Pub Date : 2023-11-30DOI: 10.7196/sajch.2023.v17i4.1957
S. Muttoo, M. Jeena, PhD M Röösli, A. C. Olin, PhD H K Carlsen, PhD K Asharam, G. Naidoo, A. A. Mitku, PhD R N Naidoo
Background. Early assessment of infant lung function (ILF) is necessary to improve our understanding of factors that determine long- term respiratory health. Objective. To identify predictors of lung function among infants aged 6 weeks, 6, 12 and 24 months, from low socioeconomic settings, enrolled within the Mother and Child in the Environment (MACE) study. Methods. ILF tests were performed assessing multiple breath washout and tidal breathing during spontaneous sleep. Several risk factors, relating to infant growth, maternal and environmental exposures, were assessed cross-sectionally against the lung function parameters in multivariable models for each age group. Results. Maternal smoking during pregnancy affected the ratio of time to peak expiratory flow, showing a decline across the age groups, while being statistically significant (β (95% confidence interval (CI)) at 6 weeks (–24.6% (–43.92 - –4.59)) and 12 months (−12.68 (−25.25 - −0.11)). Low birthweight was associated with a lower tidal volume at 6 weeks (−5.99 mL (–9.59 - –2.39)), 6 months (−15.02 mL (−22.48 - −7.57)) and 12 months (−23.7 mL (−35.55 - −11.85)), compared with those with normal birthweight. This was further observed for minute ventilation at 6 weeks (−157.78 mL/min (−338.95 - 23.38)), 6 months (−325.57 mL/min (–619.06 - −32.08)) and 12 months (−527.58 mL/min (−947.85 - −107.32)), though less evident at 24 months. Conclusion. Low birthweight was the main predictor for low tidal volumes and minute ventilation at 6 weeks, with smaller differences observed at 12 and 24 months. Lung function development early in life is primarily driven by infant size and postnatal growth factors, consistent with other studies.
{"title":"Low birthweight and maternal smoking as predictors of infant lung function from a South African birth cohort within low socioeconomic communities","authors":"S. Muttoo, M. Jeena, PhD M Röösli, A. C. Olin, PhD H K Carlsen, PhD K Asharam, G. Naidoo, A. A. Mitku, PhD R N Naidoo","doi":"10.7196/sajch.2023.v17i4.1957","DOIUrl":"https://doi.org/10.7196/sajch.2023.v17i4.1957","url":null,"abstract":"Background. Early assessment of infant lung function (ILF) is necessary to improve our understanding of factors that determine long- term respiratory health. Objective. To identify predictors of lung function among infants aged 6 weeks, 6, 12 and 24 months, from low socioeconomic settings, enrolled within the Mother and Child in the Environment (MACE) study. Methods. ILF tests were performed assessing multiple breath washout and tidal breathing during spontaneous sleep. Several risk factors, relating to infant growth, maternal and environmental exposures, were assessed cross-sectionally against the lung function parameters in multivariable models for each age group. Results. Maternal smoking during pregnancy affected the ratio of time to peak expiratory flow, showing a decline across the age groups, while being statistically significant (β (95% confidence interval (CI)) at 6 weeks (–24.6% (–43.92 - –4.59)) and 12 months (−12.68 (−25.25 - −0.11)). Low birthweight was associated with a lower tidal volume at 6 weeks (−5.99 mL (–9.59 - –2.39)), 6 months (−15.02 mL (−22.48 - −7.57)) and 12 months (−23.7 mL (−35.55 - −11.85)), compared with those with normal birthweight. This was further observed for minute ventilation at 6 weeks (−157.78 mL/min (−338.95 - 23.38)), 6 months (−325.57 mL/min (–619.06 - −32.08)) and 12 months (−527.58 mL/min (−947.85 - −107.32)), though less evident at 24 months. Conclusion. Low birthweight was the main predictor for low tidal volumes and minute ventilation at 6 weeks, with smaller differences observed at 12 and 24 months. Lung function development early in life is primarily driven by infant size and postnatal growth factors, consistent with other studies.","PeriodicalId":44732,"journal":{"name":"South African Journal of Child Health","volume":"64 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139198459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-30DOI: 10.7196/10.7196/sajch.2023.v17i4.2003
K. M. Afolabi, A. Van der Byl, G. Joubert
Background. A discharge summary may be the only available health record for a patient, especially in resource-limited settings with suboptimal record-keeping. Considering the risk of adverse neurodevelopmental outcomes secondary to hypoxic ischaemic encephalopathy (HIE) and litigation, the quality of summaries for neonates with HIE is particularly important. Objectives. To audit electronic discharge summaries of neonates admitted with HIE to two tertiary hospitals in [City], South Africa. Methods. A retrospective, quantitative study was conducted. Electronic discharge summaries of late preterm and term neonates with HIE, admitted in 2018 and 2019 were audited for relevant information: final diagnosis, birth history, clinical evaluation, management, investigations, plan at discharge, and counselling of parents. Results. Of the 165 identified cases, 34 (20.6%) were excluded. Ten patients did not have electronic discharge summaries. Details of the other 24 cases in admission registers were incomplete. The final diagnosis of HIE appeared in 87 (66.4%) of 131 audited summaries. More than half (52.7%) lacked correct ICD-10 coding for HIE. Information on foetal distress and sentinel events was absent in 61.1% and 42.0%. Requirement for resuscitation was recorded in 90.8% of summaries. Performance of cardiac compressions and adrenaline administration were not specified in 46.6% and 54.2%. Admission blood gas results, particularly base deficit, lactate and glucose, were absent in 42.7%, 63.4% and 90.8% of summaries. Eligibility for therapeutic hypothermia was not captured in 41.2%. Cranial ultrasound, neuro-imaging, exclusion of meningitis, or multisystem involvement was not mentioned in 80.9%, 99.2%, 80.2% and 96.2%, respectively. Notes on counselling of parents were lacking (83.2%). Final cause of death was unspecified in 12 of 14 (85.7%) patients who died. Conclusion. Discharge summaries of neonates at risk of adverse neurodevelopmental outcomes secondary to HIE lacked essential information. Quality improvement and regular auditing of patient records must be prioritised.
