Pub Date : 2024-07-12DOI: 10.7196/sajch.2024.v18i2.1851
L. Mfingwana, MPhil, P. Goussard, PhD Van Wyk, PhD S Andronikou
Echinococcus granulosus (CE) is a worldwide public health problem causing considerable human morbidity and mortality. We report on a case of complicated paediatric echinococcosis as evidenced by pulmonary, hepatic and cardiac cysts. Combined surgery and chemotherapy represent an appropriate strategy for managing cardiac and cardiopulmonary echinococcosis. However, there is a pressing need for developing a prevention strategy, collaborative research efforts and establishing a registry for information sharing, particularly in SA and other endemic regions.
{"title":"Hepatocardiopulmonary hydatid cysts: A rare paediatric case","authors":"L. Mfingwana, MPhil, P. Goussard, PhD Van Wyk, PhD S Andronikou","doi":"10.7196/sajch.2024.v18i2.1851","DOIUrl":"https://doi.org/10.7196/sajch.2024.v18i2.1851","url":null,"abstract":"\u0000 \u0000 \u0000 \u0000Echinococcus granulosus (CE) is a worldwide public health problem causing considerable human morbidity and mortality. We report on a case of complicated paediatric echinococcosis as evidenced by pulmonary, hepatic and cardiac cysts. Combined surgery and chemotherapy represent an appropriate strategy for managing cardiac and cardiopulmonary echinococcosis. However, there is a pressing need for developing a prevention strategy, collaborative research efforts and establishing a registry for information sharing, particularly in SA and other endemic regions. \u0000 \u0000 \u0000 \u0000","PeriodicalId":44732,"journal":{"name":"South African Journal of Child Health","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141653272","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 : 2024-07-12DOI: 10.7196/sajch.2024.v18i2.1028
M. Sichula, FCPaed SA MB ChB, S. Pillay, MMed Paed, Cert Neonatology, Nakibuuka, M. Harrison, A. Horn
Background. Hypoxic-ischaemic encephalopathy (HIE) remains a leading cause of death and disability in term neonates despite therapeutic hypothermia. Hyperglycaemia in the first 12 hours of life is associated with poor outcomes in some studies. This relationship has not yet been explored in South African (SA) cohorts. Objective. To describe the association between hyperglycaemia (in the first 12 hours of life) and poor outcome, which was defined as death or a severely abnormal amplitude-integrated electroencephalogram (aEEG) at 48 hours, in neonates with moderate-to-severe HIE who were treated with hypothermia at an SA tertiary hospital. Methods. Folders from a database of 57 neonates with moderate-to-severe HIE treated with hypothermia between January 2011 and December 2012, were reviewed to obtain glycaemic profiles. Maternal and neonatal characteristics and outcomes were extracted from the database. Results. Only 47 neonates had adequate glucose and aEEG data. Seventeen neonates (36%) had hyperglycaemia (>8.3 mmol/L), 25 (53%) were normoglycaemic and 5 neonates (10%) were hypoglycaemic (<2.3 mmol/L). Hyperglycaemia was only associated with death or severely abnormal aEEG at a glucose value ≥25.6 mmol/L. Hyperglycaemia was significantly associated with a low 5-minute Apgar score (p=0.007), severely abnormal aEEG at 6 hours (p=0.029), and a higher HIE score at 6 hours (p=0.002). Hyperglycaemia was associated with death (odds ratio 10; 95% confidence interval 1 - 96; p=0.045), but the association was not independent of the 5-minute Apgar score. Conclusion. Early hyperglycaemia in neonates with moderate-to-severe HIE was associated with disease severity at birth and death despite cooling.
