Pub Date : 2021-10-14DOI: 10.7196/SAJCH.2021.V15I3.01772
Q. A. Adeleye, O. Oniyangi, L. Audu
Background . Haematocrit check after red blood cell transfusion remains relevant in paediatric healthcare. The common practice of checking haematocrit at least 24 hours after transfusion has been challenged by recent evidence supporting much earlier timing. Available data are, however, limited and inconclusive. Objective . To document the changes in haematocrit levels and to determine the earliest time of haematocrit stabilisation after packed red blood cell transfusion in children aged 29 days to 15 years. Methods . This was a prospective observational study among 114 eligible participants. Capillary haematocrit was obtained pre-transfusion and at 1, 6, 12, 24 and 48 hours after transfusion. Post-transfusion haematocrit was considered to have stabilised if the difference in mean serial levels within at least 3 consecutive timed intervals was ≤1.8%. Target outcome was the earliest time to haematocrit stabilisation. Mean haematocrit at the earliest stabilisation time was compared with the expected level using the Student t -test. Results . The age range of the 103 subjects analysed was 1.5 months - 14 years with a median of 48 months (interquartile range 12 - 96 months). Haematocrit increased significantly from pre-transfusion to 1-hour post-transfusion level and declined subsequently. The maximum difference between measurements at 1, 6 and 12 hours was 0.7%. In disaggregated analysis, it was 0.7%, 0.4%, 0.7% and 1.1% among subjects <1 year, 1 - <5 years, 5 - <10 years and 10 - 14 years old, respectively. The mean observed haematocrit at the first hour was similar to the expected level. Conclusion . Post-transfusion haematocrit stabilised at the first hour. Haematocrit checking as early as 1 hour after packed cell transfusion is recommended in children.
{"title":"The earliest time for haematocrit check after packed red blood cell transfusion among children with anaemia","authors":"Q. A. Adeleye, O. Oniyangi, L. Audu","doi":"10.7196/SAJCH.2021.V15I3.01772","DOIUrl":"https://doi.org/10.7196/SAJCH.2021.V15I3.01772","url":null,"abstract":"Background . Haematocrit check after red blood cell transfusion remains relevant in paediatric healthcare. The common practice of checking haematocrit at least 24 hours after transfusion has been challenged by recent evidence supporting much earlier timing. Available data are, however, limited and inconclusive. Objective . To document the changes in haematocrit levels and to determine the earliest time of haematocrit stabilisation after packed red blood cell transfusion in children aged 29 days to 15 years. Methods . This was a prospective observational study among 114 eligible participants. Capillary haematocrit was obtained pre-transfusion and at 1, 6, 12, 24 and 48 hours after transfusion. Post-transfusion haematocrit was considered to have stabilised if the difference in mean serial levels within at least 3 consecutive timed intervals was ≤1.8%. Target outcome was the earliest time to haematocrit stabilisation. Mean haematocrit at the earliest stabilisation time was compared with the expected level using the Student t -test. Results . The age range of the 103 subjects analysed was 1.5 months - 14 years with a median of 48 months (interquartile range 12 - 96 months). Haematocrit increased significantly from pre-transfusion to 1-hour post-transfusion level and declined subsequently. The maximum difference between measurements at 1, 6 and 12 hours was 0.7%. In disaggregated analysis, it was 0.7%, 0.4%, 0.7% and 1.1% among subjects <1 year, 1 - <5 years, 5 - <10 years and 10 - 14 years old, respectively. The mean observed haematocrit at the first hour was similar to the expected level. Conclusion . Post-transfusion haematocrit stabilised at the first hour. Haematocrit checking as early as 1 hour after packed cell transfusion is recommended in children.","PeriodicalId":44732,"journal":{"name":"South African Journal of Child Health","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2021-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41841896","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 : 2021-10-14DOI: 10.7196/SAJCH.2021.V15I3.01799
G. Musiime, L. Lloyd, M. McCaul, N. V. Zyl, S. Holgate
Background. Neonates of extremely low birthweight (ELBW; <1 000 g) have the highest neonatal mortality in South Africa (SA). Objective. To describe the morbidity and mortality of ELBW neonates treated at a tertiary hospital in SA. Methods. This was a retrospective cohort study including all live-born ELBW neonates treated at Tygerberg Hospital between 1 January and 31 December 2016. Data were extrapolated from a prospectively collected neonatal database and patient records. Multiple logistic regression and survival analysis were performed to identify risk factors of mortality. Results. The sample included 256 neonates. The following morbidities were recorded: respiratory distress syndrome (83.2%); bronchopulmonary dysplasia (8.2%); intraventricular haemorrhage (34.5%); periventricular leukomalacia (0.6%); necrotising enterocolitis (10.5%); and retinopathy of prematurity (31.2%). The survival-to-discharge rate was 63.3%. Cause of death was documented as extreme prematurity in 41% of the inpatient deaths. Birthweight was a significant predictor of mortality (hazard ratio 0.99; 95% confidence interval 0.992 - 0.999). Of the 162 neonates who survived until discharge, 11 died following discharge. Conclusion. Morbidity and mortality rates remain high among ELBW neonates. To improve survival, resources need to be allocated to neonatal resuscitation, surfactant therapy and increasing availability of intensive-care beds.