{"title":"An audit of electronic discharge summaries of neonates admitted with hypoxic ischaemic encephalopathy to tertiary hospitals in [City], 2018–2019.","authors":"K. M. Afolabi, A. Van der Byl, G. Joubert","doi":"10.7196/10.7196/sajch.2023.v17i4.2003","DOIUrl":"https://doi.org/10.7196/10.7196/sajch.2023.v17i4.2003","url":null,"abstract":"Background. A discharge summary may be the only available health record for a patient, especially in resource-limited settings with suboptimal record-keeping. Considering the risk of adverse neurodevelopmental outcomes secondary to hypoxic ischaemic encephalopathy (HIE) and litigation, the quality of summaries for neonates with HIE is particularly important. Objectives. To audit electronic discharge summaries of neonates admitted with HIE to two tertiary hospitals in [City], South Africa. Methods. A retrospective, quantitative study was conducted. Electronic discharge summaries of late preterm and term neonates with HIE, admitted in 2018 and 2019 were audited for relevant information: final diagnosis, birth history, clinical evaluation, management, investigations, plan at discharge, and counselling of parents. Results. Of the 165 identified cases, 34 (20.6%) were excluded. Ten patients did not have electronic discharge summaries. Details of the other 24 cases in admission registers were incomplete. The final diagnosis of HIE appeared in 87 (66.4%) of 131 audited summaries. More than half (52.7%) lacked correct ICD-10 coding for HIE. Information on foetal distress and sentinel events was absent in 61.1% and 42.0%. Requirement for resuscitation was recorded in 90.8% of summaries. Performance of cardiac compressions and adrenaline administration were not specified in 46.6% and 54.2%. Admission blood gas results, particularly base deficit, lactate and glucose, were absent in 42.7%, 63.4% and 90.8% of summaries. Eligibility for therapeutic hypothermia was not captured in 41.2%. Cranial ultrasound, neuro-imaging, exclusion of meningitis, or multisystem involvement was not mentioned in 80.9%, 99.2%, 80.2% and 96.2%, respectively. Notes on counselling of parents were lacking (83.2%). Final cause of death was unspecified in 12 of 14 (85.7%) patients who died. Conclusion. Discharge summaries of neonates at risk of adverse neurodevelopmental outcomes secondary to HIE lacked essential information. Quality improvement and regular auditing of patient records must be prioritised.","PeriodicalId":44732,"journal":{"name":"South African Journal of Child Health","volume":"117 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139199818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-30DOI: 10.7196/10.7196/sajch.2023.v17i4.1998
N. Naka, MMed Paeds, F. Solomon, S. A. Madhi, PhD J M Pettifor, PhD Z Dangor, S. G. Lala
Background. In children, hypernatraemia occurs most commonly in infants (younger than 1 year). Although hypernatraemia is associated with high mortality and morbidity rates, it is variably defined in the paediatric literature as either serum sodium ≥150 mmol/L or serum sodium >145 mmol/L. In hospitalised adults, a serum sodium level >145 mmol/L but <150 mmol/L (called borderline hypernatraemia) has recently been identified as an independent risk factor for mortality. There are limited data about a potential association between borderline hypernatraemia and mortality in infants. Objectives. To determine whether borderline hypernatraemia is associated with increased mortality in hospitalised infants. Methods. We conducted a single-centre, retrospective observational study of 8 343 infants admitted to a tertiary-level academic hospital in Johannesburg, South Africa, of whom 254 had borderline hypernatraemia, 376 had hypernatraemia (serum sodium ≥150 mmol/L), and 7 713 did not have hypernatraemia. Mortality rates were reported as odds ratios (ORs) with 95% confidence intervals (CIs). Results. In 254 infants with borderline hypernatraemia, 115 (45.3%) were neonates (≤28 days old) and 140 (55.1%) were male. In 139 infants >28 days old with borderline hypernatraemia, the mortality rate (n=9/139; 6.5%) was significantly higher than the mortality rate observed in infants without hypernatraemia (n=194/5 857; 3.3%) (OR 2.02; 95% CI 1.03 - 3.98). Conclusion. Borderline hypernatraemia may be a risk factor associated with higher mortality in hospitalised infants. Prospective studies are required to determine whether borderline hypernatraemia contributes independently to mortality risk in hospitalised infants.