{"title":"Hyperglycaemia and outcome in neonates with hypoxic-ischaemic encephalopathy","authors":"M. Sichula, FCPaed SA MB ChB, S. Pillay, MMed Paed, Cert Neonatology, Nakibuuka, M. Harrison, A. Horn","doi":"10.7196/sajch.2024.v18i2.1028","DOIUrl":"https://doi.org/10.7196/sajch.2024.v18i2.1028","url":null,"abstract":"\u0000\u0000\u0000\u0000Background. Hypoxic-ischaemic encephalopathy (HIE) remains a leading cause of death and disability in term neonates despite therapeutic hypothermia. Hyperglycaemia in the first 12 hours of life is associated with poor outcomes in some studies. This relationship has not yet been explored in South African (SA) cohorts.\u0000Objective. To describe the association between hyperglycaemia (in the first 12 hours of life) and poor outcome, which was defined as death or a severely abnormal amplitude-integrated electroencephalogram (aEEG) at 48 hours, in neonates with moderate-to-severe HIE who were treated with hypothermia at an SA tertiary hospital.\u0000Methods. Folders from a database of 57 neonates with moderate-to-severe HIE treated with hypothermia between January 2011 and December 2012, were reviewed to obtain glycaemic profiles. Maternal and neonatal characteristics and outcomes were extracted from the database.\u0000Results. Only 47 neonates had adequate glucose and aEEG data. Seventeen neonates (36%) had hyperglycaemia (>8.3 mmol/L), 25 (53%) were normoglycaemic and 5 neonates (10%) were hypoglycaemic (<2.3 mmol/L). Hyperglycaemia was only associated with death or severely abnormal aEEG at a glucose value ≥25.6 mmol/L. Hyperglycaemia was significantly associated with a low 5-minute Apgar score (p=0.007), severely abnormal aEEG at 6 hours (p=0.029), and a higher HIE score at 6 hours (p=0.002). Hyperglycaemia was associated with death (odds ratio 10; 95% confidence interval 1 - 96; p=0.045), but the association was not independent of the 5-minute Apgar score.\u0000Conclusion. Early hyperglycaemia in neonates with moderate-to-severe HIE was associated with disease severity at birth and death despite cooling.\u0000\u0000\u0000\u0000","PeriodicalId":44732,"journal":{"name":"South African Journal of Child Health","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141653987","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 : 2024-07-12DOI: 10.7196/sajch.2024.v18i2.808
MTech M C Ferreira, DHSc Comp Med R K Razlog, Twr J Pellow, D. Tech
Background. Complementary medicines (CMs) for infantile colic are widely available on the South African market, in various pharmacies and retail outlets, without the need for a prescription. Pharmacists therefore have an important role to play in educating patients about safe and appropriate use of CM products. Objectives. To investigate the perceptions and prescribing patterns of CMs for infantile colic by pharmacists and pharmacist assistants employed in the greater Johannesburg area. Methods. We used a quantitative approach with a descriptive survey design. A total of 100 pharmacists and pharmacist assistants registered with the South African Pharmacy Council completed a pen-and-paper questionnaire. Results. Many participants reported recommending both conventional and CMs for infantile colic and, overall, positive perceptions of CM were reported. Most participants agreed that they had a responsibility to counsel patients on the use of CM but felt that they needed to expand their own knowledge base. Conclusions. There appears to be a positive shift towards CM for the treatment of infantile colic; however, improved training is needed to ensure pharmacists and pharmacist assistants are better informed regarding CM products in order to give appropriate advice to patients.
{"title":"The perceptions and prescribing patterns of complementary medicines for infantile colic by pharmacists in Johannesburg, South Africa","authors":"MTech M C Ferreira, DHSc Comp Med R K Razlog, Twr J Pellow, D. Tech","doi":"10.7196/sajch.2024.v18i2.808","DOIUrl":"https://doi.org/10.7196/sajch.2024.v18i2.808","url":null,"abstract":"\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000Background. Complementary medicines (CMs) for infantile colic are widely available on the South African market, in various pharmacies and retail outlets, without the need for a prescription. Pharmacists therefore have an important role to play in educating patients about safe and appropriate use of CM products.\u0000Objectives. To investigate the perceptions and prescribing patterns of CMs for infantile colic by pharmacists and pharmacist assistants employed in the greater Johannesburg area.\u0000Methods. We used a quantitative approach with a descriptive survey design. A total of 100 pharmacists and pharmacist assistants registered with the South African Pharmacy Council completed a pen-and-paper questionnaire.\u0000Results. Many participants reported recommending both conventional and CMs for infantile colic and, overall, positive perceptions of CM were reported. Most participants agreed that they had a responsibility to counsel patients on the use of CM but felt that they needed to expand their own knowledge base.\u0000Conclusions. There appears to be a positive shift towards CM for the treatment of infantile colic; however, improved training is needed to ensure pharmacists and pharmacist assistants are better informed regarding CM products in order to give appropriate advice to patients.\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000","PeriodicalId":44732,"journal":{"name":"South African Journal of Child Health","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141654655","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 : 2024-07-12DOI: 10.7196/sajch.2024.v18i2.1583
