South African Journal of Child Health - Volume 7, Issue 4, 2013
Volume 7, Issue 4, 2013
Author D.F. WittenbergSource: South African Journal of Child Health 7 (2013)More Less
The World Health Organization's definition of health as a state of physical, mental and social well-being implies for children the opportunity to grow and develop to a state of optimal functioning in adulthood. It is clear that this is not possible under circumstances of poverty, deprivation of access to resources of food, housing and education, existential insecurity, natural disasters and human conflict.
Source: South African Journal of Child Health 7 (2013)More Less
The 4th South African (SA) Child Health Priorities Conference was convened by the SA Child Health Priorities Association at Wits Medical School in Johannesburg on 31 October - 2 November 2013. Its aim was to review progress in child health in South Africa, reflect on recent achievements, and set priorities for the forthcoming year.
Keeping children alive and healthy in South Africa - how do we reach this goal? Perspectives from a paediatrician in a District Clinical Specialist Team : hot topicsAuthor U.D. FeuchtSource: South African Journal of Child Health 7, pp 124 –126 (2013)More Less
District Clinical Specialist Teams (DCSTs) are part of the primary healthcare re-engineering process in South Africa. These multidisciplinary clinical teams were established throughout the country in 2012, and their main role is reduction of maternal and childhood mortality and morbidity through improvement of service delivery at primary care level in their health districts. The Tshwane DCST is used as a case study to describe the challenges encountered in establishing the team within the complex district health system. On the other hand, the cross-disciplinary approach has proved itself a winning combination if the team shares a common vision and has a work plan to guide the priorities and facility support visits. Through their clinical expertise, and using extensive networking, DCSTs are well positioned in the health system to have a strong positive effect on child health.
Source: South African Journal of Child Health 7, pp 127 –134 (2013)More Less
Objective. To examine associations between ambient air pollutants and respiratory outcomes among schoolchildren in Durban, South Africa.
Methods. Primary schools from within each of seven communities in two regions of Durban (the highly industrialised south compared with the non-industrial north) were selected. Children from randomly selected grade 4 classrooms were invited to participate. Standardised interviews, spirometry, methacholine challenge testing and skin-prick testing were conducted. Particulate matter (PM), sulphur dioxide (SO2) and carbon monoxide were monitored at each school, while nitrogen oxides (NOx) and other pollutants were monitored at other sites.
Results. SO2 was significantly higher in the south than in the north, while PM concentrations were similar across the city. The prevalence of symptoms consistent with asthma of any severity was 32.1%. Covariate-adjusted prevalences were higher among children from schools in the south than among those from the north for persistent asthma (12.2% v. 9.6 %) and for marked airway hyperreactivity (AHR) (8.1% v. 2.8%), while SO2 resulted in a twofold increased risk of marked AHR (95% confidence interval 0.98 - 4.66; p=0.056).
Conclusions. Schoolchildren from industrially exposed communities experienced higher covariate-adjusted prevalences of persistent asthma and marked AHR than children from communities distant from industrial sources. Our findings are strongly suggestive of industrial pollution-related adverse respiratory health effects among these children.
Outcomes in malnourished children at a tertiary hospital in Swaziland after implementation of the World Health Organization treatment guidelines : researchSource: South African Journal of Child Health 7, pp 135 –138 (2013)More Less
Background. Swaziland adopted the World Health Organization (WHO) guidelines for the inpatient treatment of severely malnourished children in 2007, with the aim of reducing high case fatality rates for childhood malnutrition. However, no follow-up studies have been conducted to determine the reduction in these rates after implementation of the guidelines.
Objectives. To determine the case fatality rate for childhood malnutrition after implementation of the WHO treatment guidelines.
Methods. A retrospective observational study was undertaken. Demographic, anthropometric and clinical characteristics and outcomes for all children aged under 5 years admitted for inpatient treatment of malnutrition between January 2010 and December 2011 were recorded and analysed.
