South African Journal of Child Health - Volume 9, Issue 2, 2015
Volume 9, Issue 2, 2015
Author J.M. PettiforSource: South African Journal of Child Health 9 (2015) http://dx.doi.org/10.7196/SAJCH.947More Less
In this South African Journal of Child Health issue, we publish an article from Nigeria on the association of hypoxaemia with the outcome in children under the age of 5 years admitted with pneumonia. In this study, children with hypoxaemia (pulse oximetry SpO2 <90%) were 48 times more likely to die, and those who survived were likely to spend almost twice as long in hospital as those who were not hypoxaemic. The overall mortality rate of admitted children with pneumonia was 8.5%, but all the deaths occurred in those who were hypoxaemic on admission (giving a mortality rate of 20% in that group). In a very recent systematic review of risk factors for mortality from acute lower respiratory infections (ALRIs) in <5-year old children in low- and middle-income countries (95% of all deaths from ALRIs occur in these countries), the major risk factors were the diagnosis of very severe pneumonia using the World Health Organization (WHO) definition, being <2 months of age, and having underlying chronic disease, HIV or severe malnutrition. The usual socioeconomic and environmental factors also contributed, namely young maternal age, low maternal education, second-hand smoke exposure and indoor air pollution.
Apartheid and healthcare access for paediatric systemic lupus erythematosus patients in South Africa : opinionSource: South African Journal of Child Health 9, pp 36 –37 (2015) http://dx.doi.org/10.7196/SAJCH.869More Less
South Africa (SA) still faces the legacy of apartheid: the history, politics and economics have a lasting, indelible effect on the health of its people. Here, we discuss the challenges of caring for patients with chronic disease, focusing on paediatric systemic lupus erythematosus (SLE), as a framework for evaluating the structural challenges to accessing care in SA. Prior reports have demonstrated numerous factors influencing access for SA patients with chronic disease. This article explores the economic, social and political vestiges of apartheid as it affects the healthcare system and subsequently, our patients.
Audiological practices and findings post HPCSA position statement : assessment of children aged 0 - 35 months : researchSource: South African Journal of Child Health 9, pp 38 –40 (2015) http://dx.doi.org/10.7196/SAJCH.778More Less
Background. Early detection of hearing loss is important to ensure optimal development, and may be influenced by the audiological assessment process.
Objective. To describe the actual practices and audiological findings with regard to the assessment of 0 - 35-month-old children referred for a hearing assessment at a public hospital.
Methods. A retrospective record review was conducted. The study sample comprised 100 participant files.
Results. The mean age of initial hearing screening was 13.1 months. Of the participants, 99% received an initial hearing screening and 44%received a second hearing screening. Only four of the eight participants who were referred underwent auditory brainstem response testing and were diagnosed with hearing loss. These four participants were diagnosed after the age of 2 years. The audiological protocol differed from that recommended by the Health Professions Council of South Africa, resulting in limited diagnostic assessment results.
Conclusion. The study highlighted gaps in the practice of recommended, age-appropriate audiological protocols as well as the ages at which the initial hearing screenings were conducted, which affects early diagnosis of hearing loss.
The Micral-test as a screening tool to detect micro-albuminuria in children 5 - 15 years old with sickle cell anaemia, Lagos State University Teaching Hospital : researchSource: South African Journal of Child Health 9, pp 41 –44 (2015) http://dx.doi.org/10.7196/SAJCH.755More Less
Objective. To determine the sensitivity, specificity, and positive and negative predictive values of the Micral-Test in determination of microalbuminuria (MA).
Methods. Eighty children aged 5 - 15 years with sickle cell anaemia (SCA) (HbSS) in a steady state attending the Lagos State University Teaching Hospital were recruited. The subjects were age-, sex- and social-class-matched with controls of genotype AA (HbAA). This prospective, descriptive and cross-sectional study lasted for 3 months, between October and December 2009. Morning random spot urine was used to assess the Micral-Test and the albumin/creatinine ratio (ACR). The performance of the Micral-Test was determined using the ACR as the gold standard.