G. Brisighelli, MD FC Paeds Surg, A. Theron, FC MB ChB, E. Mapunda, MMed Paed Mbbs, Surg
Background. In our clinical setting, a three-staged approach is consistently employed to manage patients with anorectal malformations (ARMs). Objective. To evaluate the safety and feasibility of end-colostomies, in particular subtypes of ARMs. Methods. The medical records of babies born with an ARM treated between 1 January 2017 and 31 December 2022 were reviewed. Information regarding the type of ARM, type of colostomy, complications during colostomy formation, posterior sagittal anorectoplasty (PSARP) and colostomy closure was recorded. Results. Ultimately, 194 patients were included. Of those, 137 patients had divided colostomies with distal mucus fistulas (DC) and 57 had end-colostomies (EC). Ninety-seven patients (50%) had perineal and vestibular fistulas, including 40 (41%) patients with DC and 57 (59%) with EC. For post-colostomy formation, eight (20%) complications were recorded in the DC group and nine (16%) in the EC group (p=0.78). Wound sepsis presented in six patients with DC and four with EC (p=0.3). Nineteen percent (16/85) of patients who had PSARP developed complications, including 4/37 (11%) with DC and 12/48 (25%) with EC (p=0.16). Of the 72 patients who underwent stoma reversal, six (8%) had complications post-operatively: three in the DC group and three in the EC group. Conclusion. For patients with rectoperineal and vestibular fistulas, where divided colostomies are not warranted, end colostomies provide a safe alternative.
{"title":"Are end colostomies always contraindicated in anorectal malformations?","authors":"G. Brisighelli, MD FC Paeds Surg, A. Theron, FC MB ChB, E. Mapunda, MMed Paed Mbbs, Surg","doi":"10.7196/sajch.2024.v18i2.1583","DOIUrl":"https://doi.org/10.7196/sajch.2024.v18i2.1583","url":null,"abstract":"\u0000\u0000\u0000\u0000Background. In our clinical setting, a three-staged approach is consistently employed to manage patients with anorectal malformations (ARMs).\u0000Objective. To evaluate the safety and feasibility of end-colostomies, in particular subtypes of ARMs.\u0000Methods. The medical records of babies born with an ARM treated between 1 January 2017 and 31 December 2022 were reviewed. Information regarding the type of ARM, type of colostomy, complications during colostomy formation, posterior sagittal anorectoplasty (PSARP) and colostomy closure was recorded.\u0000Results. Ultimately, 194 patients were included. Of those, 137 patients had divided colostomies with distal mucus fistulas (DC) and 57 had end-colostomies (EC). Ninety-seven patients (50%) had perineal and vestibular fistulas, including 40 (41%) patients with DC and 57 (59%) with EC. For post-colostomy formation, eight (20%) complications were recorded in the DC group and nine (16%) in the EC group (p=0.78). Wound sepsis presented in six patients with DC and four with EC (p=0.3). Nineteen percent (16/85) of patients who had PSARP developed complications, including 4/37 (11%) with DC and 12/48 (25%) with EC (p=0.16). Of the 72 patients who underwent stoma reversal, six (8%) had complications post-operatively: three in the DC group and three in the EC group.\u0000Conclusion. For patients with rectoperineal and vestibular fistulas, where divided colostomies are not warranted, end colostomies provide a safe alternative.\u0000\u0000\u0000\u0000","PeriodicalId":44732,"journal":{"name":"South African Journal of Child Health","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141654976","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 : 2024-07-12DOI: 10.7196/sajch.2024.v18i2.1130
PhD M Shoko
Background. Globally, adolescent fertility rates (AFR) vary widely, with stark inequality in the Southern African subregion. Orphanhood and parental absence are key social factors studied in relation to adolescent fertility, but research focusing on girls aged 15 - 19 years is constrained by the international age cap of 17 years for collecting direct orphanhood and living arrangement data. Objectives. To characterise fertility among adolescents largely excluded from research because of age restrictions in the data. Methods. The study uses the cross-sectional household-based Demographic and Health Survey (DHS) data for Southern Africa, defined according to both local and international geoschemes. It models parental absence and intrahousehold effects on fertility for adolescents aged 15 - 19 years old, using the fixed effects logistic regression, adjusting for inter-country differences. Results. The relationship between orphanhood, parental absence and rates of adolescent childbearing varied across countries. Parent absence was associated with a higher likelihood of childbearing (adjusted odds ratio (aOR) 3.07, p<0.05). Conversely, having an orphaned child(ren) in the household was associated with a 36% lower likelihood of childbearing, though not statistically significant. Compared with South Africa (SA), all the countries in the study showed significantly higher odds of adolescent childbearing (aOR 1.4 - 5.4, p<0.05). The probability of adolescents giving birth was generally lower when residing with orphaned children in the household, with Angola, Malawi and Zambia showing the highest differences, and SA the smallest. Conclusions. The study underscores the critical role of household living arrangements and parental absence in understanding and addressing adolescent fertility in Southern Africa. Addressing this issue necessitates a dual approach, encompassing interventions for adolescents in general and specifically targeting those with absent parents.