Results. Of the 227 children who met the study inclusion criteria, 179 (64.6%) were severely malnourished and 98 (35.4%) had moderate malnutrition; 111 children died during admission, giving an overall case fatality rate of 40.1%. Mortality was significantly higher among severely malnourished children than among those with moderate malnutrition (46.9% v. 27.6%) (odds ratio (OR) 3.0, 95% confidence interval (CI) 1.7 - 5.3). Co-morbid pneumonia and gastroenteritis were significant predictors of mortality (OR 2.0, 95% CI 1.2 - 3.4 and OR 1.9, 95% CI 1.1 - 3.2, respectively).
Conclusion. Case fatality rates for childhood malnutrition remain high despite adoption of the WHO treatment guidelines. There is a need for periodic clinical audits and mortality review meetings to reduce deaths from childhood malnutrition so as to meet the WHO mortality target of less than 5% and improve child survival.
Outcomes of babies born before arrival at a tertiary hospital in Johannesburg, South Africa : researchSource: South African Journal of Child Health 7, pp 139 –145 (2013)More Less
Background. Babies born before arrival (BBBAs) to hospital constitute a high-risk newborn population. The literature demonstrates that BBBAs have increased perinatal mortality and morbidity.
Objectives. To describe the maternal and neonatal characteristics of BBBAs presenting to Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), South Africa, and assess whether they have increased morbidity and mortality compared with inborn babies.
Methods. This was a matched case-controlled retrospective record review of newborns presenting to the neonatal unit at CMJAH between 1 January 2011 and 31 January 2013. BBBAs were matched 1:1 with the next consecutive inborn on birthweight category and gender.
Results. A total of 356 neonates were analysed. BBBAs had higher mortality than inborn controls within the first 24 hours of hospital presentation (7.9% v. 3.9%; p=0.05). Mothers of BBBAs were more likely to be unbooked (58.4% v. 10.7%; p<0.001). Cases had a higher prevalence of early sepsis (22.9% v. 3.6%; p=0.03) and birth asphyxia (14.5% v. 0.8%; p<0.001) than controls. Overall, more deaths occurred in the very-low-birthweight (VLBW) (24% v. 10%; p=0.06) and low-birthweight (LBW) (7.46% v. 0%; p=0.02) BBBAs compared with controls.
Conclusion. We demonstrated higher mortality in the immediate postnatal period and in the VLBW and LBW categories compared with hospital-delivered neonates. Mothers who delivered out of hospital were more likely to be multiparous and unbooked and to have unknown HIV, syphilis and rhesus results. Neonatal resuscitation, transport and immediate care on arrival at the hospital should be prioritised in the management of BBBAs.
Source: South African Journal of Child Health 7, pp 146 –147 (2013)More Less
Background. Methylxanthines such as caffeine have been proven to reduce apnoea of prematurity and are often discontinued at 35 weeks' corrected gestational age (GA).
Objective. To ascertain whether a caffeine protocol based on international guidelines is applicable in our setting, where GA is often uncertain.
Methods. A prospective folder review was undertaken of all premature infants discharged home over a 2-month period.
Results. Fifty-five babies were included. All babies born at less than 35 weeks' GA were correctly started on caffeine as per protocol. GA was assigned in 85.5% of cases by Ballard scoring and in 14.5% from antenatal ultrasound findings. Caffeine was discontinued before 35 weeks in 54.5%.
Discussion. The main reason for discontinuing caffeine early was the baby's ability to feed satisfactorily, a demonstration of physiological maturity. As feeding behaviours mature significantly between 33 and 36 weeks, the ability to feed may be a good indication that caffeine therapy can be stopped.
Respiratory outcomes following 100 mg/kg v. 200 mg/kg of poractant alpha : a retrospective review : researchSource: South African Journal of Child Health 7, pp 148 –152 (2013)More Less
Background. The treatment guideline for the management of respiratory distress syndrome in the newborn unit at Auckland City Hospital (ACH), Auckland, New Zealand, was amended in July 2010. In keeping with current evidence, the initial dose of poractant alpha was increased from 100 mg/kg to 200 mg/kg. The outcomes of newborns requiring treatment with surfactant before and after this change were reviewed.