{"title":"Borderline hypernatraemia and mortality rates in South African infants: A single-centre observational study","authors":"N. Naka, MMed Paeds, F. Solomon, S. A. Madhi, PhD J M Pettifor, PhD Z Dangor, S. G. Lala","doi":"10.7196/10.7196/sajch.2023.v17i4.1998","DOIUrl":"https://doi.org/10.7196/10.7196/sajch.2023.v17i4.1998","url":null,"abstract":"Background. In children, hypernatraemia occurs most commonly in infants (younger than 1 year). Although hypernatraemia is associated with high mortality and morbidity rates, it is variably defined in the paediatric literature as either serum sodium ≥150 mmol/L or serum sodium >145 mmol/L. In hospitalised adults, a serum sodium level >145 mmol/L but <150 mmol/L (called borderline hypernatraemia) has recently been identified as an independent risk factor for mortality. There are limited data about a potential association between borderline hypernatraemia and mortality in infants. Objectives. To determine whether borderline hypernatraemia is associated with increased mortality in hospitalised infants. Methods. We conducted a single-centre, retrospective observational study of 8 343 infants admitted to a tertiary-level academic hospital in Johannesburg, South Africa, of whom 254 had borderline hypernatraemia, 376 had hypernatraemia (serum sodium ≥150 mmol/L), and 7 713 did not have hypernatraemia. Mortality rates were reported as odds ratios (ORs) with 95% confidence intervals (CIs). Results. In 254 infants with borderline hypernatraemia, 115 (45.3%) were neonates (≤28 days old) and 140 (55.1%) were male. In 139 infants >28 days old with borderline hypernatraemia, the mortality rate (n=9/139; 6.5%) was significantly higher than the mortality rate observed in infants without hypernatraemia (n=194/5 857; 3.3%) (OR 2.02; 95% CI 1.03 - 3.98). Conclusion. Borderline hypernatraemia may be a risk factor associated with higher mortality in hospitalised infants. Prospective studies are required to determine whether borderline hypernatraemia contributes independently to mortality risk in hospitalised infants.","PeriodicalId":44732,"journal":{"name":"South African Journal of Child Health","volume":"2 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139200501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-23DOI: 10.7196/sajch.2023.v17i1.1899
J Chandramati, S Ponthenkandath
Background. Although C-reactive protein (CRP) is used as a biomarker, its value in resource-limited settings for diagnosis andmanagement of late-onset sepsis in neonates has not been reported previously.Objective. To evaluate the value of CRP as a biomarker in identifying late-onset sepsis in symptomatic infants.Method. We performed a retrospective study to evaluate the value of CRP as a biomarker in identifying late-onset sepsis in symptomatic infants. Infants were classified into three groups (blood culture-proven sepsis (n=72), clinical sepsis (n=38) and no sepsis (n=114)). Infants underwent sepsis work-up consisting of complete blood count (CBC), blood culture, urine and cerebrospinal fluid (CSF) culture including CRP measurements.Results. The overall sensitivity and specificity of CRP levels >10 μg/mL was 94.5% and 91.2%, respectively, for the diagnosis of late-onset sepsis. Positive predictive value was 91.2% and negative predictive value was 92.8%. Total white blood cell (WBC) counts had poorsensitivity and specificity compared with CRP. The cost for CRP testing was only 2.5% of the total cost for sepsis work-up in neonates.Conclusion. Our study indicates that CRP has excellent sensitivity and specificity in the diagnosis of late-onset sepsis. In low- and middle-income countries, CRP testing perhaps offers more value compared with W14BC counts
{"title":"The cost-effectiveness and value of C-reactive protein in the diagnosis and management of neonatal late-onset sepsis in resource-limited settings","authors":"J Chandramati, S Ponthenkandath","doi":"10.7196/sajch.2023.v17i1.1899","DOIUrl":"https://doi.org/10.7196/sajch.2023.v17i1.1899","url":null,"abstract":"Background. Although C-reactive protein (CRP) is used as a biomarker, its value in resource-limited settings for diagnosis andmanagement of late-onset sepsis in neonates has not been reported previously.Objective. To evaluate the value of CRP as a biomarker in identifying late-onset sepsis in symptomatic infants.Method. We performed a retrospective study to evaluate the value of CRP as a biomarker in identifying late-onset sepsis in symptomatic infants. Infants were classified into three groups (blood culture-proven sepsis (n=72), clinical sepsis (n=38) and no sepsis (n=114)). Infants underwent sepsis work-up consisting of complete blood count (CBC), blood culture, urine and cerebrospinal fluid (CSF) culture including CRP measurements.Results. The overall sensitivity and specificity of CRP levels >10 μg/mL was 94.5% and 91.2%, respectively, for the diagnosis of late-onset sepsis. Positive predictive value was 91.2% and negative predictive value was 92.8%. Total white blood cell (WBC) counts had poorsensitivity and specificity compared with CRP. The cost for CRP testing was only 2.5% of the total cost for sepsis work-up in neonates.Conclusion. Our study indicates that CRP has excellent sensitivity and specificity in the diagnosis of late-onset sepsis. In low- and middle-income countries, CRP testing perhaps offers more value compared with W14BC counts","PeriodicalId":44732,"journal":{"name":"South African Journal of Child Health","volume":"44 2","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135461266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-20DOI: 10.7196/sajch.2023.v17i4.1986