{"title":"Exploring adolescent fertility inequality in Southern Africa","authors":"PhD M Shoko","doi":"10.7196/sajch.2024.v18i2.1130","DOIUrl":"https://doi.org/10.7196/sajch.2024.v18i2.1130","url":null,"abstract":"\u0000\u0000\u0000\u0000Background. Globally, adolescent fertility rates (AFR) vary widely, with stark inequality in the Southern African subregion. Orphanhood and parental absence are key social factors studied in relation to adolescent fertility, but research focusing on girls aged 15 - 19 years is constrained by the international age cap of 17 years for collecting direct orphanhood and living arrangement data.\u0000Objectives. To characterise fertility among adolescents largely excluded from research because of age restrictions in the data.\u0000Methods. The study uses the cross-sectional household-based Demographic and Health Survey (DHS) data for Southern Africa, defined according to both local and international geoschemes. It models parental absence and intrahousehold effects on fertility for adolescents aged 15 - 19 years old, using the fixed effects logistic regression, adjusting for inter-country differences.\u0000Results. The relationship between orphanhood, parental absence and rates of adolescent childbearing varied across countries. Parent absence was associated with a higher likelihood of childbearing (adjusted odds ratio (aOR) 3.07, p<0.05). Conversely, having an orphaned child(ren) in the household was associated with a 36% lower likelihood of childbearing, though not statistically significant. Compared with South Africa (SA), all the countries in the study showed significantly higher odds of adolescent childbearing (aOR 1.4 - 5.4, p<0.05). The probability of adolescents giving birth was generally lower when residing with orphaned children in the household, with Angola, Malawi and Zambia showing the highest differences, and SA the smallest.\u0000Conclusions. The study underscores the critical role of household living arrangements and parental absence in understanding and addressing adolescent fertility in Southern Africa. Addressing this issue necessitates a dual approach, encompassing interventions for adolescents in general and specifically targeting those with absent parents.\u0000\u0000\u0000\u0000","PeriodicalId":44732,"journal":{"name":"South African Journal of Child Health","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141653501","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 : 2024-07-12DOI: 10.7196/sajch.2024.v18i2.1463
M. Wagener
Background. Intestinal failure because of congenital or acquired massive bowel loss is an extremely difficult problem to manage and has traditionally been associated with a very poor outcome. Objective. To describe the current management of short bowel syndrome (SBS) and the factors associated with survival and achievement of enteral autonomy in a South African context. Methods. A retrospective chart review of children managed with intestinal failure due to SBS was conducted at Inkosi Albert Luthuli Central Hospital, South Africa, from November 2015 to February 2023. Results. A total of 22 patients with intestinal failure were managed during the study period. The diagnoses included: type 4 jejunal atresia with 3b component (n=5; 22.7%); type 3b jejunal atresia (n=5; 22.7%); type 4 jejunal atresia without 3b component (n=3; 13.6%) and malrotation with volvulus (n=3; 13.6%). One patient each had necrotising enterocolits, gastroschisis with atresia, intussusception, type 1, jejunal atresia with volvulus, type 3a jejunal atresia and volvulus around an ileostomy. The median bowel length was 36.5 cm and average length of stay was 122 days. Enteral autonomy was achieved in 10 patients (45%) and survival in 9 patients (41%). Surgical complication requiring early re-operation (odds ratio 18) and bowel length ≤20 cm were associated with non-survival. Conclusion. A substantial proportion of children with intestinal failure can achieve enteral autonomy and survival in our context. The treatment process is, however, resource intensive. Avoiding early re-operation and bowel length >20 cm are associated with better survival.