{"title":"Outcomes of extremely low-birthweight neonates at a tertiary hospital in the Western Cape, South Africa: A retrospective cohort study","authors":"G. Musiime, L. Lloyd, M. McCaul, N. V. Zyl, S. Holgate","doi":"10.7196/SAJCH.2021.V15I3.01799","DOIUrl":"https://doi.org/10.7196/SAJCH.2021.V15I3.01799","url":null,"abstract":"Background. Neonates of extremely low birthweight (ELBW; <1 000 g) have the highest neonatal mortality in South Africa (SA). Objective. To describe the morbidity and mortality of ELBW neonates treated at a tertiary hospital in SA. Methods. This was a retrospective cohort study including all live-born ELBW neonates treated at Tygerberg Hospital between 1 January and 31 December 2016. Data were extrapolated from a prospectively collected neonatal database and patient records. Multiple logistic regression and survival analysis were performed to identify risk factors of mortality. Results. The sample included 256 neonates. The following morbidities were recorded: respiratory distress syndrome (83.2%); bronchopulmonary dysplasia (8.2%); intraventricular haemorrhage (34.5%); periventricular leukomalacia (0.6%); necrotising enterocolitis (10.5%); and retinopathy of prematurity (31.2%). The survival-to-discharge rate was 63.3%. Cause of death was documented as extreme prematurity in 41% of the inpatient deaths. Birthweight was a significant predictor of mortality (hazard ratio 0.99; 95% confidence interval 0.992 - 0.999). Of the 162 neonates who survived until discharge, 11 died following discharge. Conclusion. Morbidity and mortality rates remain high among ELBW neonates. To improve survival, resources need to be allocated to neonatal resuscitation, surfactant therapy and increasing availability of intensive-care beds.","PeriodicalId":44732,"journal":{"name":"South African Journal of Child Health","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2021-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48538434","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 : 2021-10-14DOI: 10.7196/SAJCH.2021.V15I3.01798
D. N. Montwedi, J. Meyer, V. Nkwinika, R. Burnett
Background. South Africa (SA) experiences vaccine-preventable disease outbreaks despite officially reporting high administrative fully immunised under-1-year-old coverage (FIC) figures. Objective. To investigate immunisation coverage and reasons for missed vaccinations in Tshwane Region 5 in Gauteng province, SA, in 2017. Methods. A household survey, based on a World Health Organization protocol, was conducted among consenting caregivers of children aged 12 - 23 months who had Road to Health cards (RtHC). RtH cards were checked and photographed, and reasons were recorded for missed vaccinations. Epi Info 7 was used for descriptive statistical analysis. Results. Eligible children resided in 327 of 8 060 houses visited, with 84.4% ( n =276/327) of caregivers consenting to participate. Vaccination coverage ranged from 99.6% ( n =275/276) for the oral polio vaccine at birth to 87.3% ( n =241/276) for the third dose of the pneumococcal conjugate vaccine (PCV3). Of the children who received PCV3, 24 had missed earlier vaccinations, resulting in a FIC rate of 78.6% ( n =217/276). Overall, 123 vaccinations were missed by 59 children, with reasons related to health facility obstacles (34.1%; n =42/123) and lack of information (26.8%; n =33/123) being the largest contributors. Conclusion. The FIC rate of 78.6% can realistically be improved, as most missed vaccinations are due to modifiable healthcare facility obstacles, including poor communication. Suggested solutions include providing accredited programmes for empowering vaccinators to effectively communicate with their clients and manage vaccination logistics, and extending clinic hours to early evenings and weekends.