Methods. Electronic clinical records were reviewed of infants admitted to ACH who received surfactant during the period December 2008 - December 2011. There were two groups: group A were infants who received 100 mg/kg of poractant alpha as an initial dose (December 2008 - June 2010), and group B were infants who received 200 mg/kg as an initial dose (July 2010 - December 2011). Infants with congenital anomalies and those treated with surfactant before transfer to ACH were excluded.
Results. A total of 256 infants were included in the analysis, 118 in group A and 138 in group B. Infants in group B had a higher median gestational age (28 v. 27 weeks; p=0.52) and birth weight (1 065 g v. 930 g; p=0.08) compared with infants in group A. Significantly more infants in group A received more than one dose of surfactant (33.9% v.15.9%; odds ratio 2.7; p=0.0008). Infants in group B showed a significant reduction in oxygen requirement after the administration of surfactant (p=0.0003).
Conclusion. The administration of 200 mg/kg poractant alpha led to a significant improvement in oxygenation and a reduction in the need for further doses of surfactant.
Pattern of steroid-resistant nephrotic syndrome in children and the role of histopathology : a single-centre study : researchSource: South African Journal of Child Health 7, pp 153 –154 (2013)More Less
Background. Steroid-resistant nephrotic syndrome (SRNS) is a common problem in paediatric nephrology practice. There is currently little information on the spectrum of histopathological lesions in children presenting with SRNS in India and other south-east Asian countries.
Objective. To determine the histopathological lesions in children presenting with SRNS at our institution.
Methods. The study was conducted at Sardar Vallabh Bhai Patel Postgraduate Institute of Paediatrics and Sriram Chandra Bhanja Medical College, Cuttack, Odisha, India, from January 2009 to March 2013. All children aged 1 - 14 years presenting with primary SRNS and in whom renal biopsies were performed were included in the study. Their demographic, clinical, laboratory and histopathological data were retrieved from files and original renal biopsy forms.
Results. A total of 40 children had a clinical diagnosis of SRNS; 23 were males and 17 females (male:female ratio 1:35). Their mean age (± standard deviation) was 4.47 (±2.98) years (range 1 - 14 years). The histopathological lesions seen on renal biopsy specimens comprised minimal-change disease (MCD) (n=18), focal segmental glomerulosclerosis (FSGS) (n=12), immunoglobulin A nephropathy (IgAN) (n=5), immunoglobulin M nephropathy (n=2), membranous nephropathy (n=2) and idiopathic mesangial proliferative glomerulonephritis (n=1).
Conclusion. MCD is the predominant lesion in children with SRNS at our institution, followed by FSGS and IgAN.
Pulmonary alveolar proteinosis in a child from an informal settlement : 12 litres of fluid drained from the lungs and successful use of ECMO : short reportSource: South African Journal of Child Health 7, pp 155 –157 (2013)More Less
Pulmonary alveolar proteinosis (PAP) is a rare cause of chronic interstitial lung disease, characterised by accumulation of pulmonary surfactant, respiratory insufficiency and an increased incidence of infections. The current standard therapy is whole-lung lavage to remove the accumulated surfactant. We report on a cachexic 12-year-old boy from an informal settlement in South Africa, presenting for the first time with PAP. Twelve litres of broncho-alveolar lavage fluid were drained under extracorporeal membrane oxygenation, and the patient gained 10 kg during his 2-month admission.
Source: South African Journal of Child Health 7, pp 157 –159 (2013)More Less
Congenital central hypoventilation syndrome (CCHS), also called 'Ondine's curse', is characterised by an abnormal ventilatory response to progressive hypercapnia and sustained hypoxaemia. Neonates with this condition experience hypoventilation or apnoea while asleep. Patients may also have congenital intestinal aganglionosis (CIA), aganglionic megacolon or Hirschsprung's disease, suggesting an aberrant phenotype arising from a defect of migration or differentiation of neural crest cells. Some patients also have tumours of neural crest cell origin, including neuroblastoma, ganglioneuroma and ganglioneuroblastoma. The association of CCHS and CIA is called Ondine-Hirschsprung disease (Haddad syndrome). A few cases have been diagnosed in South Africa, but none has been reported. We report a case of CCHS and CIA with a PHOX2B gene mutation.