{"title":"A description of the management and outcomes of infants with short bowel syndrome in a South African context","authors":"M. Wagener","doi":"10.7196/sajch.2024.v18i2.1463","DOIUrl":"https://doi.org/10.7196/sajch.2024.v18i2.1463","url":null,"abstract":"\u0000\u0000\u0000\u0000Background. Intestinal failure because of congenital or acquired massive bowel loss is an extremely difficult problem to manage and has traditionally been associated with a very poor outcome.\u0000Objective. To describe the current management of short bowel syndrome (SBS) and the factors associated with survival and achievement of enteral autonomy in a South African context.\u0000Methods. A retrospective chart review of children managed with intestinal failure due to SBS was conducted at Inkosi Albert Luthuli Central Hospital, South Africa, from November 2015 to February 2023.\u0000Results. A total of 22 patients with intestinal failure were managed during the study period. The diagnoses included: type 4 jejunal atresia with 3b component (n=5; 22.7%); type 3b jejunal atresia (n=5; 22.7%); type 4 jejunal atresia without 3b component (n=3; 13.6%) and malrotation with volvulus (n=3; 13.6%). One patient each had necrotising enterocolits, gastroschisis with atresia, intussusception, type 1, jejunal atresia with volvulus, type 3a jejunal atresia and volvulus around an ileostomy. The median bowel length was 36.5 cm and average length of stay was 122 days. Enteral autonomy was achieved in 10 patients (45%) and survival in 9 patients (41%). Surgical complication requiring early re-operation (odds ratio 18) and bowel length ≤20 cm were associated with non-survival.\u0000Conclusion. A substantial proportion of children with intestinal failure can achieve enteral autonomy and survival in our context. The treatment process is, however, resource intensive. Avoiding early re-operation and bowel length >20 cm are associated with better survival.\u0000\u0000\u0000\u0000","PeriodicalId":44732,"journal":{"name":"South African Journal of Child Health","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141654471","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 : 2024-07-12DOI: 10.7196/sajch.2024.v18i2.1516
H. Crichton, MB ChB, L. Tooke, Cert FCPaed, Neonatol
Background. With the advancement of neonatal care there has been a decrease in mortality rates of very low-birthweight (VLBW) (≤1 500 g) infants worldwide. However, this has been at the cost of increased morbidity in this vulnerable group. Currently there are little up to date data on short-term morbidities for VLBW infants in low and middle-income countries. Objectives. The primary objective was to describe the neonatal mortality rate in infants weighing 401 to 1 500 g admitted to Groote Schuur Hospital neonatal unit over a 9-year period. Secondary objectives were to evaluate the main neonatal short-term morbidities. Methods. We conducted a secondary analysis of prospectively collected observational data. All VLBW infants admitted to GSH neonatal unit from 2012 - 2020 were included in the study. Data were benchmarked against the Vermont Oxford Network (VON) database. Results. A total of 4 645 infants were included in the study. The overall mortality rate was 19.8%, which remained static over the study period. There was a significantly higher mortality rate associated with decreasing birthweight. The mortality rate for outborn v. inborn infants was higher: 30.3% v. 18.4% (p=0.046). There was a significant risk of higher short-term morbidity in infants <1 000 g. The survival rate without major morbidity was 68.5% which compared favourably with that of the VON. Conclusion. The results demonstrate that mortality rates are higher compared with developed countries. However, and importantly, survival without morbidity was comparable. Strategies to improve mortality and morbidity in VLBW infants are multifaceted and require a collaborative and innovative approach.