{"title":"Health facility obstacles result in missed vaccination opportunities in Tshwane Region 5, Gauteng Province","authors":"D. N. Montwedi, J. Meyer, V. Nkwinika, R. Burnett","doi":"10.7196/SAJCH.2021.V15I3.01798","DOIUrl":"https://doi.org/10.7196/SAJCH.2021.V15I3.01798","url":null,"abstract":"Background. South Africa (SA) experiences vaccine-preventable disease outbreaks despite officially reporting high administrative fully immunised under-1-year-old coverage (FIC) figures. Objective. To investigate immunisation coverage and reasons for missed vaccinations in Tshwane Region 5 in Gauteng province, SA, in 2017. Methods. A household survey, based on a World Health Organization protocol, was conducted among consenting caregivers of children aged 12 - 23 months who had Road to Health cards (RtHC). RtH cards were checked and photographed, and reasons were recorded for missed vaccinations. Epi Info 7 was used for descriptive statistical analysis. Results. Eligible children resided in 327 of 8 060 houses visited, with 84.4% ( n =276/327) of caregivers consenting to participate. Vaccination coverage ranged from 99.6% ( n =275/276) for the oral polio vaccine at birth to 87.3% ( n =241/276) for the third dose of the pneumococcal conjugate vaccine (PCV3). Of the children who received PCV3, 24 had missed earlier vaccinations, resulting in a FIC rate of 78.6% ( n =217/276). Overall, 123 vaccinations were missed by 59 children, with reasons related to health facility obstacles (34.1%; n =42/123) and lack of information (26.8%; n =33/123) being the largest contributors. Conclusion. The FIC rate of 78.6% can realistically be improved, as most missed vaccinations are due to modifiable healthcare facility obstacles, including poor communication. Suggested solutions include providing accredited programmes for empowering vaccinators to effectively communicate with their clients and manage vaccination logistics, and extending clinic hours to early evenings and weekends.","PeriodicalId":44732,"journal":{"name":"South African Journal of Child Health","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2021-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43765885","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 : 2021-10-14DOI: 10.7196/SAJCH.2021.V15I3.01777
E. Otieku, A. Fenny, Appiah-Korang Labi, U. Enemark
Background. Preterm births (PTBs) notably contribute to neonatal morbidity and mortality in neonatal intensive care units (NICUs). Therefore, an examination of maternal risk factors is essential in reducing the incidence of PTB. Objective. To estimate maternal risk factors of PTBs with subsequent admission to the NICU. Methods. We interviewed 357 mothers who gave birth at the Korle-Bu Teaching Hospital (KBTH) and their neonates admitted to the hospital’s NICU. A binary multivariate logistic regression model was used to analyse the odds ratios of each predictor variable. Results. The incidence of PTBs associated with admission to the NICU was 70%. From our estimation model, maternal parity emerged as the single most influential risk factor of preterm neonates who subsequently had to be admitted to the NICU, contributing to a significant 17.3% of the model fit compared with 12.9% for maternal stress and 1% for maternal age. Approximately 35% of the mothers did not attend the minimum number of antenatal care (ANC) visits (four) recommended by the Ghana Ministry of Health, which may have increased their risk of PTB. Conclusion. The most appropriate intervention to reduce the high risk of PTB is for expectant mothers to attend ANC during their pregnancy. Health professionals rendering ANC services should also educate mothers on how to avoid or manage stress during pregnancy to reduce the incidence of PTB.
{"title":"Incidence of preterm births in a referral teaching hospital in Ghana: What is the role of maternal age, parity, gravidity and stress during pregnancy?","authors":"E. Otieku, A. Fenny, Appiah-Korang Labi, U. Enemark","doi":"10.7196/SAJCH.2021.V15I3.01777","DOIUrl":"https://doi.org/10.7196/SAJCH.2021.V15I3.01777","url":null,"abstract":"Background. Preterm births (PTBs) notably contribute to neonatal morbidity and mortality in neonatal intensive care units (NICUs). Therefore, an examination of maternal risk factors is essential in reducing the incidence of PTB. Objective. To estimate maternal risk factors of PTBs with subsequent admission to the NICU. Methods. We interviewed 357 mothers who gave birth at the Korle-Bu Teaching Hospital (KBTH) and their neonates admitted to the hospital’s NICU. A binary multivariate logistic regression model was used to analyse the odds ratios of each predictor variable. Results. The incidence of PTBs associated with admission to the NICU was 70%. From our estimation model, maternal parity emerged as the single most influential risk factor of preterm neonates who subsequently had to be admitted to the NICU, contributing to a significant 17.3% of the model fit compared with 12.9% for maternal stress and 1% for maternal age. Approximately 35% of the mothers did not attend the minimum number of antenatal care (ANC) visits (four) recommended by the Ghana Ministry of Health, which may have increased their risk of PTB. Conclusion. The most appropriate intervention to reduce the high risk of PTB is for expectant mothers to attend ANC during their pregnancy. Health professionals rendering ANC services should also educate mothers on how to avoid or manage stress during pregnancy to reduce the incidence of PTB.","PeriodicalId":44732,"journal":{"name":"South African Journal of Child Health","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2021-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48502530","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 : 2021-10-14DOI: 10.7196/SAJCH.2021.V15I3.01771
S. Abushkiwa, R. Singh, K. Naidoo
Background. Congenital HIV infection has declined in South Africa with an expanded programme to decrease perinatal HIV transmission. Understanding the challenges within this programme can identify opportunities for improvements. There is an opportunity with birth HIV DNA polymerase chain reaction testing to expedite very early treatment of neonates born with HIV in referral hospitals. Objectives. This study was aimed at describing the characteristics of mothers of neonates born with HIV as well as the evaluation of the access and availability of birth HIV DNA PCR results within a referral hospital. Method. This study was a retrospective chart review of all documented neonates born with HIV delivered between 1 January 2017 and 30 June 2019 at King Edward VIII Hospital, Durban, KwaZulu-Natal. The birth HIV DNA PCR results provided through institutional programmes were analysed, and the clinical characteristics of mothers of neonates born with HIV were described. Results. Review of hospital-based records, during the 30-month study period, identified 6 902 (40.02% of 17 243 total live births) birth HIV DNA PCR tests having been done. During the sample period, documented positive, rejected or indeterminate results were analysed. These results indicated only 37 (0.54%) of known HIV-exposed neonates who were tested, to have a documented positive birth HIV DNA PCR result. Fifty-nine neonates had either indeterminate or rejected results. Negative HIV DNA PCR results could not be verified. Analysis of the mothers of neonates with documented HIV-positive results indicated high mean viral loads of these mothers (52 343 copies/mL) and most were diagnosed in the current pregnancy or at delivery. Conclusion. Review of the characteristics of mothers of neonates born with HIV within a public referral hospital reiterates that late HIV diagnosis is common in this high-risk group. Birth HIV DNA PCR results may fail to adequately identify all positive neonates timeously for very early initiation of antiretroviral treatment.