N Geddara, L Mubaiwa, R Thejpal, C Hendricks
Background. Malnutrition in children with cancer is a common problem, especially in developing countries. Determination of nutritional status on admission and during treatment is crucial to reduce morbidity and mortality. Objectives. This study reports the prevalence of malnutrition in children with cancer and its impact on outcomes. Methods. A retrospective study identified newly diagnosed children with cancer between January 2017 and June 2018 at Inkosi Albert Luthuli Central Hospital (IALCH), an academic hospital in South Africa (SA). The cohort comprised 139 patients. Demographic, anthropometric and outcome data were collected from the hospital electronic database. World Health Organization (WHO) criteria were applied to classify nutritional status. The impact of nutritional status on mortality, length of hospital stay and infection status in the first year was assessed. Results. The prevalence of malnutrition in our cohort of 139 patients was 31.7% (17.3% wasted, 7.2% stunted and 7.2% wasted and stunted). There was a higher incidence of wasting in children with solid tumours than those with haematological malignancies although this was not statistically significant (21.2% v. 7.7% respectively, p-value 0.242). No significant difference in early mortality, length of hospital stay or rate of infection was noted in malnourished patients compared with well-nourished patients. Conclusion. The prevalence of malnutrition in our cohort with cancer was high but not associated with an increased risk of mortality, hospital stay or infection. A larger sample size using a combination of arm- and weight/height-based anthropometry is recommended to confirm these findings.
背景。癌症儿童营养不良是一个普遍问题，特别是在发展中国家。入院时和治疗期间确定营养状况对降低发病率和死亡率至关重要。目标。本研究报告了癌症儿童营养不良的发生率及其对预后的影响。方法。一项回顾性研究确定了2017年1月至2018年6月在南非学术医院英科西阿尔伯特卢图利中心医院(IALCH)新诊断的癌症儿童。该队列包括139名患者。人口统计学、人体测量学和结果数据从医院电子数据库中收集。采用世界卫生组织(世卫组织)的标准对营养状况进行分类。评估了第一年营养状况对死亡率、住院时间和感染状况的影响。结果。139例患者中营养不良发生率为31.7%(17.3%消瘦，7.2%发育不良，7.2%消瘦并发育不良)。患有实体瘤的儿童消瘦的发生率高于患有血液系统恶性肿瘤的儿童，尽管这没有统计学意义(分别为21.2% vs . 7.7%， p值0.242)。与营养良好的患者相比，营养不良患者的早期死亡率、住院时间或感染率没有显著差异。结论。在我们的癌症患者队列中，营养不良的发生率很高，但与死亡率、住院时间或感染风险的增加无关。建议使用基于手臂和体重/身高的人体测量相结合的更大样本量来证实这些发现。
{"title":"Issue 4","authors":"N Geddara, L Mubaiwa, R Thejpal, C Hendricks","doi":"10.7196/sajch.2023.v17i4.1986","DOIUrl":"https://doi.org/10.7196/sajch.2023.v17i4.1986","url":null,"abstract":"Background. Malnutrition in children with cancer is a common problem, especially in developing countries. Determination of nutritional status on admission and during treatment is crucial to reduce morbidity and mortality. Objectives. This study reports the prevalence of malnutrition in children with cancer and its impact on outcomes. Methods. A retrospective study identified newly diagnosed children with cancer between January 2017 and June 2018 at Inkosi Albert Luthuli Central Hospital (IALCH), an academic hospital in South Africa (SA). The cohort comprised 139 patients. Demographic, anthropometric and outcome data were collected from the hospital electronic database. World Health Organization (WHO) criteria were applied to classify nutritional status. The impact of nutritional status on mortality, length of hospital stay and infection status in the first year was assessed. Results. The prevalence of malnutrition in our cohort of 139 patients was 31.7% (17.3% wasted, 7.2% stunted and 7.2% wasted and stunted). There was a higher incidence of wasting in children with solid tumours than those with haematological malignancies although this was not statistically significant (21.2% v. 7.7% respectively, p-value 0.242). No significant difference in early mortality, length of hospital stay or rate of infection was noted in malnourished patients compared with well-nourished patients. Conclusion. The prevalence of malnutrition in our cohort with cancer was high but not associated with an increased risk of mortality, hospital stay or infection. A larger sample size using a combination of arm- and weight/height-based anthropometry is recommended to confirm these findings.","PeriodicalId":44732,"journal":{"name":"South African Journal of Child Health","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135665170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-20DOI: 10.7196/sajch.2023.v17i4.1976
H Hblous, L Mubaiwa, R Govender