Result. The sensitivity and specificity of the Micral-Test were 84.6% and 81.0%, respectively. The sensitivity and specificity were 100% and 86.6%, respectively, in children <10 years of age compared with 80% and 73.8%, respectively, in those >10 years old. The positive predictive value was 28.2% and the negative predictive value was 98% among the study subjects.
Conclusion. The sensitivity and specificity of the Micral-Test make it a good screening tool to detect MA in children with SCA. The Micral- Test is cheaper than quantitative measurement of ACR. Patients with a single positive Micral-Test should be followed up with two more Micral-Tests over a 3-month period to confirm persistent MA.
Source: South African Journal of Child Health 9, pp 45 –48 (2015) http://dx.doi.org/10.7196/SAJCH.859More Less
Background. Nasal continuous positive airway pressure (NCPAP) is well established as a treatment for hyaline membrane disease (HMD) and other respiratory diagnoses in neonates. NCPAP is an affordable intervention that reduces the number of neonatal admissions to the intensive care unit (ICU) for ventilation. At the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) we have been using NCPAP since April 2006.
Objectives. To review the use of early NCPAP in our hospital setting.
Methods. This was a retrospective, descriptive study of all neonates ≥750 g admitted to CMJAH between 1 January 2013 and 31 July 2014,who received NCPAP within 72 hours of birth. The characteristics and the survival of all infants who received NCPAP were described using univariate analysis.
Results. The NCPAP group (n=481) of neonates < 1 500 g was significantly associated with surfactant use (p<0.0005), bronchopulmonary dysplasia (p<0.0005) and late sepsis (p<0.0005). The survival to day 7 and to discharge of infants treated with NCPAP was significantly decreased (p<0.0005). NCPAP alone (without ventilation) improved the survival to discharge (p=0.001). The survival was 95.4% in the ≥1 500 g infants, compared with 87.6% in the very low birth weight infants and 55.2% in the extremely low birth weight infants.
Conclusion. NCPAP is an effective intervention for HMD; it is both cost-effective and easy to use in a resource-limited setting, and reduces the morbidity and mortality associated with ICU admission.
Determinants of mother-to-child transmission of HIV despite PMTCT interventions in Enugu, Nigeria : researchSource: South African Journal of Child Health 9, pp 49 –52 (2015) http://dx.doi.org/10.7196/SAJCH.803More Less
Background. The burden of paediatric HIV is unacceptably high in Nigeria. Prevention of mother-to-child transmission (PMTCT) of HIV represents a critical opportunity for reducing the burden of paediatric HIV.
Objectives. To determine risk factors of MTCT of HIV following PMTCT interventions.
Methods. This was a prospective study over a 12-month period, involving HIV-positive pregnant mothers in their third trimester. A structured, interviewer-administered questionnaire was used to obtain relevant information about mothers and their babies. Maternal HIV RNA levels (viral load) and CD4 counts were also obtained. DNA polymerase chain reaction (PCR) testing was done for all the infants. Data analysis was with SPSS version 15 (Chicago, USA).
Results. There was a total of 210 infants, comprising 198 singletons and 6 sets of twins. Two infants had a positive DNA PCR, giving an MTCT rate of 1%. There was significant association between MTCT of HIV and maternal HIV RNA levels (p=0 .009) and mixed feeding (p<0.001). None of the other risk factors studied, namely maternal CD4 count, mode of delivery and duration of rupture of fetal membrane before delivery, had any influence on MTCT.
Conclusion. The rate of MTCT can be reduced markedly if there is strict adherence to PMTCT strategies. It is therefore recommended that there be increased access to PMTCT programmes and full participation of mothers in Nigeria.
Hypoxaemia as a measure of disease severity in young hospitalised Nigerian children with pneumonia : a cross sectional study : researchSource: South African Journal of Child Health 9, pp 53 –56 (2015) http://dx.doi.org/10.7196/SAJCH.901More Less
Background. Pneumonia remains a common cause of mortality among children in developing countries. Hypoxaemia is a common consequence of pneumonia in children.