{"title":"Evaluating maternal characteristics and DNA polymerase chain reaction birth testing of neonates born with HIV in a KwaZulu-Natal referral hospital – missed opportunities?","authors":"S. Abushkiwa, R. Singh, K. Naidoo","doi":"10.7196/SAJCH.2021.V15I3.01771","DOIUrl":"https://doi.org/10.7196/SAJCH.2021.V15I3.01771","url":null,"abstract":"Background. Congenital HIV infection has declined in South Africa with an expanded programme to decrease perinatal HIV transmission. Understanding the challenges within this programme can identify opportunities for improvements. There is an opportunity with birth HIV DNA polymerase chain reaction testing to expedite very early treatment of neonates born with HIV in referral hospitals. Objectives. This study was aimed at describing the characteristics of mothers of neonates born with HIV as well as the evaluation of the access and availability of birth HIV DNA PCR results within a referral hospital. Method. This study was a retrospective chart review of all documented neonates born with HIV delivered between 1 January 2017 and 30 June 2019 at King Edward VIII Hospital, Durban, KwaZulu-Natal. The birth HIV DNA PCR results provided through institutional programmes were analysed, and the clinical characteristics of mothers of neonates born with HIV were described. Results. Review of hospital-based records, during the 30-month study period, identified 6 902 (40.02% of 17 243 total live births) birth HIV DNA PCR tests having been done. During the sample period, documented positive, rejected or indeterminate results were analysed. These results indicated only 37 (0.54%) of known HIV-exposed neonates who were tested, to have a documented positive birth HIV DNA PCR result. Fifty-nine neonates had either indeterminate or rejected results. Negative HIV DNA PCR results could not be verified. Analysis of the mothers of neonates with documented HIV-positive results indicated high mean viral loads of these mothers (52 343 copies/mL) and most were diagnosed in the current pregnancy or at delivery. Conclusion. Review of the characteristics of mothers of neonates born with HIV within a public referral hospital reiterates that late HIV diagnosis is common in this high-risk group. Birth HIV DNA PCR results may fail to adequately identify all positive neonates timeously for very early initiation of antiretroviral treatment.","PeriodicalId":44732,"journal":{"name":"South African Journal of Child Health","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2021-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44214098","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 : 2021-10-14DOI: 10.7196/SAJCH.2021.V15I3.01757
D. Goolab, L. Tooke, S. L. Roux, Y. Joolay
Background. Prematurity is a major risk factor for intraventricular haemorrhage (IVH). Premature infants often require respiratory support. There is little information on neonates with IVH on respiratory support in low- and middle-income countries. Objective. To describe the characteristics and short-term outcomes of very-low-birthweight (VLBW) infants with IVH receiving respiratory support in a tertiary neonatal unit with resource limitations. Methods. This was a matched retrospective observational study. The population included VLBW infants with IVH, who received positive pressure respiratory support between January 2014 and December 2016. Severe IVH was compared with mild IVH. Results. One hundred and fifty infants were included in the study; 56 (37%) received continuous positive airway pressure (CPAP) only and 94 (63%) mechanical ventilation. Severe IVH was associated with surfactant therapy across both ventilation groups ( p =0.03). Infants with severe IVH had prolonged oxygen requirements at 28 days (79% v. 38%; p =0.01) (odds ratio (OR) 6.11; 95% confidence interval (CI) 1.19 - 31.34; p =0.03) v. those with mild IVH. Severe IVH and the presence of coagulopathy were the strongest predictors of death in both ventilation groups ( p <0.0001). Pulmonary haemorrhage was the most common cause of death in severe IVH and blood culture-confirmed sepsis in mild IVH. Periventricular leukomalacia (PVL) was associated with severe IVH in invasive ventilation (OR 6.67; 95% CI 1.11 - 40.17). Conclusion. VLBW infants with severe IVH who are mechanically ventilated or with coagulopathy have a high mortality, with pulmonary haemorrhage being the prominent cause of death. These prognostic factors may assist in end-of-life care in resource-limited settings.
