.77 (standard deviation 0.57)), compared with those with adequate sleep duration (-0.31 (0.08)), which was found to be significant (t=22.59, df=1, p<0.001).
Conclusion. Inadequate sleep is an obesogenic factor, even in developing countries. It is a cause of concern, as the habits developed/strengthened at this stage may be lifelong.
Adherence to phototherapy guidelines in term neonates : study at a private tertiary-level neonatal unit : short reportAuthor T. EkramSource: South African Journal of Child Health 9 (2015) http://dx.doi.org/http://dx.doi.org/10.7196/SAJCH.714More Less
Guidelines for starting phototherapy for neonatal jaundice in term neonates have been published by the American Academy of Pediatrics (AAP) and others, such as the National Institute for Health and Clinical Excellence (NICE), but the practical implementation of such guidelines and factors associated with possible non-adherence have not been studied. We report our experience at a self-paying tertiary-care hospital. Of the 155 term babies given phototherapy in our hospital between August 2012 and August 2013, 65 (41.9%) babies were found to have received phototherapy at serum bilirubin values lower than recommended AAP guidelines. Factors found responsible for non-adherence to guidelines were: (i) parents' request for early discharge, with unwillingness to come the next day for follow-up despite borderline serum bilirubin level noted in 25 (38.5%); (ii) clinical assessment of bilirubin was higher than reported laboratory value in 16 (24.6%); and (iii) babies were given phototherapy as parents had been counselled regarding the need for phototherapy by a referring paediatrician in 12 (18.5%).
Source: South African Journal of Child Health 9, pp 23 –26 (2015) http://dx.doi.org/http://dx.doi.org/10.7196/SAJCH.771More Less
Background. The Smith-Lemli-Opitz syndrome (SLOS), due to defective function of 7-dehydrocholesterol reductase, is an autosomal recessive disorder that is more common than other defects in cholesterol biosynthesis. The dysmorphology can be suggestive, but biochemical and genetic investigations are required for confirmation of this diagnosis to assist with the management of the patient and planning for future children in affected families.
Objective. To perform biochemical and genetic work-ups in four South African families of European ancestry with suspected SLOS in a range of presentations, from early fatality, congenital malformations, feeding problems and developmental delay.
Methods. Plasma was analysed by ultraviolet spectrophotometry. The genetic cause was investigated by polymerase chain reaction, followed by high-resolution melting and sequencing of amplicons displaying abnormal patterns.
Results. Spectrophotometry confirmed the diagnosis in three families. Genetic confirmation was made in these patients, and carrier status confirmed in the parents of the fatal case. All the patients were of European ancestry, and the mutations reflected those in European studies.
Conclusion. This rare disorder should be considered in antenatal assessment when increased nuchal lucency is detected on sonography, or in newborns with syndactyly, hypotonia and feeding problems. Less severe forms could present with developmental delay and behavioural problems. Confirmation of the diagnosis may assist in decisions about nutritional management as well as future pregnancies in the affected family and primary relatives.
A case of disseminated Candida dubliniensis in a preterm infant : the importance of early detection and management of invasive fungal infections in neonates : case reportAuthor C. CrauseSource: South African Journal of Child Health 9, pp 27 –29 (2015) http://dx.doi.org/http://dx.doi.org/10.7196/SAJCH.722More Less
Acute fulminant myocarditis complicated by complete atrioventricular block with favourable outcome in a resource-limited setting : case reportSource: South African Journal of Child Health 9, pp 30 –32 (2015) http://dx.doi.org/http://dx.doi.org/10.7196/SAJCH.656More Less
Complete heart block in paediatric acute fulminant myocarditis (AFM) is rare and carries a grave prognosis. Aggressive haemodynamic support, especially mechanical support, i.e. with an extracorporeal membrane oxygenator during the initial presentation, improves the outcome in such patients. Unavailability of mechanical support in developing countries warrants aggressive rhythm management to achieve haemodynamic stability. We report a case of a 5-month-old who presented with AFM complicated with complete heart block. Quick recognition, aggressive cardiopulmonary management and transcatheter placement of a temporary pacemaker as soon as possible resulted in complete recovery in this patient. Aggressive management with rhythm control can lead to a favourable outcome in paediatric patients with AFM complicated by complete heart block, even in a resource-limited set-up.