Background. An important part of holistic care management of children with epilepsy (CWE) is measuring their health-related quality of life (HRQOL). However, little is known about the HRQOL of CWE who live in resource-limited settings, particularly in South Africa. Objectives. To assess the HRQOL of CWE and to identify the possible factors that correlate with HRQOL including demographic variables and epilepsy health-related factors. Methods. A cross-sectional prospective quantitative study was undertaken at the paediatric neurology outpatient clinic at Inkosi Albert Luthuli Hospital (IALCH), a quaternary care teaching hospital in Durban, South Africa. Participants were recruited during the period between December 2019 and February 2020. CWE between 2 and 12 years old with no comorbid syndromic disorder or other chronic diseases accompanied by English-speaking caregivers were included in the study. We used the Pediatric Quality of Life Inventory 4.0 (PedsQL 4.0) generic core parent-proxy questionnaire modified with separate sociodemographic and epilepsy data collection sheets. Results. One hundred and twenty participants were recruited. The majority of patients (54.2%) had generalised epilepsy. The aetiology of epilepsy was unknown in 40.8% of patients. The most commonly used anti-seizure medication was sodium valproate (39.2%). The mean of the total score of HRQOL (SD) (coefficient of variation %) was 66.7 (24.1 (36.1). School attendance p-value<0.001, financial aid for indigent families p 0.047, monotherapy p<0.001, absence of disability p<0.001 and absence of comorbidity p <0.001were strongly associated with good HRQOL total scores. Conclusion. CWE attending IALCH in Durban, South Africa, have compromised HRQOL scores. The variables that significantly correlate with better HRQOL scores are school attendance, receiving financial aid for indigent families, monotherapy, and absence of disabilities and comorbidities. We recommend a multicentre study that involves a larger number of epileptic children with the employment of the epilepsy-specific PedsQL 4.0 module translated into local languages.
{"title":"Issue 4","authors":"H Hblous, L Mubaiwa, R Govender","doi":"10.7196/sajch.2023.v17i4.1976","DOIUrl":"https://doi.org/10.7196/sajch.2023.v17i4.1976","url":null,"abstract":"Background. An important part of holistic care management of children with epilepsy (CWE) is measuring their health-related quality of life (HRQOL). However, little is known about the HRQOL of CWE who live in resource-limited settings, particularly in South Africa. Objectives. To assess the HRQOL of CWE and to identify the possible factors that correlate with HRQOL including demographic variables and epilepsy health-related factors. Methods. A cross-sectional prospective quantitative study was undertaken at the paediatric neurology outpatient clinic at Inkosi Albert Luthuli Hospital (IALCH), a quaternary care teaching hospital in Durban, South Africa. Participants were recruited during the period between December 2019 and February 2020. CWE between 2 and 12 years old with no comorbid syndromic disorder or other chronic diseases accompanied by English-speaking caregivers were included in the study. We used the Pediatric Quality of Life Inventory 4.0 (PedsQL 4.0) generic core parent-proxy questionnaire modified with separate sociodemographic and epilepsy data collection sheets. Results. One hundred and twenty participants were recruited. The majority of patients (54.2%) had generalised epilepsy. The aetiology of epilepsy was unknown in 40.8% of patients. The most commonly used anti-seizure medication was sodium valproate (39.2%). The mean of the total score of HRQOL (SD) (coefficient of variation %) was 66.7 (24.1 (36.1). School attendance p-value<0.001, financial aid for indigent families p 0.047, monotherapy p<0.001, absence of disability p<0.001 and absence of comorbidity p <0.001were strongly associated with good HRQOL total scores. Conclusion. CWE attending IALCH in Durban, South Africa, have compromised HRQOL scores. The variables that significantly correlate with better HRQOL scores are school attendance, receiving financial aid for indigent families, monotherapy, and absence of disabilities and comorbidities. We recommend a multicentre study that involves a larger number of epileptic children with the employment of the epilepsy-specific PedsQL 4.0 module translated into local languages.","PeriodicalId":44732,"journal":{"name":"South African Journal of Child Health","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135665169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-20DOI: 10.7196/sajch.2023.v17i3.1994
S Ismail, S Panday