背景。早产是脑室内出血(IVH)的主要危险因素。早产儿通常需要呼吸支持。关于低收入和中等收入国家IVH新生儿呼吸支持的信息很少。目标。描述极低出生体重(VLBW) IVH婴儿在资源有限的第三新生儿病房接受呼吸支持的特点和短期结局。方法。这是一项匹配的回顾性观察性研究。人群包括2014年1月至2016年12月期间接受正压呼吸支持的IVH的VLBW婴儿。重度IVH与轻度IVH比较。结果。150名婴儿参与了这项研究;56例(37%)仅接受持续气道正压通气(CPAP)， 94例(63%)接受机械通气。在两个通气组中，重度IVH与表面活性剂治疗相关(p =0.03)。严重IVH患儿在28天的耗氧时间延长(79% vs . 38%;p =0.01)(优势比(OR) 6.11;95%置信区间(CI) 1.19 ~ 31.34;p =0.03)。在两个通气组中，严重IVH和存在凝血功能障碍是死亡的最强预测因子(p <0.0001)。肺出血是严重IVH中最常见的死亡原因，而在轻度IVH中经血培养证实的败血症是最常见的死亡原因。有创通气时脑室周围白质软化(PVL)与严重IVH相关(OR 6.67;95% ci 1.11 - 40.17)。结论。严重IVH的VLBW婴儿如果采用机械通气或有凝血功能障碍，死亡率很高，肺出血是主要死亡原因。在资源有限的环境中，这些预后因素可能有助于临终关怀。
{"title":"Short-term outcomes of very low-birthweight infants with intraventricular haemorrhage who received respiratory support in a middle-income country neonatal unit","authors":"D. Goolab, L. Tooke, S. L. Roux, Y. Joolay","doi":"10.7196/SAJCH.2021.V15I3.01757","DOIUrl":"https://doi.org/10.7196/SAJCH.2021.V15I3.01757","url":null,"abstract":"Background. Prematurity is a major risk factor for intraventricular haemorrhage (IVH). Premature infants often require respiratory support. There is little information on neonates with IVH on respiratory support in low- and middle-income countries. Objective. To describe the characteristics and short-term outcomes of very-low-birthweight (VLBW) infants with IVH receiving respiratory support in a tertiary neonatal unit with resource limitations. Methods. This was a matched retrospective observational study. The population included VLBW infants with IVH, who received positive pressure respiratory support between January 2014 and December 2016. Severe IVH was compared with mild IVH. Results. One hundred and fifty infants were included in the study; 56 (37%) received continuous positive airway pressure (CPAP) only and 94 (63%) mechanical ventilation. Severe IVH was associated with surfactant therapy across both ventilation groups ( p =0.03). Infants with severe IVH had prolonged oxygen requirements at 28 days (79% v. 38%; p =0.01) (odds ratio (OR) 6.11; 95% confidence interval (CI) 1.19 - 31.34; p =0.03) v. those with mild IVH. Severe IVH and the presence of coagulopathy were the strongest predictors of death in both ventilation groups ( p <0.0001). Pulmonary haemorrhage was the most common cause of death in severe IVH and blood culture-confirmed sepsis in mild IVH. Periventricular leukomalacia (PVL) was associated with severe IVH in invasive ventilation (OR 6.67; 95% CI 1.11 - 40.17). Conclusion. VLBW infants with severe IVH who are mechanically ventilated or with coagulopathy have a high mortality, with pulmonary haemorrhage being the prominent cause of death. These prognostic factors may assist in end-of-life care in resource-limited settings.","PeriodicalId":44732,"journal":{"name":"South African Journal of Child Health","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2021-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43409193","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 : 2021-10-14DOI: 10.7196/SAJCH.2021.V15I3.01752
S. Pillai, M. Makhetha, C. Aldous
Background. Autism spectrum disorder (ASD) retards the holistic development of a child owing to both inherent and comorbid medical pathology. Despite the profound effect of ASD on a child’s life, information regarding this neurodevelopmental disorder is limited. In South Africa (SA), there is a dearth of knowledge regarding ASD. In addition, the resources available to accommodate the needs of autistic children are largely insufficient in quantity and quality. Objectives. To determine demographics and comorbidities in autistic children at the KwaZulu-Natal Children’s Hospital (KZNCH). Methods. This study was a retrospective chart review conducted at the neurodevelopmental and neuropsychiatric clinics at the KZNCH in Durban, SA. Medical records of autistic children at their initial presentation to KZNCH from 1 January 2017 - 31 December 2017 were obtained and analysed. Results. The study sample comprised 114 study participants. Most participants (87%) presented above 36 months of age to the KZNCH. A 24-month delay was noted between onset of symptoms suggestive of ASD and presentation to a healthcare facility or KZNCH. Almost 50% of participants were awaiting placement in a special school. Attention deficit hyperactivity disorder (ADHD) was the most common comorbidity, affecting 43% of participants. Conclusion. The study illustrated the demographic profiles and comorbidities of autistic children presenting to the KZNCH. However, the medical and social shortcomings in KZN elucidated in this study reinforce the necessity for further research to be conducted and resources to be invested to address the plight of children with ASD.