{"title":"Short-term mortality and morbidity of very low-birthweight infants over 9 years at Groote Schuur Hospital, Cape Town, South Africa","authors":"H. Crichton, MB ChB, L. Tooke, Cert FCPaed, Neonatol","doi":"10.7196/sajch.2024.v18i2.1516","DOIUrl":"https://doi.org/10.7196/sajch.2024.v18i2.1516","url":null,"abstract":"\u0000\u0000\u0000\u0000Background. With the advancement of neonatal care there has been a decrease in mortality rates of very low-birthweight (VLBW) (≤1 500 g) infants worldwide. However, this has been at the cost of increased morbidity in this vulnerable group. Currently there are little up to date data on short-term morbidities for VLBW infants in low and middle-income countries.\u0000Objectives. The primary objective was to describe the neonatal mortality rate in infants weighing 401 to 1 500 g admitted to Groote Schuur Hospital neonatal unit over a 9-year period. Secondary objectives were to evaluate the main neonatal short-term morbidities.\u0000Methods. We conducted a secondary analysis of prospectively collected observational data. All VLBW infants admitted to GSH neonatal unit from 2012 - 2020 were included in the study. Data were benchmarked against the Vermont Oxford Network (VON) database.\u0000Results. A total of 4 645 infants were included in the study. The overall mortality rate was 19.8%, which remained static over the study period. There was a significantly higher mortality rate associated with decreasing birthweight. The mortality rate for outborn v. inborn infants was higher: 30.3% v. 18.4% (p=0.046). There was a significant risk of higher short-term morbidity in infants <1 000 g. The survival rate without major morbidity was 68.5% which compared favourably with that of the VON.\u0000Conclusion. The results demonstrate that mortality rates are higher compared with developed countries. However, and importantly, survival without morbidity was comparable. Strategies to improve mortality and morbidity in VLBW infants are multifaceted and require a collaborative and innovative approach.\u0000\u0000\u0000\u0000","PeriodicalId":44732,"journal":{"name":"South African Journal of Child Health","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141654486","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 : 2024-07-12DOI: 10.7196/sajch.2024.v18i2.881
N. Yachad, DCh Dip Hiv Man MB ChB, T. D. Maayer, C. MMed, Paed
Background. Neonatal cholestatic jaundice is a common paediatric condition with a paucity of recent local data and a notable absence of locally influenced diagnostic algorithms. Objectives. To describe the causes of cholestatic jaundice, investigations conducted and patient outcomes. Methods. This was a retrospective file review of 96 patients presenting to the Specialist Clinic at Rahima Moosa Mother and Child Hospital in Johannesburg between 1 January 2014 and 31 December 2020. Clinical features, serum biochemistry at presentation, diagnostic investigations (haematological, radiological and histological), diagnosis and outcome were analysed during data collection. Results. Ninety-six patients were included in the study. The median age of jaundice onset was at 2 months, while the median age of presentation was 3.3 months. Causes of jaundice fell into three main categories: 38 had biliary atresia (BA); 24 had another specific diagnosis; and 34 remained without an underlying diagnosis (idiopathic neonatal hepatitis). An overall mortality rate of 26% was noted at a median (interquartile range) age of 13 (5 - 24) months and it was highest in the BA group (n=14; 56%). Conclusion. The evaluation of neonatal jaundice requires a wide differential and expeditious referral to optimise outcomes and avoid complications. Many patients remained undiagnosed, and the overall prognosis was poor. The authors recommend the development of a locally relevant diagnostic protocol to minimise delays in the identification, diagnosis and treatment of neonatal jaundice.
{"title":"An audit of infants presenting with cholestatic jaundice at a secondary hospital in Johannesburg, South Africa","authors":"N. Yachad, DCh Dip Hiv Man MB ChB, T. D. Maayer, C. MMed, Paed","doi":"10.7196/sajch.2024.v18i2.881","DOIUrl":"https://doi.org/10.7196/sajch.2024.v18i2.881","url":null,"abstract":"\u0000\u0000\u0000\u0000Background. Neonatal cholestatic jaundice is a common paediatric condition with a paucity of recent local data and a notable absence of locally influenced diagnostic algorithms.\u0000Objectives. To describe the causes of cholestatic jaundice, investigations conducted and patient outcomes.\u0000Methods. This was a retrospective file review of 96 patients presenting to the Specialist Clinic at Rahima Moosa Mother and Child Hospital in Johannesburg between 1 January 2014 and 31 December 2020. Clinical features, serum biochemistry at presentation, diagnostic investigations (haematological, radiological and histological), diagnosis and outcome were analysed during data collection.\u0000Results. Ninety-six patients were included in the study. The median age of jaundice onset was at 2 months, while the median age of presentation was 3.3 months. Causes of jaundice fell into three main categories: 38 had biliary atresia (BA); 24 had another specific diagnosis; and 34 remained without an underlying diagnosis (idiopathic neonatal hepatitis). An overall mortality rate of 26% was noted at a median (interquartile range) age of 13 (5 - 24) months and it was highest in the BA group (n=14; 56%).\u0000Conclusion. The evaluation of neonatal jaundice requires a wide differential and expeditious referral to optimise outcomes and avoid complications. Many patients remained undiagnosed, and the overall prognosis was poor. The authors recommend the development of a locally relevant diagnostic protocol to minimise delays in the identification, diagnosis and treatment of neonatal jaundice.\u0000\u0000\u0000\u0000","PeriodicalId":44732,"journal":{"name":"South African Journal of Child Health","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141654392","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/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":null,"pages":null},"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":null,"pages":null},"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}
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