Background. Noise is a known environmental stressor in the neonatal intensive care unit (NICU), as it may result in adverse effects on preterm neonates because of the unique vulnerability and physiological immaturity of their central nervous systems. Objective. To investigate noise levels in public sector NICUs in the eThekwini District, KwaZulu-Natal Province, South Africa. Methods. An analytical observational study design with purposive sampling of public sector hospitals was used. Noise was continuously measured with a sound level meter in a central location for 48 hours on 2 consecutive days (Sunday and Monday) in the four NICUs. A sample of noise sources, as well as their frequency of occurrence, was identified through direct observation and a frequency spectrum analysis using one-third octave bands. Data were analysed using descriptive and inferential statistics. Results. This study included one tertiary hospital and three regional hospitals in the eThekwini District. Mean noise levels exceeded international recommendations of an A-weighted equivalent continuous sound level (LAeq) of 45 A-weighted decibel (dBA) and an A-weighted maximum sound level (LAmax) of 65 dBA in all four hospitals. The most frequently occurring sources of noise were staff conversations (30.9%, Hospital A), device alarms (21.0%, Hospital B) and closing metal pedal bins (20.0%, Hospital B). Mean LAeqs >45 BA were found in the mid and high frequencies (250 Hz - 6 300 Hz) in all hospitals, particularly during the afternoon. Conclusion. The findings emphasise the need for continuous noise monitoring, awareness and education among healthcare professionals in the NICU. Future research should expand on existing findings and focus on interventions for noise control in NICUs.
{"title":"Issue 4","authors":"S Ismail, S Panday","doi":"10.7196/sajch.2023.v17i3.1994","DOIUrl":"https://doi.org/10.7196/sajch.2023.v17i3.1994","url":null,"abstract":"Background. Noise is a known environmental stressor in the neonatal intensive care unit (NICU), as it may result in adverse effects on preterm neonates because of the unique vulnerability and physiological immaturity of their central nervous systems. Objective. To investigate noise levels in public sector NICUs in the eThekwini District, KwaZulu-Natal Province, South Africa. Methods. An analytical observational study design with purposive sampling of public sector hospitals was used. Noise was continuously measured with a sound level meter in a central location for 48 hours on 2 consecutive days (Sunday and Monday) in the four NICUs. A sample of noise sources, as well as their frequency of occurrence, was identified through direct observation and a frequency spectrum analysis using one-third octave bands. Data were analysed using descriptive and inferential statistics. Results. This study included one tertiary hospital and three regional hospitals in the eThekwini District. Mean noise levels exceeded international recommendations of an A-weighted equivalent continuous sound level (LAeq) of 45 A-weighted decibel (dBA) and an A-weighted maximum sound level (LAmax) of 65 dBA in all four hospitals. The most frequently occurring sources of noise were staff conversations (30.9%, Hospital A), device alarms (21.0%, Hospital B) and closing metal pedal bins (20.0%, Hospital B). Mean LAeqs >45 BA were found in the mid and high frequencies (250 Hz - 6 300 Hz) in all hospitals, particularly during the afternoon. Conclusion. The findings emphasise the need for continuous noise monitoring, awareness and education among healthcare professionals in the NICU. Future research should expand on existing findings and focus on interventions for noise control in NICUs.","PeriodicalId":44732,"journal":{"name":"South African Journal of Child Health","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135665167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-20DOI: 10.7196/sajch.2023.v17i4.1922
R M Tshehla, M Coetzee, P J Becker
Background. Neonatal hypothermia, defined as a body temperature <36.5°C, is a known contributor to neonatal morbidity and mortality. The admission temperature is an important predictor of neonatal outcomes, and a measure of quality of care. Objectives. This study aims to determine the incidence of and factors associated with hypothermia on admission to the neonatal unit at Steve Biko Academic Hospital (SBAH), a public tertiary hospital in South Africa. Methods. A retrospective, cross-sectional study of infants admitted to the neonatal unit from September 2019 to February 2020 using data from patient records. Results. The overall incidence of hypothermia on admission was 66% (mild 25%, moderate to severe 41%), with a mean (standard deviation (SD)) admission temperature of 35.1 (4.7)°C, and 82% (mild 19%, moderate to severe 62%) in very-low-birthweight infants. Infants remained hypothermic for a mean (SD) of 4.1 (3.9) hours post admission. Birthweight ≤1 500 g (odds ratio (OR) 1.87; p=0.019), admission to the neonatal intensive care unit (OR 1.97; p<0.0001), and admission from the delivery room within the first 60 minutes of life (OR 3.06; p=0.026) were independent risk factors for hypothermia. Hypothermia was associated with increased duration of respiratory support (mean 3.2 (5.6) v. 1.7 (4.5) days; p<0.0001), and longer length of hospital stay (mean 17.9 (18.8) v. 10.9 (12.6) days; p<0.0001). Conclusion. The incidence of hypothermia on admission to the unit is significantly high, and hypothermic infants take a significant length of time to regain normothermia. A standardised protocol for the prevention and management of hypothermia needs to be introduced in the unit.