{"title":"A study reflecting the demographics and comorbidities of children diagnosed with autism spectrum disorder at initial presentation to the KwaZulu-Natal Children’s Hospital","authors":"S. Pillai, M. Makhetha, C. Aldous","doi":"10.7196/SAJCH.2021.V15I3.01752","DOIUrl":"https://doi.org/10.7196/SAJCH.2021.V15I3.01752","url":null,"abstract":"Background. Autism spectrum disorder (ASD) retards the holistic development of a child owing to both inherent and comorbid medical pathology. Despite the profound effect of ASD on a child’s life, information regarding this neurodevelopmental disorder is limited. In South Africa (SA), there is a dearth of knowledge regarding ASD. In addition, the resources available to accommodate the needs of autistic children are largely insufficient in quantity and quality. Objectives. To determine demographics and comorbidities in autistic children at the KwaZulu-Natal Children’s Hospital (KZNCH). Methods. This study was a retrospective chart review conducted at the neurodevelopmental and neuropsychiatric clinics at the KZNCH in Durban, SA. Medical records of autistic children at their initial presentation to KZNCH from 1 January 2017 - 31 December 2017 were obtained and analysed. Results. The study sample comprised 114 study participants. Most participants (87%) presented above 36 months of age to the KZNCH. A 24-month delay was noted between onset of symptoms suggestive of ASD and presentation to a healthcare facility or KZNCH. Almost 50% of participants were awaiting placement in a special school. Attention deficit hyperactivity disorder (ADHD) was the most common comorbidity, affecting 43% of participants. Conclusion. The study illustrated the demographic profiles and comorbidities of autistic children presenting to the KZNCH. However, the medical and social shortcomings in KZN elucidated in this study reinforce the necessity for further research to be conducted and resources to be invested to address the plight of children with ASD.","PeriodicalId":44732,"journal":{"name":"South African Journal of Child Health","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2021-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44586062","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 : 2021-10-14DOI: 10.7196/SAJCH.2021.V15I3.01797
M. T. Mailula, Y. Goga, P. Jeena
Background . The clinical presentation and the outcome of patients with transfusion-dependent thalassaemia (TDT) in the province of KwaZulu-Natal, South Africa, have not been previously reported. Objectives. To document the clinical characteristics, treatment strategies, outcomes and complications from a case series of children with TDT. Method. A retrospective chart review of the clinical hospital records, laboratory, and blood transfusion data of patients with beta thalassaemia was performed. Data on serum ferritin (SF) levels, magnetic resonance imaging (MRI) R2 and/or T2* radiological tests to assess the presence of iron overload were collated and analysed. Iron chelator medications and haematopoietic stem cell transplantation (HSCT) outcomes were reported. Results. All the 12 children enrolled with TDT were of Indian descent. All patients had regular blood transfusion and iron chelation therapy (ICT). Four patients had iron overload diagnosed on SF, liver and cardiac MRI scanning. Most of the children in this study were either initiated or changed to oral deferasirox (DFX) during treatment follow-up. One child on parenteral iron chelation deferoxamine, with high SF levels, died. Four patients successfully underwent HSCT without complications and are in remission. Conclusion. The study confirms that haemoglobin-level-driven blood transfusions with adequate chelation are possible in the public health service in South Africa. Close monitoring for iron overload is required, using a combination of SF and MRI scanning. Oral ICTs are the preferred agents for reducing iron overload. HSCT remains the treatment of choice for TDT when feasible.