Objectives. To define the relationship between Hb oxygen saturation (SpO2) and parameters of outcome, duration of supplemental oxygen and duration of hospitalisation among children with pneumonia.
Methods. A cross-sectional study was carried out at the paediatric wards of a tertiary hospital in North-Central Nigeria. Two hundred children aged between 2 and 59 months with pneumonia seen at the University of Ilorin Teaching Hospital were recruited consecutively. Sociodemographic and clinical information regarding the illness was obtained. Hb SpO2 of subjects was recorded with a pulse oximeter at presentation. The primary outcome was the SpO2 of the children with pneumonia. Secondary outcome measures were disease outcome, duration of supplemental oxygen and duration of hospitalisation among children with pneumonia.
Results. The prevalence of hypoxaemia among the children was 41.5% and their mean SpO2 was 90.4% (standard deviation (SD) 8.9%). Surviving children with hypoxaemia had a longer mean (SD) duration of hospitalisation of 6.9 (6.4) days compared with those without hypoxaemia (4.9 (2.7) days; p=0.001). Children with hypoxaemia spent a longer duration receiving supplemental oxygen compared with those without hypoxaemia (p=0.001). The case fatality rate from pneumonia was 8.5% (17 deaths). The risk of death among children with hypoxaemia was 48 times higher than among the non-hypoxaemic children.
Conclusion. Hypoxaemia with increasing severity significantly predicts a longer duration of hospitalisation, duration on supplemental oxygen and poorer outcome in children with pneumonia.
Source: South African Journal of Child Health 9, pp 57 –58 (2015) http://dx.doi.org/10.7196/SAJCH.828More Less
Tuberous sclerosis complex (TSC) is an extremely variable genetic disorder that can affect virtually any organ in the body. Disease manifestations continue to develop over the lifetime of an affected individual. Many manifestations can be life threatening; appropriate surveillance and management are necessary to limit morbidity and mortality in this disease. We report a case of an 8-year-old girl with TSC and bilateral renal cell carcinoma, which is usually thought to be a complication diagnosed in adulthood. Our report emphasises the need for frequent surveillance and renal imaging in paediatric patients with TSC.
Source: South African Journal of Child Health 9, pp 59 –60 (2015) http://dx.doi.org/10.7196/SAJCH.882More Less
Neuroregression in infants has diverse aetiologies, and vitamin B12 deficiency is a rare one. Infantile vitamin B12 deficiency is usually secondary to maternal pernicious anaemia or maternal vegetarian diet. We report a 10-month-old infant with developmental regression secondary to vitamin B12 deficiency. Her mother was a strict vegetarian and the patient was exclusively breastfed. Clinical symptoms normalised after vitamin B12 supplementation.
Source: South African Journal of Child Health 9, pp 61 –62 (2015) http://dx.doi.org/http://dx.dio.org/10.7196/SAJCH.840More Less
Source: South African Journal of Child Health 9, pp 63 –64 (2015) http://dx.doi.org/10.7196/SAJCH.865More Less
Accidental poisoning in children remains a common presentation in healthcare centres worldwide, with the highest rates of fatal poisonings occurring in Africa. Podophyllin, commonly used for genital warts, is a rare agent in poisoning cases. A few cases have been reported in the international literature, with serious systemic and neurological side-effects. We report a case of accidental podophyllin poisoning in a 3-year-old boy, which was complicated with organ dysfunction. The case highlights the severe neurological side-effects of podophyllin poisoning and the importance of accident prevention in our communities.
Source: South African Journal of Child Health 9, pp 65 –66 (2015) http://dx.doi.org/10.7196/SAJCH.855More Less
Oesophageal achalasia is a neuromuscular disorder of unknown aetiology, characterised by abnormal motility of the oesophagus and failure of the lower oesophageal sphincter to relax. This causes an abnormal dilatation of the oesophagus and resultant symptoms of vomiting/regurgitation, dysphagia, chest pain and at times, signs of lung aspiration and infection. In children, it may present as a chronic cough. The condition usually presents in the 4th and 5th decades and has very rarely been described in children. We describe two cases of achalasia and their imaging findings in adolescents.