{"title":"Issue 4","authors":"R M Tshehla, M Coetzee, P J Becker","doi":"10.7196/sajch.2023.v17i4.1922","DOIUrl":"https://doi.org/10.7196/sajch.2023.v17i4.1922","url":null,"abstract":"Background. Neonatal hypothermia, defined as a body temperature <36.5°C, is a known contributor to neonatal morbidity and mortality. The admission temperature is an important predictor of neonatal outcomes, and a measure of quality of care. Objectives. This study aims to determine the incidence of and factors associated with hypothermia on admission to the neonatal unit at Steve Biko Academic Hospital (SBAH), a public tertiary hospital in South Africa. Methods. A retrospective, cross-sectional study of infants admitted to the neonatal unit from September 2019 to February 2020 using data from patient records. Results. The overall incidence of hypothermia on admission was 66% (mild 25%, moderate to severe 41%), with a mean (standard deviation (SD)) admission temperature of 35.1 (4.7)°C, and 82% (mild 19%, moderate to severe 62%) in very-low-birthweight infants. Infants remained hypothermic for a mean (SD) of 4.1 (3.9) hours post admission. Birthweight ≤1 500 g (odds ratio (OR) 1.87; p=0.019), admission to the neonatal intensive care unit (OR 1.97; p<0.0001), and admission from the delivery room within the first 60 minutes of life (OR 3.06; p=0.026) were independent risk factors for hypothermia. Hypothermia was associated with increased duration of respiratory support (mean 3.2 (5.6) v. 1.7 (4.5) days; p<0.0001), and longer length of hospital stay (mean 17.9 (18.8) v. 10.9 (12.6) days; p<0.0001). Conclusion. The incidence of hypothermia on admission to the unit is significantly high, and hypothermic infants take a significant length of time to regain normothermia. A standardised protocol for the prevention and management of hypothermia needs to be introduced in the unit.","PeriodicalId":44732,"journal":{"name":"South African Journal of Child Health","volume":"43 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135665168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-20DOI: 10.7196/sajch.2023.v17i4.2004
M Milovanovic, S Omar, S G Lala, Z Dangor
Background. Paediatric hypernatraemia is a severe and life-threatening electrolyte abnormality that is associated with considerable morbidity and mortality. Although intravenous (IV) fluid therapy is a crucial component of management, there are no management guidelines, and varying approaches to IV fluid therapy are commonplace in clinical practice. Objectives. To determine the variance in IV fluid therapy in the management of paediatric hypernatraemia among paediatric registrars and consultants in South Africa. Methods. A self-administered online survey was conducted from November 2020 to February 2021. The survey assessed paediatricians’ management of three typical clinical scenarios of community-acquired hypernatraemia seen in South Africa. Descriptive results were presented as proportions, frequencies and medians with interquartile ranges. Comparisons were done using contingency tables. Results. Responses from 119 participants were analysed. Most respondents worked in the state sector (69.8%), and were based mainly in Gauteng (46.2%) or Western Cape (25.2%) province. Most (60.2%) respondents considered a serum sodium level ≥146 mmol/L indicative of hypernatraemia, and 43.6% (n=51/117) reported seeing >10 cases of paediatric hypernatraemia in 2019. For all three cases, at least eight different types of infusate (of varying sodium concentrations) were chosen as maintenance fluids. Fluid deficits were calculated using either the free water method or based on the perceived degree/percentage of clinical dehydration. Conclusion. There is considerable variability in the management of hypernatraemia among paediatricians in South Africa. There is an urgent need to develop a standardised guideline for the treatment of paediatric hypernatraemia.