{"title":"The clinical profile and outcome of children with transfusion-dependent thalassaemia in KwaZulu-Natal Province, South Africa: A 16-year retrospective review","authors":"M. T. Mailula, Y. Goga, P. Jeena","doi":"10.7196/SAJCH.2021.V15I3.01797","DOIUrl":"https://doi.org/10.7196/SAJCH.2021.V15I3.01797","url":null,"abstract":"Background . The clinical presentation and the outcome of patients with transfusion-dependent thalassaemia (TDT) in the province of KwaZulu-Natal, South Africa, have not been previously reported. Objectives. To document the clinical characteristics, treatment strategies, outcomes and complications from a case series of children with TDT. Method. A retrospective chart review of the clinical hospital records, laboratory, and blood transfusion data of patients with beta thalassaemia was performed. Data on serum ferritin (SF) levels, magnetic resonance imaging (MRI) R2 and/or T2* radiological tests to assess the presence of iron overload were collated and analysed. Iron chelator medications and haematopoietic stem cell transplantation (HSCT) outcomes were reported. Results. All the 12 children enrolled with TDT were of Indian descent. All patients had regular blood transfusion and iron chelation therapy (ICT). Four patients had iron overload diagnosed on SF, liver and cardiac MRI scanning. Most of the children in this study were either initiated or changed to oral deferasirox (DFX) during treatment follow-up. One child on parenteral iron chelation deferoxamine, with high SF levels, died. Four patients successfully underwent HSCT without complications and are in remission. Conclusion. The study confirms that haemoglobin-level-driven blood transfusions with adequate chelation are possible in the public health service in South Africa. Close monitoring for iron overload is required, using a combination of SF and MRI scanning. Oral ICTs are the preferred agents for reducing iron overload. HSCT remains the treatment of choice for TDT when feasible.","PeriodicalId":44732,"journal":{"name":"South African Journal of Child Health","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2021-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43654236","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 : 2021-07-21DOI: 10.7196/SAJCH.2021.V15I2.01698
Nega Degefa Megersa, Eshetu Zerihun Tariku, G. E. Yesera, Befikadu Tariku Gutema
Background. Introduction of prelacteal feeds to newborn babies negates the recommendation of the World Health Organization that breastfeeding should be initiated within an hour after childbirth. As a result, many known health benefits of breastfeeding for infants, children and mothers are precluded. Therefore, to obviate the harmful effects of prelacteal feeding, it remains of paramount concern to identify the current status of prelacteal feeding and its contributing factors. Objective. To assess the prevalence of prelacteal feeding and associated factors among mothers of under-24-month-old children in Arba Minch Zuria District, Ethiopia. Methods. A community-based cross-sectional study was conducted among 400 mother/caregiver-child pairs. A structured and pretested questionnaire uploaded on mobile devices pre-installed with open data kit software was used for data collection. Factors associated with prelacteal feeding practices were explored using multivariable logistic regression analysis. The Hosmer-Lemeshow goodness-of-fit test was used to determine whether the model adequately described the data or not. Results. A total of 400 mothers/caregivers participated in the study, of whom 67 (16.8%) practised prelacteal feeding. Mothers who had poor knowledge of breastfeeding were nearly four times more likely to practise prelacteal feeding than those who had good knowledge (adjusted odds ratio (aOR) 3.95; 95% confidence interval (CI) 1.82 - 8.54). Mothers who did not receive counselling on breastfeeding during antenatal care (ANC) follow-up were 4.1 times more likely to provide prelacteal feeds than those who received counselling (aOR 4.1; 95% CI 1.70 - 9.76). Furthermore, mothers who did not receive immediate postnatal care were 6.46 times more likely to give prelacteal feeding than those who received immediate postnatal care (aOR 6.46; 95% CI 2.85 - 14.63). Conclusions. One out of six neonates was given prelacteal feeds in the study area. Poor knowledge among mothers about breastfeeding, lack of counselling on optimal breastfeeding during ANC visits, and lack of immediate postnatal care mainly led to prelacteal feeding. Therefore, attention should be given to improving maternal knowledge of breastfeeding through the refining of skilled counseling during ANC and immediate postnatal care
{"title":"Prevalence of prelacteal feeding and its associated factors among mothers of under-24-month-old children at Arba Minch Zuria District, Ethiopia: A cross-sectional study","authors":"Nega Degefa Megersa, Eshetu Zerihun Tariku, G. E. Yesera, Befikadu Tariku Gutema","doi":"10.7196/SAJCH.2021.V15I2.01698","DOIUrl":"https://doi.org/10.7196/SAJCH.2021.V15I2.01698","url":null,"abstract":"Background. Introduction of prelacteal feeds to newborn babies negates the recommendation of the World Health Organization that breastfeeding should be initiated within an hour after childbirth. As a result, many known health benefits of breastfeeding for infants, children and mothers are precluded. Therefore, to obviate the harmful effects of prelacteal feeding, it remains of paramount concern to identify the current status of prelacteal feeding and its contributing factors. Objective. To assess the prevalence of prelacteal feeding and associated factors among mothers of under-24-month-old children in Arba Minch Zuria District, Ethiopia. Methods. A community-based cross-sectional study was conducted among 400 mother/caregiver-child pairs. A structured and pretested questionnaire uploaded on mobile devices pre-installed with open data kit software