{"title":"Issue 4","authors":"M Milovanovic, S Omar, S G Lala, Z Dangor","doi":"10.7196/sajch.2023.v17i4.2004","DOIUrl":"https://doi.org/10.7196/sajch.2023.v17i4.2004","url":null,"abstract":"Background. Paediatric hypernatraemia is a severe and life-threatening electrolyte abnormality that is associated with considerable morbidity and mortality. Although intravenous (IV) fluid therapy is a crucial component of management, there are no management guidelines, and varying approaches to IV fluid therapy are commonplace in clinical practice. Objectives. To determine the variance in IV fluid therapy in the management of paediatric hypernatraemia among paediatric registrars and consultants in South Africa. Methods. A self-administered online survey was conducted from November 2020 to February 2021. The survey assessed paediatricians’ management of three typical clinical scenarios of community-acquired hypernatraemia seen in South Africa. Descriptive results were presented as proportions, frequencies and medians with interquartile ranges. Comparisons were done using contingency tables. Results. Responses from 119 participants were analysed. Most respondents worked in the state sector (69.8%), and were based mainly in Gauteng (46.2%) or Western Cape (25.2%) province. Most (60.2%) respondents considered a serum sodium level ≥146 mmol/L indicative of hypernatraemia, and 43.6% (n=51/117) reported seeing >10 cases of paediatric hypernatraemia in 2019. For all three cases, at least eight different types of infusate (of varying sodium concentrations) were chosen as maintenance fluids. Fluid deficits were calculated using either the free water method or based on the perceived degree/percentage of clinical dehydration. Conclusion. There is considerable variability in the management of hypernatraemia among paediatricians in South Africa. There is an urgent need to develop a standardised guideline for the treatment of paediatric hypernatraemia.","PeriodicalId":44732,"journal":{"name":"South African Journal of Child Health","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135666068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-20DOI: 10.7196/sajch.2023.v17i4.2007
S F Maphumulo, E M Honey, N Abdelatif, M Karsas
Background. Down syndrome (DS) is the most common chromosomal abnormality in the paediatric setting, and thyroid dysfunction is more commonly encountered in this population than among the general population. The literature shows that the most common type of thyroid dysfunction seen in these children is subclinical hypothyroidism.Objective. The purpose of this study was to establish the prevalence and spectrum of thyroid disease in this population with the aim of establishing easy-to-follow protocols. Method. A retrospective study was conducted in children with DS who were seen at the paediatric genetic clinic at two academic hospitals. Data were collected from the hospital files and the results were extracted from the National Health Laboratory Service database system. Results. A total of 158 children were recruited; 25 children were excluded as they had had no thyroid function tests done. From the total of 133 included children, 70 (52.6%) were male. Babies born in one of the two hospitals numbered 60 (45.1%), whereas 54.9% were born in the other hospital. A total of 77 (57.9%) were found to have thyroid dysfunction; 55.8% of these patients were male. The most common thyroid abnormality was subclinical hypothyroidism in n=66/133 (49.6%), accounting for 85.7% of the causes of the thyroid dysfunction. Most children (n=45/133 (33.8%)) had their first thyroid function test done before the age of 2 months, followed by the age group of 1 - 5 years (n=34/133 (25.56%)). The total number of children started on treatment for their thyroid dysfunction was n=5/77 (6.49%). Conclusion. Thyroid dysfunction is seen more commonly in children with DS compared with the general population, which was very evident in the present study. A standardised protocol will have a significant impact on the early management of these children, to prevent further cognitive impairment, especially in developing countries and at any level of healthcare. The recommendations for thyroid dysfunction screening by the American Academy of Pediatrics can be adjusted and tailored for the South African population. Early diagnosis and referral of children with DS to a secondary- or tertiary-level facility is of utmost benefit for these children for screening and treatment of comorbidities and complications.
{"title":"Issue 4","authors":"S F Maphumulo, E M Honey, N Abdelatif, M Karsas","doi":"10.7196/sajch.2023.v17i4.2007","DOIUrl":"https://doi.org/10.7196/sajch.2023.v17i4.2007","url":null,"abstract":"Background. Down syndrome (DS) is the most common chromosomal abnormality in the paediatric setting, and thyroid dysfunction is more commonly encountered in this population than among the general population. The literature shows that the most common type of thyroid dysfunction seen in these children is subclinical hypothyroidism.Objective. The purpose of this study was to establish the prevalence and spectrum of thyroid disease in this population with the aim of establishing easy-to-follow protocols. Method. A retrospective study was conducted in children with DS who were seen at the paediatric genetic clinic at two academic hospitals. Data were collected from the hospital files and the results were extracted from the National Health Laboratory Service database system. Results. A total of 158 children were recruited; 25 children were excluded as they had had no thyroid function tests done. From the total of 133 included children, 70 (52.6%) were male. Babies born in one of the two hospitals numbered 60 (45.1%), whereas 54.9% were born in the other hospital. A total of 77 (57.9%) were found to have thyroid dysfunction; 55.8% of these patients were male. The most common thyroid abnormality was subclinical hypothyroidism in n=66/133 (49.6%), accounting for 85.7% of the causes of the thyroid dysfunction. Most children (n=45/133 (33.8%)) had their first thyroid function test done before the age of 2 months, followed by the age group of 1 - 5 years (n=34/133 (25.56%)). The total number of children started on treatment for their thyroid dysfunction was n=5/77 (6.49%). Conclusion. Thyroid dysfunction is seen more commonly in children with DS compared with the general population, which was very evident in the present study. A standardised protocol will have a significant impact on the early management of these children, to prevent further cognitive impairment, especially in developing countries and at any level of healthcare. The recommendations for thyroid dysfunction screening by the American Academy of Pediatrics can be adjusted and tailored for the South African population. Early diagnosis and referral of children with DS to a secondary- or tertiary-level facility is of utmost benefit for these children for screening and treatment of comorbidities and complications.","PeriodicalId":44732,"journal":{"name":"South African Journal of Child Health","volume":"140 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135666072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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