was used for data collection. Factors associated with prelacteal feeding practices were explored using multivariable logistic regression analysis. The Hosmer-Lemeshow goodness-of-fit test was used to determine whether the model adequately described the data or not. Results. A total of 400 mothers/caregivers participated in the study, of whom 67 (16.8%) practised prelacteal feeding. Mothers who had poor knowledge of breastfeeding were nearly four times more likely to practise prelacteal feeding than those who had good knowledge (adjusted odds ratio (aOR) 3.95; 95% confidence interval (CI) 1.82 - 8.54). Mothers who did not receive counselling on breastfeeding during antenatal care (ANC) follow-up were 4.1 times more likely to provide prelacteal feeds than those who received counselling (aOR 4.1; 95% CI 1.70 - 9.76). Furthermore, mothers who did not receive immediate postnatal care were 6.46 times more likely to give prelacteal feeding than those who received immediate postnatal care (aOR 6.46; 95% CI 2.85 - 14.63). Conclusions. One out of six neonates was given prelacteal feeds in the study area. Poor knowledge among mothers about breastfeeding, lack of counselling on optimal breastfeeding during ANC visits, and lack of immediate postnatal care mainly led to prelacteal feeding. Therefore, attention should be given to improving maternal knowledge of breastfeeding through the refining of skilled counseling during ANC and immediate postnatal care","PeriodicalId":44732,"journal":{"name":"South African Journal of Child Health","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2021-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47149058","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 : 2021-07-21DOI: 10.7196/SAJCH.2021.V15I2.01773
M. Nchabeleng, Kenny Hamese, S. Ntuli
Background. Persistent pulmonary hypertension of the newborn (PPHN) is a condition of high pulmonary arterial pressures leading to hypoxaemia and continued shunting of blood across fetal channels as a result of failure of circulatory transition at birth. Objective. To determine the prevalence and outcomes of PPHN at Mankweng Hospital, Limpopo Province, South Africa. Methods. A retrospective descriptive review of patients’ files from January 2015 to December 2017 was conducted. PPHN was diagnosed on echocardiogram. Results. During the 3-year period of the study, a total of 6 776 neonates were admitted to the neonatal unit, of whom 0.76% ( n =52) were diagnosed with PPHN. Of these, 98% (n=51) had complete information in their medical records and were further analysed. Slightly more than half (53%) were males, 59% were delivered by caesarean section, 94% had gestational age ≥37 weeks, and 39% and 14% had Apgar scores of <6 at 1 minute and 5 minutes, respectively. Most neonates (72%) had meconium aspiration as the single risk factor or in combination with other conditions. Nearly half (45.1%) of the neonates with PPHN did not survive. Gender, mode of delivery, and Apgar score were each correlated with PPHN mortality and they all showed no statistically significant association. A significantly higher proportion of non-survivors received inotropic support than survivors ( p <0.05). Conclusions. The prevalence of PPHN was found to be lower than in other low- and middle-income countries; nonetheless, the all-cause mortality rate is significantly high. The commonest aetiology of PPHN is meconium aspiration syndrome as a single underlying risk factor, and in combination with other conditions. Most neonates who needed inotropic support died.
{"title":"Prevalence and outcomes of persistent pulmonary hypertension of the newborn in a neonatal unit, Mankweng Hospital, Limpopo Province, South Africa","authors":"M. Nchabeleng, Kenny Hamese, S. Ntuli","doi":"10.7196/SAJCH.2021.V15I2.01773","DOIUrl":"https://doi.org/10.7196/SAJCH.2021.V15I2.01773","url":null,"abstract":"Background. Persistent pulmonary hypertension of the newborn (PPHN) is a condition of high pulmonary arterial pressures leading to hypoxaemia and continued shunting of blood across fetal channels as a result of failure of circulatory transition at birth. Objective. To determine the prevalence and outcomes of PPHN at Mankweng Hospital, Limpopo Province, South Africa. Methods. A retrospective descriptive review of patients’ files from January 2015 to December 2017 was conducted. PPHN was diagnosed on echocardiogram. Results. During the 3-year period of the study, a total of 6 776 neonates were admitted to the neonatal unit, of whom 0.76% ( n =52) were diagnosed with PPHN. Of these, 98% (n=51) had complete information in their medical records and were further analysed. Slightly more than half (53%) were males, 59% were delivered by caesarean section, 94% had gestational age ≥37 weeks, and 39% and 14% had Apgar scores of <6 at 1 minute and 5 minutes, respectively. Most neonates (72%) had meconium aspiration as the single risk factor or in combination with other conditions. Nearly half (45.1%) of the neonates with PPHN did not survive. Gender, mode of delivery, and Apgar score were each correlated with PPHN mortality and they all showed no statistically significant association. A significantly higher proportion of non-survivors received inotropic support than survivors ( p <0.05). Conclusions. The prevalence of PPHN was found to be lower than in other low- and middle-income countries; nonetheless, the all-cause mortality rate is significantly high. The commonest aetiology of PPHN is meconium aspiration syndrome as a single underlying risk factor, and in combination with other conditions. Most neonates who needed inotropic support died.","PeriodicalId":44732,"journal":{"name":"South African Journal of Child Health","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2021-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44231260","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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